Archive for November, 2018

[Magazine] Major Issues in Post-acute TBI Rehabilitation by Brain Injury Professional – issuu

via Major Issues in Post-acute TBI Rehabilitation by Brain Injury Professional – issuu

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[WEB SITE] Canadian documentary “Picture This” takes an honest look at sexuality and disability – Video

The sexuality of people with disabilities is something that is underrepresented—or not represented at all—which can lead to people with disabilities feeling either invisible or treated like an anomaly when it comes to their sexual lives.

However, a Toronto advocate has been raising awareness about sex and disabled people, and a Canadian film about him and his work is now available for online viewing.

On November 19, the National Film Board of Canada (NFB) released Jari Osborne’s short documentary Picture This for free online streaming. (Osborne’s previous NFB documentaries include Unwanted Soldiers and Sleeping Tigers: The Asahi Baseball Story.)

The 33-minute film profiles Toronto disability awareness consultant and podcaster Andrew Gurza, who identifies himself as a “queer cripple”, as he prepares for the second edition of a sex-positive play party, which has been labelled a “handicapped orgy” by the media and garnered international coverage.

Andrew Gurza with model
Andrew Gurza with model

Gurza previously held a discussion in Vancouver in 2016, in conjunction with Vancouver queer organization Health Initiative for Men, that was filmed for and is featured in the documentary.

Among the topics Gurza discusses in the documentary, he describes the awkwardness and discomfort he has witnessed potential sex partners have been unable to hide (not to mention his own heartbreak) once they find out he is disabled. In addition, he also talks about the challenges of being both gay and disabled.

Picture This can be viewed below, or at the NFB website, and is also available on iTunes and Amazon.


Picture ThisJari Osborneprovided by the National Film Board of Canada


via Canadian documentary Picture This takes an honest look at sexuality and disability | Georgia Straight Vancouver’s News & Entertainment Weekly

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[BLOG POST] 6 Ways to Get Past Plateau After Stroke

Past Plateau After Stroke

The road to recovery after stroke is not always a straight line. Oftentimes there is rapid recovery during the first three months, but then the progress slows down. This eventually leads to a plateau in recovery after about six months.

In a scenario where varying levels of paralysis are common, a shift in mindset and making little changes to lifestyle is all it takes to break the plateau. This blog offers few tips that can help you dissect that plateau and get past it.

1. Understand the root-cause

In order to break out of the plateau, it helps to understand what causes it to begin with. Some of the most significant functional improvements often occur during the early days, reflecting the initial plasticity of the brain. However, after few days, you may feel that the initial spike in progress was the end of rehabilitation and that there is no further improvement possible. But for many stroke survivors, the plateau phase is quite common and even to be expected. Understanding this will help both the stroke survivor and caregiver to avoid losing hope and persistence during this difficult time.

2. Revise your workout regime

If you aren’t making any progress, you might need something new and different to jump-start it back into rehabilitation mode. Traditional therapy that isn’t evidence-based can be ineffective and can actually cause a plateau. Thus, familiar exercises must be altered and adjusted. Try switching up your workout intensity, duration, frequency or exercises you do. For that, you will be needing your therapist’s expert guidance.

3. Find the right therapist

If the therapist isn’t modifying the treatment to your specific needs and incorporating the latest proven interventions because he hasn’t been trained in them, perhaps, it’s time to try a new therapist. Your new therapist should be able to prescribe a new evidence-based technique.

With the help of your therapist, learn to set SMART goal(s): specific, measurable, achievable, relevant, and time-bound. When you’re working systematically toward something, your motivation will stay high. After all, the recently damaged brain is taking the necessary time to heal and regrow. And, this requires setting relevant, short-term goals.

4. Learn and try new things

Along with making changes to your regimen (as recommended by the therapist, of course), pick a new skill you want to learn (like playing piano) and practice that. Simple changes like this will initiate Neuroplasticity and help you get past Plateau.

blog cta

Be part of the relevant research studies (only if your therapist allows you). It may not always work, but you may just luck out with a great new treatment. It’s also not a bad idea to join a stroke group.

5. Track your progress

Tracking everything is essential to making the stroke rehabilitation work for you. Take your current measurements to get a more accurate view of the progress made. Track these measures and compare them to your most recent stats. Apart from tracking your functional performance, it’s also wise to keep track of your:

  1. Daily meals (breakfast, lunch, and dinner) and snacks
  2. Exercise and activity
  3. BMI (Body Mass Index)
  4. Water/hydration

6. Handle emotional changes

Stroke recovery is a long (and often slow) process. Hence, frustration, anger, and depression are understandable obstacles to encounter. If you’re tired, sick, overwhelmed, or stressed, your speech or mobility may suffer.

Don’t give up hope. Many studies show that it is possible to break plateau after stroke. Everyone recovers at different rates. It’s best not to compare your recovery to others. Hope is the most powerful drug, hold onto it.

via 6 Ways to Get Past Plateau After Stroke – 9zest

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[Abstract] The wearable hand robot: supporting impaired hand function in activities of daily living and rehabilitation


Our hands are very important in our daily life. They are used for non-verbal communication and sensory feedback, but are also important to perform both fine (e.g. picking up paperclips) and gross (e.g. lifting heavy boxes) motor tasks. Decline of hand function in older adults as a result of age-related loss of muscle mass (i.e. sarcopenia) and/or age-related diseases such as stroke, rheumatoid arthritis or osteoarthritis, is a common problem worldwide. The decline in hand function, in particular grip strength, often results in increased difficulties in performing activities of daily living (ADL), such as carrying heavy objects, doing housework, (un)dressing, preparing food and eating.
New developments, based on the concept of wearable soft-robotic devices, make it possible to support impaired hand function during the performance of daily activities and intensive task-specific training. The ironHand and HandinMind systems are examples of such novel wearable soft-robotic systems that have been developed in the ironHand and HandinMind projects. Both systems are developed to provide grip support during a wide range of daily activities. The ironHand system consists of a 3-finger wearable soft-robotic glove, tailored to older adults with a variety of physical age-related hand function limitations. The HandinMind system consists of a 5-finger wearable soft-robotic glove, dedicated towards application in stroke. In both cases, the wearable soft-robotic system could be connected to a computer with custom software to train specific aspects of hand function in a motivating game-like environment with multiple levels of difficulty. By adding the game environment, an assistive device is transformed into a dedicated training device.
The aim of the current thesis is to define user requirements, to investigate feasibility and to evaluate the direct and clinical effects of a wearable soft-robotic system that is developed to support impaired hand function of older adults and stroke patients in a wide range of daily activities and in exercise training at home.

via The wearable hand robot: supporting impaired hand function in activities of daily living and rehabilitation — University of Twente Research Information

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[ARTICLE] Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): protocol of an intervention feasibility trial – Full Text


Introduction Effective interventions to promote upper-limb recovery poststroke are characterised by intensive and repetitive movements. However, the repetitive nature of practice may adversely impact on adherence. Therefore, the development of rehabilitation devices that can be used safely and easily at home, and are motivating, enjoyable and affordable is essential to the health and well-being of stroke survivors.

The Neurofenix platform is a non-immersive virtual reality device for poststroke upper-limb rehabilitation. The platform uses a hand controller (a NeuroBall) or arm bands (NeuroBands) that facilitate upper-limb exercise via games displayed on a tablet. The Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke trial aims to determine the safety, feasibility and acceptability of the Neurofenix platform for home-based rehabilitation of the upper-limb poststroke.


Methods and analysis Thirty people poststroke will be provided with a Neurofenix platform, consisting of a NeuroBall or NeuroBands (dependent on impairment level), seven specially designed games, a tablet and handbook to independently exercise their upper limb for 7 weeks. Training commences with a home visit from a research therapist to teach the participant how to safely use the device. Outcomes assessed at baseline and 8 weeks and 12 weeks are gross level of disability, pain, objectively measured arm function and impairment, self-reported arm function, passive range of movement, spasticity, fatigue, participation, quality of life (QOL) and health service use. A parallel process evaluation will assess feasibility, acceptability and safety of the intervention through assessment of fidelity to the intervention measured objectively through the Neurofenix platform, a postintervention questionnaire and semistructured interviews exploring participants’ experiences of the intervention. The feasibility of conducting an economic evaluation will be determined by collecting data on QOL and resource use.

Strengths and limitations of this study

  • The Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke trial will investigate the feasibility, acceptability and safety of a novel gaming platform (the Neurofenix platform) at home for upper-limb exercise after stroke.

  • Upper-limb activity data will be objectively measured by the device. Assessment outcome measures include objective (assessed blind to timepoint) and self-reported measures.

  • To be maximally inclusive, stroke survivors with moderate to severe arm impairment will be included in the study.

  • The feasibility of conducting an economic evaluation will be determined by collected data on quality of life and resource use.

  • This is a home-based intervention study; thus, participants and researchers collecting the data will not be blinded.


Stroke is the leading cause of severe disability worldwide with approximately 17 million new strokes each year.1 2 The UK has 1.2 million stroke survivors with 110 000 first-time strokes occurring each year resulting in an estimated societal cost of £26 billion per year.1 2 Following stroke, 85% of people initially experience upper-limb weakness, and of those with minimal movement on hospital admission, only 11%–14% regain full function of their arm.2–4 This loss in upper-limb function results in increased dependence and decreased quality of life (QOL).5 Reduced upper-limb function has been identified as a strong predictor of lowered psychological well-being poststroke.5 6 Innovation and investigation of effective treatments for arm recovery has been identified as a priority for stroke research.7

Evidence indicates the most effective interventions to improve upper-limb function are characterised by high intensity and repetitive practice.8 A higher intensity and frequency of upper-limb stroke rehabilitation is associated with improved QOL,9 motor function and ability to perform activities of daily life10 and is cost-effective.11 The UK quality standard for stroke advises 45 min of each relevant therapy for a minimum of 5 days a week.11 However, a 2015 UK national stroke audit showed on average most hospitals are unable to meet this quality standard.12 Specifically, time spent retraining the upper limb is very low, with an average of 32 repetitions per rehabilitation session.13 14 As such, there is a growing emphasis on the stroke survivor exercising independently without the presence of a therapist. However, adherence to home exercise is known to be poor.15 16 A perceived lack of support and feedback along with boredom with exercises are the most frequently cited factors associated with poor compliance.17 18

Virtual reality (VR)-based activities have been suggested as an intervention to improve upper-limb recovery by providing motivating environments or gameplay to facilitate rehabilitation.19 This digital health solution helps address boredom and compliance problems, can facilitate increased time in therapy and may not be reliant on therapist contact time.19 20 In addition, the ability of VR activities to provide feedback may enhance motor learning.21 22 Visual feedback via an on-screen character (avatar) can activate mirror neurones, which may aid recovery from stroke.23 24

VR can be considered in terms of the level of immersion provided, that is, the degree the user feels present in the virtual world due to the technical aspects of the VR environment. Immersive systems can generate life-scaled, three-dimensional images, with surround sound auditory and sensory feedback such as vibration, and pressure,25 whereas non-immersive systems involve two-dimensional images typically viewed on a screen with interaction being via controller-based systems (such as computer keyboards, joysticks, balance boards and handheld devices) or via camera-based tracking systems.26 Non-immersive systems are more commonly used for rehabilitation as they have smaller space requirements, cost less and have fewer side effects (eg, motion sickness).27

The Neurofenix platform is a non-immersive device designed to enable and encourage stroke survivors to independently exercise their upper limb with minimal therapist input. The platform was developed by Neurofenix, a bioengineering enterprise (, along with stroke survivors and neurological physiotherapists. The platform consists of a hand controller or armbands, seven specially designed games, a tablet and an instruction handbook.[…]

Continue —> Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): protocol of an intervention feasibility trial | BMJ Open

Figure 1. Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS) trial design.

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[WEB SITE] Psilocybin Could Soon Be a Legal Treatment for Depression: Johns Hopkins Professor, Roland Griffiths, Explains How Psilocybin Can Relieve Suffering

Much of the recent scientific research into psychedelics has picked up where researchers left off in the mid-20th century, before LSD, psilocybin, and other psychoactive drugs became countercultural means of consciousness expansion, and then banned, illegal substances the government sought to control. Scientists from several fields studied psychedelics as treatments for addiction, depression, and anxiety, and end-of-life care. These applications were conceived and tested several decades ago.

Now, thanks to some serious investment from high-profile institutions like Johns Hopkins University, and thanks to changing government attitudes toward psychoactive drugs, it may be possible for psilocybin, the active ingredient in “magic mushrooms,” to get legal approval for therapy in a clinical setting by 2021. “For the first time in U.S. history,” Shelby Hartman reports at Rolling Stone, “a psychedelic drug is on the fast track to getting approved for treating depression by the federal government.”

As Michael Pollan has detailed in his latest book, How to Change Your Mind, the possibilities for psilocybin and other such drugs are vast. “But before the Food and Drug Administration can be petitioned to reclassify it,” Brittany Shoot notes at Fortune, the drug “first has to clear phase III clinical trials. The entire process is expected to take about five years.” In the TEDMED video above, you can see Roland R. Griffiths, Professor of Psychiatry and Behavioral Sciences at Johns Hopkins, discuss the ways in which psilocybin, “under supported conditions, can occasion mystical-type experiences associated with enduring positive changes in attitudes and behavior.”

The implications of this research span the fields of ethics and medicine, psychology and religion, and it’s fitting that Dr. Griffiths leads off with a statement about the compatibility of spirituality and science, supported by a quote from Einstein, who said “the most beautiful and profound emotion we can experience is the sensation of the mystical. It’s the source of all true science.” But the work Griffiths and others have been engaged in is primarily practical in nature—though it does not at all exclude the mystical—like finding effective means to treat depression in cancer patients, for example.

“Sixteen million Americans suffer from depression and approximately one-third of them are treatment resistant,” Hartman writes. “Depression is also an epidemic worldwide, affecting 300 million people around the world.” Psychotropic drugs like psilocybin, LSD, and MDMA (which is not classified as a psychedelic), have been shown for a long time to work for many people suffering from severe mental illness and addictions.

Although such drugs present some potential for abuse, they are not highly addictive, especially relative to the flood of opioids on the legal market that are currently devastating whole communities as people use them to self-medicate. It seems that what has most prevented psychedelics from being researched and prescribed has as much or more to do with long-standing prejudice and fear as it does with a genuine concern for public health. (And that’s not even to mention the financial interests who exert tremendous pressure on drug policy.)

But now, Hartman writes, “it appears [researchers] have come too far to go back—and the federal government is finally recognizing it, too.” Find out why this research matters in Dr. Griffiths’ talk, Pollan’s book, the Multidisciplinary Association for Psychedelic Studies, and some of the posts we’ve linked to below.

Related Content:

How to Use Psychedelic Drugs to Improve Mental Health: Michael Pollan’s New Book, How to Change Your Mind, Makes the Case

New LSD Research Provides the First Images of the Brain on Acid, and Hints at Its Potential to Promote Creativity

Artist Draws 9 Portraits While on LSD: Inside the 1950s Experiments to Turn LSD into a “Creativity Pill”

When Aldous Huxley, Dying of Cancer, Left This World Tripping on LSD, Experiencing “the Most Serene, the Most Beautiful Death” (1963)

Josh Jones is a writer and musician based in Durham, NC. Follow him at @jdmagness

via Psilocybin Could Soon Be a Legal Treatment for Depression: Johns Hopkins Professor, Roland Griffiths, Explains How Psilocybin Can Relieve Suffering | Open Culture

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[Abstract] Antiepileptic drug treatment during pregnancy and delivery in women with epilepsy – A retrospective single center study


Pregnancies in women with epilepsy (WWE) increased significantly during our 11-year study period (41% increase).

Twelve different AEDs were prescribed to WWE during pregnancies in the 11-year period investigated (2005-2015) with Lamotrigine (36.1%), Carbamazepine (25.0%), and Valproic Acid (13.5%) most commonly used.

Valproic acid use was markedly reduced comparing the years 2005-2010 (18.4%) and 2011-2015 (9.4%), a reduction of 48%.

Unfortunately, a trend towards an increase in treating WWE with more than one AED was observed.

Cover image Epilepsy ResearchAbstract


Antiepileptic drugs (AED) are among the most common teratogenic drugs prescribed to women of childbearing age. During pregnancy, the risk of seizures has to be weight against the use of AED treatment. Primary goal was to observe and describe AED treatment policy and its changes during an eleven-year period at our third referral center.


We scrutinized the medical health records for all cases of female epileptic patients admitted for labor at the Rabin Medical Center during the years 2005 – 2015.


A total of 296 deliveries were recorded with 136 labors occurring in the period 2005-2010 (22.7/y) and 160 in 2011-2015 (32.0/y; increase of 41%). Twelve different AEDs were prescribed to WWE during pregnancies in the 11-year period investigated (2005-2015). Most commonly used AEDs during pregnancy were Lamotrigine (36.1%), Carbamazepine (25.0%), and Valproic Acid (13.5%). Comparing their use during the years 2005-2010 and 2011-2015, Lamotrigine (35.3% vs. 36.9%) and Carbamazepine use (23.5% vs. 26.0%) increased slightly. Valproic acid use was markedly reduced in the second period: 18.4% in the years 2005-2010 lowered to 9.4% during 2011-2015, a reduction of 48%. Unfortunately, a trend towards an increase in treating WWE with more than one AED was observed.


The proportion of WWE treated with VPA during pregnancy was significantly reduced in the observed period (2005-2015). Change in fetal outcome during this period for WWE could not be detected.

via Antiepileptic drug treatment during pregnancy and delivery in women with epilepsy—A retrospective single center study – ScienceDirect

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[Thesis] Recovery of arm-hand function after stroke: developing neuromechanical biomarkers to optimize rehabilitation strategies. – Leiden University


The aim of this thesis was to explore the neuromechanics of recovery of arm-hand function after stroke. A literature review revealed six articles that measured biomechanical and electromyographical outcome measures simultaneously, while applying active and passive tasks and multiple movement velocities to separate neural and non-neural contributors to movement disorders after stroke. Therefore, a neuromechanic assessment protocol was developed. Parameters were responsive to clinical status and had good to excellent test-retest reliability. Selective muscle activation was assessed with high measurement reliability and was significantly lower in chronic stroke patients compared to healthy participants. Longitudinally, neuromechanical parameters were combined with data on arm-hand function at six months after stroke. Paresis and diminished modulation of reflexes were associated with poor functional outcome. Changes in tissue properties were represented by a shift in wrist rest angle towards flexion and decline in passive range of motion. Increase in active range of motion and steady rest angle contributed most to prediction of functional outcome. The precision diagnostics provided by a neuromechanical assessment protocol could support clinical decision making and should be used in prediction models and as biomarkers in recovery of arm-hand function after stroke, for example by improving the selection of time-window and patients.

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via Recovery of arm-hand function after stroke: developing neuromechanical biomarkers to optimize rehabilitation strategies.

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[Poster] Action Observation in Upper Extremity Rehabilitation for Moderately Impaired Stroke: A Literature Review

To determine the efficacy of action observation (AO) for upper extremity (UE) rehabilitation in moderately impaired stroke survivors as reported in current literature.

First page of article

via Action Observation in Upper Extremity Rehabilitation for Moderately Impaired Stroke: A Literature Review – Archives of Physical Medicine and Rehabilitation

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[Conference Proceedings] Rhythmic Entrainment for Hand Rehabilitation Using the Leap Motion Controller – Full Text PDF


Millions of individuals around the world suffer from motor impairment or disability, yet effective, engaging, and cost-effective therapeutic solutions are still lacking. In this work, we propose a game for hand rehabilitation that leverages the therapeutic aspects of music for motor rehabilitation, incorporates the power of gamification to improve adherence to medical treatment, and uses the versatility of devices such as the Leap Motion Controller to track users’ movements. The main characteristics of the game as well as future research directions are outlined.

Full Text PDF

via Rhythmic Entrainment for Hand Rehabilitation Using the Leap Motion Controller | Kat Agres

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