Archive for July, 2019

[Abstract] Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014 – Archives of Physical Medicine and Rehabilitation

Η εικόνα ίσως περιέχει: κείμενο



To conduct an updated, systematic review of the clinical literature, classify studies based on the strength of research design, and derive consensual, evidence-based clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) or stroke.

Data Sources

Online PubMed and print journal searches identified citations for 250 articles published from 2009 through 2014.

Study Selection

Selected for inclusion were 186 articles after initial screening. Fifty articles were initially excluded (24 focusing on patients without neurologic diagnoses, pediatric patients, or other patients with neurologic diagnoses, 10 noncognitive interventions, 13 descriptive protocols or studies, 3 nontreatment studies). Fifteen articles were excluded after complete review (1 other neurologic diagnosis, 2 nontreatment studies, 1 qualitative study, 4 descriptive articles, 7 secondary analyses). 121 studies were fully reviewed.

Data Extraction

Articles were reviewed by the Cognitive Rehabilitation Task Force (CRTF) members according to specific criteria for study design and quality, and classified as providing class I, class II, or class III evidence. Articles were assigned to 1 of 6 possible categories (based on interventions for attention, vision and neglect, language and communication skills, memory, executive function, or comprehensive-integrated interventions).

Data Synthesis

Of 121 studies, 41 were rated as class I, 3 as class Ia, 14 as class II, and 63 as class III. Recommendations were derived by CRTF consensus from the relative strengths of the evidence, based on the decision rules applied in prior reviews.


CRTF has now evaluated 491 articles (109 class I or Ia, 68 class II, and 314 class III) and makes 29 recommendations for evidence-based practice of cognitive rehabilitation (9 Practice Standards, 9 Practice Guidelines, 11 Practice Options). Evidence supports Practice Standards for (1) attention deficits after TBI or stroke; (2) visual scanning for neglect after right-hemisphere stroke; (3) compensatory strategies for mild memory deficits; (4) language deficits after left-hemisphere stroke; (5) social-communication deficits after TBI; (6) metacognitive strategy training for deficits in executive functioning; and (7) comprehensive-holistic neuropsychological rehabilitation to reduce cognitive and functional disability after TBI or stroke.

via Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014 – Archives of Physical Medicine and Rehabilitation

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[Abstract] Remote Upper Limb Exoskeleton Rehabilitation Training System Based on Virtual Reality


According to the present situation that the treatment means for apoplectic patients is lagging and weak, a set of long-distance exoskeleton rehabilitation training system with 5 DOF for upper limb was developed. First, the mechanical structure and control system of the training system were designed. Then a new kind of building method for virtual environment was proposed. The method created a complex model effectively with good portability. The new building method was used to design the virtual training scenes for patients’ rehabilitation in which the virtual human model can move following the trainer on real time, which can reflect the movement condition of arm of patient factually and increase the interest of rehabilitation training. Finally, the network communication technology was applied into the training system to realize the remote communication between the client-side of doctor and training system of patient, which makes it possible to product rehabilitation training at home.

via Remote Upper Limb Exoskeleton Rehabilitation Training System Based on Virtual Reality – IEEE Conference Publication

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[Abstract] Development of a Compatible Exoskeleton (Co-Exos II) for Upper-Limb Rehabilitation


A key approach for reducing motor impairment and regaining independence after spinal cord injuries or strokes is frequent and repetitive functional training. A compatible exoskeleton (Co-Exos II) is proposed for the upper-limb rehabilitation. A compatible configuration was selected according to optimum configuration principles. Four passive translational joints were introduced into the connecting interfaces to adapt the glenohumeral joint (GH) movements and improve the compatibility of the exoskeleton. This configuration of the passive joints could reduce the influence of gravity of the exoskeleton device and the upper extremities. A Co-Exos II prototype was developed and still owned a compact volume. A new approach was presented to compensate the vertical GH movements. The shoulder closed-loop was simplified as a guide-bar mechanism. The compatible models of this loop were established based on the kinematic model of GH. The compatible experiments were completed to verify the kinematic models and analyze the human-machine compatibility of Co-Exos II. The theoretical displacements of the translational joints were calculated by the kinematic model of the shoulder loop. The passive joints exhibited good compensations for the GH movements through comparing the theoretical and measured results, especially vertical GH movements. Co-Exos II showed good human-machine compatibility for upper limbs.

via Development of a Compatible Exoskeleton (Co-Exos II) for Upper-Limb Rehabilitation* – IEEE Conference Publication

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[Abstract] Evidence based practice ‘on-the-go’: using ViaTherapy as a tool to enhance clinical decision making in upper limb rehabilitation after stroke – a quality improvement initiative


Recovery of upper limb function after stroke is currently sub-optimal, despite good quality evidence showing that interventions enabling repetitive practice of task-specific activity are effective in improving function. Therapists need to access and engage with such evidence to optimise outcomes with people with stroke, but this is challenging in fast-paced stroke rehabilitation services. This quality improvement project aimed to investigate acceptability and service impact of a new, international tool for accessing evidence on upper limb rehabilitation after stroke- ‘ViaTherapy’- in a team of community rehabilitation therapists. Semi-structured interviews were undertaken at baseline to determine confidence in, and barriers to, evidence-based practice (EBP) to support clinical decision making. Reported barriers included time, lack of access to evidence, and a research-practice disconnect. The clinicians then integrated use of ‘ViaTherapy’ into their practice for four weeks. Follow-up interviews explored the accessibility of the tool in community rehabilitation practice, and its impact on clinician confidence, treatment planning and provision. Clinicians found the tool, used predominantly in mobile device app format, to be concise and simple to use, providing evidence “on-the-go.” Confidence in accessing and using EBP grew by 22% from baseline. Clinicans reported changes in intensity of delivery of interventions, as rapid access to recommended doses via the tool was available. Following this work, the participating health and social care service provider changed provision of therapists’ technology to enable use of apps. Barriers to use of EBP in stroke rehabilitation persist; the baseline situation here supported the need for more accessible means of integrating best evidence into clinical processes. This quality improvement project successfully integrated ViaTherapy into clinical practice, and found that the tool has potential to underpin positive changes in upper limb therapy service delivery after stroke, by increasing accessibility to, use of, and confidence in evidence-based practice. Definitive evaluation is now indicated.

via Evidence based practice ‘on-the-go’: using ViaTherapy as a tool to enhance clinical decision making in upper limb rehabilitation after stroke – a quality improvement initiative – UEA Digital Repository


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[ARTICLE] Factors influencing the implementation of Home-Based Stroke Rehabilitation: Professionals’ perspective – Full Text



Stroke has a major impact on survivors and their social environment. Care delivery is advocated to become more client-centered and home-based because of their positive impact on client outcomes. The objective of this study was to explore professionals’ perspectives on the provision of Home-Based Stroke Rehabilitation (HBSR) in the Netherlands and on the barriers and facilitators influencing the implementation of HBSR in daily practice.


Semi-structured focus groups were conducted to explore the perspectives of health and social care professionals involved in stroke rehabilitation. Directed content analysis was performed to analyze the transcripts of recorded conversations.


Fourteen professionals participated in focus groups (n = 12) or, if unable to attend, an interview (n = 2). Participants varied in professional backgrounds and roles in treating Dutch clients post stroke. Barriers and facilitators influencing the implementation of HBSR in daily practice were identified in relation to: the innovation, the user, the organization and the socio-political context. Participants reported that HBSR can be efficient and effective to most clients because it facilitates client- and caregiver-centered rehabilitation within the clients’ own environment. However, barriers in implementing HBSR were perceived in a lack of (structured) inter-professional collaboration and the transparency of expertise of primary care professionals. Also, the current financial structures for HBSR in the Netherlands are viewed as inappropriate.


In line with previous studies, we found that HBSR is recognized by professionals as a promising alternative to institution-based rehabilitation for clients with sufficient capabilities (e.g. their own health and informal support).


Multiple factors influencing the implementation of HBSR were identified. Our study suggests that, in order to implement HBSR in daily practice, region specific implementation strategies need to be developed. We recommend developing strategies concerning: organized and coordinated inter-professional collaboration, transparency of the expertise of primary care professionals, and the financial structures of HBSR.


Stroke is one of the major causes of mortality, loss of independence, and lower quality of life of stroke survivors and has a great impact on the social environment [1]. Between 2010 and 2030 the absolute number of people with a stroke is expected to increase by 56% in men and 37% in women [2]. Also, stroke is known to have major socio-economic consequences. The financial burden placed on European countries by stroke is huge. For 2010, the estimated cost of stroke in Europe was €64 billion [3].

Stroke rehabilitation in the Netherlands

In the Netherlands, stroke rehabilitation is organized and delivered in various ways. From the late ‘90, three main types of stroke rehabilitation can be distinguished in the Netherlands.

Firstly, stroke rehabilitation can be offered as institution-based rehabilitation: organized within hospitals, rehabilitation centers and nursing homes. Within institution-based rehabilitation, care is centered around a diagnosis. Professionals are specialized in treating clients with this specific diagnosis. Also, within the institution, regular (formal and informal) inter-professional meetings take place [4].

Secondly, stroke rehabilitation can be offered on outpatient basis. After their transfer home (from the stroke unit or institution-based rehabilitation), stroke survivors can consult outpatient rehabilitation professionals. Stroke survivors receiving outpatient rehabilitation live at home and visit the institution to receive therapy.

Thirdly, stroke rehabilitation can be offered as Home-Based Stroke Rehabilitation (HBSR). During HBSR (Home-Based Stroke Rehabilitation) rehabilitation is offered within the home environment of the client. It includes community-based rehabilitation delivered by primary care professionals, such as occupational therapists, physical therapists, speech therapists, dieticians, social workers, nurses and general practitioners [5]. A broad range of professionals can be involved during HBSR, because the impact of stroke is multifaceted, affecting a broad range of body functions, activities and participation patterns [6]. In the Netherlands primary care is not nationally organized: professionals deliver care from independent private practices and from a variety of institutions. General health insurances cover a certain (predefined) amount of treatment hours for selected disciplines only. The variety in financial legislations between these selected disciplines is large. Sometimes additional treatment hours and/or disciplines are financed, depending on the severity of symptoms, personal circumstances and insurance coverage. Insurance coverage differs per person and depends on the selection of optional insurances.

Home-Based Stroke Rehabilitation (HBSR)

Healthcare professionals and organizations are challenged to provide high quality health and social care, in a client centered and cost-efficient manner. To improve the quality and efficiency of care, the location of care delivery is shifting from institution-based settings to home-based services such as HBSR.

HBSR is known for its positive impact on client outcomes. HBSR resulted in more independent clients [78] who are better at performing daily activities [89] and who are more satisfied with their treatment compared to clients who receive conventional (institution-based) rehabilitation [812]. Also, HBSR is shown to reduce the length of hospital stay and to decrease the likelihood of admittance in a long-term stay facility [8]. Furthermore, HBSR has the benefit of treating clients within a familiar environment. According to prior studies this tends to stimulate mental and physical activity, provides more meaning to tasks [1314] and prevents potential problems with the transfer of learned skills from the training setting to executing daily activities [15].

Implementing HBSR

In the Netherlands a number of reforms and new policies have been implemented over the last years to facilitate client-centered and cost-effective care. These changes include policies increasing the responsibility of the municipalities for care and welfare on the municipality and transferring more responsibilities from professional carers to civilians and local communities themselves [16]. Despite these efforts, the client-centered and cost-effective provision of high quality care remains a challenge because guidelines, practical suggestions and organisational support seems to be missing [17]. Consequently, both researchers as well as healthcare professionals initiate new regional projects [1719]. According to the literature, this does not only take place in the Netherlands. Many clients do not receive appropriate care, or receive unnecessary or even harmful care [20].

Major difficulties can arise when implementing innovations, like HBSR, into routine practice. Even though previous studies have shown positive effects of HBSR [715], innovations are not always provided to those clients for whom it could be beneficial [21]. Prior studies show that clients and caregivers experience a gap after institution-based rehabilitation (e.g. delays and discontinuity of therapy and feeling abandoned and unsupported) and poor accessibility of community services [2223]. In order to further implement an innovation like HBSR, context specific implementation strategies are needed at different levels [2426].

This Dutch study explores and describes professionals’ perspectives on determinants that could influence the further implementation of HBSR. These insights can guide the selection of context specific implementation strategies. This study will not only provide insight into region specific factors influencing implementation, but also general issues playing a role in the implementation of HBSR.

In this qualitative focus group study we focused on the following questions:

  1. How do professionals characterize stroke rehabilitation services that are currently provided in the Netherlands?
  2. What are the current and potential barriers and facilitators influencing the implementation of HBSR in their daily practice, according to professionals?



Continue —>  Factors influencing the implementation of Home-Based Stroke Rehabilitation: Professionals’ perspective

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[WEB SITE] 5 top tips for managing memory problems after brain injury

5 top tips for managing memory problems after brain injury

5 top tips: memory

Managing memory problems after brain injury




Impairment of memory is one of the most common effects of a brain injury and can cause serious problems with day-to-day living.

While there is unfortunately no cure available, there are a number of strategies that for many people make it easier to live with memory problems and can increase independence.

Adapt the environment

One of the simplest ways to help with memory problems is to adapt your environment so you rely on memory less.

Some ideas for doing so which have helped others are:

  • Keeping a notepad by the phone to make a note of phone calls and messages
  • Putting essential information on a noticeboard
  • Deciding on a special place to keep important objects like keys, wallets or spectacles and always putting them back in the same place
  • Attaching important items to your person so they can’t be mislaid, for example using a neck cord for reading glasses
  • Labelling cupboards and storage vessels as a reminder of where things are kept
  • Labelling perishable food with the date it was opened
  • Painting the toilet door a distinctive colour so it is easier to find
  • Labelling doors as a reminder of which room is which

Use external memory aids

woman writing in diaryMany people use external memory aids, regardless of whether they have a brain injury or not. External memory aids are particularly important for people with memory problems as they limit the work the memory has to do.

Some examples of external memory aids you could try include:

  • Smartphones with diary or calendar applications
  • Diaries, filofaxes or datebooks
  • Notebooks
  • Lists
  • Alarm clocks
  • Watches
  • Calendars
  • Wall charts
  • Tape recorders and dictaphones
  • Electronic organisers
  • Pagers
  • Pill reminder boxes for medication
  • Sticky-backed notes
  • Photo albums
  • Cameras

Follow a set routine

Having a daily and weekly routine means that people with memory problems can get used to what to expect, which helps to reduce the demands on memory. Changes in routine are, however, often necessary, but can be confusing.

Relatives and carers can help by explaining any changes in routine carefully to help you prepare for the change, giving plenty of spoken and written reminders.

You could also try the following reminder strategies in order to establish routines:

  • Make a note of regular activities in a diary or on a calendar
  • Make a chart of regular events, perhaps using pictures or photographs, on a noticeboard

Combine several strategies to make a substitute memory system

Most people with memory problems find it useful to combine several aids and strategies. A combination of two or three strategies can cover the areas where there would otherwise be problems and provide a safety net for things that must be remembered.

Here are examples of the components of two such ‘combination systems’ you can try:

System one:

  • Three lists – one showing routine tasks, one showing where to find files in the filing cabinet and one showing key ‘rules’, such as when to do the filing each day
  • A ring binder with sections on ‘immediate/urgent tasks’ and ‘long-term projects’
  • A notebook
  • A telephone message pad to make notes of conversations
  • A computer calendar and alarm
  • Practising assertiveness techniques to ‘buy time’ instead of having to respond to requests immediately. For instance, encouraging the person with the memory problems to say, “hang on, let me just find my notepad” and then taking their time with finding the relevant information in the notepad
  • Simple relaxation and breathing techniques to reduce anxiety

System two:

  • Filofax
  • Journal
  • Watch
  • Dictaphone
  • Various lists
  • Sticky-backed notes
  • Menu chart
  • Keeping things in the same place
  • Following routines

Improve general well-being

Memory is very important in giving us a sense of our own identity. Memory problems often have major emotional effects, including feelings of loss and anger and increased levels of depression and anxiety. Some approaches to dealing with this are as follows:

  • Share your feelings with others. People with memory problems often find that talking to people who understand their problems can provide relief and reassurance. Headway Groups and Branches can be an excellent source of support and details of how to find your local service are provided at the end of this factsheet.
  • Identify activities you find enjoyable and relaxing, such as listening to music or exercising, and take the time to indulge in them.

Find out more

Finding a strategy that suits you can be a case of trial and error, and it is important to take things slowly. You should always speak to your doctor before changing your routine, and you might like to seek a referral to a specialist such as a neuropsychologist or occupational therapist for personalised professional support.

This information is adapted from Headway’s factsheet Coping with memory problems – practical strategies, which you can download below or from our information library. Much of the information contained here is included in the book Coping with memory problems, and is used with kind permission from Pearson Assessment. You can purchase this book in the Headway shop.

You can contact our helpline on 0808 800 2244 or to discuss any of the issues covered here, or get in touch with your local Headway group or branch.


via 5 top tips for managing memory problems after brain injury | Headway

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[WEB SITE] Driving after brain injury

Although we may take it for granted, driving is a very complex activity requiring a number of cognitive and physical skills, as well as the ability to co-ordinate these. Any of these skills may be impaired after a brain injury.

Can I drive after brain injury?

Fortunately, many people who have sustained a brain injury retain most of their previous driving abilities, and are able to return to driving soon afterwards. However, there are legal requirements which must be adhered to.

It is sensible to take precautions such as having a driving assessment, even if you feel that your driving skills remain intact. It should be remembered that a car is a potentially lethal weapon: many people with a brain injury were themselves injured in a road traffic collision.

It can be relatively straightforward to make adaptations to a vehicle in order to compensate for physical disabilities. However, the less obvious effects of brain injury – on thinking, memory, judgement, decision making and emotions – can be more difficult to overcome.

Ultimately, the decision on whether someone is safe to drive lies with the licensing authorities. This booklet explains the processes involved in reporting a medical condition and provides advice on minimising cognitive and physical impairments.

What are the legal requirements for driving after brain injury?

If you drive and have had a brain injury, you must inform the licensing authorities. This applies to any ‘notifiable’ condition which could affect your ability to drive and failure to inform the authorities could result in a fine of up to £1000. It would also mean that your licence is not valid and that you would be uninsured in the event of an accident.

As a general rule, the medical standards state that after a traumatic brain injury drivers with an ordinary car or motorcycle (Group 1) licence should cease driving for 6 to 12 months, depending on factors such as post-traumatic amnesia, seizures, and clinical recovery. Other forms of acquired brain injury have slightly different rules, but if there are lasting impairments which affect driving ability then the licence is likely to be removed for a period.

However, because every brain injury is different, each case is considered on an individual basis.

Further information on the legal requirements, rules for professional drivers and how to inform the authorities is contained in the Headway booklet Driving after brain injury, which is available to download in the Related resources section.

Support with driving after brain injury

As your driving ability can change after a brain injury, you may need support to get back on the road.

If you are receiving the higher rate mobility component of Disability Living Allowance or the enhanced rate moving around component of Personal Independence Payment, you may be able to get a car through Motability. They also have a list of accredited suppliers who can make adaptations to your car if you find it hard to operate because of a physical disability.

You might need to get an assessment before getting back on the road, to see if you are fit to drive and/or to get advice on adaptations you might need. For more information, contact Driving Mobility.

Further information

Our booklet Driving after brain injury (PDF) provides detailed information on the subject, from the legal requirements and the effect of brain injury on driving, to the process of returning to driving and financial support for those who wish to do so.

You can download it now using the link above or through our information library.

via Driving after brain injury | Headway

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[ARTICLE] Food for Thought: Basic Nutrition Recommendations for the Mature Brain – Archives of Physical Medicine and Rehabilitation

Mild changes in memory and the way that we think can be normal as we age, but there are actions you can do to take charge of your brain health! We now better understand the importance of healthy eating for brain health in older adults. Doctors recommend healthy lifestyle changes to maintain or improve brain health, which include getting enough sleep, physical activity, and eating healthy foods. With your brain in mind, we created this page to help you adopt a healthy lifestyle. Most of the foods that we discuss can be found at grocery stores around your neighborhood. In addition, table 1 has useful online resources to help you keep your brain healthy.

Table 1Resources
Alzheimer’s Association: Alzheimer’s and Public Health Resource Center
Caregiver Tips and Tools

The MIND diet The MIND diet and tips on how to follow it.
Adopt a Healthy Diet The DASH and Mediterranean Diets
Administration for Community Living
Nutrition Services The Administration for Community Living’s Administration on aging nutrition programs targeting older adults.
Global Council on Brain Health
Brain-Food Recommendations on nourishing your brain health.
National Institute on Aging
Healthy Eating Choosing healthy meals as you get older, overcoming roadblocks to healthy eating, serving and portion sizes, maintaining a healthy weight

Abbreviations: DASH, Dietary Approaches to Stop Hypertension; MIND, Mediterranean-DASH Intervention for Neurodegenerative Delay.

General dietary recommendations for the aging brain

Plan your meals keeping these tips in mind. It is important to meet with a registered dietitian for individual dietary advice.1, 2, 3, 4, 5

  • 1.

    Eat whole grains with every meal

    • Sources include whole grain bread (wheat, rye, or barley), whole grain pasta, brown or wild rice, quinoa, and oats.

    • By eating at least 3 portions of whole grains a day you give your brain energy in the form of complex carbohydrates, B vitamins (thiamine, riboflavin, niacin, and folate), and minerals (iron, magnesium, and selenium).

  • 2.

    Eat a variety of fruits and vegetables every day

    • Make your plate colorful!

    • Eat berries, especially blueberries, at least twice per week as they are packed with protective substances called antioxidants.

    • Eat dark green leafy and cruciferous vegetables (spinach, kale, parsley, broccoli, asparagus, and Brussel sprouts) at least 6 times per week as these are rich in antioxidants, vitamins K and C, and folate.

  • 3.

    Eat legumes 3 or more times per week

    • Legumes (peas, beans, lentils, soybeans, and peanuts) are good sources of complex carbohydrates, protein, folate, and fiber.

  • 4.

    Limit red meat to once or twice a week

    • Swap out red meat, which is high in unhealthy saturated fat (lamb, beef, pork, and sausages), for poultry (chicken or turkey), fish, and beans and other legumes.

  • 5.

    Focus on healthy fats

    • Use extra-virgin olive oil instead of butter, margarine, or vegetable shortening.

    • Eat omega-3 rich foods from animal sources such as fish (sardines, mackerel, herring, salmon, sea bass, and trout) at least once a week. Vegetarian? No problem! Plant sources of omega-3 fatty acids include flax seeds, walnuts, and their oils, and Chia seeds.

    • Other sources of healthy fats include almonds, nut butters (eg, peanut butter), seeds, olives, and avocados.

    • Limit baked goods, fast foods, and fried foods since they contain unhealthy saturated and trans fatty acids.

  • 6.

    Don’t forget about dark chocolate

    • Dark chocolate has been shown to aid in brain health and to improve mood, learning, memory, and attention.

    • Aim for a small square (2cm×2cm) of dark chocolate (>70% cocoa) 2 to 3 times a week.

  • 7.

    Spice up meals with herbs and spices

    • Cook with herbs and spices and limit the use of salt.

    • Turmeric, cinnamon, clove, cumin, basil, parsley, cayenne pepper, oregano, and sage can all be helpful for brain health.

  • 8.

    Stay hydrated

    • Drink 6-8 8-oz glasses of water or non-caffeinated herbal teas per day. This helps to keep your entire body, including your brain, in tip top shape.6, 7

  • 9.

    Drink caffeine, but in moderation

    • Caffeine and antioxidants found in coffee can improve mood and increase alertness and attention.8

    • Daily cups of green or black tea brewed from tea leaves have been linked to brain health.

    • However, aim for no more than 1-3 cups of caffeinated tea or coffee daily, and limit drinking caffeine in the afternoon and at night as this can lead to poor sleep.

  • 10.

    If you consume alcohol, enjoy a glass of red wine with meals

    • Red wine contains a number of antioxidants, such as resveratrol, which have been shown to be helpful for the brain.

    • It is best to enjoy red wine in moderation, in other words, one glass a night and always consume with meals.

  • 11.

    Practice balance and do not overeat

    • Control your portion sizes and eat protein-packed snacks such as low fat yogurt with walnuts or seeded bread or rice/quinoa cakes with peanut butter, low fat cheese, or egg whites to help prevent you from overeating.

Practical cooking tips

  • 1.

    Cooking whole grains? Cook the whole bag and store the extra portions in your freezer for later use.

  • 2.

    Make sure you always have lentils in your pantry as they are the quickest legumes to prepare.

  • 3.

    Roasting salmon or other fatty fish? Roast an extra filet and make a fish spread for tomorrow’s sandwiches (puree the fish in a food processor with herbs and add a tablespoon of olive oil or tahini).

  • 4.

    Store berries and other fruits in your freezer to use in shakes or frozen desserts or to put on top of yogurt and hot cereals.

  • 5.

    Increase your vegetable intake by making an antipasto! Mix a variety of vegetables with a few tablespoons of olive oil and roast 20 minutes in a 450°F (230°C) oven.

  • 6.

    Legumes are not only for vegans! Replace beans for half of the meat you are cooking.

  • 7.

    Make homemade soft drinks! Place fruit slices and herbs (eg, mint, lemongrass) in a large container of water and set aside to allow the flavors to blend.

  • 8.

    Thicken soup using nuts! Add a handful of nuts to a soup and puree with a blender to thicken and add flavor.

  • 9.

    Experiment with spices! Cardamom goes great with cauliflower and sage works well with pumpkin.

  • 10.

    Make your own sauces! Mix 4 tablespoons of olive oil, 4 tablespoons of soy sauce, 1 crushed garlic clove, and 1 tablespoon of chopped spring onion for a great sauce that can be used on pasta or meat.


This page was developed by the members of the American Congress of Rehabilitation Medicine (ACRM) Neurodegenerative Diseases Networking Group and the ACRM Culinary Medicine Task Force: Elena Philippou, RD, PhD (e-mail address:, Rani Polak, MD, Chef, MBA, Ana Michunovich, DO, Michele York, PhD, Julie M. Faieta, MOT, OTR/L, Mark A. Hirsch, PhD, and Patricia C. Heyn, PhD, FGSA, FACRM.


This information is not meant to replace the advice of a medical professional. You should always talk to your health care provider if you have any specific medical concerns or questions about treatment. This Information/Education Page may be used noncommercially by health care professionals to help educate patients and their caregivers. Any other reproduction is subject to approval by the publisher.


  1. Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate.National Academies PressWashington (DC)2005
  2. Institute of Medicine. Dietary reference intakes. The essential guide to nutrient requirements.National Academies PressWashington (DC)2006
  3. Masento, N.A., Golightly, M., Field, D.T., Butler, L.T., and van Reekum, C.M. Effects of hydration status on cognitive performance and mood. Br J Nutr20141111841–1852
  4. Morris, M.C., Tangney, C.C., Wang, Y., Sacks, F.M., Bennett, D.A., and Aqqarwal, N.T. MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimers Dement2015111007–1014
  5. Ngandu, T., Lehtisalo, J., Solomon, A. et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet20153852255–2263
  6. Panza, F., Solfrizzi, V., Barulli, M.R. et al. Coffee, tea, and caffeine consumption and prevention of late-life cognitive decline and dementia: a systematic review. J Nutr Health Aging201519313–328
  7. Petersson, S.D. and Philippou, E. Mediterranean diet, cognitive function, and dementia: a systematic review of the evidence. Adv Nutr20167889–904
  8. Solfrizzi, V., Custodero, C., Lozupone, M. et al. Relationships of dietary patterns, foods, and micro- and macronutrients with Alzheimer’s disease and late-life cognitive disorders: a systematic review. J Alzheimers Dis201759815–849

via Food for Thought: Basic Nutrition Recommendations for the Mature Brain – Archives of Physical Medicine and Rehabilitation

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[Abstract] Robot-Assisted Arm Training in Chronic Stroke: Addition of Transition-to-Task Practice

Background. Robot-assisted therapy provides high-intensity arm rehabilitation that can significantly reduce stroke-related upper extremity (UE) deficits. Motor improvement has been shown at the joints trained, but generalization to real-world function has not been profound.

Objective. To investigate the efficacy of robot-assisted therapy combined with therapist-assisted task training versus robot-assisted therapy alone on motor outcomes and use in participants with moderate to severe chronic stroke-related arm disability.

Methods. This was a single-blind randomized controlled trial of two 12-week robot-assisted interventions; 45 participants were stratified by Fugl-Meyer (FMA) impairment (mean 21 ± 1.36) to 60 minutes of robot therapy (RT; n = 22) or 45 minutes of RT combined with 15 minutes therapist-assisted transition-to-task training (TTT; n = 23). The primary outcome was the mean FMA change at week 12 using a linear mixed-model analysis. A subanalysis included the Wolf Motor Function Test (WMFT) and Stroke Impact Scale (SIS), with significance P<.05.

Results. There was no significant 12-week difference in FMA change between groups, and mean FMA gains were 2.87 ± 0.70 and 4.81 ± 0.68 for RT and TTT, respectively. TTT had greater 12-week secondary outcome improvements in the log WMFT (−0.52 ± 0.06 vs −0.18 ± 0.06; P = .01) and SIS hand (20.52 ± 2.94 vs 8.27 ± 3.03; P = .03).

Conclusion. Chronic UE motor deficits are responsive to intensive robot-assisted therapy of 45 or 60 minutes per session duration. The replacement of part of the robotic training with nonrobotic tasks did not reduce treatment effect and may benefit stroke-affected hand use and motor task performance.


via Robot-Assisted Arm Training in Chronic Stroke: Addition of Transition-to-Task Practice – Susan S. Conroy, George F. Wittenberg, Hermano I. Krebs, Min Zhan, Christopher T. Bever, Jill Whitall,

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