Archive for September, 2019

[WEB PAGE] 8 techniques to improve memory

Most people have occasional lapses in memory, such as forgetting a new acquaintance’s name or misplacing the car keys.

Most of the time, this is simply a sign that a person is a bit too busy or is preoccupied. On the other hand, having a consistently poor memory can be problematic for someone.

Many factors play a role in memory loss, including genetics, age, and medical conditions that affect the brain. There are also some manageable risk factors for memory loss, such as diet and lifestyle.

While not all memory loss is preventable, people may be able to take measures to protect the brain against cognitive decline as they age.

In this article, learn about eight techniques to try to help improve your memory.

1. Do brain training

a man improving his memory with a brain training exercise on an iPad

There are many brain training activities online that may help improve a person’s memory.

A large trial from the journal PLoS One found that people who did just 15 minutes of brain training activities at least 5 days a week had improvements in brain function.

The participants’ working memory, short term memory, and problem solving skills all significantly improved when researchers compared them to a control group doing crossword puzzles.

The researchers used brain training activities from the website Lumosity. The challenges work on a person’s ability to recall details and quickly memorize patterns.

2. Exercise

Physical exercise has a direct impact on brain health. As the author of research in the Journal of Exercise Rehabilitation notes, regular exercise reduces the risk of cognitive decline with age and protects the brain against degeneration.

The results of a 2017 study suggest that aerobic exercise can improve memory function in people with early Alzheimer’s disease. The control group did nonaerobic stretching and toning.

Aerobic exercise increases a person’s heart rate and can include any of these activities:

3. Meditate

meditation class

Research suggests that meditation may cause long term changes in the brain that improve memory.

Mindfulness meditation may help improve memory. The authors of a 2018 research paper note that many studies show meditation improves brain function, reduces markers of brain degeneration, and improves both working memory and long term memory.

The researchers observed the brains of people who regularly practiced meditation and those who did not.

Their results indicated that making a habit of meditating may cause long term changes in the brain, including increasing brain plasticity, which helps keep it healthy.

Learn about a variety of different meditation types and how to do them in this article.

4. Get enough sleep

Sleep is vital for overall brain health. Disrupting the body’s natural sleep cycle can lead to cognitive impairments, as this interrupts the processes the brain uses to create memories.

Getting a full night’s rest, typically about 7–9 hours a night for an adult, helps the brain create and store long term memories.

5. Reduce sugar intake

Sugary foods can taste delicious and feel rewarding at first, but they may play a role in memory loss. Research from 2017 in animal models noted that a diet high in sugary drinks has a link to Alzheimer’s disease.

The researchers also found that drinking too many sugary drinks, including fruit juice, may have a connection a lower total brain volume, which is an early sign of Alzheimer’s disease.

Avoiding extra sugar may help combat this risk. While naturally sweet foods, such as fruits, are a good addition to a healthful diet, people can avoid drinks sweetened with sugar and foods with added, processed sugars.

6. Avoid high calorie diets

Along with cutting out sources of excess sugar, reducing overall caloric intake may also help protect the brain.

Researchers note that high calorie diets can impair memory and lead to obesity. The effects on memory may be due to how high calorie diets lead to inflammation in particular parts of the brain.

While most research in this area has been with animals, a study from 2009 looked at whether restricting calories in humans could improve memory.

Female participants with an average age of 60.5 years reduced their calorie intake by 30%. The researchers found that they had a significant improvement in verbal memory scores and that the benefit was most significant in those who stuck to the diet best.

7. Increase caffeine intake

Caffeine from sources such as coffee or green tea may be helpful for the memory.

The authors of a 2014 study found that consuming caffeine after a memory test boosted how well participants’ brain stored memories long term.

People who took 200 milligrams of caffeine scored better on recall tests after 24 hours than people who did not take caffeine.

Caffeine may also boost memory in the short term. A study in Frontiers in Psychology found that young adults who took caffeine in the morning had improved short term memory.

This insight might be useful for individuals who have to take tests or recall information during a time of day when they may otherwise be tired.

8. Eat dark chocolate

Eating dark chocolate sounds like an indulgence, but it may also improve a person’s memory. The results of a 2011 study suggest that cocoa flavonoids, which are the active compounds in chocolate, help boost brain function.

People who ate dark chocolate performed better on spatial memory tests than those who did not. The researchers noted that cocoa flavonoids improved the blood flow to the brain.

With that said, it is important not to add more sugar to the diet, and so people should aim for at least 72% cacao content in dark chocolate and avoid chocolate with added sugar.

Risk factors for memory impairment

woman using bcaas supplement running on racing track

Exercising regularly may help keep the mind sharp.

There are risk factors a person has no control over, such as genetics. Some people may be more predisposed to conditions, such as Alzheimer’s, which greatly affect the brain and memory.

In other cases, a person may be able to reduce the risk of memory impairment. Eating a diet high in refined sugar and fats and leading a sedentary lifestyle may increase the risk of memory loss.

Eating a rounded, healthful diet and exercising regularly may contribute to keeping the mind sharp and reduce memory loss.

Summary

Many techniques for improving memory can be beneficial for a person’s overall health and well-being. For example, practicing mindfulness meditation may not only make a person less forgetful but can also reduce stress.

Even adding one or two memory boosting practices to a person’s daily routine may help them keep their brain healthy and protect it from memory loss.

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[REVIEW] Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls – Full Text

Acute brain ischemia causes changes in several neural networks and related cortico-subcortical excitability, both in the affected area and in the apparently spared contralateral hemisphere. The modulation of these processes through modern techniques of noninvasive brain stimulation, namely repetitive transcranial magnetic stimulation (rTMS), has been proposed as a viable intervention that could promote post-stroke clinical recovery and functional independence. This review provides a comprehensive summary of the current evidence from the literature on the efficacy of rTMS applied to different clinical and rehabilitative aspects of stroke patients. A total of 32 meta-analyses published until July 2019 were selected, focusing on the effects on motor function, manual dexterity, walking and balance, spasticity, dysphagia, aphasia, unilateral neglect, depression, and cognitive function after a stroke. Only conventional rTMS protocols were considered in this review, and meta-analyses focusing on theta burst stimulation only were excluded. Overall, both HF-rTMS and LF-rTMS have been shown to be safe and well-tolerated. In addition, the current literature converges on the positive effect of rTMS in the rehabilitation of all clinical manifestations of stroke, except for spasticity and cognitive impairment, where definitive evidence of efficacy cannot be drawn. However, routine use of a specific paradigm of stimulation cannot be recommended yet due to a significant level of heterogeneity of the studies in terms of protocols to be set and outcome measures that have to be used. Future studies need to preliminarily evaluate the most promising protocols before going on to multicenter studies with large cohorts of patients in order to achieve a definitive translation into daily clinical practice.

Background

Stroke is a common acute neurovascular disorder that causes disabling long-term limitations to daily living activities. The most common consequence of a stroke is motor deficit of variable degree,1 although nonmotor symptoms are also relevant and often equally disabling.2 To date, to the best of the authors’ knowledge, there is no validated treatment that is able to restore the impaired functions by a complete recovery of the damaged tissue. Indeed, stroke management basically consists of reducing the initial ischemia in the penumbra, preventing future complications, and promoting a functional recovery using physiotherapy, speech therapy, occupational therapy, and other conventional treatments.3,4

Ischemic damage is associated with significant metabolic and electrophysiological changes in cells and neural networks involved in the affected area. From a pure electrophysiological perspective, however, beyond the affected area, there is a local shift in the balance between the inhibition and excitation of both the affected and contralateral hemisphere, consisting of increased excitability and disinhibition (reduced activity of the inhibitory circuits).3,5 In addition, subcortical areas and spinal regions may be altered.3,5 In particular, the role of the uninjured hemisphere seems to be of utmost significance in post-stroke clinical and functional recovery.

Different theoretical models have been proposed to explain the adaptive response of the brain to acute vascular damage. According to the vicariation model, the activity of the unaffected hemisphere contributes to the functional recovery after a stroke through the replacement of the lost functions of the affected areas. The interhemispheric competition model considers the presence of mutual inhibition between the hemispheres, and the damage caused by a stroke disrupts this balance, thus producing a reduced inhibition of the unaffected hemisphere by the affected side. This results in increased inhibition of the affected hemisphere by the unaffected side. More recently, a new model, called bimodal balance recovery, has been proposed.3,5 It introduces the concept of a structural reserve, which describes the extent to which the nondamaged neural pathways contribute to the clinical recovery. The structural reserve determines the prevalence of the interhemispheric imbalance over vicariation. When the structural reserve is high, the interhemispheric competition model can predict the recovery better than the vicariation model, and vice versa.3

Repetitive transcranial magnetic stimulation

One of the proposed interventions to improve stroke recovery, by the induction of neuromodulation phenomena, is based on methods of noninvasive brain stimulation. Among them, transcranial magnetic stimulation (TMS) is a feasible and painless neurophysiological technique widely used for diagnostic, prognostic, research, and, when applied repetitively, therapeutic purposes.69 By electromagnetic induction, TMS generates sub or suprathreshold currents in the human cortex in vivo and in real time.10,11

The most common stimulation site is the primary motor cortex (M1), that generates motor evoked potentials (MEPs) recorded from the contralateral muscles through surface electromyography electrodes.11 The intensity of TMS, measured as a percentage of the maximal output of the stimulator, is tailored to each patient based on the motor threshold (MT) of excitability. Resting MT (rMT) is found when the target muscle is at rest, it is defined as the minimal intensity of M1 stimulation required to elicit an electromyography response with a peak-to-peak amplitude > 50 µV in at least 5 out of 10 consecutive trials.11 Alternatively TMS MTAT 2.0 software (http://www.clinicalresearcher.org/software.htm) is a free tool for TMS researchers and practitioners. It provides four adaptive methods based on threshold-tracking algorithms with the parameter estimation by sequential testing, using the maximum-likelihood strategy for estimating MTs. Active MT (aMT) is obtained during a tonic contraction of the target muscle at approximately 20% of the maximal muscular strength.11

The rMT is considered a basic parameter in providing the global excitation state of a central core of M1 neurons.11 Accordingly, rMT is increased by drugs blocking the voltage-gated sodium channels, where the same drugs may not have an effect on the gamma-aminobutyric acid (GABA)-ergic functions. In contrast, rMT is reduced by drugs increasing glutamatergic transmission not mediated by the N-methyl-D-aspartate (NMDA) receptors, suggesting that rMT reflects both neuronal membrane excitability and non-NMDA receptor glutamatergic neurotransmission.12 Finally, the MT increases, being often undetectable, when a substantial portion of M1 or the cortico-spinal tract is damaged (i.e. by stroke or motor neuron disease), and decreases when the motor pathway is hyperexcitable (such as epilepsy).13

Repetitive (rTMS) is a specific stimulation paradigm characterized by the administration of a sequence of consecutive stimuli on the same cortical region, at different frequencies and inter sequence intervals. As known, rTMS can transiently modulate the excitability of the stimulated cortex, with both local and remote effects outlasting the stimulation period. Conventional rTMS modalities include high-frequency (HF-rTMS) stimulation (>1 Hz) and low-frequency (LF-rTMS) stimulation (⩽1 Hz).11 High-frequency stimulation typically increases motor cortex excitability of the stimulated area, whereas low-frequency stimulation usually produces a decrease in excitability.14 The mechanisms by which rTMS modulates the brain are rather complex, although they seem to be related to the phenomena of long-term potentiation (LTP) and long-term depression (LTD).15

When applied after a stroke, rTMS should ideally be able to suppress the so called ‘maladaptive plasticity’16,17 or to enhance the adaptive plasticity during rehabilitation. These goals can be achieved by modulating the local cortical excitability or modifying connectivity within the neuronal networks.10

rTMS in stroke rehabilitation: an overview

According to the latest International Federation of Clinical Neurophysiology (IFCN) guidelines on the therapeutic use of rTMS,10 there is a possible effect of LF-rTMS of the contralesional motor cortex in post-acute motor stroke, and a probable effect in chronic motor stroke. An effect of HF-rTMS on the ipsilesional motor cortex in post-acute and chronic motor stroke is also possible.

The potential role of rTMS in gross motor function recovery after a stroke has been assessed in a recent comprehensive systematic review of 70 studies by Dionisio and colleagues.18 The majority of the publications reviewed report a role of rTMS in improving motor function, although some randomized controlled trials (RCTs) were not able to confirm this result,1923 as shown by a recent large randomized, sham-controlled, clinical trial of navigated LF-rTMS.24 It has also been suggested that rTMS can specifically improve manual dexterity,10 which is defined as the ability to coordinate the fingers and efficiently manipulate objects, and is of crucial importance for daily living activities.25 Notably, most of the studies focused on motor impairment in the upper limbs, whereas limited data is available on the lower limbs.18 Walking and balance are frequently impaired in stroke patients and significantly affect the quality of life (QoL),26,27 and rTMS might represent a valid aid in the recovery of these functions.28,29 Spasticity is another common complication after a stroke, consisting of a velocity-dependent increase of muscular tone,30 and for which rTMS has been proposed as a rehabilitation tool.31

Dysphagia is highly common in stroke patients, it impairs the global clinical recovery, and predisposes to complications.32 It has been pointed out that rTMS targeting the M1 area representing the muscles involved in swallowing may contribute to the treatment of post-stroke dysphagia.33

Nonmotor deficit is also a relevant post-stroke disability that negatively impacts the QoL. Aphasia is a very common consequence of stroke, affecting approximately 30% of stroke survivors and significantly limiting rehabilitation.34 According to the IFCN guidelines, to date, there is no recommendation for LF-rTMS of the contralesional right inferior frontal gyrus (IFG). Similarly, no recommendation for HF-rTMS or intermittent theta burst stimulation (TBS) of the ipsilesional left IFG or dorsolateral prefrontal cortex (DLPFC) in Broca’s aphasia has been currently approved.10 The same is true for LF-rTMS of the right superior temporal gyrus in Wernicke’s aphasia.10

Neglect is the incapacity to respond to tactile or visual contralateral stimuli that are not caused by a sensory-motor deficit.35 Although hard to treat, rTMS has been proposed as a tool for neglect rehabilitation.36 However, the IFCN guidelines state that currently there is no recommendation for LF-rTMS of the contralesional left posterior parietal cortex, or for HF-rTMS of the ipsilesional right posterior parietal cortex.10 In a recent systematic review, most of the included studies supported the use of TMS for the rehabilitation of aphasia, dysphagia, and neglect, although the heterogeneity of stimulation protocols did not allow definitive conclusions to be drawn.37

Post-stroke depression is a relevant complication of cerebrovascular diseases.38 The role of rTMS in the management of major depressive disorders is well documented,39,40 and currently, rTMS is internationally approved and indicated for the treatment of major depression in adults with antidepressant medication resistance, and in those with a recurrent course of illness, or in cases of moderate-to-severe disease severity.39 In major depression disorders, according to the IFCN guidelines, there is a clear antidepressant effect of HF-rTMS over the left DLPFC, a probable antidepressant effect of LF-rTMS on the right DLPFC, and probably no differential antidepressant effect between right LF-rTMS and left HF-rTMS. Moreover, there is currently no recommendation for bilateral stimulation combining HF-rTMS of the left DLPFC and LF-rTMS of the right DLPFC. The mentioned guidelines also state that the antidepressant effect when stimulating DLPFC is probably additive, and possibly potentiating, to the efficacy of antidepressant drugs.10 However, no specific recommendation currently addresses the use of rTMS in post-stroke depression. Recently, rTMS has been proposed as a treatment option for the late-life depression associated with chronic subcortical ischemic vascular disease, the so called ‘vascular depression’.4144 Three studies tested rTMS efficacy in vascular depression (one was a follow-up study with citalopram). Although presenting positive findings, further trials should refine clinical and diagnostic criteria to assess its impact on antidepressant efficacy.45

Approximately 25–30% of stroke patients develop an immediate or delayed cognitive impairment or an overt picture of vascular dementia.46 There is evidence of an overall positive effect on cognitive function for both LF-rTMS47 and HF-rTMS,48 supported by studies on experimental models of vascular dementia.4952 Nonetheless, the few trials examining the effect on stroke-related cognitive deficit produced mixed results.5356 In particular, two studies found no effect on cognition when stimulating the left DLPFC at 1 Hz and 10 Hz,53,54 whereas a pilot study found a positive effect on the Stroop interference test with HF-rTMS over the left DLPFC in patients with vascular cognitive impairment without dementia.55 However, this finding was not replicated in a follow-up study.56 To summarize, rTMS can induce beneficial effects on specific cognitive domains, although data are limited and their clinical significance needs to be further validated. Major challenges exist in terms of appropriate patient selection and optimization of the stimulation protocols.57

Central post-stroke pain (CPSP) is the pain resulting from an ischemic lesion of the central nervous system.58 It represents a relatively common complication after a stroke, although it is often under-recognized and, therefore, undertreated.59 According to the IFCN guidelines for the use of rTMS in the treatment of neuropathic pain, there is a definite analgesic effect of HF-rTMS of contralateral M1 to the pain side, and LF-rTMS of contralateral M1 to the pain side is probably ineffective. In addition, there is currently no recommendation for cortical targets other than contralateral M1 to the pain side.10 Notably, rTMS might be effective in drug-resistant CPSP patients.58 A recent systematic review that included nine HF-rTMS studies suggested an effect on CPSP relief, but also underlined the insufficient quality of the studies considered.60

Study objective

In this article, we aim to provide an up-to-date overview of the most recent evidence on the efficacy of rTMS in the rehabilitation of stroke patients. Although several studies have been published, a conclusive statement supporting a systematic use of rTMS in the multifaceted clinical aspects of stroke rehabilitation is still lacking.

[…]

 

Continue —> Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls – Francesco Fisicaro, Giuseppe Lanza, Alfio Antonio Grasso, Giovanni Pennisi, Rita Bella, Walter Paulus, Manuela Pennisi, 2019

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[WEB PAGE] Chemical imbalance in the brain: Myths and facts

Everything you need to know about chemical imbalances in the brain

Last reviewed 

A chemical imbalance in the brain occurs when a person has either too little or too much of certain neurotransmitters.

Neurotransmitters are the chemical messengers that pass information between nerve cells. Examples of neurotransmitters include serotonin, dopamine, and norepinephrine.

People sometimes call serotonin and dopamine the “happy hormones” because of the roles that they play in regulating mood and emotions.

A popular hypothesis is that mental health disorders, such as depression and anxiety, develop as a result of chemical imbalances in the brain.

While this theory may hold some truth, it runs the risk of oversimplifying mental illnesses. In reality, mood disorders and mental health illnesses are highly complex conditions that affect 46.6 million adults living in the United States alone.

In this article, we discuss conditions with links to chemical imbalances in the brain, myths surrounding this theory, possible treatment options, and when to see a doctor.

Myths

a man looking sad because he is experiencing a Chemical imbalance in the brain

Many factors may contribute to a person’s risk of mental illness.

Although chemical imbalances in the brain seem to have an association with mood disorders and mental health conditions, researchers have not proven that chemical imbalances are the initial cause of these conditions.

Other factors that contribute to mental health conditions include:

  • genetics and family history
  • life experiences, such as a history of physical, psychological, or emotional abuse
  • having a history of alcohol or illicit drug use
  • taking certain medications
  • psychosocial factors, such as external circumstances that lead to feelings of isolation and loneliness

While some studies have identified links between distinct chemical imbalances and specific mental health conditions, researchers do not know how people develop chemical imbalances in the first place.

Current biological testing also cannot reliably verify a mental health condition. Doctors do not, therefore, diagnose mental health conditions by testing for chemical imbalances in the brain. Instead, they make a diagnosis based on a person’s symptoms and the findings of a physical examination.

What conditions are linked to chemical imbalances?

Research has linked chemical imbalances to some mental health conditions, including:

Depression

Depression, also called clinical depression, is a mood disorder that affects many aspects of a person’s life, from their thoughts and feelings to their sleeping and eating habits.

Although some research links chemical imbalances in the brain to depression symptoms, scientists argue that this is not the whole picture.

For example, researchers point out that if depression were solely due to chemical imbalances, treatments that target neurotransmitters, such as selective serotonin reuptake inhibitors (SSRIs), should work faster.

The symptoms of depression vary widely among individuals, but they can include:

  • persistent feelings of sadness, hopelessness, anxiety, or apathy
  • persistent feelings of guilt, worthlessness, or pessimism
  • loss of interest in formerly enjoyable activities or hobbies
  • difficulty concentrating, making decisions, or remembering things
  • irritability
  • restlessness or hyperactivity
  • insomnia or sleeping too much
  • changes in appetite and weight
  • physical aches, cramps, or digestive problems
  • thoughts of suicide

It is possible to develop depression at any age, but symptoms usually begin when a person is in their teenage years or early 20s and 30s. Women are more likely than men to experience depression.

Many different types of depression exist. These include:

The dramatic hormonal changes that take place after giving birth are among the factors that can increase a woman’s risk of developing postpartum depression. According to the National Institute of Mental Health, 10–15% of women experience postpartum depression.

Bipolar disorder

Bipolar disorder is a mood disorder that causes alternating periods of mania and depression. These periods can last anywhere from a few days to a few years.

Mania refers to a state of having abnormally high energy. A person experiencing a manic episode may exhibit the following characteristics:

  • feeling elated or euphoric
  • having unusually high levels of energy
  • participating in several activities at once
  • leaving tasks unfinished
  • talking extremely fast
  • being agitated or irritable
  • frequently coming into conflict with others
  • engaging in risky behavior, such as gambling or drinking excessive quantities of alcohol
  • a tendency to experience physical injuries

Severe episodes of mania or depression can cause psychotic symptoms, such as delusions and hallucinations.

People who have bipolar disorder can experience distinct changes in their mood and energy levels. They may have an increased risk of substance abuse and a higher incidence of certain medical conditions, such as:

The exact cause of bipolar disorder remains unknown. Researchers believe that changes in the dopamine receptors — resulting in altered dopamine levels in the brain — may contribute to the symptoms of bipolar disorder.

Anxiety

pensive woman

A person with an anxiety disorder may experience excessive worry.

However, people who have an anxiety disorder often experience persistent anxiety or excessive worry that worsens in response to stressful situations.

According to the authors of a 2015 review article, evidence from neuroscience research suggests that the gamma aminobutyric acid (GABA) neurotransmitter may play a crucial role in anxiety disorders.

The GABA neurotransmitter reduces neuronal activity in the amygdala, which is the part of the brain that stores and processes emotional information.

GABA is not the only neurotransmitter that anxiety disorders involve. Other neurotransmitters that may contribute to these disorders include:

  • serotonin
  • endocannabinoids
  • oxytocin
  • corticotropin-releasing hormone
  • opioid peptides
  • neuropeptide Y

Treatment

Doctors can prescribe a class of medications called psychotropics to rebalance the concentration of particular neurochemicals in the brain.

Doctors use these medications to treat a range of mental health conditions, including depression, anxiety, and bipolar disorder.

Examples of psychotropics include:

  • Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft).
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs), including venlafaxine (Effexor XR), duloxetine (Cymbalta), and desvenlafaxine (Pristiq).
  • Tricyclic antidepressants (TCAs), such as amitriptyline (Elavil), desipramine (Norpramin), and nortriptyline (Pamelor).
  • Benzodiazepines, including clonazepam (Klonopin) and lorazepam (Ativan).

According to 2017 researchantidepressants improved symptoms in an estimated 40–60% of individuals with moderate-to-severe depression within 6–8 weeks.

While some people experience reduced symptoms within a few weeks, it can sometimes take months for others to feel the effects.

Different psychotropics have varying side effects. People can discuss the benefits and risks of these medications with their doctor.

The side effects of psychotropic medications can include:

Suicide prevention

  • If you know someone at immediate risk of self-harm, suicide, or hurting another person:
  • Call 911 or the local emergency number.
  • Stay with the person until professional help arrives.
  • Remove any weapons, medications, or other potentially harmful objects.
  • Listen to the person without judgment.
  • If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.

When to see a doctor

man talking to doctor in her office both smiling

If a person experiences anxiety and mood changes every day for longer than 2 weeks, they should consider speaking to their doctor.

These symptoms should not cause alarm if they are mild and resolve within a few days.

However, people may wish to consider speaking with a doctor or trained mental health professional if they experience emotional, cognitive, or physical symptoms every day for more than 2 weeks.

Summary

Mental health is complex and multifaceted, and numerous factors can affect a person’s mental well-being.

Although chemical imbalances in the brain may not directly cause mental health disorders, medications that influence the concentration of neurotransmitters can sometimes provide symptom relief.

People who experience signs and symptoms of a mental health problem for more than 2 weeks may wish to speak to a doctor.

 

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[WEB PAGE] How New Ketamine Drug Helps with Depression

Yale psychiatrists, pioneers of ketamine research, shed light on new FDA approval

An illustration of a woman suffering from depression who might be helped by esketamine

The FDA approval of esketamine gives doctors another valuable tool in their arsenal against depression—and offers new hope for patients no one had been able to help before. “This is a game changer,” says John Krystal, MD, chief psychiatrist at Yale Medicine and one of the pioneers of ketamine research in the country.

On March 5, the Food and Drug Administration (FDA) approved the first truly new medication for major depression in decades. The drug is a nasal spray called esketamine, derived from ketamine—an anesthetic that has made waves for its surprising antidepressant effect.

Because treatment with esketamine might be so helpful to patients with treatment-resistant depression (meaning standard treatments had not helped them), the FDA expedited the approval process to make it more quickly available. In one study, 70 percent of patients with treatment-resistant depression who were started on an oral antidepressant and intranasal esketamine improved, compared to just over half in the group that did not receive the medication (called the placebo group).

“This is a game changer,” says John Krystal, MD, chief psychiatrist at Yale Medicine and one of the pioneers of ketamine research in the country. The drug works differently than those used previously, he notes, calling ketamine “the anti-medication” medication. “With most medications, like valium, the anti-anxiety effect you get only lasts when it is in your system. When the valium goes away, you can get rebound anxiety. When you take ketamine, it triggers reactions in your cortex that enable brain connections to regrow. It’s the reaction to ketamine, not the presence of ketamine in the body that constitutes its effects,” he says.

And this is exactly what makes ketamine unique as an antidepressant, says Dr. Krystal.

However, as the nasal spray becomes available via prescription, patients have questions: How does it work? Is it safe? And who should get it? Read on for answers.

How do antidepressants work?

Research into ketamine as an antidepressant began in the 1990s with Dr. Krystal and his colleagues Dennis Charney, MD, and Ronald Duman, PhD, at the Yale School of Medicine. At the time (as is still mostly true today) depression was considered a “black box” disease, meaning that little was known about its cause.

One popular theory was the serotonin hypothesis, which asserted that people with depression had low levels of a neurotransmitter called serotonin. This hypothesis came about by accident—certain drugs given to treat other diseases like high blood pressure and tuberculosis seemed to drastically affect people’s moods. Those that lowered serotonin levels caused depression-like symptoms; others that raised serotonin levels created euphoric-like feelings in depressed patients. This discovery ushered in a new class of drugs meant to treat depression, known as selective serotonin reuptake inhibitors (SSRIs). The first one developed for the mass market was Prozac.

But eventually it became clear that the serotonin hypothesis didn’t fully explain depression. Not only were SSRIs of limited help to more than one-third of people given them for depression, but growing research showed that the neurotransmitters these drugs target (like serotonin) account for less than 20 percent of the neurotransmitters in a person’s brain. The other 80 percent are neurotransmitters called GABA and glutamate.

GABA and glutamate were known to play a role in seizure disorders and schizophrenia. Together, the two neurotransmitters form a complex push-and-pull response, sparking and stopping electrical activity in the brain. Researchers believe they may be responsible for regulating the majority of brain activity, including mood.

What’s more, intense stress can alter glutamate signaling in the brain and have effects on the neurons that make them less adaptable and less able to communicate with other neurons.

This means stress and depression themselves make it harder to deal with negative events, a cycle that can make matters even worse for people struggling with difficult life events.

Ketamine—from anesthetic to depression “miracle drug”

Interestingly, studies from Yale research labs showed that the drug ketamine, which was widely used as anesthesia during surgeries, triggers glutamate production, which, in a complex, cascading series of events, prompts the brain to form new neural connections. This makes the brain more adaptable and able to create new pathways, and gives patients the opportunity to develop more positive thoughts and behaviors. This was an effect that had not been seen before, even with traditional antidepressants.

“I think the interesting and exciting part of this discovery is that it came largely out of basic neuroscience research, instead of by chance,” says Gerard Sanacora, MD, PhD, a psychiatrist at Yale Medicine who was also involved in many of the ketamine studies. “It wasn’t just, ‘let’s try this drug and see what happens.’ There was increasing evidence suggesting that there was some abnormality within the glutamatergic system in the brains of people suffering from depression, and this prompted the idea of using a drug that targets this system.”

For the last two decades, researchers at Yale have led ketamine research by experimenting with using subanesthetic doses of ketamine delivered intravenously in controlled clinic settings for patients with severe depression who have not improved with standard antidepressant treatments. The results have been dramatic: In several studies, more than half of participants show a significant decrease in depression symptoms after just 24 hours. These are patients who felt no meaningful improvement on other antidepressant medications.

Most important for people to know, however, is that ketamine needs to be part of a more comprehensive treatment plan for depression. “Patients will call me up and say they don’t want any other medication or psychotherapy, they just want ketamine, and I have to explain to them that it is very unlikely that a single dose, or even several doses of ketamine alone, will cure their depression,” says Dr. Sanacora. Instead, he explains, “I tell them it may provide rapid benefits that can be sustained with comprehensive treatment plans that could include ongoing treatments with ketamine.  Additionally, it appears to help facilitate the creation new neural pathways that can help them develop resiliency and protect against the return of the depression.”

This is why Dr. Sanacora believes that ketamine may be most effective when combined with cognitive behavioral therapy (CBT). CBT is a type of psychotherapy that helps patients learn more productive attitudes and behaviors. Ongoing research, including clinical trials, addressing this idea are currently underway here at Yale.

A more patient-friendly version

The FDA-approved drug esketamine is one version of the ketamine molecule, and makes up half of what is found in the commonly used anesthetic form of the drug. It works similarly, but its chemical makeup allows it to bind more tightly to the NMDA glutamate receptors, making it two to five times more potent. This means that patients need a lower dose of esketamine than they do ketamine. The nasal spray allows the drug to be taken more easily in an outpatient treatment setting (under the supervision of a doctor), making it more accessible for patients than the IV treatments currently required to deliver ketamine.

But like any new drug, this one comes with its cautions. Side effects, including dizziness, a rise in blood pressure, and feelings of detachment or disconnection from reality may arise. In addition, the research is still relatively new. Studies have only followed patients for one year, which means doctors don’t yet know how it might affect patients over longer periods of time. Others worry that since ketamine is sometimes abused (as a club drug called Special K), there may be a downside to making it more readily available—it might increase the likelihood that it will end up in the wrong hands.

Also, esketamine is only part of the treatment for a person with depression. To date, it has only been shown to be effective when taken in combination with an oral antidepressant. For these reasons, esketamine is not considered a first-line treatment option for depression. It’s only prescribed for people with moderate to severe major depressive disorder who haven’t been helped by at least two other depression medications.

In the end, though, the FDA approval of esketamine gives doctors another valuable tool in their arsenal against depression—and offers new hope for patients no one had been able to help before.

To learn more, visit yalemedicine.org.

 

via How New Ketamine Drug Helps with Depression > Stories at Yale Medicine

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[Abstract] Functional Balance and Postural Control Improvements in Patients with Stroke after Non-Invasive Brain Stimulation: A Meta-Analysis

Highlights

  • NIBS improved deficits in functional balance and postural control post stroke.
  • The treatment effects on postural imbalance were significant following rTMS.
  • The improvements after rTMS appeared in acute, subacute, and chronic patients.
  • A higher number of rTMS sessions significantly increased the treatment effects.

Abstract

Objectives

The postural imbalance post stroke limits individual’s walking abilities as well as increase the risk of falling. We investigated the short-term treatment effects of non-invasive brain stimulation (NIBS) on functional balance and postural control in patients with stroke.

Data Sources

We started the search via PubMed and ISI’s Web of Science on March 1, 2019 and concluded the search on April 30, 2019.

Study Selection

The meta-analysis included studies that used either repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) for the recovery of functional balance and postural control post stroke. All included studies used either randomized control trial or crossover designs with a sham control group.

Data Extraction

Three researchers independently performed data extraction and assessing methodological quality and publication bias. We calculated overall and individual effect sizes using random effects meta-analysis models.

Data Synthesis

The random effects meta-analysis model on the 18 qualified studies identified the significant positive effects relating to NIBS in terms of functional balance and postural control post stroke. The moderator variable analyses revealed that these treatment effects were only significant in rTMS across acute/subacute and chronic stroke patients whereas tDCS did not show any significant therapeutic effects. The meta-regression analysis showed that a higher number of rTMS sessions was significantly associated with more improvements in functional balance and postural control post stroke.

Conclusions

Our systematic review and meta-analysis confirmed that NIBS may be an effective option for restoring functional balance and postural control for patients with stroke.

via Functional Balance and Postural Control Improvements in Patients with Stroke after Non-Invasive Brain Stimulation: A Meta-Analysis – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] Use of client-centered virtual reality in rehabilitation after stroke: a feasibility study – Full Text

ABSTRACT

Patient-centered virtual reality (VR) programs could assist in the functional recovery of people after a stroke.

Objectives:

To analyze the feasibility of a rehabilitation protocol using client-centered VR and to evaluate changes in occupational performance and social participation.

Methods:

This was a mixed methods study. Ten subacute and chronic stroke patients participated in the rehabilitation program using games in non-immersive VR for 40 minutes/day, three days/week, for 12 weeks. Sociodemographic information was collected and the outcome variables included were the Canadian Occupational Performance Measure (COPM) and the Participation Scale. A field diary was used to record the frequency of attendance and adherence of participants and an interview was conducted at the end of program.

Results:

There were significant and clinically-relevant statistical improvements in the COPM performance score (p < 0.001; CI = 1.29 − 4.858) and in the COPM satisfaction score (p < 0.001; CI = 1.37 − 5.124), with a difference greater than 4.28 points for performance and 4.58 points for satisfaction. The change in the scores for participation was statistically significant (p = 0.046), but there was no clinical improvement (dcohen = −0.596, CI = −1.862 − 0.671). The majority of participants reported more than 75% consecutive attendance of sessions and there was 100% adherence to the program. In the interviews, the participants described their post-stroke difficulties; how the video game motivated their engagement in rehabilitation; and the improvement of occupational performance and social participation after participating in the program.

Conclusions:

VR is a viable tool for the rehabilitation of stroke patients with functional gains, mainly regarding occupational performance and performance satisfaction.

 

Every year, 16 million people suffer from a stroke, with great economic and social repercussions1. In Brazil, this is the leading cause of disability1,2. A stroke is a sudden syndrome, characterized by sensory, motor, and cognitive-perceptual alterations1. These alterations are associated with disability, limitations in activities of daily life (ADL) and restrictions in social participation, with loss of autonomy and independence3,4.

Different treatment protocols are used in post-stroke rehabilitation, and consist mainly of motor control approaches, and task oriented training5,6,7. Task-based training, mediated by technologies and computerized activities such as virtual reality (VR), has been promising for post-stroke patients8,9. Virtual reality is a technology for interaction between user and operating system using graphic resources that recreate a virtual environment10. One of its advantages is that the environment can be more interesting and pleasant when compared with traditional rehabilitation, increasing motivation, engagement and adherence of patients to the treatment10,11,12.

Recent clinical trials with post-stroke patients demonstrated the effectiveness of VR in the rehabilitation of dynamic balance13,14,15,16; motor function12,17,18,19,20,21; performance and independence in ADL12,14 and quality of life17,19,20,21. However, a systematic review found no significant difference in upper limb function when comparing VR with a conventional therapy8. Differences between groups were found only when VR was added to the usual treatments8. In another review, the VR effects varied from small to moderate for ADL and outcomes for social participation did not change with the intervention9.

Although systematic reviews and meta-analyses on VR effectiveness are growing, they were not conclusive regarding the protocol or intervention parameters, which makes the clinical use of VR difficult8,9,11. Higher frequencies of treatment are preferable; however, these findings were not statistically significant8,9. Personalized VR protocols that consider a specific patient’s requirements seem to offer more benefits. However, it should be noted that these results are also not conclusive and there is no consensus about the issue8,9.

As there is little consistency in the literature indicating better VR protocols to be used in clinical practice, it is fundamental to analyze the viability and the patient response potential regarding the intervention using VR. The studies with better quality methodologies evaluated outcomes related to the body structure and function8,9. To recommend the therapeutic use of VR in post-stroke patients it is essential to develop patient-centered interventions and focus on assessing performance-related outcomes in activity and participation.

A patient-centered practice is an approach that considers the person’s ability to deal with their health condition, to self-manage, to make decisions, to motivate themselves, and adhere to treatment7. In this context, this study aimed to analyze the feasibility of a rehabilitation protocol using patient-centered VR and to evaluate changes in occupational performance and social participation of patients after a stroke. The hypothesis was that VR would increase performance, reduce restrictions in participation, and be a viable tool for outpatient intervention with post-stroke patients.

METHODS

This research was a feasibility study that used mixed methods, including a quantitative and qualitative approach. The quantitative study of the pre- and post-intervention type measured changes in occupational performance and social participation, after a rehabilitation program using VR. The feasibility of the VR was analyzed using qualitative methods. This study was approved by the Institution’s Research Ethics Committee.

Local and participants

The participants were recruited by convenience, at the Rehabilitation Center of the Clinical Hospital of the Federal University of Triângulo Mineiro (HC/UFTM), a public and free rehabilitation service with physical therapy, speech therapy, nutrition, nursing, psychology, and occupational therapy.

We selected participants with primary or recurrent stroke diagnoses, hemiparesis, age 18 or older, of either sex, who were in the rehabilitation program. We excluded participants with strokes older than five years, bilateral hemiparesis, and/or other diseases of the musculoskeletal and central nervous systems, wheelchair users, amputees, visually impaired patients, and those who could not understand or respond to the data collection instruments. The sample was selected from the medical records and by indication of the rehabilitation professionals. A total of 10 patients met the inclusion criteria and agreed to participate in the research.

Evaluation procedures and instruments

The procedures took place between January and August 2017 at the HC/UFTM Rehabilitation Center and was divided into three sequential phases.

Phase 1: Pre-intervention evaluation

The participants responded to a socio-demographic questionnaire and were evaluated according to self-reported occupational performance and social participation.

Occupational performance was measured by the Canadian Occupational Performance Measure (COPM). The patients selected the activities that they needed, but which they had not been able to perform, or were not satisfied with their performance23. The patients assigned a grade of 1-10 to the importance of each activity and selected the five with the most importance. Each activity selected was evaluated for the patient’s performance and satisfaction on a scale from 1-10. The total scores were calculated from the means of the performance and satisfaction. Changes in scores greater than two points indicated a clinically relevant improvement23.

Social participation was measured by the Participation Scale (P-Scale), version 6.0. The participants would compare themselves with a “peer without disability” and respond to how they perceived their own level of participation compared with the “peer”24. The score of any item varied from zero, when the individual did not have restrictions to his participation, to five when the restriction was considered a “big problem”. The total score varied from zero to 90, with smaller values indicating less restriction25.

Phase 2: Intervention

The rehabilitation program using VR was implemented at the HC/UFTM Rehabilitation Center. The literature does not have a standardization of interventions and/or games used in virtual reality programs. Thus, the protocol chosen had the number of sessions and duration following the findings of Aramaki et al26. Therefore, the protocol consisted of three weekly sessions lasting 40 minutes each, developed over 12 weeks, for a total of 36 sessions.

The participants were in an orthostatic position, four meters away from the screen and video game, in a room with natural light. The Xbox 360® was used with Kinect motion sensor technology.

The games were chosen according to the activities indicated in the COPM as difficult to perform in the initial evaluation. These required training in upper-limb and lower-limb motor skills, motor coordination, and cognitive skills. A detailed description of the information for each game and its main effects are shown in the Figure 1.

The sessions began with the game “20,000 Leaks” to familiarize the participant with the video game interface. Each participant played two or three games for 10 minutes each. In order to avoid fatigue, if necessary, a two-minute interval between games took place.

 

[…]

Continue —->  Use of client-centered virtual reality in rehabilitation after stroke: a feasibility study

 

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[Abstract] A novel backstepping adaptive impedance control for an upper limb rehabilitation robot

Abstract

Stroke contributes to hemiplegia, which severely reduces people’s ability to perform activities of daily living. Due to the insufficiency of medical resources, there is an urgent need for home-based rehabilitation robot. In this paper, we design a home-based upper limb rehabilitation robot, based on the principle that three axes intersect at one point. A three-dimensional force sensor is equipped at the end of the manipulator to measure the interaction forces between the affected upper limb and the robot during rehabilitation training. The virtual rehabilitation training environment is designed to improve the enthusiasm of patients. A backstepping adaptive fuzzy based impedance control method is proposed for the home-based upper limb rehabilitation robot to prevent secondary injury of the affected limb. The adaptive law is introduced, and the backstepping adaptive fuzzy based impedance controller is proved in details. Experiments results demonstrate the effectiveness of the proposed control method.

 

via A novel backstepping adaptive impedance control for an upper limb rehabilitation robot – ScienceDirect

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[Abstract] DESIGN AND DEVELOPMENT OF A NEW APPROACH TO WRIST REHABILITATION

Abstract

Wrist injuries are a very common type of pathology that can compromise most daily
tasks. Conventional therapy is dependent on the availability of physiotherapists as well as devices
designed for this purpose. Conventional devices do not accompany the patient throughout their
rehabilitation process, requiring their constant replacement. Vibratory therapies emerged in recent
years and have demonstrated several benefits in this area. However, there are few vibratory
devices designed for wrist rehabilitation. In this paper, we propose two different portable and
active models for wrist rehabilitation based on vibratory therapy for wrist rehabilitation. The first
model has a cylindrical shape and the second model has a dumbbell shape. The results obtained
showed that vibratory therapy can assist the wrist rehabilitation because it promoted
improvements in joint amplitude gain in all wrist movements. Furthermore, the second device
demonstrated higher joint gains than the first device. In addition, the results obtained from the
measurement of accelerations demonstrate that the natural frequencies of both devices are
adequate for wrist and forearm rehabilitation as well as the mode of vibration. There are
differences between what the simulations predicted and what was obtained in practice in terms of
natural frequency values.

Full Text PDF

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[BLOG POST] What are the pitfalls and perils of intracranial pressure?

Crudely speaking, the nervous system is made up of two parts. The peripheral nervous system, composed of nerves and muscles, is rather robust and roams free, exposed to the elements. On the other hand, the central nervous system, consisting of the brain and spinal cord, is delicate and fragile. It is therefore protectively cocooned in a rigid skull and a hardy vertebral skeleton. But even this tough fortress isn’t secure enough for these dainty neurones; they are, after all, the command and control system for the whole body. Therefore, to further insulate them from the physical and physiological perturbations that continuously threaten them, nature has further sequestered them within a very exquisitely regulated irrigation system, the cerebrospinal fluid (CSF).

Internet Archive book Images on Flickr. https://www.flickr.com/photos/internetarchivebookimages/14769907251/

The CSF is actually a fine filtrate of the blood that flows in the arteries. The sieve is the very forbidding blood-brain barrier (BBB) which turns away all the blood cells, and carefully sets a target on how much protein and glucose to let in. The pressure within the CSF is also very finely tuned, not too high…and not too low; that is how the neurones like it.

 

By Dr. Johannes Sobotta – Atlas and Text-book of Human Anatomy Volume III Vascular System, Lymphatic system, Nervous system and Sense Organs, Public Domain, https://commons.wikimedia.org/w/index.php?curid=29135482

 

Alas, as with all systems, the CSF is vulnerable to external miscreants; infections such as meningitis,  encephalitis, and brain abscesses which cause brain swelling or cerebral edema. The CSF is also largely defenceless to internal insurgents, fifth columnists, such as a brain tumours, haematomas (bleeds), and cerebral vein thrombosis (venous clots). The smooth flow of the CSF may also be obstructed, resulting in hydrocephalus or enlargement of the brain’s ventricular system. In all these circumstances, the intracranial pressure is often elevated, a situation aptly dubbed intracranial hypertension. Very often, intracranial hypertension may occur without any obvious cause, and this condition is referred to as idiopathic intracranial hypertension (IIH). Because IIH threatens vision, neurologists have abandoned its old and misleading name, benign intracranial hypertension (BIH).

By BruceBlaus. When using this image in external sources it can be cited as:Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014“. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010ISSN 2002-4436. – Own workCC BY 3.0Link

Intracranial hypertension is no walk in the park as it portends disaster, whatever its cause. As it is a  potentially fatal state, the early warning signs are drilled into all doctors in medical school…when their brains are still malleable. These red flag features are severe headacheimpaired consciousness, progressive visual lossdilated or blown pupilspapilledema (swelling of the optic nerve head), and neck stiffness. The standard operating procedure for intracranial hypertension is to deflate the pressure as quickly as possible, by hook or by crook. This may be medical, with infusions such as mannitol, or surgical, with procedures such as decompressive craniectomy (removal of part of the skull). The terminal stage of intracranial hypertension, the most ominous neurological emergency, is cerebral herniation: this is the catastrophic compression of the brainstem into the narrow and tight spinal canal: a physical state that is incompatible with life.

By Ambika S., Arjundas D., Noronha V. – https://openi.nlm.nih.gov/detailedresult.php?img=2859586_AIAN-13-37-g001&query=papilledema&it=xg&req=4&npos=2, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=47658492

As with all waves, intracranial pressure also has its lows, and it is a no-brainer that neurologists call this intracranial hypotension. This is not as hazardous as intracranial hypertension, but it is worthy of respect in view of its devastating morbidity. The usual cause, and again no prizes for guessing this, is a leak. The puncture in this case is often iatrogenic, in other words, the whodunnit is the doctor. This may be deliberate, such as when the doctor attempts to remove some CSF to test, via a procedure called a  lumbar puncture (LP). It may also be accidental, such as when your friendly anaesthetist performs an epidural to relieve pain. In both situations, the dura protecting the CSF is perforated, causing spinal fluid leakage. This manifests as postural or orthostatic headache; by definition, this is a headache that sets in within 15 minutes of standing up, and resolves within 15 minutes of lying down flat. The treatment in such cases is strict bed rest, drinking loads of fluids, including caffeinated drinks, and waiting for the dura to heal itself…usually within one week. If this does not happen, then an intravenous caffeine infusion may be required. An epidural blood patch may also be carried out, again by your friendly anaesthetist, who squirts a little of the victims blood around the site of the leak, to, well, ‘patch it up’. In extremis, surgery may be needed to seal the leak, but this is way beyond my pay grade.

By Paul Anthony Stewart – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=75808444

Intracranial hypotension may however develop without any apparent cause, and this is called spontaneous intracranial hypotension (SIH). The causes of SIH include unpredictable dural tearsruptured meningeal diveticuli (outpouchings of the dura), and direct CSF-venous fistulae (don’t ask!) There are a variety of risk factors for SIH such as connective tissue diseases and bariatric surgery. It is very helpful that SIH leaves characteristic tell-tale clues on brain MRI scans, and these include subdural hygroma (plain fluid collections under the dura); subdural haematoma (blood under the dura); meningeal enhancement with contrast dye; engorgement of the pons and pituitary; and the interesting dinosaur tail sign on fat suppression T2 MRI (FST2WI). The gold standard test to localise the site of leakage in SIH is radionuclide cisternography. In the absence of this rather sophisticated test, a CT myelogram may be considered. Treatment is similar to that of other forms of intracranial hypotension, but other measures that may be required to seal the leak, including the use of fibrin sealeant.

By Hellerhoff – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18946727

If you have reached the end of this blog post, then you deserve a prize. Four prizes actually: recent interesting reports in the field of SIH to explore:

  1. The use of transorbital ultrasound in making a diagnosis.
  2. Treatment of complicated SIH with intrathecal saline infusion.
  3. SIH complicated by superficial siderosis.
  4. Severe SIH complicated by sagging brain causing causing postural loss of consciousness.
By © Nevit Dilmen, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=45660723

 

 

via What are the pitfalls and perils of intracranial pressure? – The Neurology Lounge

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[WEB PAGE] 10 of the best apps for stroke recovery in 2018

Following a stroke, the body needs time to heal, and recovery time depends on the symptoms and severity of the stroke. We have identified the best apps to help stroke survivors with their recovery and rehabilitation.
older man looking at phone

Smartphone apps can assist with stroke recovery and rehabilitation.

More than 795,000 individuals in the United States have a stroke each year, and around 140,000 of these people die from stroke.

Ischemic strokes — wherein “blood flow to the brain is blocked” — account for roughly 87 percent of all strokes.

Stroke can cause significant injury to the brain that may result in many long-term problems.

For example, communication, concentration, memory, and executive function, as well as spatial awareness, are all cognitive functions that may be impacted by stroke.

Stroke can also trigger mental health issues such as anxiety and depression, as well as movement and coordination problems, paralysis, difficulties swallowing, visual impairment, and urinary incontinence and loss of bowel control.

The faster a person is treated after stroke, the more likely they are to recover from it. Surveys have shown that people who “arrived at the emergency room within 3 hours” of their first symptoms of stroke had “less disability” 3 months later than those who were treated later.

While some people recover quickly from stroke, others may need long-term support. Apps are available to help aid the stroke recovery process. They can help you or your loved one to track appointments and medications, provide language therapy, train the brain, and even lower some risk factors for future strokes.

Medical News Today have selected the top 10 apps to assist with stroke recovery.

Cozi

Android: Free

iPhone: Free

Cozi logo

Keep track of schedules with a shared color-coded calendar and set reminders for yourself or other family members so that medical appointments and medications are not missed.

Shopping and to-do lists can also be shared with everyone in the family to ensure that you have everything you need from the grocery store. All items added to lists are viewable instantly in real-time.

Medisafe

Android: Free

iPhone: Free

Medisafe logo

According to the app, mistakes with medicine use and dosage tracking result in 50 percent of individuals not taking medication as prescribed, 700,000 hospital visits, 125,000 deaths each year, and 44 in every 100 prescriptions not being collected from the pharmacy.

Whether you are taking one drug dose or multiple doses each day, it can be challenging to remember to take the right pill at the right time. Medisafe takes the stress out of having to remember if you or your loved one took their medications correctly.

Stop, Breathe & Think

Android: Free

iPhone: Free

Stop, Breathe & Think logo

Stop, Breathe & Think is a meditation and mindfulness app that helps to decrease stress and anxiety. The app provides guided meditations, breathing exercises, and yoga and acupressure videos to help you check in with your emotions.

Stop, Breathe & Think says that taking a few minutes every day to feel calm is just as important as getting frequent exercise and will reduce stress and promote peace of mind.

7 Minute Workout Challenge

Android: $2.99

iPhone: $2.99

7 Minute Workout Challenge logo

If you are unsure of how to start an exercise routine after stroke, the 7 Minute Workout Challenge app could be the perfect app for you. The 7-minute workout is a research-backed exercise program that has become a hit internationally.

Scientists have put together 12 exercises to perform for 30 seconds each with a rest period of 10 seconds in-between. The exercise sequences are easy to do, require no equipment, and can be done anywhere.

Language Therapy 4-in-1

Android: $59.99

iPhone: $59.99

Language Therapy logo

Language Therapy 4-in-1 is a scientifically proven speech therapy app that aims to improve speaking, listening, reading, and writing in those with aphasia. Get started by giving their free version, Language Therapy Lite, a try today.

Research led by the University of Cambridge in the United Kingdom found that using the app for 20 minutes each day for 4 weeks showed improvements in all study participants with chronic aphasia.

Constant Therapy

Android: Free trial

iPhone: Free trial

Constant Therapy logo

With more than 65 task categories, 100,000 exercises, and 10 levels of difficulty, Constant Therapy can help to improve cognition, memory, speech, language, reading, and comprehension skills.

Constant Therapy was developed by scientists at Boston University in Massachusetts and is recommended by neurologists, speech language pathologists, and occupational therapists. Research published in the journal Frontiers in Human Neuroscience showed a significant improvement in standardized tests for stroke survivors after using Constant Therapy.

VocalEyes AI

iPhone: Free

VocalEyes logo

VocalEyes is computer vision for the visually impaired. The app uses machine learning to help people with vision problems identify objects in their everyday lives. Take a photo, and the app will tell you what the camera sees.

VocalEyes’s audio response describes scenes and environments, identifies objects, label logos, and brands, reads text, detects faces, classifies emotions, recognizes ages, and distinguishes currency denominations.

Glasses

iPhone: Free

Glasses logo

If your vision is impaired after stroke or you have simply forgotten your glasses, the app can zoom in on labels and nutritional information in a grocery store and menus in dark restaurants as well as help you see how much to pay on the bill after eating out.

Glasses is simple to use. Double tapping quickly zooms in or out by 6x, while swiping uses a slow and continuous zoom method. If you have shaky hands, you can tap and hold to freeze the image on screen.

Elevate

Android: Free

iPhone: Free

Elevate logo

Elevate is a brain-training app that is designed to enhance speaking abilities, processing speed, focus, and memory. Elevate provides a personalized training program that adapts in difficulty over time to ensure you are always challenged.

Elevate features more than 40 games aimed at improving your skills, plus a workout calendar that tracks your streaks to keep you motivated. Users who train with Elevate at least three times each week have reported considerable gains in abilities and increased confidence.

Peak

Android: Free

iPhone: Free

Peak logo

Peak features a personal brain trainer, known as Coach, who selects the perfect workouts for you at the correct time. Choose your training exercises from Coach’s recommendations to challenge yourself and stay motivated by tracking your progress with in-depth insights.

Free games challenge your attention, memory, problem-solving skills, mental agility, coordination, emotional control, language, and creativity. Upgrade to Pro for additional features.

 

via 10 of the best apps for stroke recovery in 2018

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