Archive for September, 2020
[Abstract] How Commercially Available Virtual Reality–Based Interventions Are Delivered and Reported in Gait, Posture, and Balance Rehabilitation: A Systematic Review
Virtual reality (VR) technologies are increasingly used in physical rehabilitation; however, it is unclear how VR interventions are being delivered, and, in particular, the role of the therapist remains unknown. The purpose of this study was to systematically evaluate how commercially available VR technologies are being implemented in gait, posture, and balance rehabilitation, including justification, content, procedures, and dosage of the intervention and details of the therapist role.
Five databases were searched between 2008 and 2018. Supervised interventional trials with >10 adult participants using commercially available VR technologies to address mobility limitations were independently selected by 2 authors. One author extracted reported intervention characteristics into a predesigned table and assessed methodological quality, which was independently verified by a second author. A total of 29 studies were included.
Generally, minimal clinical reasoning was provided to justify technology or activity selection, with recreational systems and games used most commonly (n = 25). All but 1 study used a single interventional technology. When explicitly described, the intervention was delivered by a physical therapist (n = 14), a therapist assistant (n = 2), both (n = 1), or an occupational therapist (n = 1). Most studies reported supervision (n = 12) and safeguarding (n = 8) as key therapist roles, with detail of therapist feedback less frequently reported (n = 4). Therapist involvement in program selection, tailoring, and progression was poorly described.
Intervention protocols of VR rehabilitation studies are incompletely described and generally lack detail on clinical rationale for technology and activity selection and on the therapist role in intervention design and delivery, hindering replication and translation of research into clinical practice. Future studies utilizing commercially available VR technologies should report all aspects of intervention design and delivery and consider protocols that allow therapists to exercise clinical autonomy in intervention delivery.
The findings of this systematic review have highlighted that VR rehabilitation interventions targeting gait, posture, and balance are primarily delivered by physical therapists, whose most reported role was supervision and safeguarding. There was an absence of detail regarding complex clinical skills, such as tailoring of the intervention and reasoning for the choice of technology and activity. This uncertainty around the role of the therapist as an active ingredient in VR-based rehabilitation hinders the development of implementation guidelines. To inform the optimal involvement of therapists in VR rehabilitation, it is essential that future studies report on all aspects of VR intervention design and delivery.
An overview of what happens when an individual suffers from a brain injury and what their journey from the moment they are taken into the hospital through to rehabilitation and recovery looks like.
It’s 99.6 accurate detecting seizures up to an hour before they happen.
We’ve seen a smart arm bracelet that can predict nightly seizures, but now a pair of researchers have created something even more promising: an AI system that can predict epileptic seizures with 99.6-percent accuracy. Even better, it can do so up to an hour before they occur. As IEEE Spectrum reports, that gives people enough time to prepare for the attack by taking medication. Around 50 million people around the world currently have epilepsy, according to the World Health Organization, and 70 percent of those patients can control their seizures with medication.
While it’s not a complete fix, the new AI system, developed by Hisham Daoud and Magdy Bayoumi of the University of Louisiana at Lafayette, is a major leap forward from existing prediction methods. Currently, other methods analyze brain activity with an EEG (electroencephalogram) test and apply a predictive model afterwards. The new method does both of those things at once, with the help of a deep learning algorithm that maps brain activity and another that can predict the electrical channels lighting up during a seizure.
It’ll still be some time before this technique will be available for widespread use — the team is now working on a custom chip that can help process the necessary algorithms — but it could be life-changing news for patients with epilepsy.
WHAT IS STROKE
A stroke occurs if the flow of oxygen-rich blood to a portion of the brain is blocked. Without oxygen, brain cells start to die after a few minutes. Sudden bleeding in the brain also can cause a stroke if it damages brain cells.
If brain cells die or are damaged because of a stroke, symptoms occur in the parts of the body that these brain cells control. Examples of stroke symptoms include sudden weakness; paralysis or numbness of the face, arms, or legs (paralysis is an inability to move); trouble speaking or understanding speech; and trouble seeing.
A stroke is a serious medical condition that requires emergency care. A stroke can cause lasting brain damage, long-term disability, or even death.
If you think you or someone else is having a stroke, call 9–1–1 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts.
The two main types of stroke are ischemic (is-KE-mik) and hemorrhagic (hem-ah-RAJ-ik). Ischemic is the more common type of stroke.
An ischemic stroke occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes.
A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures (breaks open). The pressure from the leaked blood damages brain cells. High blood pressure and aneurysms (AN-u-risms) are examples of conditions that can cause hemorrhagic strokes. (Aneurysms are balloon-like bulges in an artery that can stretch and burst.)
Another condition that’s similar to a stroke is a transient ischemic attack, also called a TIA or “mini-stroke.” A TIA occurs if blood flow to a portion of the brain is blocked only for a short time. Thus, damage to the brain cells isn’t permanent (lasting).
Like ischemic strokes, TIAs often are caused by blood clots. Although TIAs are not full-blown strokes, they greatly increase the risk of having a stroke. If you have a TIA, it’s important for your doctor to find the cause so you can take steps to prevent a stroke.
Both strokes and TIAs require emergency care.
Stroke is a leading cause of death in the United States. Many factors can raise your risk of having a stroke. Talk with your doctor about how you can control these risk factors and help prevent a stroke.
If you have a stroke, prompt treatment can reduce damage to your brain and help you avoid lasting disabilities. Prompt treatment also may help prevent another stroke.
Researchers continue to study the causes and risk factors for stroke. They’re also finding new and better treatments and new ways to help the brain repair itself after a stroke.
Source: National Institutes of Health
What is a neuropsychologist?
A neuropsychologist is a psychologist who specializes in understanding the relationship between the physical brain and behavior. The brain is complex. Disorders within the brain and nervous system can alter behavior and cognitive function.
According to the University of Rochester Medical Center, the role of a neuropsychologist is to understand how brain structures and systems relate to behavior and thinking.
Neuropsychologists have a doctorate in psychology and training in neuropsychology. They often work in research or clinical settings.
Neuropsychologists evaluate and treat people with various types of nervous system disorders. They work closely with doctors, including neurologists.
Illnesses, injuries, and diseases of the brain and nervous system can affect the way a person feels, thinks, and behaves. Symptoms that may call for a neuropsychologist include:
- memory difficulties
- mood disturbances
- learning difficulties
- nervous system dysfunction
If other doctors can’t identify the cause of a symptom, a neuropsychologist can help determine a diagnosis. If a diagnosis is already known, an assessment can still be helpful.
A neuropsychologist can help determine what impairments you might have and how severe they are. The following are examples of conditions they evaluate and treat:
- A stroke can affect behavior, thinking, memory, and other brain functions in obvious or subtle ways. They can perform an evaluation to help determine the degree of stroke impairment.
- Parkinson’s disease, a progressive disorder, can cause several neurological problems. A neuropsychologist’s exam can provide a baseline to help them determine disease progression and decreased function.
- Alzheimer’s disease and other types of dementia can interfere with memory, personality, and cognitive abilities. A neuropsychologist can perform an exam to help them identify it in its early stage.
- Traumatic brain injuries can cause a wide variety of symptoms. A neuropsychologist can help determine how an injury affects functions like reasoning or problem-solving skills.
- A neuropsychologist can help determine which of the many types of learning disabilities someone has and develop a treatment plan.
The nervous system is complex. Neuropsychologists use different types of procedures to identify problems and treatment plans. Typical procedures they perform include:
This evaluation is an assessment of how your brain functions. The evaluation will include an interview and questions that will help outline your performance of daily tasks, as well as identify memory issues and mental health concerns. The interview will also cover information on symptoms, medical history, and medications you take.
An evaluation includes different types of standardized tests to measure many areas of brain function, including:
- cognitive ability
Brain scans, such as CT or MRI scans, can also help a neuropsychologist make a diagnosis.
Your neuropsychologist will compare your test results with those of other people with a similar education and age.
Evaluation and test results may help determine the cause of an issue when other methods don’t work. Tests can even help identify mild thinking and memory issues, which may be subtle.
Neuropsychologists help develop a treatment plan by understanding how the brain functions and how that functioning relates to behavior. Treatment plans may include medication, rehabilitation therapy, or surgery.
A neuropsychologist can help diagnose a cognitive, behavioral, or neurological condition. Seeing a neuropsychologist and completing their tests can lead to a deeper understanding of your condition. When other doctors might not be able to diagnose an issue, consider seeing a neuropsychologist.
Out of all of our senses — seeing, hearing, smelling, tasting, feeling — vision is our most dominant sense. Researchers estimate that 80-85 percent of our perception, learning, and cognition are mediated through our eyes. So dealing with vision issues after a brain injury can be challenging.
Common forms of vision problems
In general, 20-40 percent of people with traumatic brain injury (TBI) experience related vision disorders. Some vision-related issues can be permanent; others resolve quickly. This depends on the individual and his unique brain injury.
Vision can be broken down into the following general categories:
- Visual motor abilities, including alignment, refer to “eye posture” — meaning the direction in which the eyes point. For example, if the eyes are straight and aligned, the eye posture is normal.
- Visual perception is the ability to interpret information and surroundings from visible light reaching the eye.
- Visual acuity refers to clarity of sight.
- Visual field is the complete central and peripheral range, or panorama of vision; picture a pie as your visual field. Here are the common types of visual field loss:
- homonymous hemianopsia
- bitemporal hemianopsia
What happens with change or loss of vision?
When we can’t see clearly or have lost part of our field of vision, everyday tasks can become more challenging, some even impossible.You might have trouble with reading, driving, dealing with bright lights, or doing activities that involve hand-eye coordination. In many cases, there are tools and strategies that can help.
Techniques and compensatory strategies
In rehab, there are various techniques and strategies to help people with vision problems after TBI. They can include:
- Wearing prescription glasses
- Using magnification
- Implementing better or varying lighting for different environments
- Using assistive technologies to help make reading and using a computer easier
- Learning to use scanning and head turning
- Re-teaching the eyes to move and look into missing areas in the vision field
Getting the right professional help
Someone with vision problems after a TBI should find a top-notch ophthalmologist or neurologist who can administer a comprehensive vision exam. From there, the ophthalmologist may suggest the patient work with an interdisciplinary rehabilitation team to integrate all the necessary treatments for optimal recovery.
Having vision problems after a TBI can definitely interfere with a person’s quality of life, but it doesn’t have to be that way. Vision expert Dr. Gregory Goodrich advises, “Even if your symptoms don’t seem that serious, try to find an optometrist or ophthalmologist who has experience working with people with TBI. And keep persisting until you get the help you need.”
Posted on BrainLine June 21, 2017.
One of the biggest stressors that most brain injury survivors talk about is how relations between them and their circle of friends and family starts to show cracks. I have brought this up before in Breakdown of relationships after a brain injury and Advice for family of a recent TBI survivor. But there’s another important part that I want to take the time to address to try to help those cracks heal.
Previously I have explained how within a short period of time after my car accident, which caused my traumatic brain injury, my Dad was diagnosed with Alzheimer’s. As my Mum had sadly passed away just weeks after my accident, I needed to help Dad whilst he continued to try to live at home. Therefore, I was in the position of being the person who needed to be cared for, whilst supporting someone else who was also having cognitive difficulties. I hope you can see that I was in a position of getting a sense of what it’s like for a brain injury patient as well as the person who is trying to help them.
Forgive me; I warn you that you probably won’t like what I’m about to say.
Firstly, know that I am not shaming brain injury survivors for the issues that develop in their personal relationships. However, as Newton said in his third law of motion, “Every action has an equal and opposite reaction.” Now I know that’s about physics, but it can still relate to many parts of life. There are consequences for everything we do, and that includes how people feel as a result of our actions, even if we didn’t intend to affect them.
The sheer worry of what Dad was or wasn’t doing was turning me into a nervous wreck. I did my best not to show him, but then it meant it sometimes came out in frustration. I would be short with him and be overly blunt and direct with him about his errors. But he didn’t realise that I would worry 24/7, whether I was with him or not. “Out of sight, out of mind” didn’t come into it for me. That left me on the verge of panic every waking second (and there were a lot because I couldn’t sleep at all!).
I know that at the time, I didn’t appreciate how my partner James was going through the same thing with me.
There were several times that I fell down the stairs when James was at work. Thankfully my injuries were no worse than bruises and the odd strained muscle. But that meant he would be trying to hold down a stressful job whilst wondering what mayhem I was getting myself into. Thinking back, now I can identify times where I lacked the insight to see why my behaviour was so difficult to deal with, and I’m certain there’s 1000’s more that I just don’t remember at all.
The short of it is this: We don’t want to be a burden on our loved ones, but the truth is we have become an added strain on their lives. It’s nobodies fault, and I’m not suggesting that survivors can choose to behave differently. I know that many of us struggle to appreciate how the situation is affecting our loved ones because we just don’t have enough cognitive capacity left to see it.
They want to be acknowledged, but we just don’t see their needs or are unable to express it in the way they need.
If you’ve not seen what I mean by not being able to see their needs, or think that can’t apply to you I’ve got a different type of example that might hit the mark. If you’ve ever had a review with your manager that went worse than you were expecting, you’ll know want I’m talking about. I remember when I was trying to make my mark in my early twenties, and I worked hard every day. So, I would be perplexed when in a review, my manager would be able to pick out so many errors which I had thought were minor at the time. And then as they explained the knock-on effects of these “minor” errors, it would slowly dawn on me how important these events actually were. These meetings were horrible, and I would be annoyed at myself for not seeing the consequences first. If I’d been able to acknowledge the problem first, I could have doused the flames, thus reducing the dressing down I got.
Therefore, I understand that it’s hard to recognise something that you can’t see happening. But we know our family and friends are trying. We can admit that it’s not an ideal situation for anyone involved.
Just like it’s heart-warming when someone gives you a present just because “I saw this and thought of you”, random acts to remind those close to you that you appreciate them can go a long way.
Here are some suggestions that could help them feel acknowledged that don’t cost money:
- Send them an email just saying thank you for all they do. If you want to make it extra fancy, you could send them an ecard and customise it. Smilebox.com lets you do this for free and they have loads of templates that you can use to make it easy.
- Write a little message on a post-it note and leave it somewhere that they will come across later. The inside of the front door or the bathroom mirror are always a winner. Keep it simple, “I love you” tends to go down well.
- Get your local radio station to give them a shout out, so everyone knows what a star they really are.
- Post it on Facebook/Twitter/Instagram or whichever social network you like best, saying why you think so much of them.
Dad had an even simpler solution which was precisely what I needed.
There were times that I didn’t know how to continue when I was doing my best for Dad. I would cry saying to myself “I just can’t do any more than I do, even if it’s not enough.” But I did that only in private, so Dad never saw how close to the edge I was. Then it would be during a conversation with one of his life–long friends, or my sister in America that I would find that I did have the strength to continue… They would tell me how Dad always told them “Without Michelle I don’t know where I would be.” The honesty in that statement from a very proud man who was desperately trying to protect his independence was all I needed to know. The fact that he was telling others as well as me proved he wasn’t just trying to say the right thing.
Love is unconditional, but just like a parent needs to hear their child say thank you and know that their efforts to do the best for their children are recognised, the same goes for those who are trying to support us through a brain injury.
Nothing in this blog should be taken as providing medical advice or recommendations. Please always consult your doctor for medical advice and before taking any medication or supplement. Any opinions expressed in this article are of the author and not CFG Law Limited.
When you have a traumatic brain injury, knowing which foods you should eat and avoid becomes more very important.
Your body reacts to everything you put into your body so you want everything you eat to to have a positive impact on your brain. Each type of food comes with its particular nutrients and macro-nutrients, some that are beneficial for the brain and others that are bad overall.
In this article, you will discover the 10 best foods to eat for TBI recovery, particularly brain rich foods and others that encourage the healthy regeneration of your brain and boost your general well-being.
What Your Brain Needs
Before you learn the best foods, it’s important to understand the qualities that your brain needs to regenerate. When you suffer a TBI, your brain desperately needs energy and certain vitamins and minerals to help repair it effectively.
Therefore, your brain’s diet should consist of protein-rich foods and foods that are high in favorable vitamins and minerals like magnesium and zinc.
You also want to help protect your brain from further inflammation, free radicals, and you want to boost the communication between brain cells, which is achieved through powerful antioxidants.
And, of course, you want to avoid highly processed foods that generally don’t offer any of these necessary vitamins and minerals.
You’ll also want to avoid sugary drinks, fatty meat cuts such as lamb chops, alcohol, caffeine, and dairy products like cheese and cream. You’ll want to eat some of these very sparingly to get the best improvements.
With that in mind, you can essentially gauge the right foods for you, but here is a list to help get you started.
#1 Fatty Fish
Fish such as salmon, trout, and sardines are great for brain recovery because they are high in omega-3 fatty acids. Did you know that 60% of the brain is made up of fat?
Half of this comprises omega-3, so if fatty fish is the best source of both protein and fat for your brain. But that’s not all – omega-3 also preserves the brain’s plasticity, and since you, the TBI sufferer, needs to virtually rewire the brain, this is crucial. Another benefit of fish is that it is a great source of creatine, which also helps rebuilding brain cells.
According to Psychology Today, “Eating protein raises the levels of another amino acid called tyrosine, which prompts the brain to manufacture norepinephrine and dopamine… A healthy brain produces hundreds of neurotransmitters needed for regular maintenance of the brain and needs proteins to do so.” Meat is not only nutritious, it is protein dense as well Red meat, in particular, is an excellent source of zinc, which is another nutrient left heavily depleted after a brain injury.
Be sure not to eat too much red meat, though, as that itself can cause other issues. Incorporating some into your diet is ideal for brain improvement, though.
Other red meat alternatives include soybeans and legumes, such as beans and lentils.
#3 – Blueberries
Blueberries are powerful antioxidants and provide a range of health benefits, all positive for the brain. Some studies have even shown blueberries to help improve memory!
There are also other berries you can include in your diet, such as raspberries and blackberries, that also provide a similar effect.
#4 – Dark Chocolate
Yes, you can include some sweet into the diet with dark chocolate! The darker you can eat, the better. Dark chocolate has very high levels of magnesium and antioxidants, but even so, it should be eaten in moderation.
The more cocoa there is, the better it is for you, so always try and eat the darkest chocolate you can manage – at least 70% cocoa.
#5 – Turmeric
Recently, turmeric has exploded in popularity for its famed health effects. It may look familiar because it is one of the key ingredients in curry powder.
Curcumin, which is the active ingredient in turmeric, can cross the blood-brain barrier, therefore meaning it can directly enter the brain.
It is a powerful antioxidant and anti-inflammatory compound, and with its ability to enter the brain, it can provide an enormous range of benefits, including increased memory, promotion of brain cells, and reduced depression symptoms.
Turmeric can be purchased in supplement form or as a spice sprinkled on your food.
Eating nuts is excellent for your health, and each type of nut comes with its own benefits. But most offer healthy fats, vitamin E, and antioxidants that offer excellent brain-health benefits.
Walnuts, in particular, have omega-3 fatty acids, and almonds have high levels of magnesium, so both of these should be considered. In addition to ALA omege-3 fatty acid, walnuts are also one of the best sources for melatonin, the sleep regulating hormone. So if you suffer from insomnia, incorporating walnuts into a balanced diet, and exercise, might benefit you.https://www.youtube.com/embed/tO73SkzQ-C4?version=3&rel=1&fs=1&autohide=2&showsearch=0&showinfo=1&iv_load_policy=1&wmode=transparent
#7 – Oranges
Oranges are packed with vitamin C, and you can get your daily dose with just one medium orange. Did you know that vitamin C is a key factor in preventing mental conditions?
You can help boost your brain’s recovery while also protecting it against age-related mental diseases and conditions, such as Alzheimer’s disease.
Other vitamin C rich foods include kiwi, tomatoes, and guava.
#8- Dark Leafy Greens
“Make sure you eat your greens” – your parents were right. Eating your dark leafy greens is crucial to an optimal diet because they each contain a great source of fiber, folate, and carotenoids. Most importantly for TBI survivors, however, dark leafy greens are packed with magnesium which can help with TBI related side-effects such as tight muscles, insomnia, and anxiety.
Furthermore, they are rich in vitamins C and K, and the minerals calcium and iron. Many greens provide both an anti-inflammatory and antioxidant effect for your brain.
Dark leafy greens include kale, rocket, collards, bok choy, spinach, and broccoli is also another powerful vegetable for the brain.
Eggs are a must-have food for TBI sufferers because they contain a good source of choline. This is a nutrient that creates the neurotransmitter “acetylcholine,” which assists with both mood and memory.
When you have a higher choline intake, you have improved cognitive function. Try having eggs as a main part of your diet to boost your brain’s recovery process.
Avocadoes are a source of unsaturated fat. Since high blood pressure is linked with cognitive decline – two possible negative side effects of TBI – eating monounsaturated fats may help to reduce blood pressure, thus protecting against cognitive decline.
Other sources of healthy unsaturated fats include walnuts, cashews, and fish.
Herbal remedies also pose well for positive cognitive functioning, such as sage, chamomile, lemon balm, ginseng, and green tea remedies that have shown to lead to sharper thinking, boosted mood, and improved memory.
To Sum it up
It’s important to remember that everyone is different with their own likes and dislikes. Additionally, you could be allergic to one of the foods mentioned, which you would, of course, avoid in that case.
There are also some supplements that might be beneficial for you, such as multivitamins, probiotics, and antioxidant tablets like vitamins C and E.
Take your personal situation into account when incorporating these foods into your diet. Still, you can ultimately expect your brain to healthily improve over the days and weeks of your recovery with these 10 essential foods.