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[WEB SITE] The Truth About Electrical Brain Stimulation

Shocking your scalp using two wet sponges and electrodes is having a bit of a moment. The procedure, called transcranial direct current stimulation (tDCS), has been shown to help you learn math, improve your language skills, and even work out harder for longer. But scientists are split on whether tDCS can really do what it claims.

Some scientists are enthusiastic about the technology and say it has substantially fewer side effects than psychotropic medications. Numerous studies suggest it may improve our ability to learn pretty much anything, and there does seem to be evidence that a mild shock to the brain can help treat several psychiatric disorders.

Clinical trials are currently testing tDCS to treat a long list of disorders, including depression, pain, insomnia, Parkinson’s disease, schizophrenia, and addiction. A community of biohackers and self-experimenters has arisen in garages and online forums to build their own devices, or you can order a kit and test the technology on yourself.

But other researchers are more skeptical, doubting whether tDCS is as safe and effective as its champions claim. Despite promising lab results, none of the medical benefits have been verified by the FDA, and recent studies have called into question the technology’s ability to affect brain activity at all. Critics express concern about small study sizes and placebo effects, as well as the potential for side effects such as skin burns.

 https://vitals.lifehacker.com/video/3454137?utm_medium=sharefromsite&utm_source=Vitals

Jason Forte, a cognitive neuroscientist at the University of Melbourne, says he is particularly concerned about the potential dangers of using tDCS in the home. “There is risk of skin damage at the site of the electrode if the device is not used correctly. Poorly designed devices used in the wrong way could compromise heart function, although this has not been reported.”

Within the walls of academia, this debate is normal. A new drug or device arises every decade or so, exciting researchers and capturing the imagination of the public. Before it is released, scientists conduct hundreds of studies to figure out if the technique is safe, how best to administer it, and what it might be most useful for.

However, because of its relative safety and ease to build, tDCS has bypassed much of the usual review process and jumped from the lab to the living room. Private start-ups, such as The Brain Stimulator, TransCranial Technologies, and Halo Neuroscience, now sell DIY tDCS devices to curious self-experimenters and desperate patients. This shift has alarmed some researchers and regulatory experts, while others say they see no harm in sharing the technology.

How Brain Stimulation Works

With tDCS, the brain is zapped using a simple, consistent electrical current—typically 1 to 2 milliamps—for 20 to 30 minutes a day. The stimulation feels like a tingling or mild stinging at the site of the electrode. Neurons communicate through electrical and chemical signals. Scientists think the small amount of current neurons receive from tDCS makes them more likely to fire an electrical pulse, which results in a neurotransmitter being released into the brain.

tDCS is just one of several types of mild electrical brain stimulation. Other options include transcranial alternating current stimulation (tACS) and cranial electrotherapy stimulation (CES). In tACS, the keyword is “alternating.” In contrast to tDCS, the current in tACS constantly changes, oscillating between positive and negative. Scientists think that tACS works not by changing individual neurons, but by shifting the electrical frequency of the whole brain, which can optimize it for different states, like sleep or attention.

The current is also pulsed in a related technology, CES. Fisher Wallace, a company that sells CES devices, claims that the technology can increase neurochemical levels in the brain, including serotonin, but there is little evidence this is true. Of the three, it is the only device that is FDA-approved to treat depression, anxiety, and insomnia. But it was on the market before the FDA required proof of efficacy for class III medical devices, so it has not faced the same scrutiny that such devices face today.

tDCS has garnered more attention from researchers than the other types of brain stimulation, including ongoing clinical trials, and consequently more self-experimenters trying to mimic them.

Devices’ Claims Haven’t Been Thoroughly Tested

Michael Oxley was inspired to create his first brain stimulator device after reading a New Scientist article on tDCS in 2012. A mechanical engineer, he hoped that mildly shocking his brain would increase his energy levels and improve his concentration. Five years later, Oxley has sold tens of thousands of tDCS headsets through his company, foc.us, which claim to “enhance alertness, boost focus and increase capacity to learn” and even “help you run further and faster.”

 

However, Oxley admits foc.us’s devices have not undergone any formal outside testing or clinical trials, and instead base their statements on self-experimentation and the wider scientific literature.

These statements about cognitive and physical performance are allowed by the FDA because they do not make any medical assertions. But Anna Wexler, a biomedical ethicist at the University of Pennsylvania, says they can be regulated by the Federal Trade Commission.

“[The FTC has] taken action against a number of companies making cognitive enhancement claims, both in the supplement world but also in the brain training world, so they’ve shown a willingness to kind of get involved,” she says. “They have not taken any action against a tCDS company, but in practice, in principle they could.”

Oxley emphasized he does not advertise their product to treat any psychiatric conditions, not just for fear of FDA retaliation, but because he feels it would be irresponsible. However, in reviews for foc.us’s devices, several customers report using the product to treat their depression. Wexler’s research supports this; in an upcoming study, she reveals that a third of home users administer the technology to self-medicate for conditions like depression.

The Potential Benefits of tDCS

Marom Bikson, a professor of biomedical engineering at The City College of New York, says that on its own, tDCS doesn’t do very much. Its real value comes when it is combined with learning. He recommends using the technology before or during learning a new activity, like playing the piano.

Neurons that fire together, wire together. By increasing the likelihood that a neuron will fire, tDCS helps the brain to forge new connections while it learns, a process called plasticity. This ability to impact learning is why tDCS is marketed as having such a broad range of potential uses.

“When you apply direct current stimulation, you can change ongoing plasticity. Not generate plasticity, but change plasticity that’s already ongoing,” says Bikson. “The direct current stimulation can boost that plasticity, so basically making the learning more effective.”

Bikson says with this type of functional targeting, it doesn’t really matter where the sponges and electrodes are placed, because only the neurons undergoing plasticity will be affected by tDCS.

In contrast, for conditions like anxiety and depression, researchers aim to increase activity in a specific area of the brain, the dorsolateral prefrontal cortex, that is underactive in people with depression. Stimulating this area with daily tDCS brings the neurons’ activity back up to a normal level, which is thought to help boost people’s mood.

A large-scale trial published earlier this year showed that tDCS performed better than placebo in treating depression. These results imply that tDCS really can improve depression symptoms, but the study also showed it is not as effective as traditional medications like SSRIs.

What Could Go Wrong

Areas just a few millimeters apart can have very different functions. With tDCS, the sponges that go on the scalp span several centimeters, so it’s difficult to ensure you’re stimulating the right area. Some researchers have expressed concerns about off-target effects of tDCS, particularly when treating psychiatric disorders, which requires activation of a particular region. The brain is like real estate: it’s all about location, location, location. Off-target effects are especially a concern for DIY brain stimulators who may not have a background in neuroanatomy.

“You’re affecting large swaths of neurons that then have downstream effects in their relationship with other neuronal populations and networks, so where you place the electrodes is really critical,” says Tracy Vannorsdall, a neuropsychologist at Johns Hopkins University School of Medicine. “We know that very small changes in the electrode montage—where we’re placing them on the brain—can have significant different effects in terms of cognitive outcomes.”

Studies have shown that increasing function in one area of the brain can actually impair performance in a different area. Less dramatic but perhaps more pressing are reports of home users experiencing burns or skin damage at the site of the electrodes.

Another concern is that the technique may not do anything at all. Many studiesreport no effect either behaviorally or in terms of brain activity using tDCS. In perhaps the most unique test of the technology, scientists demonstrated that only 10 percent of the electrical current penetrated the skull of a cadaver to reach its brain. These findings suggest tDCS has far less of an impact on the brain than researchers originally hoped, and possibly not enough to make any meaningful difference in neurons’ behavior.

So, Should You Do It?

Interested in trying it yourself? Instead of putting down a couple hundred dollars for your own device, neuropsychologist Vannorsdall recommends joining one of the 700 tDCS clinical trials listed on clinicaltrials.gov, which recruit both patients and healthy people. “I think right now that it’s just too early for people to be experimenting on themselves,” she says.

But Bikson, the biomedical engineer, says self-experimentation may not be such a bad thing. Five years ago, his “knee-jerk reaction [as] the researcher in the academic ivory tower [was] this is my toy, don’t touch it.” But now his stance has softened. “I’m really really hesitant to tell someone who is really suffering or whose loved one is suffering to do or not do something,” he says. “I’m not going to endorse it, but I’m not going to condemn them. Obviously, many of us in the clinical and basic research communities believe these technologies can be effective.”[…]

via The Truth About Electrical Brain Stimulation

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[Abstract] Biomechatronics design of a robotic arm for rehabilitation – IEEE Conference Publication

Abstract

Rehabilitation is an important process to restore muscle strength and joint’s range of motion. This paper proposes a biomechatronic design of a robotic arm that is able to mimic the natural movement of the human shoulder, elbow and wrist joint. In a preliminary experiment, a subject was asked to perform four different arm movements using the developed robotic arm for a period of two weeks. The experimental results were recorded and can be plotted into graphical results using Matlab. Based on the results, the robotic arm shows encouraging effect by increasing the performance of rehabilitation process. This is proven when the result in degree value are accurate when being compared with the flexion of both shoulder and elbow joints. This project can give advantages on research if the input parameter needed in the flexion of elbow and wrist.

I. Introduction

According to the United Nations (UN), by 2030 the number of people over 60 years will increase by 56 per cent, from 901 million to more than 1.4 billion worldwide [1]. As the number of older persons is expected to grow, it is imperative that government and private health care providers prepare adequate and modern facilities that can provide quality services for the needs of older persons especially in rehabilitation centers. Implementation of robotic technology in rehabilitation process is a modern method and definitely can contribute in this policy and capable in promoting early recovery and motor learning [2]. Furthermore, systematic application of robotic technology can produce significant clinical results in motor recovery of post-traumatic central nervous system injury by assisting in physical exercise based on voluntary movement in rehabilitation [3].

via Biomechatronics design of a robotic arm for rehabilitation – IEEE Conference Publication

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[WEB SITE] Coping With Emotional Changes After Stroke for Families

Coping With Emotional Changes After Stroke-blog

As a stroke survivor, you can face major life changes. In the aftermath of a stroke, you may experience a sense of loss that is rooted in the feeling that you’ve lost the life you had before your stroke, or your independence. These strong emotional reactions take a toll.

It is normal to experience emotions ranging from frustration, anxiety, and depression to a sense of grief, or even guilt, anger, and denial after such a monumental change. Realizing that these emotions are normal, and that you are not alone in experiencing them, is an important step to acknowledging and coping with them in a healthy way. By doing this, you avoid becoming overwhelmed, thus avoiding further difficulties during your recovery.

Reasons for Emotional Changes After a Stroke

Young Man At Balcony In Depression Suffering Emotional Crisis And Grief

A stroke causes physical damage to your brain. Feeling or behaving differently after a stroke may be connected to the area of your brain that was damaged. If the area of your brain that controls personality or emotion is affected, you may be susceptible to changes in your emotional response or everyday behavior. Strokes may also cause emotional distress due to the suddenness of their occurrence. As with any traumatic life experience, it may take time for you to accept and adapt to the emotional trauma of having experienced a stroke.

Emotional Changes a Stroke Might Cause

PseudoBulbar Affect

crying

Sometimes referred to as “reflex crying,” “emotional lability,” or “labile mood,” Pseudobulbar Affect (PBA) is a symptom of damage to the area of the brain that controls expression of emotions. Characteristics of the disorder include rapid changes in mood, such as suddenly bursting into tears and stopping just as suddenly, or even beginning to laugh at inappropriate times.

Depression

depressed

If you are feeling sad, hopeless, or helpless after having suffered a stroke, you may be experiencing depression. Other symptoms of depression may include irritability or changes to your eating and sleeping habits. Talk to your doctor if you are experiencing any of these symptoms, as it may be necessary to treat with prescription antidepressants or therapy to avoid it becoming a road block to your recovery.

Anxiety

anxiety

Anxiety is quite common after a stroke. You may have feelings of uneasiness or fears about your health; this is normal and healthy. However, if your anxiety does not subside in time and you feel overwhelmed, you may be dealing with an anxiety disorder, which requires help from your doctor or a mental health professional.

Medical staff will perform an informal evaluation to check for anxiety while you are in the hospital. Often, this involves a quick discussion with hospital staff, during which they will ask you if you have any worries or fears about your health. This evaluation may also involve hospital staff asking your family members if they have noticed a change in your mood or behavior. It is important that you are kept in the loop about any issues that may present themselves, and that you are provided with as much information about your health and treatment options as possible.

Symptoms of anxiety to watch for may include irritability or trouble concentrating. You may also experience trouble sleeping due to your mind racing about your health. Sometimes, you can become tired easily, even if well rested.

Physical symptoms may also present themselves. These symptoms include a racing heart and restlessness and are often coupled with a sense of overwhelming worry or dread. If you find yourself avoiding your normal activities, such as grocery shopping, visiting friends, going for walks, or spending a large portion of your day dwelling on things you are worried about, you may have an anxiety disorder. Your doctor can recommend that you visit a psychologist to help cope with and eventually overcome anxiety.

Other Emotional Reactions

You may experience a range of other emotional reactions after a stroke, including anger and frustration. Additional symptoms may be a sense of apathy or a lack of motivation to accomplish things you typically enjoy.

Coping With Changing Emotions

Physician Ready To Examine Patient And Help

There are many ways to treat the emotional changes associated with a stroke. The first step is discussing how you feel, as well as any concerns you may have about your health with your doctor. One treatment option is counseling, which involves speaking about your distressing thoughts and feelings with a mental health professional or therapist. Simply talking about the way you are feeling can be helpful when coping with overwhelming emotions after experiencing a traumatic event such as a stroke.

Your doctor may also prescribe antidepressants or anti-anxiety medication to help you deal with the emotions involved with a stroke. While they are not a cure-all for emotional troubles, antidepressants change the levels of certain chemicals in your brain, alleviating the symptoms of depression and anxiety, lifting your mood, and making life feel more bearable while you’re recovering. It is important to stay in contact with your doctor if you decide to take medication, as it will not be effective for everyone and may have unpleasant side effects.

Seek Support or Professional Advice

A stroke can come on suddenly and have a monumental effect on your life. For this reason, it is common for many patients to struggle with emotional side effects following a stroke. You may suffer damage to the section of your brain that affects emotions, causing a change in personality or emotional expression known as Pseudobulbar Affect. You may also experience symptoms of anxiety or depression, along with feelings of anger, frustration, or uncharacteristic apathy.

It is important to discuss your emotional concerns with your doctor. You may need a prescription for antidepressants or anti-anxiety medication, or a recommendation to see a mental health professional who can help you form healthy coping mechanisms.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

via Coping With Emotional Changes After Stroke for Families

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[WEB SITE] How a Stroke In The Right brain Affects The Body & How to Recover | Saebo

Guide to Recovering From a Right Brain Stroke

Two is stronger than one, and your brain is no exception to the adage. What many people may not realize is that your brain consists of two distinct parts that work together as one, much like your eyes or ears.

Essentially, each side of the brain—left and right—is responsible for carrying out specific tasks. An easy way to understand this concept is to imagine a photograph of a loved one or friend. Immediately, the right side of your brain will see that it’s a person in a kind of setting (visual). But the left side of the brain will be the one to associate that person and place with a specific memory (analytical). You may have heard people say that they’re more “left-brained” or “right-brained”; they are identifying with the side of their brain, and its associated processes, that they feel is more dominant in their thinking. This symbiotic relationship is crucial to how everyone’s mind processes and stores information, so when either side of the brain is damaged by a stroke, there can be specific repercussions.

In most cases, a stroke occurs on one side of the brain. In this article, we examine the right brain in particular, its functions, and share what processes may be affected by a stroke.

What Does The Right Brain Control?

What Does The Right Brain Control?

When it comes to physical movement, the right side of the brain is responsible for carrying out functions for the left side of the body. The same is true for the opposite—the left side of the brain controls the right side of the body. Although we essentially live with crossed wires in our system, the same principles don’t necessarily apply when it comes to certain cognitive functions for each.

Specific duties performed by the right side consist of:

  • Spatial Reasoning
  • Musical Comprehension
  • Basic Object Recognition
  • Creative Abilities
  • Emotion
  • Imagination

Taking these things into consideration, it’s easy to see why any disruption to the right brain can be devastating. Unfortunately, a stroke can occur on either side of the brain depending on where the damage takes place. If you or a loved one has suffered from a right brain stroke, it’s important to be aware of what kinds of complications may arise.

Possible Effects Of Right Brain Stroke on Survivors

Suffering from a right brain stroke is certainly difficult to endure and overcome but, by increasing your awareness of what the potential side effects are, you can better prepare yourself for the road to recovery.

Potential Effects Of A Right Brain Stroke Consist Of:

  • Loss of Mobility and Control of the Left Side of the Body: Like what was mentioned above, damage to the right side of the brain can result in a loss of functionality in the left side of the body. This means that a stroke survivor can potentially lose the ability to move their left hand, arm, leg, foot, or left-side face muscles.
  • Unilateral Neglect: Mostly prominent in right-brain affected stroke patients, Unilateral Neglect (or Hemispatial Neglect) refers to an unawareness of objects to one side of the body or personal space. In severe cases, a side can be completely ignored when carrying out certain tasks and everyday functions.
  • Denial Syndrome or Anosognosia (Self-awareness): Due to various parts of the brain that remain unaffected after a stroke, stroke survivors will mentally believe that they are carrying out their physical functions in a normal fashion despite their actual inability to do so. These issues can also lead to a stroke survivor not wanting to undergo physical rehabilitation, which can put them at risk for further injury if left unresolved.
  • Emotional Indifference: A lack of emotion or change in emotional affect can be exhibited after a stroke, rendering the survivor to act as if nothing serious—physical or mental—needs to be addressed. This kind of indifference or unmotivated behavior can make initiation of or following through with the rehabilitation process difficult. Learn more about coping with emotional changes after stroke here.
  • Visual & Spatial Issues: Stroke survivors can experience a myriad of issues when it comes to visual and spatial comprehension. Primarily, a survivor will have trouble judging their location amid objects in their surroundings. This can manifest in difficulty feeding themselves, climbing up and down stairs, and changing clothes. Additionally, one may lose the ability to visually and mentally recall certain objects. A new rehab approach for retraining the brain in these areas is with the use of virtual reality. Learn how the SaeboVR can make recovery exercises fun!
  • Social Challenges: In many cases, a stroke survivor will have a difficult time recognizing certain social behaviors and cues. Things like body language, nonverbal communication, humor and sarcasm have the potential to go unnoticed.
  • Lack of Focus: One may not be able to give their full attention to a subject for extended periods of time. This inability can also surface if a stroke survivor is trying to follow directions, answer questions, or solve problems with basic reasoning practices (instinctual errors).
  • Loss of Hearing & Musicality: When considering the range of variables that make up one’s persona—emotions, actions, and mental processes—it’s important to realize that a person’s hearing and understanding is made of similar components. This means that a stroke survivor may have trouble picking up on certain sounds, which could result in miscommunication or an inability to appreciate the musicality of speech and tone altogether.

 

Treatments for Right Brain Stroke

Treatments for Right Brain Strokes

For any survivor to begin to see positive changes after a stroke, the rehabilitation process must start right away. Of course, the pathway to recuperation will be different for every individual, but the process that must always take effect in order to see results is something called neuroplasticity.

Neuroplasticity, in essence, refers to the regenerative properties of the brain—a re-establishment and rearrangement of neural connections. This means that the brain is essentially reprogramming itself in undamaged areas to support damaged ones, and the sooner this activity begins, the sooner one can recover.

Process of Dealing with Right Brain Stroke

To enhance this process, proper execution of rehabilitation exercises—both mental and physical—must be carried out on a regular basis. Over time, consistent and repetitive efforts will aid in constructing healthy neural connections, as well strengthening damaged ones.

In addition to consistency and repetition, there are rehabilitation exercise aids which can enhance the effectiveness of rehab exercises after stroke. These devices offer additional supports that allow the user to execute a wider range of exercises and adjust the difficulty for individualized results. For weakness in the arm or hand, the SaeboGloveSaeboFlexSaeboStretch, or SaeboMas can significantly increase the speed and effectiveness of rehabilitation.

Although the difficulties of life post-stroke can seem insurmountable, always remember that the brain and the heart are two of our most powerful organs. Given the right tools, patience, and support, you or a loved one can move forward on the path to recovery.

All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

more —>  How a Stroke In The Right brain Affects The Body & How to Recover | Saebo

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[ARTICLE] Classification of Traumatic Brain Injury for Targeted Therapies – Full Text

Abstract

The heterogeneity of traumatic brain injury (TBI) is considered one of the most significant barriers to finding effective therapeutic interventions. In October, 2007, the National Institute of Neurological Disorders and Stroke, with support from the Brain Injury Association of America, the Defense and Veterans Brain Injury Center, and the National Institute of Disability and Rehabilitation Research, convened a workshop to outline the steps needed to develop a reliable, efficient and valid classification system for TBI that could be used to link specific patterns of brain and neurovascular injury with appropriate therapeutic interventions. Currently, the Glasgow Coma Scale (GCS) is the primary selection criterion for inclusion in most TBI clinical trials. While the GCS is extremely useful in the clinical management and prognosis of TBI, it does not provide specific information about the pathophysiologic mechanisms which are responsible for neurological deficits and targeted by interventions. On the premise that brain injuries with similar pathoanatomic features are likely to share common pathophysiologic mechanisms, participants proposed that a new, multidimensional classification system should be developed for TBI clinical trials. It was agreed that preclinical models were vital in establishing pathophysiologic mechanisms relevant to specific pathoanatomic types of TBI and verifying that a given therapeutic approach improves outcome in these targeted TBI types. In a clinical trial, patients with the targeted pathoanatomic injury type would be selected using an initial diagnostic entry criterion, including their severity of injury. Coexisting brain injury types would be identified and multivariate prognostic modeling used for refinement of inclusion/exclusion criteria and patient stratification. Outcome assessment would utilize endpoints relevant to the targeted injury type. Advantages and disadvantages of currently available diagnostic, monitoring, and assessment tools were discussed. Recommendations were made for enhancing the utility of available or emerging tools in order to facilitate implementation of a pathoanatomic classification approach for clinical trials.

Introduction

Traumatic brain injury (TBI) remains a major cause of death and disability. Although much has been learned about the molecular and cellular mechanisms of TBI in the past 20 years, these advances have failed to translate into a successful clinical trial, and thus there has been no significant improvement in treatment. Among the numerous barriers to finding effective interventions to improve outcomes after TBI, the heterogeneity of the injury and identification and classification of patients most likely to benefit from the treatment are considered some of the most significant challenges (Doppenberg et al., 2004; Marshall, 2000; Narayan et al., 2002).

The type of classification one develops depends on the available data and the purpose of the classification system. An etiological classification describes the factors to change in order to prevent the condition. A symptom classificationdescribes the clinical manifestation of the problem to be solved. A prognostic classification describes the factors associated with outcome, and a pathoanatomic classification describes the abnormality to be targeted by the treatment. Most diseases were originally classified on the basis of the clinical picture using a symptom-based classification system. Beginning in the 18th century, autopsies became more routine, and an increasing number of disease conditions were classified by their pathoanatomic lesions. With improvement of diagnostic tools, modern disease classification in most fields of medicine uses a mixture of anatomically, physiologically, metabolically, immunologically, and genetically defined parameters.

Currently, the primary selection criterion for inclusion in a TBI clinical trial is the Glasgow Coma Scale (GCS), a clinical scale that assesses the level of consciousness after TBI. Patients are typically divided into the broad categories of mild, moderate, and severe injury. While the GCS has proved to be extremely useful in the clinical management and prognosis of TBI, it does not provide specific information about the pathophysiologic mechanisms responsible for the neurological deficits. This is clearly demonstrated in Figure 1, in which all six patients are classified as having a severe TBI. Given the heterogeneity of the pathoanatomic features depicted in these computed tomography (CT) scans, it is difficult to see how a therapy targeted simply for severe TBI could effectively treat all of these different types of injury. Many tools such as CT scans and magnetic resonance imaging (MRI) already exist to help differentiate the multiple types of brain injury and variety of host factors and other confounders that might influence the yield of clinical trials. In addition, newer advances in neuroimaging, biomarkers, and bioinformatics may increase the effectiveness of clinical trials by helping to classify patients into groups most likely to benefit from specific treatments.

 

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Heterogeneity of severe traumatic brain injury (TBI). Computed tomography (CT) scans of six different patients with severe TBI, defined as a Glasgow Coma Scale score of <8, highlighting the significant heterogeneity of pathological findings. CT scans represent patients with epidural hematomas (EDH), contusions and parenchymal hematomas (Contusion/Hematoma), diffuse axonal injury (DAI), subdural hematoma (SDH), subarachnoid hemorrhage and intraventricular hemorrhage (SAH/IVH), and diffuse brain swelling (Diffuse Swelling).

Continue —>  Classification of Traumatic Brain Injury for Targeted Therapies

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[WEB SITE] Dopamine deficiency: Symptoms, causes, and treatment

    1. Symptoms
    2. Causes
    3. Diagnosis
    4. Treatment
    5. Dopamine vs. serotonin
    6. Outlook

 

 

Dopamine is a chemical found naturally in the human body. It is a neurotransmitter, meaning it sends signals from the body to the brain.

Dopamine plays a part in controlling the movements a person makes, as well as their emotional responses. The right balance of dopamine is vital for both physical and mental wellbeing.

Vital brain functions that affect mood, sleep, memory, learning, concentration, and motor control are influenced by the levels of dopamine in a person’s body. A dopamine deficiency may be related to certain medical conditions, including depression and Parkinson’s disease.

A dopamine deficiency can be due to a drop in the amount of dopamine made by the body or a problem with the receptors in the brain.

Symptoms

 

Sad and depressed woman with low dopamine levels. alone in thought.

A dopamine deficiency is associated with depression, but researchers are still investigating this complex link.

 

The symptoms of a dopamine deficiency depend on the underlying cause. For example, a person with Parkinson’s disease will experience very different symptoms from someone with low dopamine levels due to drug use.

Some signs and symptoms of conditions related to a dopamine deficiency include:

  • muscle cramps, spasms, or tremors
  • aches and pains
  • stiffness in the muscles
  • loss of balance
  • constipation
  • difficulty eating and swallowing
  • weight loss or weight gain
  • gastroesophageal reflux disease (GERD)
  • frequent pneumonia
  • trouble sleeping or disturbed sleep
  • low energy
  • an inability to focus
  • moving or speaking more slowly than usual
  • feeling fatigued
  • feeling demotivated
  • feeling inexplicably sad or tearful
  • mood swings
  • feeling hopeless
  • having low self-esteem
  • feeling guilt-ridden
  • feeling anxious
  • suicidal thoughts or thoughts of self-harm
  • low sex drive
  • hallucinations
  • delusions
  • lack of insight or self-awareness

Causes

 

Dopamine model 3D render.

 Dopamine deficiency may be influenced by a number of factors. Existing conditions, drug abuse, and an unhealthy diet may all be factors.

 

Low dopamine is linked to numerous mental health disorders but does not directly cause these conditions.

The most common conditions linked to a dopamine deficiency include:

In Parkinson’s disease, there is a loss of the nerve cells in a specific part of the brain and loss of dopamine in the same area.

It is also thought that drug abuse can affect dopamine levels. Studies have shown that repeated drug use could alter the thresholds required for dopamine cell activation and signaling.

Damage caused by drug abuse means these thresholds are higher and therefore it is more difficult for a person to experience the positive effects of dopamine. Drug abusers have also been shown to have significant decreases in dopamine D2 receptors and dopamine release.

Diets high in sugar and saturated fats can suppress dopamine, and a lack of protein in a person’s diet could mean they do not have enough l-tyrosine, which is an amino acid that helps to build dopamine in the body.

Some studies have found that people who are obese are more likely to be dopamine deficient too.

Diagnosis

There is no reliable way to measure levels of dopamine in a person. However, a doctor may look at a person’s symptoms, lifestyle factors, and medical history to determine if they have a condition related to low levels of dopamine.

Treatment

 

Omega-3 fatty acid supplements.

Omega-3 fatty acid supplements may help to boost dopamine levels naturally.

 

 Treatment of dopamine deficiency depends on whether an underlying cause can be found.

If a person is diagnosed with a mental health condition, such as depression or schizophrenia, a doctor may prescribe medications to help with the symptoms. These drugs may include anti-depressants and mood stabilizers.

Ropinirole and pramipexole can boost dopamine levels and are often prescribed to treat Parkinson’s disease. Levodopa is usually prescribed when Parkinson’s is first diagnosed.

Other treatments for a dopamine deficiency may include:

  • counseling
  • changes in diet and lifestyle
  • physical therapy for muscle stiffness and movement problems

Supplements to boost levels of vitamin Dmagnesium, and omega-3 essential fatty acids may also help to raise dopamine levels, but there needs to be more research into whether this is effective.

Activities that make a person feel happy and relaxed are also thought to increase dopamine levels. These may include exercise, therapeutic massage, and meditation.

Dopamine vs. serotonin

Dopamine and serotonin are both naturally occurring chemicals in the body that have roles in a person’s mood and wellbeing.

Serotonin influences a person’s mood and emotions, as well as sleep patterns, appetite, body temperature, and hormonal activity, such as the menstrual cycle.

Some researchers believe that low levels of serotonin contribute to depression. The relationship between serotonin and depression and other mood disorders is complex and unlikely to be caused by a serotonin imbalance alone.

Additionally, dopamine affects how a person’s moves, but there is no clear link to the role of serotonin in movement.

Outlook

Dopamine deficiency can have a significant impact on a person’s quality of life, affecting them both physically and mentally. Many mental health disorders are linked to low levels of dopamine. Other medical conditions, including Parkinson’s disease, have also been linked to low dopamine.

There is limited evidence that diet and lifestyle can affect the levels of dopamine a person creates and transmits in their body. Certain medications and some therapies may help relieve symptoms, but a person should always speak to a doctor first if they are concerned about their dopamine levels.

 

via Dopamine deficiency: Symptoms, causes, and treatment

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[Abstract] Hand strengthening exercises in chronic stroke patients: Dose-response evaluation using electromyography

Abstract

STUDY DESIGN: Cross-sectional.

PURPOSE OF THE STUDY: This study evaluates finger flexion and extension strengthening exercises using elastic resistance in chronic stroke patients.

METHODS: Eighteen stroke patients (mean age: 56.8 ± 7.6 years) with hemiparesis performed 3 consecutive repetitions of finger flexion and extension, using 3 different elastic resistance levels (easy, moderate, and hard). Surface electromyography was recorded from the flexor digitorum superficialis (FDS) and extensor digitorum (ED) muscles and normalized to the maximal electromyography of the non-paretic arm.

RESULTS: Maximal grip strength was 39.2 (standard deviation: 12.5) and 7.8 kg (standard deviation: 9.4) in the nonparetic and paretic hand, respectively. For the paretic hand, muscle activity was higher during finger flexion exercise than during finger extension exercise for both ED (30% [95% confidence interval {CI}: 19-40] vs 15% [95% CI: 5-25] and FDS (37% [95% CI: 27-48] vs 24% [95% CI: 13-35]). For the musculature of both the FDS and ED, no dose-response association was observed for resistance and muscle activity during the flexion exercise (P > .05).

CONCLUSION: The finger flexion exercise showed higher muscle activity in both the flexor and extensor musculature of the forearm than the finger extension exercise. Furthermore, greater resistance did not result in higher muscle activity during the finger flexion exercise. The present results suggest that the finger flexion exercise should be the preferred strengthening exercise to achieve high levels of muscle activity in both flexor and extensor forearm muscles in chronic stroke patients. The finger extension exercise may be performed with emphasis on improving neuromuscular control.

LEVEL OF EVIDENCE: 4b.

via Hand strengthening exercises in chronic stroke patients: Dose-response evaluation using electromyography. – PubMed – NCBI

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[ARTICLE] Soft robotic devices for hand rehabilitation and assistance: a narrative review – Full Text

Abstract

Introduction

The debilitating effects on hand function from a number of a neurologic disorders has given rise to the development of rehabilitative robotic devices aimed at restoring hand function in these patients. To combat the shortcomings of previous traditional robotics, soft robotics are rapidly emerging as an alternative due to their inherent safety, less complex designs, and increased potential for portability and efficacy. While several groups have begun designing devices, there are few devices that have progressed enough to provide clinical evidence of their design’s therapeutic abilities. Therefore, a global review of devices that have been previously attempted could facilitate the development of new and improved devices in the next step towards obtaining clinical proof of the rehabilitative effects of soft robotics in hand dysfunction.

Methods

A literature search was performed in SportDiscus, Pubmed, Scopus, and Web of Science for articles related to the design of soft robotic devices for hand rehabilitation. A framework of the key design elements of the devices was developed to ease the comparison of the various approaches to building them. This framework includes an analysis of the trends in portability, safety features, user intent detection methods, actuation systems, total DOF, number of independent actuators, device weight, evaluation metrics, and modes of rehabilitation.

Results

In this study, a total of 62 articles representing 44 unique devices were identified and summarized according to the framework we developed to compare different design aspects. By far, the most common type of device was that which used a pneumatic actuator to guide finger flexion/extension. However, the remainder of our framework elements yielded more heterogeneous results. Consequently, those results are summarized and the advantages and disadvantages of many design choices as well as their rationales were highlighted.

Conclusion

The past 3 years has seen a rapid increase in the development of soft robotic devices for hand rehabilitative applications. These mostly preclinical research prototypes display a wide range of technical solutions which have been highlighted in the framework developed in this analysis. More work needs to be done in actuator design, safety, and implementation in order for these devices to progress to clinical trials. It is our goal that this review will guide future developers through the various design considerations in order to develop better devices for patients with hand impairments.

Background

Imagine tying your shoes or putting on a pair of pants while having limited use of your hands. Now imagine the impact on your daily life if that limitation was permanent. The ability to perform activities of daily living (ADL) is highly dependent on hand function, leaving those suffering with hand impairments less capable of executing ADLs and with a reduced quality of life. Unfortunately, the hand is often the last part of the body to receive rehabilitation.

According to a 2015 National Health Interview Survey, there were approximately 4.7 million adults in the United States that found it “Very difficult to or cannot grasp or handle small objects” [1]. Hand impairments are commonly observed in neurological and musculoskeletal diseases such as arthritis, Cerebral Palsy, Parkinson’s Disease, and stroke. A summary of motor impairment prevalence associated with these diseases may be seen in Table 1. Fortunately, physical rehabilitation has been shown to promote motor recovery through repetitive isolated movements [2345]. This is largely due to neuroplasticity – the ability for the brain to reorganize itself by establishing new neural connections. Occupational and physical therapists thus attempt to take advantage of neuroplasticity in order to re-map motor function in the brain through repeated exercise. Currently, however, there is no consensus on the best mode and dosing to facilitate neuroplasticity [6]. Additionally, recovery success relies heavily on a patient’s ability to attend therapy, which can be deterred by the frequency, duration, or cost of the therapy. Robotic devices could enhance access to repeated exercise. As such, they have been developed and investigated for their utilization as an adjunctive therapy to improve patient access, compliance and subsequent outcomes of rehabilitation efforts. An overview of the designs with comparisons between the different approaches will help future development of these tools.[…]

Continue —> Soft robotic devices for hand rehabilitation and assistance: a narrative review | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 5Methods of detection along motor pathway [81]

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[Abstract] Interventions for Improving Upper Limb Function after Stroke – Cochrane Database Syst Rev.

Abstract

Impairment of the upper limbs is quite frequent after stroke, making rehabilitation an essential step towards clinical recovery and patient empowerment. This review aimed to synthetize existing evidence regarding interventions for upper limb function improvement after Stroke and to assess which would bring some benefit. The Cochrane Database of Systematic Reviews, the Database of Reviews of Effects and PROSPERO databases were searched until June 2013 and 40 reviews have been included, covering 503 studies, 18 078 participants and 18 interventions, as well asdifferent doses and settings of interventions. The main results were:

  1. Information currently available is insufficient to assess effectiveness of each intervention and to enable comparison of interventions;
  2. Transcranial direct current stimulation brings no benefit for outcomes of activities of daily living;
  3. Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy, mental practice, mirror therapy, interventions for sensory impairment, virtual reality and repetitive task practice;
  4. Unilateral arm training may be more effective than bilateral arm training;
  5. Moderate-quality evidence showed a beneficial effect of robotics on measures of impairment and ADLs;
  6. There is no evidence of benefit or harm for technics such as repetitive transcranial magnetic stimulation, music therapy, pharmacological interventions, electrical stimulation and other therapies.

Currently available evidence is insufficient and of low quality, not supporting clear clinical decisions. High-quality studies are still needed.

 

via [Analysis of the Cochrane Review: Interventions for Improving Upper Limb Function after Stroke. Cochrane Database Syst Rev. 2014,11:CD010820]. – PubMed – NCBI

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[BOOK] Emerging Therapies in Neurorehabilitation II – [Chapter] Virtual Rehabilitation – Request PDF

Abstract

This chapter addresses the current state of the art of virtual rehabilitation by summarizing recent research results that focus on the assessment and remediation of motor impairments using virtual rehabilitation technology. Moreover, strengths and weaknesses of the virtual rehabilitation approach and its technical and clinical implications will be discussed. This overview is an update and extension of a previous virtual rehabilitation chapter with a similar focus. Despite tremendous advancements in virtual reality hardware in the past few years, clinical evidence for the efficacy of virtual rehabilitation methods is still sparse. All recent meta-analyses agree that the potential of virtual reality systems for motor rehabilitation in stroke and traumatic brain injury populations is evident, but that larger clinical trials are needed that address the contribution of individual aspects of virtual rehabilitation systems on different patient populations in acute and chronic stages of neurorehabilitation.

Virtual Rehabilitation | Request PDF. Available from: https://www.researchgate.net/publication/300324828_Virtual_Rehabilitation

via Virtual Rehabilitation | Request PDF

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