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[ARTICLE] Preliminary Analysis of Perception, Knowledge and Attitude of Home Health Patients Using Tele Rehabilitation in Riyadh, Saudi Arabia – Full Text

ABSTRACT

Telerehabilitation is defined as delivery of rehabilitation services over telecommunication networks and the internet, which comprise of clinical assessment (the patient’s functional abilities in his or her environment) and clinical therapy.This new area  of medical advancement, using state of the art technology is developing at a great speed and is  definitely going to be the next milestone in health care revolution.The objective of this study was to explore the awareness, knowledge and perception of the patients for using telerehabilitation as a medium to provide physiotherapy services as a part of home healthcare services.  A pretest-post test design was used where the home healthcare patients (n = 90) aged between 50 -75 years were asked to express views by given a validated modified TUQ questionnaire followed by an indepth interviewing to develop a key understanding regarding the themes. Interviews were transcribed and a qualitative thematic analysis was conducted. The awareness level regarding the  telerehabilitation changed significantly from 57% to 96% post session(p<0.05). Similarly, the knowledge of the participants regarding  online consultation, followup and online therapy  changed significantly from 50%, 47% and 57% to 96%, 76% and 96% respectively post session of rehabilitation(p<0.05). The perception level regarding the key benefits including  its usage in emergency(83%), convenience of no travel(84%), ease of getting treated at home(97%) and  availability of specialist consultation (84%) were the prime ideas for excellent rating among 95% participants (p<0.05) post session. Findings are helpful to health practitioners in designing their intervention programs across the kingdom. However the actual impact could be only derived from future studies which has to conducted based on different clinical conditions.

Introduction

Telerehabilitation is defined as the provision and delivery of rehabilitation health services at a distance using information and communication technologies and tools (Tan 2005; Russell 2007). Throughout the world, the health care practices is going through major transformation as it is driven through sea change because of the increased use of technology. The kingdom of Saudi Arabia too is witnessing a massive change with significant restructuring of healthcare systems with some major high-end technology driven development solutions. The increased demand is created on account of rapidly increasing saudi population including the growing elderly community, changing disease patterns, global climatic changes and financial inequity (Mahmood 2018).  According to a United nations report the elderly population of Saudi Arabia  those aged 60 and above is projected to increase from 3% in 2010 to 9.5% and 18.4% in 2035 and 2050, respectively (UN Report, 2018).

Similarly, comparing this phenomenon to an average life expectancy of the population in Saudi Arabia, the latest WHO data published in 2018, suggests that Saudi male and female have an average of 73.5 and female 76.5 life years with an average life expectancy of 74.8 years as against an average world life expectancy of 84 years.The increased demand in kingdom also raised because of immense economic pressure with steep fall in global oil prices in 2015-16 affecting the GDP significantly thereby been one of the key stimulus for the government to take timely corrective actions and diversify the economy from heavily oil dependent to develop other verticals for revenue generation (MoH Report, 2018).

Brian child of Crown Prince HH Mohammad Bin Salman, Vision 2030 was adopted in April 2016 and has identified its priorities across all economic sectors and serves as a roadmap for the economic development of the KSA with development of health services been one of the most important key themes. Therefore, as a part of realization of this vision the government strongly supports the partnership of private and public sectors and been seen as a strong indication of the Government’s commitment for making healthcare accessible to its citizens irrespective of the disparities available in the Saudi society (Vision 2030 Report, 2016). Access to healthcare generally relates to people’s ability to use health services when and where they are needed. Determinants of healthcare access are the types and quality of services, including the costs, time, distance (ease of travel) as well as regular interface between service users and healthcare providers. Saudi Arabia is the largest and fastest growing health care market in the region and is estimated to reach $40 billion by 2020 (NTP 2020 Report, 2016).

Moreover, the steep increase in the number of hospitals across all major cities of KSA are run by both government and private organizations which use  corporate business strategies and technology driven specializations, which aim to create demand as well as attract high number patients as the facilities in majority of these hospitals are world class.Among the various strategies listed in the NTP Report 2020, one of the key components of making healthcare accessible across the kingdom is the enhanced use of telemedicine (NTP 2020 Report, 2016). In the last one decade the health services across the kingdom have taken gigantic leap jumps with private healthcare taking lead and using innovations in delivering healthcare. One of such innovations is using Home Healthcare for delivering physiotherapy and other rehabilitation based services for the patients at home (Pulse Report 2018).

Rehabilitation is a very important component in medical care and helps in propelling patient to preinjury level. It is a well known fact that in all long term cases which requires follow-ups such as in surgical cases and other debilitating disorders including Stroke, Cancer, Multiple Sclerosios, rehabilitation is time consuming and financially constraining. To add to this, patients travelling long distances for treatment, it is not only physically challenging but emotionally draining too and especially in case of geriatric patients.Therefore home tele rehabilitation programs, are winding up progressively as an elective method of service delivery. In the western countries, quite a number of research studies has been proved that the Telerehabilitation for the delivery of health services is quite effective, however the scope of using such services in the kingdom is still novice and requires a detailed study, (Hailey et al., 2010, Johansson and Wild 2011, Chang et al 2019     ).

There are scant studies to prove its efficacy in the developing countries as its successful will depends on a number of factors (Clemens et al 2018) . However, among all the variables, the two most important are the technological component and second been its implementation in real terms (Jackson and McClean 2012, Clemens et al 2018). Accordingly, these both are of extreme critical importance from the patient satisfaction point of view. The perceptions of the stakeholders, i.e. the patient and the members of the Rehabilitation team are of utmost importance for its use and wide spread application.The home healthcare services in Saudi Arabia is still in infancy stages with few delivery partners across the kingdom. The usage of telerehabilitation is even more nascent, as the perception of patients in using such a technology for delivering healthcare would be quite critical and important to understand the phenomenon which would be quite useful in framing the guidelines for its applications at a mass level, (Alaboudi et al 2016).

Therefore, this study is an attempt to study the awareness, knowledge and perceptions of  the home healthcare patients in using physiotherapy services delivered via cloud based telerehabilitation. This study, to our knowledge is the first of its kind in the kingdom especially from the perspective of home healthcare patients. It aims to explore the key ideas which might work in favour or against the successful implementation of telerehabilitation used for the home healthcare delivery.

Materials and Methods

The pretest-post test study design was conducted on home healthcare patients so as to obtain an in-depth understanding of the patients’ perception about telerehabilitation services which they will receive as a part of home health services. While a few studies  conducted earlier emphasized about telemedicine to be a key part in delivery of health services, however none of the studies emphasized on perception of patients to implement telerehabilitation as part of home healthcare (Clemens et al 2018, Khalil et al 2018).

Due necessary approval were taken from the ethical clearance committee of the respective organization, which is a reputed home healthcare organization based in Riyadh. In order to recruit participants for the study, sample population were selected from a pool of home healthcare patients who were undergoing treatment under one of the most prominent home healthcare organizations in the kingdom, which incidentally was the only first licensed stand-alone home healthcare services company in Riyadh province.

The study was conducted from Jan 15 to May 30, 2019. In this context, non-probability sampling method was used. Out of 113 home healthcare patients who underwent treatment for different ailments, 90 were randomly selected who also gave their consent to participate in the study out of which 57 were males and 33 were females. Those patients who suffered from orthopedic problems such as Knee pain, low back ache, disc prolapse etc. or underwent orthopedic surgeries such as knee replacement or meniscectomy etc. participated in the study. The study mainly included common geriatric patients for the study who were willing to participate but excluded the pediatric and the critical care, neurological and cardiac patients as they underwent major surgeries such as for stroke or CABG and also were unable to respond directly to answer the questions. The patients who were able respond in English or Arabic were recruited for the study.

Based on literature review and discussion with key stakeholders, a questionnaire and an the interview guide was prepared, modified from Telehealth Usability Questionnaire (TUQ) based on key themes of perceived usefulness, ease of use and learnability,  Interaction quality, Reliability and Satisfaction and future use (Langbecker et al 2017) . The questionnaire was converted to Arabic version adapted from the original English version and pilot tested for the home healthcare patients using both forward and backward translation methods and achieved very acceptable score of confirmatory factor analysis of 0.78 using SPSS. It was also pilot tested   for the members of the rehabilitation team. The questionnaires as given in Appendix 1 were responded by the patients and the members of the rehabilitation team followed by a semi structured individual interview from the patient as well as from the team members involved in providing home health services. The interviews were audio recorded and transcribed verbatim using Text Analysis Markup System (TAMS) Analyzer as suggested by Yin (Yin 2013).

The Tele-rehabilitation Technological solutions were a part of home health services which were delivered by the company. As a part of cloud based HIPAA compliant network, the telemedicine unit consists of a portal to track health metrics and rehabilitation treatment plan and progress by the PT specialists as well as the Case Managers. The system included case briefing, consultation by specialists as well as providing physiotherapy sessions both by Home health therapists or via health workers such as PTAs within the vicinity of home environment at patient’s ease as schematically represented in Fig. no.1.

Figure 1: Set-up for in-home telerehabilitation: (A) Framework system; (B) dashboard Screen (C) Integrated loop with benefits

The participants were given a pre and post session modified TUQ and asked to reflect on their entire rehabilitation experience using the Telerehabilitation platform so as to get relevant information about telemedicine services including key events such as finding out they would receive services at home by videoconference, having the internet and videoconferencing equipment installed at home and receiving services by videoconference including dealing with technical issues. Following the same detailed interview was taken using the TAMS so as to identify key ideas which can affect usage of telerehabilitation. . Statistical tests was conducted  using SPSS for Pre-post differences evaluation. using paired  t-tests to assess factors associated with awareness, knowledge and perception. Significance was set a priori at p < 0.05. […]

Continue —> Preliminary Analysis of Perception, Knowledge and Attitude of Home Health Patients Using Tele Rehabilitation in Riyadh, Saudi Arabia

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[f/b Post] HOW DO I EXPLAIN WHAT I FEEL?

By Monti Skiby. 9/9/2019

Η εικόνα ίσως περιέχει: ένα ή περισσότερα άτομα και κείμενο

Disappointment is difficult to to face. We have pre-conceived ideas of how someone or something is going to happen. There can be expectations in order to receive acceptance. We see it in children who receive a low test score. Others who can not hit a home run or make every basket they try. Valentine’s Day may come and go and no one remembers. It happens all the time in various situations. Throughout our entire life we are disappointed and we disappoint others. Not with the intent of disappointing but trying to meet someone elses expectation (s). Searching for acceptance and meeting expectations from others often develops into “part” of our identy.

When a person survives a brain injury it is common to have a loss of identy.

Many of us are no longer able to work or be the wife, husband, mom, dad, aunt, uncle, sister, brother… we once were. Some can not provide for their family any longer or fill the position as they once did as a mother, father, grandparent, aunt/uncle or have a position of making decisions for the family. Each one of the things I mentioned is a loss of a purpose we once had. Our purpose needs to be re-identified.

We are taught from a very young,”what do you want to be when you grow up”? A police officer, a fire fighter, a teacher, a lawyer, a mommy, a daddy…. determining our worth and identity by the job or position in the family we have. Is is “WHAT” we are. Never do we ask children “WHO” do you want to be? Compassionate, peaceful, spiritual, loving, gentle, hateful, angry…. Being identified by a job or position in the family is external to who you are. Not the characteristics which have developed inside within you.

“WHO” you are involves your character as a person. It comes from traits you develop as your inner self. A reflection of your emotions, mental state, spirituality, feelings towards others, feelings toward yourself, ability to think of someone other than yourself. When we loose the identity society has identified by “WHAT” we are we feel like a failure.

Same happens when a person survives a brain injury, “you just got fired from your life”. No longer able to work, be a husband or wife, etc … I’m sure you get the point. How do we feel? Like a failure. Unable to do what was once the roles we played. The hats we wore as teacher and mother/father and aunt/uncle, brother/sister. Now we need to depend on others, not being totally independent any more, and not be able to think as we once did. It takes longer to process thoughts, answers or even to understand what was said.

The rug has been pulled right out from under us. Having to look at “WHO” we are for the first time in our life. Learning to identify characteristics within you is Hell. Territory not travelled before. We believe; we have lost the position of being equal, we no longer are able to provide for others as we once did, we think we have or are losing everything we had.

All of these things can not be seen but only felt. Feeling worthless comes easy. Explaining it to someone does not.

Do not abandon us. Do not treat us as if we are at fault. We are not stupid. We have a brain injury which will heal for the rest of our life. We have not changed as a person. We now have limitations.

Having someone who cares about you is very difficult to find. Many people leave because they do not understand, don’t want to understand, want “WHAT” you were before, they can not find the love and acceptance to see the light at the end of the tunnel.

Expectations have to be eliminated. There is no room for pre-conceived notions of what must be done for acceptance. There never should have been expections in the first place.

I was a swim coach for a young group of kids years ago. 1st rule for parents was there would be no negative comments made to child (ren).

2. Parents were not allowed on deck. Even at swim meets. They sit in the bleachers (as long as no negative remarks).

3. If they persisted in negative remarks they were not allowed at the practices or meets.

There were 6 yr olds who had to be taught to swim. There was a 9 yr old who was deaf. There were young teens who believed they could do nothing right. I loved this group of kids.

The kids were taught not to compare times with other kids at meets but to focus on how their times improved from the last meet. Smiles came from shaving off 2 seconds, 5 seconds and even 12 seconds. The teen who said she could not do or accomplish anything shaved off seconds every meet and she smiles as the seconds came off. If the kids swam in 3 meets they received a metal from me for good attendance & doing the best they could do. If they swam in 6 meets another metal for attendance & doing the best they could. Same for 9 meets. The 12 kids succeeded no matter what. They learned self respect, responsibility of following through and setting goals. 9 of the 12 went to go to the State Meet because of their times and achievements.

We are the same person. Our personality and abilities have changed. The person is the same. Loving someone enough to help them heal is a genuine love. This is for ourself, friends and family.

Hope this helps. God has kept you alive for a reason. Love you. By Monti Skiby.

 

Η εικόνα ίσως περιέχει: ένα ή περισσότερα άτομα και κείμενο

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[VIDEO] Cognitive and Psychological Consequences of Traumatic Brain Injury (TBI) – YouTube

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[ARTICLE] Levetiracetam and brivaracetam: a review of evidence from clinical trials and clinical experience – Full Text

Until the early 1990s, a limited number of antiepileptic drugs (AEDs) were available. Since then, a large variety of new AEDs have been developed and introduced, several of them offering new modes of action. One of these new AED families is described and reviewed in this article. Levetiracetam (LEV) and brivaracetam (BRV) are pyrrolidone derivate compounds binding at the presynaptic SV2A receptor site and are thus representative of AEDs with a unique mode of action. LEV was extensively investigated in randomized controlled trials and has a very promising efficacy both in focal and generalized epilepsies. Its pharmacokinetic profile is favorable and LEV does not undergo clinically relevant interactions. Adverse reactions comprise mainly asthenia, somnolence, and behavioral symptoms. It has now been established as a first-line antiepileptic drug. BRV has been recently introduced as an adjunct antiepileptic drug in focal epilepsy with a similarly promising pharmacokinetic profile and possibly increased tolerability concerning psychiatric adverse events. This review summarizes the essential preclinical and clinical data of LEV and BRV that is currently available and includes the experiences at a large tertiary referral epilepsy center.

Since the introduction of bromides as the first effective antiepileptic drugs (AEDs),1 chronic AED treatment that consisted of the sustained prevention of epileptic seizures has remained the standard of epilepsy therapy.2 Before to the introduction of the newer generation of AEDs, a limited number of drugs were available that addressed the blockade of sodium channels, acting on gamma-aminobutyric acid (GABA) type A receptors, or interacting with calcium channels as the leading modes of action.3 With the introduction of the newer AEDs a heterogeneous group of drugs appeared, some of them offering new mechanisms of action2 including the blockade of GABA aminotransferase (vigabatrin [VGB]), GABA re-uptake from the synaptic cleft (tiagabine [TGB]), the modulation of calcium channels (gabapentin [GBP], pregabalin [PGB]), the selective non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazolproprionic acid (AMPA) receptor antagonism (perampanel [PER]), and the binding to the presynaptic SV2A receptor site which is the unique mode of action of levetiracetam (LEV) and brivaracetam (BRV), the AEDs this review will cover. The authors will summarize the development of both compounds as derivatives of piracetam, review the currently available preclinical and clinical data, and discuss the question of whether BRV has the potential to be recognized as being superior to LEV and if it can replace it as the standard AED with the main mode of action both AEDs reflect.[…]

 

Continue —-> Levetiracetam and brivaracetam: a review of evidence from clinical trials and clinical experience – Bernhard J. Steinhoff, Anke M. Staack, 2019

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[WEB SITE] Disability and sex: why can’t disabled people have a sex life?

Why can’t disabled people have a sex life?Wheelchair user Caroline believes that we are just as entitled as anyone else to have lots of fun, whether that’s travelling, shopping or even being pleasured in the bedroom. Yes, she’s tackling the taboo of disability and sex with her book Wheely Lots of Fun. Read on to find out more and tell us about your experiences.

My name is Caroline and I have arthrogryposis, which is not easy to say even when sober. I’m also 49, with two wonderful kids and an equally wonderful, supportive husband. I blog on disabled issues, fight for better disabled access to the high street and I also build websites.

Arthrogryposis multiplex congenita (AMC) is a rare condition, divided into three groups, namely amyoplasia, distal arthrogryposis, and syndromic arthrogryposis. Amyoplasia is characterised by severe joint contractures and muscle weakness. Distal arthrogryposis mainly involves the hands and feet. I suffer from both Amyoplasia and Distal Arthrogryposis.

I became a full-time wheelchair user roughly 15 years ago, due to scoliosis of my spine. I used to walk with leg braces (also known as calipers) and remember how difficult it was when I lost my independence, but that’s another story.

Having been disabled for some time now, I am passionate about fighting for disabled people’s rights to enjoy the same full life as anyone else. Why should we be any different?

Caroline in her wheelchair with pink hair and headrest

Tackling the topic of sex and disability

I am in the process of writing a book called Wheely Lots of Fun’ about having a sex life as a wheelchair user.  I feel that this is, in particular, an area where disabled people are not represented at all  – there is little or no literature on the subject. Yes, there are medical journals and other ’professional’ opinions, but nothing on a personal level.

This is where I hope my book will make a difference. While I am trying my best to give correct and informed advice about having a sex life as a wheelchair user, my book is written very much on a personal level, as I use my own experiences to guide me.

Disabled people are asexualised in the media

The media seems to completely ignore the fact that disabled people have sex! How many disabled people do you see on TV, let alone in a romantic role? If we are portrayed in a film in a romantic role, we always seem to be portrayed as the victim.

The media contributes greatly to telling society what is perceived as ’normal’ – what we should look like, eat, wear and do? But whose ideal is this? Where did this originate? Who knows?

Health professionals should talk about sex

It’s not just the media either; the medical industry is probably the worse. Because my disability is so rare, doctors never discussed with me anything about having children, or even if my disability would be a factor. So here I was, four months pregnant (I didn’t know I was pregnant until then) with my first child and having to find someone who could give me some information.

Surely something of this magnitude should have been discussed with me? I can’t help but wonder whether this was because they didn’t believe I would ever want or have children. This would mean I’d had sex – surely not?

So I decided I wanted to publicise the fact that disabled people do have sex, enjoy sex and will always continue to do so.

Sex as a wheelchair user

Heart shape made up of lots of colourful wheelchair symbols

Sex in a wheelchair is not an easy task, I can tell you! In my book, I share my findings about how, if you make a few changes and are somewhat creative, you can enjoy sex as a wheelchair user. When talking about my own experiences I highlight both the ups and downs (pardon the pun!) of life as a wheelchair user, as well as and how to have a fulfilling and satisfying sex life.

I also talk about relationships and how they are beneficial to your health, and I talk about the taboo surrounding disability and sex and how this can impact our lives.

Why is disability and sex a taboo?

So, what does ‘taboo’ mean? The dictionary’s definition is: “Proscribed by society as improper or unacceptable”. Based on this definition, disabled people having sex or any kind of sexual relations is deemed as improper and/or unacceptable. What a load of tosh!

Obviously, I can’t speak for every disabled person, but I’m sure I can speak for a lot of you when I say that we all ultimately want the same thing – a happy, safe, fulfilling and satisfying sexual relationship with our partner. How this is achieved, of course, varies from one couple to the next and I explore this in my book. Disabled people have the same issues as any able-bodied person wanting to have a sex life. We all have self-confidence concerns.

We all have physical barriers, although obviously wheelchair users have many more. Finding a partner? Well, let’s just say that my dating days were not a pretty sight.

Yet this taboo is made all the more difficult by the challenges of finding someone with whom to have open and informed discussions – especially when so many people believe that disabled people don’t or shouldn’t have sex.

Why sex is good for you

So it’s important that we break down this taboo. Why? Well did you know that sex is good for your health? According to some scientific studies, a loving relationship, physical touching and sex is good for reducing your blood pressure.

Sexual arousal sends the heart rate higher and the number of beats per minute reaches its peak during orgasm. Some studies show that the average peak heart rate at orgasm is the same as during light exercises, such as walking upstairs.

It’s also been shown that having heart disease doesn’t have to hold you back. Experts say that as long as you can do everyday tasks without any pain, you can have sex. Of course, I’m no GP, so if you have any concerns in any way, please speak with your GP first.

I think the media is just starting to wake up to the different types of people in the world and are starting to represent them better, including disabled people. Television, magazines and the like are showing more disabled people every day. Let’s hope it goes from strength to strength!

By Caroline 

We want to help break the taboo of talking about sex and disability. Share your experiences of being held back or made to feel ashamed by commenting below or on Facebook and Twitter. Or, why not share your tips too 😉

More on Disability Horizons…

via Disability and sex: why can’t disabled people have a sex life?

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[WEB PAGE] Upper arm rehabilitation after severe stroke: where are we? – Physics World

10 Sep 2019 Andrea Rampin 
EEG cap

Stroke is the second leading cause of death worldwide and the third cause of induced disability, according to estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study. Treatments based on constraint-induced movement therapy, occupational practice, virtual reality and brain stimulation can work well for patients with mild impairment of upper limb movement, but they are not as effective for those burdened by severe disability. Therefore, novel individualized approaches are needed for this patient group.

Martina Coscia from the Wyss Center for Bio and Neuroengineering in Geneva, and colleagues from several other Swiss institutes, have published a review paper summarizing the most advanced techniques in use today for treatment of severe, chronic stroke patients. The researchers describe techniques being developed for upper limb motor rehabilitation: from robotics and muscular electrical stimulation, to brain stimulation and brain–computer/machine interfaces (Brain 10.1093/brain/awz181).

Robot-aided rehabilitation approaches include movement-assisting exoskeletons and end-effector devices, which enable upper arm movement by stimulating the peripheral nervous system. These techniques can also trigger reorganization of the impaired peripheral nervous system and encourage rehabilitation of the damaged somatosensory system. Several studies have reported the efficiency of robot-aided rehabilitation, alone or in combination with other techniques, in the treatment of upper limb motor impairment. One study that included severely impaired individuals also demonstrated encouraging results.

Muscular electrical stimulation can help improve the connection of motor neurons to the spinal cord and the motor cortex. Researchers have also demonstrated that application of electrical stimuli to the muscles provides positive effects on the neurons responsible for sensory signal transduction to the brain, thereby improving the motion control loop function. By modulating motor neurons’ sensitivity, muscular electrical stimulation inhibits the muscle spasms observed in other treatments.

More recently, therapies have moved on from the simple use of currents to harnessing coordinated stimuli to orchestrate more complex, task-related movements. Although this particular set of techniques didn’t show a particular advantage over physiotherapy in long-term studies of patients with mild upper limb impairment, it did seem to have a stronger effect for chronic severe patients.

Stimulating the brain

Brain stimulation, meanwhile, stimulates cortical neurons in order to improve their ability to form new connections within the affected neural network. Brain stimulation techniques can be divided into two branches – electrical and magnetic – both of which can activate or inhibit neural activity, depending on the polarity and intensity of the stimulus.

Transcranial magnetic stimulation

Researchers have achieved encouraging results using both techniques. In particular, magnetic field-triggered inhibition of the contralesional hemisphere (the hemisphere that was not affected by the stroke) activity yielded positive results. Magnetic, low-frequency stimulation of the contralesional hemisphere also proved encouraging – improving the reach to grasp ability of patients, although only for small objects. Excitingly, some studies suggest that coupling contralesional cortex inhibition with magnetic stimulation of the chronically affected area could achieve effective results.

Within these techniques, one promising approach is invasive brain stimulation, in which a device is surgically implanted in a superficial region of the brain. Such techniques allow for more sustained and spatially-oriented stimulation of the desired brain regions. The Everest trial used such methods and showed significant improvement for a larger percentage of patients after 24 weeks, compared with standard rehabilitation protocols.

Another promising recent development is non-invasive deep-brain stimulation, achieved by temporally interfering electric fields. The authors envision that a deeper understanding of the complex mechanisms involved in the brain’s reactions to magnetic and electrical stimulation will provide an important assistance in clinical application of these techniques.

The final category, brain–computer or brain–machine interfaces (BCIs or BMIs), exploit electroencephalogram (EEG) patterns to trigger feedback or an action output from an external device. Devices that produce feedback are used to train the patient to recruit the correct zone of the brain and help reorganize its interconnections. These techniques have only recently transitioned to the clinic; however, early results and observations are promising. For example, a BCI technique coupled with muscular electrical stimulation restored patients’ ability to extend their fingers.

In recent years, researchers have also tested combinations of the techniques described above. For example, combinations of robotics and muscular electrical stimulation have shown encouraging results, especially when more than one articulation was targeted by the treatment. Combining brain stimulation with muscular electrical stimulation and robotics has proved more effective in severe than in moderate cases. Also, coupling of muscular electrical stimulation with magnetic inhibitory brain stimulation provided better results than either individual technique. Interestingly, addition of electrical brain stimulation to a BCI system coupled with a robotic motor feedback enhanced the outcome, helping to achieve adaptive brain remodelling at the expense of inappropriate reorganization.

Coscia and co-authors highlight that all the techniques studied share a range of limitations that should be addressed, such as small sample size, limited understanding of the underlying mechanisms, lack of treatment personalization and minimal attention to the training task, which they note is often of limited importance for daily life. Addressing these limitations might be key to improving the clinical outcome for patients with severe stroke-induced upper limb paralysis treated with neurotechnology-aided interventions. Moreover, the authors plan to begin a clinical trial to test the use of a novel personalized therapy approach that will include a combination of the described techniques.

 

via Upper arm rehabilitation after severe stroke: where are we? – Physics World

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[WEB SITE] The Top 10 Caregiving Blogs for Caregivers – Caring Village

Being a Caregiver can be tough and unfortunately, life doesn’t slow down to give you time to learn how to care for someone you love. This is why caregiver blogs, which provide resources and information (often from other past or present caregivers and/or industry professionals) can be extremely helpful in navigating your caregiving journey. Below is a list of the top caregiving blogs online including Caring.comThe Caregiver SpaceTransition Aging ParentsThe Caregiver’s VoiceCareGiving.comEldercareABCeCareDiaryDaily CaregivingCaring for Parents Made Easy, and Caring Village’s own resource section.

Caring.com

Caring.com is a leading online destination for those seeking information and support as they care for aging parents, spouses, and other loved ones. Their mission is to help the helpers. They equip family caregivers to make better decisions, save time and money, and feel less alone — and less stressed — as they face the many challenges of caregiving.

The Caregiver Space

The Caregiver Space provides a safe and open space—at no cost— where visitors can be real about what it’s like to care for someone dealing with a serious disability or illness. Use their community forums to ask questions, share experiences, get real answers, or just get things off your chest.

Transition Aging Parents

Transition Aging Parents is a blog written by Dale Carter, a respected voice for adult children of aging parents. Since facing her own mother’s health/life crisis in 2008, Dale has established herself as a voice of reason, as she has traveled around the country from the Midwest to Atlanta, through Florida and New York City. She shares her message of how to approach any change or crisis in your aging parent’s life with clarity and confidence. Since immersing herself with authors and experts in the field of gerontology, she has expanded her reach to adult children across this country. She wants to now show you how to guide your aging parent(s) so they can thrive and find joy in every stage of their life.

The Caregiver’s Voice

Founded in 1998 by Brenda Avadian, MA, TheCaregiversVoice.com serves family caregivers and professionals who work with adults with cognitive impairment or dementia caused by Alzheimer’s, stroke, related illnesses, or trauma.

CareGiving.com

Denise M. Brown launched CareGiving.com in 1996. The site features the blogs of family caregivers, weekly words of comforts, weekly self-care plans, daily chats, a Community Caregiving Journal, free webinars, and daily chats.

EldercareABC

The ‘ABC’ in EldercareABC stands for ‘About Being Connected’. So come in, get connected and have your say about what information you need. Most importantly discover a group of people that are here to support you and who you can support in your own way.

eCareDiary

eCareDiary is a web community created based on the founders experiences as caregivers for their parents who were diagnosed with chronic illnesses such as Parkinson’s, Type II diabetes, and dementia. Having backgrounds in the healthcare system, they found coordinating long term care to be difficult and frustrating because of the lack of good resources available online. They created eCareDiary.com as a centralized place to help families with care coordination by offering comprehensive online tools, expert content, and resources.

DailyCaring

DailyCaring is for the 43.5 million adult family caregivers who care for someone 50+ years of age. They’re perfect for family caregivers who use the Internet to find solutions for day-to-day challenges, help with important care decisions, and advice on how to plan for the future. They also cater to help professionals in the aging care industry.

Caregiving for Parents Made Easy

Caregiving for Parents Made Easy is a site designed to give you some tips and tricks for navigating the caregiver role. If you’re new to caregiving, this site provides places to turn for caregiving resources, as well as general resources for older adults.

Caringvillage.com

Caring Village is a caregiving assistance platform that makes caring for an older loved one safer,easier, and less stressful. The Caring Village suite of easy-to-use mobile apps, interactive dashboard, and marketplace allows families to easily communicate, collaborate and coordinate caregiving activities for their loved ones. With insightful content and preparedness checklists, Caring Village helps provide you with all the information you need to be the best Caregiver you can be.

via The Top 10 Caregiving Blogs for Caregivers – Caring Village

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[WEB SITE] Nutritional Therapies for Traumatic Brain Injury

A change in diet might alleviate some of the long term symptoms of TBI.

Posted Dec 22, 2017

 

You have just experienced a traumatic injury to your head; a series of changes are about to occur in your brain that will have short and long term negative consequences.  You just joined the ranks of 1.7 million other people living in the U.S. who experience a traumatic brain injury (TBI) every year.  TBI is an alteration of brain function caused by external forces leading to loss of consciousness, temporary memory loss and alterations in mental state at the time of the injury.  

 

A study by the Mayo Clinic found that one-third of patients’ brains showing pathology and evidence of chronic degenerative diseases had participated in contact sports. The popular press has carried numerous stories about retired players of the National Football League who have a threefold increase in their risk of developing depression as well as a variety of worsening cognitive impairments.  Indeed, all athletes, especially young adults, exposed to repetitive concussions are at increased risk of developing cognitive deficits.

In the hours, days and weeks following initial accident a series of secondary biochemical changes develop that lead to a progressive degeneration within vulnerable brain regions. Many of these changes are also commonly seen associated with advanced normal aging and are thus rather well studied.  One of the initial changes involves a dysfunction of the mitochondria inside of the neurons of the brain.  Mitochondrial are responsible for energy production and are critical to the survival of neurons, which use a lot of energy. The injury to the mitochondria leads to a condition called oxidative stress where individual atoms of oxygen that we inhale become very toxic to the brain. Next, the oxidative stress induces brain inflammation which leads to an assortment of degenerative diseases, particularly during the years following the TBI event.  These three critical events following the TBI, i.e. loss of normal energy production, oxidative stress and long term brain inflammation, underlies the development of seizures, sleep disruption, fatigue, depression, impulsivity, irritability and cognitive decline. Although no effective treatments are available to alleviate these biochemical events in the brain, research has advanced sufficiently to understand how specific chemicals in the diet can target the negative effects of oxidative stress and inflammation.

A series of recent studies (Nutritional Neuroscience 2018, 21:79), conducted primarily using animal models, have discovered that adding certain vitamins and minerals to the diet might alleviate some of the long term consequences of TBI. I would never recommend taking mega-doses of any supplement, thus I have listed the dietary sources of these nutrients.  It is always most effective, and considerably cheaper, to obtain nutrients via their natural sources.  Supplementation with Vitamins B3 (found in white meat from turkey, chicken and tuna), D (most dairy products, fatty fish such as salmon, tuna, and mackerel) & E (nuts and seeds, spinach, sweet potatoes) improved cognitive function following repetitive concussive brain injury.

Magnesium and zinc are both depleted following TBI.  Zinc supplementation for four weeks reduced inflammation and neuronal cell death and decreased the symptoms of depression and anxiety in rats following TBI.  Both zing and magnesium can be obtained by eating nuts, seeds, tofu, wheat germ and chocolate. The omega-3 fatty acids DHA and α-linolenic acid were also shown to be neuroprotective in animal studies whether taken prior to, or after, the injury.  Thus, people who participate in contact sports might want to add these fats to their regular diet.  However, don’t waste your money on α-linolenic acid or DHA supplements; adequate amounts are easily obtained via a diet containing fatty fish, flaxseeds, canola oil, soybeans, pumpkin seeds, tofu and walnuts.

Sulforaphane was shown to improve blood–brain barrier integrity, reduce cerebral edema and improve cognition in a rodent model of TBI.  Sulforaphane can be obtained via a diet containing brussels sprouts, broccoli, cabbage, cauliflower, kale, broccoli sprouts, turnips and radish. Finally, enzogenol improved cognition when administered to TBI patients in a randomized, controlled study. Enzogenol is a water extract of the bark from Pinus radiate that contains high levels of proanthocyanidins. Once again, do not waste your money, proanthocyanidins are easily obtained by consuming grapes (seeds and skins), apples, unsweetened baking chocolate, red wines, blueberries, cranberries, bilberries, black currants, hazelnuts, pecans and pistachios.

Interventional studies with natural anti-oxidants and anti-inflammatories via the diet are becoming attractive options for patients with TBI.  Unfortunately, very few clinical trials to treat this neurological condition have been performed. Finally, because I have written so often about this topic in other blogs, I must also recommend a daily puff of marijuana which will reduce the consequences of oxidative stress and brain inflammation following TBI.

© Gary L. Wenk, Ph.D. is the author of The Brain: What Everyone Needs to Know (2017) and Your Brain on Food, 2nd Edition, 2015 (Oxford University Press).

 

via Nutritional Therapies for Traumatic Brain Injury | Psychology Today

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[Abstract] Virtual Physical Rehabilitation Is As Effective As In-Person Services

Virtual physical rehabilitation, facilitated by at-home video sessions and device-based apps, is as effective as in-person physical rehabilitation. At the end of a 12-week trial, there was also no differences between in-person and virtual physical therapy in terms of six-week knee extension, flexion, and gait speed; and in 12-week pain scores and hospital readmissions. Those who completed a virtual physical therapy (PT) trial saw a median cost reduction of $1,755 at 12 weeks post-discharge. Costs for those following a virtual rehabilitation program saw costs averaging $1,050 per person; while those . . .

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via Virtual Physical Rehabilitation Is As Effective As In-Person Services | OPEN MINDS

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[ARTICLE] Locomotor skill acquisition in virtual reality shows sustained transfer to the real world – Full Text

Abstract

Background

Virtual reality (VR) is a potentially promising tool for enhancing real-world locomotion in individuals with mobility impairment through its ability to provide personalized performance feedback and simulate real-world challenges. However, it is unknown whether novel locomotor skills learned in VR show sustained transfer to the real world. Here, as an initial step towards developing a VR-based clinical intervention, we study how young adults learn and transfer a treadmill-based virtual obstacle negotiation skill to the real world.

Methods

On Day 1, participants crossed virtual obstacles while walking on a treadmill, with the instruction to minimize foot clearance during obstacle crossing. Gradual changes in performance during training were fit via non-linear mixed effect models. Immediate transfer was measured by foot clearance during physical obstacle crossing while walking over-ground. Retention of the obstacle negotiation skill in VR and retention of over-ground transfer were assessed after 24 h.

Results

On Day 1, participants systematically reduced foot clearance throughout practice by an average of 5 cm (SD 4 cm) and transferred 3 cm (SD 1 cm) of this reduction to over-ground walking. The acquired reduction in foot clearance was also retained after 24 h in VR and over-ground. There was only a small, but significant 0.8 cm increase in foot clearance in VR and no significant increase in clearance over-ground on Day 2. Moreover, individual differences in final performance at the end of practice on Day 1 predicted retention both in VR and in the real environment.

Conclusions

Overall, our results support the use of VR for locomotor training as skills learned in a virtual environment readily transfer to real-world locomotion. Future work is needed to determine if VR-based locomotor training leads to sustained transfer in clinical populations with mobility impairments, such as individuals with Parkinson’s disease and stroke survivors.

Background

In recent years, virtual reality (VR) has been increasingly used to provide engaging, interactive, and task-specific locomotor training [1,2,3,4,5,6,7,8]. These studies have simulated walking in different environments such as parks or streets [34], walking on a slope [3], or walking while avoiding obstacles [3,4,57]. VR-based locomotor training frequently includes obstacle negotiation because it is an essential locomotor skill in the community [457] and tripping over obstacles is a common cause of falls in many patient populations [9]. The clinical application of VR-based training interventions is predicated on the idea that practice in VR will lead to lasting changes in trained skills and that these changes will influence real-world behavior. Therefore, understanding how locomotor skills acquired in VR are retained and how these skills generalize to the real world is critical for determining the long-term utility of VR for locomotor rehabilitation.

The presence of lasting changes in a motor skill as a result of practice is a hallmark of motor learning and this retention process has been examined across a wide variety of real and virtual learning contexts. Retention of motor skills has been examined in response to VR training, particularly in fields such as flight and medical procedural training. For example, complex surgical and medical skills are performed faster and more accurately during a retention session following a single day of VR-based training [10,11,12,13]. Retention of locomotor skills is often explored in studies that analyze how people adapt to external perturbations such as a split-belt treadmill which has separate belts for the right and left legs [14,15,16], elastic force fields [17], robotic exoskeletons [18], or added loads [19]. For instance, studies of split-belt treadmill adaptation have revealed that the increases in step length asymmetry observed during initial exposure to the belts moving at different speeds significantly decreased with subsequent exposures to the device [14,15,16]. A recent study by Krishnan and colleagues also investigated locomotor skill learning during a tracking task in which participants were instructed to match a pre-defined target of hip and knee trajectories as accurately as possible during the swing phase of the gait [20]. They found that the reduction in tracking error achieved through practice is retained the following day. Although motor skill learning in VR and locomotor learning have been examined in isolation, it remains to be seen how locomotor skills are acquired and retained following training in a virtual environment.

Skill transfer, which is defined as “the gain or loss in the capability for performance in one task as a result of practice or experience on some other task” [21], is another key feature of motor learning. Skill transfer is particularly critical when skill acquisition occurs in a context that differs from the environment in which the skill is to be expressed. One way in which skill transfer has been evaluated during motor learning is by measuring how the adaptation of reaching in a robot-generated force field generalizes to unconstrained reaching. This work has shown that adaptation to reaching in a curl-field leads to increased curvature during reaching in free space [2223]. Moreover, studies of treadmill-based locomotor skill learning often evaluate transfer of learned skills from treadmill walking to over-ground. For example, during split-belt treadmill adaptation, the learned changes in interlimb symmetry partially transfer to over-ground walking [24]. Further, VR-based training of obstacle negotiation on a treadmill led to increased walking speeds in the lab [57] and community [4]. However, the evaluation of transfer in these VR-based training studies was based on outcome measures such as walking speed that did not reflect the objective of the training task, which was the control of foot clearance obstacle negotiation. Therefore, it remains to be seen if the elements of skill from VR-training transfer to over-ground walking.

Underlying individual differences in learning can influence motor skill retention and transfer to new environments. For example, a recent study demonstrated that healthy older adults and people post-stroke who acquire a motor sequence skill at a faster rate also show greater retention of that skill [25]. Similarly, the rate of skill acquisition for a reaching task during early training predicts faster trial completion time at 1-month follow-up [26]. Lastly, the magnitude of improvements in reaching speed during skill acquisition predicts long-term changes in reaching speed in healthy individuals [27]. Studies of individual differences in transfer have most often sought to understand how the practice of a skill with one limb influences performance of the same skill with the untrained limb. For example, interlimb transfer of motor skills acquired through visuomotor adaptation varies with handedness [28] and individual differences in baseline movement variability [29]. However, far less work has sought to understand how individual differences in skill acquisition affect the transfer of learned skills to new environments. Overall, the influence of individual differences in skill acquisition on locomotor skill retention and sustained transfer has yet to be determined.

Here, we determined how individual differences in locomotor skill learning during virtual reality treadmill-based training influence retention and transfer of learned skills to over-ground walking in the real world. We used a VR-based version of a previously established precision obstacle negotiation task [3031] and asked 1) whether healthy young adults could learn to minimize clearance during virtual obstacle negotiation, 2) if the learned skill transferred to over-ground walking, 3) if the learned skill was retained in both VR and the real world after 24 h, and 4) if individual differences in the amount or rate of skill acquisition could predict retention and transfer. We hypothesized that 1) participants would reduce foot clearance in VR during practice on Day 1 and that 2) the reduced foot clearance in VR would transfer to over-ground obstacle negotiation. We also hypothesized that 3) the reduction in foot clearance in VR and over-ground would be retained in each environment after a 24-h retention period. Lastly, given that the rate and magnitude of the performance improvement during skill acquisition have been established as predictors of skill retention in previous studies, we also hypothesized that 4) these measures would predict retention of the learned skill in VR and over-ground. Given the growing use of VR for motor skill learning, our results may provide a unique opportunity to understand the factors that influence how training in VR might lead to long-term improvements in skilled locomotion. […]

 

Continue —> Locomotor skill acquisition in virtual reality shows sustained transfer to the real world | Journal of NeuroEngineering and Rehabilitation | Full Text

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