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Posted in Depression on August 21, 2018
Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.
Some forms of depression are slightly different, or they may develop under unique circumstances, such as:
- Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.
- Postpartum depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
- Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.
- Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
- Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”
Examples of other types of depressive disorders newly added to the diagnostic classification of DSM-5 include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).
Signs and Symptoms
If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.
Depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.
Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.
Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.
Risk factors include:
- Personal or family history of depression
- Major life changes, trauma, or stress
- Certain physical illnesses and medications
Treatment and Therapies
Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.
Quick Tip: No two people are affected the same way by depression and there is no “one-size-fits-all” for treatment. It may take some trial and error to find the treatment that works best for you.
Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.
Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.
Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.
If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.
To find the latest information about antidepressants, talk to your doctor and visit www.fda.gov.
You may have heard about an herbal medicine called St. John’s wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health website.
Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information on psychotherapy is available on the NIMH websiteand in the NIMH publication Depression: What You Need to Know.
Brain Stimulation Therapies
If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:
- ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.
- Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.
- Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.
- ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.
- ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.
Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn more about these therapies on the NIMH Brain Stimulation Therapies webpage.
If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for Mental Illnesses if you are unsure of where to start.
Beyond Treatment: Things You Can Do
Here are other tips that may help you or a loved one during treatment for depression:
- Try to be active and exercise.
- Set realistic goals for yourself.
- Try to spend time with other people and confide in a trusted friend or relative.
- Try not to isolate yourself, and let others help you.
- Expect your mood to improve gradually, not immediately.
- Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
- Continue to educate yourself about depression.
Join a Study
What are Clinical Trials?
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including depression. During clinical trials, some participants receive treatments under study that might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. Other participants (in the “control group”) receive a standard treatment, such as a medication already on the market, an inactive placebo medication, or no treatment. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.
How do I find a Clinical Trials at NIMH on Depression?
Doctors at NIMH are dedicated to mental health research, including clinical trials of possible new treatments as well as studies to understand the causes and effects of depression. The studies take place at the NIH Clinical Center in Bethesda, Maryland and require regular visits. After the initial phone interview, you will come to an appointment at the clinic and meet with one of our clinicians. Find NIMH studies currently recruiting participants with depression by visiting Join a Research Study: Depression.
How Do I Find a Clinical Trial Near Me?
To search for a clinical trial near you, you can visit ClinicalTrials.gov. This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world (search: depression). ClinicalTrials.gov gives you information about a trial’s purpose, who may participate, locations, and contact information for more details. This information should be used in conjunction with advice from health professionals.
Free Booklets and Brochures
- Chronic Illness & Mental Health: This brochure discusses chronic illnesses and depression, including symptoms, health effects, treatment, and recovery.
- Depression and College Students: This brochure describes depression, treatment options, and how it affects college students.
- Depression and Older Adults: Depression is not a normal part of aging. This brochure describes the signs, symptoms, and treatment options for depression in older adults.
- Depression: What You Need to Know: This booklet contains information on depression including signs and symptoms, treatment and support options, and a listing of additional resources.
- Postpartum Depression Facts: A brochure on postpartum depression that explains its causes, symptoms, treatments, and how to get help.
- Teen Depression: This flier for teens describes depression and how it differs from regular sadness. It also describes symptoms, causes, and treatments, with information on getting help and coping.
- Join a Study: Depression – Adults
- Join a Study: Depression – Children
- Join a Study: Perimenopause-Related Mood Disorders
- Join a Study: Postpartum Depression (PPD)
- Depression and Older Adults (NIHSeniorHealth.gov)
- Depression: MedlinePlus
- Moms’ Mental Health Matter: Depression and Anxiety Around Pregnancy (National Institute of Child Health and Human Development)
Research and Statistics
- Journal Articles: This webpage provides information on references and abstracts from MEDLINE/PubMed (National Library of Medicine).
- Statistics: Major Depression: This webpage provides information on the statistics currently available on the prevalence and treatment of depression among people in the U.S.
- Watch: “Baby Blues” – or Postpartum Depression?: This video provides patient testimony and information on the signs and symptoms of postpartum depression and reinforces the importance of seeking help and treatment from a health professional.
- Watch: One Woman’s Experience With Depression: This video by the National Institute on Aging tells the story of an older woman who struggled for years with depression, but who is now in recovery. For more on older adults and depression, visit the “Depression” topic on NIHSeniorHealth at www.nihseniorhealth.gov.
Last Revised: February 2018
Posted in Virtual reality rehabilitation on August 20, 2018
Virtual Reality has been a staple of science fiction for some time, Though, in terms of real-life application, the world is still coming to grips with what the tool can offer us.
In recent years, tech experts, doctors, medical students and videographers have used the tool as a way of exploring worlds not normally accessed in everyday life, and as a medium to advance our knowledge.
To fully grasp the potential of this tool, Facebook head of tech, entertainment and connectivity, Jason Juma-Ross, sat down with industry experts at Advertising Week to discuss how VR has moved beyond far entertainment and is now facilitating positive change globally.
Speaking with Facebook global head of consumer research, Helen Crossley, and Sydney University professor of biomedical sciences, Philip Poronnik, Juma-Ross and the panellists discussed how VR is being harnessed by medical students and marketers in entirely different ways.
For Poronnik, VR is a fundamental piece of learning equipment for his students – a tool he called a “total game changer”. He added, “People have been excited about VR since it came out, however we’ve been limited by cost, but now we have Oculus Go and our abilities are unlimited.”
According to professor Poronnik, the Oculus Go has enabled students to help prep patients for operations, offer better stroke rehabilitation to sufferers and even create bespoke situations where students can train in rare medical emergencies that were previously too costly or niche to study.
“The technology has an immense capacity for training,” said Poronnik. “From the Ebola virus to virtually stepping into Hazmat suits which are incredibly expensive, it allows us to teach students to prep without the cost,” he added.
“We can work on quick drug simulations and stressful situations. Teaching knowledge about these situations is critical but given their low probability, the ability to simulate them with GO has been hugely helpful to students in training.”
Poronnik also touched on how VR sets being used in ER rooms are enabling patients to temporarily disappear, creating virtual environments which distract them from the chaos surrounding them. As well as this, VR has proved very effective in helping and curing phobias.
For Crossley, the tool will be massively important to consumers and retailers. Speaking on the impact of VR, Crossley said, “Consumers want to experience a lot of different things. Immersion will soon be the norm, and it’s interesting to realise most consumers’ first experiences with VR will not be in the home.”
Crossley added, “Physical retailers are successful when they offer a completely immersive experience. Where we see VR with commerce in the future is consumers being able to experience products in a visceral way, be that in travel, auto, retail and beyond.”
Looking to the future, both Poronnik and Crossley agreed we are only at the beginning of finding out what VR can do for humans, though neither could predict what the tech would look like in 10 or even five years. Both, however, are extremely excited about it.
Poronnik, for one, questioned how the tool will physically be used by humans in the coming years given its very nature as a “body experience”. He rhetorically asked, “In the future, will it still be glasses or will it be projected onto our eyes? We’re really just scratching the surface.”
Meanwhile, Crossley likened the technological progress of the tool in marketing to the ‘chicken or the egg’ debate. At the moment both marketers and consumers are waiting to see what the other will do with tool, she said.
Crossley also asked, “How will consumers continue using the tool despite the fact there’s not a tonne of content? How will developers and marketers continue building VR considering the base is still growing? We’re not sure.
“We can only imagine what it’ll be like in 10 years,” Crossley added.
Posted in Epilepsy on August 19, 2018
Patients with focal epilepsy that does not respond to medications badly need alternative treatments.
In a first-in-humans pilot study, researchers at the University of Alabama at Birmingham have identified a sentinel area of the brain that may give an early warning before clinical seizure manifestations appear. They have also validated an algorithm that can automatically detect that early warning.
These two findings offer the possibility of squelching a focal epilepsy seizure — before the patient feels any symptoms — through neurostimulation of the sentinel area of the brain. This is somewhat akin to the way an implantable defibrillator in the heart can staunch heart arrhythmias before they injure the heart.
In the pilot study, three epilepsy patients undergoing brain surgery to map the source of their focal epilepsy seizures also gave consent to add an investigational aspect to their planned surgeries.
As neurosurgeons inserted long, thin, needle-like electrodes into the brain to map the location of the electrical storm that initiates an epileptic seizure, they also carefully positioned the electrodes to add one more task — simultaneously record the electrical activity at the anterior nucleus of the thalamus.
The thalamus is a structure sitting deep in the brain that is well connected with other parts of the brain. The thalamus controls sleep and wakefulness, so it often is called the “pacemaker” of the brain. Importantly, preclinical studies have shown that focal sources of seizures in the cortex can recruit other parts of the brain to help generate a seizure. One of these recruited areas is the anterior thalamic nucleus.
The UAB team led by Sandipan Pati, M.D., assistant professor of neurology, found that nearly all of the epileptic seizures detected in the three patients — which began in focal areas of the cortex outside of the thalamus — also recruited seizure-like electrical activity in the anterior thalamic nucleus after a very short time lag. Importantly, both of these initial electrical activities appeared before any clinical manifestations of the seizures.
The UAB researchers also used electroencelphalography, or EEG, brain recordings from the patients to develop and validate an algorithm that was able to automatically detect initiation of that seizure-like electrical activity in the anterior thalamic nucleus.
“This exciting finding opens up an avenue to develop brain stimulation therapy that can alter activities in the cortex by stimulating the thalamus in response to a seizure,” Pati said. “Neurostimulation of the thalamus, instead of the cortex, would avoid interference with cognition, in particular, memory.”
“In epilepsy, different aspects of memory go down,” Pati explained. “Particularly long-term memory, like remembering names, or remembering events. The common cause is that epilepsy affects the hippocampus, the structure that is the brain’s memory box.”
Pati said these first three patients were a feasibility study, and none of the patients had complications from their surgeries. The UAB team is now extending the study to another dozen patients to confirm the findings.
“Hopefully, after the bigger group is done, we can consider stimulating the thalamus,” Pati said. That next step would have the goals of improved control of seizures and improved cognition, vigilance and memory for patients.
For epilepsy patients where medications have failed, the surgery to map the source of focal seizures is a prelude to two current treatment options — epilepsy surgery to remove part of the brain or continuous, deep-brain stimulation. If the UAB research is successful, deep brain stimulation would be given automatically, only as the seizure initiates, and it would be targeted at the thalamus, where the stimulation might interfere less with memory.
InMotion ARM™ Helps Traumatic Brain Injury Patients
InMotion ARM – a New Generation!
InMotion Interactive Therapy enables clinicians to efficiently deliver intensive motor therapy to help patients regain motor function following a neurological condition or injury. This new generation InMotion ARM is an evidence-based neurorehabilitation technology that provides patients with real-time Assistance-as-Needed™. The InMotion ARM quietly monitors the patient’s movements during therapy while it gently assists where needed to help them complete various motor therapy activities.
The InMotion Robots are used for neurorehabilitation in over 20 countries, including the United States. Extensive research has shown InMotion robots to be effective for wide range of motor impairments including: Stroke, Cerebral Palsy, Spinal Cord Injury, Multiple Sclerosis, Parkinson’s Disease, hemiplegic shoulder pain and muscle spasticity.
For more information, or to schedule an on-site demonstration of the New Generation InMotion ARM, please email us at email@example.com or call our U.S. office at (617) 926-4800.
InMotion ARM is here to help!
- Task-specific training
- No active patient movement required
- Fast and efficient setup
- Easy-to-Learn / Easy-to-Use
- Evidence-based treatment protocols
- Over 1,000 movements per session
Tailor motor therapy to the patient’s needs with adaptive therapy protocols and easy-to-use InMotion Software™:
- Simple menus
- Streamlined workflow
- Easy report generation
Designed for Efficiency
- 40% smaller footprint than the previous generation InMotion ARM
- Wireless report printing – no cables crossing the floor!
- Easy patient start-up, easy to clean and easy to shut-down when done for the day
Posted in Epilepsy on August 18, 2018
The ketogenic diet (KD), being high in fat and low in carbohydrates, has been suggested to reduce seizure frequency. It is currently used mainly for children who continue to have seizures despite treatment with antiepileptic drugs. Recently, there has been interest in less restrictive KDs including the modified Atkins diet (MAD) and the use of these diets has extended into adult practice.
To review the evidence for efficacy and tolerability from randomised controlled trials regarding the effects of KD and similar diets.
We searched the Cochrane Epilepsy Group’s Specialized Register (30 March 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO, 30 March 2015), MEDLINE (Ovid, 30 March 2015), ClinicalTrials.gov (30 March 2015) and the WHO International Clinical Trials Registry Platform (ICTRP, 30 March 2015). We imposed no language restrictions. We checked the reference lists of retrieved studies for additional reports of relevant studies.
Studies of KDs and similar diets for people with epilepsy.
Data collection and analysis
Two review authors independently applied pre‐defined criteria to extract data and assessed study quality.
We identified seven randomised controlled trials that generated eight publications.
All trials applied an intention‐to‐treat analysis with varied randomisation methods. The seven studies recruited 427 children and adolescents and no adults. We could not conduct a meta‐analysis due to the heterogeneity of the studies.
Reported rates of seizure freedom reached as high as 55% in a 4 : 1 KD group after three months and reported rates of seizure reduction reached as high as 85% in a 4 : 1 KD group after three months.
One trial found no significant difference between the fasting‐onset and gradual‐onset KD for rates of seizure freedom and reported a greater rate of seizure reduction in the gradual‐onset KD group.
Studies assessing the efficacy of the MAD reported seizure freedom rates of up to 10% and seizure reduction rates of up to 60%. One study compared the MAD to a 4 : 1 KD, but did not report rates of seizure freedom or seizure reduction.
Adverse effects were fairly consistent across different dietary interventions. The most commonly reported adverse effects were gastrointestinal syndromes. It was common that adverse effects were the reason for participants dropping out of trials. Other reasons for drop‐out included lack of efficacy and non‐acceptance of the diet.
Although there was some evidence for greater antiepileptic efficacy for a 4 : 1 KD over lower ratios, the 4 : 1 KD was consistently associated with more adverse effects.
No studies assessed the effect of dietary interventions on quality of life, or cognitive or behavioural functioning.
The randomised controlled trials discussed in this review show promising results for the use of KDs in epilepsy. However, the limited number of studies, small sample sizes and a sole paediatric population resulted in a poor overall quality of evidence.
There were adverse effects within all of the studies and for all KD variations, such as short‐term gastrointestinal‐related disturbances, to longer‐term cardiovascular complications. Attrition rates remained a problem with all KDs and across all studies, reasons for this being lack of observed efficacy and dietary tolerance.
There was a lack of evidence to support the clinical use of KD in adults with epilepsy, therefore, further research would be of benefit.
Other more palatable but related diets, such as the MAD ketogenic diet, may have a similar effect on seizure control as classical KD but this assumption requires more investigation. For people who have medically intractable epilepsy or people who are not suitable for surgical intervention, a KD remains a valid option; however, further research is required.[…]
Posted in Virtual reality rehabilitation on August 18, 2018
[Abstract] Hand Rehabilitation via Gesture Recognition Using Leap Motion Controller – Conference Paper
Posted in Paretic Hand on August 18, 2018
Nowadays, a stroke is the fourth leading cause of death in the United States. In fact, every 40 seconds, someone in the US is having a stroke. Moreover, around 50% of stroke survivors suffer damage to the upper extremity –. Many actions of treating and recovering from a stroke have been developed over the years, but recent studies show that combining the recovery process with the existing rehabilitation plan provides better results and a raise in the patients quality of life –. Part of the stroke recovery process is a rehabilitation plan . The process can be difficult, intensive and long depending on how adverse the stroke and which parts of the brain were damaged. These processes usually involve working with a team of health care providers in a full extensive rehabilitation plan, which includes hospital care and home exercises.
[ARTICLE] Music meets robotics: a prospective randomized study on motivation during robot aided therapy – Full Text
Robots have been successfully applied in motor training during neurorehabilitation. As music is known to improve motor function and motivation in neurorehabilitation training, we aimed at integrating music creation into robotic-assisted motor therapy. We developed a virtual game-like environment with music for the arm therapy robot ARMin, containing four different motion training conditions: a condition promoting creativity (C+) and one not promoting creativity (C–), each in a condition with (V+) and without (V–) a visual display (i.e., a monitor). The visual display was presenting the game workspace but not contributing to the creative process itself. In all four conditions the therapy robot haptically displayed the game workspace. Our aim was to asses the effects of creativity and visual display on motivation.
In a prospective randomized single-center study, healthy participants were randomly assigned to play two of the four training conditions, either with (V+) or without visual display (V–). In the third round, the participants played a repetition of the preferred condition of the two first rounds, this time with a new V condition (i.e., with or without visual display). For each of the three rounds, motivation was measured with the Intrinsic Motivation Inventory (IMI) in the subscales interest/enjoyment, perceived choice, value/usefulness, and man-machine-relation. We recorded the actual training time, the time of free movement, and the velocity profile and administered a questionnaire to measure perceived training time and perceived effort. All measures were analysed using linear mixed models. Furthermore, we asked if the participants would like to receive the created music piece.
Sixteen healthy subjects (ten males, six females, mean age: 27.2 years, standard deviation: 4.1 years) with no known motor or cognitive deficit participated. Promotion of creativity (i.e., C+ instead of C–) significantly increased the IMI-item interest/enjoyment (p=0.001) and the IMI-item perceived choice (p=0.010). We found no significant effects in the IMI-items man-machine relation and value/usefulness. Conditions promoting creativity (with or without visual display) were preferred compared to the ones not promoting creativity. An interaction effect of promotion of creativity and omission of visual display was present for training time (p=0.013) and training intensity (p<0.001). No differences in relative perceived training time, perceived effort, and perceived value among the four training conditions were found.
Promoting creativity in a visuo-audio-haptic or audio-haptic environment increases motivation in robot-assisted therapy. We demonstrated the feasibility of performing an audio-haptic music creation task and recommend to try the system on patients with neuromuscular disorders.
Following a stroke, 80-90% of patients suffer from arm paresis, which remains chronic in about 30-40% of all cases [1, 2, 3]. Task-oriented, intensive, and motivational training is important to increase arm function post-stroke [2, 4, 5, 6, 7, 8].
Intensity is recognized as a key feature of successful rehabilitation therapy . Robots in neurorehabilitation allow for highly-intensive, task-oriented training and have the potential to be superior to conventional therapies (i.e., physical or occupational therapy) in improving motor function post-stroke . Robotic therapy may embed functional training tasks into computer games to facilitate motor learning and to stimulate motivation .
Autonomy, competence, and relatedness can be regarded as the main components of intrinsic motivation [12, 13]. While extrinsic motivation can be described as a goal-directed drive towards an externally provided reward (e.g., a score in a game), intrinsic motivation is a process oriented and internally provided reward due to a satisfying, interesting, meaningful or enjoyable activity [14, 15]. The knowledge regarding the meaningfulness of an activity is a positive determinant of patient motivation . Thus, for patients, an activity should not only be enjoyable, but also lead to a rehabilitation progress. Furthermore, patient engagement is related to the expected reduction of impairment during game-based therapy in stroke .
Activities with a close relation to intrinsic motivation are frequently associated with activities promoting creativity [17, 18, 19]. This might be because activities promoting creativity involve one’s own accord, active decision making, and a resulting product, thus satisfying the need of autonomy, competence, and relatedness [12, 20, 21, 22].
In addition to encouraging creativity, music is a promising stimulator for intrinsic motivation in the context of rehabilitation [23, 24]. Music effectively promotes post-stroke recovery in motor and cognitive functions, and furthermore in emotional and social domains [25, 26, 27, 28, 29, 30, 31]. Studies that compared conventional therapy forms to therapy tasks embedded in active music making revealed that music-associated training increases the level of motivation significantly [24, 32].
Auditory displays have already been determined to be effective for navigation within complex systems . Accordingly, sound is an audible source for navigation through the execution of a task in virtual scenarios without the need for a visual display unit, the advantage being that the visual focus can be on the trained limb rather than a graphical display, thus promoting visuo-motor control [34, 35].
We developed tasks for robot-assisted training of the arm that aim to increase intrinsic motivation with a focussed stimulation of the two aspects: creativity and music. To investigate whether a music condition promoting creativity influences motivation differently than a music condition not promoting creativity, we compared motivational effects of both versions. We investigated the effect of the presence or absence of a visual display for both conditions regarding promotion of creativity. As the training goal of the presented gamified task is to induce high intensity during exercise, the game is operated by repetitive horizontal movements.
For this current study, we designed audio-haptic tasks in a way that they can be performed either with visual display (i.e., a monitor presenting the game workspace) as an audio-visuo-haptic environment or without a visual display as an audio-haptic environment only. To reduce the cognitive load of the participants and have more cognitive resources for creation and decision making processes, we designed the visual display and the haptic environment such that they both presented the same game workspace . Accordingly, the visuals were not essential to complete the audio-haptic task.
Given these related works, the primary hypothesis was that a gamified task promoting creativity embedded in a task for motor therapy increases intrinsic motivation more than a gamified task not promoting creativity. Our second hypothesis was that a gamified task in motor therapy without visual display increases intrinsic motivation more than a gamified task with visual display. Moreover, we hypothesized that promoting creativity and omitting a visual display would increase total training time, free movement time and perceived product value. We further hypothesized that promoting creativity and omitting a visual display would reduce energy expenditure, relative perceived training time and perceived effort.[…]