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[ARTICLE] Patient-Active Control of a Powered Exoskeleton Targeting Upper Limb Rehabilitation Training – Full Text

Robot-assisted therapy affords effective advantages to the rehabilitation training of patients with motion impairment problems. To meet the challenge of integrating the active participation of a patient in robotic training, this study presents an admittance-based patient-active control scheme for real-time intention-driven control of a powered upper limb exoskeleton. A comprehensive overview is proposed to introduce the major mechanical structure and the real-time control system of the developed therapeutic robot, which provides seven actuated degrees of freedom and achieves the natural ranges of human arm movement. Moreover, the dynamic characteristics of the human-exoskeleton system are studied via a Lagrangian method. The patient-active control strategy consisting of an admittance module and a virtual environment module is developed to regulate the robot configurations and interaction forces during rehabilitation training. An audiovisual game-like interface is integrated into the therapeutic system to encourage the voluntary efforts of the patient and recover the neural plasticity of the brain. Further experimental investigation, involving a position tracking experiment, a free arm training experiment, and a virtual airplane-game operation experiment, is conducted with three healthy subjects and eight hemiplegic patients with different motor abilities. Experimental results validate the feasibility of the proposed scheme in providing patient-active rehabilitation training.

Introduction

Stroke is a severe neurological disease caused by the blockages or rupture of cerebral blood vessels, leading to significant physical disability and cognitive impairment (12). The recent statistics from the World Health Organization indicate that worldwide 15 million people annually suffer from the effect of stroke, and more than 5 million stroke patients survive and, however, require a prolonged physical therapy to recover motor function. Recent trends predict increased stroke incidence at younger ages in the upcoming years (34). Approximately four-fifths of all survived stroke patients suffer from the problems of hemiparesis or hemiplegia and, as a result, have difficulties in performing activities of daily living (ADL). Stroke causes tremendous mental and economic pressure on the patients and their families (5). Medical research has proved that, owing to the neural plasticity of the human brain, appropriate rehabilitation trainings are beneficial for stroke survivors to recover musculoskeletal motor abilities. Repetitive and task-oriented functional activities have substantial positive effects on improving motor coordination and avoiding muscle atrophy (67). Traditional stroke rehabilitation therapy involves many medical disciplines, such as orthopedics, physical medicine, and neurophysiology (89). Physiotherapists and medical personnel are required to provide for months one-on-one interactions to patients that are labor intensive, time consuming, patient-passive, and costly. Besides, the effectiveness of traditional therapeutic trainings is limited by the personal experiences and skills of therapists (1011).

In recent decades, robot-assisted rehabilitation therapies have attracted increasing attention because of their unique advantages and promising applications (1213). Compared with the traditional manual repetitive therapy, the use of robotic technologies helps improve the performance and efficiency of therapeutic training (14). Robot-assisted therapy can deliver high-intensive, long-endurance, and goal-directed rehabilitation treatments and reduce expense. Besides, the physical parameters and the training performance of patients can be monitored and evaluated via built-in sensing systems that facilitate the improvement of the rehabilitation strategy (1516). Many therapeutic robots have been developed to improve the motor functions of the upper extremity of disabled stroke patients exhibiting permanent sensorimotor arm impairments (17). The existing robots used for upper limb training can be basically classified into two types: end-point robots and exoskeleton robots. End-point robots work by applying external forces to the distal end of impaired limbs, and some examples are MIME (18), HipBot (19), GENTLE/s (20), and TA-WREX (21). Comparatively, exoskeleton robots have complex structures similar to anatomy of the human skeleton; some examples of such robots are NMES (22), HES (23), NEUROExos (24), CAREX-7 (25), IntelliArm (26), BONES (27), and RUPERT (28). The joints of the exoskeleton need to be aligned with the human anatomical joints for effective transfer of interactive forces.

The control strategies applied in therapeutic robots are important to ensure the effectiveness of rehabilitation training. So far, according to the training requirement of patients with different impairment severities, many control schemes have been developed to perform therapy and accelerate recovery. Early rehabilitation robot systems implemented patient-passive control algorithms to imitate the manual therapeutic actions of therapists. These training schemes are suitable for patients with severe paralysis to passively execute repetitive reaching tasks along predefined trajectories. Primary clinical results indicate that patient-passive training contributes to motivating muscle contraction and preventing deterioration of arm functions. The control of the human–robot interaction system is a great challenge due to its highly nonlinear characteristics. Many control algorithms have been proposed to enhance the tracking accuracy of passive training, such as the robust adaptive neural controller (29), fuzzy adaptive backstepping controller (30), neural proportional–integral–derivative (PID) controller (31), fuzzy sliding mode controller (32), and neuron PI controller (33).

The major disadvantage of patient-passive training is that the active participation of patients is neglected during therapeutic treatment (34). Several studies suggest that, for the patients who have regained parts of motor functions, the rehabilitation treatment integrated with the voluntary efforts of patients facilitates the recovery of lost motor ability (35). The patient-active control, normally referred as patient-cooperative control and assist-as-needed control, is capable of regulating the human–robot interaction depending on the motion intention and the disability level of patients. Keller et al. proposed an exoskeleton for pediatric arm rehabilitation. A multimodal patient-cooperative control strategy was developed to assist upper limb movements with an audiovisual game-like interface (36). Duschauwicke et al. proposed an impedance-based control approach for patient-cooperative robot-aided gait rehabilitation. The affected limb was constrained with a virtual tunnel around the desired spatial path (37). Ye et al. proposed an adaptive electromyography (EMG) signals-based control strategy for an exoskeleton to provide efficient motion guidance and training assistance (38). Oldewurtel et al. developed a hybrid admittance–impedance controller to maximize the contribution of patients during rehabilitation training (39). Banala et al. developed a force-field assist-as-need controller for intensive gait rehabilitation training (40). However, there are two limitations in the existing patient-cooperative control strategies. Firstly, the rehabilitation training process is not completely patient-active, as the patient needs to perform training tasks along a certain predefined trajectory. Secondly, existing control strategies are executed in self-designed virtual scenarios that are generally too simple, rough, and uninteresting. Besides, applying a certain control strategy to different virtual reality scenarios is difficult.

Taking the above issues into consideration, the main contribution of this paper is to develop a control strategy for an upper limb exoskeleton to assist disabled patients in performing active rehabilitation training in a virtual scenario based on their own active motion intentions. Firstly, the overall structure design and the real-time control system of the exoskeleton system are briefly introduced. A dynamic model of the human–robot interaction system is then established using the Lagrangian approach. After that, an admittance-based patient-active controller combined with an audiovisual therapy interface is proposed to induce the active participation of patients during training. Existing commercial virtual games without a specific predetermined training trajectory can be integrated into the controller via a virtual keyboard unit. Finally, three types of experiments, namely the position tracking experiment without interaction force, the free arm movement experiment, and the virtual airplane-game operation experiment, are conducted with healthy and disabled subjects. The experimental results demonstrate the feasibility of the proposed exoskeleton and control strategy.

Exoskeleton Robot Design

The architecture of the proposed exoskeleton is shown in Figure 1. This wearable force-feedback exoskeleton robot has seven actuated degrees of freedom (DOFs) and two passive DOFs covering the natural range of movement (ROM) of humans in ADL. The robot has been designed with an open-chain structure to mimic the anatomy of the human right arm and provide controllable assistance torque to each robot joint. There are three actuated DOFs at the shoulder for internal/external rotation, abduction/adduction, and flexion/extension; two DOFs at the elbow for flexion/extension and pronation/supination; and two DOFs at the wrist for flexion/extension and ulnal/radial deviation. Besides, since the center of rotation of the glenohumeral joint varies with the shoulder girdle movement, the robot is mounted on a self-aligning platform with two passive translational DOFs to compensate the human–robot misalignment and to guarantee interaction comfort. […]

Figure 1. Architecture of upper limb rehabilitation exoskeleton (1-Self-aligning platform; 2-AC servo motor; 3-Bowden cable components; 4-Support frame; 5-Wheelchair; 6-Elbow flexion/extension; 7-Proximal force/torque sensor; 8-Wrist flexion/extension; 9-Wrist ulnal/radial deviation; 10-Distal force/torque sensor; 11-Forearm pronation/supination; 12-Auxiliary links; 13-Shoulder flexion/extension; 14-Shoulder abduction/adduction; 15-Shoulder internal/external; 16-Free-length spring).

 

Continue —>  Frontiers | Patient-Active Control of a Powered Exoskeleton Targeting Upper Limb Rehabilitation Training | Neurology

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[Abstract] Target-focused exercise regime to improve patient compliance and range of motion in the stiff hand

Highlights

 

  • Stiff hands are more commonly seen in the clinics.
  • The management of stiff hand is often complicated.
  • Target-focused exercise regime is fast and simple technique for managing stiff hands.
  • Target-focused exercise regime improves compliance and ROM with ease and comfort.

via Target-focused exercise regime to improve patient compliance and range of motion in the stiff hand – ScienceDirect

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[WEB SITE] Neuroscientists unravel how two different types of brain plasticity work on synapses

 

The brain’s crucial function is to allow organisms to learn and adapt to their surroundings. It does this by literally changing the connections, or synapses, between neurons, strengthening meaningful patterns of neural activity in order to store information. The existence of this process – brain plasticity – has been known for some time.

But actually, there are two different types of brain plasticity at work on synapses. One is “Hebbian plasticity”; it is the one which effectively allows for the recording of information in the synapses, named after pioneering neuroscientist Donald Hebb. The other, more recently discovered, is “homeostatic synaptic plasticity” (HSP), and, like other “homeostatic” processes in the body such as maintaining a constant body temperature, its purpose is to keep things stable. In this case, HSP ensures that the brain doesn’t build up too much activity (as is the case in epilepsy) or become too quiet (as can happen when you lose synapses in Alzheimer’s Disease).

However, little is known about how these two types of plasticity actually interact in the brain. Now, a team of neuroscientists at the Champalimaud Centre for the Unknown, in Lisbon, Portugal, has begun to unravel the fundamental processes that happen in the synapse when the two mechanisms overlap. Their results were published in the journal iScience.

“In theory, the two types of plasticity act as opposing forces”, says Anna Hobbiss, first author of the new study, which was led by Inbal Israely. “Hebbian plasticity reacts to activity at the synapses by inciting them to get stronger while HSP reacts to it by making them weaker. We wanted to understand, on a cellular and molecular level, how the synapse deals with these two forces when they are present at the same time.”

In so doing, the authors have surprisingly shown that, contrary to what might be expected, HSP facilitates Hebbian plasticity, and thus influences memory formation and learning. This means that these two types of plasticity “may actually not be such distinct processes, but instead work together at the same synapses”, says Israely.

The team’s goal was to determine the changes in size of minute structures called dendritic spines, which are the “receiving end” of the synapse. The size of these spines changes to reflect the strength of the synaptic connection.

For this, they studied cells from the mouse hippocampus, a part of the brain which is crucial for learning. In their experiments, they blocked activity in the cells by introducing a potent neurotoxin called tetrodotoxin, thus simulating the loss of input to a certain part of the brain (“think about a person suddenly becoming blind, which leads to loss of input from the eyes to the brain”, says Hobbiss).

Forty eight hours later, they mimicked a small recovery of activity at only one synapse by releasing a few molecules of a neurotransmitter called glutamate on single spines of single neurons. This was possible thanks to a very high resolution, state-of-the-art laser technology, called two-photon microscopy, which allowed the scientists to very precisely visualize and target individual dendritic spines.

As this process evolved, the team closely watched what was happening to the spines – and they saw various anatomical changes. First, the silencing of all neural activity made the spines grow in size. “The spines are like little microphones, which, when there is silence, ramp up the ‘volume’ to try and catch even the faintest noise”, Hobbiss explains.

The scientists then activated individual spines with pulses of glutamate and watched them for two hours. One of the things they thought could happen was that the size of the spines would not grow further, since they had already turned up their ‘volume’ as far is it would go. But the opposite happened: the spines grew even more, with the smaller spines showing the biggest growth.

Finally, the authors also saw growth in neighboring spines, even though the experiment only targeted one spine. “We found that after a lack of activity, other spines in the vicinity also grew, further enhancing the cell’s sensitivity to restored neural transmission”, says Hobbiss. “The cells become more sensitive, more susceptible to encode information. It is as though the ‘gain’ has been turned up”, she adds.

“The fact that neighboring spines grew together with an active spine signifies that homeostatic plasticity changes one of the hallmark features of information storage, which is that plasticity is limited to the site of information entry”, Israely explains. “So, in this sense, the different plasticity mechanisms which are at work in the neuron can cooperate to change which and how many inputs respond to a stimulus. I think this is an exciting finding of our study.”

Taken together, these results show that homeostatic plasticity can actually rev up Hebbian plasticity, the type required for storing information. “Our work adds a piece to the puzzle of how the brain performs one of its fundamental tasks: being able to encode information while still keeping a stable level of activity”, concludes Hobbiss.

The misregulation of homeostatic plasticity – the stabilizing one – has started to be implicated in human health, specifically neurodevelopmental disorders such as Fragile X syndrome and Rett syndrome as well as neurodegenerative ones such as Alzheimer’s Disease. “Perhaps this balance is what allows us to be able to learn new information while retaining stability of that knowledge over a lifetime”, says Israely.

 

via Neuroscientists unravel how two different types of brain plasticity work on synapses

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[TEDx Talks] Can Virtual Reality Ease Post-traumatic Stress Disorder? | Dr. Brenda Wiederhold | TEDxChapmanU – YouTube

Δημοσιεύτηκε στις 2 Σεπ 2015
A licensed clinical psychologist in the U.S. and Europe, a visiting professor at the Catholic University in Milan, and an entrepreneur, Dr. Brenda Wiederhold completed the first randomized, controlled clinical trial to provide virtual reality medical therapy for war veterans suffering from post-traumatic stress disorder (PTSD).
Her most recent achievement is working with coalition troops to provide stress inoculation training prior to deployment. She is further exploring the use of VR in treating patients of all ages suffering from ailments such as claustrophobia to stress disorders. In the spirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. These local, self-organized events are branded TEDx, where x = independently organized TED event. The TED Conference provides general guidance for the TEDx program, but individual TEDx events are self-organized. Dr. Wiederhold is CEO of the Virtual Reality Medical Institute in Belgium and the Executive Vice President of the Virtual Reality Medical Center in California.
She completed the first randomized, controlled clinical trial to provide virtual reality medical therapy for war veterans suffering from post-traumatic stress disorder (PTSD). Her most recent achievement is working with coalition troops to provide stress inoculation training prior to deployment. She is further exploring the use of VR in treating patients of all ages suffering from ailments such as claustrophobia to stress disorders.
This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

 

via  Can Virtual Reality Ease Post-traumatic Stress Disorder? | Dr. Brenda Wiederhold | TEDxChapmanU – YouTube

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[WEB SITE] 7 signs of executive dysfunction after brain injury

 

 

7 signs of executive dysfunction after brain injury Main Image

7 signs of executive dysfunction after brain injury

Thu 26 Jan 2017

Executive dysfunction‘ is not, perhaps, a particularly well known term, but the effects of brain injury that it covers are very common indeed. It is used to collectively describe impairment in the ‘executive functions’ – the key cognitiveemotional and behavioural skills that are used to navigate through life, especially when undertaking activities and interacting with others.

 

Although executive dysfunction is a common problem among many brain injury survivors, it is most commonly experienced following an injury to the frontal lobe.

The importance of executive functions is shown by the difficulties caused when they don’t work properly and someone has problems with executive dysfunction. Since the executive functions are involved in even the most routine activities, frontal injuries leading to executive dysfunction can lead to problems in many aspects of life.

Here we list the most common effects of executive dysfunction, with some examples of common issues that brain injury survivors can face:

Difficulties with motivation and organisation

  • Loss of ‘get up and go’, which can be mistaken for laziness
  • Problems with thinking ahead and carrying out the sequence of steps needed to complete a task

Rigid thinking

  • Difficulty in evaluating the result of actions and reduced ability to change behaviour or switch between tasks if needed

Poor problem solving

  • Finding it hard to anticipate consequences
  • Decreased ability to make accurate judgements or find solutions if things are going wrong

Impulsivity

  • Acting too quickly and impulsively without fully thinking through the consequences, for example, spending more money than can be afforded

Mood disturbances

  • Difficulty in controlling emotions which may lead to outbursts of emotion such as anger or crying
  • Rapid mood changes may occur, for example, switching from happiness to sadness for no apparent reason

Difficulties in social situations

  • Reduced ability to engage in social interactions
  • Finding it hard to initiate, participate in, or pay attention to conversations
  • Poor judgement in social situations, which may lead to saying or doing inappropriate things

Memory/attention problems

  • Finding it harder to concentrate
  • Difficulty with learning new information
  • Decreased memory for past or current events, which may lead to disorientation

Find out more

If you or someone you care for is affected by executive dysfunction, it is important to seek support. Speak to your doctor about your symptoms, and ask about referral to specialist services such as counselling, neuropsychology and rehabilitation.

You can find out more and get tips and strategies to help manage your condition on our executive dysfunction after brain injury page.

Headway groups and branches can offer support in your area, and you can contact our helpline if you would like to talk things through.

via 7 signs of executive dysfunction after brain injury | Headway

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[WEB SITE] Top 30 Traumatic Brain Injury Blogs and Websites To Follow in 2018

Traumatic Brain Injury Blogs List.
The Best Traumatic Brain Injury blogs from thousands of Traumatic Brain Injury blogs in our index using search and social metrics. We’ve carefully selected these websites because they are actively working to educate, inspire, and empower their readers with frequent updates and high-quality information.

Traumatic Brain Injury Blogs

1. Traumatic Brain Injury and Head Trauma Blog

Traumatic Brain Injury and Head Trauma BlogAbout Blog Discover the latest news, treatment, and concerns for individuals suffering from traumatic brain and head injuries.
Frequency about 1 post per week.
Since Jul 2005
Website traumaticbraininjury.net/blog
Facebook fans 374. Twitter followers 818.View Latest Posts ▸

   

2. Broken Brain – Brilliant Mind

Broken Brain – Brilliant MindAbout Blog This blog is written by TBI blogger who is a multiple-concussion survivor, now living large, living well, and sharing info about how to restore your life and sense of self after brain injury.
Frequency about 3 posts per week.
Since Dec 2007
Website brokenbrilliant.wordpress.com
Facebook fans n/a. Twitter followers 1,193.View Latest Posts ▸

 

3. Traumatic Brain Injury Law Blog | Brain Injury Lawyer & Attorney | Stark & Stark Law Firm

Traumatic Brain Injury Law Blog | Brain Injury Lawyer & Attorney | Stark & Stark Law FirmPrinceton, New JerseyAbout Blog This law blog provides news & commentary on brain injury legal developments. Topics include personal injury claims, concussions and compensation for brain injuries.
Frequency about 1 post per month.
Since Feb 2003
Website braininjurylawblog.com
Facebook fans 2,112. Twitter followers 1,145.View Latest Posts ▸

 

4. Brain Injury Blog With Free TBI Information

Brain Injury Blog With Free TBI InformationYoungsville, North CarolinaAbout Blog Leading publisher of brain injury books, resources and information about traumatic brain injury, concussions, and post traumatic stress disorder PTSD.
Frequency about 1 post per month.
Since Jul 2008
Website lapublishing.com/blog
Facebook fans 1,047. Twitter followers 180.View Latest Posts ▸

 

5. Kara Swanson’s Brain Injury Blog | Rock This Life!

Kara Swanson's Brain Injury Blog | Rock This Life!About Blog Get all information about brain injury from Kara Swanson’s Brain Injury Blog.
Frequency about 1 post per month.
Since Dec 2008
Website karaswanson.wordpress.com
Facebook fans n/a. Twitter followers n/a.View Latest Posts ▸

 

6. Brain Injury Law Center | Brain Injury Blog – Stephen Smith

Brain Injury Law Center | Brain Injury Blog - Stephen SmithHampton, VAAbout Blog The Brain Injury Law Center are the brain injury lawyers dedicated exclusively to representing brain injury victims, survivors and their families. This blog talks about experienced attorney who helps you to seek compensation to alleviate the emotional and financial burdens this unwanted injury has placed on your family.
Frequency about 1 post per month.
Since Feb 2000
Website brain-injury-law-center.com/..
Facebook fans 1,433. Twitter followers 513.View Latest Posts ▸

 

7. Traumatic Brain Injury Blog

Traumatic Brain Injury BlogAbout Blog Helping people better understand the impact of brain injury and the remarkable work being done every day to improve our ability to diagnose brain injury, to treat brain injury, to prevent brain injury and to obtain compensation for brain injury caused by negligence.
Frequency about 1 post per month.
Since May 2013
Website vermontbraininjury.com
Facebook fans n/a. Twitter followers n/a.View Latest Posts ▸

 

8. Reddit -Traumatic Brain Injury (TBI)

Reddit -Traumatic Brain Injury (TBI)San Francisco, CAAbout Blog This is a subreddit devoted to Traumatic Brain Injury (TBI). TBI’s are life changing injuries that are not fully understood. This is a subreddit to provide support to those who have suffered TBI’s, and to discuss these injuries and the ongoing effort to learn about these injuries.
Frequency about 2 posts per month.
Website reddit.com/r/TBI
Facebook fans 13. Twitter followers 548,308.View Latest Posts ▸

 

9. BrainLine | All About Brain Injury and PTSD

BrainLine | All About Brain Injury and PTSDWashington, DCAbout Blog Information and resources about treating and living with traumatic brain injury (TBI) and PTSD: research-based articles, videos, personal stories, expert Q&A, research updates and more for people living with brain injury, caregivers, family, friends, and professionals.
Frequency about 1 post per week.
Since Dec 2017
Website brainline.org
Facebook fans 59,971. Twitter followers 43,711.View Latest Posts ▸

 

10. Brain Energy Support Team – BEST Blog

Brain Energy Support Team - BEST BlogAbout Blog The mission of BEST is to provide support, advocacy, public awareness, education and socialization opportunities to individuals with a brain injury and their families.
Frequency about 5 posts per week.
Since Feb 2011
Website brainenergysupportteam.org/b..
Facebook fans 730. Twitter followers 1,841.View Latest Posts ▸

 

11. BrainInjuryStories.org

BrainInjuryStories.orgAbout Blog Find stories of survival, inspiration, determination, and recovery from TBI survivor. In this blog you can also share your story to help others.
Frequency about 1 post per month.
Since Nov 2011
Website braininjurystories.org
Facebook fans 1,481. Twitter followers n/a.View Latest Posts ▸

 

12. Pate Rehabilitation

Pate RehabilitationDallas, TXAbout Blog Articles and news updates on the latest in recovery techniques for MTBI and TBI, with a focus on brain injury rehabilitation blog items.
Frequency about 2 posts per week.
Website paterehab.com/blog
Facebook fans 942. Twitter followers 572.View Latest Posts ▸

 

13. Faces of TBI

Faces of TBISaint Paul, MNAbout Blog Amy Zellmer is a TBI (Traumatic Brain Injury) survivor and advocate. She is a voice for survivors and their caregivers, bringing awareness to the world.
Frequency about 1 post per month.
Since Jul 2015
Website facesoftbi.com/blog
Facebook fans n/a. Twitter followers 2,282.View Latest Posts ▸

 

14. Brain Injury Blog TORONTO | The blog of the Brain Injury Society of Toronto (BIST)

Brain Injury Blog TORONTO | The blog of the Brain Injury Society of Toronto (BIST)Toronto, OntarioAbout Blog From this blog one can get knowledge about brain injury and how to live life after brain surgery as people from all around the world share their personal experiences.
Frequency about 3 posts per month.
Since Jan 2011
Website torontobraininjuryblog.com
Facebook fans n/a. Twitter followers 2,796.View Latest Posts ▸

 

15. No memory of the day that changed my life

No memory of the day that changed my lifeEast, EnglandAbout Blog My name is Michelle Munt and this is my story about surviving a brain injury and what I continue to learn about it. This is for other survivors and their loved ones, but also to raise awareness of what can happen to those in an accident. This invisible injury too often goes undiagnosed and it can be difficult to find information about it. I will talk about things that have helped me as I continue to recover and invite others to see if it works for them too.
Frequency about 2 posts per week.
Since Aug 2016
Website jumbledbrain.com/blog
Facebook fans n/a. Twitter followers 3,384.View Latest Posts ▸

   

16. Brain Injury Group

Brain Injury GroupNationalAbout Blog A network of dedicated brain injury lawyers & professionals providing a gateway to support, information & advice for brain injured people & their families.
Frequency about 1 post per week.
Website braininjurygroup.co.uk/press..
Facebook fans 1,151. Twitter followers 4,933.View Latest Posts ▸

  

17. TryMunity

TryMunityMcKinney, TXAbout Blog The purpose of the TryMunity is peer support for those of us who suffered a life-changing tragedy. We are an web-based social networking site supporting TBI survivors and their families.
Frequency about 2 posts per month.
Since Aug 2012
Website trymunity.com/blog
Facebook fans 2,313. Twitter followers 826.View Latest Posts ▸

  

18. NR Times magazine | Brain injury news

NR Times magazine | Brain injury newsLondon, EnglandAbout Blog Neuro Rehab Times: News and insight on brain injuries and neurological conditions including stroke and MS.
Frequency about 2 posts per week.
Since Sep 2017
Website nrtimes.co.uk
Facebook fans n/a. Twitter followers 179.View Latest Posts ▸

 

19. TBI Health

TBI HealthAbout Blog TBI Health provides a comprehensive range of physio, pain management and rehabilitation services across New Zealand.
Frequency about 1 post per month.
Since Mar 2016
Website tbihealth.co.nz/blog
Facebook fans 1,544. Twitter followers n/a.View Latest Posts ▸

 

20. The Silverlining Brain Injury Charity – Explore Our Blog

The Silverlining Brain Injury Charity - Explore Our BlogSurreyAbout Blog The Silverlining Charity brain injury blog. Exploring all aspects of our work and living a fulfilled life after brain injury.
Frequency about 1 post per month.
Since Sep 2016
Website thesilverlining.org.uk/blog
Facebook fans 644. Twitter followers 876.View Latest Posts ▸

 

21. TBI to 100 Miles – From Crashing to Finishing – My Journey to Recover from Brain Injury

TBI to 100 Miles - From Crashing to Finishing - My Journey to Recover from Brain InjuryAbout Blog I suffered a brain injury on a cycling trip in 2015 and this blog is about my return to running ultramarathons, from 50k to 100 miles, my ongoing mental and physical struggles, my rehab, and my life with mTBI.
Frequency about 1 post per month.
Website tbito100.co
Facebook fans n/a. Twitter followers n/a.View Latest Posts ▸

 

22. My Brain Injury

My Brain InjuryDenver, COAbout Blog My personal experience living with a TBI including alternative treatments like essential oils, acupuncture, massage and craniosacral therapy.
Frequency about 3 posts per month.
Since Jan 2017
Website mytraumaticbraininjury.com/blog
Facebook fans 734. Twitter followers 1,825.View Latest Posts ▸

 

23. TBI Survivor

TBI SurvivorMaine, USAAbout Blog Blog of Jeff Sebell, Author and TBI Survivor. Committed to helping TBI Survivors acquire the tools and confidence to lead a fulfilled life.
Frequency about 1 post per month.
Since Dec 2013
Website tbisurvivor.com
Facebook fans n/a. Twitter followers 351.View Latest Posts ▸

 

24. Surviving Traumatic Brain Injury | TBI – Survivors, Caregivers, Family, and Friends

 Surviving Traumatic Brain Injury | TBI – Survivors, Caregivers, Family, and FriendsPhoenix, AZ areaAbout Blog This blog helps to get lot of information about brain injury as people share their real life experiences.
Frequency about 2 posts per month.
Since Mar 2014
Website survivingtraumaticbraininjur..
Facebook fans n/a. Twitter followers 559.View Latest Posts ▸

 

25. David’s Traumatic Brain Injury Blog

David's Traumatic Brain Injury BlogAbout Blog David is a survivor of traumatic brain injury. In this blog he shares his experiences and gives tips to help other brain injury survivors.
Frequency about 2 posts per week.
Since Aug 2012
Website surviving-brain-injury.blogs..
Facebook fans n/a. Twitter followers n/a.View Latest Posts ▸

 

26. Movements and Looks | Blog

Movements and Looks | BlogAbout Blog A Movimentos e Olhares is a non-profit association that was born as a result of a misfortune, Trauma Brain Skull Light, lived and told in the first person.Its mission is to support the rehabilitation and integration into the working life of patients who have suffered slight Brain Trauma through a multidisciplinary team. We develop our activity among patients and caregivers, primarily in the areas of Neuropsychological Assessment, Psychological Support, Cognitive Rehabilitation and Legal Support.
Frequency about 2 posts per month.
Website nuncatepercasdeti.com
Facebook fans 883. Twitter followers n/a.View Latest Posts ▸

 

27. Sharing some Information and Thoughts on Head and Brain Injury

Sharing some Information and Thoughts on Head and Brain InjuryAbout Blog Craig likes to share knowledge and insights from his life experiences to try and help others through simple encouragement. He hopes that by sharing this information, it will help promote awareness of and also make some difference in those lives affected by brain (head) injury, what is often termed “the “silent epidemic”.
Frequency about 6 posts per week.
Since Jan 2011
Website headbraininjury.wordpress.com
Facebook fans n/a. Twitter followers n/a.View Latest Posts ▸

 

28. STEPPING STONES FOR TRAUMATIC BRAIN INJURY

STEPPING STONES FOR TRAUMATIC BRAIN INJURYCypress, TXAbout Blog This blog was developed to share the journey of Ben from recovery from TBI.
Frequency about 1 post per month.
Since Jan 2013
Website steppingstonesfortbi.blogspo..
Facebook fans n/a. Twitter followers n/a.View Latest Posts ▸

 

29. Hope After Brain Injury | Non-Profit Organization

Hope After Brain Injury | Non-Profit OrganizationNew Hampshire, USAAbout Blog Hope after brain injury is a non-profit organization focused on providing hope and guidance for those with brain injuries.
Frequency about 1 post per month.
Since Sep 2012
Website hopeafterbraininjury.org/blog
Facebook fans 592. Twitter followers 38.View Latest Posts ▸

 

30. Serpe Firm | Virginia Brain Injury Attorney Lawyer

Serpe Firm | Virginia Brain Injury Attorney Lawyer VirginiaAbout Blog Read the latest Virginia brain injury lawsuits ans settlement news. Learn more about traumatic brain injury (TBI).
Frequency about 1 post per month.
Website virginiabraininjury.com/brai..
Facebook fans 3,635. Twitter followers n/a.View Latest Posts ▸

 

These blogs are ranked based on following criteria

  • Google reputation and Google search ranking
  • Influence and popularity on Facebook, twitter and other social media sites
  • Quality and consistency of posts.
  • Feedspot’s editorial team and expert review

via Top 30 Traumatic Brain Injury Blogs and Websites To Follow in 2018

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[ARTICLE] Motor Overflow and Spasticity in Chronic Stroke Share a Common Pathophysiological Process: Analysis of Within-Limb and Between-Limb EMG-EMG Coherence – Full Text

The phenomenon of exaggerated motor overflow is well documented in stroke survivors with spasticity. However, the mechanism underlying the abnormal motor overflow remains unclear. In this study, we aimed to investigate the possible mechanisms behind abnormal motor overflow and its possible relations with post-stroke spasticity. 11 stroke patients (63.6 ± 6.4 yrs; 4 women) and 11 healthy subjects (31.18 ± 6.18 yrs; 2 women) were recruited. All of them were asked to perform unilateral isometric elbow flexion at submaximal levels (10, 30, and 60% of maximum voluntary contraction). Electromyogram (EMG) was measured from the contracting biceps (iBiceps) muscle and resting contralateral biceps (cBiceps), ipsilateral flexor digitorum superficialis (iFDS), and contralateral FDS (cFDS) muscles. Motor overflow was quantified as the normalized EMG of the resting muscles. The severity of motor impairment was quantified through reflex torque (spasticity) and weakness. EMG-EMG coherence was calculated between the contracting muscle and each of the resting muscles. During elbow flexion on the impaired side, stroke subjects exhibited significant higher motor overflow to the iFDS muscle compared with healthy subjects (ipsilateral or intralimb motor overflow). Stroke subjects exhibited significantly higher motor overflow to the contralateral spastic muscles (cBiceps and cFDS) during elbow flexion on the non-impaired side (contralateral or interlimb motor overflow), compared with healthy subjects. Moreover, there was significantly high EMG-EMG coherence in the alpha band (6–12 Hz) between the contracting muscle and all other resting muscles during elbow flexion on the non-impaired side. Our results of diffuse ipsilateral and contralateral motor overflow with EMG-EMG coherence in the alpha band suggest subcortical origins of motor overflow. Furthermore, correlation between contralateral motor overflow to contralateral spastic elbow and finger flexors and their spasticity was consistently at moderate to high levels. A high correlation suggests that diffuse motor overflow to the impaired side and spasticity likely share a common pathophysiological process. Possible mechanisms are discussed.

Introduction

When a stroke survivor with spastic hemiplegia is asked to squeeze the hand or flex the elbow joint on the non-impaired side as shown in Figure 1, there is involuntary activation of spastic finger and elbow flexors on the impaired side (Figures 1A, B). This phenomenon of involuntary activation of spastic muscles can occur in about 30% of hemiplegic stroke (1). It is often referred as motor overflow or associated reaction (18). Other terms, such as mirror movement, global synkinesis, are sometimes used interchangeably for the same clinical observation (8). Motor overflow is one form of the spastic muscle overactivity. Other types of muscle overactivity are also seen clinically, such as spastic dystonia, co-contraction (910).

Figure 1. Motor overflow in a 41 year old stroke survivor with right spastic hemiplegia from a left middle cerebral artery hemorrhagic stroke. (A) standing and relaxed; (B) standing and left hand squeezing; (C) sitting and relaxed; (D) sitting and resisted hand/finger extension on the left side. Photos were recently taken from PI’s spasticity clinic, a written consent of media release was signed by the patient.

Motor overflow is commonly observed in the contralateral homologous resting muscle(s). It can also be seen from proximal muscles to distal muscles in a form of abnormal synergy (1112), and between limbs on the impaired side through interlimb coupling (13). As demonstrated in Figures 1C,D, motor overflow to the contralateral spastic finger and elbow flexors occurs during voluntary finger extension on the non-impaired side. These clinical presentations indicate that motor overflow to the spastic muscles is non-selective, diffuse, and concomitantly with voluntary activation of other muscles. In contrast, motor overflow seen in neurologically intact adults is mainly in contralateral homologous muscles in the context of extreme effort or fatigue [see review (14)]. Therefore, motor overflow in stroke survivors is likely mediated by different mechanisms than in healthy adults. However, the underlying mechanisms for motor overflow after stroke are poorly understood.

A number of methods have been used in the literature to evaluate motor overflow after neurological impairments, including surface EMG, goniometry, dynamometry, electrogoniometry, and clinician rating form. Surface EMG is the most commonly used laboratory-based method (8). In our recent studies (1516), involuntary EMG activities of the contralateral resting muscles were used to quantify the extent of motor overflow during unilateral voluntary elbow flexion tasks. Using quantitative assessment, the level of motor overflow is found to be graded by the effort of the non-impaired muscles (3). Furthermore, EMG-EMG coherence analysis between EMG signals from the contracting muscle and the contralateral resting muscles could provide potential sources of motor overflow. Coherence analysis is based on the cross-correlation between two separate signals in the frequency domain. Coherence values fall between 0 and 1. Commonly studied frequency bands include 6–12 Hz (alpha band), 13–30 Hz (beta band), and 30–60 Hz (gamma band). It is well accepted that both beta and gamma bands have cortical origins (1720). Coherence in the alpha band is believed to have subcortical influences, may be related to the reticulospinal drive (21). For example, EMG signals were recorded from bilateral homologous muscles, such as biceps muscles during motoric responses of acoustic startle reflex and during similar voluntary movements in healthy subjects. EMG-EMG coherence in the alpha band was significantly greater during startle reflex responses than during voluntary movement, suggestive of a reticulospinal origin of such coherence in the alpha band (21).

Motor overflow is often seen and elicited in stroke survivors with spasticity. Its relation with post-stroke spasticity remains controversial. Motor overflow is found to be associated with spasticity in some studies (236), but not in others (14). In all these studies, spasticity was assessed using clinical scales, such as modified Ashworth scale or Tardieu scale. Quantitative assessment is likely to provide better insights into this relationship. Based on the velocity-dependent increase in resistance feature of spasticity, a quantitative assessment with computerized control of external stretch was developed (2223). In this approach, a joint is stretched by a motorized device at a controlled, constant speed. Resistance torque is obtained to quantify responses from spastic muscles. Reflex torque is quantified objectively by subtracting passive resistance at a very slow speed of stretch, e.g., 5°/s from that at a fast speed, e.g., 100°/s. Reflex torque is attributed primarily to underlying neural mechanisms of spasticity. In a previous study (24), we have demonstrated that reflex torque was velocity-dependent at the same wrist position (muscle length), and changed with various wrist positions at the same speed of stretch. This biomechanical quantification of spasticity is also sensitive to quantify reflex and non-reflex responses from spastic elbow flexors in response to controlled cold exposure (25).

In the present study, the specific aim was to examine the possible mechanisms mediating the phenomenon of motor overflow in chronic stroke. Stroke survivors and healthy controls were instructed to flex the elbow joint voluntarily at submaximal levels. Surface EMG signals were recorded from bilateral elbow flexors and finger flexors to quantify motor overflow. Within-limb and between-limb EMG-EMG coherence analyses were performed. Elbow flexor spasticity was quantified using our established biomechanical approach. Since motor overflow is commonly seen in stroke survivors with spasticity, they may share the same underlying pathophysiology. We hypothesized that there is greater motor overflow to the spastic elbow and finger flexors and that greater motor overflow is highly correlated with spasticity, as compared to the control group. Furthermore, post-stroke spasticity is primarily attributed to reticulospinal hyperexcitability and has separate underlying mechanisms for weakness (2627). between-limb intermuscular EMG signals were hypothesized to have significant EMG-EMG coherence in the alpha band to reflect reticulospinal hyperexcitability. Motor overflow was further hypothesized to correlate with spasticity (reflex torque), but not weakness.[…]

Continue —>  Frontiers | Motor Overflow and Spasticity in Chronic Stroke Share a Common Pathophysiological Process: Analysis of Within-Limb and Between-Limb EMG-EMG Coherence | Neurology

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[Abstract + References] Changes in sexual functioning following traumatic brain injury: An overview on a neglected issue

Highlights

  • Sexuality has a significant impact on interpersonal relationships and psychological well-being.
  • Up to 50% of patients with moderate to severe TBI report sexual problems.
  • Sexual disorders in TBI are closely dependent on the damaged brain area.
  • TBI patients and their caregivers should be provided with information useful to achieve a better sexual health.

Abstract

Traumatic brain injury (TBI) is any damage to the skull and/or the brain and its frameworks due to an external force. Following TBI, patients may report cognitive, physiological and psychosocial changes with a devastating impact on important aspects of the patient’s life, such as sexual functioning. Although sexual dysfunction (SD) occurs at a significantly greater frequency in individuals with TBI, it is not commonly assessed in the clinical setting and little information is available on this crucial aspect of patients’ quality of life. As the number of people with TBI is on the rise, there is a need for better management of TBI problems, including SD, by providing information to patients and their caregivers to achieve sexual health, with a consequent increase in their quality of life. Discussing and treating sexual problems in TBI patients enters the framework of a holistic approach. The purpose of this narrative review is provide clinicians with information concerning changes in sexual functioning and relationships in individuals with TBI, for a better management of patient’s functional outcomes and quality of life.

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via Changes in sexual functioning following traumatic brain injury: An overview on a neglected issue – Journal of Clinical Neuroscience

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[VIDEO] FIM Scale – YouTube

A demonstration of the FIM Scale.

via Waverly Glen – FIM Scale – YouTube

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[WEB SITE] Head MRI: Uses, results, and what to expect – Educational

What to know about head and brain MRI scans

Last reviewed

Doctors use MRI scans to diagnose and monitor head injuries and to check for abnormalities in the head or brain.

Magnetic resonance imaging (MRI) scans provide 3-D images of specific body parts. The scan produces highly detailed images from every angle. Depending on the purpose of the scan, a doctor may recommend contrast, which is a substance that a person takes beforehand. It helps the images to be more clearly defined.

An MRI scan is painless and noninvasive. The length of the procedure varies, depending on the situation.

In this article, we take a close look at head MRI scans in adults and children. We discuss their uses, what to expect during a scan, and how a person receives the results.

Purpose and uses of head MRI scans

Man having head and brain MRI

An MRI scan can provide detailed imagery of soft tissue.

MRI scans allow doctors to see what is happening inside the body. These scans do not produce radiation, unlike CT scans and X-rays.

MRI scans use strong magnetic forces and radio waves to create images. They can scan bone, organs, and tissue, which makes them ideal for a complex body part like the head.

MRI scans show a higher level of detail than other imaging techniques, especially in soft tissue. This is important when examining the brain or brain stem for damage or disease.

A doctor may recommend an MRI head scan if they suspect that a person has:

Procedure and what to expect during a head MRI

A head MRI is noninvasive. When a person arrives at the clinic, a doctor or technician will talk them through the process and tell them what to expect.

Preparation

First, a healthcare professional will ask a series of questions about a person’s medical history.

Radiographers also need to know if a woman is pregnant. Doctors tend not to recommend MRI scans during pregnancy, because it is unclear whether the magnetic force can affect fetal development.

They will also ask if a person has any metallic objects, such as piercings, metal plates, watches, or jewelry. These can interfere with the scan, and a person must remove them before entering the scanner.

Other metallic objects that can interfere with a scan include:

  • brain aneurysm clips
  • cochlear implants
  • dental fillings and bridges
  • eye implants
  • metallic fragments in the eyes or blood vessels
  • metal plates, wires, screws, or rods
  • surgical clips or staples

A healthcare team member will usually ask a person to put on a hospital gown. They will store a person’s clothes and any jewelry in a safe locker until the scan is finished.

During the scan

The technician will bring the person into the room that contains the MRI scanner. The person will lie on a sliding trolley, and the technician may cover them with a sheet.

The technician will then position the trolley so that the person’s head and neck are inside the MRI scanner. They will leave the room and speak to the person through a radio.

People should be aware of the following:

  • Pillows or foam blocks on the trolley will keep the head in the right position.
  • MRI machines make a lot of noise, so expect to hear loud hums, knocking sounds, and general electronic noise. Technicians will usually provide headphones or earplugs.
  • People must stay very still inside the scanner to ensure clear, accurate images. If a person moves, they may have to repeat the scan. If someone, such as a person with Parkinson’s, has trouble lying still, a technician may offer restraints to help.
  • Every MRI machine has a call button. If a person feels anxious or wants to stop the procedure, they can press the call button and talk to the medical staff.
  • Most tattoos are safe in an MRI. However, some inks contain traces of metal, which can cause heat or discomfort during a scan. If a person feels any discomfort, they should tell the radiographer.

The medical team may offer anesthetics or sedatives to people who have extreme claustrophobia.

If a person has taken a sedative, they should avoid driving themselves home. Also, a person needs time to recover from an anesthetic at the medical center. In the event of an allergic reaction, the healthcare team will keep the person under observation.

Types of MRI scanner

MRI scanner machine

MRI machines come in a range of sizes.

Several types of scanners can provide a head MRI. The size of the machine will depend on the purpose of the scan and whether the person has claustrophobia.

Types of scanner include:

  • Closed bore. These look like enormous tubes, which a person enters by lying on a sliding bench.
  • Short bore. In this type of machine, the tubular part is shorter, making it less likely to trigger claustrophobia.
  • Wide bore. The opening of the tubular area can be around 70 centimeters in these machines.
  • Open MRI. These come in a variety of shapes. They can have an open side or top.

The narrower the bore, the more detailed the image will be.

Head MRI scans with contrast vs. no contrast

Contrast is a magnetic substance. If a person drinks or receives an injection of contrast before a scan, it can help to improve the image. The majority of MRI scans do not require contrast.

The doctor and radiologist will decide if contrast is necessary, and a person takes it orally or by injection.

Contrast travels to organs and tissue through the bloodstream. The MRI procedure is the same, whether or not it requires contrast.

Contrast makes tissues and organs stand out on the MRI image. This can illuminate early abnormal tissue growth, including tumors. Receiving an early diagnosis can help improve a person’s outlook.

Scans related to the following issues can require contrast:

There is a small chance that a person may have an allergic reaction to contrast materials. Before administering the contrast, a doctor will ask about:

  • allergies
  • current medications
  • medical history
  • recent illnesses or operations

After taking the contrast, a person should check for any side effects. Report any adverse effects to a healthcare provider.

Results

The radiographer will review and interpret the scans. They will then contact the doctor with the results. This can take several days unless it was an emergency scan.

A person can request to see their scans by asking their doctor. The doctor may need a follow-up scan, and they will explain why.

Costs

The costs of an MRI procedure, and how much insurance will cover, varies.

There may also be associated costs, for contrast, anesthesia, and additional procedures.

Speak to the healthcare provider for an accurate estimate.

Head MRI scans in children

Doctor showing child MRI results

A doctor can explain the MRI process to children before undergoing the procedure.

Medical procedures can be scary. It is important for a caregiver to find out the details and explain them to the child beforehand, to reduce any anxiety. Some hospitals have leaflets that help to explain certain procedures.

Head MRI scans for children are almost identical to those for adults. The main difference is the use of a coil.

An MRI coil fits around the child’s head as they lie or sit in the machine because their heads are smaller.

Young children and babies find it hard to stay still for long, and the healthcare provider may recommend an intravenous sedative. The medical team will monitor them throughout the procedure.

Usually, a caregiver stays with the child during the scan. If this is not possible, the caregiver can often wait in the radiographer’s station.

Summary

Head MRI scans are an important tool for diagnosing and monitoring. They can indicate changes in tissue, which is vital in assessing many conditions, particularly those affecting the brain.

Unlike X-rays and CT scans, MRI scans do not involve radiation. They present no risk, apart from triggering certain anxieties or claustrophobia. There are ways to prevent this from happening.

MRI scanners are being improved all the time. With the new generation of scanners, the aim is to cut down scan times and enhance accuracy.

 

via Head MRI: Uses, results, and what to expect

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