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[VIDEO] The Effects of Brain Injury on Memory – YouTube

How does brain injury affect memory? Learn about memory impairment following brain injury in this video featuring NeuroRestorative’s Tori Harding. Following a brain injury, the deeply embedded and long-term memories usually remain intact while short-term memory may significantly be affected. Learn about the three memory system areas and strategies that can help a survivor improve their memory.

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[BLOG POST] Menses and Sexual Changes in Women After Trauma – H.O.P.E TBI

Menses and Sexual Changes in Women After Trauma

Blood cells

What is the endocrine system?

Your endocrine system includes glands and organs that make and release hormones, which are chemicals that help your body work properly. They control growth, sexual development, how your body uses and stores energy (metabolism), how it deals with illness, and more. You need proper types and amounts of hormones to feel well.

How can TBI affect the endocrine system?

Two important parts of the endocrine system—the pituitary gland and the hypothalamus—are located in or near the brain. The hypothalamus and the pituitary gland are like orchestra conductors. Their job is to tell other endocrine glands throughout the body to make the hormones that affect and protect every aspect of your health. TBI can injure them, causing hormone problems. A person with TBI may have hormone problems right away or months or even years after the injury.

Menses and Sexual Changes in Women After Brain Trauma

Repeated mild Traumatic Brain Injuries (TBI) occurring over an extended period of time can result in cumulative neurological and cognitive deficits. Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal.

After TBI, there may be some changes to the pituitary. The Pituitary is a pea-sized gland in your brain that makes hormones that help to keep your periods regular every month. When the pituitary makes low levels of certain hormones, this can mean having skipped or missed periods. Stress can cause your hormone levels to change. This can also change your periods. Certain medications can also cause changes to your periods. Ask your doctor about the side effects of the medications you are taking.endocrine3

Recent research indicates there is a higher incidence of hormone abnormalities in people who have sustained a brain injury.  This is directly related to injury of the hypothalamus, and pituitary gland and all the hormones they produce or stimulate to produce, including thyroid hormone, growth hormone, cortisol, and the sex hormones (FSH, LH, Prolactin, estrogen, and testosterone).  It is more common to see these abnormalities early on after a brain injury but they can come on as a long term consequence.  The hypothalamus and/or pituitary gland, are small structures at the base of the brain responsible for regulating the body’s hormones. Damage to these areas can lead to insufficient or increased release of one or more hormones, which causes disruption of the body’s ability to maintain a stable internal environment (homeostasis).  Damage to the pituitary gland leads to a reduction in hormone production resulting in a condition known as hypopituitarism. Medication and other medical illnesses should be ruled out as the cause of any hormone
abnormalities as well.

Chart

Women experience greater cognitive decline, poorer reaction times, more headaches, extended periods of depression, longer hospital stays and delayed return-to-work compared to men following head injury. Such results are particularly pronounced in women of childbearing age; girls who have not started their period and post-menopausal women have outcomes similar to men.

At one year after injury, negative outcomes (persistent physical symptoms, requiring assistance with cognitive difficulties, social and occupational difficulties, reduced quality of life) were repeated more frequently by those who were female, older, and had received more severe injuries.  However, among patient with mTBI injuries it has been identified that 24% of patients who suffered with persistent symptoms and significant life disruption at 3 months post injury were more likely to be young and female, had a prior head injury, neuro/psychiatric symptoms, or a TBI as a result of a motor vehicle accident.

Menstrual troubles such as amenorrhea, or the absence of a period, and irregular cycles are more common in women with TBI. The mean duration of amenorrhea was 6.5 months with a range of 1 – 60 months.  There was one participant whose menses stopped at time of injury and had not returned by time of interview.

After a TBI you may have skipped or missed periods. You may also have more pain or notice more headaches during your periods. You may notice changes to your periods while in the hospital, rehabilitation or at home. These changes can happen in mild to more serious injuries. Still, absence of a menses is more likely to happen when the brain injury is serious. Skipping or missing your period can last from 1 month to many years. For many women, the changes to their periods get better with time, but not always.

Of 104 women with TBI (W-TBI), 46% experienced amenorrhea with duration of up to 60 months. Cycles became irregular for 68% of W-TBI after the injury. These findings were significantly different from those of controls. Among W-TBI, menstrual disturbances were associated with injury severity. No differences were shown between W-TBI and controls with respect to fertility, although significantly fewer W-TBI had one or more live births, and they reported more difficulties in the postpartum period than controls. W-TBI were less likely to have regular Pap smears and reported lower mental health, self-rated health, and function.

Significantly fewer (49%) reported changes in menstrual flow after injury compared with the control counterparts (64%).  Matched case-control conditional regression analyses showed that W-TBI were 21 times more likely than controls to report amenorrhea after injury; for those with regular cycles, W-TBI were 6 times more likely to experience irregular cycles.  Among W-TBI, amenorrhea was associated with lower GCS Scores, Higher ISS, and longer length of acute hospital stays.  Irregular periods emerging after the injured were significantly associated with higher ISS only.

Pregnancy/Fertility – 28% of W-TBI indicated that they tried to conceive or became pregnant after their TBI vs. 35% of controls during a comparable time period.  Hence, the subgroups for these analyses are smaller in size.

Changes in sexual functioning are common after TBI as well. Brain Injury can change the way a person expresses or experiences their sexuality. There are many reasons sexual problems happen after TBI. Some are directly related to damage to the brain. Others are related to physical problems or changes in thinking or relationships.

No significant group differences were found in terms of difficulty conceiving or difficulties during pregnancy after injury.  Those who became pregnant however, significantly fewer W-TBI had one or more live births compared with controls.  W-TBI were also more likely to report post pregnancy difficulties in the pregnancies that occurred after the brain injury compared with controls in the equivalent time period.  The 12 women reported the following: Increased fatigue, pain, depression, mobility problems, inability to concentrate and lower extremity edema. Three women who did not report depression reported “feeling the blues” and 1 woman reported hip pain/headaches.

These findings inform prognosis after TBI for women and provide evidence for long-term monitoring of health outcomes and increased support after childbirth. More research is needed in this area, particularly with respect to the neuroendocrine system.

“I don’t think doctors consider menstrual history when evaluating a patient after a concussion, but maybe we should,” noted Bazarian, associate professor of Emergency Medicine at the University of Rochester School of Medicine and Dentistry who treats patients and conducts research on traumatic brain injury and long-term outcomes among athletes. “By taking into account the stage of their cycle at the time of injury we could better identify patients who might need more aggressive monitoring or treatment. It would also allow us to counsel women that they’re more – or less – likely to feel poorly because of their menstrual phase.”

Although media coverage tends to focus on concussions in male professional athletes, studies suggest that women have a higher incidence of head injuries than men playing sports with similar rules, such as ice hockey, soccer and basketball. Bazarian estimates that 70 percent of the patients he treats in the URMC Sport Concussion Clinic are young women. He believes the number is so high because they often need more follow-up care. In his experience, soccer is the most common sport leading to head injuries in women, but lacrosse, field hockey, cheerleading, volleyball and basketball can lead to injuries as well.

sex and tbi

Sex hormone levels often change after a head injury, as women who have suffered a concussion and subsequently missed one or more periods can attest. According to Kathleen M. Hoeger, M.D., M.P.H.,study co-author and professor of Obstetrics and Gynecology at the University of Rochester School of Medicine and Dentistry, any stressful event, like a hit to the head, can shut down the pituitary gland in the brain, which is the body’s hormone generator. If the pituitary doesn’t work, the level of estrogen and progesterone would drop quickly.

According to Bazarian, progesterone is known to have a calming effect on the brain and on mood. Knowing this, his team came up with the “withdrawal hypothesis”: If a woman suffers a concussion in the premenstrual phase when progesterone levels are naturally high, an abrupt drop in progesterone after injury produces a kind of withdrawal which either contributes to or worsens post concussive symptoms like headache, nausea, dizziness and trouble concentrating. This may be why women recover differently than men, who have low pre-injury levels of the hormone.

“If you get hit when progesterone is high and you experience a steep drop in the hormone, this is what makes you feel lousy and causes symptoms to linger,” said Bazarian. “But, if you are injured when progesterone is already low, a hit to the head can’t lower it any further, so there is less change in the way you feel.”

The team suspected that women taking birth control pills, which contain synthetic hormones that mimic the action of progesterone, would have similar outcomes to women injured in the low progesterone phase of their cycle. As expected, there was no clear difference between these groups, as women taking birth control pills have a constant stream of sex hormones and don’t experience a drop following a head hit, so long as they continue to take the pill.

“Women who are very athletic get several benefits from the pill; it protects their bones and keeps their periods predictable,” noted Hoeger. “If larger studies confirm our data, this could be one more way in which the pill is helpful in athletic women, especially women who participate in sports like soccer that present lots of opportunities for head injuries.”

In addition to determining menstrual cycle phase at the time of injury, Bazarian plans to scrutinize a woman’s cycles after injury to make sure they are not disrupted. If they are, the woman should make an appointment with her gynecologist to discuss the change.

sexandtbi

How does a traumatic brain injury affect sexual functioning?

The following changes in sexual functioning can happen after TBI:

  • Decreased Desire: Many people may have less desire or interest in sex.
  • Increased Desire: Some people have increased interest in sex after TBI and may want to have sex more often than usual. Others may have difficulty controlling their sexual behavior. They may make sexual advances in inappropriate situations or make inappropriate sexual comments.
  • Decreased Arousal: Many people have difficulty becoming sexually aroused. This means that they may be interested in sex, but their bodies do not respond. Men may have difficulty getting or keeping an erection. Women may have decreased vaginal lubrication (moisture in the vagina).
  • Difficulty or Inability to Reach Orgasm/Climax: Both men and women may have difficulty reaching orgasm or climax. They may not feel physically satisfied after sexual activity.
  • Reproductive Changes: Women may experience irregular menstrual cycles or periods. Sometimes, periods may not occur for weeks or months after injury. They may also have trouble getting pregnant. Men may have decreased sperm production and may have difficulty getting a woman pregnant.

Possible causes of changes in sexual functioning after TBI include:

  • Damage to the Brain: Changes in sexual functioning may be caused by damage to the parts of the brain that control sexual functioning.
  • Hormonal Changes: Damage to the brain can affect the production of hormones, like testosterone, progesterone, and estrogen. These changes in hormones affect sexual functioning.
  • Medication Side Effects: Many medications commonly used after TBI have negative side effects on sexual functioning.
  • Fatigue/Tiredness: Many people with TBI tire very easily. Feeling tired, physically or mentally, can affect your interest in sex and your sexual activity.
  • Problems with Movement: Spasticity (tightness of muscles), physical pain, weakness, slowed or uncoordinated movements, and balance problems may make it difficult to have sex.
  • Self-Esteem Problems: Some people feel less confident about their attractiveness after TBI. This can affect their comfort with sexual activity.
  • Changes in Thinking Abilities: Difficulty with attention, memory, communication, planning ahead, reasoning, and imagining can also affect sexual functioning.
  • Emotional Changes: Individuals with TBI often feel sad, nervous, or irritable. These feelings may have a negative effect on their sexual functioning, especially their desire for sex.
  • Changes in Relationships and Social Activities: Some people lose relationships after TBI or may have trouble meeting new people. This makes it difficult to find a sexual partner.

Problems Reported by Females with TBI regarding sexual activity include:

  • Inadequate energy for sex
  • Problems with initiation and arousal
  • Dificulty reaching orgasm
  • Inability to masterbate
  • Low sex drive or  no sex drive
  • Painful sex
  • Problems with orgasm and lubrication
  • Decreased sensation
  • Discomfort in positioning
  • Depression
  • Endocrine/hormonal problems
  • Urogenital problems

Less Reported Symptoms:

  • Safety concerns (impulsivity, judgement,promiscuity, sexual agressiveness)
  • Disinhibition and surging hormones (hypersexuality)

 

 

References:

Womens Reproductive Health and Traumatic Brain Injury (pdf)
Menstrual Phase as Predictor of Outcome After Mild Traumatic Brain Injury in Women (pdf)
Brain Injury and Sexual Issues
Sexuality After Traumatic Brain Injury
Women’s health outcomes after traumatic brain injury
Effects of Brain Injury and Hormonal Changes
Menstrual cycle influences concussion outcomes
Traumatic Brain Injury
Women face additional challenges after traumatic brain injury
Headaches are common in year following traumatic brain injury, especially among females
Does brain injury cause early onset menopause
Women At War
Traumatic brain injury outcomes
Womens Health Outcomes After Traumatic Brain Injury

Source: Menses and Sexual Changes in Women After Trauma | H.O.P.E TBI

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[TED Talk] David Casarett: A doctor’s case for medical marijuana

Subtitles and Transcript

0:12 I would like to tell you about the most embarrassing thing that has ever happened to me in my years of working as a palliative care physician. This happened a couple of years ago. I was asked as a consultant to see a woman in her 70s — retired English professor who had pancreatic cancer. I was asked to see her because she had pain, nausea, vomiting … When I went to see her, we talked about those symptoms and in the course of that consultation, she asked me whether I thought that medical marijuana might help her. I thought back to everything that I had learned in medical school about medical marijuana, which didn’t take very long because I had learned absolutely nothing. And so I told her that as far as I knew, medical marijuana had no benefits whatsoever. And she smiled and nodded and reached into the handbag next to the bed, and pulled out a stack of about a dozen randomized controlled trials showing that medical marijuana has benefits for symptoms like nausea and pain and anxiety. She handed me those articles and said, “Maybe you should read these before offering an opinion … doctor.”

1:29 (Laughter)

1:30 So I did. That night I read all of those articles and found a bunch more. When I came to see her the next morning, I had to admit that it looks like there is some evidence that marijuana can offer medical benefits and I suggested that if she really was interested, she should try it. You know what she said? This 73-year-old, retired English professor? She said, “I did try it about six months ago. It was amazing. I’ve been using it every day since. It’s the best drug I’ve discovered. I don’t know why it took me 73 years to discover this stuff. It’s amazing.”

2:10 (Laughter)

2:11 That was the moment at which I realized I needed to learn something about medical marijuana because what I was prepared for in medical school bore no relationship to reality.

2:22 So I started reading more articles, I started talking to researchers, I started talking to doctors, and most importantly, I started listening to patients. I ended up writing a book based on those conversations, and that book really revolved around three surprises — surprises to me, anyway. One I already alluded to — that there really are some benefits to medical marijuana. Those benefits may not be as huge or as stunning as some of the most avid proponents of medical marijuana would have us believe, but they are real. Surprise number two: medical marijuana does have some risks. Those risks may not be as huge and as scary as some of the opponents of medical marijuana would have us believe, but they are real risks, nonetheless. But it was the third surprise that was most … surprising. And that is that a lot of the patients I talked with who’ve turned to medical marijuana for help, weren’t turning to medical marijuana because of its benefits or the balance of risks and benefits, or because they thought it was a wonder drug, but because it gave them control over their illness. It let them manage their health in a way that was productive and efficient and effective and comfortable for them.

3:37 To show you what I mean, let me tell you about another patient. Robin was in her early 40s when I met her. She looked though like she was in her late 60s. She had suffered from rheumatoid arthritis for the last 20 years, her hands were gnarled by arthritis, her spine was crooked, she had to rely on a wheelchair to get around. She looked weak and frail, and I guess physically she probably was, but emotionally, cognitively, psychologically, she was among the toughest people I’ve ever met. And when I sat down next to her in a medical marijuana dispensary in Northern California to ask her about why she turned to medical marijuana, what it did for her and how it helped her, she started out by telling me things that I had heard from many patients before. It helped with her anxiety; it helped with her pain; when her pain was better, she slept better. And I’d heard all that before. But then she said something that I’d never heard before, and that is that it gave her control over her life and over her health. She could use it when she wanted, in the way that she wanted, at the dose and frequency that worked for her. And if it didn’t work for her, then she could make changes. Everything was up to her. The most important thing she said was she didn’t need anybody else’s permission — not a clinic appointment, not a doctor’s prescription, not a pharmacist’s order. It was all up to her. She was in control.

5:00 And if that seems like a little thing for somebody with chronic illness, it’s not — not at all. When we face a chronic serious illness, whether it’s rheumatoid arthritis or lupus or cancer or diabetes, or cirrhosis, we lose control. And note what I said: “when,” not “if.” All of us at some point in our lives will face a chronic serious illness that causes us to lose control. We’ll see our function decline, some of us will see our cognition decline, we’ll be no longer able to care for ourselves, to do the things that we want to do. Our bodies will betray us, and in that process, we’ll lose control. And that’s scary. Not just scary — that’s frightening, it’s terrifying. When I talk to my patients, my palliative care patients, many of whom are facing illnesses that will end their lives, they have a lot of be frightened of — pain, nausea, vomiting, constipation, fatigue, their impending mortality. But what scares them more than anything else is this possibility that at some point, tomorrow or a month from now, they’re going to lose control of their health, of their lives, of their healthcare, and they’re going to become dependent on others, and that’s terrifying.

6:17 So it’s no wonder really that patients like Robin, who I just told you about, who I met in that clinic, turn to medical marijuana to try to claw back some semblance of control. How do they do it though? How do these medical marijuana dispensaries — like the one where I met Robin — how do they give patients like Robin back the sort of control that they need? And how do they do it in a way that mainstream medical hospitals and clinics, at least for Robin, weren’t able to? What’s their secret? So I decided to find out.

6:54 I went to a seedy clinic in Venice Beach in California and got a recommendation that would allow me to be a medical marijuana patient. I got a letter of recommendation that would let me buy medical marijuana. I got that recommendation illegally, because I’m not a resident of California — I should note that. I should also note, for the record, that I never used that letter of recommendation to make a purchase, and to all of you DEA agents out there —

7:21 (Laughter)

7:22 love the work that you’re doing, keep it up.

7:25 (Laughter)

7:26 Even though it didn’t let me make a purchase though, that letter was priceless because it let me be a patient. It let me experience what patients like Robin experience when they go to a medical marijuana dispensary. And what I experienced — what they experience every day, hundreds of thousands of people like Robin — was really amazing. I walked into the clinic, and from the moment that I entered many of these clinics and dispensaries, I felt like that dispensary, that clinic, was there for me. There were questions at the outset about who I am, what kind of work I do, what my goals are in looking for a medical marijuana prescription, or product, what my goals are, what my preferences are, what my hopes are, how do I think, how do I hope this might help me, what am I afraid of. These are the sorts of questions that patients like Robin get asked all the time. These are the sorts of questions that make me confident that the person I’m talking with really has my best interests at heart and wants to get to know me.

8:33 The second thing I learned in those clinics is the availability of education. Education from the folks behind the counter, but also education from folks in the waiting room. People I met were more than happy, as I was sitting next to them — people like Robin — to tell me about who they are, why they use medical marijuana, what helps them, how it helps them, and to give me advice and suggestions. Those waiting rooms really are a hive of interaction, advice and support.

9:03 And third, the folks behind the counter. I was amazed at how willing those people were to spend sometimes an hour or more talking me through the nuances of this strain versus that strain, smoking versus vaporizing, edibles versus tinctures — all, remember, without me making any purchase whatsoever. Think about the last time you went to any hospital or clinic and the last time anybody spent an hour explaining those sorts of things to you. The fact that patients like Robin are going to these clinics, are going to these dispensaries and getting that sort of personalized attention and education and service, really should be a wake-up call to the healthcare system. People like Robin are turning away from mainstream medicine, turning to medical marijuana dispensaries because those dispensaries are giving them what they need.

9:57 If that’s a wake-up call to the medical establishment, it’s a wake-up call that many of my colleagues are either not hearing or not wanting to hear. When I talk to my colleagues, physicians in particular, about medical marijuana, they say, “Oh, we need more evidence. We need more research into benefits, we need more evidence about risks.” And you know what? They’re right. They’re absolutely right. We do need much more evidence about the benefits of medical marijuana. We also need to ask the federal government to reschedule marijuana to Schedule II, or to deschedule it entirely to make that research possible. We also need more research into medical marijuana’s risks. Medical marijuana’s risks — we know a lot about the risks of recreational use, we know next to nothing about the risks of medical marijuana. So we absolutely do need research, but to say that we need research and not that we need to make any changes now is to miss the point entirely. People like Robin aren’t seeking out medical marijuana because they think it’s a wonder drug, or because they think it’s entirely risk-free. They seek it out because the context in which it’s delivered and administered and used, gives them the sort of control they need over their lives. And that’s a wake-up call we really need to pay attention to.

11:16 The good news though is that there are lessons we can learn today from those medical marijuana dispensaries. And those are lessons we really should learn. These are often small, mom-and-pop operations run by people with no medical training. And while it’s embarrassing to think that many of these clinics and dispensaries are providing services and support and meeting patients’ needs in ways that billion-dollar healthcare systems aren’t — we should be embarrassed by that — but we can also learn from that. And there are probably three lessons at least that we can learn from those small dispensaries.

11:51 One: we need to find ways to give patients more control in small but important ways. How to interact with healthcare providers, when to interact with healthcare providers, how to use medications in ways that work for them. In my own practice, I’ve gotten much more creative and flexible in supporting my patients in using drugs safely to manage their symptoms — with the emphasis on safely. Many of the drugs I prescribe are drugs like opioids or benzodiazepines which can be dangerous if overused. But here’s the point. They can be dangerous if they’re overused, but they can also be ineffective if they’re not used in a way that’s consistent with what patients want and need. So that flexibility, if it’s delivered safely, can be extraordinarily valuable for patients and their families. That’s number one.

12:39 Number two: education. Huge opportunities to learn from some of the tricks of those medical marijuana dispensaries to provide more education that doesn’t require a lot of physician time necessarily, or any physician time, but opportunities to learn about what medications we’re using and why, prognoses, trajectories of illness, and most importantly, opportunities for patients to learn from each other. How can we replicate what goes on in those clinic and medical dispensary waiting rooms? How patients learn from each other, how people share with each other.

13:13 And last but not least, putting patients first the way those medical marijuana dispensaries do, making patients feel legitimately like what they want, what they need, is why, as healthcare providers, we’re here. Asking patients about their hopes, their fears, their goals and preferences. As a palliative care provider, I ask all my patients what they’re hoping for and what they’re afraid of. But here’s the thing. Patients shouldn’t have to wait until they’re chronically seriously ill, often near the end of life, they shouldn’t have to wait until they’re seeing a physician like me before somebody asks them, “What are you hoping for?” “What are you afraid of?” That should be baked into the way that healthcare is delivered.

13:58 We can do this — we really can. Medical marijuana dispensaries and clinics all across the country are figuring this out. They’re figuring this out in ways that larger, more mainstream health systems are years behind. But we can learn from them, and we have to learn from them. All we have to do is swallow our pride — put aside the thought for a minute that because we have lots of letters after our name, because we’re experts, because we’re chief medical officers of a large healthcare system, we know all there is to know about how to meet patients’ needs.

14:31 We need to swallow our pride. We need to go visit a few medical marijuana dispensaries. We need to figure out what they’re doing. We need to figure out why so many patients like Robin are leaving our mainstream medical clinics and going to these medical marijuana dispensaries instead. We need to figure out what their tricks are, what their tools are, and we need to learn from them. If we do, and I think we can, and I absolutely think we have to, we can guarantee all of our patients will have a much better experience.

15:00 Thank you.

15:01 (Applause)

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[WEB SITE] Traumatic Brain Injury Resource Guide – Neuroplasticity

Neuroplasticity

by Lisa Kreber, Ph.D. CBIS
Senior Neuroscientist, Centre for Neuro Skills

What is Neuroplasticity?
Neuronal Firing
How Neuroplasticity Works
Mechanisms of Plasticity
Synaptogenesis
Stem Cells
Modulation of Neurotransmission
Unmasking
Forms of Neuronal Plasticity
Neuronal Remodeling
Depression and Hippocampal Plasticity
Appreciating Plasticity
Ten Principles of Neuroplasticity
Learning, Injury and Recovery

Source: Traumatic Brain Injury Resource Guide – Neuroplasticity

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[OPINION ARTICLE] Enhancing Our Lives with Immersive Virtual Reality – Full Text

Summary

Virtual reality (VR) started about 50 years ago in a form we would recognize today [stereo head-mounted display (HMD), head tracking, computer graphics generated images] – although the hardware was completely different. In the 1980s and 1990s, VR emerged again based on a different generation of hardware (e.g., CRT displays rather than vector refresh, electromagnetic tracking instead of mechanical). This reached the attention of the public, and VR was hailed by many engineers, scientists, celebrities, and business people as the beginning of a new era, when VR would soon change the world for the better. Then, VR disappeared from public view and was rumored to be “dead.” In the intervening 25 years a huge amount of research has nevertheless been carried out across a vast range of applications – from medicine to business, from psychotherapy to industry, from sports to travel. Scientists, engineers, and people working in industry carried on with their research and applications using and exploring different forms of VR, not knowing that actually the topic had already passed away.

The purpose of this article is to survey a range of VR applications where there is some evidence for, or at least debate about, its utility, mainly based on publications in peer-reviewed journals. Of course not every type of application has been covered, nor every scientific paper (about 186,000 papers in Google Scholar): in particular, in this review we have not covered applications in psychological or medical rehabilitation. The objective is that the reader becomes aware of what has been accomplished in VR, where the evidence is weaker or stronger, and what can be done. We start in Section 1 with an outline of what VR is and the major conceptual framework used to understand what happens when people experience it – the concept of “presence.” In Section 2, we review some areas where VR has been used in science – mostly psychology and neuroscience, the area of scientific visualization, and some remarks about its use in education and surgical training. In Section 3, we discuss how VR has been used in sports and exercise. In Section 4, we survey applications in social psychology and related areas – how VR has been used to throw light on some social phenomena, and how it can be used to tackle experimentally areas that cannot be studied experimentally in real life. We conclude with how it has been used in the preservation of and access to cultural heritage. In Section 5, we present the domain of moral behavior, including an example of how it might be used to train professionals such as medical doctors when confronting serious dilemmas with patients. In Section 6, we consider how VR has been and might be used in various aspects of travel, collaboration, and industry. In Section 7, we consider mainly the use of VR in news presentation and also discuss different types of VR. In the concluding Section 8, we briefly consider new ideas that have recently emerged – an impossible task since during the short time we have written this page even newer ideas have emerged! And, we conclude with some general considerations and speculations.

Throughout and wherever possible we have stressed novel applications and approaches and how the real power of VR is not necessarily to produce a faithful reproduction of “reality” but rather that it offers the possibility to step outside of the normal bounds of reality and realize goals in a totally new and unexpected way. We hope that our article will provoke readers to think as paradigm changers, and advance VR to realize different worlds that might have a positive impact on the lives of millions of people worldwide, and maybe even help a little in saving the planet.

Continue —> Frontiers | Enhancing Our Lives with Immersive Virtual Reality | Virtual Environments

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[WEB SITE] EBRSR – Evidence-Based Review of Stroke Rehabilitation

Introduction

Welcome to the 17th edition of the EBRSR. The EBRSR now includes in-depth reviews of well over 4,500 studies including 1,699 randomized controlled trials. Parts of the EBRSR have been translated into a number of languages.

We extend sincere gratitude to the Canadian Partnership for Stroke Recovery (CPSR), a joint initiative of the Heart and Stroke Foundation and Canada’s leading stroke research centres, for funding the EBRSR.

Many readers have e-mailed us with their comments and we encourage you do so as well. We also encourage you to e-mail us if you have any concerns regarding our analyses. This helps us to ensure our data and conclusions are the best possible.

Robert Teasell MD FRCPC
Norhayati Hussein MBBS
Norine Foley MSc
Andreea Cotoi MSc

Source: Introduction | EBRSR – Evidence-Based Review of Stroke Rehabilitation

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[BLOG POST] Common Physical Therapy Abbreviations

When Physical Therapists document the progress of a patient, it’s common for abbreviations to be made within the notes. Rules vary depending on your facility, but it’s common to use physical therapy abbreviations such as NWB (non weight bearing) or AD (assistive device).

While the APTA does not endorse a standard set of physical therapy abbreviations (maybe it should…) you can find plenty of resources that share common words that are shortened by PTs. This list is not all inclusive or a ‘standard’ but it gives you an idea of what is commonly being used.

For student PT’s who are just starting in the clinic, it’s great to review this list in case you run into some language in the documentation that you’re not familiar seeing.

Common Physical Therapy Abbreviations

AAROM Active Assistive Range of Motion

ABD        Abduction

ADD        Adduction

(A)      assist

AD       assistive device

Amb.   ambulate, ambulated

Ant      Anterior

ā          before

abd.     abduction

ACL     anterior cruciate ligament

ADL’s activities of daily living

Add.    adduction

AFO     ankle foot orthosis

@        at

AKA     above knee amputee

ALS      Amyotrophic Lateral Sclerosis

amb    ambulate

Appt.   appointment

AROM             active range of motion

As tol   As tolerated

A/P     Anterior Posterior

(B)       Bilateral

B/L      Bilateral

BAPS   Biomechanical Ankle Platform System

bed mob. bed mobility

bk         back

BKA     below knee amputation

BID      Twice a day

BIW     bi-weekly, twice weekly

BOS     Base of support

BP       Blood pressure

bpm    Beats per minute

Bwd    Backward

CA       Cancer

cerv.    cervical

CC       Chief Complaint

CF        Cystic Fibrosis

CGA     Contact Guard Assist

CHF     Congestive Heart Failure

CHI      closed head injury

Cont.   continue

COTA  certifi ed occupational therapy assistant

COPD  Chronic Obstructive Pulmonary Disease

C/o      Complains of

COG     Center of gravity

Cont    Continue

CP       coldpack, cerebral palsy

CPM    Continuous passive motion

C/S      cervical spine

CVA     Cerebral Vascular Accident

CVD     Cardio-Vascular Disease

CRPS   Complex Regional Pain Syndrome

CP       Cerebral Palsy

CTS     Carpal Tunnel Syndrome

Cx.       cancel, cancellation

dep., D      dependent

Dexa   Dexamethazone

DC       discharge, discontinue

D/C     Discharge

DDD    Degenerative Disc Disease

DF       dorsiflexion

Diag    Diagonal

DIP      Distal Interphalangeal Joint

DJD     Degenerative Joint Disease

DM      Diabetes Mellitus

DMD   Duchenne Muscular Dystrophy

DME    durable medical equipment

DOB    Date of birth

DOI     Date of injury

DOS     Date of surgery

DVT     Deep Vein Thrombosis

Dx        Diagnosis

Eval.    evaluation eversion

Ev.       eversion

Equip.   equipment

ER       Emergency Room

E-stim    Electrical Stimulation

EOB     Edge of bed

Ex.        exercise

Ext.      extension

Ext. rot., ER     external rotation

freq       frequency

F,  3/5  fair (in reference to manual muscle testing)

FES      Functional Electrical Stimulation

Flex.    flexion

FCR     Flexor Carpi Radialis

FCU     Flexor Carpi Ulnaris

F/u      Follow up

FWW   Front wheeled walker

FWB    full weight bearing

fwd       forward

Fx.        fracture

GH       Gleno-Humeral

Gt.        Trng. gait training

G, 4/5    good (in reference to manual muscle testing)

GMT    gross muscle test

HA       Headache

Hemi. hemiplegia, hemiparesis

HEP     home exercise program

HHA    home health aide

HKAFO hip knee ankle foot orthosis

HOB    Head of bed

Hor      Horizontal

HP       hot pack

H/S     Hamstring

HNP    Herniated Nucleus Pulposus

HTN    Hypertension

HVGS   high voltage galvanic stimulation

HX       history

H/o     History of

I ,         Indep independent

IDDM  insuline dependent diabetes mellitus

IE        initial evaluation

IFC      interferential current

IMS     intramuscular stimulation

Inf       Inferior

Int. rot., IR   internal rotation

Inv.      inversion

Ionto   Iontophoresis

Isom    isometric

ITB      Ilio-tibial Band

Jt         Joint

KAFO    Knee ankle foot orthosis

L , L, Lt.    left

LAQ     long arc quad (exercise.)

Lat        Lateral

Lats      Latissimus Dorsi

LBP      low back pain

LB         lower body

LBQC   large base quad cane

LCL      Lateral Collateral Ligament

LE        lower extremity

LQ       lower quadrant

LTG     long term goal

L/S      Lumbar Spine

Max     Maximum

MCL    Medial Collateral Ligament

MCP    Metacarpophalangeal Joint

Med     Medial

MDL    moderately limited

MENS microcurrent electrical nerve stimulator

MFR    myofacial release

MI       Myocardial Infarction

Min     Minimum

M/L     Medial Lateral

MFR    Myofascial Release

MHP    Moist Hot Pack

MKL    markedly limited

mm.     muscle

MMT   manual muscle test

MNL    minimally limited

Mob    Mobilization

mod    Moderate

MS       Multiple Sclerosis

MSW   medical social worker

MTP    Metatarsophalangeal Joint

MVA    Motor Vehicle Accident

Max.    maximal

N, .5/5  normal (re: muscle strength)

NAGS     Natural Apophyseal Glides

NBQC     Narrow Based Quad Cane

NCV       nerve conduction velocity

NIDDM non-insulin dependent diabetes mellitus

N/T     numbness and tingling or not tested

NF       No Fault

NMR    Neuromuscular re-education

NWB   non-weight bearing

NS       No Show

OA       Osteoarthritis

OOB    Out of bed

OT       occupational therapy/therapist

OTR     registered occupational therapist

_
p  after

PBall   Physio-Ball

PD       Parkinson’s Disease

P, 2/5      poor (re: muscle strength)

Pec          Pectoral / Pectoralis

PCL         Posterior Cruciate Ligament

PIP          Proximal Interphalangeal Jt

PF            plantar fl exion

PMH       past medical history

Pn           pain

PNF        Proprioceptive Neuromuscular Facilitation

POC     plan of care

P/A     Posterior Anterior

PRE     progressive resistive exercises

Post     Posterior

Prec.    Precautions

Prep.   preparation

Prox    Proximal

Pron    Pronation

Phono Phonophoresis

PRN     As needed

Pt.        patient

PT       physical therapy/therapist

PTA     physical therapist assistant

P/u      Push up

PVD     Peripheral Vascular Disease

PWB    partial weight bearing

Quad   Quadriceps

QS       Quadriceps Set

RA       Rheumatoid Arthritis

R , R, rt right

Re        recheck

Rec’d   received

Rehab. rehabilitation

Reps.   repetitions

Req/d. required

RGO     reciprocating gait orthosis

ROM    Range of Motion

Rot.      rotation

r/o      Rule out

RSD     Reflex Sympathetic Dystrophy

RTC     Rotator Cuff

RTW    Return to work

Rx.       treatment

RW      Rolling Walker

SAQ     short arc quad (exercise)

SB        Sidebend

SBA     standby assist

SBQC   small base quad cane

SCI       spinal cord injury

Script   Prescription

SI, SIJ  sacroiliac joint

Sh        shoulder

S/L      Sidelying

SLP      speech-language pathologist

SLR      Straight Leg Raise

SNAGS Sustained Natural Apophyseal Glides

SOB     Shortness of Breath

S/p      Status post

SPC     Single point cane

SPT     student P.T.

SPTA   student P.T.A.

ST        speech therapy

STG     short term goals

STM    Soft Tissue Mobilization

(S)       Supervision

Sup     Supination or Superior

SW      Standard Walker

T-Band Theraband

T, 1/5 trace (re: muscle strength)

TA         Therapeutic Activities

TBI        Traumatic Brain Injury

TENS    transcutaneous electrical nerve stimulator

THA      total hip arthroplasty

THR      total hip replacement

TIW      three times per week

THA     Total Hip Arthroplasty

THR     Total Hip Replacement

Ther Ex Therapeutic Exercise

TIA      Transient Ischemic Attack

TKA     total knee arthroplasty

TKR     total knee replacement

TLSO   Thoracolumbosacal orthotic

TM      treadmill

TMJ     Temporomandibular Joint

Tol       Tolerated

TTWB   Toe Touch Weight Bearing

T/S      Thoracic Spine

Tx        Traction

UB       upper body

UBE     Upper Body Ergometer

UE       upper extremity

UQ       upper quadrant

US       ultrasound

UV       ultraviolet

VC       verbal cues

VIC      Verbalized informed consent

W/cm2 watts per centimeter squared

WB      weight bearing

WBQC    Wide based quad cane

WBAT     weight bearing as tolerated

W/C    Wheelchair

WFL    within functional limits

WNL    within normal limits

y/o      Years old

// Bars Parallel Bars

4WW Four wheeled walker

_
s          without

_
c          with

1°        primary

2°        secondary

approx. approximately

         pound

(3 dots in a triangle) therefore

(Triangle)         change

=          equals

Z, 0/5 zero (re: muscle strength)

<          Less Than

         Greater Than

1:1      One to one

‘           Foot or Feet

‘’          Inches

         Pounds

↑        Up, increased

↓        Down, decreased

√        Flexion

∕            Extension

↔        To and from

Do you see any common abbreviations that have been left out? Let us know in the comments and we’ll add them.

Source: Common Physical Therapy Abbreviations

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