Archive for category Plateau

[BLOG POST] How to Make New Brain Cells and Improve Brain Function

Scientists used to believe that the brain stopped making new brain cells past a certain age. But that believe changed in the late 1990’s as a result of several studies which were performed on mice at the Salk Institute.

After conducting maze tests, neuroscientist Fred H. Gage and his colleagues examined brain samples collected from mice. What they found challenged long standing believes held about neurogenesis, or the creation of new neurons.

To their astonishment, they discovered that the mice were creating new neurons. Their brains were regenerating themselves.

All of the mice showed evidence of neurogenesis but the brains of the athletic mice showed even more.

 These mice, the ones that scampered on running wheels, were producing two to three times as many new neurons as the mice that didn’t exercise.

The difference between the mice who performed well on the maze tests and those that floundered was exercise.

That’s great for the mice, but what about humans?

To find out if neurogensis occurred in adult humans, Gage and his colleagues obtained brain tissue from deceased cancer patients who had donated their bodies to research. While still living, these people were injected with the same type of compound used on Gage’s mice to detect new neuron growth. When Gage dyed their brain samples, he saw new neurons. Like in the mice study, they found evidence of neurogenesis – the growth of new brain cells.

From the mice study, it appears that those who exercise produce even more new brain cells than those who don’t. Several studies on humans seem to suggest the same thing.

Studies performed at both the University of Illinois at Urbana- Champaign and Columbia University in New York City have shown that exercise benefits brain function. The test subjects were given aerobic exercises such as walking for at least one hour three times a week. After 6 months they showed significant improvements in memory as measured by a word-recall test. Using fMRI scans they also showed increases in blood flow to the hippocampus (part of the brain associated with memory and learning). Scientists suspect that the blood pumping into that part of the brain was helping to produce fresh neurons.

Dr. Patricia A. Boyle and her colleagues of Rush Alzheimer’s Disease Center in Chicago found that the greater a person’s muscle strength, the lower their likelihood of being diagnosed with Alzheimer’s. The same was true for the loss of mental function that often precedes full-blown Alzheimer’s.

Neuroscientist Gage, by the way, exercises just about every day, as do most colleagues in his field. As Scott Small a neurologist at Columbia explains,

 I constantly get asked at cocktail parties what someone can do to protect their mental functioning. I tell them, ‘Put down that glass and go for a run.

So if you want to grow some new brain cells and improve your brain function, go get some exercise!

Source: How to Make New Brain Cells and Improve Brain Function | Online Brain Games Blog

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[Abstract] Chronic Stroke Survivors Improve Reaching Accuracy by Reducing Movement Variability at the Trained Movement Speed

Background. Recovery from stroke is often said to have “plateaued” after 6 to 12 months. Yet training can still improve performance even in the chronic phase. Here we investigate the biomechanics of accuracy improvements during a reaching task and test whether they are affected by the speed at which movements are practiced.

Method. We trained 36 chronic stroke survivors (57.5 years, SD ± 11.5; 10 females) over 4 consecutive days to improve endpoint accuracy in an arm-reaching task (420 repetitions/day). Half of the group trained using fast movements and the other half slow movements. The trunk was constrained allowing only shoulder and elbow movement for task performance.

Results. Before training, movements were variable, tended to undershoot the target, and terminated in contralateral workspace (flexion bias). Both groups improved movement accuracy by reducing trial-to-trial variability; however, change in endpoint bias (systematic error) was not significant. Improvements were greatest at the trained movement speed and generalized to other speeds in the fast training group. Small but significant improvements were observed in clinical measures in the fast training group.

Conclusions. The reduction in trial-to-trial variability without an alteration to endpoint bias suggests that improvements are achieved by better control over motor commands within the existing repertoire. Thus, 4 days’ training allows stroke survivors to improve movements that they can already make. Whether new movement patterns can be acquired in the chronic phase will need to be tested in longer term studies. We recommend that training needs to be performed at slow and fast movement speeds to enhance generalization.

Source: Chronic Stroke Survivors Improve Reaching Accuracy by Reducing Movement Variability at the Trained Movement Speed – Feb 01, 2017

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[Abstract] Motor Learning in Stroke. Trained Patients Are Not Equal to Untrained Patients With Less Impairment

Abstract

Background and Objective: Stroke rehabilitation assumes motor learning contributes to motor recovery, yet motor learning in stroke has received little systematic investigation. Here we aimed to illustrate that despite matching levels of performance on a task, a trained patient should not be considered equal to an untrained patient with less impairment.

Methods: We examined motor learning in healthy control participants and groups of stroke survivors with mild-to-moderate or moderate-to-severe motor impairment. Participants performed a series of isometric contractions of the elbow flexors to navigate an on-screen cursor to different targets, and trained to perform this task over a 4-day period. The speed-accuracy trade-off function (SAF) was assessed for each group, controlling for differences in self-selected movement speeds between individuals.

Results: The initial SAF for each group was proportional to their impairment. All groups were able to improve their performance through skill acquisition. Interestingly, training led the moderate-to-severe group to match the untrained (baseline) performance of the mild-to-moderate group, while the trained mild-to-moderate group matched the untrained (baseline) performance of the controls. Critically, this did not make the two groups equivalent; they differed in their capacity to improve beyond this matched performance level. Specifically, the trained groups had reached a plateau, while the untrained groups had not.

Conclusions: Despite matching levels of performance on a task, a trained patient is not equal to an untrained patient with less impairment. This has important implications for decisions both on the focus of rehabilitation efforts for chronic stroke, as well as for returning to work and other activities.

Source: Motor Learning in Stroke

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[WEB SITE] Magnifying mistakes boosts motor skills past a performance plateau – Medical News Today

Virtual tetherball shows that reducing neural “noise” could help sharpen motor skills.

Exaggerating the visual appearance of mistakes could help people further improve their motor skills after an initial performance peak, according to a new study published inPLOS Computational Biology.

Previous research has shown that manipulating the perception of mistakes can improve motor skills. Dagmar Sternad, Christopher Hasson and colleagues from Northeastern University in Boston and Hokkaido University in Japan set out to examine whether this strategy could further enhance skills after they plateau.

In the study, 42 healthy participants learned a virtual tetherball-like game in which they tried to hit a target with a ball hanging from a pole. After three days, all players reached a performance plateau. Then, for some players, the researchers secretly manipulated the game so that the distance by which the ball missed the target appeared bigger on screen than it actually was.

Participants whose mistakes appeared at least twice as bad as they really were broke past their plateau and continued sharpening their tetherball skills. A control group that remained undeceived showed negligible improvement.

By analyzing the players’ actions using computational learning models, the researchers found that error exaggeration did not change how they made corrections in their throwing techniques. Instead, it reduced random fluctuations, or noise, in nervous system signals that control muscle movement. These findings challenge existing assumptions that such noise cannot be reduced.

The authors point out that their results could help improve strategies to aid people who have reached a motor skills plateau, including elite athletes, healthy elders, stroke patients, and children with dystonia. Future research could reveal the physiological mechanisms underlying the findings.

This work was supported by the National Institute of Child Health and Human Development (NICHD) R01 HD045639, National Institute on Aging (NIA) 1F32 AR061238, National Science Foundation NSF-DMS 0928587, and the U.S. Army Research Institute for the Behavioral and Social Sciences (W5J9CQ-12-C-0046). DS was also supported by a visiting scientist appointment at the Max-Planck Institute for Intelligent Systems in Tübingen, Germany. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the funding organizations. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The authors have declared that no competing interests exist.

Article: Neuromotor Noise Is Malleable by Amplifying Perceived Errors, Hasson CJ, Zhang Z, Abe MO, Sternad D, PLOS Computational Biology, doi:10.1371/journal.pcbi.1005044, published 4 August 2016.

Source: Magnifying mistakes boosts motor skills past a performance plateau – Medical News Today

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[Research Report] Functional level during the first 2 years after moderate and severe traumatic brain injury – CNS

Research Reports – Functional level during the first 2 years after moderate and severe traumatic brain injury

Brain Inj. 2015 Sep 11:1-8. [Epub ahead of print]

Sandhaug M(1,)(2), Andelic N(3,)(4), Langhammer B(1,)(5), Mygland A(6,)(7,)(8).

BACKGROUND: Long-term outcomes after TBI are examined to a large extent, butlongitudinal studies with more than 1-year follow-up time after injury have beenfewer in number. The course of recovery may vary due to a number of factors and it is still somewhat unclear which factors are contributing.

AIM: The aim of this study was to describe the functional level at four time points up to 24 months after traumatic brain injury (TBI) and to evaluate the predictive impact of pre-injury and injury-related factors.

DESIGN: A cohort study.

SETTING: Outpatient.

POPULATION: Sixty-five patients with moderate (n = 21) or severe (n = 44) TBI.

METHODS: The patients with TBI were examined with Functional Independence Measure(FIM) and Glasgow Outcome Scale Extended (GOSE) at 3 months, 12 months and 24months after injury. Possible predictors were analysed in a regression modelusing FIM total score at 24 months as the outcome measure.

RESULTS: FIM scores improved significantly from rehabilitation unit discharge to 24 months after injury, with peak levels at 3 and 24 months after injury(p < 0.001), for the whole TBI group and the group with severe TBI. The moderateTBI group did not show significant FIM score improvement during this time period. GOSE scores for the whole group and the moderate group improved significantlyover time, but the severe group did not. FIM at admission to the rehabilitation unit and GCS score at admission to the rehabilitation unit were closest to being significant predictors of FIM total scores 24 months after injury (B = 0.265 and2.883, R(2 )= 0.39, p = 0.073, p = 0.081).

CONCLUSION: FIM levels improved during the period from rehabilitation unitdischarge to 3 months follow-up; thereafter, there was a ‘plateauing’ of recovery. In contrast, GOSE ‘plateauing’ of recovery was at 12 months.

CLINICAL REHABILITATION IMPACT: The study results may indicate that two of themost used outcome measures in TBI research are more relevant for assessment of the functional recovery in a sub-acute phase than in later stages of TBI recovery.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Functional level during the first 2 years after moderate and severe traumatic brain injury

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[ARTICLE] Role of Central Plasticity in the Outcome of Peripheral Nerve Regeneration

August 25, 2015 · by NEUROSURGERY® Editorial Office · in Editor Choice. ·

Screen Shot 2015-08-20 at 5.24.44 PMThe optimal refinement in nerve repair techniques has reached a plateau, making it imperative to continually explore newer avenues for improving the clinical outcome of peripheral nerve regeneration. The aim of this short review is to discuss the role and mechanism of brain plasticity in nerve regeneration, as well as to explore the possible application of this knowledge for improving the clinical outcome following nerve repair.

From: Role of Central Plasticity in the Outcome of Peripheral Nerve Regeneration by Mohanty et al.

Full text access for Neurosurgery subscribers.

via Editor Choice: Role of Central Plasticity in the Outcome of Peripheral Nerve Regeneration | NEUROSURGERY Report.

 

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[ARTICLE] Reinforcement-Induced Movement Therapy: A novel approach for overcoming learned non-use in chronic stroke patients – Full Text PDF

Abstract

An open question in stroke rehabilitation is, if and how chronic patients can still make improvements after they reached a plateau in motor recovery. Previous research has shown that Constraint-Induced Movement Therapy (CIMT) might be effective in treating hemiparesis and supporting functional improvements in chronic patients, but that it might also be associated with higher costs in terms of demand, resources and inconvenience for the patient.

 

Here, we offer a new therapeutic approach that combines CIMT with a positive reinforcement component. We suggest that this new therapy, called Reinforcement Induced Movement Therapy (RIMT), might be similarly effective as CIMT and could be suitable for a broader population of chronic stroke patients.

We first implemented a computational model to study the potential outcome of different CIMT and RIMT therapy combinations. Then we present the results of an ongoing clinical trial that supports predictions from the model. We conclude that an optimally combined CIMT and RIMT therapy might propose a novel and powerful rehabilitation approach, addressing the specific needs of chronic stroke patients.

 Full Text PDF

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[WEB SITE] Changing a Common Belief About Brain Injury

As a scientist, I am impassioned to share research findings that upend conventionally-held wisdom about the brain – modifying viewpoints that are obsolete, wrong, and disabling.

The journal Neuropsychological Rehabilitation has just published the results of a study conducted by our interdisciplinary team of experts at the Center for BrainHealth at The University of Texas at Dallas. The study found that strategy-based cognitive training significantly improves the cognitive performance, psychological and neural health of those who have experienced a traumatic brain injury (TBI), long after the initial injury.

These findings should permanently put to rest the view, once commonly held among scientists and the medical community, that the brain can only recover lost functions for a period of one year following injury. Unfortunately, insurance companies still base their coverage policies on this outdated assumption. What’s worse, many of those afflicted with TBI may be tempted to give up on their recovery based on what we now know to be false.

The latest findings are sure to bring much-needed hope to the 5.3 million Americans living with TBI and their family members. TBI continues to be a leading cause of death and disability, and is a particular risk for our service members; more than 327,000 have been diagnosed with TBI since 2000. Whether caused by the blast of a bomb, or sustained in a car accident, a fall, or playing sports, such injuries–even those considered mild–can have consequences that last an entire lifetime.

Those who have sustained traumatic brain injuries often experience persistent cognitive difficulties, including poor ability to focus on the task at hand, to make decisions, or to anticipate consequences. They may feel overwhelmed or paralyzed when faced with too much information or the need to generate solutions to problems. They may also suffer from psychological difficulties, such as depression and post-traumatic stress disorder, which further hinder their participation in and enjoyment of daily activities.

Fortunately, as our study and other research reveals, the brain–even an injured brain–has tremendous power to grow, change, rewire and repair itself throughout life. We are also learning the rewiring of a brain depends on the degree to which it is challenged. If a person with a brain injury is trained using predominantly low-level thinking tasks, those are the connections that will be rebuilt.

Until now, most TBI treatment protocols have focused on restoring basic mental functions, such as memory or attention. The belief has been training should occur from the bottom up to help those with TBI rebuild their skills and mental capacity. Typically these training regimens ignore higher level thinking skills controlled by frontal lobe networks, such as decision-making, planning and judgment.

Through this study, we sought to test the hypothesis that a strategy-based cognitive training regimen focusing on higher-level thinking skills would be a more effective way to repair the brain after injury than a training that taught important facts about the brain and how it operates. Using a program we developed that focuses on improving higher-level thinking skills, we set out to determine whether this training could improve brain health and cognitive function in adults with TBI. Specifically, we wanted to find out if the training could help an individual make gains toward achieving his or her personal best.

We examined 60 individuals, both veterans and civilians, between the ages of 19 and 65 who had sustained one or more traumatic brain injuries. More than two-thirds of study participants were injured a decade or more ago, well beyond the one-year period previously thought to be the limit of brain recovery.

Study participants who received strategy-based cognitive training saw significant improvement in memory and the ability to think abstractly. They reported a 60% reduction in depressive symptoms as well as an almost 40% reduction in symptoms related to post traumatic stress disorder. Blood flow to the frontal lobe region of the brain–the area responsible for memory, attention, decision-making and problem-solving–also increased significantly following the strategy-based training. And participants continued to realize cognitive, psychological and brain blood flow benefits three to four months after training, suggesting their health continued to improve even after the training ended.

The implications of these research findings are enormous. No longer can we falsely assume that brain injury survivors can recover only for a certain period or that they are destined to regain only a limited number of skills. The potential for improvement is far greater than previously believed possible. With the right interventions, TBI survivors can continue to make progress repairing their brain’s health and their lives for many years. That knowledge should significantly change the way we think about–and address–this enormous public health challenge.

via Changing a Common Belief About Brain Injury | Sandra Bond Chapman, Ph.D..

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[BLOG POST] Changing a Common Belief About Brain Injury – from Huffington Post

Broken Brain - Brilliant Mind

This was just shared from http://www.huffingtonpost.com/sandra-bond-chapman/changing-a-common-belief-_b_7588400.html

As a scientist, I am impassioned to share research findings that upend conventionally-held wisdom about the brain – modifying viewpoints that are obsolete, wrong, and disabling.

The journal Neuropsychological Rehabilitation has just published the results of a study conducted by our interdisciplinary team of experts at the Center for BrainHealth at The University of Texas at Dallas. The study found that strategy-based cognitive training significantly improves the cognitive performance, psychological and neural health of those who have experienced a traumatic brain injury (TBI), long after the initial injury.

These findings should permanently put to rest the view, once commonly held among scientists and the medical community, that the brain can only recover lost functions for a period of one year following injury. Unfortunately, insurance companies still base their coverage policies on this outdated assumption. What’s worse, many of those afflicted with TBI may be…

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[WEB SITE] Debunking the Myths of Recovery

Debunking the Myths of Recovery

The beliefs of some people limit or prevent recovery. This post sets the record straight and removes some of the easily avoidable obstacles to successful recovery. This post reveals the truth about the following four myths:

  • Myth #1: You Will be Better Soon
  • Myth #2: Full Recovery Occurs Within One Year
  • Myth #3: Therapy Must Begin Shortly After Injury
  • Myth #4: Recovery Ends When the Plateau Begins

Myth #1: You Will be Better Soon

Recovery from brain injury is not the same as recovery from flu, broken bones, or an organ transplant. At this time, there is no shot that prevents brain injury, there is no cast that repairs brain injury, and a damaged brain cannot be replaced by transplant. Recovery is often a long process that sometimes requires physical, occupational, vision, speech, cognitive, and psychological therapies. Some people have also found healing through religious devotion, yoga, exercise, medication, herbs, food, stories, music, art, animals, oxygen, and hyperbaric chambers. The fact is that recovery from brain injury is rarely quick and may require many years. An expectation of immediate recovery can lead survivors and those who interact with them, to denial, frustration, disappointment, and depression.

Myth #2: Full Recovery Occurs Within One Year

As stated above, recovery is rarely quick and may require many years. There is no reliable proof that recovery ends abruptly one year after injury occurs. In fact, the opposite is true. Many people recover over a period of many years. Recovery depends on the severity and location of injury as well as many other factors; however, a 12-month cut off is not one of the recovery factors. One year after my diagnosis, I was sleeping most of the day, throwing up occasionally, trying to remember words, and communicating in complete but barely intelligible sentences. The majority of my recovery occurred within five or so years of my injury, but I cannot claim that my recovery ended abruptly five years post injury. Today, approximately 10 years after my initial diagnosis, I solve puzzles quickly, read and understand books, watch movies without falling asleep or puking during the movie, exercise, speak in public, teach, mentor, buy groceries, cook, clean, volunteer, and write – none of which were possible within 12 month of my diagnosis. Although the physical damage may heal within 12 months of injury, true recovery is still ongoing.

Myth #3: Therapy Must Begin Shortly After Injury

Therapy might be more effective if it begins shortly after injury, but therapy can still be effective if it begins decades after injury. Many people have experienced significant recovery even though they began therapy years after their injuries. Doctors suggested a brain tumor began damaging my brain decades earlier. I didn’t begin cognitive therapy until almost one year after diagnosis of my brain injury. I certainly participated in a lot of therapy during the first year after surgery, but the therapy focused on standing, sitting, walking, moving, balancing, eating, drinking, seeing, exercising, dressing, brushing my teeth, showering . . . I’ll leave the rest to your imagination.

Myth #4: Recovery Ends When the Plateau Begins

Some people believe recovery is simply progress to an end point. Others believe recovery is a process of ups and downs to an end point. Neither of the views is a healthy way to think about recovery. Based on personal experience, I know recovery is unlikely to consist of only improvement. I also know imagining an end point can be detrimental to the recovery process. The belief that recovery is not possible beyond a certain point may lead the survivors, therapists, families, and caregivers to falsely conclude the best possible outcome has been attained. Believing this myth to be true is a great disservice to everyone who is affected by the recovery process. The myth prevents further recovery by convincing people that further recovery is impossible.

I experienced several plateaus during the first part of my recovery. I could sit and stand, but I could not walk. A few days later I could walk; some people might have considered it controlled falling rather than walking, but I was making progress. I could read a few words, but I could not understand what I was reading. A few days later, I could read whole sentences rather than just words. Shortly thereafter, I began to understand simple sentences. Plateaus are nothing more than negative thoughts that limit the benefits of recovery.

via Debunking the Myths of Recovery | Beyond Adversity.

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