Archive for category Cognitive Rehabilitation

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

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[WEB SITE] The Brain Can Give Birth To New Cells Throughout Life, Study Finds

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Researchers used to think that after adolescence, people were pretty well stuck with the brain cells they’d already formed. No so anymore. Discoveries in recent years have shown that neurogenesis—the formation of new neurons—can occur much later than this, well into adulthood. And now, a new study from the University of Illinois at Chicago finds that brain cells can form into one’s nineties, even if one has cognitive decline and Alzheimer’s disease (though at a much decelerated rate). The question is how the late-in-life growth of new neurons fits into what’s already known about degenerative diseases.

The study was published last week in the journal Cell Stem Cell.

The researchers looked at the postmortem brains of people aged 79-99, some of whom had had cognitive decline or Alzheimer’s disease. They targeted markers for two kinds of burgeoning cells—neuroblasts (stem cells that would one day give rise to neurons), and immature neurons—in the hippocampus, the brain area that’s most affected in Alzheimer’s disease.

People who had died without cognitive problems had proliferation of both kinds of cells in their brains. People with cognitive decline and Alzheimer’s also had evidence of the cells, but in much lower numbers.

Lazarov, neurogenesis study

COURTESY, ORLY LAZAROV, ET AL.

“We found that there was active neurogenesis in the hippocampus of older adults well into their 90s,” said study author Orly Lazarov in a statement. “The interesting thing is that we also saw some new neurons in the brains of people with Alzheimer’s disease and cognitive impairment.”

What was interesting was the finding that people who had scored higher on tests of cognition during their later lives had more neuroblasts in their hippocampi, compared to those who’d scored lower—and this was independent of the level of degeneration that was visible in the brain.

“In brains from people with no cognitive decline who scored well on tests of cognitive function, these people tended to have higher levels of new neural development at the time of their death, regardless of their level of pathology,” Lazarov said. “The mix of the effects of pathology and neurogenesis is complex and we don’t understand exactly how the two interconnect, but there is clearly a lot of variation from individual to individual.”

The finding is intriguing since it’s long been known that a person’s level of brain “gunk” (the plaques and tangles associated with Alzheimer’s disease) doesn’t always correlate with their cognitive and behavioral symptoms. So it’s possible that these new findings helps explain why this disconnect exists—perhaps the level of neurogenesis matters as much or more than the amount of plaques and tangles that develop. If that’s true, then the big question would be how to harness this for therapeutic purposes.

“The fact that we found that neural stem cells and new neurons are present in the hippocampus of older adults means that if we can find a way to enhance neurogenesis, through a small molecule, for example, we may be able to slow or prevent cognitive decline in older adults, especially when it starts, which is when interventions can be most effective,” said Lazarov.

More research will obviously be needed to understand all of this, but preventing cognitive decline and dementia is probably the way to go, especially since medications to treat Alzheimer’s after the fact have fallen flat in recent years. In the meantime, the study is encouraging on another level: Certain lifestyle habits—most notably exercise—have consistently been shown to boost neurogenesis. The findings suggest we’d do well to pick up exercise, and other brain-healthy habits, and engage in them for as much of our lives as we can, as regularly as we’re able.

 

via The Brain Can Give Birth To New Cells Throughout Life, Study Finds

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[Abstract] Computer-Based Cognitive Rehabilitation in Patients with Visuospatial Neglect or Homonymous Hemianopia after Stroke

Abstract

Objectives: The purpose of this pilot study was to investigate the feasibility and effects of computer-based cognitive rehabilitation (CBCR) in patients with symptoms of visuospatial neglect or homonymous hemianopia in the subacute phase following stroke.

Method: A randomized, controlled, unblinded cross-over design was completed with early versus late CBCR including 7 patients in the early intervention group (EI) and 7 patients in the late intervention group (LI). EI received CBCR training immediately after inclusion (m = 19 days after stroke onset) for 3 weeks and LI waited for 3 weeks after inclusion before receiving CBCR training for 3 weeks (m = 44 days after stroke onset).

Results: CBCR improved visuospatial symptoms after stroke significantly when administered early in the subacute phase after stroke. The same significant effect was not found when CBCR was administered later in the rehabilitation. The difference in the development of the EI and LI groups during the first 3 weeks was not significant, which could be due to a lack of statistical power. CBCR did not impact mental well-being negatively in any of the groups. In the LI group, the anticipation of CBCR seemed to have a positive impact of mental well-being.

Conclusion: CBCR is feasible and has a positive effect on symptoms in patients with visuospatial symptoms in the subacute phase after stroke. The study was small and confirmation in larger samples with blinded outcome assessors is needed.

via Computer-Based Cognitive Rehabilitation in Patients with Visuospatial Neglect or Homonymous Hemianopia after Stroke – ScienceDirect

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[WEB SITE] Virtual Reality + Psychiatry: VR Storytelling Could Transform Mental Health

Virtual Psychiatry

By Jeffrey Rindskopf  August 21, 2019

In the early ‘90s, psychologist Albert “Skip” Rizzo was trying to rehabilitate cognitive function in brain injury patients with workbooks and pen-and-paper exercises – tools one might expect more from a special education class than a psychiatric treatment center. Then one patient, a frontal lobe-impaired 22-year-old, came in with a Game Boy, playing “Tetris.”

“This is a guy I couldn’t motivate for more than five minutes to stay focused, but there he was lasered in on this Game Boy,” Rizzo recalls. “That was the first lightbulb that we could start using digital technology to motivate and engage people.”

He became one of many medical professionals at the time to recognize the early potential of virtual reality (VR) to help diagnose and treat a wide range of mental health issues. In 1995, Rizzo accepted a research director position at USC’s Institute for Creative Technologies to launch a new kind of cognitive rehab, supplementing the old analog and talk therapy tools with VR simulations.

“Now the technology has caught up with the vision,” he says.

So, what is the vision? Given that most health concerns are inseparable from one’s environment, Rizzo calls VR “the ultimate Skinner box,” meaning it can create safe yet emotionally evocative experiences to serve virtually any assessment or treatment approach imaginable. These therapeutic programs could be uniquely reliable for evaluating patients in the subjective world of mental health, wherein up to 85 percent of conditions can go undetected, according to the World Health Organization.

VR could bridge this gap in awareness and improve diagnoses by letting providers monitor patients’ physiological reactions to virtual scenarios, resulting in better treatment outcomes down the line. At Exeter University, a “mirror game” requiring subjects to duplicate the movements and expressions of a virtual avatar aided early detection of schizophrenia. In a similar vein, University of Oxford researchers are developing a VR-based test that gauges subjects’ reactions to neutral social situations for instances of paranoid thinking. Another study from Cambridge University diagnosed early Alzheimer’s-related spatial impairments more accurately than the current gold standard method, just by having participants don an HTC Vive and retrace their steps along an unmarked L-shaped path.

Another area where VR offers proven advantages is “extinction learning,” a method for overcoming fear and emotional trauma by gradually desensitizing one to the source of their anxiety. Though patients know these experiences aren’t real, that doesn’t change the preconscious response and fear activation of their limbic systems, manifesting in increased heart rate and production of the stress hormone cortisol. Our emotional command centers naturally suspend disbelief even when our logical minds know better, putting VR on par with real-life exposure therapy in clinical effectiveness, but with none of the travel costs or physical danger.

While early programs were calibrated to extinguish common phobias like fear of heights (balancing on a plank between skyscrapers), flying (sitting on the runway in a commercial aircraft) and spiders (progressing through increasingly realistic arachnid encounters), advancements in tech have allowed researchers to tailor more complex experiences, like crowded streets to stimulate social anxiety or traumatic memories for PTSD.

Starting in 2003, Rizzo modified a VR shooter game into an exposure tool called “BRAVEMIND” for veterans to reprocess their traumatic experiences, whether relating to IED blasts or sexual assault, with a therapist virtually recreating the memory as described.

“Most treatments out there for PTSD don’t have a lot of empirical evidence,” explains Rizzo. “The ones that do so far are ones that help a person focus on addressing the trauma, not avoiding it.”

The same principle seems to apply for another trial use of VR to treat schizophrenia. Traditionally, therapists advise patients to ignore auditory hallucinations, but a University of Montreal research team instead helped them create and interact with virtual avatars for the voices in their heads. While four of 19 subjects quit after the first session, the remaining 15 rated each interaction less frightening than the last, and their hallucination-related distress dropped an average of 5 points on a scale of 20 by the study’s end.

More recently, Rizzo and others have taken VR a step further, exploring something increasingly unheard of in American healthcare – prevention.

“BRAVEMIND” was retooled into the award-winning training simulation “STRIVE,” or Stress Resilience In Virtual Environments, preparing military members for the trials and traumas of combat before they’re deployed. Standing atop a vibrating platform in an immersive headset, recruits experience 15-minutes episodes at the midpoint of which an “emotionally challenging” event occurs based on real combat situations, such as the death of a civilian child or beating of a woman for infidelity. The scenario pauses, and a virtual “mentor” pulls players aside to help them process the event and teach physiological coping strategies, like deep breathing with a pair of onscreen lungs.

“We’re trying to engage people in stuff they normally get by way of death by PowerPoint,” says Rizzo. “We know experiential learning with a story sticks in the brain way more than somebody telling you in a lecture.”

Other psychological applications where VR has shown promise include weakening cravings that drive addiction and relapse, reducing body size overestimation in anorexia patients, imparting job interview skills to the autistic or formerly incarcerated, distracting from acutely discomforting procedures like chemotherapy and teaching mindfulness in ways that can engage and offer relief for even chronic pain sufferers. Some VR treatments are already rolling out to clinicians’ offices and consumers – “BRAVEMIND” and “STRIVE” are being donated by the charity SoldierStrong to VA offices across America, while the company Limbix offers $200 monthly subscriptions for a headset with their range of medical-grade VR apps.

Yet this ability to literally shape and heal human minds has mainly been overshadowed by commercial excitement for VR video games, not that Rizzo minds. Gaming industry investment has driven the technology to new heights in sensory immersion and new lows in cost – from $15k for a full setup in the ‘90s to $200 for a standalone headset today – giving it a clinical edge over pricier techniques like neuroimaging.

Now, however, Rizzo considers the incubation period for VR over and stresses the need to distinguish between entertainment versus health-related applications, lest business motives get in the way of credible science and set back public acceptance of the technology. There are many ethical considerations still to be sorted out as well, like ensuring providers have adequate training on the tech as well as patients’ needs and establishing safeguards for self-administered VR treatments.

“We’re not building games here,” Rizzo emphasizes, “we’re building experiences.”

But at the same time, that gaming element may be the key to VR’s revolutionary potential for healthcare. Effective treatment means nothing if people don’t use it, and the allure of VR, demonstrated time and time again in preliminary studies, could actually drive engagement and education in mental health as a whole. Just as the introduction of flight training simulators in the ‘30s led to a precipitous drop in aircraft accidents, this could be another immersive practice tool to minimize real-world distress, but with a universal scope and appeal well beyond that of any Game Boy.

via Virtual Reality + Psychiatry: VR Storytelling Could Transform Mental Health

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[ARTICLE] What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes – Full Text

Abstract

Background

Virtual-reality based rehabilitation (VR) shows potential as an engaging and effective way to improve upper-limb function and cognitive abilities following a stroke. However, an updated synthesis of the literature is needed to capture growth in recent research and address gaps in our understanding of factors that may optimize training parameters and treatment effects.

Methods

Published randomized controlled trials comparing VR to conventional therapy were retrieved from seven electronic databases. Treatment effects (Hedge’s g) were estimated using a random effects model, with motor and functional outcomes between different protocols compared at the Body Structure/FunctionActivity, and Participation levels of the International Classification of Functioning.

Results

Thirty-three studies were identified, including 971 participants (492 VR participants). VR produced small to medium overall effects (g = 0.46; 95% CI: 0.33–0.59, p < 0.01), above and beyond conventional therapies. Small to medium effects were observed on Body Structure/Function (g = 0.41; 95% CI: 0.28–0.55; p < 0.01) and Activity outcomes (g = 0.47; 95% CI: 0.34–0.60, p < 0.01), while Participation outcomes failed to reach significance (g = 0.38; 95% CI: -0.29-1.04, p = 0.27). Superior benefits for Body Structure/Function (g = 0.56) and Activity outcomes (g = 0.62) were observed when examining outcomes only from purpose-designed VR systems. Preliminary results (k = 4) suggested small to medium effects for cognitive outcomes (g = 0.41; 95% CI: 0.28–0.55; p < 0.01). Moderator analysis found no advantage for higher doses of VR, massed practice training schedules, or greater time since injury.

Conclusion

VR can effect significant gains on Body Structure/Function and Activity level outcomes, including improvements in cognitive function, for individuals who have sustained a stroke. The evidence supports the use of VR as an adjunct for stroke rehabilitation, with effectiveness evident for a variety of platforms, training parameters, and stages of recovery.

Background

Stroke is one of the leading global causes of disability [], with over 17 million individuals worldwide sustaining a stroke each year []. Although stroke mortality is decreasing with improvements in medical technology [], the neurological trauma resulting from stroke can be devastating, and the majority of stroke survivors have substantial motor [], cognitive [] and functional rehabilitation needs [], and much reduced quality of life []. Targeted rehabilitation can help address some of these post-stroke deficits, however, historically, many individuals, in particular patients with cognitive impairment, have difficulty engaging in standard therapies [] at a level that will produce meaningful and lasting improvements []. Enriched and interactive rehabilitation programs are clearly needed to minimize functional disability [], increase participation in age-appropriate roles and activities [], lead to greater motivation and treatment compliance [], and reduce the long-term expense of care in stroke survivors [].

Virtual reality

Virtual reality refers to simulated interactions with environments and events that are presented to the performer with the aid of technology. These so-called virtual environments may mirror aspects of the real world or represent spaces that are far removed from it, while allowing various forms of user interaction through movement and/or speech []. Virtual reality based rehabilitation, or Virtual Rehabilitation (VR), shows considerable promise as a safe, engaging, interactive, patient-centered and relatively inexpensive medium for rehabilitation training []. VR has the potential to target a wide range of motor, functional, and cognitive issues [], affords methods that automatically record and track patient performance [], and offers a high level of flexibility and control over therapeutic tasks []. This scalability allows patients to train at the highest intensity that would be possible for their individual ability [], while keeping the experience of interaction with therapeutic tasks enjoyable and compelling []. At the same time, VR may enable patients with a neurodisability (like stroke) to practice without excessive physical fatigue [] which otherwise may deter continued effort and engagement in therapy [].

Currently, there are two main types of VR: purpose-designed Virtual Environments (VE) and Commercial Gaming (CG) systems. Both types of systems can provide augmented feedback, additional forms of sensory feedback about the patient’s movement over and above the feedback that is provided as a natural consequence of the movement itself []. VE systems are often designed by rehabilitation scientists (and others) to enhance the delivery of augmented feedback in order to develop the patient’s sense of position in space [], to reinforce different movement parameters (like trajectory and endpoint) and reduce extraneous movements (e.g. excessive trunk displacement) [].

VE systems are also more likely to involve specially designed tangible user interfaces used in mixed reality rehabilitation systems [] or training of daily functional activities []. By comparison, CG rehabilitation systems are typically “off-the-shelf” devices such as Wii (Nintendo), Xbox (Microsoft) and PlayStation (Sony), which have the advantage of being readily available and relatively inexpensive when compared with VE systems []. On the other hand, CG systems are typically designed for able-bodied participants and may not consider the physiological, motor, and cognitive aspects of recovery in rehabilitation, and may lack the scalability of purpose-designed VE systems [].

Systematic reviews comparing VE and CG systems

There is conflicting evidence about the relative effectiveness of VE- and CG-based VR systems. In a recent Cochrane review of VR following stroke [], VE systems demonstrated a significant treatment effect on upper-limb function when compared to controls (d = 0.42; 95%CI: 0.07–0.76), while the effect for CG systems failed to reach significance (d = 0.50; 95%CI: -0.04-1.04); a caveat, however, was that only two of nine studies (22%) in these comparisons were CG-based. In contrast, a meta-analysis by Lohse and colleagues of VR following stroke [] found no significant difference between VE (g = 0.43, based on 13 studies) and CG interventions (g = 0.76, based on three studies) on Body Structure/Function level outcomes. For Activity level outcomes, CG interventions showed a large but non-significant effect (g = 0.76, p = 0.14), but was based on only four of 26 studies (15%); VE interventions, however, showed a significant treatment effect (g = 0.54, p < .001). Taken together, these two reviews suggest benefits of VE systems, while previous analyses of CG treatment effects have been underpowered and inconclusive.

Cognition and VR

Cognitive impairments, including difficulties in attention, language, visuospatial skills, memory, and executive function are common and persistent sequelae of stroke [] and exert considerable influence on rehabilitation outcomes []. Cognitive dysfunction may reduce the ability to (re-)acquire motor [] and functional skills [], and decrease engagement and participation in rehabilitation program []. While the important role of cognition in both conventional and VR-based rehabilitation is increasingly recognized [] the impact of VR on cognitive function has not yet been formally evaluated in a quantitative review.

Analysis of individual domains of functioning

The World Health Organization’s International Classification of Functioning, Disability, and Health (ICF-WHO []) is currently one of the most widely used classification systems. It is a foundation for understanding outcome effects in clinical practice [] and the preferred means for translating clinical findings in a patient-centered manner []. Under the ICF-WHO, disability and functioning are seen to arise by the interaction of the health condition, the environment, and personal factors, and can be measured at three main levels: (i) Body Structure/Function, (ii) Activity (or skill), and (iii) Participation. The ICF-WHO has been used to classify outcome measures in studies of VR (for example []) and in recent systematic reviews []. A brief critique of these reviews reveals a number of important conclusions, but also some significant gaps in the research.

An early systematic review by Crosbie and colleagues [] examined the efficacy of VR for stroke upon motor and cognitive outcomes. Of the 11 studies reviewed (up to 2005), only five addressed upper-limb function and two addressed cognitive outcomes. Overall, the review reported significant benefits of VR, but only three studies were RCTs and no effect size estimates were reported. At around the same time, a systematic review by Henderson and colleagues [] showed that there was very good evidence that immersive VR was more beneficial than no therapy for upper-limb rehabilitation in adult stroke, but insufficient evidence for non-immersive VR. Comparisons with traditional physical therapy were less impressive, however.

A 2016 systematic review by Vinas-Diz and colleagues [] included both controlled clinical trials and randomized controlled trials (RCTs) in stroke, and spanned 2009–2014. The review included 25 papers: four systematic reviews [] and 21 original trials. Evidence for treatment efficacy on upper-limb function was strong on a mix of measures like the Fugl-Meyer Test, Wolf Motor Function Test, and Motricity Index. However, a quantitative analysis of the effects was not undertaken, and important aspects of treatment implementation like dose and session scheduling were not formally examined.

A recent systematic review by Santos-Palma and colleagues [] examined the efficacy of VR on motor outcomes for stroke using the ICF-WHO framework, covering work published up to June 2015. Of the studies deemed high quality, 20 examined outcomes at the Body Structure/Function level, 17 at the Activity level, and eight examined Participation. Intriguingly, positive outcomes were evident only at the Body Structure/Function level, while results for Activity and Participation were not conclusive. Unfortunately, only three studies addressed manual ability at the Activity level, which severely limited any evaluation of skill-specific effects.

In a combined systematic review and meta-analysis of 37 RCTs published between 2004 and 2013, Laver and colleagues [] present a more comprehensive examination of the effects of VR on upper-limb function. As well, they classified outcomes broadly into upper-limb function, Activities of Daily Living (ADLs) and other aspects of motor function. In general, study quality was low, and the risk of bias high, in roughly one-half of the studies. Outcomes were significant for upper-limb function (d = 0.28) and ADLs (d = 0.43), but somewhat smaller than those reported by Lohse and colleagues []. Results for other aspects of motor function, including several at what may be considered the Body Structure/Function level, were non-significant. Dose varied considerably between studies, ranging from less than 5 h to more than 21 h in total. In general, studies that used higher doses (> 15 h of therapy) were reported as more effective. Unfortunately, results could not be pooled for cognitive outcomes, and the importance of additional treatment implementation parameters like training frequency and duration, and the impact of specific study design factors including the recovery stage of participants and type of control group (i.e. active vs passive) were not determined.

An updated systematic review by Laver and colleagues [], included an additional 35 studies that reported outcomes for upper limb function and activity. A subset of only 22 studies that compared VR with conventional therapy showed no significant effect of VR on upper-limb function (d = 0.07). As well, there was no significant difference between higher (> 15 h of therapy), and lower levels of dose. However, when VR was used in addition to usual care (10 studies; 210 participants), there was a significant effect on upper-limb outcomes (d = 0.49). As before, no significant difference was shown between high and low dose studies. Unfortunately, analysis of cognitive outcomes, and moderator analyses including study quality, and implementation parameters (e.g., daily intensity, weekly intensity, treatment frequency, and total number of sessions) were not included in the updated review. As well, the assessment of study quality was limited to the 5-item GRADE system, the ICF classification system was not given full consideration, and no distinction was drawn between treatment as usual (TAU) and active control groups (TAU + some form of additional therapy).

Taken together, recent reviews on the use of VR for adult stroke show encouraging evidence of efficacy at the level of Body Structure/Function, but mixed results for Activity and ADLs, and a paucity of evidence bearing on Participation. The impact and effectiveness of VR on cognitive outcomes also remains poorly understood, despite the important role of cognitive dysfunction in learning and rehabilitation [], and increased evidence of interconnection between cognitive function and motor deficits at the Body Structure/Function, Activity and Participation levels of the ICF []. VE-based platforms have been suggested to be superior to CG approaches [] in promoting motor function, but until recently there have been few CG studies available for analysis. As well, other design factors that may moderate treatment effects (like stage of recovery, control group type) have either not been explored or are too few in number to draw firm conclusions. There has been considerable variation in the total dose of VR therapy [], and no analysis has yet tested the dose-response relationship in moderator analyses. Finally, the bulk of conclusions have relied on qualitative synthesis, and there is a paucity of quantitative analysis of empirical data to inform opinion.

In view of limitations in past reviews and continued acceleration in VR the aim of our review was to conduct a systematic literature review and meta-analysis to re-evaluate the strength of evidence bearing on VR of upper-limb function and cognition in stroke. This review is critical given evidence that stroke rehabilitation needs to better optimize intervention techniques during the recovery windows that exist in the acute phase [] and beyond. Focusing only on RCTs, we consider outcomes across levels of the ICF-WHO, and analyze the moderating effect of design factors and dose-related parameters.

Methods

The current review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [], it should be noted that the protocol was not registered.

Data sources and search strategy

Scopus, Cochrane Database, CINAHL, The Allied and Complementary Medicine Database, Web of Science, MEDLINE, Pre-Medline, PsycEXTRA, and PsycINFO databases were systematically searched from inception until 28 June 2017. Boolean search terms included the following: “strokecerebrovascular disease, or cerebrovascular attack” and “Virtual realityAugmentrealityvirtual gam*” (see Appendix for an example of the full MEDLINE search strategy).

Inclusion and exclusion criteria

RCT studies published in English in peer-reviewed journals, utilizing a VR intervention to address either motor (upper-limb), cognitive, or activities of daily living in stroke patients were included in the current review (see Fig. 1). VR was defined as a type of user-computer interface that involves real-time simulation of an activity/environment, enabling the user to interact with the environment using motor actions and sensory systems. Comparison groups included “usual care”, “standard care” or “conventional therapy”, involving physical therapy and/or occupational therapy. Studies were excluded that applied a “hybrid” approach combining virtual reality with exogenous stimulation or robotics, targeted lower limb function, recruited a mixed study cohort including non-stroke participants, or did not utilize motor, cognitive, or participation outcome measures.

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Fig. 1
Population, Intervention, Comparison, Outcome (PICO) Question and the main variables included in the systematic literature review and meta-analysis

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Continue —-> What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes

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[Abstract] Cognitive Training in Young Patients With Traumatic Brain Injury: A Fixel-Based Analysis

Background. Traumatic brain injury (TBI) is associated with altered white matter organization and impaired cognitive functioning.

Objective. We aimed to investigate changes in white matter and cognitive functioning following computerized cognitive training.

Methods. Sixteen adolescents with moderate-to-severe TBI (age 15.6 ± 1.8 years, 1.2-4.6 years postinjury) completed the 8-week BrainGames program and diffusion weighted imaging (DWI) and cognitive assessment at time point 1 (before training) and time point 2 (after training). Sixteen healthy controls (HC) (age 15.6 ± 1.8 years) completed DWI assessment at time point 1 and cognitive assessment at time point 1 and 2. Fixel-based analyses were used to examine fractional anisotropy (FA), mean diffusivity (MD), and fiber cross-section (FC) on a whole brain level and in tracts of interest.

Results. Patients with TBI showed cognitive impairments and extensive areas with decreased FA and increased MD together with an increase in FC in the body of the corpus callosum and left superior longitudinal fasciculus (SLF) at time point 1. Patients improved significantly on the inhibition measure at time point 2, whereas the HC group remained unchanged. No training-induced changes were observed on the group level in diffusion metrics. Exploratory correlations were found between improvements on verbal working memory and reduced MD of the left SLF and between increased performance on an information processing speed task and increased FA of the right precentral gyrus.

Conclusions. Results are indicative of positive effects of BrainGames on cognitive functioning and provide preliminary evidence for neuroplasticity associated with cognitive improvements following cognitive intervention in TBI.

via Cognitive Training in Young Patients With Traumatic Brain Injury: A Fixel-Based Analysis – Helena Verhelst, Diana Giraldo, Catharine Vander Linden, Guy Vingerhoets, Ben Jeurissen, Karen Caeyenberghs,

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[WEB SITE] What is neurohacking and can it actually rewire your brain?

Marc Bordons / Stocksy

What is neurohacking and can it actually rewire your brain?

Although at one point, “hack” referred to a creative solution to a tech problem, the term can apply to pretty much anything now. There are kitchen hacks, productivity hacks, personal finance hacks. Brain hacks, or neurohacks, are among the buzziest, though, thanks largely to the Silicon Valley techies who often swear by them as a way to boost their cognitive function, focus, and creativity. Mic asked a neuroscientist to explain neurohacking, which neurohacking methods are especially promising, which are mostly hype, and how to make neurohacking work for you.

First things first: Neurohacking, is a broad umbrella term that encompasses anything that involves “manipulating brain function or structure to improve one’s experience of the world,” says neuroscientist Don Vaughn of Santa Clara University and the University of California, Los Angeles. Like the other myriad forms of hacking, neurohacking uses an engineering approach, treating the brain as a piece of hardware that can be systematically modified and upgraded.

Neurohacking techniques can fall under a number of categories — here are a few of the most relevant ones, as well as the thinking behind them.

Brain stimulation

This involves applying an electric or magnetic field to certain regions of the brain in non-neurotypical people to make their activity more closely resemble that seen in a neurotypical brain. In 2008, the Food and Drug Administration approved transcranial magnetic stimulation (TMS) — a noninvasive form of brain stimulation which delivers magnetic pulses to the brain in a noninvasive manner — for major depression. Since then, the FDA has also approved TMS for pain associated with migraines with auras, as well as obsessive-compulsive disorder. Established brain stimulation techniques (such as TMS or electroconvulsive therapy) performed by an expert provider, such as a psychiatrist or neuroscientist, are generally safe, Vaughn says.

Neurofeedback

This one involves using a device that measures brain activity, such as an electroencephalogram (EEG) or a functional magnetic resonance imaging (fMRI) machine. People with neuropsychological disorders receive feedback on their own brain activity — often in the form of images or sound — and focus on trying to make it more closely resemble the brain activity in a healthy person, Vaughn says. This could happen through changing their thought patterns, Vaughn says. Another possibility is that the feedback itself, or the person’s thoughts about the feedback, may somehow lead to a change in their brain’s wiring.

Reducing cognitive load

This means minimizing how much apps, devices, and other tech compete for your attention. Doing so can sharpen and sustain your focus, or what Vaughn refers to as your attention quotient (AQ). To boost his AQ, Vaughn listens to brown noise, which he likens to “white noise, but deeper.” (Think the low rush of a waterfall versus pure static.) He also chews gum, which he says provides an outlet for his restless “monkey mind” while still allowing him to focus on the task at hand.

Reducing cognitive load can also deepen your connection with others. Vaughn uses Voicea, an app based on an AI assistant that takes and store notes of meetings, whether over the phone or in-person, allowing him to focus solely on the conversation, not on recording it. “If we can quell those disruptions that occur because of the way work is done these days, it will allow us to focus and be more empathic with each other,” he says.

Monitoring sleep

Tracking your sleep patterns and adjusting them accordingly. Every night, you go through around five or so stages of sleep, each one deeper than the last. “People are less groggy and make fewer errors when they wake up in a lighter stage of sleep,” Vaughn says. He uses Sleep Cycle, an app that tracks your sleep patterns based on your movements in bed to rouse you during your lightest sleep stage.

Andrey Popov / Shutterstock

Microdosing

Microdosing is the routinely consumption of teensy doses of psychedelics like LSD, ecstasy, or magic mushrooms. Many who practice microdosing follow the regimen recommended by James Fadiman, psychologist and author of The Psychedelic Explorer’s Guide: Safe, Therapeutic, and Sacred Journeys: a twentieth to a tenth of a regular dose, once every three days for about a month. While a regular dose may make you trip, a microdose has subtler effects, with some users reporting, for instance, enhanced energy and focus, per The Cut.

Nootropics

These are OTC supplements or drugs taken to enhance cognitive function. They range from everyday caffeine and vitamin B12 (B12 deficiency has been associated with cognitive decline) to prescription drugs like Ritalin and Adderall, used to treat ADHD and narcolepsy, as well as Provigil (modafinil), used to treat extreme drowsiness resulting from narcolepsy and other sleep disorder. (All three of these drugs promote wakefulness.) The science behind nootropic supplements in particular remains rather murky, though.

Does neurohacking work, though?

Vaughn finds microdosing, neurostimulation, and neurofeedback especially promising for neuropsychological disorders. Although studies suggest that larger doses of psychedelics could help with disorders such as PTSD and treatment-resistant major depression, there are few studies on microdosing psychedelics. “The little science that has been done…is mixed—perhaps slightly positive,” Vaughn says. “Microdosing is promising mainly because of anecdotal evidence.” Meanwhile, neurostimulation can be used noninvasively in some cases, and TMS has already received FDA approval for a handful of conditions. Neurofeedback is not only non-invasive, but offers immediate feedback, and studies suggest it could be effective for PTSD and addiction.

But it’s important to note that just because these methods could positively alter brain function in people with neuropsychological disorders, that “doesn’t mean it’s going to take a normal system and make it superhuman,” Vaughn says. “I think there are lots of small hacks to be done that could add up to something big,” rather than huge hacks that can vastly upgrade cognitive function, a la Limitless. Thanks to millions of years of evolution, the human brain is already pretty damn optimized. “I just don’t know how much more we can tweak it to make it better,” Vaughn says.

As far as enhancements for neurotypical brains, he says that “you’ll probably see a much greater improvement” from removing distractions in your environment to reduce cognitive load than say, increasing your B12 intake — which brings us to an important disclaimer about nootropic supplements in particular. As with all supplements, they aren’t FDA-regulated, meaning that companies that sell them don’t need to provide evidence that they’re safe or effective. Vaughn recommends trying nootropics that research has shown to be safe and effective, like B12 or caffeine.

How can I start neurohacking?

As tempting as it is, adopting every neurohack under the sun is “not the answer,” Vaughn says. Remember, everyone is different. While your best friend may gush about how much her mood has improved since she began microdosing shrooms, your brain might not respond to microdosing—or maybe taking psychedelics just doesn’t align with your ethics.

Start by exploring different neurohacks, and of course, be skeptical of any product that makes outrageous claims. Since neurofeedback isn’t a common medical treatment, talk to your doctor about enrolling in academic studies on neurofeedback, or companies that offer it if you’re interested, Vaughn says. You should also talk to your doctor if you want to try brain stimulation. A doctor can prescribe you Adderall, Ritalin, or Provigil but only for their indicated medical uses, not for cognitive enhancement.

Ultimately, neurohacks are tools, Vaughn says. “You have to find the one that works for you.” If anything, taking this DIY approach to improving your brain function will leave you feeling empowered, a benefit that probably rivals anything a supplement or sleep tracking app could offer.

 

via What is neurohacking and can it actually rewire your brain?

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[BLOG POST] How To Cope with Sensory Overload after Brain Injury

How To Cope with Sensory Overload after Brain Injury

Sensory overload, also known as hypersensitivity, occurs when the brain’s filters no longer work properly. Unlike a healthy brain, which can identify and filter out irrelevant or unnecessary information, an injured brain often cannot.

As a result, normal, everyday stimuli can be uncomfortable, overwhelming, or unbearable. Sounds that before your injury were barely noticeable may be alarming and uncomfortable. Crowds may feel overwhelming. Clothing that was once comfortable may be irritating. Bright light can be distressing and might give you a headache.

Flooded is a word that is often used to describe the overstimulated brain. A brain that is flooded with information can shut down or freeze. It can become difficult or even impossible to continue a conversation or make a decision. Agitation and anxiety are common symptoms, but some may even experience panic attacks, nausea, or vomiting.

Hypersensitivity is more common after a mild brain injury, whereas people with severe brain injuries more often experience a loss of sensory function.

Types of Sensory Overload

Sensory overload can affect one, several, or all the senses.

  1. Sight (light intensity, light color)
  2. Sound
  3. Smell
  4. Touch (heat, cold, pressure)
  5. Taste
  6. Balance (movement, spatial awareness)

Factors that can Exacerbate Hypersensitivity

There are some factors that can stress your brain, lowering your ability to adapt to stimuli and exacerbating hypersensitivity. It is good to keep these in mind and plan accordingly.

  1. Fatigue
  2. Lack of sleep
  3. Pain
  4. Heat

Common Symptoms of Sensory Overload

  1. Fatigue
  2. Unable to think clearly
  3. Unable to respond/ feeling “frozen”
  4. Anxiety
  5. Agitation
  6. Panic attacks
  7. Difficulty breathing
  8. Migraine
  9. Nausea/vomiting

How to Deal with Sensory Overload

Common Triggers and Coping Suggestions

Note Hypersensitivity is not something that I personally deal with. If you feel that I have misrepresented any information please let me know. If you know other tips or strategies let that I have neglected to include let me know and I will promptly add them.

Light

  1. Try avoiding bright light and fluorescent lights
  2. Limit exposure to TV, phone, and computer screens
  3. Adjust electronics to display yellow light instead of blue light
  4. Wear sunglasses when needed, even indoors
  5. Wear syntonic light therapy glasses (see below)

Noise

  1. Limit time spent in noisy stores or at events
  2. Wear earplugs or noise cancelling earmuffs (see below)
  3. Ask family members to use headphones when listening to music or watching TV shows
  4. This may seem counter intuitive, but for some people adding quiet, calming background noise can help – sound machine, fan, or peaceful music
  5. When attending an event that you know will be taxing, plan to stay for a short time and/or plan time to rest afterwards
  6. If you feel a situation start to become overwhelming, excuse yourself to a quiet place like the bathroom, close your eyes, and take slow deep breaths

Crowds

  1. Go grocery shopping and run other errands early in the morning
  2. Eat at restaurants between meal times when they are less busy
  3. Plan time to rest after going out

How to Cope with Sensory Overload after Brain Injury - How To Brain

More General Coping Strategies

Planning

Plan any even that could potentially lead to overstimulation. You may need to plan time to rest before and after the event or plan to only stay for part of the event. Sometimes it may even be helpful to plan what you will do if things do not go as expected.

Make a grocery list before going shopping. If there is a chance that the store might not carry an item, consider if you will buy a substitute or go without.

If you are attending an event for the first time since your injury and do not know how it will affect you, explain this to the people joining you. When going to the movies, a concert, or a sporting event it may be a good idea to sit towards the back. It will be slightly less stimulating and you will be able to leave easily, if the need should arise.

Include other senses

Identify the stimuli that is bothering you and add in one that isn’t. For example, if a sound is bothersome try sucking on a peppermint or cinnamon candy. Or if a crowd is overwhelming squeezing a stress ball.

Syntonic light therapy glasses

I would love to get feedback from you guys on this one. Prior to researching for this post, I had not heard of syntonic therapy. But, if the claims made about it are true, it seems that many survivors could benefit from syntonic therapy.

Syntonic therapy glasses have colored lens. Depending on your symptoms, a certain color can be prescribed to alter signals the brain is sending and positively influence the vision system. They claim to be particularly beneficial for brain injury survivors, especially those suffering from light sensitivity and headaches.

If you are interested here is a little more information:

Explanation of Syntonic Therapy (article)
Explanation of Syntonic Therapy (short video)
Brain Injury Success Story

Musicians’ earplugs

I would suggest trying cheap foam ones from the grocery store first, as these seem to work well enough for most people. However, if you find that they do not block enough of the background noise, you can be prescribed custom earplugs by audiologist.

These custom earplugs are traditionally used by musicians but can be helpful for brain injury survivors with hypersensitivity to sound.  The article below explains the benefits of musicians’ earplugs over traditional earplugs for sound hypersensitivity resulting from brain injury.

Musicians’ Earplugs vs. Traditional Earplugs

Exposure

Try to slowly build up tolerance to the problematic stimuli. Though avoiding the stimulus entirely may be the most comfortable, doing so could increase your hypersensitivity to that stimulus overtime. When doing this pay close attention to your body and plan an “out” for yourself should you feel the need to rest.

Communication

You cannot expect family members, friends, and coworkers to know what you are going through if you have not told them. Let them know which stimuli are troublesome for you and what they can do to help – be as specific as possible.

What Can You do as a Loved One of a Survivor with Hypersensitivity?

The single biggest thing you can do is to be supportive. Ask your loved one what triggers sensory overwhelm for them and actively try to create an environment that is not overwhelming for them.

If they ask you to stop talking so that they can process what has already been said, listen to them. Do not continue talking until they are ready for you to do so.

When planning outings keep in mind that heat, pain, and lack of sleep can intensify hypersensitivity. Be understanding if they need to cut the outing short.

What coping strategies do you use to deal with hypersensitivity? 

How to Cope with Sensory Overload after Brain Injury - How To Brain

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[WEB SITE] Communication problems after brain injury

Communication problems after brain injury are very common. Although most of us take it for granted, the ability to communicate requires extremely complex skills and many different parts of the brain are involved.

There are four main categories of the effects of brain injury. Any of these can cause communication problems:

  • Physical – affecting how the body works
  • Cognitive – affecting how the person thinks, learns and remembers
  • Emotional – affecting how the person feels
  • Behavioural – affecting how a person acts

Many people will experience more than one form of communication problem after brain injury, depending on the areas of the brain affected and the severity of the injury. It is also important to recognise that such problems may occur alongside other changes in physical, cognitive, emotional and behavioural functions.

The diagram below shows the cerebral cortex. The cortex is the outer part of the brain, which is responsible for our more sophisticated thinking skills. Many of the functions listed are important for communication and injury to any of these areas can impair communication skills.

This section explains some of the ways brain injury can affect communication.

  • Language impairment – aphasia (often called dysphasia)
    Covers problems with understanding language and expressing thoughts through language. Also covers problems with reading and writing.
  • Speech difficulties
    Discusses disorders of speech that can occur after brain injury.
  • Cognitive communication difficulties
    Covers some of the problems with communication caused by cognitive difficulties, such as memory impairment, attention difficulties, poor social skills and fatigue.

Our booklet Coping with communication problems after brain injury provides more in-depth information about the issues covered here, and you can contact the Headway helpline if you have any further questions.

via Communication problems | Headway

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[WEB SITE] Quiz: What Type of Therapy is Best for You?

Quiz: What Type of Therapy May Be Best for You?

Medically reviewed by psychologist Sarah Schewitz, Psy.D.

Walking into therapy for the first time can feel a little like walking into “The Twilight Zone.” It’s hard to know what to expect and intimidating to think you’ll be sharing so much information with a stranger. Not to mention, each type of therapy has its own guidelines and perspective. And, while the relationship you have with your clinician is perhaps the most important indicator of how well therapy will work for you, not every type of therapy will be a good fit.

Before booking your first therapy session or enrolling in a program, it’s a good idea to find out how your new therapist might meet your needs. After all, you don’t want to be stuck in a room with a counselor whose thoughts on what’s going on for you just don’t jive at all with your experience. Plus, doing a little legwork ahead of time to match the type or types of therapy a counselor uses can help you determine who you might have the best relationship with.

Although some professionals and programs strictly adhere to one type of therapy, many now use several different types of therapy to work with clients. This lets them borrow important skills from each type to better serve your needs. These therapists consider themselves integrative or even eclectic. Keep this in mind as you’re looking for therapist — and taking the following quiz.

This quiz is not professional or medical advice, but simply a way to introduce you to some of the more common types of therapy out there — these are only four of dozens of options. Your results from this quiz will help guide you to what type of therapy may be a good fit for you.

Don’t be worried about answering the questions perfectly. There are no wrong answers. When you are finished with the quiz you will receive your match. For more information on each type of therapy, check below the quiz for more information and where you can find counselors who use those skills in their practice.

Without further ado, visit WEB SITE to TAKE the QUIZ

Cognitive Behavioral Therapy (CBT)

It’s been said what you think is who you are. Just ask Ralph Waldo Emerson, Mahatma Gandhi — or even the Bible. Cognitive behavioral therapy (CBT) borrows a little from this concept: By changing your thoughts, you can also change your emotions and behaviors for a more satisfying life.

In the CBT world, your current thoughts, emotions and behaviors interact with each other. By addressing thoughts that don’t help you, CBT therapists believe you’ll start to experience more well-being. Typically, CBT doesn’t delve way back into your childhood and it’s a format that might include homework, like keeping a log of unhelpful thoughts that might pop into your head that make you feel depressed. It’s skills-based and action-oriented, so this is a good fit if you like to get things done efficiently and in a shorter amount of time — CBT therapy is usually completed in less than 20 sessions.

Because CBT is generally very structured and focuses on concrete, in-the-moment skills, it’s especially helpful if you’re dealing with an anxiety or panic disorder, a specific phobia or obsessive-compulsive disorder (OCD). Many people with depression, suicidal ideation or self-harm, substance use disorders and eating disorders also find CBT helpful. If you live with chronic pain, your treatment team may recommend CBT because it can help you accept the pain you can’t change and learn new coping skills.

You can find CBT therapists through the Association for Behavioral and Cognitive Therapies (ABCT) or Academy of Cognitive Therapy websites.

Dialectical Behavioral Therapy (DBT)

If things feel out of control and super intense — your emotions, relationships, even sometimes your behaviors — dialectical behavior therapy (DBT) is designed with exactly that in mind. This form of therapy focuses on four main areas to help you master your well-being, including mindfulness, distress tolerance, emotion regulation and interpersonal relationships.

DBT was created to treat borderline personality disorder (BPD) and those who struggle with persistent suicidal thoughts or self-harm. One of DBT’s strengths is it gives you a toolbox full of useful life skills so you feel more in control, especially when you didn’t learn those basic emotion regulation or relationship skills earlier in life. DBT is also useful if you’re dealing with other mental health conditions like post-traumatic stress disorder (PTSD), substance use disorders and eating disorders, among others.

There are a couple ways you can do DBT. The traditional, full program includes individual sessions with a DBT therapist, a weekly group skills class and phone coaching between sessions. This can get expensive, so you can also look for a therapist with training to incorporate DBT skills into your regular sessions or participate in just a group skills class.

In whatever context you try DBT, be prepared to work. Studies show DBT can be incredibly effective but you’ll have homework, be expected to track your progress and practice your skills regularly. And know DBT is full of acronyms that might seem overwhelming at first, but soon you’ll be PLEASE-skilling and DEAR MAN-ing like a pro.

To find a DBT therapist near you, search the directories on Behavioral Tech or DBT-Linehan Board of Certification.

Psychodynamic

The premise of psychodynamic therapy is very much based in exploring how the current issues you are dealing with and who you are today originated from your early experiences. By talking through the free associations that come to mind from your past, present, future and dreams, you work with a therapist to find meaning and understanding from your history. These therapists especially focus on their relationship with you, and, traditionally, they use their reactions to you and relationship with you as another tool to help you understand yourself. Relationship is key in psychodynamic formats.

If you’re not a fan of a strict format or homework, are drawn to almost exclusively talk therapy and want to focus on how your past affected you, the more free-flowing nature of psychodynamic therapy may be a good fit for you. Over the years research has shown psychodynamic therapies can help with a variety of mental health conditions, particularly if you’ve experienced trauma.

However, because of the more open format of psychodynamic therapy, if you’re struggling with suicidal thoughts or an active substance use or eating disorder, traditional psychodynamic therapy might not be a good idea. A more structured, skills-based therapy might be needed to make sure you’re safe first. If you still want to work with a psychodynamic therapist in these instances, be sure to ask if they also have training in skills designed to keep you safe during higher-risk times in your life.

Find a psychodynamic therapist near you on Psychology Today.

Interpersonal Psychotherapy (IPT)

If you want to approach your mental health from a well-rounded perspective that takes into account your physical, social, emotional and spiritual health, you might be drawn to interpersonal psychotherapy (IPT). Its major tenant suggests struggles in your interpersonal relationships are directly connected to your mental health symptoms. IPT also believes in the medical model of mental illness, so if you often find yourself comparing dealing with a mental illness to a physical illness, IPT might suit you.

This type of therapy focuses mostly on the present and not on therapy itself, but your life in the real world. IPT is very structured and lasts a set amount of time, usually 12 to 16 sessions. It’s based on attachment — the idea your connections with others is one of the most important aspects of your emotional health. By examining and exploring issues in your current relationships, an IPT therapist works to help you develop stronger connections to reduce your mental health symptoms. This work is done using techniques like role-playing and analyzing how you communicate.

IPT was originally created to treat major depressive disorder and studies also found it’s effective for conditions like anxiety and eating disorders. It’s also helpful when you’re moving through transitions in your life, like a divorce, a move to a new city or a new job. This form of therapy can be used in group therapy settings as well.

You can search for an interpersonal psychotherapist near you on Psychology Today.

If there’s a specific type of therapy you want to try, it may be hard to find a professional in your area that’s affordable and available. If you’re having a hard time finding a local therapist, you’re not alone. You can call the National Alliance on Mental Illness (NAMI) Helpline for assistance finding mental health treatment resources in your area, including therapy and group support. Mental Health America also provides a resource list for other ways you can find referrals and mental health resources.

via Quiz: What Type of Therapy is Best for You? | The Mighty

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