Archive for category cognitive

[WEB SITE] How OCD and Traumatic Brain Injury Are Linked

Traumatic brain injuries can cause symptoms of obsessive compulsive disorder

Head bandage

Andrew Simpson / Getty Images

Traumatic brain injury (TBI) caused by motor vehicle accidents, falls or other accidents and firearms can cause a wide variety of cognitive issues. In addition to cognitive problems, if you’ve experienced a brain injury, you may also develop symptoms consistent with one or more forms of mental illness including obsessive-compulsive disorder (OCD).

TBI occurs when the brain is injured or damaged by an outside force such as a blow to the head or a gunshot.

TBIs can occur as a closed head injury in which the skull and brain remain intact, like what is seen among professional athletes such as football players, or as a penetrating head injury in which an object penetrates the skull and brain. TBI is often classified according to the severity of injury—mild, moderate or severe.

Common Changes Caused By TBI

If you have experienced a TBI you may also notice a change in your cognitive functioning. After a TBI, your performance on everyday tasks requiring memory, language, spatial or verbal ability may be negatively affected. This can be either temporarily or permanently.

If the TBI affects motor centers within the brain, mobility may also be impaired, and you may need a mobility device like a wheelchair or help with day to day tasks. TBI can also affect your behavior, causing changes in your personality. It is possible, after a TBI, that a previously calm person may become impulsive or aggressive.

Likewise, an outgoing individual may become shy and withdrawn.

TBI and Symptoms of OCD

In addition to changes in cognitive function, behavior, and mobility, TBI can trigger symptoms of OCD including obsessions and compulsions. OCD following a TBI usually occurs soon, if not immediately, after the event has taken place.

However, there have been reports of TBI-induced OCD being diagnosed months after the initial injury. In each case, localized brain damage may or may not be present when viewing a brain scan.

Research has indicated that OCD following a TBI is usually accompanied by symptoms of major depression. Whether this depression is a result of the TBI, the psychosocial stress caused by the injury, the onset of OCD, or a combination of these factors is unclear.

Treating TBI-Related OCD

If you developed OCD after a traumatic brain injury, your doctor may recommend a selective serotonin reuptake inhibitors such as Prozac (fluoxetine) or a tricyclic antidepressant such as Anafranil (clomipramine).

Psychotherapy for OCD following a TBI may also be helpful. However, since cognitive impairment is common among those with TBI, cognitive-based therapies may not be the best option for everyone and should be evaluated on a case by case basis. If you can, choose a supportive therapy which assists you and helps you cope with both the practical and emotional challenges associated with TBI and OCD.

Sources

  • Coetzer, B.R.“Obsessive-compulsive disorder following brain surgery” International Journal of Psychiatry and Medicine 2004 34: 363-377.
  • Grados, M.A. “Obsessive-compulsive disorder after traumatic brain injury” International Review of Psychiatry 2003 15: 350-358.

Source: How OCD and Traumatic Brain Injury Are Linked

, , ,

Leave a comment

[ARTICLE] Robotic-assisted serious game for motor and cognitive post-stroke rehabilitation – Full Text PDF

 

Abstract

Stroke is a major cause of long-term disability that can cause motor and cognitive impairments. New technologies such as robotic devices and serious games are increasingly being developed to improve post-stroke rehabilitation. The aim of the present project was to develop a ROBiGAME serious game to simultaneously improve motor and cognitive deficits (in particular hemiparesis and hemineglect). In this context, the difficulty level of the game was adapted to each patient’s performance, and this individualized adaptation was addressed as the main challenge of the game development. The game was implemented on the REAplan end-effector rehabilitation robot, which was used in continuous interaction with the game. A preliminary feasibility study of a target pointing game was run in order to validate the game features and parameters. Results showed that the game was perceived as enjoyable, and that patients reported a desire to play the game again. Most of the targets included in the game design were realistic, and they were well perceived by the patients. Results also suggested that the cognitive help strategy could include one visual prompting cue, possibly combined with an auditory cue. It was observed that the motor assistance provided by the robot was well adapted for each patient’s impairments, but the study results led to a suggestion that the triggering conditions should be reviewed. Patients and therapists reported the desire to receive more feedback on the patient’s performances. Nevertheless, more patients and therapists are needed to play the game in order to give further and more comprehensive feedback that will allow for improvements of the serious game. Future steps also include the validation of the motivation assessment module that is currently under development.

Full Text PDF

 

, , , , , , , , , , ,

Leave a comment

[WEB SITE] OCD linked to inflammation in the brain

 

Woman washing hands OCD
A common symptom of OCD is an obsession with cleanliness.
Obsessive-compulsive disorder is an intrusive condition that remains difficult to treat. This is due, in part, to the causes behind the disorder remaining hidden. Recent research, however, points the finger at brain inflammation.

Obsessive-compulsive disorder (OCD) is characterized by uncontrollable obsessions and compulsions. Individuals with OCD may experience intrusive thoughts that produce anxiety or a need to repeat certain actions to relieve pent-up anxiety.

Common obsessions in OCD revolve around cleanliness, sexual taboos, aggressive thoughts, and symmetry.

Affecting an estimated 1 percent of people in the United States, around half of OCD cases are classed as severe.

OCD is generally treated with talking therapies – in particular, a type of cognitive behavior therapy called exposure and response prevention is recommended. There are also some medications available, with selective serotonin reuptake inhibitors being the most commonly prescribed. Currently, however, therapies only work for around 70 percent of OCD-affected individuals.

One of the biggest stumbling blocks to finding good treatments is that the physical causes of OCD are not known.

Inflammation and OCD

Breaking research published this week in JAMA Psychiatry takes a look at the role of brain inflammation in OCD. The senior author of the study is Dr. Jeffrey Meyer, head of the Neuroimaging Program in Mood & Anxiety at the Centre for Addiction and Mental Health in Toronto, Canada.

Inflammation is a natural process; it is a normal component of the immune response and a standard reaction to injury. However, if the level of inflammation is inappropriate or continues for too long, it can have negative consequences. For instance, in a number of diseases including rheumatoid arthritis and atherosclerosis, inflammation is heavily involved.

Growing evidence suggests that certain psychiatric conditions may involve neuroinflammation, some of which include major depressive disorder, schizophrenia, and bipolar.

Dr. Meyer and his team set out to understand whether inflammation in the brain could play a role in the development of OCD. To this end, they recruited 40 participants, comprising 20 with OCD and 20 without. Each was scanned using positron emission tomography that had been adapted to pinpoint and measure inflammation in the brain.

Specifically, the researchers were able to selectively dye microglia, which are cells that act as the nervous system’s most prominent immune defense and which are activated during inflammation. The researchers measured levels of microglia in six brain regions known to be important in OCD, including the orbitofrontal cortex and anterior cingulate cortex.

The results were clear: in the brain regions associated with OCD, individuals with the disorder had 32 percent more inflammation when compared with people without the condition.

This finding represents one of the biggest breakthroughs in understanding the biology of OCD, and may lead to the development of new treatments.”

Dr. Jeffrey Meyer

From inflammation to treatment

Another interesting finding was that individuals who reported the highest levels of stress when trying to stop themselves from acting on compulsions also had the highest levels of inflammation in a particular brain region.

As so many diseases involve inflammation, there are already a range of drugs designed to tackle it. Because these drugs already exist on the market, it may be a fruitful avenue of research in the hunt for more effective treatments for OCD.

“Medications developed to target brain inflammation in other disorders could be useful in treating OCD,” Dr. Meyer says. “Work needs to be done to uncover the specific factors that contribute to brain inflammation, but finding a way to reduce inflammation’s harmful effects and increase its helpful effects could enable us to develop a new treatment much more quickly.”

Studies are now under way that examine the possibility of designing a blood marker test that could distinguish which patients would benefit most from anti-inflammatory drugs.

Although, as ever, more research is needed, this finding could mark a significant move forward in understanding and treating OCD.

Learn how certain gene mutations can cause OCD-like behaviors.

Source: OCD linked to inflammation in the brain – Medical News Today

, ,

Leave a comment

[BLOG POST] Combating Struggles with Acquired Brain Injury

The physical, neurological and emotional challenges that may arise from an acquired brain injury (ABI) are vast. Different causes and injuries create consequences that vary among individuals. Therapists need to be perceptive in order to both address struggles and provide avenues for constructive thinking.

One of the largest hurdles therapists encounter in rehabilitation with individuals who have suffered an ABI is the patient often lacks insight into their own deficits. Their injured brain signals they are fine and can successfully perform activities they used to do before injury, when in fact they may be struggling with anything from orientation and memory to executive function. This is challenging for family members and caregivers and is also is a barrier for treatment if the patient does not come to terms with these new deficits. Although insight typically improves to some degree as the patient progresses, giving the right level and amount of explanation about what has happened and future planning is helpful.

A thorough evaluation should be completed early on to identify cognitive deficits. Once strengths and deficits are identified, treatment can begin. Include tasks to promote gains in deficit areas such as memory and attention, such as deductive and/or abstract reasoning tasks, working memory tasks or word-retrieval activities. Also think about how strengths can be utilized to assist in this processIf a patient’s reading comprehension is better than auditory comprehension, printed information should be used to improve their ability to comprehend spoken information.

Combat common struggles by demonstrating compensatory strategies that aid the individual in participating in life activities. For patients experiencing memory and organization deficits, be prepared with a list of smart phone apps and functions they can use to set alerts for appointments, manage tasks, make lists, etc.

Fatigue is common in individuals recovering from a brain injury. Their brain is working “overtime” to make sense of things, and performing tasks successfully may take a great deal of conscious thought and effort. Assist patients in creating a schedule to work on their cognitive exercises and/or stay active in doing their daily activities, and include rest to help the brain recover. Once the brain begins to fatigue, there is a decrease in function. The patient will notice activities and tasks become harder, and head pain may also occur. This should signal the patient that it’s time to rest.

Lastly, there are things the brain injury survivor can focus on that will help their recovery, including:

  • Accepting their new persona
  • Allowing themselves to make mistakes
  • Striving to keep a positive attitude
  • Remembering they can continue to improve

Continued improvements may be the most important point in keeping your patient motivated. In years past, it was commonly accepted that after a window of about three years, the brain would not have any further recovery. It is now known that neuroplasticity allows for continued recovery over time with focused effort. Different parts of the brain can establish neuropathways and take over functions lost through damage to other parts of the brain.

Area Manager Jean Herauf, SLP has 30+ years’ experience, more than 20 of them with RehabVisions. Jean is active in her clinic’s local brain injury support group and has attended numerous courses over the years, and read a good deal on ABI.

Source: Combating Struggles with Acquired Brain Injury – RehabVisions

, , , , ,

Leave a comment

[BLOG POST] Recognizing the Signs of PTSD After Stroke

Post-Traumatic Stress Disorder (PTSD) is a condition that runs its victims down emotionally and physically. Though most frequently linked to combat veterans and sexual-assault survivors, PTSD can present itself following any traumatic experience, and that includes medical emergencies. Following a stroke and its resulting medical treatment, it is common for patients to feel overwhelmed.

 

According to a study published in the journal PLoS ONE in June of 2013, almost one quarter of patients who survive a stroke will suffer from PTSD. Unfortunately, it is common for the symptoms of PTSD following a stroke to go unnoticed; due to the intense nature of physical recovery, the psychological hardship associated with it can lead to increased risk for heart disease or another stroke.

 

What is PTSD?

After experiencing or witnessing a traumatic event, such as a medical emergency, natural disaster, or an assault, it is difficult to adjust to everyday life again. Some people may struggle with relaxing or sleeping, have flashbacks or unsettling memories, or feel constant anxiety.

This psychological reaction is common and very frustrating. The good news is that it typically diminishes, and life returns to normal over the course of weeks or months, depending on the severity of the event. If a patient is experiencing these mental health symptoms for longer than a few weeks or months, whether constant or in waves, it is possible that they may have PTSD.

 

Symptoms of PTSD After Stroke

It is important to know the signs and symptoms of PTSD so that you can recognize them in a patient or loved one you are caring for after a stroke. Common symptoms of PTSD include experiencing a traumatic event over and over again, having nightmares, or being unable to stop thinking about it. To add to these extremely uncomfortable experiences, victims can also feel  general, unyielding anxiety and try to avoid reminders of the event that started their suffering. They can also be tortured with feelings of self-doubt or misplaced guilt after a stroke or other traumatic event, a state of hyperarousal, or feeling overly alert.

If you are worried that a patient or family member is suffering from PTSD, ask them questions such as:

  • Are you having nightmares?
  • How are you coping?
  • How does this make you feel?

These questions can help the patient discuss their symptoms and improve the likelihood of psychological recovery.

 

TIA and PTSD

Transient Ischemic Attack (TIA), also known as a mini stroke, can increase the likelihood of developing PTSD because the fear of having a stroke may become overwhelming. According to a study published in the American Heart Association journal Stroke, about one third of TIA patients develop signs of PTSD. Approximately 14 percent of TIA patients also experience a drop in physical quality of life, with 6.5 percent of patients experiencing a drop in mental quality of life.

 

Treating PTSD

There are ways to relieve the strain of PTSD. Treatment for PTSD may include medication, psychotherapy, or both. Patients experiencing signs of PTSD should see a trained and qualified mental health professional as treatments may vary from patient to patient.

Medications

A mental health provider or psychiatrist may prescribe antidepressants to patients struggling with PTSD. Antidepressants have been shown to relieve the symptoms of anger, sadness, and overwhelming worry better than other available medications.

Psychotherapy

Sometimes referred to as “talk therapy,” psychotherapy can take place in a one-on-one capacity or in a group setting. Talk therapy is the process of speaking with a mental health professional and can encompass the discussion of PTSD symptoms alone or the effect such symptoms may be having on a patient’s life.

PTSD can sometimes wreak havoc on a person’s social, family, or professional life. To help heal the damage, a mental health professional may combine multiple forms of psychotherapy to address any and all issues a patient may be having with the aftermath of a stroke or TIA. Most often, psychotherapy lasts six to twelve weeks, but it is not unusual for it to take longer to address each patient’s symptoms and struggles. Patients are encouraged to involve family and friends in their recovery because having the extra support can improve the speed and efficiency of mental recovery from a stroke.

 

Finding Relief

PTSD can plague individuals who experience or witness a traumatic event. Medical emergencies are often traumatic, so it is common for survivors of stroke to suffer from PTSD; survivors of TIA can develop PTSD because they may be scared of suffering another mini stroke or of having a full-fledged stroke.

Symptoms can be very taxing on survivors and heartbreaking for their families to see. Fortunately, there are effective treatments for PTSD, including antidepressants and talk therapy with a mental health professional. If you are experiencing PTSD, it is important that you communicate how you feel with your doctor, family, and friends, as a strong support system can help you find the relief from psychological pain that you deserve.

Source: Recognizing the Signs of PTSD After Stroke | Saebo

, , , ,

2 Comments

[ARTICLE] Neurofeedback as a form of cognitive rehabilitation therapy following stroke: A systematic review – Full Text

Neurofeedback therapy (NFT) has been used within a number of populations however it has not been applied or thoroughly examined as a form of cognitive rehabilitation within a stroke population.

Objectives for this systematic review included:

  • i) identifying how NFT is utilized to treat cognitive deficits following stroke,
  • ii) examining the strength and quality of evidence to support the use of NFT as a form of cognitive rehabilitation therapy (CRT) and
  • iii) providing recommendations for future investigations.

Searches were conducted using OVID (Medline, Health Star, Embase + Embase Classic) and PubMed databases. Additional searches were completed using the Cochrane Reviews library database, Google Scholar, the University of Toronto online library catalogue, ClinicalTrials.gov website and select journals. Searches were completed Feb/March 2015 and updated in June/July/Aug 2015. Eight studies were eligible for inclusion in this review.

Studies were eligible for inclusion if they:

  • i) were specific to a stroke population,
  • ii) delivered CRT via a NFT protocol,
  • iii) included participants who were affected by a cognitive deficit(s) following stroke (i.e. memory loss, loss of executive function, speech impairment etc.).

NFT protocols were highly specific and varied within each study. The majority of studies identified improvements in participant cognitive deficits following the initiation of therapy. Reviewers assessed study quality using the Downs and Black Checklist for Measuring Study Quality tool; limited study quality and strength of evidence restricted generalizability of conclusions regarding the use of this therapy to the greater stroke population.

Progression in this field requires further inquiry to strengthen methodology quality and study design. Future investigations should aim to standardize NFT protocols in an effort to understand the dose-response relationship between NFT and improvements in functional outcome. Future investigations should also place a large emphasis on long-term participant follow-up.

Introduction

In 2011, stroke was identified as the third leading cause of death among Canadians (5.5%, 13 283 deaths), and considered to be the leading cause of neurological disability in Canadian adults [12]. Although stroke occurrence is most common in individuals aged 70 and older, stroke incidence for individuals over the age of 50 has increased by 24% and 13% in individuals over the age of 60, in the last decade [3]. Following a stroke, patients typically enter rehabilitation programs (i.e. physical therapy, occupational therapy, etc.) to address a multitude of physical, emotional and cognitive deficits [45]. Many rehabilitation interventions initiated following stroke primarily target functional motor impairments. In reviewing the literature, few investigations have been published that aim to target cognitive deficits, despite 40% of stroke survivors experiencing a decline in cognitive function (especially memory) following stroke [6].

The brain is a highly complex and organized organ therefore the extent of impairment and deficits that follow stroke are largely dependent on lesion severity and location [7]. Physiologically these impairments are a result of the loss of neuronal circuits and connections linked to the relevant sensory, motor, and cognitive functions [89]. Furthermore, it is thought that the neurological recovery that occurs following a stroke is a direct result of brain plasticity and it’s ability to repair and reorganize [10]. Some evidence exists for the initiation of reparative functions in the brain in as little as a few hours following a stroke [1112]. In respect to recovery trajectories following stroke, ninety-five percent of stroke patients reach their peak language recovery within 6 weeks of a stroke, and within 3 months for hemispatial neglect [1314]. Deficits that do not spontaneously resolve contribute to the large number of individuals requiring long term care following stroke (i.e. rehabilitative therapy) [1516]. Occupational and physical rehabilitation programs target functional and mobility issues however, in addition to these impairments patients experience a wide range of cognitive and neurological deficits. Individuals with impairments of this nature often require cognitive rehabilitation therapy (CRT).

CRT encompasses any intervention targeting the restoration, remediation and adaptation of cognitive functions including: attention, concentration, memory, comprehension, communication, reasoning, problem solving, planning, initiation, judgement, self-monitoring and awareness [17]. CRT can be offered in a variety of settings such as rehabilitation hospitals, community care facilities, private residences as well as the workplace [18]. Although cognitive therapy has been around since the early 19th century, the 1970’s marked the most recent biofeedback movement in CRT [18]. Traditionally used to treat muscular impairments (via electromyography (EMG) feedback) biofeedback has taken on a new form known as neurofeedback therapy (NFT). NFT targets the brain and cognitive functions through the use of electroencephalography (EEG), hence neurofeedback is sometimes referred to as EEG biofeedback [19]. In classical NFT, EEG and brainwave activity is provided as a visual or auditory cue to the user [6]. Using these cues the user can consciously adapt their brainwave activity to reach targeted training thresholds. NFT relies on operant conditioning to stimulate the neuroplastic abilities of the brain [2021]. Physiologically stimulating specific band frequencies over damaged areas stimulates cortical metabolism [19]. NFT is also used to counter excessive slow wave activity (i.e. theta waves and sometimes alpha waves) that typically follow stroke [21]. An alternative form of NFT known as nonlinear dynamical neurofeedback has also been used to restore homeostasis to the brain. This form of NFT requires no conscious effort from the participant to adapt their brainwaves in any particular direction (i.e. the participant maintains a passive role). Modalities like NeurOptimal® utilize Functional Targeting to provide the brain with “… information about itself which allows the brain to assemble it’s own, best organizing strategies moment by moment” [22]. In the context of this review, the studies included herein concern the use of classical NFT only.

To date, NFT has been used extensively to treat cognitive deficits associated with other neurological disorders and illnesses including: mild traumatic brain injury [23], ADD/ADHD [24], Epilepsy [25], Autism Spectrum Disorders [2627], Dyslexia [28], Fibromyalgia [29], Depression [30], and opiate additions [31]. Despite promising NFT outcomes within these populations, NFT has not been thoroughly evaluated for use in a stroke population. The aim of this systematic review was to thoroughly evaluate the available evidence pertinent to understanding the effectiveness of NFT as a form of CRT following stroke. To achieve this objective a number of research questions were established to guide this review:

  1. Among a stroke population, how is NFT utilized to treat cognitive deficits?
  2. Among identified NFT interventions targeting a stroke population, what is the quality and strength of evidence to support the use of NFT as a form of CRT following stroke?
  3. Based on the available NFT evidence for use in stroke populations, what recommendations can be made for future research?

 

The primary outcome of interest in this review was to identify if cognitive symptom complaints could be ameliorated following the initiation of NFT in a sub-acute and chronic post-stroke population. Secondary outcomes aimed to assess study quality, methodology and strength of support for use of NFT in this population.

Continue —> Neurofeedback as a form of cognitive rehabilitation therapy following stroke: A systematic review

Fig 1. PRISMA flow diagram.

, , ,

Leave a comment

[ARTICLE] Effects of neurofeedback on the short-term memory and continuous attention of patients with moderate traumatic brain injury: A preliminary randomized controlled clinical trial – Full Text

Abstract

Purpose

There are some studies which showed neurofeedback therapy (NFT) can be effective in clients with traumatic brain injury (TBI) history. However, randomized controlled clinical trials are still needed for evaluation of this treatment as a standard option. This preliminary study was aimed to evaluate the effect of NFT on continuous attention (CA) and short-term memory (STM) of clients with moderate TBI using a randomized controlled clinical trial (RCT).

Methods

In this preliminary RCT, seventeen eligible patients with moderate TBI were randomly allocated in two intervention and control groups. All the patients were evaluated for CA and STM using the visual continuous attention test and Wechsler memory scale-4th edition (WMS-IV) test, respectively, both at the time of inclusion to the project and four weeks later. The intervention group participated in 20 sessions of NFT through the first four weeks. Conversely, the control group participated in the same NF sessions from the fifth week to eighth week of the project.

Results

Eight subjects in the intervention group and five subjects in the control group completed the study. The mean and standard deviation of participants’ age were (26.75±15.16) years and (27.60±8.17) years in experiment and control groups, respectively. All of the subjects were male. No significant improvement was observed in any variables of the visual continuous attention test and WMS-IV test between two groups (p≥0.05).

Conclusion

Based on our literature review, it seems that our study is the only study performed on the effect of NFT on TBI patients with control group. NFT has no effect on CA and STM in patients with moderate TBI. More RCTs with large sample sizes, more sessions of treatment, longer time of follow-up and different protocols are recommended.


Introduction

Traumatic brain injury (TBI) means an injury to the brain that is caused by an external physical force. It is well known that TBI is an important cause of mortality and morbidity and it is reported that each year about 1.7 million people sustain a TBI in USA. Some of them die (about 50,000) and some other experience long-term disability (80,000 to 90,000).12 ;  3 The severity of TBI can be categorized based on the Glasgow comma scale (GCS) at the time of injury as follows: mild (13-15), moderate (9-12) and severe (<9).4 TBI usually affect the brain function such as cognitive status, executive function, memory, data processing, language skills and attention.5 It has heterogeneous aspects and based on the injury location and type. It can have different presentations. Hence it is considered as a difficult one to treat.6

The brain plasticity could help it in rehabilitation phase to restore its normal function after any trauma or disease. But the amount of this ability is poorly understood. Some studies approved that neurofeedback therapy (NFT) can promote neuroplasticity.7 In the method of neurofeedback (NF), as a non-pharmacological intervention, the feedback to brain waves which are representative of subconscious neural activity can be observed by the client and then he/she will be able to control and change them.8 ;  9 There are some evidences that show NFT can be useful in some other diseases like Obsessive-compulsive disorder,10 attention-deficit/hyperactivity disorder11 and also refractory epilepsy.12 There are also some published studies about the effect of NFT on patients with TBI. Surmeli in 2007 investigated the effect of NFT on 24 patients with mild TBI and reported that NFT can result in significant improvement in test of variables of attention, beck depression inventory and minnesota multiphasic personality inventory.13 In a study in 2014, with evaluation of two patients with moderate head injury and without control group, it is reported that electroencephalogram biofeedback can lead to increase the cognitive scores and improve the concussion symptoms and finally concluded that NFT can be effective on the changes in the structural and functional connectivity among patients with moderate TBI.14

Although these published papers reported a positive effect of NFT on the TBI patients, we have not enough data about the standard treatment protocol with NF, and literature still needs more original studies like randomized controlled clinical trial to suggest NF as a treatment option among patients with TBI regarding the two following functions of cognitive status: short-term memory (STM) and continuous attention (CA).6

In this preliminary study, we tried to evaluate the effect of NFT on CA and STM of patients with moderate TBI using a randomized controlled clinical trial. […]

Continue —> Effects of neurofeedback on the short-term memory and continuous attention of patients with moderate traumatic brain injury: A preliminary randomized controlled clinical trial

, , , , , , ,

Leave a comment

[BLOG POST] Driving After Stroke: Is it Safe? -Saebo

After having a stroke, many survivors are eager to start driving again. Driving offers independence and the ability to go where you want to go on your own schedule, so it is no surprise that survivors want to get back behind the wheel rather than rely on someone else for their transportation needs.

Unfortunately, having a stroke can have lasting effects that make driving more difficult. A survivor might not be aware of all of the effects of their stroke and could misjudge their ability to drive safely. Driving against a doctor’s orders after a stroke is not only dangerous, it may even be illegal. Many stroke survivors successfully regain their ability to safely drive after a stroke, but it is important that they do not attempt to drive until they are cleared by their healthcare provider.

 

How Stroke Affects the Ability to Drive

Having a stroke can affect an individual’s ability to drive in numerous ways, whether it be because of physical challenges, cognitive changes, or other challenges.

 

Physical Challenges

Physical-Challenges

After a stroke, it’s common to experience weakness or paralysis on one side of the body, depending on which side of the brain the stroke occurred. More than half of all stroke survivors also experience post-stroke pain. Minor physical challenges may be overcome with adaptive driving equipment, but severe challenges like paralysis or contracture can seriously affect an individual’s ability to drive.

 

Cognitive Effects

cognitive

Driving requires a combination of cognitive skills, including memory, concentration, problem solving, judgement, multitasking, and the ability to make quick decisions. A stroke can cause cognitive changes that limit the ability to do many of those things.

 

Vision Problems

vision

As many as two-thirds of stroke victims experience vision impairments as a result of a stroke. This can include vision loss, blurred vision, and visual processing problems. Stroke survivors with vision problems should not drive until their problems are resolved and they have been cleared by a doctor.

 

Fatigue

fatigue

Fatigue is a common physical condition after a stroke that affects between 40 and 70 percent of stroke survivors. Fatigue can arrive without warning, so it is dangerous to drive when suffering from post-stroke fatigue.

 

Warning Signs of Unsafe Driving

 

Stroke survivors are not always aware of how their stroke has limited their ability to drive. If they are choosing to drive after their stroke against their doctor’s advice, it is important for them and their loved ones to look out for warning signs that they might not be ready to start driving. Here are some of the common warning signs to look out for:

  • Driving faster or slower than the posted speed or the wrong speed for the current driving conditions
  • Consistently asking for instruction and help from passengers
  • Ignoring posted signs or signals
  • Making slow or poor decisions
  • Becoming easily frustrated or confused
  • Getting lost in familiar areas
  • Being in an accident or having close calls
  • Drifting into other lanes

 

If you or your loved one is showing any of these warning signs, immediately stop yourself or them from driving until your or their driving is tested.

 

Driving Again After a Stroke

Before a stroke survivor begins driving again, they should speak with their doctor or therapist to discuss whether or not it would be safe for them to continue driving. Many states require mandatory reporting by a physician to the DMV if their patient has impairments that may affect their driving after a stroke. Even if their doctor clears them to drive, they still will likely need to be evaluated by the DMV before they regain their driving privileges.

 

Driver rehabilitation specialists are available to help stroke survivors evaluate their driving ability from behind the wheel. There are also driver’s training programs that provide a driving evaluation, classroom instruction, and suggestions for modifying a car to the individual driver’s needs. For instance, an occupational therapist can provide a comprehensive in-clinic evaluation of a client’s current skills and deficits relative to driving.

 

From there a client could be sent for an in-vehicle assessment for further evaluation by a certified driver rehabilitation specialist (CDRS). They can assess driving skills in a controlled and safe environment. An in-vehicle driving test is the most thorough way to gauge a driver’s abilities. Each assessment takes about 1 hour and involves driving with a trained evaluator or driving in a computer simulator.

 

The “behind-the-wheel” evaluation will include testing for changes in key performance areas such as attention, memory, vision, reaction time, and coordination. After this assessment the CDRS can determine if the client is safe to drive, can not drive at all, or may drive with additional recommendations.

 

Often times clients may require certain modifications to their car in order to drive safely. In addition, some clients may benefit from on-going classroom training and simulation training in order to meet safety standards. These are all services that a driver rehabilitation specialist can provide. To help find these resources, The Association for Driver Rehabilitation Specialists has a directory of certified driver rehabilitation specialists, driver rehabilitation specialists, and mobility equipment dealers and manufacturers.

 

Get Back Behind the Wheel

Many stroke survivors successfully drive after a stroke; however, not all are able to. While reclaiming independence is important, staying safe is the greatest concern. It is important for stroke survivors to listen to their doctors and wait until they are fully ready before attempting to drive again. With some hard work and patience, getting back behind the wheel is possible.

 


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

Source: Driving After Stroke: Is it Safe? | Saebo

, , , , ,

Leave a comment

[ARTICLE] The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials – Full Text

Abstract

Physically-active video games (‘exergames’) have recently gained popularity for leisure and entertainment purposes. Using exergames to combine physical activity and cognitively-demanding tasks may offer a novel strategy to improve cognitive functioning. Therefore, this systematic review and meta-analysis was performed to establish effects of exergames on overall cognition and specific cognitive domains in clinical and non-clinical populations. We identified 17 eligible RCTs with cognitive outcome data for 926 participants. Random-effects meta-analyses found exergames significantly improved global cognition (g = 0.436, 95% CI = 0.18–0.69, p = 0.001). Significant effects still existed when excluding waitlist-only controlled studies, and when comparing to physical activity interventions. Furthermore, benefits of exergames where observed for both healthy older adults and clinical populations with conditions associated with neurocognitive impairments (all p < 0.05). Domain-specific analyses found exergames improved executive functions, attentional processing and visuospatial skills. The findings present the first meta-analytic evidence for effects of exergames on cognition. Future research must establish which patient/treatment factors influence efficacy of exergames, and explore neurobiological mechanisms of action.

1. Introduction

Cognition can be broadly defined as the actions of the brain involved in understanding and functioning in our external environment (Hirschfeld and Gelman, 1994). As it is generally accepted that cognition requires multiple mental processes, this broader concept has been theoretically separated into multiple ‘cognitive domains’ (Hirschfeld and Gelman, 1994). Although definitions vary, and the boundaries between domains often overlap, examples of distinct areas of cognitive functioning include the processes for learning and remembering verbal and spatial information, attentional capacities, response speed, problem-solving and planning (Strauss et al., 2006).

Various neuropsychological tests have been developed as tools for assessing and quantifying an individual’s overall cognitive functioning (or ‘global cognition’) along with their performance within the separable domains of cognition (Strauss et al., 2006). Performance in these various cognitive tests has been found to be relatively stable over time in healthy adults, and moderately accurate predictors of real-world functioning and occupational performance (Chaytor and Schmitter-Edgecombe, 2003 ;  Hunter, 1986). Furthermore, neuropsychological tests can detect the deficits in cognitive functioning which arise as a consequence of various psychiatric and neurological diseases (Mathuranath et al., 2000 ;  Nuechterlein et al., 2004). For example, people with Parkinson’s disease show marked impairments in planning and memory tasks (Dubois and Pillon, 1996), whereas those with schizophrenia have cognitive pervasive deficits, 1–2 standard deviations below population norms, which also predict the severity of disability in this population (Green et al., 2000). Additionally, cognitive abilities decline naturally in almost all people during healthy ageing (Van Hooren et al., 2007). In an ageing population, the functional consequences of cognitive decline may ultimately have a severe social and economic impact. Thus, interventions which improve cognition hold promise for the treatment of psychiatric and neurological diseases, an have positive implications for population health.

Fortunately, interventions which stimulate the brain and/or body can improve cognition, or attenuate decline. For instance, physical exercise has been shown to significantly improve global cognition, along with working memory and attentional processes, in both clinical and healthy populations (Firth et al., 2016Smith et al., 2010 ;  Zheng et al., 2016). Interventions can also be designed to target cognition directly, as computerized training programs for memory and other functions have been found to provide significant cognitive benefits, at least in the short term (Hill et al., 2017 ;  Melby-Lervåg and Hulme, 2013). Furthermore, ‘gamification’ of cognitive training programs can maximize their clinical effectiveness, as more complex and interesting programs are capable of better engaging patients in cognitively-demanding tasks while also training multiple cognitive processes simultaneously (Anguera et al., 2013).

Previous studies have found that providing both aerobic exercise and cognitive training together may have additive effects, preventing ageing-related cognitive decline more effectively (Shatil, 2013). This may be due to aerobic and cognitive activity stimulating neurogenesis through independent but complementary pathways; as animal studies show that while exercise stimulates cell proliferation, learning tasks support the survival of these new cells (Kempermann et al., 2010), such that combining these two types of training results in 30% more new neurons than either task alone (Fabel et al., 2009).

Rather than delivering aerobic and cognitive training in separate training sessions, recent advances in technology has presented an opportunity for combining physical activity with cognitively-challenging tasks in a single session through ‘exergames’. Exergames are considered as interactive video-games which require the player to produce physical body movements in order to complete set tasks or actions, in response to visual cues (Oh and Yang, 2010). Common examples include the ‘Nintendo Wii’ (along with ‘Wii Fit’ or ‘Wii Sports software’) or the ‘Microsoft Xbox Kinect’. Additionally, virtual reality systems which use exercise bikes and/or treadmills as a medium for players to interact with three-dimensional worlds have also been developed to provide immersive training experiences (Sinclair et al., 2007).

Along with their popular usage for leisure and entertainment, there is growing interest in the application of exergame systems to improve clinical outcomes. Recent systematic reviews and meta-analyses of this growing literature have provided preliminary evidence that exergames can improve various health-related outcomes, including reducing childhood obesity, improving balance and falls risk factors in elderly adults, facilitating functional rehabilitation in people with parkinson’s disease, and even reduce depression (Barry et al., 2014Li et al., 2016 ;  van’t Riet et al., 2014). However, the effects of exergames on cognitive functioning have not been systematically reviewed, despite many individual studies in this area.

Therefore, the aim of this study was to systematically review all existing trials of exergames for cognition, and apply meta-analytic techniques to establish the effects of exergames on global cognition along with individual cognitive domains. We also sought to (i) examine the effects of exergames on cognition in healthy and clinically-impaired populations, and (ii) investigate if the effects of exergames differed from those of aerobic exercise alone, by comparing exergames to traditional physical activity control conditions.

Fig. 1

Fig. 1. PRISMA flow diagram of systematic search and study selection.

Continue —> The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials

, , , , , , , ,

Leave a comment

[WEB SITE] TherapWii – game suggestions

Why TherapWii

Gaming activates and is fun to do! In a playful and often unnoticed way skills are trained. Adolescents grow up in a digital world; they enjoy gaming and do it frequently. For adults and elderly gaming has been shown to be a useful type of therapy.

In a virtual environment moving, executing, learning and enjoying are appealing; if circumstances or limitations keep you from going to the bowling alley or playing an instrument, gaming can broaden your boundaries.

Gaming with the Wii can complement therapy, can make therapy more attractive, intenser and more provocative.

TherapWii has been developed to support therapists in an effective and specific way while using the Nintendo Wii and offer options to game in the home environment.

TherapWii is the product of an exploratory research project done by the Special Lectorship Rehabilitation at the Hague University. The results of this project can be found by clicking on the header ‘research’ at the end of the page.

How does TherapWii work?

Per therapy goal there are three colored tabs to help find the most suitable games. Each game lists specific information in text and symbols. There is also a level of difficulty; by moving the cursor over this button you see more information.

User information is saved in ‘explanation and tips’. To enhance this section you can email recommendations and suggestions to the email address listed below.

TherapWii has been developed, also for home use, so that experience lead to personal growth.

Advice for game adjustments

It is important that the therapist stays close to the patient’s goals and abilities and adjusts the game program appropriately. If you, as therapist, want to make the game easier, more difficult or more daring, you can change the instruction, implementation or setting.

A few examples:

Physical: strength (add weights to the arms or legs or change the starting position); balance/stability (play while standing on an instable foundation (ball, mat). Or play the games while sitting on a stationary bicycle!

Cognition: create double tasks (ask mathematics, questions or riddles); spatial orientation or visual adjustments (play with one eye covered or in front of a mirror).

Social-emotional: stimulate cooperation or competition (create bets or role-playing).

Let us know if you have other ideas to make the games more provoking.

How are the games rated?

The games were tested by several professionals (physical therapists, occupational therapists and sport therapists). Differences in opinion or scores were discussed and voted on.

Give us feedback, corrections and advice, we will adjust the TherapWii program monthly and will use your suggestions.

Which ability do you choose?

Social-Emotional

Physical

Cognitive

Visit WEB SITE

, , , , , , ,

Leave a comment

%d bloggers like this: