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[WEB SITE] Experiences of patients with traumatic brain injury and their carers during transition from in-patient rehabilitation to the community – CNS

PURPOSE: To explore the experiences of individuals who have had a severe
traumatic brain injury (TBI) and their carers in the first month post-discharge
from in-patient rehabilitation into living in the community.

METHOD: Using a qualitative approach underpinned by critical realism, we explored the narratives of 10 patients and nine carers using semi-structured interviews approximately one month post-discharge. Thematic analysis was carried out independently by two researchers.

RESULTS: Firstly, perceptions of support were mixed but many patients and carers felt unsupported in the inpatient phase, during transitions between units and when preparing for discharge. Secondly, they struggled to accept a new reality of changed abilities, loss of roles and loss of autonomy. Thirdly, early experiences post-discharge exacerbated fears for the future.

CONCLUSIONS: Most patients and carers struggled to identify a cohesive plan that supported their transition to living in the community. Access to services required much persistence on the part of carers and tended to be short-term, and therefore did not meet their long-term needs. We propose the need for a case manager to be involved at an early stage of their rehabilitation and act as a key point for information and access to on-going rehabilitation and other support services. Implications for Rehabilitation Traumatic Brain Injury (TBI) is a major cause of long-term disability. It can affect all areas of daily life and significantly reduce quality of life for both patient and carer. Professionals appear to underestimate the change in abilities and impact on daily life once patients return home. Community services maintain a short-term focus, whereas patients and carers want to look further ahead – this dissonance adds to anxiety. The study’s findings on service fragmentation indicate an urgent need for better integration within health services and across health, social care and voluntary sectors. A link person/case manager who oversees the patient journey from admission onwards would help improve integrated care and ensure the patient, and
carer, are at the center of service provision.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Experiences of patients with traumatic brain injury and their carers during transition from in-patient rehabilitation to the community

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[BLOG POST] How do muscles change shape when they are passively lengthened?

Muscles are often referred to as ‘motors’ that drive human and animal movements. This analogy certainly captures the important role of muscles as active generators of force and movement. However, it sells the equally important passive properties of muscles short. Most of us will only appreciate the importance of passive muscle properties when these are affected by disease. For instance, people who have had a stroke or children with cerebral palsy frequently develop muscle contractures – a stiffening of muscles even when the muscle is not activated. Contractures frequently lead to loss of mobility, bone deformities and other undesirable effects that limit physical independence.

Aiming to better understand the passive mechanical properties of muscles, we have used diffusion tensor imaging (DTI), a magnetic resonance imaging (MRI) technique, to obtain the most detailed measurements to date of changes in muscle structure of a human calf muscle (medial gastrocnemius) during passive lengthening (Bolsterlee et al., 2017; note that for those interested in more details on this novel imaging technique, there is a recent review paper by Damon et al., 2017). From the DTI data we measured how several thousands of muscle fibres changed length, orientation and curvature when the whole muscle was lengthened. We also measured the change in dimensions of muscle fibres, which can be thought of as several centimeter long cylindrical tubes with diameters similar to human hairs. From anatomical MRI scans the changes in three-dimensional whole-muscle shape were derived.

Example of a three-dimensional reconstruction of the architecture of the human medial gastrocnemius from diffusion tensor imaging (DTI) data.

WHAT DID WE FIND?

We found that the medial gastrocnemius reduced both its width and its depth when the muscle lengthened. Muscle fibres rotated by about 8° and lengthened by 35% when the whole muscle changed its length by 7%. The diffusion properties of muscle tissue measured by DTI (which gives information about the microstructure of muscle cells) suggest that the diameter of muscle fibres decreases when fibres are lengthened, presumably to maintain a constant volume.

SIGNIFICANCE AND IMPLICATIONS

These data help us understand the complex changes in structure that human muscles undergo when they passively lengthen. We can now use these methods to study, in unprecedented detail, the differences in muscle structure between healthy people and people with muscle contractures. This may give us new insights into the mechanisms of contracture, which will ultimately enable better management or treatment of this condition.

PUBLICATION

Bolsterlee B, D’Souza A, Gandevia SC, Herbert RD (2017). How does passive lengthening change the architecture of the human medial gastrocnemius muscle? J Appl Physiol, 122(4): 727-738.

KEY REFERENCES

Damon BM, Froeling M, Buck AK, Oudeman J, Ding Z, Nederveen AJ, Bush EC, Strijkers GJ (2017). Skeletal muscle diffusion tensor-MRI fiber tracking: rationale, data acquisition and analysis methods, applications and future directions. Nmr Biomed 30. DOI: 10.1002/nbm.3563.

SIMILAR POSTS

Muscle: a novel way to study its structure. Written by Arkiev D’Souza

Human muscles fascicles: what can ultrasound and diffusion tensor imaging reveal? Written by Bart Bolsterlee

Source: How do muscles change shape when they are passively lengthened? – Motor Impairment

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[BLOG POST] Everything You Want To Know About Stairlifts Is Right Here  

Photo of a room with a dining table with chairs in the middle. In the corner are stairs, and a stairlift is attached to it.

Ever wondered if you can make stairs at home accessible for your elderly loved ones or other family members whose disabilities may prevent them from going up and down the stairs? Our friends over at Home Healthcare Adaptations have created a comprehensive guide that will walk you through the types of stairlifts, mechanics of how they work, who would need them, their costs, benefits, and safety features. Watch this quick video below to understand the basics of stairlifts. Text version is below the video.

What are stairlifts?

  • Stairlifts are lifting devices powered by electricity which enable people with limited mobility to travel ip and down staircases with ease.
  • They are equipped with a chair or a platform, the selection dependent upon the specific user’s needs.

How does a stairlift work?

  • A stairlift moves along a rail which is fitted to the stairs and a motor is used to move the stairlift along a track.
  • This motor is powered by a battery which charges automatically on a continual basis. It can be charged at either the top or the bottom of the stairs and will always be sufficiently charged so that it will never cut out halfway along the stairs.
  • Stairlifts are easy to operate. They are controlled by a small toggle or joystick on the armrest – simply direct this up or down to move the stairlift.
  • If you have 2 or more people using the same stairlift, it comes as standard with 2 remotes that will enable a user to summon it up/down the stairs.

Who is most likely to need a stairlift?

  • Someone with multiple sclerosis or arthritis.
  • Someone who has undergone hip replacements.
  • Someone whose mobility is affected following an operation.
  • An elderly person with notable frailty.

Types of Stairlifts

  • Straight stairlifts are the simplest of all stairlift types and can fit the majority of staircases that have a straight flight from bottom to top.
  • Curved stairlifts are used when the staircase for which it is being fitted has one or more turns.
  • Perch (or standing) stairlifts are ideal for those who find it difficult to bend their knees and sit. The seat is smaller and positioned higher than with a standard stairlift, allowing the user to perch rather than sit.
  • Outdoor lifts have similar features to indoor stairlifts, in addition to being waterproof and able to withstand extreme conditions.

How much do stairlifts cost?

  • Straight stairlifts cost in the region of €1,800 (supply and maintenance) and can be fitted within 2-3 days of being ordered.
  • Curved stairlifts are more expensive, as they are made to measure. They usually cost between €5,000 and €6,000, while manufacture and fitting could take 5-6 weeks from the initial order date.

Stairlift safety features

  • Sensors to detect potential obstructions.
  • Lockable on/off switch to deactivate the stairlift when not in use.
  • Mechanical and electrical braking systems to braking systems to bring the stairlift to a smooth, safe stop.
  • Safety belts on the seat/perch to prevent users from falling off the stairlift.
  • Swiveling footplates to bridge the gap between the stairlift and the top of the stairs.

Benefits of Stairlifts

  • Provide a safe, comfortable method of moving freely around your home.
  • Promote a substantial degree of independence.
  • No need to walk up and down stairs to fo to an upstairs bathroom or bedroom.
  • You can continue living in your current home without the need to relocate.
  • Extremely easy to use – all you need to do to operate a stairlift is move a control pad.
  • Easy to fold and unfold so as to be unobstrusive when not in use.
  • Very affordable – running costs are similar to what you’d use in boiling a kettle

Source: Home Healthcare Adaptations

Read more here.

Source: Everything You Want To Know About Stairlifts Is Right Here – Assistive Technology Blog

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[WEB SITE] Five of the best apps to train your brain

It is no secret that as we age, our brain function declines. However, studies have suggested that keeping mentally active – particularly when older – can help to maintain cognitive functioning. Brain training apps are considered a useful aid for mental stimulation, but which one is right for you? We present our pick of five of the best brain training apps around.
[An illustration of a brain and technology]

Research has suggested that brain training may be beneficial for cognitive functioning.

Brain training is based on the premise that mental stimulation can improve neuroplasticity. This is the brain’s ability to form and reorganize connections between brain cells in response to new tasks.

While some studies have failed to find a link between brain training and improved cognitive functioning, other research has found the opposite.

A study published in PLOS One in 2013, for example, found that young adults who engaged in brain training games demonstrated improvements in brain processing speed, working memory, and executive functions.

It is not only young adults who might benefit from brain training. Research presented at the 2016 Alzheimer’s Association International Conference found that older adults who took part in ten 1-hour brain training sessions over a 5-week period were 48 percent less likely to develop cognitive decline or dementia over 10 years.

Such studies have fueled the development of hundreds of brain training apps, many of which claim to improve cognitive functions such as learning, memory, and concentration. With so many to choose from, however, how do you know which one is best for you?

Medical News Today have tried and tested five of the best brain training apps available to help you make an informed decision.

Lumosity: Colorful and fun

Considered by many as the “original” brain training app, Lumosity is used by more than 85 million people across the globe. The app consists of more than 50 colorful and fun minigames designed to train five cognitive functions: speed, memory, attention, flexibility, and problem-solving.

Lumosity’s games have been created with the help of more than 100 researchers from around the world. Furthermore, their website cites a study of more than 4,700 adults that found that brain training with Lumosity improved cognition more than crosswords.

[Lumosity iOS image]

Lumosity has more than 85 million users worldwide. Image credit: Lumosity

With this in mind, we couldn’t pass up the opportunity to try the app for ourselves.

At sign-up, you are required to complete a “fit test,” which calibrates your speed, attention, and memory through three separate games.

Once the games are complete, users are shown how their results compare with those of other users in the same age group. This provides insight into the areas of cognition that require the most attention.

Each day going forward, Lumosity sends a reminder to complete a brain “workout.” The daily brain workout involves playing three minigames – five with the premium version – each focusing on the five cognitive functions.

One game we enjoyed was Train of Thought, which focuses on attention. In this game, the user must change the direction of train tracks, with the aim of guiding different colored trains to the correct home. We found that this game really challenged our concentration – although it could be frustrating at times.

Luminosity is an app that could easily appeal to both children and adults. Many of the games – such as Highway Hazards, a driving game that involves moving left or right to avoid road hazards – have a child-like appeal.

Lumosity is free to download on Android and iOS, though upgrading to a premium subscription costs $11.99 per month or $59.99 for 1 year.

Elevate: Boosting ‘productivity, earning power, and self-confidence’

While Elevate has fewer users than Lumosity, at 10 million downloads worldwide, it holds the title of iPhone’s best app of the year for 2014. So what makes it stand out?

The app consists of more than 40 minigames designed to boost math and speaking skills, as well as improve memory, attention, and processing speed.

[Elevate app]

Just like Lumosity, Elevate encourages daily brain training, which involves the completion of three games, or five games with the “PRO” version.

Elevate has more of an adult feel than many of the other brain training apps; the minigames take a more serious approach, focusing less on colorful illustrations and more on text. Each game also comes with a brief description of its goal, such as “stop mixing up commonly confused words” and “improve your reading comprehension.”

One game we enjoyed was Error Avoidance, whereby the user is required to “keep” or “swap” two words in a passage of text within a set time. For example: “He fashioned the cookie doe into the shape of a grazing dough.” In this case, the two words would be swapped.

Elevate provides a daily, weekly, and monthly rundown of overall performance, as well as performance in five specific areas: writing, listening, speaking, reading, and math. If you’re feeling competitive, you have the option of comparing your performance with that of other users in the same age group.

Elevate is available to download for free on both Android and iOS. Upgrading to PRO costs $4.99 for 1 month or $39.99 for a year.

Peak: Flexible training and tracking

Rated by Google as one of the best Android apps for 2016, Peak offers more than 30 minigames to help improve concentration, memory, mental agility, language, and problem-solving.

[Peak app]These games have been developed with the help of scientists from respectable universities across the globe, including Yale University in Connecticut and the University of Cambridge in the United Kingdom.

Like Lumosity, there are a number of games that may appeal to children and adults alike. One such game is Turtle Traffic – a mental agility game that requires the user to navigate a turtle through the sea and collect jellyfish.

Based on performance in baseline tests, a personalized workout plan is provided, although the user is not limited to this plan. In the “Pro” version, all games are available to play at any time.

The Peak creators recommend brain training for 3 days per week. One great feature of Peak is that you can select the days that you want to train and set reminders for these days.

Cognitive performance is also very easy to track. Not only does the app provide information on individual game performance, but it also provides data on overall performance in each of the five cognitive functions. Similar to the other brain training apps, you are also able to compare performance with other users.

Peak is available to download for free on Android and iOS. A 12-month subscription starts from $34.99, while 1 month starts from $4.99.

Fit Brains: Targeting emotional intelligence

Fit Brains is a creation of Rosetta Stone – an education technology software company best known for their online language courses.

[Fit brains app]This brain training app boasts the largest variety, with more than 60 minigames and more than 500 personalized training programs. With the input of neuroscientists, these games have been created to help exercise key cognitive functions, including concentration, memory, speed of thinking, and problem-solving.

What sets Fit Brains part from other brain training apps, however, is that it also targets emotional intelligence through games that focus on social skills, social awareness, self-awareness, and self-control.

One game we enjoyed at MNT was Speedy Sorts – a game that tests thinking speed by asking the user to arrange objects into the correct piles as quickly as possible.

Based on the results of each game played, the user is provided with a score out of 200 for each cognitive area. The app also compares individual results with those of other users.

Unlike many other brain training apps, Fit Brains also has a school edition – a brain training package that aims to boost the cognitive functions of schoolchildren.

Fit Brains is free to download on Android and iOS. An upgrade to premium costs $9.99 for a month and $49.99 for a year.

CogniFit: For consumers, scientists, and clinicians

CogniFit is perhaps the most advanced brain training app we reviewed, consisting of a variety of minigames designed to train more than 20 cognitive skills, including short-term memory, planning, hand-eye coordination, and auditory perception.

[CogniFit app]

The CogniFit developers are keen to point out that all of their brain training tools have been validated by scientists – including researchers from the University of Washington and the Albert Einstein College of Medicine in New York. Furthermore, they state that the efficacy of their tools has been established through general population studies.

Interestingly, CogniFit also offers tools that researchers and healthcare professionals can use in order to study and assess cognitive function in patients.

MNT tested the brain training games for consumers, and we found them to be a good balance of fun and mental stimulation.

One game we enjoyed was Reaction Field, which tests response time, visual scanning, and inhibition – which is the ability to control impulsive behavior. This game is similar to Whac-a-Mole; the user is required to remember the color of a mole and tap on moles of the same color as they pop up from holes in the ground.

Individual cognitive performance is assessed using the Lumosity Performance Index, which is calculated using the average scores of all games played. Like the other brain training apps, you can also compare your performance against that of other users.

CogniFit is available to download for free on Android and iOS. A premium upgrade costs $19.99 for 1 month or $189.99 for a year.

Learn about five of the best meditation apps.

Source: Five of the best apps to train your brain – Medical News Today

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[ARTICLE] mHealth or eHealth? Efficacy, Use, and Appreciation of a Web-Based Computer-Tailored Physical Activity Intervention for Dutch Adults: A Randomized Controlled Trial  – Full Text

ABSTRACT

Background: Until a few years ago, Web-based computer-tailored interventions were almost exclusively delivered via computer (eHealth). However, nowadays, interventions delivered via mobile phones (mHealth) are an interesting alternative for health promotion, as they may more easily reach people 24/7.

Objective: The first aim of this study was to compare the efficacy of an mHealth and an eHealth version of a Web-based computer-tailored physical activity intervention with a control group. The second aim was to assess potential differences in use and appreciation between the 2 versions.

Methods: We collected data among 373 Dutch adults at 5 points in time (baseline, after 1 week, after 2 weeks, after 3 weeks, and after 6 months). We recruited participants from a Dutch online research panel and randomly assigned them to 1 of 3 conditions: eHealth (n=138), mHealth (n=108), or control condition (n=127). All participants were asked to complete questionnaires at the 5 points in time. Participants in the eHealth and mHealth group received fully automated tailored feedback messages about their current level of physical activity. Furthermore, they received personal feedback aimed at increasing their amount of physical activity when needed. We used analysis of variance and linear regression analyses to examine differences between the 2 study groups and the control group with regard to efficacy, use, and appreciation.

Results: Participants receiving feedback messages (eHealth and mHealth together) were significantly more physically active after 6 months than participants in the control group (B=8.48, df=2, P=.03, Cohen d=0.27). We found a small effect size favoring the eHealth condition over the control group (B=6.13, df=2, P=.09, Cohen d=0.21). The eHealth condition had lower dropout rates (117/138, 84.8%) than the mHealth condition (81/108, 75.0%) and the control group (91/127, 71.7%). Furthermore, in terms of usability and appreciation, the eHealth condition outperformed the mHealth condition with regard to participants receiving (t182=3.07, P=.002) and reading the feedback messages (t181=2.34, P=.02), as well as the clarity of the messages (t181=1.99, P=.049).

Conclusions: We tested 2 Web-based computer-tailored physical activity intervention versions (mHealth and eHealth) against a control condition with regard to efficacy, use, usability, and appreciation. The overall effect was mainly caused by the more effective eHealth intervention. The mHealth app was rated inferior to the eHealth version with regard to usability and appreciation. More research is needed to assess how both methods can complement each other.

Trial Registration: Netherlands Trial Register: NTR4503; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4503 (Archived by WebCite at http://www.webcitation.org/6lEi1x40s)

Introduction

Insufficient physical activity is considered to be a major public health issue worldwide [1,2]. The Dutch public health guidelines recommend adults to engage in moderate- to vigorous-intensity physical activity for at least 30 minutes on at least 5 days per week [3,4]. Studies suggest that sufficient physical activity can effectively prevent numerous chronic diseases and mental health issues [2,46]. Lee et al [7] argued that 6% to 10% of worldwide deaths caused by noncommunicable diseases, such as cancer, cardiovascular diseases, and diabetes, can be attributed to physical inactivity. Therefore, there is a need for interventions that increase the level of physical activity and can reach a broad population cost effectively [1].

Empirical research suggests that Web-based computer-tailored interventions are a promising solution [8]. These interventions provide tailored information and feedback via the Internet and therefore have some important advantages. First, Web-based computer-tailored interventions can adapt intervention materials according to the specific situation, characteristics, and needs of an individual and accordingly make information more personally relevant for the individual [911]. Second, research has shown that tailored messages are more likely to be read, understood, discussed with others, and remembered by the receiver [1214]. Third, due to the fact that more and more people are using the Internet to search for health-related information and health advice [1517], Web-based computer-tailored health interventions offer an effective method to reach a broad population cost effectively [1822]. Fourth, even though a broad population is targeted simultaneously, each individual can make use of the intervention privately at any given point in time or place [18,23].

Until a few years ago, Web-based computer-tailored interventions were almost exclusively delivered via computer. This medium of delivery has formed the term eHealth (electronic Health). The concept of eHealth has been described as the use of the Internet and related technologies to deliver health-related information and interventions [23]. Even though eHealth has been shown to be an efficient strategy to lower costs and deliver health messages more interactively, it also has several disadvantages. One of the major problems with eHealth interventions is the high percentage of dropout [24,25].

To make interventions even more accessible, and thereby decrease chances of dropout, health promotion professionals are increasingly interested in the use of mHealth (mobile Health). mHealth refers to the delivery of health messages and interventions via mobile phones or tablets by making use of telecommunication and multimedia technologies [2631]. In the Netherlands, almost 70% of Dutch households use the Internet via mobile phones and approximately 45% use tablets [32]. Based on the increasing usage of mobile phones as a lifestyle device, it has been argued that mHealth might increase the use of interventions and thereby also their efficacy [28,29]. Whereas computers and laptops are relatively stationary, mobile phones and tablets can be carried and used everywhere [33]. People are able to use mHealth independent of time or space, which could improve the usage and evaluation of interventions compared with eHealth [28,31,33].

Most people already use their phones for a variety of personal and work-related matters, such as social networking, calendaring, financial tracking, or emailing [33]. This leads to the assumption that the inclusion of health-related information would be advisable. However, previous research shows some pitfalls of mHealth. First, mobile phone technology is a rapidly changing field that introduces new apps, communication possibilities, and additional gadgets nearly by the day. This makes it difficult for intervention developers to keep up with the newest technologies and interests of their users [34,35]. Second, although using text messaging can be a very effective way of communicating, some intervention messages might be too long or difficult to be presented in such a short manner. This restricted communication can lead to more misunderstandings between the participant and health professional, which in turn can influence the effectiveness of the intervention [36]. And third, both participants and health professionals claim to feel unsure about the safety of private and sensitive information. Although this concern can also arise in the eHealth sector, the inferior but rapidly growing mHealth sector evokes skepticism on both sides [37].

To examine whether mHealth can improve the use and efficacy and reduce dropout rates of Web-based computer-tailored interventions, this study examined the effects of an mHealth and eHealth intervention on physical activity compared with a control group. Both interventions were identical with regard to content but differed in the medium of delivery. The main aim of the study was to examine the efficacy of the 2 versions on physical activity and to compare them with a control group. A secondary aim was to study potential differences in dropout and appreciation of the mHealth and eHealth intervention.

Figure 1. Flowchart of the participation of respondents.

Continue —> JMIR-mHealth or eHealth? Efficacy, Use, and Appreciation of a Web-Based Computer-Tailored Physical Activity Intervention for Dutch Adults: A Randomized Controlled Trial | Gomez Quiñonez | Journal of Medical Internet Research

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[WEB SITE] ‘Microwave helmet’ may cut time taken to evaluate head injuries – Medical News Today

Published: Friday 10 March 2017

A portable device that covers the head and uses microwave technology to examine brain tissue in prehospital settings could cut the time it takes to evaluate brain injuries. So conclude researchers after evaluating their “microwave helmet” in a small trial.

The researchers – including members from Chalmers University of Technology and Sahlgrenska University Hospital, both in Gothenburg, Sweden – report their findings in the Journal of Neurotrauma.

They suggest that the results of their small trial show that microwave technology can be used for the rapid detection of intracranial bleeding that can result from head injuries.

First author Dr. Johan Ljungqvist, a specialist in neurosurgery at the Sahlgrenska University Hospital, says: “The microwave helmet could improve the medical assessment of traumatic head injuries even before the patient arrives at the hospital.”

He notes that even though their study was small, and they only focused on one type of head injury, “the result indicates that the microwave measurements can be useful in ambulances and in other care settings.”

In their study paper, he and his colleagues note that microwave technology has already been evaluated for other medical applications – such as distinguishing between strokes caused by blood clots and strokes caused by bleeding in the brain.

TBI is a leading cause of disability and death

Traumatic brain injury (TBI) is disruption of normal brain function due to trauma that results from an injury that bumps, jolts, hits, or penetrates the head. The severity of trauma ranges from “mild” (the most common kind, also known as concussion) to “severe.”

Fast facts about TBI

  • In the U.S. between 2006 and 2010, TBI-related deaths were highest in people aged 65 and older
  • Over that period, vehicle crashes were the leading cause of TBI-related deaths for young people aged between 5 and 24
  • Among nonfatal TBI-related injuries, rates of ED visits were highest for children aged 4 and under.

Learn more about TBI

TBI can disrupt memory, thinking, movement, vision, hearing, and emotional functioning. It can also result in personality changes and depression. The effects are not confined to individuals; they can also impact families, friends, and communities.

TBI is a major cause of death and disability in the United States, where estimates from the Centers for Disease Control and Prevention (CDC) suggest that 138 people die every day from injuries that include TBI.

The majority of TBI survivors experience effects that last a few days, while others are left with enduring disabilities that can last for the rest of their lives.

In the U.S. in 2010, the amount of visits to emergency departments (EDs), admissions to hospitals, and deaths either related to TBI alone or to TBI linked with other injuries totaled around 2.5 million.

CDC figures for between 2006 and 2010 show falls as the leading cause of TBI (accounting for 40.5 percent of ED visits, hospitalizations, and deaths), followed by unintentional blunt trauma (15.5 percent), and motor vehicle crashes (14.3 percent).

Dr. Ljungqvist and colleagues note that the key to improving outcomes for people who sustain TBIs is to reduce the time it takes from when the injury occurs to deciding the right treatment.

Microwave helmet

The microwave helmet has three parts: a helmet incorporating microwave antennae that is placed on the patient’s head; a microwave signal generator; and a computer that controls the equipment, collects the data, and processes them through advanced mathematical algorithms.

The microwave generator sends signals through transmit antennae in the helmet into the patient’s brain.

Receiving antennae in the helmet pick up the signals after they have been scattered by and reflected from the brain tissue.

The advanced algorithms analyze the complex patterns in the microwave signals to deduce what they might indicate about changes in the brain.

Dr. Ljungqvist and colleagues evaluated the ability of their microwave technology to differentiate between people with brain bleeds due to injury and people without brain injury.

Microwave technology ‘shows promise in early triage of TBI’

The team tested the device on 20 patients with traumatic intracranial hematomas, 20 patients with chronic subdural hematoma, and 20 healthy volunteers. The patients were hospitalized for surgery in a Swedish hospital.

The participants also underwent traditional scanning with computerized tomography (CT). The CT scan results were then compared with the microwave helmet results.

The authors conclude that the microwave technology “shows promise as a tool to improve triage accuracy.” It detected the hematomas at 100 percent sensitivity and 75 percent specificity.

Sensitivity indicates how well a test rules out disease, and specificity indicates how well it rules it in. Thus, in this study, the microwave helmet “over-diagnosed” 25 percent of the cases (that is, 25 percent were “false positives.”)

The researchers note that plans are already in place to test the microwave helmet with more acute head injury patients in Sweden and other countries.

“Microwave technology has the potential to revolutionize medical diagnostics by enabling faster, more flexible, and more cost-effective care.”

Mikael Persson, professor of biomedical engineering, Chalmers University of Technology

Learn how a molecule discovery may lead to new drugs for brain and spinal cord injury.

Source: ‘Microwave helmet’ may cut time taken to evaluate head injuries – Medical News Today

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[WEB SITE] One step at a time

IMAGE: DR. KIM (LEFT) WITH DR. SHARMA AND A HYBRID EXOSKELETON PROTOTYPE IN THE NEUROMUSCULAR CONTROL AND ROBOTICS LABORATORY IN THE SWANSON SCHOOL OF ENGINEERING. view more CREDIT: SWANSON SCHOOL OF ENGINEERING

PITTSBURGH (March 7, 2017) … The promise of exoskeleton technology that would allow individuals with motor impairment to walk has been a challenge for decades. A major difficulty to overcome is that even though a patient is unable to control leg muscles, a powered exoskeleton could still cause muscle fatigue and potential injury.

However, an award from the National Science Foundation’s Cyber-Physical Systems (CPS) program will enable researchers at the University of Pittsburgh to develop an ultrasound sensor system at the heart of a hybrid exoskeleton that utilizes both electrical nerve stimulation and external motors.

Principal investigator of the three year, $400,000 award is Nitin Sharma, assistant professor of mechanical engineering and materials science at Pitt’s Swanson School of Engineering. Co-PI is Kang Kim, associate professor of medicine and bioengineering. The Pitt team is collaborating with researchers led by Siddhartha Sikdar, associate professor of bioengineering and electrical and computer engineering at George Mason University, who also received a $400,000 award for the CPS proposal, “Synergy: Collaborative Research: Closed-loop Hybrid Exoskeleton utilizing Wearable Ultrasound Imaging Sensors for Measuring Fatigue.”

This latest funding furthers Dr. Sharma’s development of hybrid exoskeletons that combine functional electrical stimulation (FES), which uses low-level electrical currents to activate leg muscles, with powered exoskeletons, which use electric motors mounted on an external frame to move the wearer’s joints.

“One of the most serious impediments to developing a human exoskeleton is determining how a person who has lost gait function knows whether his or her muscles are fatigued. An exoskeleton has no interface with a human neuromuscular system, and the patient doesn’t necessarily know if the leg muscles are tired, and that can lead to injury,” Dr. Sharma explained. “Electromyography (EMG), the current method to measure muscle fatigue, is not reliable because there is a great deal of electrical “cross-talk” between muscles and so differentiating signals in the forearm or thigh is a challenge.”

To overcome the low signal-to-noise ratio of traditional EMG, Dr. Sharma partnered with Dr. Kim, whose research in ultrasound focuses on analyzing muscle fatigue.

“An exoskeleton biosensor needs to be noninvasive, but systems like EMG aren’t sensitive enough to distinguish signals in complex muscle groups,” Dr. Kim said. “Ultrasound provides image-based, real-time sensing of complex physical phenomena like neuromuscular activity and fatigue. This allows Nitin’s hybrid exoskeleton to switch between joint actuators and FES, depending upon the patient’s muscle fatigue.”

In addition to mating Dr. Sharma’s hybrid exoskeleton to Dr. Kim’s ultrasound sensors, the research group will develop computational algorithms for real-time sensing of muscle function and fatigue. Human subjects using a leg-extension machine will enable detailed measurement of strain rates, transition to fatigue, and full fatigue to create a novel muscle-fatigue prediction model. Future phases will allow the Pitt and George Mason researchers to develop a wearable device for patients with motor impairment.

“Right now an exoskeleton combined with ultrasound sensors is just a big machine, and you don’t want to weigh down a patient with a backpack of computer systems and batteries,” Dr. Sharma said. “The translational research with George Mason will enable us to integrate a wearable ultrasound sensor with a hybrid exoskeleton, and develop a fully functional system that will aid in rehabilitation and mobility for individuals who have suffered spinal cord injuries or strokes.”

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Source: One step at a time | EurekAlert! Science News

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[Abstract] Repetitive task training for improving functional ability after stroke – The Cochrane Library

Abstract

Background

Repetitive task training (RTT) involves the active practice of task-specific motor activities and is a component of current therapy approaches in stroke rehabilitation.

Objectives

Primary objective: To determine if RTT improves upper limb function/reach and lower limb function/balance in adults after stroke.

Secondary objectives: 1) To determine the effect of RTT on secondary outcome measures including activities of daily living, global motor function, quality of life/health status and adverse events. 2) To determine the factors that could influence primary and secondary outcome measures, including the effect of ‘dose’ of task practice; type of task (whole therapy, mixed or single task); timing of the intervention and type of intervention.

Search methods

We searched the Cochrane Stroke Group Trials Register (4 March 2016); the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 5: 1 October 2006 to 24 June 2016); MEDLINE (1 October 2006 to 8 March 2016); Embase (1 October 2006 to 8 March 2016); CINAHL (2006 to 23 June 2016); AMED (2006 to 21 June 2016) and SPORTSDiscus (2006 to 21 June 2016).

Selection criteria

Randomised/quasi-randomised trials in adults after stroke, where the intervention was an active motor sequence performed repetitively within a single training session, aimed towards a clear functional goal.

Data collection and analysis

Two review authors independently screened abstracts, extracted data and appraised trials. We determined the quality of evidence within each study and outcome group using the Cochrane ‘Risk of bias’ tool and GRADE (Grades of Recommendation, Assessment, Development and Evaluation) criteria. We did not assess follow-up outcome data using GRADE. We contacted trial authors for additional information.

Main results

We included 33 trials with 36 intervention-control pairs and 1853 participants. The risk of bias present in many studies was unclear due to poor reporting; the evidence has therefore been rated ‘moderate’ or ‘low’ when using the GRADE system.

There is low-quality evidence that RTT improves arm function (standardised mean difference (SMD) 0.25, 95% confidence interval (CI) 0.01 to 0.49; 11 studies, number of participants analysed = 749), hand function (SMD 0.25, 95% CI 0.00 to 0.51; eight studies, number of participants analysed = 619), and lower limb functional measures (SMD 0.29, 95% CI 0.10 to 0.48; five trials, number of participants analysed = 419).

There is moderate-quality evidence that RTT improves walking distance (mean difference (MD) 34.80, 95% CI 18.19 to 51.41; nine studies, number of participants analysed = 610) and functional ambulation (SMD 0.35, 95% CI 0.04 to 0.66; eight studies, number of participants analysed = 525). We found significant differences between groups for both upper-limb (SMD 0.92, 95% CI 0.58 to 1.26; three studies, number of participants analysed = 153) and lower-limb (SMD 0.34, 95% CI 0.16 to 0.52; eight studies, number of participants analysed = 471) outcomes up to six months post treatment but not after six months. Effects were not modified by intervention type, dosage of task practice or time since stroke for upper or lower limb. There was insufficient evidence to be certain about the risk of adverse events.

Authors’ conclusions

There is low- to moderate-quality evidence that RTT improves upper and lower limb function; improvements were sustained up to six months post treatment. Further research should focus on the type and amount of training, including ways of measuring the number of repetitions actually performed by participants. The definition of RTT will need revisiting prior to further updates of this review in order to ensure it remains clinically meaningful and distinguishable from other interventions.

Plain language summary

Repetitive task training for improving functional ability after stroke

Review question: What are the effects of repeated practice of functional tasks on recovery after stroke when compared with usual care or placebo treatments?

Background: Stroke can cause problems with movement, often down one side of the body. While some recovery is common over time, about one third of people have continuing problems. Repeated practice of functional tasks (e.g. lifting a cup) is a treatment approach used to help with recovery of movement after stroke. This approach is based on the simple idea that in order to improve our ability to perform tasks we need to practice doing that particular task numerous times, like when we first learned to write. The types of practice that people do, and the time that they spend practicing, may affect how well this treatment works. To explore this further we also looked at different aspects of repetitive practice that may influence how well it works.

Study characteristics: We identified 33 studies with 1853 participants. Studies included a wide range of tasks to practice, including lifting a ball, walking, standing up from sitting and circuit training with a different task at each station. The evidence is current to June 2016.

Key results: In comparison with usual care (standard physiotherapy) or placebo groups, people who practiced functional tasks showed small improvements in arm function, hand function, walking distance and measures of walking ability. Improvements in arm and leg function were maintained up to six months later. There was not enough evidence to be certain about the risk of adverse events, for example falls. Further research is needed to determine the best type of task practice, and whether more sustained practice could show better results.

Quality of the evidence: We classified the quality of the evidence as low for arm function, hand function and lower limb functional measures, and as moderate for walking distance and functional ambulation. The quality of the evidence for each outcome was limited due poor reporting of study details (particularly in earlier studies), inconsistent results across studies and small numbers of study participants in some comparisons.

Source: Repetitive task training for improving functional ability after stroke – French – 2016 – The Cochrane Library – Wiley Online Library

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[Abstract] Executive function is associated with off-line motor learning in people with chronic stroke

Provisional Abstract:
Background and Purpose: Sleep has been shown to promote off-line motor learning in individuals following stroke. Executive function ability has been shown to be a predictor of participation in rehabilitation and motor recovery following stroke. The purpose of this study was to explore the association between executive function and off-line motor learning in individuals with chronic stroke compared to healthy control participants.

Methods: Seventeen individuals with chronic stroke (> 6 months post stroke) and nine healthy adults were included in the study. Participants underwent three consecutive nights of polysomnography (PSG), practiced a continuous tracking task (CTT) the morning of the third day, and underwent a retention test the morning after the third night. Participants underwent testing on four executive function tests after the CTT retention test.

Results: Stroke participants showed a significant positive correlation between the off-line motor learning score and performance on the Trail Making Test (TMT D-KEFS) (r= .652 p= .005), while the healthy controls did not. Regression analysis showed that the TMT D-KEFS is a significant predictor of off-line motor learning (p= .008).

Discussion and Conclusions: This is the first study to demonstrate that better performance on an executive function test of attention and set-shifting predicts a higher magnitude of off-line motor learning in individuals with chronic stroke. This emphasizes the need to consider attention and set-shifting abilities of individuals following stroke as these abilities predict off-line motor learning. This in turn could affect learning of ADL’s and impact functional recovery following stroke.

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Source: JUST ACCEPTED: “Executive function is associated with off-line motor learning in people with chronic stroke”

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[WEB SITE] Lost & Found: Caps, Sunglasses, and Earplugs – Strategies for Coping with Sensory Hypersensitivity – brainline.org

If it seems like your sense of touch, taste, smell, hearing, or vision is extra sensitive or heightened after your brain injury, it’s not your imagination. Sensory hypersensitivities are another major, yet not as obvious, contributor to fatigue and overload after brain injury. What we experience with our senses is essentially more information for our injured brains to try to process and organize. You can have difficulties processing sensory information just like any other information in your brain. Some examples of sensory hypersensitivities are:

  • Sounds that you barely noticed before are alarming and startle you.
  • It feels like you have megaphones in your ears.
  • Background sounds and stimulating environments become overwhelming.
  • Fluorescent and bright lights give you headaches.
  • Clothing that was comfortable before feels irritating now.
  • Large gatherings of people feel overwhelming.

Pain and fatigue can intensify sensory hypersensitivities, putting you in a hyper-sensitive or hyper-vigilant state. When you are in a hyper-sensitive or hyper-vigilant state, even subtle stimulants feel overwhelming. Especially sights and sounds that didn’t bother you before, may now trigger anxiety and the fight-or-flight response where your whole being feels threatened and out of control. You may shut down and not be able to do any more or you may feel compelled to escape from the situation. It can be very taxing, physically and mentally.

Stress management, movement and using all of your senses can help your brain organize and integrate the senses. This is similar to what children do. Consider how physically active children are as they grow and develop!

See Brain Recharging Breaks at the end of this chapter for some basic meditation techniques. Meanwhile, following are suggestions for coping with sensory hypersensitivities.

General Coping Suggestions

Limit exposure to avoid sensory overload.

  • Avoid crowds and chaotic places where there are a lot of stimuli, like shopping malls.
  • Do shopping and errands early in the week and early in the day, when stores are less crowded and quieter.
  • Shop in smaller, quieter stores when possible.
  • Eat out in restaurants when they are quieter, in between regular meal times.
  • Hold conversations in a quiet place.
  • Ask people to please speak one at a time. Explain that you’d really like to hear what everyone has to say but you can only hear one person at a time.
  • Sleep during car trips.
  • If you want to attend a function that you expect will be taxing, plan to stay only a short while. Take your cap, sunglasses and earplugs. Sit towards the back to minimize the sound and where you can easily exit to a quieter place or the car.

Monitor your pain, stress and fatigue levels.

Lights and sounds will bother you the most when you are stressed or fatigued. If you are feeling especially sensitive, use it as a cue that you need to take a break and use some relaxation techniques.

Try avoiding nicotine, caffeine and alcohol.

They may make the symptoms worse. If you have vertigo, try limiting your salt intake, which can cause fluid retention. Consider strengthening exercises for your neck with the guidance of a physical therapist.

When you are starting to feel stressed or anxious, try incorporating another sense.

  • Put something in your mouth to chew or suck on. Strong flavors like peppermint or cinnamon are especially effective.
  • Put on some soothing music.
  • Apply some deep pressure. Give yourself a hug or press your palms firmly together or on the table. Squeeze the steering wheel if you are driving the car.

Experiment with activities and alternative therapies that involve your senses.

Listen to music, experiment with movement, dance, yoga, water, art, aromatherapy, etc.

Challenge your sensitivities.

Gradually increase your exposure and tolerance when using earplugs, sunglasses, etc.
Don’t eliminate the senses completely or you set yourself up for super-sensitivity.

Specific Coping Strategies

Sensitivities to sound

  • Limit your exposure to noisy stores and loud situations like sporting events, the movie theatre and children’s school activities. Don’t participate or plan to stay for a limited amount of time. Sit on the outskirts so you can gracefully escape to a quieter place if needed.
  • Use earplugs, try different kinds, and carry them with you.
  • Use headphones for TV and music:
    • For others, when you don’t want to hear it.
    • For yourself, when you want to hear it better.
  • Minimize distractions from snacking while doing things like working in groups or playing games. Use bowls for food instead of eating directly from noisy bags.
  • Add some background sound – a fan, white noise machine, soothing music.
  • Remove yourself from the situation and go to a quieter place as soon as possible, even the bathroom, when you feel overwhelmed or anxious. Then try:
    • Closing your eyes
    • Taking slow deep stomach breaths
    • Putting an ice pack on your forehead and eyes
  • Gradually expose yourself to different sounds and louder sounds to increase your tolerances.

Sensitivities to light

  • Avoid bright light and fluorescent lights.
  • Use sunglasses or a cap with a brim, even indoors.
  • Try yellow tinted glasses if florescent lights are a problem.
  • Try polarized sunglasses if driving glare is a problem.
  • Try yellow tinted glasses if night driving is a problem.
  • Make sure you are getting plenty of vitamin A (but not too much!).
  • Eat orange colored fruits and vegetables like carrots, sweet potatoes, squash, and cantaloupe.
  • Take a moment to just close your eyes for a few minutes when you are starting to feel stressed or anxious. This blocks out the visual stimuli.

Sensitivities to touch, taste, and smell

  • Experiment! Cultivate an awareness of how things feel, taste and smell.
  • Rub different textures on your arms, increasing the intensity to gradually decrease sensitivities.
  • Add texture, contrasting temperatures and flavors to your food, like ice cream with crunchy nuts or chips with spicy taco sauce.
  • Notice the textures.
  • Pay attention to smells.
  • How do different aromas make you feel?

If your sense of smell is altered, make sure to have functioning smoke and gas detectors in your home.

Doing cognitive work

  • Plan to do cognitive work when your environment is quiet. Eliminate as many distractions and interruptions as possible.
  • Screen out distractions by using earplugs or headphones, playing soothing music, or using a fan or white noise machine if you have sensitivities to sound.
  • Turn down the volume on the phone and let the machine get it.
  • Work in an uncluttered space or use a three sided table screen, to help screen out visual distractions.
  • Give children headphones for the TV if you are having trouble screening it out.
  • Do your “thinking” work while children are in school or asleep.
  • Still having trouble concentrating? Try bringing in another sense.
    • Put on some soothing nature or instrumental music, something without words at a low volume.
    • Try chewing or sucking on something while you are working. Coffee stirrers can substitute for fingernails. Strong flavored or fizzy candies and gum can aid alertness.
    • Try using some deep pressure by giving yourself a hug, pressing your palms strongly against each other or on the table.
    • Try sitting on a large therapy ball while you work. A great strategy if you have trouble sitting still!
  • Take a physical break, every 15 min. at first. Resist the urge to push through. I know it feels counter-intuitive but taking breaks will actually help you work longer! Gradually you will find you can increase the time between breaks.
    • Use a timer – without a ticking sound!
    • Pause and stretch, drink some water or make a cup of tea, walk around the house or the yard, rock in a chair, walk the dog, pat the cat.

Visual Processing Problems

Vision is an extremely important and complex source of sensory information. What you see with your eyes travels through your brain to the back area of your brain, where it is processed in the occipital lobe. There is a lot of territory between the eyes and the back of the brain where an injury can occur. The occipital lobe may be damaged directly from impact to the back of the head or it may be damaged indirectly from the ricochet of the brain inside the skull when the front of the brain is impacted. Damage to the occipital lobe frequently occurs in car accidents, falls and sports injuries. Even subtle visual problems following a brain injury can have a significant impact on cognition and functioning.

I wish I had known about visual problems and visual therapy when I had my car accident. I thought I was really going crazy! Fortunately for me, my issues improved with time but not without mishaps, like falling off a curb!

Some common problems after a brain injury related to vision include:

  • Double vision
  • Trouble tracking words on a page
  • Impaired depth perception
  • Hypersensitivities to light
  • Difficulties remembering and recalling information that is seen
  • Difficulties “filling in the gaps” or completing a picture based on seeing only some of the parts
  • Trouble seeing objects to the side
  • Low tolerances to changing light or clutter
  • Impaired balance, bumping into objects
  • Feeling overwhelmed when there is a lot of visual stimuli

If you notice problems in areas related to visual processing, please consult a visual therapist or a neuroopthalmologist, they can help!

Tips:

  • Don’t eliminate any sense completely or you set yourself up for a super-sensitivity.
  • Gradually expose yourself to more light, sound, touch, smell, and taste.
  • Be patient, in many cases your sensory hypersensitivities will decrease in time!
  • Ask for physical therapy or occupational therapy with a therapist with a background in sensory integration for help with sensory sensitivities.

Some good news about sensory hypersensitivity is that it is also associated with a heightened sense of awareness and intuition. You may find that you feel more aware of your intuition and more creative since your brain injury. This is not uncommon. Enjoy!

Brain Recharging Breaks

If I had to choose one strategy that helped me the most after my brain injury, it would be learning to meditate. Meditation is especially helpful when you are experiencing sensory overload. It can help you calm yourself down from that hyper-sensitive state. It was also the only way I have found to give my brain a rest, to put it temporarily in a “cast”, like you would a broken limb. Often, after meditating for 15-20 minutes, the “logjam” in my brain clears up and I am somehow able to think again!

I recommend using some stress management or meditation techniques at least once a day. Plan it, schedule it in your planner, make it part of your daily routine. Meditation is not as mysterious as you might think. Try these basic steps:

  • Get in a comfortable position on the bed, in a recliner or even in the car; uncross your arms and legs. Cover yourself with a blanket if you are cool.
  • Close your eyes and do some slow deep breathing.
  • Slowly inhale, expanding your stomach and counting to 7.
  • Exhale gradually, contracting your stomach towards your spine, counting to 7.

Repeat. Repeat. Repeat.

When you are feeling more relaxed, as you continue your slow deep breathing, experiment with the following suggestions to increase the effectiveness of the experience.

Do a body scan checking for areas of pain or stress.

  • Eyes closed, inhale deeply, picture your forehead and notice any stress or pain.
  • Exhale and imagine the pain floating away with your exhale.
  • Inhale, picture your eyebrows and notice any stress or pain. Exhale and release it, imagining the stress floating away.
  • Repeat for your eyes, ears, jaw, throat, back of neck, shoulders … down to your toes. Breathe in relaxation, breathe out stress and pain.

Notice how you feel after you get to your toes!

  • Visualize or imagine yourself in a warm, secure, relaxing, happy, peaceful place; floating on a cloud, floating in the water, or recalling a happy memory.
    • Continue slow deep breathing.
  • Focus on a picture or artwork that you like, noticing each detail.
    • Continue slow deep breathing.
  • Listen to music, any music that is soothing to you. Nature sounds or instrumental music is a good place to start experimenting.
    • Continue slow deep breathing.
  • Use aromatherapy – any scent that smells good to you. Favorite scents are often from childhood memories!
    • Continue slow deep breathing.

Strive to let go of that never-ending tape of worries and “shoulds” that plays in your head. Focus on your senses – your breath, the music, a relaxing place, a comforting aroma. If thoughts drift in, gently push them away. It gets easier with practice, you’ll find what works best for you and you’ll be amazed at how much it helps you!

Excerpted from Lost & Found: A Survivor’s Guide for Reconstructing Life After a Brain Injury by Barbara J. Webster. © 20ll by Lash & Associates Publishing/Training Inc. Used with permission. Click here for more information about the book.

Related Content

Source: Lost & Found: Caps, Sunglasses, and Earplugs

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