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[WEB SITE] CT head scan: Uses, procedure, risks, and results

A computed tomography (CT) scan of the head is an imaging scan that uses X-rays to develop a 3D image of the skull, brain, and other related areas of the head.

CT scan of the head can provide more detail than a traditional X-ray, which is particularly useful when a doctor wants to check the blood vessels and soft tissues in the body.

In this article, we explain why a doctor may order a CT scan of the head and what a person can expect if they need to undergo this procedure.

When do people need a CT head scan?

a man having a CT head scan

A person may have a CT head scan after trauma to check for damage.

Some of the reasons why a doctor may order a head CT scan include:

  • looking for possible damage after trauma to the head, such as soft tissue injuries, brain bleeding, and bone injuries
  • assessing a person having stroke-like symptoms to see whether there are signs of a blood clot or brain bleeding
  • looking for a possible brain tumor or other brain abnormality
  • checking the effectiveness of medical treatments in shrinking a brain tumor
  • assessing birth conditions that cause the skull to form abnormally
  • evaluating a person with a history of hydrocephalus, a condition in which an accumulation of cerebrospinal fluid causes the enlargement of the brain ventricles

If a person is having brain-related symptoms, such as changes in personality or affected movement, a doctor may order a head CT scan to make sure that a brain abnormality is not the underlying cause.

Test procedure

A doctor should provide specific instructions for the day of the CT scan. These will include whether or not to refrain from eating or drinking for a certain period before the scan.

The doctor will also usually ask the person to take off any jewelry, removable dental work, or hairpins because these can affect the scan’s images.

Sometimes, people who take metformin (Glucophage) may need to refrain from using it for a few days before getting a CT scan with contrast dye. The combination of this drug and the dye can cause a severe reaction in some individuals.

Contrast dye is a substance that the person may receive by injection before a scan. It makes certain areas of the body show up more easily on a scan. However, not all CT scans require contrast dye.

The person will often complete a checklist before undergoing the scan. The checklist includes a medical history of conditions that can affect a person’s health, such as kidney disease, heart diseaseasthma, and thyroid problems. Some health issues may affect a person’s ability to receive intravenous (IV) contrast.

The scanner usually looks like a circle shaped machine that has a hole in its center. In the center, there is a bed on which a person lies during the procedure. The scanner is usually open, which helps the person feel less claustrophobic.

radiology technician may ask the person to change into a gown before going into the room with the CT scanner.

Before the scan, a radiology technician may put an IV line in place, usually in the person’s arm, if the scan uses contrast dye.

During the scan, the radiology technician will talk to the person via a speaker to let them know them when the scan is starting. The scanner will direct X-ray beams at the person’s head. The X-rays will come back to the scanner, transmitting the images back to a computer.

After the initial scan, the radiology technician may deliver the IV contrast material. They will then restart the CT scan. The technologist will review the images to ensure that they are of high quality and are free of blurring in any key areas.

The average CT scan of the head takes no more than 10 minutes.

CT head scans in children

a doctor preparing a child for a CT scan.

Children are sensitive to radiation, so a doctor may only order a CT scan when necessary to confirm a diagnosis.

As a CT scan is relatively quick, many children can stay still long enough for the technician to complete the scan. However, if a child cannot remain still for the scan — as is the case for babies — it may be necessary to perform the procedure with the child under anesthesia.

Children are typically more sensitive to radiation than adults. As a result, doctors tend to reserve CT scans for when they are necessary to make a diagnosis. A radiology technician can usually adjust the settings on a CT scanner to deliver the lowest possible dose of radiation.

Risks

The CT scan is a painless, noninvasive procedure, and doctors generally consider it to be safe. However, it carries some possible risks.

As a CT scan exposes a person to radiation, there is a risk that the person could develop cancer from excessive radiation doses. However, the risks for this after one CT head scan are minimal. A person can ask their doctor if they should be concerned about the radiation dose from a CT head scan.

Doctors will usually recommend that women avoid CT scans during pregnancy. However, as one CT scan is unlikely to pose a significant risk, a doctor can offer advice on whether the benefits outweigh the risks.

Read about the safety of X-rays here.

A CT scan can be noisy. Sometimes, this noise or the fear of being in an enclosed space can provoke anxiety in a person. For this reason, doctors may sometimes give a person sedating medicines before they go into the CT scanner.

If a person receives a contrast dye during the procedure, they could be at risk of experiencing an allergic reaction to the dye.

Contrast dye can also cause other symptoms that may be temporarily unpleasant but are not an allergic reaction. These may include a warm feeling throughout the body, a burning sensation, or a metallic taste in the mouth. Sometimes, a doctor may prescribe a steroid or advise a person to take diphenhydramine (Benadryl) before undergoing the scan.

Results

A medical specialist called a radiologist will examine the imaging scans, looking for any abnormalities in the brain and surrounding tissues. They will write a report of their findings and send it to the doctor who ordered the scan.

If a person is in the hospital and undergoing the scan as an emergency, the radiologist will report any immediately concerning results as quickly as possible.

CT scan vs. MRI scan

a doctor showing a patient information on an ipad

A person’s doctor can advise on which type of scan is best to diagnose a certain condition.

While a CT scan is helpful in displaying some aspects of the head and brain, an MRI scan sometimes has higher sensitivity. As a result, it may be more effective in revealing disease processes in the brain and inflammation in the membranes covering the brain, which are known as the meninges.

Doctors will consider the advantages of each type of scan for scanning the head. The benefits of a CT scan compared with an MRI scan include:

  • A CT scan is faster than an MRI scan, so doctors usually use it for emergencies.
  • A CT scan generally costs less than an MRI scan.
  • Doctors can perform a CT scan on a person who has metal devices, such as a pacemaker, nerve stimulator, or cochlear implant. A person with these devices cannot undergo an MRI because of the magnet’s attraction to metal.

The benefits of an MRI scan compared with a CT scan include:

  • An MRI does not involve radiation exposure, making it preferable for children who may require multiple scans.
  • MRI scans can show soft tissues and structures that bone may hide in a CT scan.
  • A person requires a smaller amount of IV contrast for an MRI scan than for a CT scan.

People can talk to their doctor to evaluate the aspects of each scan and determine which is most appropriate for them.

Summary

A CT scan of the head is useful for helping a doctor assess damage after an accident or head trauma. It also allows them to look for brain abnormalities, such as tumors and skull defects.

Doctors consider CT scans to be relatively safe and noninvasive procedures, even though they involve exposure to radiation. People can discuss any possible risks with their doctor.

 

via CT head scan: Uses, procedure, risks, and results

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[REVIEW] Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls – Full Text

Acute brain ischemia causes changes in several neural networks and related cortico-subcortical excitability, both in the affected area and in the apparently spared contralateral hemisphere. The modulation of these processes through modern techniques of noninvasive brain stimulation, namely repetitive transcranial magnetic stimulation (rTMS), has been proposed as a viable intervention that could promote post-stroke clinical recovery and functional independence. This review provides a comprehensive summary of the current evidence from the literature on the efficacy of rTMS applied to different clinical and rehabilitative aspects of stroke patients. A total of 32 meta-analyses published until July 2019 were selected, focusing on the effects on motor function, manual dexterity, walking and balance, spasticity, dysphagia, aphasia, unilateral neglect, depression, and cognitive function after a stroke. Only conventional rTMS protocols were considered in this review, and meta-analyses focusing on theta burst stimulation only were excluded. Overall, both HF-rTMS and LF-rTMS have been shown to be safe and well-tolerated. In addition, the current literature converges on the positive effect of rTMS in the rehabilitation of all clinical manifestations of stroke, except for spasticity and cognitive impairment, where definitive evidence of efficacy cannot be drawn. However, routine use of a specific paradigm of stimulation cannot be recommended yet due to a significant level of heterogeneity of the studies in terms of protocols to be set and outcome measures that have to be used. Future studies need to preliminarily evaluate the most promising protocols before going on to multicenter studies with large cohorts of patients in order to achieve a definitive translation into daily clinical practice.

Background

Stroke is a common acute neurovascular disorder that causes disabling long-term limitations to daily living activities. The most common consequence of a stroke is motor deficit of variable degree,1 although nonmotor symptoms are also relevant and often equally disabling.2 To date, to the best of the authors’ knowledge, there is no validated treatment that is able to restore the impaired functions by a complete recovery of the damaged tissue. Indeed, stroke management basically consists of reducing the initial ischemia in the penumbra, preventing future complications, and promoting a functional recovery using physiotherapy, speech therapy, occupational therapy, and other conventional treatments.3,4

Ischemic damage is associated with significant metabolic and electrophysiological changes in cells and neural networks involved in the affected area. From a pure electrophysiological perspective, however, beyond the affected area, there is a local shift in the balance between the inhibition and excitation of both the affected and contralateral hemisphere, consisting of increased excitability and disinhibition (reduced activity of the inhibitory circuits).3,5 In addition, subcortical areas and spinal regions may be altered.3,5 In particular, the role of the uninjured hemisphere seems to be of utmost significance in post-stroke clinical and functional recovery.

Different theoretical models have been proposed to explain the adaptive response of the brain to acute vascular damage. According to the vicariation model, the activity of the unaffected hemisphere contributes to the functional recovery after a stroke through the replacement of the lost functions of the affected areas. The interhemispheric competition model considers the presence of mutual inhibition between the hemispheres, and the damage caused by a stroke disrupts this balance, thus producing a reduced inhibition of the unaffected hemisphere by the affected side. This results in increased inhibition of the affected hemisphere by the unaffected side. More recently, a new model, called bimodal balance recovery, has been proposed.3,5 It introduces the concept of a structural reserve, which describes the extent to which the nondamaged neural pathways contribute to the clinical recovery. The structural reserve determines the prevalence of the interhemispheric imbalance over vicariation. When the structural reserve is high, the interhemispheric competition model can predict the recovery better than the vicariation model, and vice versa.3

Repetitive transcranial magnetic stimulation

One of the proposed interventions to improve stroke recovery, by the induction of neuromodulation phenomena, is based on methods of noninvasive brain stimulation. Among them, transcranial magnetic stimulation (TMS) is a feasible and painless neurophysiological technique widely used for diagnostic, prognostic, research, and, when applied repetitively, therapeutic purposes.69 By electromagnetic induction, TMS generates sub or suprathreshold currents in the human cortex in vivo and in real time.10,11

The most common stimulation site is the primary motor cortex (M1), that generates motor evoked potentials (MEPs) recorded from the contralateral muscles through surface electromyography electrodes.11 The intensity of TMS, measured as a percentage of the maximal output of the stimulator, is tailored to each patient based on the motor threshold (MT) of excitability. Resting MT (rMT) is found when the target muscle is at rest, it is defined as the minimal intensity of M1 stimulation required to elicit an electromyography response with a peak-to-peak amplitude > 50 µV in at least 5 out of 10 consecutive trials.11 Alternatively TMS MTAT 2.0 software (http://www.clinicalresearcher.org/software.htm) is a free tool for TMS researchers and practitioners. It provides four adaptive methods based on threshold-tracking algorithms with the parameter estimation by sequential testing, using the maximum-likelihood strategy for estimating MTs. Active MT (aMT) is obtained during a tonic contraction of the target muscle at approximately 20% of the maximal muscular strength.11

The rMT is considered a basic parameter in providing the global excitation state of a central core of M1 neurons.11 Accordingly, rMT is increased by drugs blocking the voltage-gated sodium channels, where the same drugs may not have an effect on the gamma-aminobutyric acid (GABA)-ergic functions. In contrast, rMT is reduced by drugs increasing glutamatergic transmission not mediated by the N-methyl-D-aspartate (NMDA) receptors, suggesting that rMT reflects both neuronal membrane excitability and non-NMDA receptor glutamatergic neurotransmission.12 Finally, the MT increases, being often undetectable, when a substantial portion of M1 or the cortico-spinal tract is damaged (i.e. by stroke or motor neuron disease), and decreases when the motor pathway is hyperexcitable (such as epilepsy).13

Repetitive (rTMS) is a specific stimulation paradigm characterized by the administration of a sequence of consecutive stimuli on the same cortical region, at different frequencies and inter sequence intervals. As known, rTMS can transiently modulate the excitability of the stimulated cortex, with both local and remote effects outlasting the stimulation period. Conventional rTMS modalities include high-frequency (HF-rTMS) stimulation (>1 Hz) and low-frequency (LF-rTMS) stimulation (⩽1 Hz).11 High-frequency stimulation typically increases motor cortex excitability of the stimulated area, whereas low-frequency stimulation usually produces a decrease in excitability.14 The mechanisms by which rTMS modulates the brain are rather complex, although they seem to be related to the phenomena of long-term potentiation (LTP) and long-term depression (LTD).15

When applied after a stroke, rTMS should ideally be able to suppress the so called ‘maladaptive plasticity’16,17 or to enhance the adaptive plasticity during rehabilitation. These goals can be achieved by modulating the local cortical excitability or modifying connectivity within the neuronal networks.10

rTMS in stroke rehabilitation: an overview

According to the latest International Federation of Clinical Neurophysiology (IFCN) guidelines on the therapeutic use of rTMS,10 there is a possible effect of LF-rTMS of the contralesional motor cortex in post-acute motor stroke, and a probable effect in chronic motor stroke. An effect of HF-rTMS on the ipsilesional motor cortex in post-acute and chronic motor stroke is also possible.

The potential role of rTMS in gross motor function recovery after a stroke has been assessed in a recent comprehensive systematic review of 70 studies by Dionisio and colleagues.18 The majority of the publications reviewed report a role of rTMS in improving motor function, although some randomized controlled trials (RCTs) were not able to confirm this result,1923 as shown by a recent large randomized, sham-controlled, clinical trial of navigated LF-rTMS.24 It has also been suggested that rTMS can specifically improve manual dexterity,10 which is defined as the ability to coordinate the fingers and efficiently manipulate objects, and is of crucial importance for daily living activities.25 Notably, most of the studies focused on motor impairment in the upper limbs, whereas limited data is available on the lower limbs.18 Walking and balance are frequently impaired in stroke patients and significantly affect the quality of life (QoL),26,27 and rTMS might represent a valid aid in the recovery of these functions.28,29 Spasticity is another common complication after a stroke, consisting of a velocity-dependent increase of muscular tone,30 and for which rTMS has been proposed as a rehabilitation tool.31

Dysphagia is highly common in stroke patients, it impairs the global clinical recovery, and predisposes to complications.32 It has been pointed out that rTMS targeting the M1 area representing the muscles involved in swallowing may contribute to the treatment of post-stroke dysphagia.33

Nonmotor deficit is also a relevant post-stroke disability that negatively impacts the QoL. Aphasia is a very common consequence of stroke, affecting approximately 30% of stroke survivors and significantly limiting rehabilitation.34 According to the IFCN guidelines, to date, there is no recommendation for LF-rTMS of the contralesional right inferior frontal gyrus (IFG). Similarly, no recommendation for HF-rTMS or intermittent theta burst stimulation (TBS) of the ipsilesional left IFG or dorsolateral prefrontal cortex (DLPFC) in Broca’s aphasia has been currently approved.10 The same is true for LF-rTMS of the right superior temporal gyrus in Wernicke’s aphasia.10

Neglect is the incapacity to respond to tactile or visual contralateral stimuli that are not caused by a sensory-motor deficit.35 Although hard to treat, rTMS has been proposed as a tool for neglect rehabilitation.36 However, the IFCN guidelines state that currently there is no recommendation for LF-rTMS of the contralesional left posterior parietal cortex, or for HF-rTMS of the ipsilesional right posterior parietal cortex.10 In a recent systematic review, most of the included studies supported the use of TMS for the rehabilitation of aphasia, dysphagia, and neglect, although the heterogeneity of stimulation protocols did not allow definitive conclusions to be drawn.37

Post-stroke depression is a relevant complication of cerebrovascular diseases.38 The role of rTMS in the management of major depressive disorders is well documented,39,40 and currently, rTMS is internationally approved and indicated for the treatment of major depression in adults with antidepressant medication resistance, and in those with a recurrent course of illness, or in cases of moderate-to-severe disease severity.39 In major depression disorders, according to the IFCN guidelines, there is a clear antidepressant effect of HF-rTMS over the left DLPFC, a probable antidepressant effect of LF-rTMS on the right DLPFC, and probably no differential antidepressant effect between right LF-rTMS and left HF-rTMS. Moreover, there is currently no recommendation for bilateral stimulation combining HF-rTMS of the left DLPFC and LF-rTMS of the right DLPFC. The mentioned guidelines also state that the antidepressant effect when stimulating DLPFC is probably additive, and possibly potentiating, to the efficacy of antidepressant drugs.10 However, no specific recommendation currently addresses the use of rTMS in post-stroke depression. Recently, rTMS has been proposed as a treatment option for the late-life depression associated with chronic subcortical ischemic vascular disease, the so called ‘vascular depression’.4144 Three studies tested rTMS efficacy in vascular depression (one was a follow-up study with citalopram). Although presenting positive findings, further trials should refine clinical and diagnostic criteria to assess its impact on antidepressant efficacy.45

Approximately 25–30% of stroke patients develop an immediate or delayed cognitive impairment or an overt picture of vascular dementia.46 There is evidence of an overall positive effect on cognitive function for both LF-rTMS47 and HF-rTMS,48 supported by studies on experimental models of vascular dementia.4952 Nonetheless, the few trials examining the effect on stroke-related cognitive deficit produced mixed results.5356 In particular, two studies found no effect on cognition when stimulating the left DLPFC at 1 Hz and 10 Hz,53,54 whereas a pilot study found a positive effect on the Stroop interference test with HF-rTMS over the left DLPFC in patients with vascular cognitive impairment without dementia.55 However, this finding was not replicated in a follow-up study.56 To summarize, rTMS can induce beneficial effects on specific cognitive domains, although data are limited and their clinical significance needs to be further validated. Major challenges exist in terms of appropriate patient selection and optimization of the stimulation protocols.57

Central post-stroke pain (CPSP) is the pain resulting from an ischemic lesion of the central nervous system.58 It represents a relatively common complication after a stroke, although it is often under-recognized and, therefore, undertreated.59 According to the IFCN guidelines for the use of rTMS in the treatment of neuropathic pain, there is a definite analgesic effect of HF-rTMS of contralateral M1 to the pain side, and LF-rTMS of contralateral M1 to the pain side is probably ineffective. In addition, there is currently no recommendation for cortical targets other than contralateral M1 to the pain side.10 Notably, rTMS might be effective in drug-resistant CPSP patients.58 A recent systematic review that included nine HF-rTMS studies suggested an effect on CPSP relief, but also underlined the insufficient quality of the studies considered.60

Study objective

In this article, we aim to provide an up-to-date overview of the most recent evidence on the efficacy of rTMS in the rehabilitation of stroke patients. Although several studies have been published, a conclusive statement supporting a systematic use of rTMS in the multifaceted clinical aspects of stroke rehabilitation is still lacking.

[…]

 

Continue —> Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls – Francesco Fisicaro, Giuseppe Lanza, Alfio Antonio Grasso, Giovanni Pennisi, Rita Bella, Walter Paulus, Manuela Pennisi, 2019

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[Abstract] Functional Balance and Postural Control Improvements in Patients with Stroke after Non-Invasive Brain Stimulation: A Meta-Analysis

Highlights

  • NIBS improved deficits in functional balance and postural control post stroke.
  • The treatment effects on postural imbalance were significant following rTMS.
  • The improvements after rTMS appeared in acute, subacute, and chronic patients.
  • A higher number of rTMS sessions significantly increased the treatment effects.

Abstract

Objectives

The postural imbalance post stroke limits individual’s walking abilities as well as increase the risk of falling. We investigated the short-term treatment effects of non-invasive brain stimulation (NIBS) on functional balance and postural control in patients with stroke.

Data Sources

We started the search via PubMed and ISI’s Web of Science on March 1, 2019 and concluded the search on April 30, 2019.

Study Selection

The meta-analysis included studies that used either repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) for the recovery of functional balance and postural control post stroke. All included studies used either randomized control trial or crossover designs with a sham control group.

Data Extraction

Three researchers independently performed data extraction and assessing methodological quality and publication bias. We calculated overall and individual effect sizes using random effects meta-analysis models.

Data Synthesis

The random effects meta-analysis model on the 18 qualified studies identified the significant positive effects relating to NIBS in terms of functional balance and postural control post stroke. The moderator variable analyses revealed that these treatment effects were only significant in rTMS across acute/subacute and chronic stroke patients whereas tDCS did not show any significant therapeutic effects. The meta-regression analysis showed that a higher number of rTMS sessions was significantly associated with more improvements in functional balance and postural control post stroke.

Conclusions

Our systematic review and meta-analysis confirmed that NIBS may be an effective option for restoring functional balance and postural control for patients with stroke.

via Functional Balance and Postural Control Improvements in Patients with Stroke after Non-Invasive Brain Stimulation: A Meta-Analysis – Archives of Physical Medicine and Rehabilitation

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[WEB SITE] Bring Back Handwriting: It’s Good for Your Brain

People are losing the brain benefits of writing by hand as the practice becomes less common

Illustration: Kieran Blakey

NNot so long ago, putting pen to paper was a fundamental feature of daily life. Journaling and diary-keeping were commonplace, and people exchanged handwritten letters with friends, loved ones, and business associates.

While longhand communication is more time-consuming and onerous, there’s evidence that people may in some cases lose out when they abandon handwriting for keyboard-generated text.

Psychologists have long understood that personal, emotion-focused writing can help people recognize and come to terms with their feelings. Since the 1980s, studies have found that “the writing cure,” which normally involves writing about one’s feelings every day for 15 to 30 minutes, can lead to measurable physical and mental health benefits. These benefits include everything from lower stress and fewer depression symptoms to improved immune function. And there’s evidence that handwriting may better facilitate this form of therapy than typing.

A commonly cited 1999 study in the Journal of Traumatic Stress found that writing about a stressful life experience by hand, as opposed to typing about it, led to higher levels of self-disclosure and translated to greater therapeutic benefits. It’s possible that these findings may not hold up among people today, many of whom grew up with computers and are more accustomed to expressing themselves via typed text. But experts who study handwriting say there’s reason to believe something is lost when people abandon the pen for the keyboard.

Psychologists have long understood that personal, emotion-focused writing can help people recognize and come to terms with their feelings.

“When we write a letter of the alphabet, we form it component stroke by component stroke, and that process of production involves pathways in the brain that go near or through parts that manage emotion,” says Virginia Berninger, a professor emerita of education at the University of Washington. Hitting a fully formed letter on a keyboard is a very different sort of task — one that doesn’t involve these same brain pathways. “It’s possible that there’s not the same connection to the emotional part of the brain” when people type, as opposed to writing in longhand, Berninger says.

Writing by hand may also improve a person’s memory for new information. A 2017 study in the journal Frontiers in Psychology found that brain regions associated with learning are more active when people completed a task by hand, as opposed to on a keyboard. The authors of that study say writing by hand may promote “deep encoding” of new information in ways that keyboard writing does not. And other researchers have argued that writing by hand promotes learning and cognitive development in ways keyboard writing can’t match.

The fact that handwriting is a slower process than typing may be another perk, at least in some contexts. A 2014 study in the journal Psychological Science found that students who took notes in longhand tested higher on measures of learning and comprehension than students who took notes on laptops.

“The primary advantage of longhand notes was that it slowed people down,” says Daniel Oppenheimer, co-author of the study and a professor of psychology at Carnegie Mellon University. While the students who typed could take down what they heard word for word, “people who took longhand notes could not write fast enough to take verbatim notes — instead they were forced to rephrase the content in their own words,” Oppenheimer says. “To do that, people had to think deeply about the material and actually understand the arguments. This helped them learn the material better.”

Slowing down and writing by hand may come with other advantages. Oppenheimer says that because typing is fast, it tends to cause people to employ a less diverse group of words. Writing longhand allows people more time to come up with the most appropriate word, which may facilitate better self-expression. He says there’s also speculation that longhand note-taking can help people in certain situations form closer connections. One example: “A doctor who takes notes on a patient’s symptoms by longhand may build more rapport with patients than doctors who are typing into a computer,” he says. Also, a lot Berninger’s NIH-funded work found that learning to write first in print and then in cursive helps young people develop critical reading and thinking skills.

Finally, there’s a mountain of research that suggests online forms of communication are more toxic than offline dialogue. Most of the researchers who study online communication speculate that a lack of face-to-face interaction and a sense of invisibility are to blame for the nasty and brutish quality of many online interactions. But the impersonal nature of keyboard-generated text may also, in some small way, be contributing to the observed toxicity. When a person writes by hand, they have to invest more time and energy than they would with a keyboard. And handwriting, unlike typed text, is unique to each individual. This is why people usually value a handwritten note more highly than an email or text, Berninger says. If words weren’t quite so easy to produce, it’s possible that people would treat them — and maybe each other — with a little more care.

via Bring Back Handwriting: It’s Good for Your Brain – Elemental

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[WEB SITE] Nootropics: Types, safety, and risks of smart drugs

Last reviewed 

Nootropics, or “smart drugs,” are a class of substances that can boost brain performance. They are sometimes called cognition enhancers or memory enhancing substances.

Prescription nootropics are medications that have stimulant effects. They can counteract the symptoms of medical conditions such as attention deficit hyperactivity disorder (ADHD), narcolepsy, or Alzheimer’s disease.

Nonprescription substances that can enhance brain performance or focus — such as caffeine and creatine — are also considered nootropics. They do not treat diseases but may have some effects on thinking, memory, or other mental functions.

This article looks at prescription and nonprescription smart drugs, including their uses, side effects, and safety warnings.

Prescription nootropics

a woman taking nootropics at her desk.

A person may take a nootropic to treat ADHD, narcolepsy, or dementia.

Prescription nootropics include:

  • modafinil (Provigil), a stimulant that addresses the sudden drowsiness of narcolepsy
  • Adderall, which contains amphetamines to treat ADHD
  • methylphenidate (Ritalin), a stimulant that can manage symptoms of narcolepsy and ADHD
  • memantine (Axura), which treats symptoms of Alzheimer’s disease

While these can be effective in treating specific medical conditions, a person should not take them without a prescription.

Like any prescription medications, they carry risks of side effects and interactions, and a person should only take them under a doctor’s care.

Common side effects of prescription nootropics include:

Some evidence suggests that people who use prescription nootropics to improve brain function have a higher risk of impulsive behaviors, such as risky sexual practices.

Healthcare providers should work closely with people taking prescription nootropics to manage any side effects and monitor their condition.

Over-the-counter nootropics

The term “nootropic” can also refer to natural or synthetic supplements that boost mental performance. The following sections discuss nootropics that do not require a prescription.

Caffeine

Many people consume beverages that contain caffeine, such as coffee or tea, because of their stimulant effects. Studies suggest that caffeine is safe for most people in moderate amounts.

Having a regular cup of coffee or tea may be a good way to boost mental focus. However, extreme amounts of caffeine may not be safe.

The Food and Drug Administration (FDA) recommend that people consume no more than 400 milligrams (mg) of caffeine a day. This is the amount in 4–5 cups of coffee.

Caffeine pills and powders can contain extremely high amounts of the stimulant. Taking them can lead to a caffeine overdose and even death, in rare cases.

Women who are pregnant or may become pregnant may need to limit or avoid caffeine intake. Studies have found that consuming 4 or more servings of caffeine a day is linked to a higher risk of pregnancy loss.

L-theanine

L-theanine is an amino acid that occurs in black and green teas. People can also take l-theanine supplements.

A 2016 review reported that l-theanine may increase alpha waves in the brain. Alpha waves may contribute to a relaxed yet alert mental state.

L-theanine may work well when paired with caffeine. Some evidence suggests that this combination helps boost cognitive performance and alertness. Anyone looking to consume l-theanine in tea should keep the FDA’s caffeine guidelines in mind.

There are no dosage guidelines for l-theanine, but many supplements recommend taking 100–400 mg per day.

Omega-3 fatty acids

person at desk holding omega 3 supplements in palm

Studies have shown that omega-3 fatty acids are important to fight against brain aging.

These polyunsaturated fats are found in fatty fish and fish oil supplements. This type of fat is important for brain health, and a person must get it from their diet.

Omega-3s help build membranes around the body’s cells, including the neurons. These fats are important for repairing and renewing brain cells.

A 2015 review found that omega-3 fatty acids protect against brain aging. Other research has concluded that omega-3s are important for brain and nervous system function.

However, a large analysis found “no benefit for cognitive function with omega‐3 [polyunsaturated fatty acids] supplementation among cognitively healthy older people.” The authors recommend further long term studies.

A person can get omega-3 supplements in various forms, including fish oil, krill oil, and algal oil.

These supplements carry a low risk of side effects when a person takes them as directed, but they may interact with medications that affect blood clotting. Ask a doctor before taking them.

Racetams

Racetams are synthetic compounds that can affect neurotransmitters in the brain. Some nootropic racetams include:

  • piracetam
  • pramiracetam
  • phenylpiracetam
  • aniracetam

A study conducted in rats suggests that piracetam may have neuroprotective effects.

One review states that “Some of the studies suggested there may be some benefit from piracetam, but, overall, the evidence is not consistent or positive enough to support its use for dementia or cognitive impairment.” Confirming this will require more research.

There is no set dosage for racetams, so a person should follow instructions and consult a healthcare provider. Overall, studies have no found adverse effects of taking racetams as directed.

Ginkgo biloba

Ginkgo biloba is a tree native to China, Japan, and Korea. Its leaves are available as an herbal supplement.

2016 study found that gingko biloba is “potentially beneficial” for improving brain function, but confirming this will require more research.

Ginkgo biloba may help with dementia symptoms, according to one review, which reported the effects occurring in people who took more than 200 mg per day for at least 5 months.

However, the review’s authors note that more research is needed. Also, with prescription nootropics available, ginkgo biloba may not be the most safe or effective option.

Panax ginseng

Panax ginseng is a perennial shrub that grows in China and parts of Siberia. People use its roots for medicinal purposes.

People should not confuse Panax ginseng with other types of ginseng, such as Siberian or American varieties. These are different plants with different uses.

2018 review reports that Panax ginseng may help prevent certain brain diseases, including Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease. It also may help with brain recovery after a stroke.

Panax ginseng interacts with many medications, so consult a doctor before taking it. A typical dosage for mental function is 100–600 mg once or twice a day.

Rhodiola

Some evidence suggests that Rhodiola rosea L., also known as rhodiola or roseroot, can help with cognitive ability.

One review reported that rhodiola may have neuroprotective effects and may help treat neurodegenerative diseases.

Another review found that rhodiola helped regulate neurotransmitters in the brain, having a positive effect on mood.

Rhodiola capsules have varying strengths. Usually, a person takes a capsule once or twice daily.

Creatine

Creatine is an amino acid, which is a building block of protein. This supplement is popular among athletes because it may help improve exercise performance. It may also have some effects on mental ability.

A 2018 review found that taking creatine appears to help with short term memory and reasoning. Whether it helps the brain in other ways is unclear.

The International Society of Sports Nutrition report that creatine supplementation of up to 30 grams per day is safe for healthy people to take for 5 years.

Another 2018 review notes that there has been limited research into whether this supplement is safe and effective for adolescent athletes.

Do nootropics work?

Some small studies show that some nootropic supplements can affect the brain. But there is a lack of evidence from large, controlled studies to show that some of these supplements consistently work and are completely safe.

Because of the lack of research, experts cannot say with certainty that over-the-counter nootropics improve thinking or brain function — or that everyone can safely use them.

For example, one report on cognitive enhancers found that there is not enough evidence to indicate that they are safe and effective for healthy people. The researchers also point to ethical concerns.

However, there is evidence that omega-3 fatty acids can benefit the brain and overall health. In addition, caffeine can improve mental focus in the short term.

Notes on the safety of nootropics

doctor and patient in office discussing adrenal cancer

A person should talk to a doctor about any interactions supplements may have with existing medications.

Also, some supplements may not contain what their labels say. A study of rhodiola products, for example, found that some contain contaminants or other ingredients not listed on the label.

For this reason, it is important to only purchase supplements from reputable companies that undergo independent testing.

BUYING NOOTROPICSA prescription is necessary for some nootropics, such as Provigil and Adderall. Over-the-counter nootropics are available in some supermarkets and drug stores, or people can choose between brands online:

Not all of these supplements are recommended by healthcare providers and some may interact with medications. Always speak to a doctor before trying a supplement.

Summary

Many doctors agree that the best way to boost brain function is to get adequate sleep, exercise regularly, eat a healthy diet, and manage stress.

For people who want to boost their cognitive function, nootropic supplements may help, in some cases. Anyone interested in trying a nootropic should consult a healthcare professional about the best options.

 

via Nootropics: Types, safety, and risks of smart drugs

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[BOOK] Virtual Reality for Psychological and Neurocognitive Interventions

Virtual Reality for Psychological and Neurocognitive Interventions

  • Albert “Skip” Rizzo
  • Stéphane Bouchard

Part of the Virtual Reality Technologies for Health and Clinical Applications book series (VRTHCA)

Table of contents

Search within book

  1. Front Matter

    Pages i-xii

  1. William S. Ryan, Jessica Cornick, Jim Blascovich, Jeremy N. Bailenson
    Pages 15-46
  2. Berenice Serrano, Cristina Botella, Brenda K. Wiederhold, Rosa M. Baños
    Pages 47-84
  3. Melissa Peskin, Brittany Mello, Judith Cukor, Megan Olden, JoAnn Difede
    Pages 85-102
  4. Stéphane Bouchard, Mylène Laforest, Pedro Gamito, Georgina Cardenas-Lopez
    Pages 103-130
  5. Patrick S. Bordnick, Micki Washburn
    Pages 131-161
  6. Giuseppe Riva, José Gutiérrez-Maldonado, Antonios Dakanalis, Marta Ferrer-García
    Pages 163-193
  7. Hunter G. Hoffman, Walter J. Meyer III, Sydney A. Drever, Maryam Soltani, Barbara Atzori, Rocio Herrero et al.
    Pages 195-208
  8. Dominique Trottier, Mathieu Goyette, Massil Benbouriche, Patrice Renaud, Joanne-Lucine Rouleau, Stéphane Bouchard
    Pages 209-225
  9. Thomas D. Parsons, Albert “Skip” Rizzo
    Pages 247-265
  10. P. J. Standen, David J. Brown
    Pages 267-287
  11. Roos Pot-Kolder, Wim Veling, Willem-Paul Brinkman, Mark van der Gaag
    Pages 289-305
  12. Pierre Nolin, Jérémy Besnard, Philippe Allain, Frédéric Banville
    Pages 307-326
  13. Lindsay A. Yazzolino, Erin C. Connors, Gabriella V. Hirsch, Jaime Sánchez, Lotfi B. Merabet
    Pages 361-385
  14. Thomas Talbot, Albert “Skip” Rizzo
    Pages 387-405
  15. Back Matter

    Pages 407-415

About this book

Introduction

This exciting collection tours virtual reality in both its current therapeutic forms and its potential to transform a wide range of medical and mental health-related fields. Extensive findings track the contributions of VR devices, systems, and methods to accurate assessment, evidence-based and client-centered treatment methods, and—as described in a stimulating discussion of virtual patient technologies—innovative clinical training. Immersive digital technologies are shown enhancing opportunities for patients to react to situations, therapists to process patients’ physiological responses, and scientists to have greater control over test conditions and access to results. Expert coverage details leading-edge applications of VR across a broad spectrum of psychological and neurocognitive conditions, including:

  • Treating anxiety disorders and PTSD.
  • Treating developmental and learning disorders, including Autism Spectrum Disorder,
  • Assessment of and rehabilitation from stroke and traumatic brain injuries.
  • Assessment and treatment of substance abuse.
  • Assessment of deviant sexual interests.
  • Treating obsessive-compulsive and related disorders.
  • Augmenting learning skills for blind persons.

Readable and relevant, Virtual Reality for Psychological and Neurocognitive Interventions is an essential idea book for neuropsychologists, rehabilitation specialists (including physical, speech, vocational, and occupational therapists), and neurologists. Researchers across the behavioral and social sciences will find it a roadmap toward new and emerging areas of study.

via Virtual Reality for Psychological and Neurocognitive Interventions | SpringerLink

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[ARTICLE] Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial – Full Text

Abstract

Background

Mirror therapy for stroke patients was reported to be effective in improving upper-extremity motor function and daily life activity performance. In addition, game-based virtual reality can be realized using a gesture recognition (GR) device, and various tasks can be presented. Therefore, this study investigated changes in upper-extremity motor function, quality of life, and neck discomfort when using a GR device for mirror therapy to observe the upper extremities reflected in the mirror.

Material/Methods

A total of 36 subjects with chronic stroke were randomly divided into 3 groups: GR mirror therapy (n=12), conventional mirror therapy (n=12), and control (n=12) groups. The GR therapy group performed 3D motion input device-based mirror therapy, the conventional mirror therapy group underwent general mirror therapy, and the control group underwent sham therapy. Each group underwent 15 (30 min/d) intervention sessions (3 d/wk for 5 weeks). All subjects were assessed by manual function test, neck discomfort score, and Short-Form 8 in pre- and post-test.

Results

Upper-extremity function, depression, and quality of life in the GR mirror therapy group were significantly better than in the control group. The changes of neck discomfort in the conventional mirror therapy and control groups were significantly greater than in the GR mirror therapy group.

Conclusions

We found that GR device-based mirror therapy is an intervention that improves upper-extremity function, neck discomfort, and quality of life in patients with chronic stroke.

Background

In patients with acute stroke that occurred >6 months previously, 85% have upper-limb disorders, and 55% to 75% have upper-limb disorders []. The upper-limb movement function is decreased due to weakening of upper-limb muscles, which is primarily caused by changes in the central nervous system and secondarily by weakness due to inactivity and reduced activity [,].

Activities of daily living are limited due to body dysfunction, and most stroke patients have limited social interaction; these disorders reduce the quality of life []. In addition, stroke patients may experience depression due to reduced motivation []. Depression results in loss of interest and joy, anxiety, fear, hostility, sadness, and anger, which negatively affect functional recovery and rehabilitation in stroke patients [].

Constraint-induced movement therapy, action observation training, and mirror therapy have been recently studied as therapies for upper-extremity motor function []. These interventions are used to increase the use of paralyzed limbs to overcome disuse syndromes, observe and imitate movement, and change the neural network involved in movement. Providing various tasks in upper-extremity rehabilitation is necessary and virtual reality is used as a method for providing various tasks [,].

Interventions using virtual reality require cognitive factors, such as judgment and memory, as the task progresses. It can use visual and auditory stimuli, and can induce interest and motivation, helping stroke patients to be mentally stable and motivated []. Gesture recognition (GR) is a topic that studies the reading of these movements using algorithms. These GR algorithms mainly focus on the movement of arm, hands, eyes, legs, and other body parts. The main idea is to capture body movements using capture devices and send the acquired data to a computer []. A remarkable example is shown in physical rehabilitation, where the low-cost hardware and algorithms accomplish outstanding results in therapy of patients with mobility issues. A 3D motion input device is required for upper-body rehabilitation in virtual reality. The Leap motion controller, a GR input device, has been recently released, which monitors hand and finger movements and reflects them on the monitor []. In addition, game-based virtual reality can be realized using a GR device, and various tasks can be presented.

Mirror therapy has been used as a therapeutic intervention for phantom pain in amputees. The painful and paralyzed body parts are covered with a mirror. The mirror is placed in the center of the body, and the movement of the paralyzed body is viewed through the mirror. The patient has a visual illusion that the paralyzed side is normally moving []. Mirror therapy for stroke patients was reported to be effective in upper-extremity motor function and daily life activity performance []. However, conventional mirror therapy methods require high concentration and can become tedious, making active participation difficult []. In addition, conventional mirror therapy differs from the actual situation wherein a mirror positioned at the center of the body should be viewed with the head sideways. Because patients are in a suboptimal posture, they may have neck discomfort after mirror therapy. The body has muscle strength disproportion when maintaining poor posture for a long time. This results in inadequate tension on adjacent muscles and joints, resulting in movement restriction, reduced flexibility, pain, and changes in bone and soft tissue [].

This study investigated the effect on upper-extremity motor function, quality of life, and neck discomfort by using GR device mirror therapy in patients with chronic stroke, and evaluated the efficacy of this technique.

[…]

 

Continue —>  Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial

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Figure 2
(A) Gesture recognition mirror therapy group, (B) Conventional mirror therapy, (C) Control group.

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[Clinimetrics] The Scandinavian Stroke Scale

Summary

The Scandinavian Stroke Scale (SSS) is a clinical measure of functional impairment and activity limitations in patients with acute stroke. It was first presented by the Copenhagen Stroke Study Group in 1985.1 The SSS consists of nine items measuring consciousness, eye movement, arm motor power, hand motor power, leg motor power, orientation, speech, facial palsy and gait.1 Each item is scored on an ordinal scale with two to five categories, with item scores ranging from 2 to 12. In the original scale, unconscious patients could not be scored, as the lowest category in this item read: reacts to verbal command, but is not fully conscious (score 2).1 However, a scale revision added the category unconscious (score 0).2 Thus, sum scores range from 0 to 58 in the edited version, with 0 indicating severe neurological deficits and 58 indicating no neurological deficits. The SSS includes items that are of functional significance to the patients and are easy to assess.1 Therefore, items such as dysarthria, visual field, sensation, and reflexes were omitted during scale development.1 The SSS can be administered in < 5 minutes by non-specialists (ie, physiotherapists and nurses).3 It is used worldwide and is available in multiple languages, including English,1 Danish4 and Portuguese.5

Reliability and validity: The internal consistency of items in the SSS is high (Cronbach’s α: 0.91).6 The interrater reliability of items is also good to excellent, with weighted Kappa coefficients ranging from 0.608 to 0.912.7 The items with the strongest agreement are gait (κ: 0.912) and speech (κ: 0.860), while the items with the poorest agreement are leg motor power (κ: 0.688) and facial palsy (κ: 0.608). It is also possible to obtain reliable SSS scores based on information from medical records when compared with face-to-face assessment, with excellent agreement (κ > 0.75) except for consciousness (κ: 0.71) and eye movements (κ: 0.58).8 The positive predictive value for the speech item is 0.55 (95% CI 0.23 to 0.83) when assessed by trained nurses compared to comprehensive assessments by speech and language therapists.9

Ninety-day SSS scores correlate with the National Institute of Health Stroke Scale (NIHSS) (r2 = 81.2%), Barthel Index (r2 = 72.3%) and modified Rankin Scale (r2 = 76.9%).10 However, interconversion models for SSS to NIHSS, accounting for age and gender, demonstrate that the relationship between SSS and NIHSS depends on the timing of measurement. In the acute phase, the adjusted r2 = 0.60 whereas 90 days after stroke the adjusted r2 = 0.80.11 The SSS predicts 1-week mortality3 and 3-month disability12 with the same accuracy as the NIHSS scale. The area under the ROC curve is 0.76 for 1-week mortality3 and 0.769 for 3-month disability.12 Using a cut-off score of 36, the SSS predicts 1-week mortality with a sensitivity of 0.83 and specificity of 0.633 and using a cut-off score > 42 predicts 3-month disability with a sensitivity of 69.5% and specificity of 82.2%.12

Commentary

The SSS is a common measure of stroke impairment in acute care settings (eg, in Denmark it is mandatory to administer the SSS to all hospitalised patients with acute stroke or transient ischaemic attack), and is used in clinical trials and observational studies as a measure of neurological deficit. To our knowledge, the SSS did not undergo testing of its clinimetric properties during its development. However, subsequent studies have provided some information on the reliability, validity and internal consistency. Although the SSS has some predictive validity, the values are likely to be optimistic, as the predictions were not externally validated.

In comparison with other commonly used scales such as NIHSS, the SSS assesses gait but does not include items measuring ataxia, neglect or sensation. This facilitates ease of use and administration by non-specialists but could miss useful information that may assist in determining appropriate management and potential prognosis. Low inter-rater reliability has been reported in the item facial palsy,7 likely due to the simplicity/ambiguity of the item, with categorisation as either present facial palsy or none/dubious facial palsy.1 Furthermore, the speech item in the SSS has low positive predictive value, resulting in patients without aphasia being scored as having aphasia.13

The SSS is an easy-to-use measure of functional limitations in patients with stroke, which may be useful for clinical and research purposes. Further research investigating the clinimetric and prognostic properties of the SSS is warranted.

References

via Clinimetrics: The Scandinavian Stroke Scale – ScienceDirect

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[WEB SITE] Turn Up the Walking Intensity to Spur Further Stroke Recovery

TreadmillPatient

 

High-intensity step training  that mimics real-world conditions may better improve walking ability in stroke survivors compared to traditional, low-impact training, according to new research published in the American Heart Association’s journal Stroke.

“People who suffer strokes often have difficulty walking and impaired balance. Rehabilitation after a stroke traditionally focuses on patients practicing low-intensity walking, usually only in a forward direction, which does not provide enough of a challenge to the nervous system to enable patients to negotiate real-world situations, such as uneven surfaces, stairs or changing direction,” says study author T. George Hornby, PhD, professor of physical medicine and rehabilitation at Indiana University School of Medicine in Indianapolis, in a media release from the American Heart Association.

“Our study suggests that stroke patients can perform higher-intensity walking exercises and more difficult tasks than previously thought possible. We need to move beyond traditional, low-intensity rehabilitation to challenge the nervous and cardiovascular systems so patients can improve function and perform better in the real world.”

Researchers evaluated 90 people, 18- to 85-years-old with weakness on one side of the body who had survived a stroke at least six months prior.

Participants received training of either high-intensity stepping performing variable, difficult tasks; high-intensity stepping performing only forward walking; or low-intensity stepping of variable tasks. Variable tasks included walking on uneven surfaces, up inclines and stairs, over randomly placed obstacles on a treadmill and across a balance beam.

The researchers observed the following, the release explains:

  • Survivors in both the high-intensity, variable training and high-intensity, forward walking groups walked faster and farther than the low-intensity, variable training group.
  • For all walking outcomes, 57% to 80% of participants in the high-intensity groups had important clinical gains, while only 9% to 31% of participants did so following low-intensity training.
  • High-intensity variable training also resulted in improved dynamic balance while walking and improved balance confidence.

Hornby notes that no serious adverse events occurred during the training sessions, suggesting stroke survivors can be pushed to higher-intensity walking with more variable tasks during rehabilitation.

“Rehabilitation that allows walking practice without challenging the nervous system doesn’t do enough to make a statistical or clinically significant difference in a patient’s recovery after a stroke,” Hornby suggests.

“We found that when stroke patients are pushed harder, they see greater changes in less time, which translates into more efficient rehabilitation services and improved mobility.”

Ultimately, their goal is to incorporate high-intensity variable step training into regular clinical rehabilitation protocols.

The study was small compared to larger, multicenter clinical trials. Hornby adds in the release that the next step would be to test high-intensity, variable step training in larger patient populations in a large, multicenter clinical trial.

[Source(s): American Heart Association, Science Daily]

 

via Turn Up the Walking Intensity to Spur Further Stroke Recovery – Rehab Managment

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[Infographic] Foods linked to better brainpower

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