[WEB SITE] Hot Topic Module: Changes in Memory After Traumatic Brain Injury

This Hot Topic Module consists of a suite of resources to help individuals with traumatic brain injury understand changes in memory after TBI and offers strategies that can help people who experience this function more effectively.

Resources

TBI and Memory Resources

VIDEOS: Changes in Memory After Traumatic Brain Injury
Our featured video and brief video clips explain changes in memory after traumatic brain injury (TBI). Jason Cowper and Tonya Howell share their stories of coming to terms with changes in their memory, and strategies they use to compensate for these changes. The video also includes the perspectives of TBI experts at the Texas TBI Model System of TIRR Memorial Hermann, who provide clinical insight on the changes in memory that some people experience after sustaining a TBI. View the featured video here. View additional video clips here.

FACTSHEET: Memory and Moderate to Severe Traumatic Brain Injury
This fact sheet explains memory problems that may affect people with moderate to severe traumatic brain injury (TBI). By understanding the new limits on their memory and ways to help overcome those limits, people with TBI can still get things done every day. View the factsheet here.

SLIDESHOW: Memory and Moderate to Severe Traumatic Brain Injury
Memory problems are very common in people with moderate to severe TBI. The information in this slideshow explains memory problems that may affect people with moderate to severe TBI. By understanding the new limits on their memory and ways to help overcome those limits, people with TBI can still get things done every day. View the slideshow here.

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FACTSHEET: Depression After Traumatic Brain Injury
Fatigue is one of the most common problems people have after a traumatic brain injury (TBI). If you are experiencing fatigue, there are things you can do to decrease feelings of exhaustion, tiredness, weariness or lack of energy. The information in this factsheet describes causes of fatigue after TBI and ways to help alleviate these problems. View the factsheet here.

FACTSHEET: Emotional Problems After Traumatic Brain Injury
A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems. This factsheet discusses possible emotional problems and what can be done about depression. View the factsheet here.

SLIDESHOW: Emotional Problems After Traumatic Brain Injury
Emotional problems occur in people after a traumatic brain injury (TBI). A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems. The information in this slideshow describes the causes of emotional problems after a TBI. View the slideshow here.

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[ARTICLE] How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers – Full Text

Abstract

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.

Background

Disabilities cause complex problems in society often unique to each person. A physical disability can limit a person’s ability to access buildings and other facilities, drive, use public transportation, or obtain the health benefits of regular exercise. Blindness can limit a person’s ability to interpret images or navigate the environment. Disabilities in speaking or writing ability may limit the effectiveness of communication. Cognitive disabilities can alter a person’s employment opportunities. In total, a substantial fraction of the world’s population – at least 1 in 6 people – face these individualized problems that combine to create major societal impacts, including limited participation. Further, the average person in the United States can expect to live 20% of his or her life with disability, with the rate of disability increasing seven-fold by age 65 [1].

In light of these complex, pervasive issues, the field of rehabilitation engineering asks, “How can technology help?” Answering this question is also complex, as it often requires the convergence of multiple engineering and design fields (mechanical, electrical, materials, and civil engineering, architecture and industrial design, information and computer science) with clinical fields (rehabilitation medicine, orthopedic surgery, neurology, prosthetics and orthotics, physical, occupational, and speech therapy, rehabilitation psychology) and scientific fields (neuroscience, neuropsychology, biomechanics, motor control, physiology, biology). Shaping of policy, generation of new standards, and education of consumers play important roles as well.

In the US, a unique research center structure was developed to try to facilitate this convergence of fields. In the 1970’s the conceptual model of a Rehabilitation Engineering Center (REC), focusing engineering and clinical expertise on particular problems associated with disability, was first tested. The first objective of the nascent REC’s, defined at a meeting held by the Committee on Prosthetic Research and Development of the National Academy of Sciences, was “to improve the quality of life of the physically handicapped through a total approach to rehabilitation, combining medicine, engineering, and related science” [2]. This objective became a working definition of Rehabilitation Engineering [2].

The first five centers focused on topics including functional electrical stimulation, powered orthoses, neuromuscular control, the effects of pressure on tissue, prosthetics, sensory feedback, quantification of human performance, total joint replacement, and control systems for powered wheelchairs and the environment [2]. The first two RECs were funded by the Department of Health, Education, and Welfare in 1971 at Rancho Los Amigos Medical Center in Downey, CA, and Moss Rehabilitation Hospital in Philadelphia. Three more were added the following year at the Texas Institute for Rehabilitation and Research in Houston, Northwestern University/the Rehabilitation Institute of Chicago, and the Children’s Hospital Center in Boston, involving researchers from Harvard and the Massachusetts Institute of Technology [3]. The Rehabilitation Act of 1973 formally defined REC’s and mandated that 25 percent of research funding under the Act go to them [2]. The establishment of these centers was stimulated by “the polio epidemic, thalidomide tragedy and the Vietnam War, as well as the disability movement of the early 70s with its demands for independence, integration and employment opportunities” [3].

After the initial establishment of these RECs, the governmental funding agency evolved into the National Institute on Disability and Rehabilitation Research (NIDRR, a part of the U.S. Department of Education), and now is the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR, a part of the U.S. Department of Health and Human Services. Today, as we describe below, the RERC’s study a diverse set of technologies and their use by people with a disability, including human-computer interaction, mobile computing, wearable sensors and actuators, robotics, computer gaming, motion capture, wheeled mobility, exoskeletons, lightweight materials, building and transportation technology, biomechanical modeling, and implantable technologies. For this review, we invited all RERCs that were actively reporting to NIDILRR at the onset of this review project in 2015, and had not begun in the last two years, to participate. These were centers that were funded (new or renewal) in the period 2008-2013, except the RERC Wheelchair Transportation Safety, which was funded from 2001-2011. Two of the RERCs did not respond (see Table 1). For each center, we asked it to describe the user needs it targets, summarize key advances that it had made, and identify emerging innovations and opportunities. By reviewing the scope of rehabilitation engineering research through the lens of the RERCs, our goal was to better understand the evolving nature and demands of rehabilitation technology development, as well as the influence of a multidisciplinary structure, like the RERCs, in shaping the producing of such technology. We also performed an analysis of how multidisciplinary the current RERCs actually are (see Table 3), and asked the directors to critique and suggest future directions for the RERC program.[…]

Continue —>  How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 14 Some MARS RERC projects. a) The KineAssist MX® Gait and Balance Device b) The Armeo Spring® reaching assistance device c) The March Hare virtual reality therapy game d) The Lokomat® gait assistance robot e) Robotic Error Augmentation between the therapist and patient f) lever drive wheelchair g) Ekso® exoskeleton h) Body-machine interface for device control

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[WEB SITE] SaeboStep

Get Your FREE Stroke Recovery Exercise Guide! Download

Walk Smarter. Confidence and comfort are one step away.

The SaeboStep consists of a lightweight, uniquely designed foot drop brace that provides convenience and comfort while offering optimum foot clearance and support during walking.

The SaeboStep was designed to replace uncomfortable, stiff, or bulky splints that go inside the shoe as well as poorly manufactured braces designed for outside of the shoe that lack support and durability.

 Learn more about the features and benefits

 View brochure

Stylish. Safe. Sturdy.

Foot Drop. What is it and how does it affect your recovery?

Foot drop, also known as dropped foot or drop foot, is the inability to raise the front part of the foot due to weakness or paralysis of the muscles that lift the foot (National Institute of Neurological Disorders).

Consequentially, people who have foot drop scuff their toes along the ground; they may also bend their knees to lift their foot higher than usual to avoid the scuffing, which causes what is called a “steppage” gait.

 Learn more about Foot Drop

Why use the SaeboStep?

Universal Eyelets

No Laces? No Problem.

The SaeboStep can even be worn comfortably with the majority of male or female shoe styles. Individuals can use their favorite shoes by ordering the accessory kit to enable footwear without eyelets to be modified.

Learn how to customize your favorite shoes.

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[Abstract] Virtual Rehabilitation through Nintendo Wii in Poststroke Patients: Follow-Up

Objective

To evaluate in the follow-up the sensory-motor recovery and quality of life patients 2 months after completion of the Nintendo Wii console intervention and determine whether learning retention was obtained through the technique.

Methods

Five hemiplegics patients participated in the study, of whom 3 were male with an average age of 54.8 years (SD = 4.6). Everyone practiced Nintendo Wii therapy for 2 months (50 minutes/day, 2 times/week, during 16 sessions). Each session lasting 60 minutes, under a protocol in which only the games played were changed, plus 10 minutes of stretching. In the first session, tennis and hula hoop games were used; in the second session, football (soccer) and boxing were used. For the evaluation, the Fulg-Meyer and Short Form Health Survey 36 (SF-36) scales were utilized. The patients were immediately evaluated upon the conclusion of the intervention and 2 months after the second evaluation (follow-up).

Results

Values for the upper limb motor function sub-items and total score in the Fugl–Meyer scale evaluation and functional capacity in the SF-36 questionnaire were sustained, indicating a possible maintenance of the therapeutic effects.

Conclusion

The results suggest that after Nintendo Wii therapy, patients had motor learning retention, achieving a sustained benefit through the technique.

via Virtual Rehabilitation through Nintendo Wii in Poststroke Patients: Follow-Up

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[Abstract+References] ] The Effectiveness of Developing Motor Skills Through Motion-Based Video Gaming: A Review

Background. Technology growth affords innovative teaching techniques as video gaming within education has increased in popularity. Motion-based video gaming (MBVG) is a type of gaming that requires the individual playing the game to be physically interactive. Thus, whatever movements the individual playing the game does is picked up by motion sensors and is mimicked via the on-screen character. MBVG provides constant feedback to learners and has been found to help motivate students, replace sedentary with active gaming, and can facilitate social interactions with peers.

Aim. This literature review reveals the current knowledge regarding the potential educational benefits of MBVG, particularly in physical education and sport pedagogy settings. Developments of video gaming in education as well as recent research regarding MBVG and its potential impact on physical skill development within educational environments are discussed.

Conclusion. MBVG may be beneficial with novices in teaching basic sport concepts or with individuals with special needs who might otherwise not be able to participate in the full authentic version of the sport. However, empirical evidence is lacking which supports the effective use of MBVG in accurately teaching authentic sport-specific motor skills.

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 via The Effectiveness of Developing Motor Skills Through Motion-Based Video Gaming: A ReviewSimulation & Gaming – Seth E. Jenny, David P. Schary, Kristy M. Noble, Shelley D. Hamill, 2017

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[ARTICLE] Objective assessment of cortical activity changes in stroke patients before and after hand rehabilitation with and without botulinum toxin injection – Full Text

Abstract

Background Upper limb spasticity is a disabling condition and may result in severe functional limitation. The peripheral action of botulinum toxin (BTX) injection on spasticity is well known, but there are debates around its possible central action.
Aim The aim of this study was to assess the clinical, functional, and cortical activation outcome of two antispastic treatments for stroke of the hand and wrist. Thirty patients with upper limb poststroke spasticity were recruited in this study.
Patients and methods They were randomly allocated to two groups: group A and group B. Both groups received rehabilitation program, whereas group B received additional BTX injection. All patients were assessed at baseline and 8 weeks after treatment using the Modified Ashworth Scale, the Action Research Arm Test and Nine-Hole Peg Test, and somatosensory-evoked potential study of the median nerve.
Results Group B showed a higher percentage of change in Modified Ashworth Scale of the wrist flexors and long flexors of fingers and in Action Research Arm Test compared with group A.
Conclusion BTX injection in spastic muscles of the wrist and hand, followed by a rehabilitation program led to greater clinical and functional improvement compared with implementing the rehabilitation program alone.

Introduction

Upper limb spasticity can be disabling and can result in several functional limitations. Although some neural plasticity following stroke contributes to motor recovery, maladaptive plasticity can weaken motor function and limits the recovery. Spasticity represents an example of maladaptive plasticity [1].

Local injection of botulinum toxin-A (BTX) is the standard treatment for spasticity, particularly in poststroke patients. In addition to its peripheral action, evidence of its possible effects on central nervous systems has emerged [1].

Somatosensory-evoked potential (SEP) studies in patients with spasticity showed improvement in SEP following BTX injection, which may support the possible central action of BTX in the cerebral cortex [2],[3].[…]

Continue —> Objective assessment of cortical activity changes in stroke patients before and after hand rehabilitation with and without botulinum toxin injection Abu-Bakr OA, Nassar NM, Al-Ganzoury AM, Ahmed KA, Tawfik EA – Egypt Rheumatol Rehabil

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[ARTICLE] Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: A meta-analysis providing direction for future research – Full Text PDF

Abstract

Objective: To compare the randomized controlled trial evidence for therapeutic effects on walking of functional electrical stimulation and ankle foot orthoses for foot drop caused by central nervous system conditions.
Data sources: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination, Scopus and clinicaltrials.gov.
Study selection: One reviewer screened titles/abstracts. Two independent reviewers then screened the full articles.
Data extraction: One reviewer extracted data, another screened for accuracy. Risk of bias was assessed by 2 independent reviewers using the Cochrane Risk of Bias Tool.
Data synthesis: Eight papers were eligible; 7 involving participants with stroke and 1 involving participants with cerebral palsy. Two papes reporting different measures from the same trial were grouped, resulting in 7 synthesized randomized controlled trials (n= 464). Meta-analysis of walking speed at final assessment (p = 0.46), for stroke participants (p = 0.54) and after 4–6 weeks’ use (p = 0.49) showed equal improvement for both devices.
Conclusion: Functional electrical stimulation and ankle foot orthoses have an equally positive therapeutic effect on walking speed in non-progressive central nervous system diagnoses. The current randomized controlled trial evidence base does not show whether this improvement translates into the user’s own environment or reveal the mechanisms that achieve that change. Future studies should focus on measuring activity, muscle activity and gait kinematics. They should also report specific device details, capture sustained therapeutic effects and involve a variety of central nervous system diagnoses.

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[BLOG POST] The gamble of socialising after brain injury

The gamble of socialising after brain injury

I used to enjoy socialising with my friends, at work or an evening out. But even now, almost 2 years after my traumatic brain injury, I struggle with groups. There are so many reasons why this is difficult for me. I hate it needing to turn down kind offers for events, but I have to.

Socialising in groups means too many conversations to follow

Trying to get used to having a massively shortened attention span, like me, and following what someone is saying is tough. But add in several conversations happening at the same time, and it’s too much. I find I get distracted by hearing a word or two that someone else said. Then I’m trying to workout what they might be talking about. Oh but the conversation I’m having isn’t over. Yes you’ve lost me now, what did you say?

Socialising with a brain injury isn't always fun

I’m not stupid, I’m just slow

As many of my brains pathways are damaged, thinking and processing takes a lot more effort than before. It takes me time to think about what you said, let alone a reply. I get there, and other than the fact I struggle to find the words I’m looking for, my response is still the same. But when you have met up with friends, and the buzz is flying as this group are excited about socialising, you don’t want to be stuck with me. I suck the energy out of the flow as I slow it down so much. So I can’t blame people when they start up conversations with others, and I’m left like the lemon that I am.

All the concentrating wears me out

I get tired, and although adrenaline might carry me through the event, I pay for it later. The headaches and eye aches are awful. coupled with the cognitive fatigue, it can wipe me out for a week. And I mean I’m struggling to even get out of bed I’m so bad. I can’t string a thought together, not even that I should try taking some more painkillers.

This aftermath is the part that only my partner James sees. If I do decide to go to something, I know he’s thinking of both sides. Yes it’s good it have that social contact, but he knows it’s probably going to cost me more than dinner.

Socialising with a brain injury

I can cope with a couple at a time so much better. It means there’s just one conversation for me to follow. And I don’t mind if they do most of the talking, in fact it takes the pressure off me. It’s not that I’ve gone off socialising. I just have to weigh up the pluses and minuses of each situation. That’s pretty much the same for everything when you are living with a brain injury, you have to choose your battles.

Another thing to consider when thinking about going to an event is the environment. You can read why in Light and Noise Sensitivity.

Other articles you like like:

Do you find socialising in groups works for you? Please share any good tips.

Source: The gamble of socialising after brain injury | No memory of the day that changed my life

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[Abstract+References] A Home-Based Telerehabilitation Program for Patients With Stroke 

Background. Although rehabilitation therapy is commonly provided after stroke, many patients do not derive maximal benefit because of access, cost, and compliance. A telerehabilitation-based program may overcome these barriers. We designed, then evaluated a home-based telerehabilitation system in patients with chronic hemiparetic stroke. Methods. Patients were 3 to 24 months poststroke with stable arm motor deficits. Each received 28 days of telerehabilitation using a system delivered to their home. Each day consisted of 1 structured hour focused on individualized exercises and games, stroke education, and an hour of free play. Results. Enrollees (n = 12) had baseline Fugl-Meyer (FM) scores of 39 ± 12 (mean ± SD). Compliance was excellent: participants engaged in therapy on 329/336 (97.9%) assigned days. Arm repetitions across the 28 days averaged 24,607 ± 9934 per participant. Arm motor status showed significant gains (FM change 4.8 ± 3.8 points, P = .0015), with half of the participants exceeding the minimal clinically important difference. Although scores on tests of computer literacy declined with age (r = −0.92; P < .0001), neither the motor gains nor the amount of system use varied with computer literacy. Daily stroke education via the telerehabilitation system was associated with a 39% increase in stroke prevention knowledge (P = .0007). Depression scores obtained in person correlated with scores obtained via the telerehabilitation system 16 days later (r = 0.88; P = .0001). In-person blood pressure values closely matched those obtained via this system (r = 0.99; P < .0001). Conclusions. This home-based system was effective in providing telerehabilitation, education, and secondary stroke prevention to participants. Use of a computer-based interface offers many opportunities to monitor and improve the health of patients after stroke.

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Source: A Home-Based Telerehabilitation Program for Patients With StrokeNeurorehabilitation and Neural Repair – Lucy Dodakian, Alison L. McKenzie, Vu Le, Jill See, Kristin Pearson-Fuhrhop, Erin Burke Quinlan, Robert J. Zhou, Renee Augsberger, Xuan A. Tran, Nizan Friedman, David J. Reinkensmeyer, Steven C. Cramer, 2017

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[Abstract] Fuzzy logic-based mobile computing system for hand rehabilitation after neurological injury.  

Abstract

BACKGROUND:

Effective neurological rehabilitation requires long term assessment and treatment. The rapid progress of virtual reality-based assistive technologies and tele-rehabilitation has increased the potential for self-rehabilitation of various neurological injuries under clinical supervision.

OBJECTIVE:

The objective of this study was to develop a fuzzy inference mechanism for a smart mobile computing system designed to support in-home rehabilitation of patients with neurological injury in the hand by providing an objective means of self-assessment.

METHODS:

A commercially available tablet computer equipped with a Bluetooth motion sensor was integrated in a splint to obtain a smart assistive device for collecting hand motion data, including writing performance and the corresponding grasp force. A virtual reality game was also embedded in the smart splint to support hand rehabilitation. Quantitative data obtained during the rehabilitation process were modeled by fuzzy logic. Finally, the improvement in hand function was quantified with a fuzzy rule database of expert opinion and experience.

RESULTS:

Experiments in chronic stroke patients showed that the proposed system is applicable for supporting in-home hand rehabilitation.

CONCLUSIONS:

The proposed virtual reality system can be customized for specific therapeutic purposes. Commercial development of the system could immediately provide stroke patients with an effective in-home rehabilitation therapy for improving hand problems.

Source: Fuzzy logic-based mobile computing system for hand rehabilitation after neurological injury. – PubMed – NCBI

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