[ARTICLE] Enhancing visual performance in individuals with cortical visual impairment (homonymous hemianopsia): Tapping into blindsight – Full Text

Highlights

Patients with occipital lobe damage may have blind areas in their visual field.

Other non-cortical areas of the brain still process visual information.

Modifying visual input can stimulate non-cortical visual processing areas.

Augmented virtual reality goggles as a therapy for cortical blindness is proposed.

Abstract

Homonymous hemianopsia is a type of cortical blindness in which vision is lost completely or partially in the left half or the right half of the field of vision. It is prevalent in approximately 12% of traumatic brain injury and 35% of strokes. Patients often experience difficulty with activities such as ambulating, eating, reading, and driving. Due to the high prevalence of homonymous hemianopsia and its associated difficulties, it is imperative to find methods for visual rehabilitation in this condition. Traditional methods such as prism glasses can cause visual confusion and result in patient noncompliance. There is a large unmet medical need for improving this condition. In this article, we propose that modifying visual stimuli to activate non-cortical areas of visual processing, such as lateral geniculate nucleus and superior colliculus, may result in increased visual awareness. Presenting high contrast and low spatial frequency visual stimuli can increase visual detection in patients with cortical blindness, a phenomenon known as blindsight. Augmented virtual reality goggles have the potential to alter real-time visual input to high contrast and low spatial frequency images, possibly improving visual detection in the blind hemifield and providing an alternative therapy for homonymous hemianopsia.

Graphical abstract

Introduction

Cortical visual impairment comprises a significant component of strokes and traumatic brain injury. Cortical visual impairment includes homonymous hemianopsia, in which vision is lost completely or partially in the left half or the right half of the field of vision. Homonymous hemianopsia is prevalent in approximately 12% of traumatic brain injury and 35% of strokes [1–3]. Individuals with this vision loss usually have difficulties with activities of daily living such as ambulating, eating, reading, and driving [4,5]. Due to the high prevalence of homonymous hemianopsia and its associated difficulties, it is imperative to find methods for visual rehabilitation in this condition. Traditional methods of visual rehabilitation for homonymous hemianopsia include fitting spectacles with prisms to shift the visual field from the blind hemifield to the intact visual field. This is accomplished by placing the base of the prism in the blind hemifield, which shifts the image toward the apex of the prism into the intact hemifield. Many patients discontinue treatment with prisms because the prisms may induce visual confusion and double vision [1–4]. Another technique used is to train individuals with hemianopsia to make quick eye movements in the direction of the blind hemifield, though there is not much evidence supporting efficacy [6]. Although these methods may provide some compensation for the visual field loss, they do not restore the impaired visual field. Accordingly, other methods of improving vision are needed.

Individuals with homonymous hemianopsia do not consciously see vision in the blind hemifield. However, there is evidence of a ‘blindsight’ phenomenon, whereby some affected individuals can detect objects in their blind visual field, albeit without conscious awareness of being able to see the object. Functional magnetic resonance imaging (fMRI) studies have indicated that visual processing occurs in other parts of the brain, such as the lateral geniculate nucleus (LGN) and superior colliculus (SC) (Fig. 1). Visual processing in these regions provides the neural network that enables patients with blindsight to see [7–11]. Blindsight has been manipulated in some individuals to enhance visual awareness. Sahraie et al. studied a patient with homonymous hemianopsia and well-documented blindsight over a long period of time [7]. The patient reported increased awareness of visual stimuli in his blind visual field when the stimulus was presented with high contrast and low spatial frequency. Spatial frequency refers to the level of detail in an image appearing within a degree of the visual field. Temporal frequency, the number of times a stimulus is flashed within a second, also modulates detection. Multiple studies have shown that within a temporal frequency range of 5–20 Hz (cycles/s), detection of visual stimuli in a forced-choice test is significantly better than chance [7–11]. The time of stimulus onset also affects the rate of detection. Patients with parietal lobe injury often cannot detect a visual stimulus in the neglected hemifield when it is presented simultaneously in the intact hemifield, but can detect the stimulus when it is presented by itself in the neglected hemifield only, a phenomenon known as visual extinction [12,13]. It is thought that visual extinction reflects an attentional deficit as opposed to primarily a sensory deficit, although this remains an area of active research [14]. Despite that visual extinction is primarily studied in patients with hemi-neglect, patients with hemianopsia also can have hemi-neglect from injury to both the occipital and parietal lobes [15]. Therefore, the relevant visual variables for increasing visual detection in hemianopsia are stimuli contrast, spatial frequency, temporal frequency and stimulus onset asynchrony.

 

Figure 1. 3-D representation of tracts overlaid on T1-weighted fMRI images between the lateral geniculate nucleus (LGN) and human motion complex (hMT+), adapted from Ajina and colleagues (eLife. 2015;4:e08935. doi: 10.7554/eLife.08935[26]. (A) Dark green tracts are in the ipsilesional hemisphere, light green tracts are in the contralesional hemisphere and in controls. (B) Fractional anisotropy, reflecting neuronal damage, demonstrates increased impaired tissue microstructure in the ipsilesional tract in blindsight negative patients as compared with blindsight positive patients and controls.

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[Abstract] Do neurologists around the world agree when diagnosing epilepsy? – Results of an international EpiNet study

Highlights

189 Physicians assessed the same 30 case scenarios.

Agreement was good when epileptologists and neurologists diagnosed epilepsy.

Agreement was fair-moderate for seizure type and aetiology based on history alone.

Agreement improved significantly when results of investigations were included.

Agreement was better for epileptologists than neurologists interested in epilepsy.

Abstract

Objective

Previous studies have shown moderate agreement between physicians when diagnosing epilepsy, but have included small numbers. The EpiNet study group was established to undertake multicentre clinical trials in epilepsy. Before commencing trials, we wanted to determine levels of agreement between physicians from different countries and different health systems when diagnosing epilepsy, specific seizure types and etiologies.

Methods

30 Case scenarios describing six children and 24 adults with paroxysmal events (21 epileptic seizures, nine non-epileptic attacks) were presented to physicians with an interest in epilepsy. Physicians were asked how likely was a diagnosis of epilepsy; if seizures were generalised or focal; and the likely etiology. For 23 cases, clinical information was presented in Step 1, and investigations in Step 2.

Results

189 Participants from 36 countries completed the 30 cases. Levels of agreement were determined for 154 participants who provided details regarding their clinical experience. There was substantial agreement for diagnosis of epilepsy (kappa = 0.61); agreement was fair to moderate for seizure type(s) (kappa = 0.40) and etiology (kappa = 0.41). For 23 cases with two steps, agreement increased from step 1 to step 2 for diagnosis of epilepsy (kappa 0.56–0.70), seizure type(s) (kappa 0.38–0.52), and etiology (kappa 0.38–0.47). Agreement was better for 53 epileptologists (diagnosis of epilepsy, kappa = 0.66) than 56 neurologists with a special interest in epilepsy (kappa = 0.58). Levels of agreement differed slightly between physicians practicing in different parts of the world, between child and adult neurologists, and according to one’s experience with epilepsy.

Conclusion

Although there is substantial agreement when epileptologists diagnose epilepsy, there is less agreement for diagnoses of seizure types and etiology. Further education of physicians regarding semiology of different seizure types is required. Differences in approach to diagnosis, both between physicians and between countries, could impact negatively on clinical trials of anti-epileptic drugs.

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[VIDEO] A/Prof Danny Eckert: Sleep Your Way to Good Mental Health – NeuRA Talks

What does sleep have to do with mental health? Everything!

To see more seminars like this, visit: neuratalks.org

The focus of Neuroscience Research Australia, or NeuRA, has always been on neuroscience. We conduct clinical and laboratory research into neurological, psychiatric and psychological disorders.

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via NeuRA Talks – A/Prof Danny Eckert: Sleep Your Way to Good Mental Health – YouTube

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[WEB SITE] Medication Adherence Key to Epilepsy Treatment

In assessing the effectiveness of prescribed medication there is a strong emphasis on the ability of the patient to adhere to the regime recommended by the clinician. For individuals with epilepsy, adherence to medication is crucial in preventing or minimizing seizures and their cumulative impact on everyday life. Non-adherence to antiepileptic drugs (AEDs) can result in breakthrough seizures many months or years after a previous episode and can have serious repercussions on an individual’s perceived quality of life. Reasons for non-adherence are complex and multilayered. Patients can accidentally fail to adhere through forgetfulness, misunderstanding, or uncertainty about clinician’s recommendations, or intentionally due to their own expectations of treatment, side-effects, and lifestyle choice.

Adherence in epilepsy

Adherence is acting in accordance with advice, recommendations or instruction. Ways that adherence can be optimized;

  1. Educating individuals and their families and carers in understanding of their condition and the rationale of treatment, reducing the stigma associated with the conditions.
  2. Using simple medication regimes.
  3. Positive relationships between healthcare professionals, the individual with epilepsy and their family and /or carers.
  4. Other measures are; manual telephones follow up, home visits, special reminders, regular appointments/ refill reminders.

While failing to adhere to treatment plans can adversely affect individuals with any general medical condition, Non- adherence to anti-epileptic drugs results to increased risk of status epilepticus (prolonged seizures) resulting into brain damage, SUDEP, risk of injuries, increase rates of admission to hospital due prolonged seizures. The consequences of not taking medication can be more immediate with epilepsy.​

Epilepsy as a chronic condition relies heavily on adherence to medical advice in order to maximize an individual’s quality of life by controlling seizures more effectively while avoiding unwanted side-effects. Treatment of those diagnosed with epilepsy the vast majorities are treated with AEDs and approximately 70% can become seizure-free once the most effective regime is followed.

Monotherapy is viewed as the initial and preferential option for treating epilepsy, the choice of drug depending on seizure type and effectiveness of the drug balanced against possible side-effects. It is difficult to find estimates of how many people are on monotherapy or polytherapy at any one point in time.

However, in one of the cases I encountered that of Sarafina Muthoni from Banana, Kiambu County, she was diagnosed with Epilepsy at a very young age in her primary school days. With no history of such a condition in her family, it got everybody thinking what could have gone wrong with their lovely daughter. After days of trying to figure out, the family had to adapt to reality of their daughter living with Epilepsy. She was lucky to have very supportive parents ready to see her through the long journey of treating the condition. The motivation and support from her loved ones to access medication improved her status by far as she continued to adhere to the prescribed treatment. Unfortunately, the support didn’t last long and the burden of continuing with treatment squarely relied on her. This adversely contributed to the beginning of non-adherence to medication for lack of funds to buy drugs. Not only were finances a challenge but also finding a good hospital to comply was a problem.

Muthoni had to live with the sad reality of pain every time she experienced a seizure. Pain which she clearly knew with access to medication the situation could by far be controlled. At the very worse of her situation she found help. Cheshire Disability Services Kenya (CDSK) a Non-Governmental Organization in Kenya whose objective is to empower an inclusive society of persons with disability and develop their full potential to lead a quality life, in partnership with Kenya Association of People with Epilepsy (KAWE) came for Muthonis’ rescue.

Under CDSK’s program to help Epilepsy patients’ access medication and ensure compliance, Muthoni benefited and today she leads a life full of potential and energy as she explores her skills as a beauty and hair stylist.

As we celebrate International Epilepsy Day on Feb 12th 2018, themed on “Life is beautiful”, Muthoni’s story is a highlight of what beauty is all about. Hers’ is just but one of the many inspiring stories to celebrate during this season of Epilepsy Awareness.

Managing Adherence

Adherence to medication regardless of medical condition remains an important problem in treatment. Factors that have been discussed here – side-effects, drug regime, family support, impact on everyday life, relationship with the clinician – are unlikely to be the only predictors of adherence. While adherence to treatment within the context of epilepsy has been the focus of this review, these factors can equally be applied to various chronic conditions.

Assessment of adherence should be a routine part of management of epilepsy. Further recognition and support should be given to patients who have poor seizure control since they are more likely to be more anxious and have unhelpful illness and treatment beliefs.

Finally, patients may be fully aware of the importance of taking AED medication and the benefits gained by altering their lifestyle choices in order to prevent seizures, but will make a decision about the degree to which they follow advice. Patients only have a small amount of time in contact with the clinician in their “patient role”, after which they return to the practicalities of their everyday routine where their adherence fluctuates based on how they feel their medication affects their quality of life.

Strategies to manage adherence originate from different perspectives. While the medical model may advocate less complex drug regimes, the use of measured pill containers, and minimization of side-effects, the psychosocial model analyzes non-adherence in terms of patient attitudes to medication, stigma, family and peer influences, and ability to manage self care. Neither model can adequately improve adherence independently. Perhaps the best approach is to offer a “menu” of adherence-enhancing strategies. However, what is increasingly clear from both models is that total adherence is an unrealistic goal. The emphasis has shifted away from total adherence towards a compromise with both patient and clinician involved in a joint process of treatment negotiation and decision-making in order to achieve the best outcome for the individual.

 

via Medication Adherence Key to Epilepsy Treatment : Evewoman – The Standard

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[WEB SITE] AEDs: Which Work Best as Monotherapy in Epilepsy? – Neurology Times

Which antiepileptic drugs (AEDs) are best as monotherapy? Before the updated Cochrane review, first-line therapy in adults and children with partial onset seizures was with carbamazepine or lamotrigine. And first-line therapy for generalized seizure onset was with sodium valproate.

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  • 60%-70% of people with epilepsy reach remission from seizures shortly after starting AED treatment. Most are treated with AED monotherapy. The National Institute for Health and Care Excellence (NICE) guidelines in the UK recommend carbamazepine or lamotrigine as first-line-therapy in adults and children with partial onset seizures and sodium valproate as first-line for generalized onset seizures. A 2007 network meta-analysis of AED monotherapy generally agreed with these recommendations.[1]

     

  • The Cochrane Review of AED monotherapy, which updates previous meta-analysis with studies published since 2007, adds levetiracetam and zonisamide.[2]

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  • Individual participant data (IPD) approach were used; considered gold standard for time-to-event pooled network meta-analysis. Combined IPD data from 12,391 people in 36 studies and compared 10 AEDS: carbamazepine, phenytoin, sodium valproate, phenobarbitone, oxcarbazepine, lamotrigine, gabapentin, topiramate, levetiracetam, zonisamide. ooled data from trials that did head-to-head comparisons were analyzed; a second analysis combined all data from trials to compare drugs that had not been previously compared.

  • For partial seizures, levetiracetam was found to be significantly better than carbamazepine and lamotrigine. Lamotrigine was significantly better than all other AEDs (except levetiracetam). And carbamazepine was significantly better than gabapentin and phenobarbitone. For generalized onset seizures, valproate was significantly better than carbamazepine, topiramate and phenobarbitone. For both partial and generalized onset seizures: phenobarbitone, the earliest licensed treatment, performed worse in terms of treatment failure than all other treatments.

    ©Chaikom/ Shutterstock.com

  • There were few notable differences for partial or generalized seizure types, except fpr 12-month remission: Carbamazepine was significantly better than levetiracetam for partial seizures; and 6-month remission: Sodium valproate was significantly better than lamotrigine for generalized seizures. Regarding time to bot partial and generalized seizures: the oldest AEDs (phenytoin and phenobarbitone) were generally better than newer AEDs. The most commonly reported adverse events across all drugs: drowsiness/fatigue, headache/migraine, GI disturbances, dizziness/faintness, rash/skin disorders.

  • IPD data were available for just 69% of total participants from 47% of eligible trials, leaving out 31% of eligible participants. Methodological inadequacies in some trials could have biased results

  • 1. Phenobarbitone and phenytoin are better for seizure control, but at the expense of earlier treatment failure. 2. Carbamazepine and lamotrigine are suitable as first-line monotherapy for partial onset seizures; levetiracetam may be a suitable alternative. 3. Sodium valproate is suitable as first-line monotherapy for generalized seizures; lamotrigine and levetiracetam may be suitable alternatives, especially for women of child-bearing age given the potential teratogenicity of sodium valproate 4. Zonisamide may effective in partial onset seizures: evidence is limited and more research is needed.

1. Tudur Smith C, Marson AG, Chadwick DW, Williamson PR. Multiple treatment comparisons in epilepsy monotherapy trials. Trials. 2007;5(8):34
2. Nevitt SJ, Sudell M, Weston J, Tudur Smith C, Marson AG. Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data. Cochrane Database of Systematic Reviews. 2017, Issue 6. Art. No. CD011412.

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Which AEDs work best as monotherapy?

A new Cochrane review scrutinizes the efficacy and tolerability of various agents.

 

via AEDs: Which Work Best as Monotherapy in Epilepsy? | Neurology Times

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[Abstract] Long-term safety of repeated high doses of incobotulinumtoxinA injections for the treatment of upper and lower limb spasticity after stroke

Highlights

    Current guidelines suggested a dosage up to 600 units (U) of botulinum toxin type A (BoNT-A) in post-stroke spasticityHigh doses of incobotulinumtoxinA (840U) showed efficacy and safety in severe post-stroke upper and lower limb spasticityIn a 2-year follow-up on 20 patients, a reduction of spasticity/disability was found with repeated high doses of incobotulinumtoxinAOne month after the last BoNT-A administration, the efficacy on spasticity/disability was similar to that at baselineLong-term treatment with high doses of incobotulinumtoxinA was safe and effective in post-stroke upper and lower limb spasticity

Abstract

Current guidelines suggested a dosage up to 600 units (U) of botulinum toxin type A (BoNT-A) (onabotulinumtoxinA or incobotulinumtoxinA) in reducing spastic hypertonia with low prevalence of complications, although a growing body of evidence showed efficacy with the use of high doses (> 800 U). The available evidence mainly referred to a single set of injections evaluating the efficacy and safety of the neurotoxin 30 days after the treatment. In a prospective, non-randomized, open-label study, we studied the safety of repeated higher doses of incobotulinumtoxinA in post-stroke upper and lower limb spasticity.

Two years after the first set of injections, we evaluated in 20 stroke survivors with upper and lower limb spasticity the long-term safety of repeated high doses of incobotulinumtoxinA (up to 840 U) for a total of eight sets of injections.

Patients reported an improvement of their clinical picture concerning a reduction of spasticity measured with the Asworth Scale (AS) for elbow, wrist, fingers and ankle flexor muscles and disability measured with the Disability Assessment Scale (DAS) 30 days after the last set of injections (eighth set) compared to the baseline (p < 0.0001). No difference in AS and DAS scores has been found between t1 (30 days after the first injection set) and t2 (30 days after the eighth set of injections), with also similar safety.

In a two-year follow-up, repeated high doses of incobotulinumtoxinA, administered for eight sets of injections, appeared to be safe in patients with upper and lower limb spasticity after stroke without general adverse effects.

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[WEB SITE] The Truth About Electrical Brain Stimulation

Shocking your scalp using two wet sponges and electrodes is having a bit of a moment. The procedure, called transcranial direct current stimulation (tDCS), has been shown to help you learn math, improve your language skills, and even work out harder for longer. But scientists are split on whether tDCS can really do what it claims.

Some scientists are enthusiastic about the technology and say it has substantially fewer side effects than psychotropic medications. Numerous studies suggest it may improve our ability to learn pretty much anything, and there does seem to be evidence that a mild shock to the brain can help treat several psychiatric disorders.

Clinical trials are currently testing tDCS to treat a long list of disorders, including depression, pain, insomnia, Parkinson’s disease, schizophrenia, and addiction. A community of biohackers and self-experimenters has arisen in garages and online forums to build their own devices, or you can order a kit and test the technology on yourself.

But other researchers are more skeptical, doubting whether tDCS is as safe and effective as its champions claim. Despite promising lab results, none of the medical benefits have been verified by the FDA, and recent studies have called into question the technology’s ability to affect brain activity at all. Critics express concern about small study sizes and placebo effects, as well as the potential for side effects such as skin burns.

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Jason Forte, a cognitive neuroscientist at the University of Melbourne, says he is particularly concerned about the potential dangers of using tDCS in the home. “There is risk of skin damage at the site of the electrode if the device is not used correctly. Poorly designed devices used in the wrong way could compromise heart function, although this has not been reported.”

Within the walls of academia, this debate is normal. A new drug or device arises every decade or so, exciting researchers and capturing the imagination of the public. Before it is released, scientists conduct hundreds of studies to figure out if the technique is safe, how best to administer it, and what it might be most useful for.

However, because of its relative safety and ease to build, tDCS has bypassed much of the usual review process and jumped from the lab to the living room. Private start-ups, such as The Brain Stimulator, TransCranial Technologies, and Halo Neuroscience, now sell DIY tDCS devices to curious self-experimenters and desperate patients. This shift has alarmed some researchers and regulatory experts, while others say they see no harm in sharing the technology.

How Brain Stimulation Works

With tDCS, the brain is zapped using a simple, consistent electrical current—typically 1 to 2 milliamps—for 20 to 30 minutes a day. The stimulation feels like a tingling or mild stinging at the site of the electrode. Neurons communicate through electrical and chemical signals. Scientists think the small amount of current neurons receive from tDCS makes them more likely to fire an electrical pulse, which results in a neurotransmitter being released into the brain.

tDCS is just one of several types of mild electrical brain stimulation. Other options include transcranial alternating current stimulation (tACS) and cranial electrotherapy stimulation (CES). In tACS, the keyword is “alternating.” In contrast to tDCS, the current in tACS constantly changes, oscillating between positive and negative. Scientists think that tACS works not by changing individual neurons, but by shifting the electrical frequency of the whole brain, which can optimize it for different states, like sleep or attention.

The current is also pulsed in a related technology, CES. Fisher Wallace, a company that sells CES devices, claims that the technology can increase neurochemical levels in the brain, including serotonin, but there is little evidence this is true. Of the three, it is the only device that is FDA-approved to treat depression, anxiety, and insomnia. But it was on the market before the FDA required proof of efficacy for class III medical devices, so it has not faced the same scrutiny that such devices face today.

tDCS has garnered more attention from researchers than the other types of brain stimulation, including ongoing clinical trials, and consequently more self-experimenters trying to mimic them.

Devices’ Claims Haven’t Been Thoroughly Tested

Michael Oxley was inspired to create his first brain stimulator device after reading a New Scientist article on tDCS in 2012. A mechanical engineer, he hoped that mildly shocking his brain would increase his energy levels and improve his concentration. Five years later, Oxley has sold tens of thousands of tDCS headsets through his company, foc.us, which claim to “enhance alertness, boost focus and increase capacity to learn” and even “help you run further and faster.”

 

However, Oxley admits foc.us’s devices have not undergone any formal outside testing or clinical trials, and instead base their statements on self-experimentation and the wider scientific literature.

These statements about cognitive and physical performance are allowed by the FDA because they do not make any medical assertions. But Anna Wexler, a biomedical ethicist at the University of Pennsylvania, says they can be regulated by the Federal Trade Commission.

“[The FTC has] taken action against a number of companies making cognitive enhancement claims, both in the supplement world but also in the brain training world, so they’ve shown a willingness to kind of get involved,” she says. “They have not taken any action against a tCDS company, but in practice, in principle they could.”

Oxley emphasized he does not advertise their product to treat any psychiatric conditions, not just for fear of FDA retaliation, but because he feels it would be irresponsible. However, in reviews for foc.us’s devices, several customers report using the product to treat their depression. Wexler’s research supports this; in an upcoming study, she reveals that a third of home users administer the technology to self-medicate for conditions like depression.

The Potential Benefits of tDCS

Marom Bikson, a professor of biomedical engineering at The City College of New York, says that on its own, tDCS doesn’t do very much. Its real value comes when it is combined with learning. He recommends using the technology before or during learning a new activity, like playing the piano.

Neurons that fire together, wire together. By increasing the likelihood that a neuron will fire, tDCS helps the brain to forge new connections while it learns, a process called plasticity. This ability to impact learning is why tDCS is marketed as having such a broad range of potential uses.

“When you apply direct current stimulation, you can change ongoing plasticity. Not generate plasticity, but change plasticity that’s already ongoing,” says Bikson. “The direct current stimulation can boost that plasticity, so basically making the learning more effective.”

Bikson says with this type of functional targeting, it doesn’t really matter where the sponges and electrodes are placed, because only the neurons undergoing plasticity will be affected by tDCS.

In contrast, for conditions like anxiety and depression, researchers aim to increase activity in a specific area of the brain, the dorsolateral prefrontal cortex, that is underactive in people with depression. Stimulating this area with daily tDCS brings the neurons’ activity back up to a normal level, which is thought to help boost people’s mood.

A large-scale trial published earlier this year showed that tDCS performed better than placebo in treating depression. These results imply that tDCS really can improve depression symptoms, but the study also showed it is not as effective as traditional medications like SSRIs.

What Could Go Wrong

Areas just a few millimeters apart can have very different functions. With tDCS, the sponges that go on the scalp span several centimeters, so it’s difficult to ensure you’re stimulating the right area. Some researchers have expressed concerns about off-target effects of tDCS, particularly when treating psychiatric disorders, which requires activation of a particular region. The brain is like real estate: it’s all about location, location, location. Off-target effects are especially a concern for DIY brain stimulators who may not have a background in neuroanatomy.

“You’re affecting large swaths of neurons that then have downstream effects in their relationship with other neuronal populations and networks, so where you place the electrodes is really critical,” says Tracy Vannorsdall, a neuropsychologist at Johns Hopkins University School of Medicine. “We know that very small changes in the electrode montage—where we’re placing them on the brain—can have significant different effects in terms of cognitive outcomes.”

Studies have shown that increasing function in one area of the brain can actually impair performance in a different area. Less dramatic but perhaps more pressing are reports of home users experiencing burns or skin damage at the site of the electrodes.

Another concern is that the technique may not do anything at all. Many studiesreport no effect either behaviorally or in terms of brain activity using tDCS. In perhaps the most unique test of the technology, scientists demonstrated that only 10 percent of the electrical current penetrated the skull of a cadaver to reach its brain. These findings suggest tDCS has far less of an impact on the brain than researchers originally hoped, and possibly not enough to make any meaningful difference in neurons’ behavior.

So, Should You Do It?

Interested in trying it yourself? Instead of putting down a couple hundred dollars for your own device, neuropsychologist Vannorsdall recommends joining one of the 700 tDCS clinical trials listed on clinicaltrials.gov, which recruit both patients and healthy people. “I think right now that it’s just too early for people to be experimenting on themselves,” she says.

But Bikson, the biomedical engineer, says self-experimentation may not be such a bad thing. Five years ago, his “knee-jerk reaction [as] the researcher in the academic ivory tower [was] this is my toy, don’t touch it.” But now his stance has softened. “I’m really really hesitant to tell someone who is really suffering or whose loved one is suffering to do or not do something,” he says. “I’m not going to endorse it, but I’m not going to condemn them. Obviously, many of us in the clinical and basic research communities believe these technologies can be effective.”[…]

via The Truth About Electrical Brain Stimulation

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[Abstract] Biomechatronics design of a robotic arm for rehabilitation – IEEE Conference Publication

Abstract

Rehabilitation is an important process to restore muscle strength and joint’s range of motion. This paper proposes a biomechatronic design of a robotic arm that is able to mimic the natural movement of the human shoulder, elbow and wrist joint. In a preliminary experiment, a subject was asked to perform four different arm movements using the developed robotic arm for a period of two weeks. The experimental results were recorded and can be plotted into graphical results using Matlab. Based on the results, the robotic arm shows encouraging effect by increasing the performance of rehabilitation process. This is proven when the result in degree value are accurate when being compared with the flexion of both shoulder and elbow joints. This project can give advantages on research if the input parameter needed in the flexion of elbow and wrist.

I. Introduction

According to the United Nations (UN), by 2030 the number of people over 60 years will increase by 56 per cent, from 901 million to more than 1.4 billion worldwide [1]. As the number of older persons is expected to grow, it is imperative that government and private health care providers prepare adequate and modern facilities that can provide quality services for the needs of older persons especially in rehabilitation centers. Implementation of robotic technology in rehabilitation process is a modern method and definitely can contribute in this policy and capable in promoting early recovery and motor learning [2]. Furthermore, systematic application of robotic technology can produce significant clinical results in motor recovery of post-traumatic central nervous system injury by assisting in physical exercise based on voluntary movement in rehabilitation [3].

via Biomechatronics design of a robotic arm for rehabilitation – IEEE Conference Publication

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[WEB SITE] Coping With Emotional Changes After Stroke for Families

Coping With Emotional Changes After Stroke-blog

As a stroke survivor, you can face major life changes. In the aftermath of a stroke, you may experience a sense of loss that is rooted in the feeling that you’ve lost the life you had before your stroke, or your independence. These strong emotional reactions take a toll.

It is normal to experience emotions ranging from frustration, anxiety, and depression to a sense of grief, or even guilt, anger, and denial after such a monumental change. Realizing that these emotions are normal, and that you are not alone in experiencing them, is an important step to acknowledging and coping with them in a healthy way. By doing this, you avoid becoming overwhelmed, thus avoiding further difficulties during your recovery.

Reasons for Emotional Changes After a Stroke

Young Man At Balcony In Depression Suffering Emotional Crisis And Grief

A stroke causes physical damage to your brain. Feeling or behaving differently after a stroke may be connected to the area of your brain that was damaged. If the area of your brain that controls personality or emotion is affected, you may be susceptible to changes in your emotional response or everyday behavior. Strokes may also cause emotional distress due to the suddenness of their occurrence. As with any traumatic life experience, it may take time for you to accept and adapt to the emotional trauma of having experienced a stroke.

Emotional Changes a Stroke Might Cause

PseudoBulbar Affect

crying

Sometimes referred to as “reflex crying,” “emotional lability,” or “labile mood,” Pseudobulbar Affect (PBA) is a symptom of damage to the area of the brain that controls expression of emotions. Characteristics of the disorder include rapid changes in mood, such as suddenly bursting into tears and stopping just as suddenly, or even beginning to laugh at inappropriate times.

Depression

depressed

If you are feeling sad, hopeless, or helpless after having suffered a stroke, you may be experiencing depression. Other symptoms of depression may include irritability or changes to your eating and sleeping habits. Talk to your doctor if you are experiencing any of these symptoms, as it may be necessary to treat with prescription antidepressants or therapy to avoid it becoming a road block to your recovery.

Anxiety

anxiety

Anxiety is quite common after a stroke. You may have feelings of uneasiness or fears about your health; this is normal and healthy. However, if your anxiety does not subside in time and you feel overwhelmed, you may be dealing with an anxiety disorder, which requires help from your doctor or a mental health professional.

Medical staff will perform an informal evaluation to check for anxiety while you are in the hospital. Often, this involves a quick discussion with hospital staff, during which they will ask you if you have any worries or fears about your health. This evaluation may also involve hospital staff asking your family members if they have noticed a change in your mood or behavior. It is important that you are kept in the loop about any issues that may present themselves, and that you are provided with as much information about your health and treatment options as possible.

Symptoms of anxiety to watch for may include irritability or trouble concentrating. You may also experience trouble sleeping due to your mind racing about your health. Sometimes, you can become tired easily, even if well rested.

Physical symptoms may also present themselves. These symptoms include a racing heart and restlessness and are often coupled with a sense of overwhelming worry or dread. If you find yourself avoiding your normal activities, such as grocery shopping, visiting friends, going for walks, or spending a large portion of your day dwelling on things you are worried about, you may have an anxiety disorder. Your doctor can recommend that you visit a psychologist to help cope with and eventually overcome anxiety.

Other Emotional Reactions

You may experience a range of other emotional reactions after a stroke, including anger and frustration. Additional symptoms may be a sense of apathy or a lack of motivation to accomplish things you typically enjoy.

Coping With Changing Emotions

Physician Ready To Examine Patient And Help

There are many ways to treat the emotional changes associated with a stroke. The first step is discussing how you feel, as well as any concerns you may have about your health with your doctor. One treatment option is counseling, which involves speaking about your distressing thoughts and feelings with a mental health professional or therapist. Simply talking about the way you are feeling can be helpful when coping with overwhelming emotions after experiencing a traumatic event such as a stroke.

Your doctor may also prescribe antidepressants or anti-anxiety medication to help you deal with the emotions involved with a stroke. While they are not a cure-all for emotional troubles, antidepressants change the levels of certain chemicals in your brain, alleviating the symptoms of depression and anxiety, lifting your mood, and making life feel more bearable while you’re recovering. It is important to stay in contact with your doctor if you decide to take medication, as it will not be effective for everyone and may have unpleasant side effects.

Seek Support or Professional Advice

A stroke can come on suddenly and have a monumental effect on your life. For this reason, it is common for many patients to struggle with emotional side effects following a stroke. You may suffer damage to the section of your brain that affects emotions, causing a change in personality or emotional expression known as Pseudobulbar Affect. You may also experience symptoms of anxiety or depression, along with feelings of anger, frustration, or uncharacteristic apathy.

It is important to discuss your emotional concerns with your doctor. You may need a prescription for antidepressants or anti-anxiety medication, or a recommendation to see a mental health professional who can help you form healthy coping mechanisms.


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

via Coping With Emotional Changes After Stroke for Families

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[WEB SITE] How a Stroke In The Right brain Affects The Body & How to Recover | Saebo

Guide to Recovering From a Right Brain Stroke

Two is stronger than one, and your brain is no exception to the adage. What many people may not realize is that your brain consists of two distinct parts that work together as one, much like your eyes or ears.

Essentially, each side of the brain—left and right—is responsible for carrying out specific tasks. An easy way to understand this concept is to imagine a photograph of a loved one or friend. Immediately, the right side of your brain will see that it’s a person in a kind of setting (visual). But the left side of the brain will be the one to associate that person and place with a specific memory (analytical). You may have heard people say that they’re more “left-brained” or “right-brained”; they are identifying with the side of their brain, and its associated processes, that they feel is more dominant in their thinking. This symbiotic relationship is crucial to how everyone’s mind processes and stores information, so when either side of the brain is damaged by a stroke, there can be specific repercussions.

In most cases, a stroke occurs on one side of the brain. In this article, we examine the right brain in particular, its functions, and share what processes may be affected by a stroke.

What Does The Right Brain Control?

What Does The Right Brain Control?

When it comes to physical movement, the right side of the brain is responsible for carrying out functions for the left side of the body. The same is true for the opposite—the left side of the brain controls the right side of the body. Although we essentially live with crossed wires in our system, the same principles don’t necessarily apply when it comes to certain cognitive functions for each.

Specific duties performed by the right side consist of:

  • Spatial Reasoning
  • Musical Comprehension
  • Basic Object Recognition
  • Creative Abilities
  • Emotion
  • Imagination

Taking these things into consideration, it’s easy to see why any disruption to the right brain can be devastating. Unfortunately, a stroke can occur on either side of the brain depending on where the damage takes place. If you or a loved one has suffered from a right brain stroke, it’s important to be aware of what kinds of complications may arise.

Possible Effects Of Right Brain Stroke on Survivors

Suffering from a right brain stroke is certainly difficult to endure and overcome but, by increasing your awareness of what the potential side effects are, you can better prepare yourself for the road to recovery.

Potential Effects Of A Right Brain Stroke Consist Of:

  • Loss of Mobility and Control of the Left Side of the Body: Like what was mentioned above, damage to the right side of the brain can result in a loss of functionality in the left side of the body. This means that a stroke survivor can potentially lose the ability to move their left hand, arm, leg, foot, or left-side face muscles.
  • Unilateral Neglect: Mostly prominent in right-brain affected stroke patients, Unilateral Neglect (or Hemispatial Neglect) refers to an unawareness of objects to one side of the body or personal space. In severe cases, a side can be completely ignored when carrying out certain tasks and everyday functions.
  • Denial Syndrome or Anosognosia (Self-awareness): Due to various parts of the brain that remain unaffected after a stroke, stroke survivors will mentally believe that they are carrying out their physical functions in a normal fashion despite their actual inability to do so. These issues can also lead to a stroke survivor not wanting to undergo physical rehabilitation, which can put them at risk for further injury if left unresolved.
  • Emotional Indifference: A lack of emotion or change in emotional affect can be exhibited after a stroke, rendering the survivor to act as if nothing serious—physical or mental—needs to be addressed. This kind of indifference or unmotivated behavior can make initiation of or following through with the rehabilitation process difficult. Learn more about coping with emotional changes after stroke here.
  • Visual & Spatial Issues: Stroke survivors can experience a myriad of issues when it comes to visual and spatial comprehension. Primarily, a survivor will have trouble judging their location amid objects in their surroundings. This can manifest in difficulty feeding themselves, climbing up and down stairs, and changing clothes. Additionally, one may lose the ability to visually and mentally recall certain objects. A new rehab approach for retraining the brain in these areas is with the use of virtual reality. Learn how the SaeboVR can make recovery exercises fun!
  • Social Challenges: In many cases, a stroke survivor will have a difficult time recognizing certain social behaviors and cues. Things like body language, nonverbal communication, humor and sarcasm have the potential to go unnoticed.
  • Lack of Focus: One may not be able to give their full attention to a subject for extended periods of time. This inability can also surface if a stroke survivor is trying to follow directions, answer questions, or solve problems with basic reasoning practices (instinctual errors).
  • Loss of Hearing & Musicality: When considering the range of variables that make up one’s persona—emotions, actions, and mental processes—it’s important to realize that a person’s hearing and understanding is made of similar components. This means that a stroke survivor may have trouble picking up on certain sounds, which could result in miscommunication or an inability to appreciate the musicality of speech and tone altogether.

 

Treatments for Right Brain Stroke

Treatments for Right Brain Strokes

For any survivor to begin to see positive changes after a stroke, the rehabilitation process must start right away. Of course, the pathway to recuperation will be different for every individual, but the process that must always take effect in order to see results is something called neuroplasticity.

Neuroplasticity, in essence, refers to the regenerative properties of the brain—a re-establishment and rearrangement of neural connections. This means that the brain is essentially reprogramming itself in undamaged areas to support damaged ones, and the sooner this activity begins, the sooner one can recover.

Process of Dealing with Right Brain Stroke

To enhance this process, proper execution of rehabilitation exercises—both mental and physical—must be carried out on a regular basis. Over time, consistent and repetitive efforts will aid in constructing healthy neural connections, as well strengthening damaged ones.

In addition to consistency and repetition, there are rehabilitation exercise aids which can enhance the effectiveness of rehab exercises after stroke. These devices offer additional supports that allow the user to execute a wider range of exercises and adjust the difficulty for individualized results. For weakness in the arm or hand, the SaeboGloveSaeboFlexSaeboStretch, or SaeboMas can significantly increase the speed and effectiveness of rehabilitation.

Although the difficulties of life post-stroke can seem insurmountable, always remember that the brain and the heart are two of our most powerful organs. Given the right tools, patience, and support, you or a loved one can move forward on the path to recovery.

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

more —>  How a Stroke In The Right brain Affects The Body & How to Recover | Saebo

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