[BLOG POST] 4 Ways to Harness Neuroplasticity to Improve Your Brain

Every minute of every day, your brain is literally changing its physical form and function in response to your experiences, behaviors, and even your thoughts through a process known as neuroplasticity. Now, think about that for just a minute.

Constantly worrying about the bills. Criticizing yourself relentlessly for a mistake you made at work. Bingeing on Netflix and junk food most nights to de-stress. Replaying painful memories of a break-up over and over in your head. Checking your phone as soon as it dings. Whether you know it or not, these things are changing the neuronal pathways in your brain. What you do repeatedly — both good and bad — literally gets wired into the structure of your brain. This can help you or hurt you.

A lot of the time neuroplastic change is happening below your conscious awareness in ways that don’t benefit you. It’s because of neuroplasticity that addictions and some major brain illnesses and conditions show up in humans. Schizophrenia, bipolar disorder, depression, obsessive-compulsive and phobic behaviors, epilepsy, and more occur because of neuroplastic changes in the brain. However, neuroplasticity also allows all learning and memory and recovery from brain damage, injury, addictions, and many mental health conditions. And if you intentionally guide neuroplastic change, you can improve your brain and life.

You are changing your brain every day anyway. Why not intentionally use neuroplasticity to help you?

What Exactly Is Neuroplasticity?

Neuroplasticity is an umbrella term referring to the ability of your brain to reorganize itself, both physically and functionally, throughout your life due to your environment, behavior, thinking, and emotions. Science used to believe that the brain only changed significantly during critical periods in childhood. While it is true that the brain is much more plastic in youth and capacity declines with age, plasticity happens from birth until death.

Harnessing neuroplasticity as an adult does require a little extra effort and specific circumstances, but it can be done. What you pay attention to, what you think, feel, and want, and how you react and behave all physically shape your brain. The point is you can intentionally change your brain.

Neuroplasticity has possible implications for every aspect of human nature and culture including medicine, psychiatry, psychology, relationships, education, and more. Where it stands to have the most potential is for the individual in their own life. Because you can learn to consciously control your thinking, reactions, and behavior, and some of the experiences you have, you can oversee your own “self-directed neuroplasticity” and invite change and healing into your life. We have grossly underestimated how our minds and brains can help us and the huge role they play in shaping our lives and realities.You’re changing your brain every day you’re alive anyway. Why not use this to help you?

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Four Ways to Use Your Mind to Change Your Brain

How to Use Your Mind to Change Your Brain to Decrease Depression & Anxiety

It’s because of neuroplasticity that depression and anxiety become established patterns in your brain in the first place. Negative mental states become negative neural traits. Cruelly enough, these mental conditions reinforce themselves. Your brain is a feedback loop. The same neuroplasticity also allows you to use your mind to interrupt the loop and establish new patterns in your brain to overcome the conditions.

Research shows self-directed neuroplasticity can make positive changes in your brain, but it’s not immediate or effortless and requires motivation, intention, and persistence. Most neuroplastic change is incremental, not dramatic. Because neuroplasticity occurs for whatever’s in your field of focused awareness, your attention is like a vacuum cleaner, sucking its contents into your brain. Directing your attention purposefully allows you to shape your brain and life over time. Read more

Four Steps to Take Control Of Your Mind and Change Your Brain

In the 1990s, Jeffrey Schwartz, M.D., a research psychiatrist, combined his interest in Buddhist philosophy with his nueroatonomy research and came up with a Four Step method for successfully altering the behavior of persons with obsessive-compulsive disorder (OCD). The Four Step program has become the established treatment for OCD and has been verified to physically change brains in studies using brain scans.

The good news is that you can use the thought reframing process to retrain your brain to eliminate mild to moderate unwanted, unhealthy thought patterns and behaviors. When symptoms are severe and debilitating, people might not be able to focus their attention enough and would benefit from the method as part of a structured, professional therapy program. Read more

How Your Neurons Make You a Nervous Wreck (and how to rewire them)

Your brain learns, through a process called conditioning, to continually adapt your behavior in an attempt to be better suited to survive in its environment. In classical conditioning, your brain learns to associate two stimuli, such as in Pavlov’s well-known experiments with dogs. In the second kind of learning, operant conditioning, your brain learns to associate your behavior with consequences, good or bad. When it is followed by a reinforcing reward, the behavior is strengthened. When followed by a negative reward, it’s diminished.

In everyday life, you are continually being conditioned in both ways, and as you learn, your behaviors are reinforced, shaped, and refined by your environment and simultaneously influenced by your thoughts, feelings, and memories. Your brain changes as a result. Your brain learns to be over-anxious, but the good news is that it can unlearn in the same way. Read more

How to Use Your Attention to Rewire Your Brain

Directing your attention is the answer to calming a busy brain that jumps around from one anxiety-inducing thought to another. Bringing your attention back into the present can immediately stop your brain from ruminating about painful memories. Being able to direct and sustain your attention to a specific desired place is the foundation of changing your brain through experience-dependent neuroplasticity.

Your happiness, baseline disposition, how you respond to the world, interact in relationships, think of and talk to yourself is largely determined by your subconscious. Implicit memories from your childhood and past, which are below your conscious awareness and cannot easily be measured or retrieved, primarily make up your brain’s subconscious material. In order to change your subconscious chatter, you have to change your brain’s default pattern of operation. Luckily, you already have everything you need to do that. You sculpt your brain with your attention 

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Source: The Best Brain Possible

[Abstract] Can cognitive rehabilitation improve attention deficits following stroke? – A Cochrane Review summary with commentary

Abstract

Background: Disorders of attention are common following stroke, reducing quality of life and limiting rehabilitation.

Objective: To determine if cognitive rehabilitation can improve attention and functional outcomes in stroke survivors with attentional disorders.

Methods: A summary of the Cochrane Review update by Loetscher et al. 2019, with comments.

Results: Six studies with 223 participants were included: this was the same as the previous review (in 2013). Evidence quality was very low to moderate, and results suggest a beneficial impact on divided attention immediately after training, but no effect on any other outcome either immediately or at follow up timepoints.

Conclusions: The low methodological quality and small number of studies means current evidence provides limited clinical guidance. Clearly more research is needed to inform care: researchers must improve the methodological quality of studies, plus fully consider and report the aspects of attention and function addressed in their work.

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• Cognitive rehabilitation for attention deficits following stroke.Loetscher T, Lincoln NB.Cochrane Database Syst Rev. 2013 May 31;2013(5):CD002842. doi: 10.1002/14651858.CD002842.pub2.PMID: 23728639 Free PMC article. Updated. Review.
• Memory rehabilitation for people with multiple sclerosis.das Nair R, Martin KJ, Lincoln NB.Cochrane Database Syst Rev. 2016 Mar 23;3:CD008754. doi: 10.1002/14651858.CD008754.pub3.PMID: 27004596 Review.
• Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes.Kumar KS, Samuelkamaleshkumar S, Viswanathan A, Macaden AS.Cochrane Database Syst Rev. 2017 Jun 20;6(6):CD007935. doi: 10.1002/14651858.CD007935.pub2.PMID: 28631816 Free PMC article. Review.
• Exercise rehabilitation following intensive care unit discharge for recovery from critical illness.Connolly B, Salisbury L, O’Neill B, Geneen L, Douiri A, Grocott MP, Hart N, Walsh TS, Blackwood B; ERACIP Group.Cochrane Database Syst Rev. 2015 Jun 22;2015(6):CD008632. doi: 10.1002/14651858.CD008632.pub2.PMID: 26098746 Free PMC article. Review.
• Cognitive rehabilitation for memory deficits after stroke.das Nair R, Cogger H, Worthington E, Lincoln NB.Cochrane Database Syst Rev. 2016 Sep 1;9(9):CD002293. doi: 10.1002/14651858.CD002293.pub3.PMID: 27581994 Free PMC article. Review.

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[ARTICLE] Effect of transcranial direct-current stimulation on cognitive function in stroke patients: A systematic review and meta-analysis – Full Text

Abstract

Objective

Transcranial direct-current stimulation (tDCS) is a noninvasive approach that can alter brain excitability. Several studies have shown the effectiveness of tDCS in improving language and movement function in stroke patients. However, the effect of tDCS on cognitive function after stroke remains uncertain.

Methods

We searched Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the China National Knowledge Infrastructure, the China Science and Technology Journal Database, and the Wanfang Data Knowledge Service Platform from inception to April 2, 2019. Two reviewers independently screened the studies, extracted the data, and evaluated the quality of the included studies using the Cochrane Collaboration Risk of Bias Tool. All statistical analyses were performed in RevMan 5.3, and the mean difference (MD) or standard mean difference (SMD) were used as the pooled statistics.

Results

Fifteen studies involving 820 participants were included. When compared with passive tDCS, anodal tDCS was associated with improved general cognitive performance as examined by the Minimum Mental State Examination or Montreal Cognitive Assessment (SMD = 1.31, 95% CI 0.91–1.71, P < 0.00001), attention performance (SMD = 0.66, 95% CI 0.11–1.20, P = 0.02). There was no significant difference in memory performance (SMD = 0.41, 95% CI -0.67–1.50, P = 0.46).

Conclusions

tDCS is likely to be effective for patients with cognitive impairment after stroke. The evidence for different effects based on population characteristics and stimulation methods was limited, but a real effect cannot be ruled out. More high-quality research in this field is required to determine the potential benefits of tDCS in the treatment of cognitive deficits after stroke and to establish the optimal treatment program.

Introduction

Although stroke has fallen from the second leading cause of death to the fourth in the United States, it remains the leading cause of severe adult disability, which produces a major burden to society [1]. In 2010, there were an estimated 11.6 million events of incident ischemic stroke and 5.3 million events of incident hemorrhagic stroke, most of which were in low- and middle-income countries [2]. In addition to the high morbidity and mortality, the burden of stroke-related disability is another major problem in survivors; the incidence of poststroke cognitive impairment (PSCI) ranges from 22% to 47% in different studies [3–5], and it has had a serious impact on both the economy and quality of life.

Transcranial direct-current stimulation (tDCS) was first developed for clinical purposes in 2000[6]; currently, it constitutes a promising method for neurological condition regulation [7, 8]. As a neuromodulatory approach, tDCS works by depolarizing or hyperpolarizing neuronal membrane potentials through the activation of sodium- and calcium-dependent channels and NMDA receptor activity, thereby modulating neural activity and cortical excitability [7, 9].

Several systematic reviews have evaluated the efficacy of tDCS on motor function and aphasia after stroke [10–12]; some preliminary studies have shown beneficial effects of tDCS on cognitive function in healthy subjects as well as in stroke patients [13–16]. However, it remains largely uncertain whether tDCS promotes the recovery of cognitive function after stroke. Therefore, we conducted this systematic review and meta-analysis to evaluate the effectiveness of tDCS on cognition after stroke.[…]

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[ARTICLE] The Use of Therapeutic Music Training to Remediate Cognitive Impairment Following an Acquired Brain Injury: The Theoretical Basis and a Case Study – Full Text

Abstract

Cognitive impairment is the most common sequelae following an acquired brain injury (ABI) and can have profound impact on the life and rehabilitation potential for the individual. The literature demonstrates that music training results in a musician’s increased cognitive control, attention, and executive functioning when compared to non-musicians. Therapeutic Music Training (TMT) is a music therapy model which uses the learning to play an instrument, specifically the piano, to engage and place demands on cognitive networks in order to remediate and improve these processes following an acquired brain injury. The underlying theory for the efficacy of TMT as a cognitive rehabilitation intervention is grounded in the literature of cognition, neuroplasticity, and of the increased attention and cognitive control of musicians. This single-subject case study is an investigation into the potential cognitive benefit of TMT and can be used to inform a future more rigorous study. The participant was an adult male diagnosed with cognitive impairment as a result of a severe brain injury following an automobile accident. Pre- and post-tests used standardized neuropsychological measures of attention: Trail Making A and B, Digit Symbol, and the Brown– Peterson Task. The treatment period was twelve months. The results of Trail Making Test reveal improved attention with a large decrease in test time on both Trail Making A (−26.88 s) and Trail Making B (−20.33 s) when compared to normative data on Trail Making A (−0.96 s) and Trail Making B (−3.86 s). Digit Symbol results did not reveal any gains and indicated a reduction (−2) in free recall of symbols. The results of the Brown–Peterson Task reveal improved attention with large increases in the correct number of responses in the 18-s delay (+6) and the 36-s delay (+7) when compared with normative data for the 18-s delay (+0.44) and the 36-s delay (−0.1). There is sparse literature regarding music based cognitive rehabilitation and a gap in the literature between experimental research and clinical work. The purpose of this paper is to present the theory for Therapeutic Music Training (TMT) and to provide a pilot case study investigating the potential efficacy of TMT to remediate cognitive impairment following an ABI.

1. Introduction

An acquired brain injury (ABI) can result in impairment in a variety of domains including motor, speech, emotional, and cognitive. Cognitive impairment is the most common sequelae following an ABI [1,2,3,4] and is a result of deficit in one or more areas of cognition such as the various forms of attention, working memory, memory, executive function, or processing speed [5,6,7,8,9,10,11]. An individual with cognitive impairment may experience challenge to suppress distraction, remain on task, shift between tasks, follow directions, organize and initiate a response, or have difficulties with memory. Cognitive impairment can impact participation and progress in rehabilitation therapies for any of the above domains due to reduced attention, poor executive functioning, or impaired memory. The inability to attend to instructions of the therapist, to cognitively plan and organize a response, or to remember rehabilitation objectives outside the therapy session can potentially disqualify an individual from participation in rehabilitative programs or may impede progress in them. Furthermore, cognitive impairment is reported by family and caregivers as a significant source of stress [8,12,13,14]. Addressing cognitive impairment should be a priority in patient treatment following an acquired brain injury. Therefore, it is important to have on-going research into potentially effective cognitive rehabilitation tools.Music training has been noted in the literature to impact areas of non-musical functioning including phonological awareness [15], speech processing [16], listening skills [17], perceiving speech in noise [18] and reading [19,20]. Of significance to the theory of Therapeutic Music Training, the literature demonstrates the impact of music training on cognitive abilities including attention and executive functioning [21,22,23,24,25,26,27].Therapeutic Music Training (TMT) is a music therapy model in which the use of music training, specifically learning to play the piano, is used to address and remediate cognitive impairment following an acquired brain injury [28]. TMT is informed by clinical work and is grounded in literature. The hypothesis of the efficacy of TMT to remediate cognitive impairment is supported by literature regarding the influence of music training on cognition [23,24,25,29], musician’s enhanced abilities in attention, working memory, and cognitive control [26], theories of attention [30,31,32,33,34,35] and the neuroplasticity of the brain, including following injury [36,37,38,39,40]. Because of the engagement of the prefrontal cortex and the demands placed on working memory and attention during TMT, it can be an effective tool to address cognitive impairment. Although functionally interconnected, specific aspects of cognition such as working memory, attention, executive function, and memory are targeted in TMT tasks. TMT is a remedial approach to cognitive rehabilitation, that is, the goal is to drive, strengthen, and improve the underlying neural processes involved in the target cognitive areas. This is in contrast to a compensatory approach to cognitive rehabilitation, in which the goal is to provide the individual with strategies and accommodations to deal with the outcomes of cognitive impairment. The tangible outcome of producing a song provides motivation for the client to engage in cognitive rehabilitation and to remain in the rehabilitative process for an extended period of time as is required to stimulate a neuroplastic response and for the remediation of neural processing to take place.TMT is distinct from modified music education in that the goal of TMT is the remediation of cognitive processes rather than music performance. Tasks involved in learning to play the piano are designed with the goal of placing demands on the various components of cognition. The sequencing and pacing of tasks are determined by the cognitive goals with consideration to target cognitive processes and the time required to drive and strengthen the networks involved. Novelty and the gradual increase in complexity of tasks are utilized to place on-going demands on attention networks and to gradually benefit higher cognitive processes. This is in contrast to modified music education, in which the primary goal is the acquisition of musical abilities and performance.TMT is distinct from other models of music therapy in that it uses music training as the intervention for rehabilitative purposes. TMT contrasts from other music therapy models which use music primarily for expressive purposes, lack corrective feedback from the therapist, or use isolated music tasks which are not intended as music training. TMT is distinct from Neurologic Music Therapy (NMT) [41] in addressing cognitive goals as NMT does not use music training in its music-based rehabilitative interventions. Bruscia highlighted the importance of the music therapist’s “non-judgemental acceptance of what the client does musically” [42] (p. 3). While the TMT therapist would express empathy and support to the client, s/he would also provide constructive and corrective feedback as required in the learning to play an instrument. As in other models of music therapy, the therapist’s use-of-self and the role of the client–therapist relationship are important contributors to the success of the therapy.Remarkably, much of cognitive rehabilitation is not grounded in the literature [36,43,44,45]. This may be due in part to the fact that rehabilitation therapy used to address cognitive impairment is most often based on a compensatory approach, accommodating or supporting the impairment, rather than attempting to remediate the cognitive processes that have been impaired. While the use of music and instrument playing for motor rehabilitation has been widely investigated [41,46,47,48], there is sparse literature investigating the potential efficacy of music-based cognitive rehabilitation interventions. This paper provides a brief introduction to the theory for TMT. This case study investigates the hypothesis of the potential effectiveness of therapeutic music training, TMT, to remediate cognitive impairment and serves as a pilot project to inform future, more rigorous studies. This investigation can contribute to the literature regarding music-based cognitive rehabilitation and inform clinical practice. There is a gap between cognitive experimental research and treatment applications [49]. The hypothesis for TMT has been informed by clinical work and this study can help fill in the gap between experimental research and clinical application. […]

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[Abstract + References] Predictors of Arm Nonuse in Chronic Stroke: A Preliminary Investigation

Abstract

Background. Nonuse (NU) after stroke is characterized by failure to use the contralesional arm despite adequate capacity. It has been suggested that NU is a consequence of the greater effort and/or attention required to use the affected limb, but such accounts have not been directly tested, and we have poor understanding of the predictors of NU. 

Objective. We aimed to provide preliminary evidence regarding demographic, neuropsychological (ie, apraxia, attention/arousal, neglect), and psychological (ie, self-efficacy) factors that may influence NU in chronic stroke. 

Methods. Twenty chronic stroke survivors with mild to moderate sensory-motor impairment characterized by the Upper-Extremity Fugl-Meyer (UEFM) were assessed for NU with a modified version of the Actual Amount of Use Test (AAUT), which measures the disparity between amount of use in spontaneous versus forced conditions. Participants were also assessed with measures of limb apraxia, spatial neglect, attention/arousal, and self-efficacy. Using stepwise multiple regression, we determined which variables predicted AAUT NU scores. 

Results. Scores on the UEFM as well as attention/arousal predicted the degree of NU (P < .05). Attention/arousal predicted NU above and beyond UEFM (P < .05). 

Conclusions. The results are consistent with the importance of attention and engagement necessary to fully incorporate the paretic limb into daily activities. Larger-scale studies that include additional behavioral (eg, sensation, proprioception, spasticity, pain, mental health, motivation) and neuroanatomical measures (eg, lesion volume and white matter connectivity) will be important for future investigations.

References

1.	Raghavan, P. Upper limb motor impairment after stroke. Phys Med Rehabil Clin N Am. 2015;26:599-610. doi:10.1016/j.pmr.2015.06.008 Google Scholar | Crossref | Medline
2.	Taub, E, Uswatte, G, Mark, VW, Morris, DM. The learned nonuse phenonmenon: implications for rehabilitation. Eura Medicophys. 2006;42:241-256. Google Scholar | Medline
3.	Wolf, SL. Revisiting constraint-induced movement therapy: are we too smitten with the mitten? Is all nonuse “learned?” and other quandaries. Phys Ther. 2007;87:1212-1223. doi:10.2522/ptj.20060355 Google Scholar | Crossref | Medline | ISI
4.	Waddell, KJ, Strube, MJ, Bailey, RR, et al. Does task-specific training improve upper limb performance in daily life poststroke? Neurorehabil Neural Repair. 2017;31:290-300. doi:10.1177/1545968316680493 Google Scholar | SAGE Journals | ISI
5.	Young, NL, Williams, JI, Yoshida, KK, Bombardier, C, Wright, JG. The context of measuring disability: does it matter whether capability or performance is measured? J Clin Epidemiol. 1996;49:1097-1101. doi:10.1016/0895-4356(96)00214-4 Google Scholar | Crossref | Medline | ISI
6.	Bailey, RR, Klaesner, JW, Lang, CE. Quantifying real-world upper-limb activity in nondisabled adults and adults with chronic stroke. Neurorehabil Neural Repair. 2015;29:969-978. doi:10.1177/1545968315583720 Google Scholar | SAGE Journals | ISI
7.	Bakhti, KKA, Mottet, D, Schweighofer, N, Froger, J, Laffont, I. Proximal arm non-use when reaching after a stroke. Neurosci Lett. 2017;657:91-96. doi:10.1016/j.neulet.2017.07.055 Google Scholar | Crossref | Medline
8.	Stewart, JC, Cramer, SC. Patient-reported measures provide unique insights into motor function after stroke. Stroke. 2013;44:1111-1116. doi:10.1161/STROKEAHA.111.674671 Google Scholar | Crossref | Medline | ISI
9.	van der Lee, JH, Wagenaar, RC, Lankhorst, GJ, Vogelaar, TW, Deville, WL, Bouter, LM. Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Stroke. 1999;30:2369-2375. Google Scholar | Crossref | Medline | ISI
10.	Wolf, SL, Winstein, CJ, Miller, JP, et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006;296:2095-2104. doi:10.1001/jama.296.17.2095 Google Scholar | Crossref | Medline | ISI
11.	Sterr, A, Elbert, T, Berthold, I, Koölbel, S, Rockstroh, B, Taub, E. Longer versus shorter daily constraint-induced movement therapy of chronic hemiparesis: an exploratory study. Arch Phys Med Rehabil. 2002;83:1374-1377. doi:10.1053/apmr.2002.35108 Google Scholar | Crossref | Medline | ISI
12.	Park, J, Lee, N, Cho, Y, Yang, Y. Modified constraint-induced movement therapy for clients with chronic stroke: interrupted time series (ITS) design. J Phys Ther Sci. 2015;27:963-966. doi:10.1589/jpts.27.963 Google Scholar | Crossref | Medline
13.	Takebayashi, T, Koyama, T, Amano, S, et al. A 6-month follow-up after constraint-induced movement therapy with and without transfer package for patients with hemiparesis after stroke: a pilot quasi-randomized controlled trial. Clin Rehabil. 2013;27:418-426. doi:10.1177/0269215512460779 Google Scholar | SAGE Journals | ISI
14.	Ballester, BR, Maier, M, San Segundo Mozo, RM, Castada, V, Duff, A, Verschure, PFMJ. Counteracting learned non-use in chronic stroke patients with reinforcement-induced movement therapy. J Neuroeng Rehabil. 2016;13:74. doi:10.1186/s12984-016-0178-x Google Scholar | Crossref | Medline
15.	Liu, XH, Huai, J, Gao, J, Zhang, Y, Yue, SW. Constraint-induced movement therapy in treatment of acute and sub-acute stroke: a meta-analysis of 16 randomized controlled trials. Neural Regen Res. 2017;12:1443-1450. doi:10.4103/1673-5374.215255 Google Scholar | Crossref | Medline
16.	Taub, E, Uswatte, G, Pidikiti, R. Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation—a clinical review. J Rehabil Res Dev. 1999;36:237-251. Google Scholar | Medline
17.	Sunderland, A, Tuke, A. Neuroplasticity, learning and recovery after stroke: a critical evaluation of constraint-induced therapy. Neuropsychol Rehabil. 2005;15:81-96. doi:10.1080/09602010443000047 Google Scholar | Crossref | Medline | ISI
18.	Wulf, G, Lewthwaite, R. Optimizing performance through intrinsic motivation and attention for learning: the OPTIMAL theory of motor learning. Psychon Bull Rev. 2016;23:1382-1414. doi:10.3758/s13423-015-0999-9 Google Scholar | Crossref | Medline | ISI
19.	Taub, E, Uswatte, G, Mark, VW, et al. Method for enhancing real-world use of a more affected arm in chronic stroke: transfer package of constraint-induced movement therapy. Stroke. 2013;44:1383-1388. doi:10.1161/STROKEAHA.111.000559 Google Scholar | Crossref | Medline | ISI
20.	Gauthier, LV, Taub, E, Perkins, C, Ortmann, M, Mark, VW, Uswatte, G. Remodeling the brain: plastic structural brain changes produced by different motor therapies after stroke. Stroke. 2008;39:1520-1525. doi:10.1161/STROKEAHA.107.502229 Google Scholar | Crossref | Medline | ISI
21.	Katz, N, Hartman-Maeir, A, Ring, H, Soroker, N. Functional disability and rehabilitation outcome in right hemisphere damaged patients with and without unilateral spatial neglect. Arch Phys Med Rehabil. 1999;80:379-384. Google Scholar | Crossref | Medline | ISI
22.	van Dalen, JW, van Charante, EPM, Nederkoorn, PJ, van Gool, WA, Richard, E. Poststroke apathy. Stroke. 2013;44:851-860. doi:10.1161/STROKEAHA.112.674614 Google Scholar | Crossref | Medline | ISI
23.	Sundet, K, Finset, A, Reinvang, I. Neuropsychological predictors in stroke rehabilitation. J Clin Exp Neuropsychol. 1988;10:363-379. doi:10.1080/01688638808408245 Google Scholar | Crossref | Medline
24.	Chen, S, Lewthwaite, R, Schweighofer, N, Winstein, CJ. Discriminant validity of a new measure of self-efficacy for reaching movements after stroke-induced hemiparesis. J Hand Ther. 2013;26:116-123. doi:10.1016/j.jht.2012.09.002 Google Scholar | Crossref | Medline | ISI
25.	Sugg, K, Müller, S, Winstein, C, Hathorn, D, Dempsey, A. Does action observation training with immediate physical practice improve hemiparetic upper-limb function in chronic stroke? Neurorehabil Neural Repair. 2015;29:807-817. doi:10.1177/1545968314565512 Google Scholar | SAGE Journals | ISI
26.	Stewart, JC, Lewthwaite, R, Rocktashel, J, Winstein, CJ. Self-efficacy and reach performance in individuals with mild motor impairment due to stroke. Neurorehabil Neural Repair. 2019;33:319-328. doi:10.1177/1545968319836231 Google Scholar | SAGE Journals | ISI
27.	Schwartz, MF, Brecher, AR, Whyte, J, Klein, MG. A patient registry for cognitive rehabilitation research: a strategy for balancing patients’ privacy rights with researchers’ need for access. Arch Phys Med Rehabil. 2005;86:1807-1814. doi:10.1016/j.apmr.2005.03.009 Google Scholar | Crossref | Medline
28.	Woytowicz, EJ, Westlake, KP, Whitall, J, Sainburg, RL. Handedness results from complementary hemispheric dominance, not global hemispheric dominance: evidence from mechanically coupled bilateral movements. J Neurophysiol. 2018;120:729-740. doi:10.1152/jn.00878.2017 Google Scholar | Crossref | Medline
29.	Woodbury, ML, Velozo, CA, Richards, LG, Duncan, PW. Rasch analysis staging methodology to classify upper extremity movement impairment after stroke. Arch Phys Med Rehabil. 2013;94:1527-1533. doi:10.1016/j.apmr.2013.03.007 Google Scholar | Crossref | Medline | ISI
30.	Buxbaum, LJ, Kyle, KM, Menon, R. On beyond mirror neurons: internal representations subserving imitation and recognition of skilled object-related actions in humans. Brain Res Cogn Brain Res. 2005;25:226-239. doi:10.1016/j.cogbrainres.2005.05.014 Google Scholar | Crossref | Medline
31.	Buxbaum, LJ, Shapiro, AD, Coslett, HB. Critical brain regions for tool-related and imitative actions: a componential analysis. Brain. 2014;137(pt 7):1971-1985. doi:10.1093/brain/awu111 Google Scholar | Crossref | Medline
32.	Altman, DG. Statistics in medical journals: developments in the 1980s. Stat Med. 1991;10:1897-1913. doi:10.1002/sim.4780101206 Google Scholar | Crossref | Medline | ISI
33.	Van Vleet, TM, DeGutis, JM. The nonspatial side of spatial neglect and related approaches to treatment. Prog Brain Res. 2013;207:327-349. doi:10.1016/B978-0-444-63327-9.00012-6 Google Scholar | Crossref | Medline
34.	Buxbaum, LJ, Dawson, AM, Linsley, D. Reliability and validity of the Virtual Reality Lateralized Attention Test in assessing hemispatial neglect in right-hemisphere stroke. Neuropsychology. 2012;26:430-441. doi:10.1037/a0028674 Google Scholar | Crossref | Medline | ISI
35.	Taub, E, DeLuca, S, Crago, JE. Actual Amount of Use Test. Unpublished Manuscript. Birmingham, AL: Psychology Department, University of Alabama, 1996. Google Scholar
36.	Kunkel, A, Kopp, B, Müller, G, et al. Constraint-induced movement therapy for motor recovery in chronic stroke patients. Arch Phys Med Rehabil. 1999;80:624-628. doi:10.1016/S0003-9993(99)90163-6 Google Scholar | Crossref | Medline | ISI
37.	Uswatte, G, Taub, E. Constraint-induced movement therapy: new approaches to outcome measurement in rehabilitation. In: Stuss, DT, Winocur, G, Robertson, IH, eds. Cognitive Neurorehabilitation. New York, NY: Cambridge University Press; 1999:215-229. Google Scholar
38.	Sterr, A, Freivogel, S, Schmalohr, D. Neurobehavioral aspects of recovery: assessment of the learned nonuse phenomenon in hemiparetic adolescents. Arch Phys Med Rehabil. 2002;83:1726-1731. Google Scholar | Crossref | Medline | ISI
39.	Woytowicz, EJ, Rietschel, JC, Goodman, RN, et al. Determining levels of upper extremity movement impairment by applying a cluster analysis to the Fugl-Meyer assessment of the upper extremity in chronic stroke. Arch Phys Med Rehabil. 2017;98:456-462. doi:10.1016/j.apmr.2016.06.023 Google Scholar | Crossref | Medline
40.	Kutner, MH, Nachtsheim, CJ, Neter, J, Li, W. Applied Linear Statistical Models. 5th ed. New York, NY: McGraw-Hill; 2005. Google Scholar
41.	Schweighofer, N, Han, CE, Wolf, SL, Arbib, MA, Winstein, CJ. A functional threshold for long-term use of hand and arm function can be determined: predictions from a computational model and supporting data from the Extremity Constraint-Induced Therapy Evaluation (EXCITE) Trial. Phys Ther. 2009;89:1327-1336. doi:10.2522/ptj.20080402 Google Scholar | Crossref | Medline | ISI
42.	Rafiei, MH, Kelly, KM, Borstad, AL, Adeli, H, Gauthier, LV. Predicting improved daily use of the more affected arm poststroke following constraint-induced movement therapy. Phys Ther. 2019;99:1667-1678. doi:10.1093/ptj/pzz121 Google Scholar | Crossref | Medline
43.	Moruzzi, G, Magoun, HW. Brain stem reticular formation and activation of the EEG. Electroencephalogr Clin Neurophysiol. 1949;1:455-473. Google Scholar | Crossref | Medline
44.	Malik, PRA, Muir, RT, Black, SE, et al. Subcortical brain involvement is associated with impaired performance on the psychomotor vigilance task after minor stroke. Neurorehabil Neural Repair. 2018;32:999-1007. doi:10.1177/1545968318804415 Google Scholar | SAGE Journals | ISI
45.	Boukrina, O, Barrett, AM. Disruption of the ascending arousal system and cortical attention networks in post-stroke delirium and spatial neglect. Neurosci Biobehav Rev. 2017;83:1-10. doi:10.1016/j.neubiorev.2017.09.024 Google Scholar | Crossref | Medline
46.	Heilman, KM, Van Den Abell, T. Right hemisphere dominance for attention: the mechanism underlying hemispheric asymmetries of inattention (neglect). Neurology. 1980;30:327-330. doi:10.1212/wnl.30.3.327 Google Scholar | Crossref | Medline | ISI
47.	van Kessel, ME, van Nes, IJW, Brouwer, WH, Geurts, ACH, Fasotti, L. Visuospatial asymmetry and non-spatial attention in subacute stroke patients with and without neglect. Cortex. 2010;46:602-612. doi:10.1016/j.cortex.2009.06.004 Google Scholar | Crossref | Medline
48.	Rinne, P, Hassan, M, Fernandes, C, et al. Motor dexterity and strength depend upon integrity of the attention-control system. Proc Natl Acad Sci U S A. 2017;115:E536-E545. doi:10.1073/pnas.1715617115 Google Scholar | Crossref | Medline
49.	Mathôt, S, Siebold, A, Donk, M, Vitu, F. Large pupils predict goal-driven eye movements. J Exp Psychol Gen. 2015;144:513-521. doi:10.1037/a0039168 Google Scholar | Crossref | Medline
50.	Dimenichi, BC, Richmond, LL. Reflecting on past failures leads to increased perseverance and sustained attention. J Cogn Psychol. 2015;27:180-193. doi:10.1080/20445911.2014.995104 Google Scholar | Crossref
51.	Kalia, V, Thomas, R, Osowski, K, Drew, A. Staying alert? Neural correlates of the association between Grit and Attention Networks. Front Psychol. 2018;9:1377. doi:10.3389/fpsyg.2018.01377 Google Scholar | Crossref | Medline
52.	Park, JS, Lee, G, Choi, JB, Hwang, NK, Jung, YJ. Game-based hand resistance exercise versus traditional manual hand exercises for improving hand strength, motor function, and compliance in stroke patients: a multi-center randomized controlled study. NeuroRehabilitation. 2019;45:221-227. doi:10.3233/nre-192829 Google Scholar | Crossref | Medline
53.	Ward, NS, Brander, F, Kelly, K. Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. J Neurol Neurosurg Psychiatry. 2019;90:498-506. doi:10.1136/jnnp-2018-319954 Google Scholar | Crossref | Medline
54.	Lewthwaite, R, Winstein, CJ, Lane, CJ, et al. Accelerating stroke recovery: body structures and functions, activities, participation, and quality of life outcomes from a large rehabilitation trial. Neurorehabil Neural Repair. 2018;32:150-165. doi:10.1177/1545968318760726 Google Scholar | SAGE Journals | ISI
55.	Kobylańska, M, Kowalska, J, Neustein, J, et al. The role of biopsychosocial factors in the rehabilitation process of individuals with a stroke. Work. 2019;61:523-535. doi:10.3233/WOR-162823 Google Scholar | Crossref
56.	Sit, JWH, Chair, SY, Choi, KC, et al. Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial. Clin Interv Aging. 2016;11:1441-1450. doi:10.2147/CIA.S109560 Google Scholar | Crossref | Medline
57.	Marks, R, Allegrante, JP, Lorig, K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part II). Health Promot Pract. 2005;6:148-156. doi:10.1177/1524839904266792 Google Scholar | SAGE Journals
58.	Winstein, C, Lewthwaite, R, Blanton, SR, Wolf, LB, Wishart, L. Infusing motor learning research into neurorehabilitation practice: a historical perspective with case exemplar from the accelerated skill acquisition program. J Neurol Phys Ther. 2014;38:190-200. doi:10.1097/NPT.0000000000000046 Google Scholar | Crossref | Medline
59.	Winstein, C, Kim, B, Kim, S, Martinez, C, Schweighofer, N. Dosage matters. Stroke. 2019;50:1831-1837. doi:10.1161/STROKEAHA.118.023603 Google Scholar | Crossref | Medline
60.	Dušica, SP, Devečerski, GV, Jovićević, MN, Platiša, NM. Stroke rehabilitation: which factors influence the outcome? Ann Indian Acad Neurol. 2015;18:484-487. doi:10.4103/0972-2327.165480 Google Scholar | Crossref | Medline
61.	Hadidi, N, Treat-Jacobson, DJ, Lindquist, R. Poststroke depression and functional outcome: a critical review of literature. Heart Lung. 2009;38:151-162. doi:10.1016/j.hrtlng.2008.05.002 Google Scholar | Crossref | Medline | ISI
62.	Winstein, C, Varghese, R. Been there, done that, so what’s next for arm and hand rehabilitation in stroke? NeuroRehabilitation. 2018;43:3-18. doi:10.3233/NRE-172412 Google Scholar | Crossref | Medline

Source: https://journals.sagepub.com/doi/abs/10.1177/1545968320913554?journalCode=nnrb

[Abstract] Effects of transcranial magnetic stimulation on the performance of the activities of daily living and attention function after stroke: a randomized controlled trial

Abstract

Objective:

We aimed to interrogate the effects of transcranial magnetic stimulation (TMS) on the performance in activities of daily living (ADL) and attention function after stroke.

Design:

Randomized controlled trial.

Setting:

Inpatient rehabilitation hospital.

Subjects:

We randomized 62 stroke patients with attention dysfunction who were randomly assigned into two groups, and two dropped out from each group. The TMS group (n = 29) and a sham group (n = 29), whose mean (SD) was 58.12 (6.72) years. A total of 33 (56.9%) patients had right hemisphere lesion while the rest 25 (43.1%) patients had left hemisphere lesion.

Interventions:

Patients in the TMS group received 10 Hz, 700 pulses of TMS, while those in the sham group received sham TMS for four weeks. All the participants underwent comprehensive cognitive training.

Main measures:

At baseline, and end of the four-week treatment, the performance in the activities of daily living was assessed by Functional Independence Measure (FIM). On the other side, attention dysfunction was screened by Mini-Mental State Examination (MMSE), while the attention function was assessed by the Trail Making Test-A (TMT-A), Digit Symbol Test (DST) and Digital Span Test (DS).

Results:

Our data showed a significant difference in the post-treatment gains in motor of Functional Independence Measure (13.00 SD 1.69 vs 4.21 SD 2.96), cognition of Functional Independence Measure (4.69 SD 1.56 vs 1.52 SD 1.02), total of Functional Independence Measure (17.69 SD 2.36 vs 5.72 SD 3.12), Mini-Mental State Examination (3.07 SD 1.36 vs 1.21 SD 0.62), time taken in Trail Making Test-A (96.67 SD 25.18 vs 44.28 SD 19.45), errors number in Trail Making Test-A (2.72 SD 1.03 vs 0.86 SD 1.03), Digit Symbol Test (3.76 SD 1.09 vs 0.76 SD 0.87) or Digital Span Test (1.69 SD 0.54 vs 0.90 SD 0.72) between the TMS group and the sham group (P < 0.05).

Conclusions:

Taken together, we demonstrate that TMS improves the performance in the activities of daily living and attention function in patients with stroke.

via Effects of transcranial magnetic stimulation on the performance of the activities of daily living and attention function after stroke: a randomized controlled trial – Yuanwen Liu, Mingyu Yin, Jing Luo, Li Huang, Shuxian Zhang, Cuihuan Pan, Xiquan Hu, 2020

[Abstract] SMART Program in Chronic Stroke

Abstract

INTRODUCTION: Long-term functional cognitive impairments are common sequelae of stroke, often resulting in decreased participation in daily life activities. Earlier research showed the benefits of training paradigms targeted at memory, attention, and some executive functions.

METHODS: The current study examined the feasibility of a functionally relevant training program called Strategic Memory Advanced Reasoning Training (SMART). The SMART program teaches strategies to improve abstract reasoning skills and has been shown to enhance aspects of functional cognition, strengthen brain networks, and improve participation in daily life activities across clinical populations. The current study describes the benefits of the SMART program in adults (N = 12) between 54 and 77 years (64.46 ± 8.14 years) with chronic stroke. Participants had 10 sessions of the SMART program over a period of 6 weeks.

RESULTS: The findings showed significant gains in abstract reasoning (p < .05) and participation in daily activities after the SMART program. These gains were relatively stable 6 months later.

CONCLUSION: These findings offer the promise of cognitive gains, even years after stroke. Limitations of the study include a small sample size, potential confounding as a result of additional ongoing therapy, and a relatively short period of follow-up. Further research is needed to examine the benefits of the SMART program. [Annals of International Occupational Therapy. 2020;X(X):xx–xx.]

Source: Annals of International Occupational Therapy. https://doi.org/10.3928/24761222-20200116-03

[I/Ep] Strategies to Cope With Behavior Changes After Acquired Brain Injury – Archives of Physical Medicine and Rehabilitation

Behavior changes are common after acquired brain injury (ABI) because the brain processes information differently after the injury. About 62% of people with ABI experience behavior changes.¹ For some people with ABI, the changes in behavior have a major effect on their daily lives, while for others they may be relatively small. These changes can make daily tasks and social interactions difficult. People with ABI may be more sensitive to stress and fatigue, which can make the behaviors described in this article worse.

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via Strategies to Cope With Behavior Changes After Acquired Brain Injury – Archives of Physical Medicine and Rehabilitation

[VIDEO] RehaCom introduction – YouTube

RehaCom is a modular software used for cognitive therapy. It assists therapist in the rehabilitation of cognitive disorders that affect specific aspects of attention, concentration, memory, perception, activities of daily living and much more.

 

[ARTICLE] Effect of the Wii Sports Resort on the improvement in attention, processing speed and working memory in moderate stroke – Full Text

Abstract

Background

Stroke is the most common neurological disease in the world. After the stroke, some people suffer a cognitive disability. Commercial videogames have been used after stroke for physical rehabilitation; however, their use in cognitive rehabilitation has hardly been studied. The objectives of this study were to analyze attention, processing speed, and working memory in patients with moderate stroke after an intervention with Wii Sports Resort and compared these results with a control group.

Methods

A pre-post design study was conducted with 30 moderate stroke patients aged 65 ± 15. The study lasted eight weeks. 15 participated in the intervention group and 15 belong to the control group. They were assessed in attention and processing speed (TMT-A and B) and working memory (Digit Span of WAIS-III). Parametric and effect size tests were used to analyze the improvement of those outcomes and compared both groups.

Results

At the baseline, there was no difference between TMT-A and B. A difference was found in the scalar score of TMT-B, as well as in Digit Backward Span and Total Digit Task. In TMT-A and B, the intervention group had better scores than the control group. The intervention group in the Digit Forward Span and the Total Digit obtained a moderate effect size and the control group also obtained a moderate effect size in Total Digit. In the Digit scalar scores, the control group achieved better results than the intervention group.

Conclusions

The results on attention, processing speed and working memory improved in both groups. However, according to the effect sizes, the intervention group achieved better results than the control group. In addition, the attention and processing speed improved more than the working memory after the intervention. Although more studies are needed in this area, the results are encouraging for cognitive rehabilitation after stroke.

 

Background

Stroke is a really common neurological circulatory disorder, around 795,000 people suffer a new stroke every year and 185,000 are recurrent cases [1]. It is the second most common cause of dementia, death and more than 32% people after stroke suffer from cognitive impairments [2], and the third most common cause of disability which in five years after stroke the disabilities levels increase from 14 to 23% [1]. The after-effects of suffering a stroke can appear on a physical level, such as motor disorders [3, 4], hemiparesis [5], dizziness, vertigo and various sight and speech problems [6]. There can also be cognitive side-effects [7, 8], such as cognitive impairment [9, 10] and various attention disorders [11] on a spatial cognition [12] and behavioral [13] level.

Various studies have been conducted to improve the physical after-effects and to analyze functional capacity through physical activity and motor skills [3, 14, 15], and evidence has been found to suggest that physical activity leads to changes in brain structure [16, 17]. On a physical level, rehabilitation exercises have also been designed to recover the mobility of the affected hands and upper limbs [4, 18], as well as botox (botulinum toxin type A) treatments to improve the spasticity of the affected upper limbs [19].

There has also been research on a psychological level [20] to analyze post-stroke depression [21, 22] and quality of life [2, 23]. To improve the effects on a cognitive level, rehabilitation studies have been conducted to reduce attention deficits [11], aphasia [24] and to work on cognition to improve functional activity [25, 26]. The cognitive after-effects have been studied in the fields of neuropsychology [27] and neurorehabilitation [28, 29]. In neuropsychology, two of the most widely used instruments to measure cognitive abilities such as attention, processing speed and working memory, among others, have been the Trail Making Test [30, 31] and the WAIS Digit Span task [32].

Meanwhile, to decrease the affect-effects of strokes, there have also been studies on the impact of physical activity using commercial videogames, and their use in rehabilitation to control mainly physical consequences [33, 34], such as balance and gait disorders [33, 35] and effects on the upper limbs [36, 37]. However, there is hardly any scientific evidence regarding the use of commercial videogames to do physical activity in order to recover cognition [38, 39]. Hence, the main goal of this study was to evaluate the effect on the cognitive areas of attention, processing speed and working memory in people that have suffered a moderate stroke following an intervention with the Nintendo Wii Sports Resort and compared to a control group who did not receive the intervention with the Nintendo Wii Sport Resort.[…]

 

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