Posts Tagged chronic pain

[VIDEO] Arm Range of Motion – Karuna Labs: Virtual Embodiment Training for Chronic Pain – YouTube

via Arm Range of Motion – Karuna Labs: Virtual Embodiment Training for Chronic Pain – YouTube

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[NEWS] New Virtual Reality Therapy game could offer relief for patients with chronic pain, mobility issues

News-MedicalA Virtual Reality Therapy game (iVRT) which could introduce relief for patients suffering from chronic pain and mobility issues has been developed by a team of UK researchers.

Dr Andrew Wilson and colleagues from Birmingham City University built the CRPS app in collaboration with clinical staff at Sandwell and West Birmingham Hospitals NHS Trust for a new way to tackle complex regional pain syndrome and to aid people living with musculoskeletal conditions.

Using a head mounted display and controllers, the team created an immersive and interactive game which mimics the processes used in traditional ‘mirror therapy’ treatment. Within the game, players are consciously and subconsciously encouraged to stretch, move and position the limbs that are affected by their conditions.

Mirror therapy is a medical exercise intervention where a mirror is used to create areflective illusion that encourages patient’s brain to move their limb more freely. This intervention is often used by occupational therapists and physiotherapists to treat CRPS patients who have experienced a stroke. This treatment has proven to be successful exercises are often deemed routine and mundane by patients, which contributes to decline in the completion of therapy.

Work around the CRPS project, which could have major implications for other patient rehabilitation programmes worldwide when fully realised, was presented at the 12th European Conference on Game Based Learning (ECGBL) in France late last year.

Dr Wilson, who leads Birmingham City University’s contribution to a European research study into how virtual reality games can encourage more physical activity, and how movement science in virtual worlds can be used for both rehabilitation and treatment adherence, explained, “The first part of the CRPS project was to examine the feasibility of being able to create a game which reflects the rehabilitation exercises that the clinical teams use on the ground to reduce pain and improve mobility in specific patients.”

“By making the game enjoyable and playable we hope family members will play too and in doing so encourage the patient to continue with their rehabilitation. Our early research has shown that in healthy volunteers both regular and casual gamers enjoyed the game which is promising in terms of our theory surrounding how we may support treatment adherence by exploiting involvement of family and friends in the therapy processes.”

The CRPS project was realized through collaborative working between City Hospital, Birmingham, and staff at the School of Computing and Digital Technology, and was developed following research around the provision of a 3D virtual reality ophthalmoscopy trainer.

Andrea Quadling, Senior Occupational Therapist at Sandwell Hospital, said “The concept of using virtual reality to treat complex pain conditions is exciting, appealing and shows a lot of potential. This software has the potential to be very helpful in offering additional treatment options for people who suffer with CRPS.”

via New Virtual Reality Therapy game could offer relief for patients with chronic pain, mobility issues

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[Abstract] Systematic review: Predicting adverse psychological outcomes after hand trauma

Abstract

Study Design

Systematic review.

Introduction and Purpose of the Study

After traumatic hand injury, extensive physical and psychological adaptation is required following surgical reconstruction. Recovery from injury can understandably be emotionally challenging, which may result in impaired quality of life and delayed physical recovery. However, the evidence base for identifying high-risk patients is limited.

Methods

A PROSPERO-registered literature search of MEDLINE (1946-present), EMBASE (1980-present), PsychInfo, and CINAHL electronic databases identified 5156 results for studies reporting psychological outcomes after acute hand trauma. Subsequent review and selection by 2 independent reviewers identified 19 studies for inclusion. These were poor quality level 2 prognostic studies, cross sectional or cohort in design, and varied widely in methodology, sample sizes, diagnostic methods, and cutoff values used to identify psychological symptoms. Data regarding symptoms, predisposing factors, and questionnaires used to identify them were extracted and analyzed.

Results

Patients with amputations or a tendency to catastrophize suffered highest pain ratings. Persisting symptom presence at 3 months was the best predictor of chronicity. Many different questionnaires were used for symptom detection, but none had been specifically validated in a hand trauma population of patients. Few studies assessed the ability of selection tools to predict patients at high risk of developing adverse psychological outcomes.

Discussion and Conclusion

Despite a limited evidence base, screening at 3 months may detect post-traumatic stress disorder, anxiety, depression, and chronic pain, potentially allowing for early intervention and improved treatment outcomes.

Source: Systematic review: Predicting adverse psychological outcomes after hand trauma – Journal of Hand Therapy

 

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[WEB SITE] Let’s Talk About Sex …. After Brain Injury

 

5 reasons why my sex drive changed after a traumatic brain injury

“Sexual energy is the primal and creative energy of the universe.” — Deepak Chopra

As someone who had a fairly healthy sex drive before falling on the ice and suffering a traumatic brain injury (TBI), I was confused as to what was going on with my libido.

It’s a story I hear far too often among TBI survivors — they want to be intimate with their partner, yet just don’t have the bandwidth to even consider it. The partner feels neglected and/or frustrated, and the survivor feels helpless and misunderstood. This cycle can continue for years, and I felt it was time to speak out on a topic that affects 2.5 million Americans each year, yet is rarely talked about: Sex After Brain Injury.

For the past few years I have had a “friends-with-benefits” situation with Tim (not his real name.) We enjoy each other’s company, and have a great sexual chemistry together. He lives about an hour west of the Twin Cities, so I see him only every few months, which works out perfectly for both of us.

I saw Tim several times in the first few months after my fall and it was, well, interesting. In addition to a TBI, I had also sustained whiplash, torn muscles, and a dislocated sternum. Finding a position for me to get comfortable in was challenging, to say the least. Tim was patient with me, and very gentle and kind. He understood my situation and wanted to do whatever he could to make it easier for me.

It was almost comical, the amount of work it took—propping me up on pillows so that I wouldn’t be dizzy, repositioning me every few minutes so that I wouldn’t be in pain, and let’s not forget that I couldn’t “jiggle” my head around or it would cause an instant headache.

After the first two visits, I simply wasn’t even interested in sex any more. Not because it took too much work, but because I just didn’t have the energy. I didn’t even have the desire to “make out,” and even just giving him a hug took everything I had. When Tim would stop by for a visit, I would basically sit on the couch in a zombie-like state while we talked about the weather. It was awkward, but he never made me feel bad, although I am sure he was disappointed.

His visits became less frequent, but we still talked often on the phone. Fortunately we had a good friendship, and the “benefits” were only part of the deal.

About two years after my fall, I was expecting a visit from Tim and was actually looking forward to it. I felt I was ready to give an afternoon romp another try. Alas, I had a killer headache when he showed up. He could tell just by looking at me — and hearing the difficulty I had speaking — that a romp just wasn’t going to happen.

I was so frustrated because I had actually psyched myself up enough to want to have sex again. It was the first time in almost two years that I had felt the need inside of me. I knew how good we were together in the bedroom, and wanted to experience that feeling of intimacy with him again.

He recently came to town again, and this time I was determined to make it happen. Finally, after two and a half years, Amy was ready for “sexy time” again. I still struggled with a bit of dizziness, but I powered through it and didn’t let it distract me. I reassured Tim that I was ready to try this or that, and we had a fun afternoon together. I had missed the feeling of intimacy, almost as much as I missed my memory and spunky personality.

While most of my physical injuries have healed, every inch of my body hurt the following day. It took me a few days to recover physically and restore my energy levels, but it was completely worth it — Amy got her groove back! Tim commented on the fact that he could tell my personality was returning to “normal” and was happy to see me feeling more energetic and lively.

While I am fortunate that my “friend with benefits” was compassionate and understanding, I completely get how relationships are turned upside by TBI. Not only is the person and his or her partner dealing with an invisible injury, the partner is also getting frustrated with what is and isn’t happening in the bedroom. While the person may be physically back to normal, she or he is still dealing with a lot of the invisible symptoms of TBI.

From my experience, I’ve learned that five main areas of my TBI were holding my body back from having a sex drive:

  1. Neuro Fatigue. Our energy levels are severely limited after a brain injury. Every single thing we do throughout the day requires energy. Whether it’s brushing our teeth, reading emails, going for a walk, or washing the dishes, we are taking energy from our reserves. We are easily tired, and I know that I sleep 10 hours at night, and still require a 2-hour nap during the afternoon. The thought of trying to add sex into my daily routine was daunting, and I’m sure if I had a spouse or partner, he would have been frustrated. However, it is important for the partner to understand that it’s not him (or her)—it has absolutely nothing to do with him—and it could take a long time to get our energy levels and stamina back. It took me two and a half years to be ready to participate in a single afternoon of lovemaking.
  2. Dizzy and Balance Issues. Many brain injury survivors suffer from being dizzy and having balance disorders. In the early days after my TBI, I couldn’t lie flat on my back, nor could I bend over without practically passing out. While one can try a lot of positions in the bedroom, almost all of them caused some degree of dizziness. Circle back to my first point about neuro fatigue, and combine the already-tired brain with some dizziness, and that’s a recipe for disaster.
  3. Chronic Pain. Not all brain injury survivors will have physical injuries, but I did. Even two and a half years later, I still deal with a lot of chronic pain. In the bedroom it hurt my chest, neck, and shoulders to be on the top, bottom, or anywhere in between. Again, think of neuro fatigue, coupled with chronic pain… are you starting to get the picture?
  4. Apathy. Having a total lack of interest in anything—not just sex—is one of the most common side effects of a brain injury. I remember my personality being “flat” for the first two years, and wondering if I would ever laugh again, or want to do any of my hobbies again. I can’t say it too often: every single thing we do takes energy. I think our brains instinctively try to preserve as much energy as possible, and having an interest in something is a low priority. I remember not wanting to do pretty much anything. Laundry and cooking were horrific tasks, as was driving myself to my favorite store.
  5. Overstimulation. Let’s be real: sex involves a LOT of stimulation. Even a healthy, active person without a brain injury can readily admit that sex engages pretty much every one of our senses to an extreme. Our brains are already running on conserved energy. I remember worrying that I was going to stroke-out the first time I had sex after my TBI. My heart was racing out of control, my head was pounding, I was dizzy, my entire body hurt, and all the while I was trying to make sure my partner wasn’t aware of the hell going on inside my head. Even going out to eat at a loud and people-filled restaurant is a major undertaking with all the background noise and lights and people talking. Is there any wonder that having sex is just too much for our brains?

I hope that having read this far, you are gaining a better understanding into the struggle of living with a brain injury. I hope…

  • – If you are the survivor, you give yourself grace and know that you’re not alone in the journey.
  • – If you’re the partner, you can have a better understanding of what the other person is going through. While I can’t even imagine how frustrating this has to be for you, it’s 10 times more frustrating for the survivor.

While I know I got my sexual groove back, it’s going to be different for every single person. It’s important for both of you to be patient and understanding, and for the partner to be compassionate and empathetic. And most importantly for both of you…just enjoy being there with your loved one.

Amy Zellmer is an award-winning author, speaker, and advocate of traumatic brain injury (TBI). She is a frequent contributor to the Huffington Post, and has created a privateFacebook groupfor survivors and also produces a podcast series. She sits on the Brain Injury Association of America’sAdvisory Council (BIAAAC) and is involved with theMinnesota Brain Injury Alliance. She travels the country with her Yorkie, Pixxie, to help raise awareness about this silent and invisible injury that affects over 2.5 million Americans each year.

In November, 2015 she released her first book,Life With a Traumatic Brain Injury: Finding the Road Back to Normalwhich received a silver award at the Midwest Book Awards in May, 2016. Her second book, “Surviving Brain Injury: Stories of Strength and Inspiration” is a collection of stories written by brain injury survivors and caregivers and will be released November 2016. for more information: www.facesoftbi.com

Amy Zellmer Award winning author, speaker, & traumatic brain injury survivor located in Saint Paul, MN

Source: Let’s Talk About Sex …. After Brain Injury | Huffington Post

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[WEB SITE] 5 Things Every TBI Survivor Wants You to Understand

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March is National Brain Injury Awareness Month, and as promised, I am writing a series of blogs to help educate others and bring awareness to traumatic brain injuries (TBI).

1. Our brains no longer work the same.

We have cognitive deficiencies that don’t make sense, even to us. Some of us struggle to find the right word, while others can’t remember what they ate for breakfast. People who don’t understand, including some close to us, get annoyed with us and think we’re being “flaky” or not paying attention. Which couldn’t be further from the truth, we have to try even harder to pay attention to things because we know we have deficiencies.

Martha Gibbs from Richmond, VA, suffered a TBI in May of 2013 after the car she was a passenger in hit a tree at 50 mph. She sums up her “new brain” with these words:

Almost 2 years post-accident, I still suffer short-term memory loss and language/speech problems. I have learned to write everything down immediately or else it is more than likely that information is gone and cannot be retrieved. My brain sometimes does not allow my mouth to speak the words that I am trying to get out.

2. We suffer a great deal of fatigue.

We may seem “lazy” to those who don’t understand, but the reality is that our brains need a LOT more sleep than normal, healthy brains. We also have crazy sleep patterns, sometimes sleeping only three hours each night (those hours between 1 and 5 a.m. are very lonely when you’re wide awake) and at other times sleeping up to 14 hours each night (these nights are usually after exerting a lot of physical or mental energy).

Every single thing we do, whether physical or mental, takes a toll on our brain. The more we use it, the more it needs to rest. If we go out to a crowded restaurant with a lot of noise and stimulation, we may simply get overloaded and need to go home and rest. Even reading or watching tv causes our brains to fatigue.

Toni P from Alexandria, VA, has sustained multiple TBI’s from three auto accidents, her most recent one being in 2014. She sums up fatigue perfectly:

I love doing things others do, however my body does not appreciate the strain and causes me to ‘pay the price,’ which is something that others don’t see.  I like to describe that my cognitive/physical energy is like a change jar. Everything I do costs a little something out of the jar.  If I keep taking money out of the jar, without depositing anything back into the jar, eventually I run out of energy. I just don’t know when this will happen.  Sometimes it’s from an activity that seemed very simple, but was more work then I intended. For me, like others with TBIs, I’m not always aware of it until after I’ve done too much.

Continue —>  5 Things Every TBI Survivor Wants You to Understand | Amy Zellmer.

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[WEB SITE] 5 Things Every TBI Survivor Wants You to Understand

  1. Our brains no longer work the same.

We have cognitive deficiencies that don’t make sense, even to us. Some of us struggle to find the right word, while others can’t remember what they ate for breakfast. People who don’t understand, including some close to us, get annoyed with us and think we’re being “flaky” or not paying attention. Which couldn’t be further from the truth, we have to try even harder to pay attention to things because we know we have deficiencies.

Martha Gibbs from Richmond, VA, suffered a TBI in May of 2013 after the car she was a passenger in hit a tree at 50 mph. She sums up her “new brain” with these words:

Almost 2 years post-accident, I still suffer short-term memory loss and language/speech problems. I have learned to write everything down immediately or else it is more than likely that information is gone and cannot be retrieved. My brain sometimes does not allow my mouth to speak the words that I am trying to get out.

  1. We suffer a great deal of fatigue.

We may seem “lazy” to those who don’t understand, but the reality is that our brains need a LOT more sleep than normal, healthy brains. We also have crazy sleep patterns, sometimes sleeping only three hours each night (those hours between 1 and 5 a.m. are very lonely when you’re wide awake) and at other times sleeping up to 14 hours each night (these nights are usually after exerting a lot of physical or mental energy).

Every single thing we do, whether physical or mental, takes a toll on our brain. The more we use it, the more it needs to rest. If we go out to a crowded restaurant with a lot of noise and stimulation, we may simply get overloaded and need to go home and rest. Even reading or watching tv causes our brains to fatigue.

Toni P from Alexandria, VA, has sustained multiple TBI’s from three auto accidents, her most recent one being in 2014. She sums up fatigue perfectly:

I love doing things others do, however my body does not appreciate the strain and causes me to ‘pay the price,’ which is something that others don’t see.  I like to describe that my cognitive/physical energy is like a change jar. Everything I do costs a little something out of the jar.  If I keep taking money out of the jar, without depositing anything back into the jar, eventually I run out of energy. I just don’t know when this will happen.  Sometimes it’s from an activity that seemed very simple, but was more work then I intended. For me, like others with TBIs, I’m not always aware of it until after I’ve done too much.

more–>  5 Things Every TBI Survivor Wants You to Understand | Amy Zellmer.

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[WEB SITE] 5 Things Every TBI Survivor Wants You to Understand

1. Our brains no longer work the same.

We have cognitive deficiencies that don’t make sense, even to us. Some of us struggle to find the right word, while others can’t remember what they ate for breakfast. People who don’t understand, including some close to us, get annoyed with us and think we’re being “flaky” or not paying attention. Which couldn’t be further from the truth, we have to try even harder to pay attention to things because we know we have deficiencies.

Martha Gibbs from Richmond, VA, suffered a TBI in May of 2013 after the car she was a passenger in hit a tree at 50 mph. She sums up her “new brain” with these words:

Almost 2 years post-accident, I still suffer short-term memory loss and language/speech problems. I have learned to write everything down immediately or else it is more than likely that information is gone and cannot be retrieved. My brain sometimes does not allow my mouth to speak the words that I am trying to get out.

2. We suffer a great deal of fatigue.

We may seem “lazy” to those who don’t understand, but the reality is that our brains need a LOT more sleep than normal, healthy brains. We also have crazy sleep patterns, sometimes sleeping only three hours each night (those hours between 1 and 5 a.m. are very lonely when you’re wide awake) and at other times sleeping up to 14 hours each night (these nights are usually after exerting a lot of physical or mental energy).

Every single thing we do, whether physical or mental, takes a toll on our brain. The more we use it, the more it needs to rest. If we go out to a crowded restaurant with a lot of noise and stimulation, we may simply get overloaded and need to go home and rest. Even reading or watching tv causes our brains to fatigue.

Toni P from Alexandria, VA, has sustained multiple TBI’s from three auto accidents, her most recent one being in 2014. She sums up fatigue perfectly:

Continue –> 5 Things Every TBI Survivor Wants You to Understand | Amy Zellmer.

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[WEB SITE] tDCS – A Therapy For The Future? – Brain Blogger

Transcranial direct current stimulation (tDCS) is a non-invasive, painless brain stimulation method which uses electrical currents to modulate neuronal activity in specific parts of the brain. A constant, low intensity current is delivered through small electrodes attached to the scalp in order to either increase or reduce neuronal activity.

This is clearly a trending topic: although interest in tDCS dates back to the 1960s, a search in PubMed reveals that more than half of the articles on tDCS were published in the last two years.

Despite numerous studies on different applications for tDCS, its use is still not generally accepted in the clinical setting; tDCS is not an FDA-approved therapy, remaining mostly an experimental method. Although tDCS has been tested on numerous conditions such as depression, anxiety, schizophrenia, Parkinson’s disease, Alzheimer’s disease, chronic pain, fibromyalgia, and stroke, its efficacy is still largely inconclusive.

Many studies applying tDCS have already been published in 2015, as well as a few reviews analyzing its efficacy for different conditions. By gathering the available information for the application of tDSC in a specific context, reviews are particularly useful, allowing researchers to sort through all the conflicting data. And these have actually shown some promising applications for tDSC.

Learning and Memory

There have been claims that tDCS can enhance cognition in healthy adult populations, especially working memory and language production, spiking the interest in tDCS as a neuroenhancement tool.

tDCS seems to act as a neuromodulatory technique, inducing a long-term enhancement or reduction of signal transmission between neurons. By strengthening or weakening neuronal connections, it may facilitate learning and memory formation, as well as neural plasticity that contributes to functional recovery after stroke, for example.

However, a review on the effects of a single-session of tDCS showed that it did not have a significant effect on a variety of cognitive function such as language, episodic memory, working memory or mental arithmetic, just to name a few. Nevertheless, it did not exclude the possibility that tDCS may be effective after multiple sessions.

There are in fact many reports from studies in healthy subjects stating that tDCS enhances verbal performance and learning, improving such outcomes as verbal speed, fluency, and amount of verbal learning. These language enhancement outcomes could potentially be quite useful in treating language deficits associated with different pathological conditions. In fact, tDCS has been used to enhance treatment efficacy in post-stroke aphasia rehabilitation and the results seem promising, with tDCS being effective in increasing language skills despite a high variety of stimulation parameters and patient characteristics.

Language enhancement can also be applied to a word reading context. Repeated tDCS application to adults with developmental dyslexia has been shown to significantly improve reading speed and fluency.

Reports supporting a positive effect on memory enhancement can also be found. Different studies have demonstrated an improvement in working memory and episodic memory in healthy subjects, with an increase in accuracy and in response time. But again, the evidences are still considered insufficient for a clinical application.

These memory enhancement effects could be quite useful in both Alzheimer’s and Parkinson’s disease, and in post-stroke rehabilitation. Again, some promising outcomes in these pathologies have been reported, but there are still conflicting results.

Continue–> tDCS – A Therapy For The Future? | Brain Blogger.

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