Posts Tagged cognition

[WEB SIDE] RPW Technology Announces The Launch Of Liftid Neurostimulation

OSSINING, N.Y.Aug. 16, 2019 /PRNewswire/ — RPW Technology, LLC introduces Liftid Neurostimulation (www.GetLiftid.com), a transcranial direct current stimulation (tDCS) recreational device for consumers that can improve attention, productivity, and memory through mild electrical stimulation. Liftid uses a constant, low-level electric current, passed through two electrodes placed on the forehead area, to stimulate the brain. tDCS is one of the hottest categories in neuroscience today and supported by over 4,000 published studies.

Maximize attention and elevate performance with LIFTiD Neurostimulation.

 

Dr. Ted Schwartz, MD, a New York based neurosurgeon and RPW’s lead scientist, explains, “As has been shown in several studies, tDCS delivers a small amount of electrical current to the cerebral cortex, rendering neurons in the brain more likely to fire. As a result, the user demonstrates increased abilities, alertness and focus.”

In today’s world, most working professionals, college and grad students, video gamers, musicians, and athletes are chemically stimulating their brains through caffeine, sugar, snacks, and performance enhancers. Liftid Neurostimulation uses a safe and effective technology as an alternative to these forms of chemical stimulation.

RPW Technology is proud to be on the forefront of this emerging technology by bringing to market a tDCS device for healthy individuals (ages 18 & up) that is stylish, extremely lightweight (70 grams) including a soft, comfortable, adjustable headband, and easy to operate. Designed and developed by a team of world renowned neuroscientists, Liftid is preset for a 20 minute stimulation session and has many unique features built-in to the device. Using Liftid Neurostimulation for 20 minutes a day trains the brain to maximize attention, focus, alertness, and memory, thus putting the Liftid user in the right mindset to accomplish tasks and elevate performance.

For more information, purchase, and/or instructional video, please visit the Liftid Neurostimulation website at: www.GetLiftid.com. Unit price is $149.00, which includes an attractive and functional storage case with custom accessories and free shipping within the United States. Liftid is packaged for retail sales.

RPW Technology is a New York startup dedicated to the development and marketing of transcranial electrical stimulation devices. The company, in association with Dr. Schwartz and several neuroscientists, set out to develop a high quality, hi-tech, recreational tDCS device to introduce to consumers worldwide.

Contact for RPW Technology, LLC:
Bridget Argana
Orca Communications Unlimited, LLC
bridget.argana@orcapr.com
(480) 231-3582

Cision View original content to download multimedia:http://www.prnewswire.com/news-releases/rpw-technology-announces-the-launch-of-liftid-neurostimulation-300902988.html

SOURCE RPW Technology, LLC

via RPW Technology Announces The Launch Of Liftid Neurostimulation | BioSpace

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[ARTICLE] What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes – Full Text

Abstract

Background

Virtual-reality based rehabilitation (VR) shows potential as an engaging and effective way to improve upper-limb function and cognitive abilities following a stroke. However, an updated synthesis of the literature is needed to capture growth in recent research and address gaps in our understanding of factors that may optimize training parameters and treatment effects.

Methods

Published randomized controlled trials comparing VR to conventional therapy were retrieved from seven electronic databases. Treatment effects (Hedge’s g) were estimated using a random effects model, with motor and functional outcomes between different protocols compared at the Body Structure/FunctionActivity, and Participation levels of the International Classification of Functioning.

Results

Thirty-three studies were identified, including 971 participants (492 VR participants). VR produced small to medium overall effects (g = 0.46; 95% CI: 0.33–0.59, p < 0.01), above and beyond conventional therapies. Small to medium effects were observed on Body Structure/Function (g = 0.41; 95% CI: 0.28–0.55; p < 0.01) and Activity outcomes (g = 0.47; 95% CI: 0.34–0.60, p < 0.01), while Participation outcomes failed to reach significance (g = 0.38; 95% CI: -0.29-1.04, p = 0.27). Superior benefits for Body Structure/Function (g = 0.56) and Activity outcomes (g = 0.62) were observed when examining outcomes only from purpose-designed VR systems. Preliminary results (k = 4) suggested small to medium effects for cognitive outcomes (g = 0.41; 95% CI: 0.28–0.55; p < 0.01). Moderator analysis found no advantage for higher doses of VR, massed practice training schedules, or greater time since injury.

Conclusion

VR can effect significant gains on Body Structure/Function and Activity level outcomes, including improvements in cognitive function, for individuals who have sustained a stroke. The evidence supports the use of VR as an adjunct for stroke rehabilitation, with effectiveness evident for a variety of platforms, training parameters, and stages of recovery.

Background

Stroke is one of the leading global causes of disability [], with over 17 million individuals worldwide sustaining a stroke each year []. Although stroke mortality is decreasing with improvements in medical technology [], the neurological trauma resulting from stroke can be devastating, and the majority of stroke survivors have substantial motor [], cognitive [] and functional rehabilitation needs [], and much reduced quality of life []. Targeted rehabilitation can help address some of these post-stroke deficits, however, historically, many individuals, in particular patients with cognitive impairment, have difficulty engaging in standard therapies [] at a level that will produce meaningful and lasting improvements []. Enriched and interactive rehabilitation programs are clearly needed to minimize functional disability [], increase participation in age-appropriate roles and activities [], lead to greater motivation and treatment compliance [], and reduce the long-term expense of care in stroke survivors [].

Virtual reality

Virtual reality refers to simulated interactions with environments and events that are presented to the performer with the aid of technology. These so-called virtual environments may mirror aspects of the real world or represent spaces that are far removed from it, while allowing various forms of user interaction through movement and/or speech []. Virtual reality based rehabilitation, or Virtual Rehabilitation (VR), shows considerable promise as a safe, engaging, interactive, patient-centered and relatively inexpensive medium for rehabilitation training []. VR has the potential to target a wide range of motor, functional, and cognitive issues [], affords methods that automatically record and track patient performance [], and offers a high level of flexibility and control over therapeutic tasks []. This scalability allows patients to train at the highest intensity that would be possible for their individual ability [], while keeping the experience of interaction with therapeutic tasks enjoyable and compelling []. At the same time, VR may enable patients with a neurodisability (like stroke) to practice without excessive physical fatigue [] which otherwise may deter continued effort and engagement in therapy [].

Currently, there are two main types of VR: purpose-designed Virtual Environments (VE) and Commercial Gaming (CG) systems. Both types of systems can provide augmented feedback, additional forms of sensory feedback about the patient’s movement over and above the feedback that is provided as a natural consequence of the movement itself []. VE systems are often designed by rehabilitation scientists (and others) to enhance the delivery of augmented feedback in order to develop the patient’s sense of position in space [], to reinforce different movement parameters (like trajectory and endpoint) and reduce extraneous movements (e.g. excessive trunk displacement) [].

VE systems are also more likely to involve specially designed tangible user interfaces used in mixed reality rehabilitation systems [] or training of daily functional activities []. By comparison, CG rehabilitation systems are typically “off-the-shelf” devices such as Wii (Nintendo), Xbox (Microsoft) and PlayStation (Sony), which have the advantage of being readily available and relatively inexpensive when compared with VE systems []. On the other hand, CG systems are typically designed for able-bodied participants and may not consider the physiological, motor, and cognitive aspects of recovery in rehabilitation, and may lack the scalability of purpose-designed VE systems [].

Systematic reviews comparing VE and CG systems

There is conflicting evidence about the relative effectiveness of VE- and CG-based VR systems. In a recent Cochrane review of VR following stroke [], VE systems demonstrated a significant treatment effect on upper-limb function when compared to controls (d = 0.42; 95%CI: 0.07–0.76), while the effect for CG systems failed to reach significance (d = 0.50; 95%CI: -0.04-1.04); a caveat, however, was that only two of nine studies (22%) in these comparisons were CG-based. In contrast, a meta-analysis by Lohse and colleagues of VR following stroke [] found no significant difference between VE (g = 0.43, based on 13 studies) and CG interventions (g = 0.76, based on three studies) on Body Structure/Function level outcomes. For Activity level outcomes, CG interventions showed a large but non-significant effect (g = 0.76, p = 0.14), but was based on only four of 26 studies (15%); VE interventions, however, showed a significant treatment effect (g = 0.54, p < .001). Taken together, these two reviews suggest benefits of VE systems, while previous analyses of CG treatment effects have been underpowered and inconclusive.

Cognition and VR

Cognitive impairments, including difficulties in attention, language, visuospatial skills, memory, and executive function are common and persistent sequelae of stroke [] and exert considerable influence on rehabilitation outcomes []. Cognitive dysfunction may reduce the ability to (re-)acquire motor [] and functional skills [], and decrease engagement and participation in rehabilitation program []. While the important role of cognition in both conventional and VR-based rehabilitation is increasingly recognized [] the impact of VR on cognitive function has not yet been formally evaluated in a quantitative review.

Analysis of individual domains of functioning

The World Health Organization’s International Classification of Functioning, Disability, and Health (ICF-WHO []) is currently one of the most widely used classification systems. It is a foundation for understanding outcome effects in clinical practice [] and the preferred means for translating clinical findings in a patient-centered manner []. Under the ICF-WHO, disability and functioning are seen to arise by the interaction of the health condition, the environment, and personal factors, and can be measured at three main levels: (i) Body Structure/Function, (ii) Activity (or skill), and (iii) Participation. The ICF-WHO has been used to classify outcome measures in studies of VR (for example []) and in recent systematic reviews []. A brief critique of these reviews reveals a number of important conclusions, but also some significant gaps in the research.

An early systematic review by Crosbie and colleagues [] examined the efficacy of VR for stroke upon motor and cognitive outcomes. Of the 11 studies reviewed (up to 2005), only five addressed upper-limb function and two addressed cognitive outcomes. Overall, the review reported significant benefits of VR, but only three studies were RCTs and no effect size estimates were reported. At around the same time, a systematic review by Henderson and colleagues [] showed that there was very good evidence that immersive VR was more beneficial than no therapy for upper-limb rehabilitation in adult stroke, but insufficient evidence for non-immersive VR. Comparisons with traditional physical therapy were less impressive, however.

A 2016 systematic review by Vinas-Diz and colleagues [] included both controlled clinical trials and randomized controlled trials (RCTs) in stroke, and spanned 2009–2014. The review included 25 papers: four systematic reviews [] and 21 original trials. Evidence for treatment efficacy on upper-limb function was strong on a mix of measures like the Fugl-Meyer Test, Wolf Motor Function Test, and Motricity Index. However, a quantitative analysis of the effects was not undertaken, and important aspects of treatment implementation like dose and session scheduling were not formally examined.

A recent systematic review by Santos-Palma and colleagues [] examined the efficacy of VR on motor outcomes for stroke using the ICF-WHO framework, covering work published up to June 2015. Of the studies deemed high quality, 20 examined outcomes at the Body Structure/Function level, 17 at the Activity level, and eight examined Participation. Intriguingly, positive outcomes were evident only at the Body Structure/Function level, while results for Activity and Participation were not conclusive. Unfortunately, only three studies addressed manual ability at the Activity level, which severely limited any evaluation of skill-specific effects.

In a combined systematic review and meta-analysis of 37 RCTs published between 2004 and 2013, Laver and colleagues [] present a more comprehensive examination of the effects of VR on upper-limb function. As well, they classified outcomes broadly into upper-limb function, Activities of Daily Living (ADLs) and other aspects of motor function. In general, study quality was low, and the risk of bias high, in roughly one-half of the studies. Outcomes were significant for upper-limb function (d = 0.28) and ADLs (d = 0.43), but somewhat smaller than those reported by Lohse and colleagues []. Results for other aspects of motor function, including several at what may be considered the Body Structure/Function level, were non-significant. Dose varied considerably between studies, ranging from less than 5 h to more than 21 h in total. In general, studies that used higher doses (> 15 h of therapy) were reported as more effective. Unfortunately, results could not be pooled for cognitive outcomes, and the importance of additional treatment implementation parameters like training frequency and duration, and the impact of specific study design factors including the recovery stage of participants and type of control group (i.e. active vs passive) were not determined.

An updated systematic review by Laver and colleagues [], included an additional 35 studies that reported outcomes for upper limb function and activity. A subset of only 22 studies that compared VR with conventional therapy showed no significant effect of VR on upper-limb function (d = 0.07). As well, there was no significant difference between higher (> 15 h of therapy), and lower levels of dose. However, when VR was used in addition to usual care (10 studies; 210 participants), there was a significant effect on upper-limb outcomes (d = 0.49). As before, no significant difference was shown between high and low dose studies. Unfortunately, analysis of cognitive outcomes, and moderator analyses including study quality, and implementation parameters (e.g., daily intensity, weekly intensity, treatment frequency, and total number of sessions) were not included in the updated review. As well, the assessment of study quality was limited to the 5-item GRADE system, the ICF classification system was not given full consideration, and no distinction was drawn between treatment as usual (TAU) and active control groups (TAU + some form of additional therapy).

Taken together, recent reviews on the use of VR for adult stroke show encouraging evidence of efficacy at the level of Body Structure/Function, but mixed results for Activity and ADLs, and a paucity of evidence bearing on Participation. The impact and effectiveness of VR on cognitive outcomes also remains poorly understood, despite the important role of cognitive dysfunction in learning and rehabilitation [], and increased evidence of interconnection between cognitive function and motor deficits at the Body Structure/Function, Activity and Participation levels of the ICF []. VE-based platforms have been suggested to be superior to CG approaches [] in promoting motor function, but until recently there have been few CG studies available for analysis. As well, other design factors that may moderate treatment effects (like stage of recovery, control group type) have either not been explored or are too few in number to draw firm conclusions. There has been considerable variation in the total dose of VR therapy [], and no analysis has yet tested the dose-response relationship in moderator analyses. Finally, the bulk of conclusions have relied on qualitative synthesis, and there is a paucity of quantitative analysis of empirical data to inform opinion.

In view of limitations in past reviews and continued acceleration in VR the aim of our review was to conduct a systematic literature review and meta-analysis to re-evaluate the strength of evidence bearing on VR of upper-limb function and cognition in stroke. This review is critical given evidence that stroke rehabilitation needs to better optimize intervention techniques during the recovery windows that exist in the acute phase [] and beyond. Focusing only on RCTs, we consider outcomes across levels of the ICF-WHO, and analyze the moderating effect of design factors and dose-related parameters.

Methods

The current review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [], it should be noted that the protocol was not registered.

Data sources and search strategy

Scopus, Cochrane Database, CINAHL, The Allied and Complementary Medicine Database, Web of Science, MEDLINE, Pre-Medline, PsycEXTRA, and PsycINFO databases were systematically searched from inception until 28 June 2017. Boolean search terms included the following: “strokecerebrovascular disease, or cerebrovascular attack” and “Virtual realityAugmentrealityvirtual gam*” (see Appendix for an example of the full MEDLINE search strategy).

Inclusion and exclusion criteria

RCT studies published in English in peer-reviewed journals, utilizing a VR intervention to address either motor (upper-limb), cognitive, or activities of daily living in stroke patients were included in the current review (see Fig. 1). VR was defined as a type of user-computer interface that involves real-time simulation of an activity/environment, enabling the user to interact with the environment using motor actions and sensory systems. Comparison groups included “usual care”, “standard care” or “conventional therapy”, involving physical therapy and/or occupational therapy. Studies were excluded that applied a “hybrid” approach combining virtual reality with exogenous stimulation or robotics, targeted lower limb function, recruited a mixed study cohort including non-stroke participants, or did not utilize motor, cognitive, or participation outcome measures.

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Fig. 1
Population, Intervention, Comparison, Outcome (PICO) Question and the main variables included in the systematic literature review and meta-analysis

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Continue —-> What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes

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[BLOG POST] Me, Myself, and My (More or Less) Creative I (after traumatic brain injury)

By Bill Herrin

Working with the topic of brain injury at Lash & Associates Publishing, I’ve heard on quite a few occasions that TBI can seriously alter a person’s ability to do certain things that they were once highly skilled at. Some basic things can also be affected, like driving a car, riding a bicycle, outdoor activities, walking/balance and more.

Many may also sustain a brain injury that affects them on an even deeper level – such as paralysis, cognition, thought patterns, speech, logic, etc. The one thing that is very intriguing about TBI is how it can affect creativity – and how it may change a more logical “left-brained” person, and make them more creative, imaginative, musical, or artistic. This also could bring the opposite effect to a more “right-brained” person and erase most or all of their previous creative strengths and talents. Although I’m not a TBI Survivor, I truly empathize with those who have dealt with these extreme changes and thought that it would be an interesting topic to explore.

One such case was Hilary Zayed. She worked as a teacher, was a flutist, a passionate horseback rider, and a mother of 2 grown children when she had a brain injury. Her recovery and subsequent reinvention of her prior life came with much hard work. She couldn’t enjoy music like she used to, so she worked toward finding a creative outlet – and soon discovered the art of making mosaics, paintings, and more.

After three years of being at home with a rotation of visiting nurses – often lying on the couch, she started to maneuver down the stairs to her art studio/space more and more. Some health professionals encouraged her to exhibit her works (art and writing), and soon she found herself doing several other solo shows across the Northeast. She found that sharing her experience through her art opened doors for others to be inspired to try harder after their own TBI. Here is a quote taken directly from Hilary’s book titled: Reinventing Oneself After Loss:

“One of the biggest lessons I learned was the importance of sharing my experience. It seemed to speak to people and inspire them to do the same. It felt as if the “butterfly effect” was happening and I was the one with the moving wings. As I finish writing this personal journey it has been almost seven years. I cannot say that I have fully reinvented myself but I have attempted to stay on course, refine my goals and continue to work hard on moving through

obstacles and leaning forward. Oddly, it was leaning forward on my horse, that fateful day, which changed my life. That action gave me the gift of making art and writing about it, on this journey to reinvent myself after loss.

May you find the courage to move forward as you deal with loss.”*

With every instance of people that make gains creatively after TBI, there are also people who suffer losses in the same arena. Being creative, artistic, musical, inventor, a writer, etc. is a gift that can be rewarding, and even help a person identify with others on a huge level. Losing that creative spark can be a harsh reality. Overall “loss of self” is basically the same thing, but it’s a huge transition for a creative person.

Shown below, I’m referencing an incredible article (by Dahlia W. Zaidel) that discusses the neurological changes that can take place in the brain of a creative person after a TBI, and also changes in a less creative person…here’s an excerpt:
“Neurological cases of visual artists who had practiced their craft professionally prior to the brain damage can help point the way to neuroanatomical and neurofunctional underpinnings of creativity. Approximately 50 or so cases with unilateral brain damage (largely in one side of the brain, and where the etiology is commonly stroke or tumor) have by now been described in the neurological literature (Rose, 2004Bogousslavsky and Boller, 2005Zaidel, 20052013a,cFinger et al., 2013Mazzucchi et al., 2013Piechowski-Jozwiak and Bogousslavsky, 2013).

The key questions concern post-damage alterations in creativity, as well as loss of talent, or skill. A review of the majority of these neurological cases suggests that, on the whole, they go on producing art, sometimes prolifically, despite the damage’s laterality or localization (Zaidel, 2005). Importantly, post-damage output has revealed that their creativity does not increase, nor diminish (Zaidel, 200520102013b). Given that the damage arises unilaterally (only one or the other hemisphere), artistic creativity in the healthy brain can not simply be attributed to a single hemisphere, dedicated neural “regional center”, network, or pathway, but rather to a diffusely represented capacity in the brain. Indeed, it would further seem that creativity is highly sensitive to brain damage, more so than artistic productivity, talent, or skill.

We could speculate that in the healthy brain cognitive associative networks in the left hemisphere alone, in the right hemisphere alone, or both hemispheres working together contribute to the creative process in art. However, recent functional neuroimaging evidence based on non-artistic behavior in healthy volunteers points to greater left hemisphere involvement in creativity (Gonen-Yaacovi et al., 2013). Where do the original ideas in the artwork arise, is a complex question that researchers would like understand (Dietrich and Kanso, 2010Heilman and Acosta, 2013Jung and Haier, 2013). The likely answer with regards to the cerebral hemispheres is that both are functional in exceptional creativity, but with each hemisphere contributing a different facet, yet little understood, to the creativity process (Zaidel, 2013d).”**

From the most basic approaches to eye/hand coordination, thought and cognition, and creative expression – to advanced creativity and artistic endeavors after TBI, the persistence and determination required to persevere takes incredible inner strength. As I often say, every person’s TBI is different, and each has its own starting point – and the ending point remains to be determined. Finding your way through the maze of TBI (of which there may be many causes such as concussions, blast injuries, stroke, etc.) is one of total commitment to stay the course. Time, along with effort brings results for many TBI survivors, but not all.

It’s my hope to encourage you in your creative outlets, to find solace in your “new normal”, and to express yourself through creativity…and creativity doesn’t just have to be visual arts, it can be writing, crafting, music, knitting or crocheting, poetry, relaxing with an adult coloring book, and lots more. Everything we see around us was created by someone – including the devices we are reading this post on! Make the most of every day, and my prayer for all of us is that we find abundant personal reward from all that we aspire to accomplish in life…creative or otherwise!

Feel free to leave a comment, and share your story regarding the changes in creativity, too. It may inspire, it may not…but your story is important – and it’s worth sharing!

**Here is the link to the entire referenced article by Dahlia W. Zaidel:

https://www.frontiersin.org/articles/10.3389/fnhum.2014.00389/full

via Me, Myself, and My (More or Less) Creative I (after traumatic brain injury)

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[WEB SITE] Parenting After Brain Injury

Parenting After Brain Injury

Parenting is a challenging life role for all people, yet one of the most valued roles within society. Brain Injury frequently occurs at a life stage where people are yet to complete their parenting responsibilities. For people with acquired brain injury (ABI), facing cognitive, physical, communication, behavioural and psychological challenges, parenting can present complex challenges. In addition, persons with ABI often face societal and environmental barriers. These fact sheets have been developed to assist parents with an ABI and their partners to improve their knowledge and skills to meet the ongoing challenges of parenting. family walking together
little girl finger painting boy doing his homework two little girls arguing

Encouraging your
Developing Child

Setting Routines

Managing Behaviour

Other Useful Parenting Website Links and Resources

Parenting Fact Sheet References and Acknowledgements
Return to Support for Families

Contact ABIOS
abios@health.qld.gov.au

Last updated: 20 March 2017

via Parenting After Brain Injury | Queensland Health

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[Abstract] Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology

Highlights

  • Virtual reality technology improves cognitive function post-traumatic brain injury.
  • Optimal treatment protocol is; 10–12 sessions, 20–40 min in duration with 2–4 sessions per week.
  • There was weak evidence for positive effect of virtual reality on attention.

Abstract

Background

Traumatic brain injury (TBI) can causes numerous cognitive impairments usually in the aspects of problem-solving, executive function, memory, and attention. Several studies has suggested that rehabilitation treatment interventions can be effective in treating cognitive symptoms of brain injury. Virtual reality (VR) technology potential as a useful tool for the assessment and rehabilitation of cognitive processes.

Objectives

The aims of present systematic review are to examine effects of VR training intervention on cognitive function, and to identify effective VR treatment protocol in patients with TBI.

Methods

PubMed, Scopus, PEDro, REHABDATA, EMBASE, web of science, and MEDLINE were searched for studies investigated effect of VR on cognitive functions post TBI. The methodological quality were evaluated using PEDro scale. The results of selected studies were summarized.

Results

Nine studies were included in present study. Four were randomized clinical trials, case studies (n = 3), prospective study (n = 1), and pilot study (n = 1). The scores on the PEDro ranged from 0 to 7 with a mean score of 3. The results showed improvement in various cognitive function aspects such as; memory, executive function, and attention in patients with TBI after VR training.

Conclusion

Using different VR tools with following treatment protocol; 10–12 sessions, 20–40 min in duration with 2–4 sessions per week may improves cognitive function in patients with TBI. There was weak evidence for effects of VR training on attention post TBI.

via Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology – Journal of Clinical Neuroscience

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[ARTICLE] Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study – Full Text

 

Abstract

Background

Virtual reality technologies show potential as effective rehabilitation tools following neuro-trauma. In particular, the Elements system, involving customized surface computing and tangible interfaces, produces strong treatment effects for upper-limb and cognitive function following traumatic brain injury. The present study evaluated the efficacy of Elements as a virtual rehabilitation approach for stroke survivors.

Methods

Twenty-one adults (42–94 years old) with sub-acute stroke were randomized to four weeks of Elements virtual rehabilitation (three weekly 30–40 min sessions) combined with treatment as usual (conventional occupational and physiotherapy) or to treatment as usual alone. Upper-limb skill (Box and Blocks Test), cognition (Montreal Cognitive Assessment and selected CogState subtests), and everyday participation (Neurobehavioral Functioning Inventory) were examined before and after inpatient training, and one-month later.

Results

Effect sizes for the experimental group (d = 1.05–2.51) were larger compared with controls (d = 0.11–0.86), with Elements training showing statistically greater improvements in motor function of the most affected hand (p = 0.008), and general intellectual status and executive function (p ≤ 0.001). Proportional recovery was two- to three-fold greater than control participants, with superior transfer to everyday motor, cognitive, and communication behaviors. All gains were maintained at follow-up.

Conclusion

A course of Elements virtual rehabilitation using goal-directed and exploratory upper-limb movement tasks facilitates both motor and cognitive recovery after stroke. The magnitude of training effects, maintenance of gains at follow-up, and generalization to daily activities provide compelling preliminary evidence of the power of virtual rehabilitation when applied in a targeted and principled manner.

Trial registration

this pilot study was not registered.

Introduction

Stroke is one of the most common forms of acquired brain injury (ABI), with around 60,000 new and recurrent strokes occurring every year in Australia alone [1]. The clinical outcome of stroke is variable but often includes persistent upper-limb motor deficits, including weakness, discoordination, and reduced speed and mobility [2], and cognitive impairments in information processing and executive function [34]. Not surprisingly, stroke is a leading cause of disability worldwide, and the burden of stroke across all levels of the International Classification of Functioning (ICF) – body structures/function, activity, and participation – underlines the importance of interventions that can impact multiple domains of functioning [56].

Recovery of functional performance following stroke remains a significant challenge for rehabilitation specialists [78], but may be enhanced by innovation in the use of new technologies like virtual reality [9101112]. A critical goal is to find compelling ways of engaging individuals in their therapy by creating meaningful, stimulating and intensive forms of training [13]. The term, virtual rehabilitation (VR), is used to describe a form of training wherein patients interact with virtual or augmented environments, presented with the aid of technology [1415]. The technologies can be either commercial systems (e.g. Nintendo Wii, Xbox Kinect) or those customised specifically for rehabilitation. VR offers a number of advantages over traditional therapies, including the ability to engage individuals in the simulated practice of functional tasks at higher doses [1617], automated assessment of performance over time, flexibility in the scaling of task constraints, and a variety of reward structures to help maintain compliance [18].

While evaluation research is still in its infancy, recent systematic reviews and meta-analyses show that VR can enhance upper-limb motor outcomes in stroke [101119], yielding treatment effects of medium-to-large magnitude [1011], and complementing conventional approaches to rehabilitation. VR has been shown to engender high levels of engagement in stroke patients undergoing physical therapy [2021] and training of even moderate intensity can afford functional benefits at the activity/skill level [919]. In the specific case of upper-limb VR, however, there is little available evidence that these benefits transfer to participation [9]. Furthermore, most available data is on patients in chronic stages of recovery, with less on acute stroke [9]. Notwithstanding this, use of VR has begun to emerge in clinical practice, recommended in Australian and international stroke guidelines as a viable adjunct in therapy to improve motor and functional outcomes [222324].

Until recently, most VR systems have been designed to improve motor functions, with cognitive outcomes often a secondary consideration in evaluation studies [91011]. Notwithstanding this, treatments that target both motor and cognitive functions are indicated for stroke, given evidence that cognitive and motor systems overlap at a structural and functional level [2526], and work synergistically in a “perception-action cycle” [27] in stroke patients undergoing rehabilitation [28]. Recent studies provide preliminary evidence of improved attention and memory in stroke patients following motor-oriented VR [29303132], amounting to a small-to-medium effect on cognition [9]. When designed to address aspects of cognitive control and planning, VR has the potential to enhance dual-task control, resulting in better generalization of trained skills to daily functioning [33].

While evaluation research is still in its infancy, several recent customized systems (like Elements, the system evaluated here) have been deliberately designed to exploit factors known to enhance training intensity and motor learning. Informed by neuroscience and learning theory [for a recent review see 12], the Elements VR system was designed to enhance neuro-plastic recovery processes via: (1) an enriched therapeutic environment affording a natural form of user interaction via tangible computing and surface displays [34], which engage both the cognitive attention of participants and their motivation to explore training tasks; (2) concurrent augmented feedback (AF) on performance [35] offering participants additional information on the outcome of their actions to assist in re-building a sense of body position in space (aka body schema) and ability to predict/plan future actions; and (3) scaling of task challenges to the current level of motor and cognitive function [36], ensuring dynamic scaffolding of participants’ information processing and response capabilities. The Elements system, described in detail below and in earlier publications [3738], consists of a large (42 in.) tabletop surface display, tangible user interfaces, and software for presenting both goal-directed and exploratory virtual environments. Previous evaluations of the system in patients with traumatic brain injury showed improvements in both motor and cognitive performance, with transfer to activities of daily living [3739]. However, the impact of Elements in other forms of ABI, such as stroke, has not been evaluated.

The broad aim of current study was to evaluate the efficacy of the Elements VR interactive tabletop system for rehabilitation of motor and cognitive functions in sub-acute stroke, compared with treatment as usual (TAU). We were particularly interested in motor and cognitive outcomes, their relationship, and the transfer and maintenance of treatment effects. Training-related changes at the activity/skill level on standardized measures of motor and cognitive performance were investigated, together with functional changes. By offering an engaging, principled and customized form of interaction, we predicted that the Elements system would effect (i) greater changes on both motor and cognitive outcomes than with TAU alone; (ii) sustained benefits, as assessed over a short follow-up period, and (iii) transfer to everyday functional performance (i.e. participation).[…]

 

Continue —> Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1

 

Fig. 1

Examples of the Elements (a) goal-directed Bases task with visual augmented feedback, and (b) exploratory Squiggles task

 

 

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[Abstract] The Effect of Noninvasive Brain Stimulation on Poststroke Cognitive Function: A Systematic Review

Abstract

Introduction. Cognitive impairment after stroke has been associated with lower quality of life and independence in the long run, stressing the need for methods that target impairment for cognitive rehabilitation. The use of noninvasive brain stimulation (NIBS) on recovery of language functions is well documented, yet the effects of NIBS on other cognitive domains remain largely unknown. Therefore, we conducted a systematic review that evaluates the effects of different stimulation techniques on domain-specific (long-term) cognitive recovery after stroke. 

Methods. Three databases (PubMed, EMBASE, and PsycINFO) were searched for articles (in English) on the effects of NIBS on cognitive domains, published up to January 2018. 

Results. A total of 40 articles were included: randomized controlled trials (n = 21), studies with a crossover design (n = 9), case studies (n = 6), and studies with a mixed design (n = 4). Most studies tested effects on neglect (n = 25). The majority of the studies revealed treatment effects on at least 1 time point poststroke, in at least 1 cognitive domain. Studies varied highly on the factors time poststroke, number of treatment sessions, and stimulation protocols. Outcome measures were generally limited to a few cognitive tests. 

Conclusion. Our review suggests that NIBS is able to alleviate neglect after stroke. However, the results are still inconclusive and preliminary for the effect of NIBS on other cognitive domains. A standardized core set of outcome measures of cognition, also at the level of daily life activities and participation, and international agreement on treatment protocols, could lead to better evaluation of the efficacy of NIBS and comparisons between studies.

https://journals.sagepub.com/doi/abs/10.1177/1545968319834900

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[ARTICLE] Comparing memory group training and computerized cognitive training for improving memory function following stroke: A phase II randomized controlled trial – Full Text HTML

Abstract

Objectives: Memory deficits are common after stroke, yet remain a high unmet need within the community. The aim of this phase II randomized controlled trial was to determine whether group compensatory or computerized cognitive training approaches were effective in rehabilitating memory following stroke.

Methods: A parallel, 3-group, single-blind, randomized controlled trial was used to compare the effectiveness of a compensatory memory skills group with restorative computerized training on functional goal attainment. Secondary outcomes explored change in neuropsychological measures of memory, subjective ratings of prospective and everyday memory failures and ratings of internal and external strategy use.

Results: A total of 65 community dwelling survivors of stroke were randomized (24: memory group, 22: computerized cognitive training, and 19: wait-list control). Participants allocated to the memory group reported significantly greater attainment of memory goals and internal strategy use at 6-week follow-up relative to participants in computerized training and wait-list control conditions. However, groups did not differ significantly on any subjective or objective secondary outcomes.

Conclusion: Preliminary evidence shows that memory skills groups, but not computerized training, may facilitate achievement of functional memory goals for community dwelling survivors of stroke. These findings require further replication, given the modest sample size, subjective nature of the outcomes and the absence of objective eligibility for inclusion.

 

Lay Abstract

Memory problems are commonly reported following stroke but receiving help for these difficulties remains a high unmet need among survivors. Two different approaches to memory rehabilitation are available: memory skills group training and computerised cognitive training; however, it is unclear which approach is more effective. This study compared these two approaches in 65 stroke survivors who all reported memory difficulties. We found that participants who received memory group training were more likely to achieve their memory improvement goals than those who received computerised cognitive training. It was concluded that memory skills group training may be a more effective approach to improve memory function in daily life following stroke, but more research is required.

 

Introduction

Memory impairment is one of the most commonly reported cognitive consequences of stroke (1) and can compromise rehabilitation engagement (2). Despite this, support for memory problems remains a high unmet need within the community (3) and has been identified by patients, researchers and clinicians as a high-priority research area (4).

Memory skills group (MSG) training and computerized cognitive training (CCT) are commonly used approaches to rehabilitate memory. Although both share the fundamental goal of improving everyday memory outcomes (5), there are a number of key differences between these interventions. CCT adopts a restorative approach to rehabilitation, with the theoretical goal of restoring underlying impairment through cognitive exercises (6). Repetitive drill and practice style activities are purported to result in everyday functional gains, although there remains no robust evidence of this transfer (6). By contrast, MSG interventions take a compensatory approach to rehabilitation with a theoretical aim of lessening the disabling impact of impairment (7). In addition, the format of delivery differs. CCT training tasks are generally completed individually, with associated well-recognized advantages of low cost, wide availability and potential for at personalized use at home (8). MSG intervention is facilitated by a trained clinician and is delivered face-to-face in a group format, due, in part, to increased recognition of the multifaceted nature of memory dysfunction and limited economic resources (9).

While a number of comprehensive reviews have explored best-practice recommendations for cognitive impairment following acquired brain injury (10, 11), only a minority of studies included in these reviews were conducted in stroke-only samples. Consequently, the long-held view that MSG training is the treatment of choice in rehabilitating memory has been largely speculative post-stroke and appears to have been based on an absence of evidence, rather than evidence of absence for the effectiveness of CCT (5). The aim of this study was to compare the effectiveness of CCT and MSG training in community dwelling survivors of stroke in achieving individualized, functional memory goals. A further aim was to explore the effect of training on secondary measures of objective, neuropsychological memory tasks and subjective memory ratings. In addressing these aims, we intended to maintain ecological validity by evaluating the interventions as they are clinically implemented (rather than transforming them to be experimentally matched with each other on characteristics such as group vs individual format), with the goal of facilitating clinical translation. We hypothesized that intervention participants (i.e. CCT and MSG) would show greater improvement in performance on outcome measures than waitlist control participants (WC). Given the proposed mechanism of action of each approach, we also hypothesized participants in the CCT group would show greater improvement on neuropsychological tests of memory, while participants in the MSG would show greater improvement on functional measures of memory and strategy use.[…]

 

Continue —> Journal of Rehabilitation Medicine – Comparing memory group training and computerized cognitive training for improving memory function following stroke: A phase II randomized controlled trial – HTML

 

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[ARTICLE] Technology-based cognitive training and rehabilitation interventions for individuals with mild cognitive impairment: a systematic review

Abstract

Background

Individuals with mild cognitive impairment (MCI) are at heightened risk of developing dementia. Rapid advances in computing technology have enabled researchers to conduct cognitive training and rehabilitation interventions with the assistance of technology. This systematic review aims to evaluate the effects of technology-based cognitive training or rehabilitation interventions to improve cognitive function among individuals with MCI.

Methods

We conducted a systematic review using the following criteria: individuals with MCI, empirical studies, and evaluated a technology-based cognitive training or rehabilitation intervention. Twenty-six articles met the criteria.

Results

Studies were characterized by considerable variation in study design, intervention content, and technologies applied. The major types of technologies applied included computerized software, tablets, gaming consoles, and virtual reality. Use of technology to adjust the difficulties of tasks based on participants’ performance was an important feature. Technology-based cognitive training and rehabilitation interventions had significant effect on global cognitive function in 8 out of 22 studies; 8 out of 18 studies found positive effects on attention, 9 out of 16 studies on executive function, and 16 out of 19 studies on memory. Some cognitive interventions improved non-cognitive symptoms such as anxiety, depression, and ADLs.

Conclusion

Technology-based cognitive training and rehabilitation interventions show promise, but the findings were inconsistent due to the variations in study design. Future studies should consider using more consistent methodologies. Appropriate control groups should be designed to understand the additional benefits of cognitive training and rehabilitation delivered with the assistance of technology.

Background

Due to the aging of the world’s population, the number of people who live with dementia is projected to triple to 131 million by the year 2050 []. Development of preventative strategies for individuals at higher risk of developing dementia is an international priority []. Mild cognitive impairment (MCI) is regarded as an intermediate stage between normal cognition and dementia []. Individuals with MCI usually suffer with significant cognitive complaints, yet do not exhibit the functional impairments required for a diagnosis of dementia. These people typically have a faster rate of progression to dementia than those without MCI [], but the cognitive decline among MCI subjects has the potential of being improved []. Previous systematic reviews of cognitive intervention studies, both cognitive training and cognitive rehabilitation, have demonstrated promising effects on improving cognitive function among subjects with MCI [].

Recently, rapid advances in computing technology have enabled researchers to conduct cognitive training and rehabilitation interventions with the assistance of technology. A variety of technologies, including virtual reality (VR), interactive video gaming, and mobile technology, have been used to implement cognitive training and rehabilitation programs. Potential advantages to using technology-based interventions include enhanced accessibility and cost-effectiveness, providing a user experience that is immersive and comprehensive, as well as providing adaptive responses based on individual performance. Many computerized cognitive intervention programs are easily accessed through a computer or tablet, and the technology can objectively collect data during the intervention to provide real-time feedback to participants or therapists. Importantly, interventions delivered using technology have shown better effects compared to traditional cognitive training and rehabilitation programs in improving cognitive function and quality of life []. The reasons for this superiority are not well-understood but could be related to the usability and motivational factors related to the real-time interaction and feedback received from the training system [].

Three recent reviews of cognitive training and rehabilitation for use with individuals with MCI and dementia suggest that technology holds promise to improve both cognitive and non-cognitive outcomes []. The reviews conducted by Coyle, et al. [] and Chandler, et al. [] were limited by accessing articles from only two databases, and did not comprehensively cover available technologies. Hill, et al. [] limited their review to papers published until July 2016 and included only older adults aged 60 and above. More technology-based intervention studies have been conducted since then, and only including studies with older adults 60 and above could limit the scope of the review given that adults can develop early-onset MCI in their 40s []. Therefore, the purpose of this review is to 1) capture more studies using technology-based cognitive interventions by conducting a more comprehensive search using additional databases 2) understand the effect of technology-based cognitive interventions on improving abilities among individuals with MCI; and 3) examine the effects of multimodal technology-based interventions and their potential superiority compared to single component interventions.[…]

 

Continue —-> Technology-based cognitive training and rehabilitation interventions for individuals with mild cognitive impairment: a systematic review

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[Abstract] Efficacy of Virtual Reality Combined with Real Instrument Training for Patients with Stroke: A Randomized Controlled Trial

Abstract

Objective

To investigate the efficacy of real instrument training in VR environment for improving upper-extremity and cognitive function after stroke.

Design

Single-blind, randomized trial.

Setting

Medical center.

Participants

Enrolled subjects (N=31) were first-episode stroke, assessed for a period of 6 months after stroke onset; age between 20 and 85 years; patients with unilateral paralysis and a Fugl-Meyer assessment upper-extremity scale score >18.

Interventions

Both groups were trained 30 min per day, 3 days a week, for 6 weeks, with the experimental group performing the VR combined real instrument training and the control group performing conventional occupational therapy.

Main Outcome Measures

Manual muscle test, Modified Ashworth scale, Fugl-Meyer upper motor scale, Hand grip, Box and Block, 9-hole pegboard, Korean mini-mental status examination, and Korean-Montreal cognitive assessment.

Results

The experimental group showed greater therapeutic effects in a time-dependent manner than the control group, especially on the motor power of wrist extension, spasticity of elbow flexion and wrist extension, and box and block tests. Patients in the experimental group, but not the control, also showed significant improvements on the lateral, palmar, and tip pinch power; box and block, and 9-hole pegboard tests from before to immediately after training. Significantly greater improvements in the tip pinch power immediately after training and spasticity of elbow flexion 4 weeks after training completion were noted in the experimental group.

Conclusions

VR combined real instrument training was effective at promoting recovery of patients’ upper-extremity and cognitive function, and thus may be an innovative translational neurorehabilitation strategy after stroke.

via Efficacy of Virtual Reality Combined with Real Instrument Training for Patients with Stroke: A Randomized Controlled Trial – Archives of Physical Medicine and Rehabilitation

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