Posts Tagged cognition

[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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[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 [34], hemiparesis [5], dizziness, vertigo and various sight and speech problems [6]. There can also be cognitive side-effects [78], such as cognitive impairment [910] 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 [31415], and evidence has been found to suggest that physical activity leads to changes in brain structure [1617]. On a physical level, rehabilitation exercises have also been designed to recover the mobility of the affected hands and upper limbs [418], 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 [2122] and quality of life [223]. 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 [2526]. The cognitive after-effects have been studied in the fields of neuropsychology [27] and neurorehabilitation [2829]. 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 [3031] 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 [3334], such as balance and gait disorders [3335] and effects on the upper limbs [3637]. However, there is hardly any scientific evidence regarding the use of commercial videogames to do physical activity in order to recover cognition [3839]. 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.[…]

 

Continue —> Effect of the Wii Sports Resort on the improvement in attention, processing speed and working memory in moderate stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

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[NEWS] Vitamin D Deficiency Linked to Loss in Brain Plasticity

Feb 21, 2019 | Original Press Release from the University of Queensland

Vitamin D Deficiency Linked to Loss in Brain Plasticity

Perineuronal nets (bright green) surround particular neurons (blue). Fluorescence labelling reveals just how detailed these structures are. Credit: Phoebe Mayne, UQ

University of Queensland research may explain why vitamin D is vital for brain health, and how deficiency leads to disorders including depression and schizophrenia.

 

via Vitamin D Deficiency Linked to Loss in Brain Plasticity | Technology Networks

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[Abstract] Active exergames to improve cognitive functioning in neurological disabilities: a systematic review and meta-analysis

INTRODUCTION: Exergames represent a way to perform physical activity through active video games, serving as potentially useful tool in the field of neurorehabilitation. However, little is known regarding the possible role of exergames in improving cognitive functions in persons suffering from neurological disabilities.

 

EVIDENCE ACQUISITION: A search for relevant articles was carried out on PubMed/Medline, Scopus, PEDro, and Google Scholar. Only randomized controlled studies and non-randomized but controlled studies were retained. The following additional inclusion criteria were applied: studies focused on physical activity interventions carried out by means of exergames; populations targeted were affected by neurological disabilities; and reported results were related to cognitive outcomes. We calculated standardized mean differences (SMD) and pooled results using a random effects meta-analysis.

EVIDENCE SYNTHESIS: Of 520 abstracts screened, thirteen studies met the criteria to be included yielding a total of 465 participants, 233 randomized to exergames, and 232 allocated to the alternative or no intervention. The included studies varied in terms of studied populations (e.g., multiple sclerosis, post-stroke hemiparesis, Parkinson’s disease, dementia, dyslexia, Down syndrome), type and duration of interventions, and cognitive outcome measures. Exergames significantly improved executive functions (SMD=0.53, P=0.005; 8 studies, N.=380) and visuo-spatial perception (SMD=0.65, P<0.0001; 5 studies, N.=209) when compared to the alternative or no intervention. There were no significant differences for attention (SMD=0.57, P=0.07; 7 studies, N.=250) and global cognition (SMD=0.05, P=0.80; 6 studies, N.=161).

CONCLUSIONS: Exergames are a highly-flexible tool for rehabilitation of both cognitive and motor functions in adult populations suffering from various neurological disabilities and developmental neurological disorders. Additional high-quality clinical trials with larger samples and more specific cognitive outcomes are needed to corroborate these preliminary findings.

CLINICAL REHABILITATION IMPACT: Exergames could be considered either as a supplemental treatment to conventional rehabilitation, or as strategy to extend benefits of conventional programs at home.

PDF

via Active exergames to improve cognitive functioning in neurological disabilities: a systematic review and meta-analysis – European Journal of Physical and Rehabilitation Medicine 2018 June;54(3):450-62 – Minerva Medica – Journals

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[BLOG POST] One day at a time. Cognition and Caregiving after a TBI

By Bill Herrin

Thinking comes so naturally that most people take it for granted, but after a traumatic brain injury – many times, thinking can be more of a deliberate action. It takes focus and effort to put a series of thoughts together after TBI, to speak clearly, or to even move. Simply put, the brain (like the body) takes time to heal. Since no two brain injuries are identical, there is no clear path to better cognition. There are, however, certain broad directives that can get you moving in the right direction in most situations. The hardest part of this is to accept your “new normal”. Acceptance, once you come to terms with it, gives you the desire to work toward the goal of better cognition, coordination, memory, anger management, judgement, attention, and other challenges. Once you accept your situation isn’t going to change overnight, you can start the process of healing, along with testing your limitations. Although finding your limitations is difficult, knowing what they are is a huge step towards improvement in areas that need changing. When a person lacks enough cognition to be self-aware or to strive towards improvement, that’s a test for the caregiver’s guidance and patience. Sometimes just being there for your friend, spouse, or loved one is all you can do.

As a caregiver, high expectations from a TBI survivor shouldn’t be overly discouraged, as they can bring progress through their desire to improve. They may not reach the goal they wanted to, but they’ll make strides towards it! That is positivity in its purest form. Nobody wants to be working through such a huge change in their life without encouragement – cheer them onward and upward! Even if they fail, they are trying, and that shows initiative. Their desire to improve should never be underappreciated.

When cognition is in the early stages of improvement, the changes may be noticed more by the family or caregiver than they are by the survivor. Sometimes incremental change is just too subtle for survivors to realize, but pointing out the changes to them is incredibly positive reinforcement. The following tips on cognition are excerpted from Lash & Associates’ tip card titled “Cognition – Compensatory strategies after brain injury”

Cognitive fatigue is one of the most common consequences of brain injury. The survivor’s brain is simply working harder to think and learn. Cognitive rest is just as important – maybe even more important – as physical rest after the brain has been injured. Cognitive fatigue can have a ripple effect. You may have a shorter temper, find it harder to concentrate, make more errors, misplace things or forget appointments. You may feel like you can’t think straight no matter how hard you try. Many survivors describe cognitive fatigue as “hitting the wall”.

Do you…

• Feel tired after mental exertion?

• Have a harder time thinking after working on longer or more complex tasks?

• Need more sleep than usual?

• Find it hard to get through the day without napping?

 

Tips on compensatory strategies…

• Take breaks.

• Schedule rest periods.

• Stay organized.

• Use a daily planner.

• Use time management strategies.

• Eat nutritious meals on a regular schedule.

• Go to bed at a consistent time.

– Create a weekly exercise routine.

• Request a medical evaluation.

• Discuss medications that may help with a physician specializing in brain injury rehabilitation.

There are a plenty of great suggestions for compensatory strategies for survivors and their caregivers in the tip card referenced above. Here’s a link to it here!

 

When it comes to cognitive functional rehabilitation – seek professional advice first (of course), but when the TBI survivor is at home with a caregiver, clinician, friend or family member, there are some great approaches to working on communication, social interaction, organization, reading, attention, problem solving, and rebuilding other deficits through consistent application by any or all of the people involved in the care of the TBI survivor.

Referencing the book titled “Cognition Functional Rehabilitation Activities Manual” (Developed by Barbara Messenger, MEd, ABDA and Niki Ziarnek, MS, CCC-SLP/L), I’m sharing an excerpt that provides a glimpse into the workbook’s approach to helping a person with cognitive challenges. Many of the exercises use interaction and documentation to assess where the TBI survivor is at (cognitively speaking) on an ongoing basis. Remember, this is a workbook, and there are plenty of exercises that build activities and responses ongoing. Here is the example of how the manual challenges a TBI survivor with structured and specific activities:

Task: Provide awareness training.

Procedure:

  1. Prompt participant to work on awareness training.
  2. Ask why participant is here receiving rehabilitation.
  3. Ask what skills/activities are harder since the brain injury.
  4. Ask what participant does to compensate for these difficulties and which therapies address them.Ask what participant’s strengths are (what is participant good at?).
  1. Ask the participant how the brain injury and difficulties affect daily activities.
  2. Provide answers and examples when needed.
  3. Provide positive reinforcement for strengths, being receptive to information regarding brain injury, for participating in the task, and for being motivated to participate in rehabilitation.

Staff Reminder: (clinician, caregivers, family, etc.)

Provide a complete description of this activity in the Functional Rehabilitation Documentation Form.

Last words…

By asking specific questions, and recording the corresponding answers, this workbook is a great tool for tracking progress – and the exercises can be done more than once, to check and see how/if the answers have changed. So, what’s the takeaway from this excerpt? It illustrates that structure and consistency of care and treatment by family/caregivers and professionals can overlap and create a solid overview of cognitive deficits, and improvements.

In closing, the main goal of this post is to address the expectations of TBI survivors and their caregivers, to encourage them to strive for progress and to offer resources for compensatory strategies, and cognitive rehabilitation. If all parties work in tandem with the common goal of helping a TBI survivor make it to the next level, they’re all closer to the goal…and the whole team wins. That’s the goal!

via cognition-caregiving-tbi

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