Posts Tagged cognitive impairment

[BOOK] Virtual Reality for Psychological and Neurocognitive Interventions

Virtual Reality for Psychological and Neurocognitive Interventions

  • Albert “Skip” Rizzo
  • Stéphane Bouchard

Part of the Virtual Reality Technologies for Health and Clinical Applications book series (VRTHCA)

Table of contents

Search within book

  1. Front Matter

    Pages i-xii

  1. William S. Ryan, Jessica Cornick, Jim Blascovich, Jeremy N. Bailenson
    Pages 15-46
  2. Berenice Serrano, Cristina Botella, Brenda K. Wiederhold, Rosa M. Baños
    Pages 47-84
  3. Melissa Peskin, Brittany Mello, Judith Cukor, Megan Olden, JoAnn Difede
    Pages 85-102
  4. Stéphane Bouchard, Mylène Laforest, Pedro Gamito, Georgina Cardenas-Lopez
    Pages 103-130
  5. Patrick S. Bordnick, Micki Washburn
    Pages 131-161
  6. Giuseppe Riva, José Gutiérrez-Maldonado, Antonios Dakanalis, Marta Ferrer-García
    Pages 163-193
  7. Hunter G. Hoffman, Walter J. Meyer III, Sydney A. Drever, Maryam Soltani, Barbara Atzori, Rocio Herrero et al.
    Pages 195-208
  8. Dominique Trottier, Mathieu Goyette, Massil Benbouriche, Patrice Renaud, Joanne-Lucine Rouleau, Stéphane Bouchard
    Pages 209-225
  9. Thomas D. Parsons, Albert “Skip” Rizzo
    Pages 247-265
  10. P. J. Standen, David J. Brown
    Pages 267-287
  11. Roos Pot-Kolder, Wim Veling, Willem-Paul Brinkman, Mark van der Gaag
    Pages 289-305
  12. Pierre Nolin, Jérémy Besnard, Philippe Allain, Frédéric Banville
    Pages 307-326
  13. Lindsay A. Yazzolino, Erin C. Connors, Gabriella V. Hirsch, Jaime Sánchez, Lotfi B. Merabet
    Pages 361-385
  14. Thomas Talbot, Albert “Skip” Rizzo
    Pages 387-405
  15. Back Matter

    Pages 407-415

About this book

Introduction

This exciting collection tours virtual reality in both its current therapeutic forms and its potential to transform a wide range of medical and mental health-related fields. Extensive findings track the contributions of VR devices, systems, and methods to accurate assessment, evidence-based and client-centered treatment methods, and—as described in a stimulating discussion of virtual patient technologies—innovative clinical training. Immersive digital technologies are shown enhancing opportunities for patients to react to situations, therapists to process patients’ physiological responses, and scientists to have greater control over test conditions and access to results. Expert coverage details leading-edge applications of VR across a broad spectrum of psychological and neurocognitive conditions, including:

  • Treating anxiety disorders and PTSD.
  • Treating developmental and learning disorders, including Autism Spectrum Disorder,
  • Assessment of and rehabilitation from stroke and traumatic brain injuries.
  • Assessment and treatment of substance abuse.
  • Assessment of deviant sexual interests.
  • Treating obsessive-compulsive and related disorders.
  • Augmenting learning skills for blind persons.

Readable and relevant, Virtual Reality for Psychological and Neurocognitive Interventions is an essential idea book for neuropsychologists, rehabilitation specialists (including physical, speech, vocational, and occupational therapists), and neurologists. Researchers across the behavioral and social sciences will find it a roadmap toward new and emerging areas of study.

via Virtual Reality for Psychological and Neurocognitive Interventions | SpringerLink

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[Abstract] Functional independence after acquired brain injury: Prospective effects of health self-efficacy and cognitive impairment.

Abstract

Objective: To examine how health self-efficacy and cognitive impairment severity relate to functional independence after acquired brain injury (ABI).

Design: Observational. Setting: Outpatient rehabilitation hospital.

Participants: Seventy-five adults with predominately stroke or traumatic brain injury who were beginning a course of occupational therapy.

Main Measures: Health self-efficacy was assessed with the Self-Rated Abilities for Health Practices. Cognitive functioning was assessed via a composite z score of neuropsychological tests. Trait affectivity was assessed with the Positive and Negative Affect Schedule. Functional independence was assessed with the Barthel Index and Lawton Instrumental Activities of Daily Living Scale.

Results: Health self-efficacy correlated moderately with functional independence. A moderation threshold effect was detected that revealed for whom health self-efficacy predicted functional independence. Among participants with normal to mildly impaired cognition (>−2 z cognitive composite), health self-efficacy correlated positively with functional independence, which held after accounting for trait affectivity. In contrast, health self-efficacy was not correlated with functional independence among participants with greater impairment (<−2 z cognitive composite).

Conclusions: Health self-efficacy predicts functional independence and may serve as a protective factor after ABI among individuals with relatively intact cognition. However, health self-efficacy does not predict functional independence among individuals with moderate or severe cognitive impairment, possibly due to limited self-awareness.

This study extends the literature linking health self-efficacy with rehabilitation outcomes and reinforces the need for promoting self-management in ABI. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

via PsycNET Record Display – PsycNET

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[WEB SITE] Beginner’s Guide to Light Therapy for Brain Injury

February 5, 2018

Beginner’s Guide to Light Therapy for Brain Injury

In its most general sense light therapy refers to the use of light, typically red or near-infrared light, to stimulate and heal injured tissue. One of the major mechanisms by which light therapy is thought to work is by improving the mitochondrial function of compromised cells. The improved mitochondrial function leads to an increase in ATP production, providing the energy needed for the cells to heal [1]. Research supporting the use of light therapy for a number of disorders, including those of the brain, has been overwhelmingly good.

Related: 5 Ways Light Therapy Heals the Brain

Sources of Light Therapy

Sunlight

Sunlight was used long before the invention of antibiotics to speed healing of wounds, treat skin diseases, and even fight infections. Physicians in ancient Greece would often prescribe sunbathing to promote good health and vitality. Today, we have shifted our focus from the benefits of sun exposure to the hazards. How could this outlook be affecting our brains?

Sunlight is the main source of vitamin D for most people. Due to a lack of adequate exposure to the sun, vitamin D deficiency is now recognized as a worldwide pandemic [2]. Over 1,000 different genes in the body are regulated by vitamin D [3]. A study investigating vitamin D and brain development found that it stimulates the production of neurotransmitters and improves synaptic density [4].

Other studies have linked lower levels of sunlight to cognitive impairment [5].

Finally, sunlight influences our circadian rhythm by impacting melatonin and serotonin levels in the blood. Exposure to sunlight in the morning boosts melatonin production at night translating to faster sleep onset. High serotonin levels from adequate sun exposure result in a more positive mood and a calm, focused metal state [3].

Light Emitting Diode (LED)

LED therapy is noninvasive, painless, and non-thermal. It has been cleared by the United States FDA as an insignificant risk device [1]. Compared to lasers, LEDs are inexpensive, easy to obtain for at home use, and vary widely in size making it easier to treat larger areas of the body. Though there isn’t a lot of research available for LEDs as a treatment for the brain, the existing research has been encouraging.

In one case study two subjects with traumatic brain injury applied an LED array to their foreheads. After eight weeks of LED treatments, subject 1’s ability to concentrate on a task increased from 20 minutes to 3 hours. She also reported better memory when reading, improved math skills, and decreased sensitivity of her scalp. When the study began, subject 1 was seven years post injury.  Subject 2 had been on medical disability for 5 months prior to treatment, but after 4 months of LED treatments she was able to return to work. Additionally, neuropsychological testing showed a significant improvement in her memory and executive functioning [6].

A similar study was performed on eleven subjects to determine if LED therapy could improve cognition in patients with mild traumatic brain injury. The subjects ranged from 10 months to 8 years post-TBI. The subjects’ cognitive performance levels were tested periodically and a significant positive trend was observed for cognitive performance and LED treatment over time. Additionally subjects reported improved sleep, fewer PTSD symptoms, and enhanced ability to perform social functions [1].

Cold Lasers

Cold laser therapy is also known as low-level laser therapy (LLLT) or photobiomodulation. Lasers differ from LEDs in that lasers are a coherent source of light. Coherent light means that all the light waves travel perfectly together in a single beam. LED light, like sunlight, is incoherent meaning each light wave can travel in a different direction than the other light waves. As a result, lasers are much more concentrated and powerful than LEDs. Here’s what the research says:

A case study involving a subject who suffered a brainstem stroke two years before beginning LLLT showed dramatic improvements after eight weeks of light therapy. Her mood and memory improved. Her double vision was eliminated. Her muscle spasticity decreased, she gained increased function in her left and right hands, and her arm and leg strength increased [7].

In animal models with spinal cord injury, LLLT has been shown to increase total axon number and average length of axonal regrowth [8][9].

A patient with a moderate TBI showed favorable results after receiving laser treatments for two months. After receiving the treatments he showed decreased depression, insomnia, anxiety, and headaches, while cognition and quality of life improved [10].

Additionally LLLT has shown promising results as a treatment for chronic pain [11].

What are the Risks?

Light therapy is generally safe, but there have been some minor side effects reported. The most common side effects include eyestrain, headaches, and nausea. Side effects are usually relieved by decreasing the amount of time exposed to the light.

Because coherent light is so powerful, there is potential that it could damage your retina if you look directly into the laser beam. To protect your eyes, you should always wear protective goggles when working with a cold laser. Eye damage is not a concern when working with LEDs, since they are a non-coherent light source.

I would recommend consulting your chiropractor or physician before starting a light therapy routine. They will be able to help you determine the best locations and length of exposure for optimum results.

Purchasing a Light Therapy Device

LED arrays are easy to obtain and fairly cheap. I would recommend buying an array that has both red (600-700nm) and near infrared light (760-940nm) to get a wider range of benefits. The one my family uses is the DPL FlexPad*.  There are many to choose from so you may want to do some research and choose the one that works best for you.

Getting a cold laser is a little more complicated and the restrictions on who can own one vary from state to state. Because they are so expensive (expect to pay $5,000+) I would suggest not buying one and getting treatments from your chiropractor instead. In my experience cold laser treatments are more reasonably priced, ranging from $30 -$60 per session.

Where can I find more Information?

I would highly recommend reading Norman Doidge’s book The Brain’s Way of Healing*, even if you aren’t interested in light therapy. For light therapy, I would suggest you start with chapter seven (the chapters can be read independently so you can go back and read the earlier ones later).

Michael Hamblin is another great resource. You can search him on YouTube and find several interviews where he discusses light therapy. In addition, here is a fairly comprehensive literature review he wrote addressing light therapy and the brain.

See my other post on this topic: 5 Ways Light Therapy Heals the Brain.

You may also be interested in reading: 

PoNS Device – The Key to Neuroplastic Healing 

Restoring Sleep-Wake Cycle after Brain Injury

 

via Beginner’s Guide to Light Therapy for Brain Injury – How To Brain

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[Abstract] A study of the influence of cognitive complaints, cognitive performance and symptoms of anxiety and depression on self-efficacy in patients with acquired brain injury

Abstract

Objective:
To examine the relationship between self-efficacy for managing brain injury–specific symptoms and cognitive performance, subjective cognitive complaints and anxiety and depression symptoms in patients with acquired brain injury (ABI).

Design:
Clinical cohort study.

Setting:
General hospitals, rehabilitation centres.

Subjects:
A total of 122 patients with newly ABI (mean age = 54.4 years (SD, 12.2)) were assessed at discharge home from inpatient neurorehabilitation or at start of outpatient neurorehabilitation after discharge home from acute hospital. Mean time since injury was 14.1 weeks (SD, 8.6).

Main measures:
Self-efficacy was measured using the Traumatic Brain Injury (TBI) Self-Efficacy Questionnaire (SEsx), mean score = 82.9 (SD, 21.8). Objective cognitive performance was measured with the Symbol Digit Modalities Test (SDMT), mean z-score = −1.36 (SD, 1.31). Anxiety and depression symptoms were measured with the Hospital Anxiety and Depression Scale (HADS), cognitive complaints with the self-rating form of the Dysexecutive Questionnaire (DEX-P).

Results:
Higher levels of subjective cognitive complaints and higher levels of anxiety and depression symptoms were significantly associated with lower self-efficacy (β = −0.35; P = .001 and β =−0.43; P < .001, respectively). Objective cognitive performance was not significantly associated with self-efficacy (β = 0.04, P = .53). DEX-P scores accounted for 42% and HADS scores for 7% of the total 57% variance explained. Objective cognitive performance did not correlate significantly with subjective cognitive complaints (r = −.13, P = .16).

Conclusion:
Control over interfering emotions and mastery over brain injury–associated symptoms seems important in the development of self-efficacy for managing brain injury–specific symptoms.

via A study of the influence of cognitive complaints, cognitive performance and symptoms of anxiety and depression on self-efficacy in patients with acquired brain injury – Ingrid MH Brands, Inge Verlinden, Gerard M Ribbers, 2018

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[BLOG POST] “I’m So Tired My Brain Hurts” Cognitive Fatigue

Sleeping boy

 Fatigue. And the good news is there are strategies to help minimize it.

Before I get to the strategies, here are a couple of real life descriptions to help explain what it is like:

In an article in The Guardian newspaper Tim Lusher  described his experiences following an abscess on the cerebellum, (the part of the brain that controls movement, balance and coordination).He vividly describes cognitive fatigue:

Ah, the tiredness. That’s another thing everyone talks about. It’s not a tough-week-at-the-office tiredness that you can rally through with a couple of drinks and the prospect of a weekend lie-in. It’s a leaden blanket of exhaustion that sweeps over you – utterly undeniable, non-negotiable and unshakeable.

And this description in an article entitled “Learning to Pace Yourself” from Synapse

Those who haven’t had their brain banged around won’t understand the feeling – they’ll picture how they feel after a bad night’s sleep or a big work day. But this mental exhaustion is much more than that. It feels as though even the simple act of pushing a few sluggish thoughts through this damaged brain takes far too much energy, let alone attempting things requiring physical exertion. To make things worse, when I got tired my emotions were worse than ever – my family was already struggling with my temper, depression and poor social skills. What little control I had in these areas just flew out the window once fatigue set in.

Cognitive fatigue is common after a brain injury, whether mild, moderate or severe.

The brain is working harder to keep up all its functions, even ones that were once second nature. Eventually it is like an overload button, the brain needs a rest. Without rest it can lead to headaches, or becoming irritable, confused and sometimes increasing problems with behaviour.

What can you do about it? Well even understanding what it is, gives you clues about how you could assist a person manage it. Here are some ideas to get you started.

What Can You Do for Cognitive Fatigue?

Below is a list of strategies you might find useful to work with. Decide what might work with the person you are supporting and their network. Just choose the key strategies that might suit. Keep the change manageable for everyone involved.

  • Balance the daily routine with quiet times, rests, or restful activity; building in whatever rest time the person needs whether a short nap or a longer sleep time.
  • Help family and friends to understand cognitive fatigue and know that it is as a result of the brain damage, it’s not laziness or deliberate.
  • Plan ahead to allow opportunity for sleep and rest, program this into the daily plan before fatigue occurs.
  • Work out what time of day is best for activity. We often talk about whether we are a morning, afternoon or evening person, this is important in planning to minimize fatigue.
  • Allow extra time to complete work that requires extra concentration and effort.
  • Plan ahead for demanding activities, or when going to special events. Allow for extra rest time and / or quieter routines before and after.
  • Use aids, equipment, and technology to reduce effort wherever possible. For instance if the person has mobility aids encourage their use to minimize fatigue.
  • If helpful see about shorter days for school or work; and with frequent breaks according to need.
  • Encourage saying no to activities or demands that are not important, or that would overly fatigue them.
  • If there are a number of activities or things to do on a day, work out priorities and tackle the important, or interesting tasks first.
  • As much as possible have familiar routines and surroundings, which reduces to effort and need to concentrate.
  • Take notice of what factors contribute to fatigue and work out how to manage these as much as possible. This might include the effect of medication, weather, or illness, people, places.
  • Be aware that sensory overload can impact on fatigue; situations such as a busy shopping centre with lights and noise. Limit or avoid these situations.
  • Maintain optimal health and fitness. Take care with exercise that it is does not itself cause fatigue.
  • Develop ways to manage fatigue if and when it occurs. Think about at home and when out.
  • You as a supporter can minimize fatigue by assisting where necessary, and where appropriate. Carrying out tasks, understanding what needs to be done, assisting to maintain agreed rest routines.

When looking at ways to manage fatigue remember it is better for a person to try and manage cognitive fatigue before rather than after it happens. Plan to prevent rather than manage after fatigue occurs.

Finally remember to always work with the person and their support team when developing any strategies. Each person will have different needs and different responses. This may change over time. Consistency is a key.

Please share any successful (or unsuccessful ways) you might have seen cognitive fatigue managed.

via “I’m So Tired My Brain Hurts” Cognitive Fatigue – Changed Lives New Journeys

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[ARTICLE] A customized home-based computerized cognitive rehabilitation platform for patients with chronic-stage stroke: study protocol for a randomized controlled trial – Full Text

Abstract

Background

Stroke patients usually suffer primary cognitive impairment related to attention, memory, and executive functions. This impairment causes a negative impact on the quality of life of patients and their families, and may be long term. Cognitive rehabilitation has been shown to be an effective way to treat cognitive impairment and should be continued after hospital discharge. Computerized cognitive rehabilitation can be performed at home using exercise programs that advance with predetermined course content, interval, and pace. We hypothesize that computerized rehabilitation might be improved if a program could customize course content and pace in response to patient-specific progress. The present pilot study is a randomized controlled double-blind crossover clinical trial aiming to study if chronic stroke patients with cognitive impairment could benefit from cognitive training through a customized tele-rehabilitation platform (“Guttmann, NeuroPersonalTrainer”®, GNPT®).

Methods/design

Individuals with chronic-stage stroke will be recruited. Participants will be randomized to receive experimental intervention (customized tele-rehabilitation platform, GNPT®) or sham intervention (ictus.online), both with the same frequency and duration (five sessions per week over 6 weeks). After a washout period of 3 months, crossover will occur and participants from the GNPT® condition will receive sham intervention, while participants originally from the sham intervention will receive GNPT®. Patients will be assessed before and after receiving each treatment regimen with an exhaustive neuropsychological battery. Primary outcomes will include rating measures that assess attention difficulties, memory failures, and executive dysfunction for daily activities, as well as performance-based measures of attention, memory, and executive functions.

Discussion

Customized cognitive training could lead to better cognitive function in patients with chronic-stage stroke and improve their quality of life.

Background

Stroke, the most common cerebrovascular disease, is a focal neurological disorder of abrupt development due to a pathological process in blood vessels [1]. There are three main types of stroke, namely transient ischemic attack, characterized by a loss of blood flow in the brain and which reverts in less than 24 h without associated acute infarction [2]; ischemic stroke, characterized by a lack of blood reaching part of the brain due to the obstruction of blood vessels and causing tissue damage (infarction), wherein cells die in the immediate area and those surrounding the infarction area are at risk; and a hemorrhagic stroke, where either a brain aneurysm bursts or a weakened blood vessel leaks, resulting in blood spillage into or around the brain, creating swelling and pressure, and damaging cells and tissue in the brain [3].

In 2013, according to the World Health Organization (WHO) and the Global Burden of Disease study, worldwide, there were 11–15 million people affected by stroke and almost 1.5 million deaths from this cerebrovascular disease [45]. Moreover, in 2013, the total Disability-Adjusted Life Years (years of healthy life lost while living with a poor health condition) from all strokes was 51,429,440. In Spain, in 2011, the National Institute of Statistics reported 116,017 cases of stroke, corresponding to an incidence of 252 episodes per 100,000 inhabitants [6]. Although stroke incidence increases with advancing age, adults aged 20–64 years comprise 31% of the total global incidence.

Stroke often results in cognitive dysfunction, and medical treatment may cause great expense on a personal, family, economic, and social level. Depending on the area of the brain affected and the severity of lesions, stroke patients may suffer cognitive impairment, and alteration in emotional and behavioral regulation [7]. Generally, cognitive impairment derived from stroke includes alterations in attention, memory, and executive function [8].

Recent reports have begun to show positive results from the use of computerized cognitive rehabilitation systems (CCRS) for stroke patients to improve attention, memory, and executive functions. Nevertheless, more research is needed to better control variables and improve training designs in order to reduce heterogeneity and increase control of the intensity and level of performance during treatments [9101112].

CCRS allow adjustment of the type of exercises administered to the specific cognitive impairment profile of each patient, but within a fixed set of possible exercises such that heterogeneity of therapy choice is minimized. This can improve studies by allowing better categorization of patient groups that execute similar training sessions in a similar range of responses [13]. Further, CCRS offers the possibility of applying cognitive rehabilitation at home, while patient adherence and performance can be monitored online, so that patients do not need to live near, lodge near, or travel to a rehabilitation center to receive therapy. Because CCRS therapy is entirely digitized, it generates objective data that can be analyzed to determine the relative effectiveness of these interventions. We hypothesize that by allowing a trained professional to oversee an automated customization program that stratifies the level of difficulty, duration, and stimulus speed of presentation, we will reduce the heterogeneity of traditional cognitive training and improve the efficacy of intervention in chronic stroke patients.

The first objective of this pilot study is to assess if chronic stroke patients with cognitive impairment could benefit from cognitive training through a customized tele-rehabilitation platform (“Guttmann, NeuroPersonalTrainer”®, GNPT ® ) [14] intended to increase the control of experimental variables (cognitive impairment profile, adherence, and performance) traditionally identified as a source of experimental heterogeneity. The study aims to assess if this benefit could translate into an improvement of the trained cognitive domains (attention, memory, and executive functions).

The second objective is focused on generalization, namely the ability to use what has been learned in rehabilitation contexts and apply it in different environments [15]. Transfer of learning is included within the concept of generalization when specifically referring to the ability to apply specific strategies to related tasks [16]. Two types of transfer have been proposed – near transfer and far transfer [17]. By near transfer we mean that, through the training of a task within a given cognitive domain, improved function in other similar, untrained tasks may be observed in the same cognitive domain. For instance, a patient who performs selective attention exercises and improves execution through the training might improve their performance in other selective attention exercises too. By far transfer we mean that training in a given cognitive domain may improve performance of tasks in other cognitive domains. Such improvement will be observable in tasks that are structurally dissimilar from the ones used in the training. For instance, if a patient performs selective attention exercises, they may also improve their performance in memory tasks.

It has been demonstrated that computerized cognitive training can lead to the phenomenon of transfer, as previously studied in stroke patients [18]. Thus, our research aims to note whether the application of patient-customized tele-rehabilitation can give rise to an improvement in other functions that are based on cognitive domains related to those that have been trained (near transfer) as well as in different ones (far transfer).

Finally, the third objective is to assess the variables of demography (age, sex, years of education) and etiology (ischemic stroke or hemorrhage) and their impact on rehabilitation outcome, given the need to understand the patient characteristics that may influence treatment effectiveness [19].[…]

 

Continue —> A customized home-based computerized cognitive rehabilitation platform for patients with chronic-stage stroke: study protocol for a randomized controlled trial | Trials | Full Text

 

Fig. 4Sham intervention (ictus.online) screenshots. a To access to the platform, the user must enter their username and password. b Each exercise begins with an instruction screen. c The user watches a 10-min video. d When finished, the user accesses a three-question quiz with four response options. e When the quiz is finished, a results screen is displayed. In each session, three videos with their corresponding quiz are presented

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[WEB SITE] Hospital wins patent in VR treatment for cognitive disorders.

A local hospital is drawing attention by winning a patent in cognitive rehabilitation treatment using a 3D virtual reality (VR) technology.

The Gil Medical Center and Gachon University’s industry-university cooperation foundation said on Monday they registered the patent in “a method and system using 3D virtual reality for the treatment of cognitive impairment.” Professor Lee Ju-kang of Gachon University Gil Medical Center’s physical medicine and rehabilitation department had developed the system.

The invention allows doctors to treat a wide range of cognitive disorders, including dementia, with all the different kinds of virtual space. Physicians expect better treatment results with the new technology, which offers virtual areas such as homes that are more familiar to patients than hospital’s treatment rooms.

To build 3D background information, the user of the program should visit the patient’s home and scan it first. Then, the user can save it as a database.

“Existing dementia treatments are quite limited, as most of them focus on prevention of further progress rather than on cure. Thus, it is becoming more important to use rehabilitation treatment to prevent dementia-derived adjustment disorders or accidents in daily life,” the medical center stated in the patent explanation.

“Existing treatments include cognitive rehabilitation offered in a limited environment such as hospital’s treatment room and cognitive training through a few computer programs, which are far from real life,” it went on to say. “By generating 3D virtual reality, we have developed a system to give patients easier access to necessary environment and targets and treat their cognitive impairment.”

Earlier, the hospital unveiled a plan to open a “VR Life Center” next January to treat patients with post-traumatic stress disorder and panic disorder.

“If we combine VR technology with medical treatment software, we can reenact an environment, which is difficult to visit in reality and expect better treatment results,” the hospital said. “VR treatments have already been used as a psychological treatment for a phobia and an addiction and have proven effective.”

via Hospital wins patent in VR treatment for cognitive disorders – Korea Biomedical Review

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[Abstract] Subjective complaints after acquired brain injury: presentation of the Brain Injury Complaint Questionnaire (BICoQ)

Abstract

The objective of the present study was to present a new complaint questionnaire designed to assess a wide range of difficulties commonly reported by patients with acquired brain injury. Patients (n =  619) had been referred to a community re-entry service at a chronic stage after brain injury, mainly traumatic brain injury (TBI). The Brain Injury Complaint Questionnaire (BICoQ) includes 25 questions in the following domains: cognition, behavior, fatigue and sleep, mood, and somatic problems. A self and a proxy questionnaire were given. An additional question was given to the relative, about the patient’s awareness of his difficulties. The questionnaires had a good internal coherence, as measured with Cronbach’s alpha. The most frequent complaints were, in decreasing order, mental slowness, memory troubles, fatigue, concentration difficulties, anxiety, and dual tasking problems. Principal component analysis with varimax rotation yielded six underlying factors explaining 50.5% of total variance: somatic concerns, cognition, and lack of drive, lack of control, psycholinguistic disorders, mood, and mental fatigue/slowness. About 52% of patients reported fewer complaints than their proxy, suggesting lack of awareness. The total complaint scores were not significantly correlated with any injury severity measure, but were significantly correlated with disability and poorer quality of life (Note: only factor 2 [cognition/lack of drive] was significantly related to disability.) The BICoQ is a simple scale that can be used in addition to traditional clinical and cognitive assessment measures, and to assess awareness of everyday life problems.

The figure shows the most frequent complaints (in decreasing order) reported by patients with acquired brain injury (traumatic brain injury or stroke) and by a close relative, using the Brain Injury Complaint Questionnaire (BICoQ). These complaints indicate a combination of cognitive difficulties and behavioral and personality changes.

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[ARTICLE] The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials – Full Text

Abstract

Physically-active video games (‘exergames’) have recently gained popularity for leisure and entertainment purposes. Using exergames to combine physical activity and cognitively-demanding tasks may offer a novel strategy to improve cognitive functioning. Therefore, this systematic review and meta-analysis was performed to establish effects of exergames on overall cognition and specific cognitive domains in clinical and non-clinical populations. We identified 17 eligible RCTs with cognitive outcome data for 926 participants. Random-effects meta-analyses found exergames significantly improved global cognition (g = 0.436, 95% CI = 0.18–0.69, p = 0.001). Significant effects still existed when excluding waitlist-only controlled studies, and when comparing to physical activity interventions. Furthermore, benefits of exergames where observed for both healthy older adults and clinical populations with conditions associated with neurocognitive impairments (all p < 0.05). Domain-specific analyses found exergames improved executive functions, attentional processing and visuospatial skills. The findings present the first meta-analytic evidence for effects of exergames on cognition. Future research must establish which patient/treatment factors influence efficacy of exergames, and explore neurobiological mechanisms of action.

1. Introduction

Cognition can be broadly defined as the actions of the brain involved in understanding and functioning in our external environment (Hirschfeld and Gelman, 1994). As it is generally accepted that cognition requires multiple mental processes, this broader concept has been theoretically separated into multiple ‘cognitive domains’ (Hirschfeld and Gelman, 1994). Although definitions vary, and the boundaries between domains often overlap, examples of distinct areas of cognitive functioning include the processes for learning and remembering verbal and spatial information, attentional capacities, response speed, problem-solving and planning (Strauss et al., 2006).

Various neuropsychological tests have been developed as tools for assessing and quantifying an individual’s overall cognitive functioning (or ‘global cognition’) along with their performance within the separable domains of cognition (Strauss et al., 2006). Performance in these various cognitive tests has been found to be relatively stable over time in healthy adults, and moderately accurate predictors of real-world functioning and occupational performance (Chaytor and Schmitter-Edgecombe, 2003 ;  Hunter, 1986). Furthermore, neuropsychological tests can detect the deficits in cognitive functioning which arise as a consequence of various psychiatric and neurological diseases (Mathuranath et al., 2000 ;  Nuechterlein et al., 2004). For example, people with Parkinson’s disease show marked impairments in planning and memory tasks (Dubois and Pillon, 1996), whereas those with schizophrenia have cognitive pervasive deficits, 1–2 standard deviations below population norms, which also predict the severity of disability in this population (Green et al., 2000). Additionally, cognitive abilities decline naturally in almost all people during healthy ageing (Van Hooren et al., 2007). In an ageing population, the functional consequences of cognitive decline may ultimately have a severe social and economic impact. Thus, interventions which improve cognition hold promise for the treatment of psychiatric and neurological diseases, an have positive implications for population health.

Fortunately, interventions which stimulate the brain and/or body can improve cognition, or attenuate decline. For instance, physical exercise has been shown to significantly improve global cognition, along with working memory and attentional processes, in both clinical and healthy populations (Firth et al., 2016Smith et al., 2010 ;  Zheng et al., 2016). Interventions can also be designed to target cognition directly, as computerized training programs for memory and other functions have been found to provide significant cognitive benefits, at least in the short term (Hill et al., 2017 ;  Melby-Lervåg and Hulme, 2013). Furthermore, ‘gamification’ of cognitive training programs can maximize their clinical effectiveness, as more complex and interesting programs are capable of better engaging patients in cognitively-demanding tasks while also training multiple cognitive processes simultaneously (Anguera et al., 2013).

Previous studies have found that providing both aerobic exercise and cognitive training together may have additive effects, preventing ageing-related cognitive decline more effectively (Shatil, 2013). This may be due to aerobic and cognitive activity stimulating neurogenesis through independent but complementary pathways; as animal studies show that while exercise stimulates cell proliferation, learning tasks support the survival of these new cells (Kempermann et al., 2010), such that combining these two types of training results in 30% more new neurons than either task alone (Fabel et al., 2009).

Rather than delivering aerobic and cognitive training in separate training sessions, recent advances in technology has presented an opportunity for combining physical activity with cognitively-challenging tasks in a single session through ‘exergames’. Exergames are considered as interactive video-games which require the player to produce physical body movements in order to complete set tasks or actions, in response to visual cues (Oh and Yang, 2010). Common examples include the ‘Nintendo Wii’ (along with ‘Wii Fit’ or ‘Wii Sports software’) or the ‘Microsoft Xbox Kinect’. Additionally, virtual reality systems which use exercise bikes and/or treadmills as a medium for players to interact with three-dimensional worlds have also been developed to provide immersive training experiences (Sinclair et al., 2007).

Along with their popular usage for leisure and entertainment, there is growing interest in the application of exergame systems to improve clinical outcomes. Recent systematic reviews and meta-analyses of this growing literature have provided preliminary evidence that exergames can improve various health-related outcomes, including reducing childhood obesity, improving balance and falls risk factors in elderly adults, facilitating functional rehabilitation in people with parkinson’s disease, and even reduce depression (Barry et al., 2014Li et al., 2016 ;  van’t Riet et al., 2014). However, the effects of exergames on cognitive functioning have not been systematically reviewed, despite many individual studies in this area.

Therefore, the aim of this study was to systematically review all existing trials of exergames for cognition, and apply meta-analytic techniques to establish the effects of exergames on global cognition along with individual cognitive domains. We also sought to (i) examine the effects of exergames on cognition in healthy and clinically-impaired populations, and (ii) investigate if the effects of exergames differed from those of aerobic exercise alone, by comparing exergames to traditional physical activity control conditions.

Fig. 1

Fig. 1. PRISMA flow diagram of systematic search and study selection.

Continue —> The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials

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[ARTICLE] Effects of Virtual Reality Exercise Program on Balance, Emotion and Quality of Life in Patients with Cognitive Decline

Abstract

Purpose:

In this study, we investigated the effectiveness of a 12-week virtual reality exercise program using the Nintendo Wii console (Wii) in improving balance, emotion, and quality of life among patients with cognitive decline.

Methods:

The study included 30 patients with cognitive decline (12 female, 18 male) who were randomly assigned to an experimental (n=15) and control groups (n=15). All subjects performed a traditional cognitive rehabilitation program and the experimental group performed additional three 40-minute virtual reality based video game (Wii) sessions per week for 12 weeks. The berg balance scale (BBS) was used to assess balance abilities. The short form geriatric depression scale-Korean (GDS-K) and the Korean version of quality of life-Alzheimer’s disease (KQOL-AD) scale were both used to assess life quality in patients. Statistical significance was tested within and between groups before and after treatment, using Wilcoxon signed rank and Mann-Whitney u-tests.

Results:

After 36 training sessions, there were significant beneficial effects of the virtual reality game exercise on balance (BBS), GDS-K, and KQOL-AD in the experimental group when compared to the control group. No significant difference was observed within the control group.

Conclusion:

These findings demonstrate that a virtual reality-training program could improve the outcomes in terms of balance, depression, and quality of life in patients with cognitive decline. Long-term follow-ups and further studies of more efficient virtual reality training programs are needed.

INTRODUCTION

Dementia is a degenerative disease of the nervous system, which is prevalent in the elderly population. It involves deterioration in cognitive function and ability to perform everyday activities. As the early diagnosis and treatment of dementia is delayed, its economic costs and burden on families and society are gradually increasing and becoming a social problem.1 Older people with dementia have an increased risk of falls and lower levels of everyday activities being performed due to cognitive decline and decreased muscle mass. This is a result of reduced physical activity, which further deteriorates their quality of life.2 Therapeutic interventions to improve cognitive function and to increase activities of daily living (ADL) in patients with dementia are divided into pharmacological and non-pharmacological treatments. For pharmacological treatment, acetylcholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists are the most widely used in clinical practice.3 However, because pharmacological treatment alone cannot prevent the progression of cognitive decline and ADL deterioration in patients with dementia, various non-pharmacological treatments including cognitive therapy or physical exercise are used as additional treatments.4
Recent reports have stated that regular exercise was effective in delaying cognitive impairment in people with dementia.5 In a three-year follow-up study of healthy older people, a combination of cognitive activity and physical activity was found to be effective in reducing the risk for mild cognitive impairment.6 However, physical activity was found to be more important than cognitive activity in order to further reduce the risk for cognitive decline.6 When older people with dementia performed regular physical exercise, there was an improvement in the mini-mental state examination (MMSE) score.7 Physical exercise prevented the deterioration of ADL.8 The mechanism of the benefit of physical exercise on patients with dementia is thought to be that it can facilitate neuroplasticity, promote injury recovery mechanisms at a molecular level and facilitate self-healing of the brain through its neuroprotective effect.9
However, unless individuals perform exercise in the long run, such beneficial effects of exercise may wear off, leading to impaired brain function and worsened disease.10 Therefore, patients with dementia should continue exercise under the supervision of professional physical therapists in order to stop the progression of cognitive impairment for a long time. In order to achieve this, it is required to keep patients interested in the exercise therapy allowing them to maintain adherence. However, it is difficult to execute exercise treatment continuously in patients with dementia because of space, time, and cost issues in Korea. Patients get easily bored and tired of passive and simply repetitive forms of exercise treatment. In general, 20-50% of older people who start an exercise program will stop within six months.11 Patients with dementia are expected to be more likely to discontinue exercise program due to lowered levels of patience and self-regulation abilities. Therefore, exercise programs utilizing media, including games, attempt to keep patients interested in exercise programs and to improve therapeutic effects. With recent advances in scientific technologies and computer programs, exercise and rehabilitation interventions using virtual reality are being introduced in the medical field.12 Virtual reality refers to a computer-generated environment that allows users to have experiences similar to those in the real world. It is an interactive simulation characterized by technology that provides reality through various feedbacks.13 While performing predetermined tasks such as playing a game in virtual reality, users manipulate objects as if they were real and can control their movements by giving and receiving various feedbacks via numerous senses such as sight and hearing.14
The virtual reality-enhanced exercise consisting of exercise with computer-simulated environments and interactive videogame features allows patients to enjoy performing tasks, encourages competition, and creates motivation and interest in their treatment.15 Participation in a virtual reality-enhanced exercise was reported to lead to higher exercise frequency and intensity and enhanced health outcomes when compared with traditional exercise.16
However, despite these advantages, conventional virtual reality systems could not be widely available for patients in clinical settings due to several limitations including high costs and a large size.17 Therefore, it is necessary to develop virtual reality exercise programs that are easy to follow in hospitals and at home. As an alternative, the use of computer-based individual training programmes is becoming increasingly popular due to the low cost, independence and ease of use in the home. One such system that is increasing in popularity for use in exercise training is the Nintendo Wii (Wii; Nintendo Inc., Kyoto, Japan) personal game, which became commercially available. Wii is a video gaming console with a simple method, as its virtual reality system is implemented via a television monitor. It combine physical exercise with computer-simulated environments and interactive videogame features. Because the Wii console is inexpensive and small in size, it is easy to install or move it in hospitals or at home. This gaming console is designed to be controlled using a wireless controller, allowing user to interact with his/her own avatar, which is displayed on the screen through a movement sensing system. The controller is provided with an acceleration sensor that responds to acceleration changes recognizing direction and velocity changes.18 Wii-balance board is being used when playing a Wii Fit game. It is a force plate collecting movement information in the center of pressure of the standing user, enabling reflection of movements in a virtual environment on the monitor and thus constantly resending visual feedback to the user. Through this process, the user can adjust his/her postural responses. Studies have shown that the Wii balance board can be helpful in postural control training.19 Because Wii is a typical example of virtual reality applications and is simple, inexpensive, and easily accessible, Wii is expected to create interest among patients encouraging them to put more efforts in exercise via games and thus augmenting effects of the treatment.
Domestic studies on the use of Wii have reported its effects on the upper extremity function, visual perception and sense of balance in chronic stroke patients,20 spinal cord injury patients,21 Parkinson’s disease patients,22 and multiple sclerosis patients.23 However, there have been only a few controlled research studies about the effects of Wii on patients with cognitive decline. The present study aimed to analyze effects of virtual reality exercise program on balance function, emotions, and quality of life (QOL) in patients with cognitive decline.

Continue —> Effects of Virtual Reality Exercise Program on Balance, Emotion and Quality of Life in Patients with Cognitive Decline – ScienceCentral

 

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Figure 1 The level of satisfaction about Wii game for dementia patients (Number=%).

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