Posts Tagged dementia

[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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[WEB SITE] Brain Derived Neurotrophic Factor (BDNF) and Exercise

Brain Derived Neurotrophic Factor (BDNF) has been referred to as a fertilizer for your brain. Find out how exercise can help you to get more of it.

Brain Derived Neurotrophic Factor (BDNF) has been referred to as a fertilizer for your brain. It is a substance that is found in your brain and helps to maintain the life of your brain cells, as well as grow new ones. You’ve probably heard all about ‘neuroplasticity’ and how we used to think our brains, once adult, were like a lump of concrete – unable to change and grow. Scientists now believe our brains are more like plastic – able to adapt, grow and change depending on what we do with them. BDNF is widely accepted as being a key player in this ‘plastic’ ability of the brain – its presence has been shown to make brain cells in petri dishes sprout new branches (necessary activity for a cell to make new connections!).

Low levels of BDNF have been associated with depression, anxiety, poor memory and brain degeneration as seen in conditions such as Alzheimer’s and dementia.

 

Why would you want more BDNF?

  • Improved learning and memory
  • May trigger the production of more serotonin (hello happy feelings!)
  • Helps with new skill acquisition
  • Improved mood (exercise increases BDNF as much or even more than taking antidepressants does)
  • Lower rates of Alzheimer’s disease and dementia in older age may be related to higher levels of BDNF.

Are you getting the picture? Better mood, better mental performance, healthier brain as you age…

How do you get more BDNF?

One word: STIMULATION.  Stimulation of your brain and all its cells can come in many forms. Of course, traditional brain exercise has been thought of as activities such as cross words and Sudoku (which are definitely good!) but here’s another aspect you can add to the list: exercise. As little as 30 minutes of jogging on three days a week has been shown to improve brain functioning, but even better gains have been suggested with more complex activity, which requires you to build or acquire a skill. An example of this is exercise that challenges your balance or thinking, like rock climbing or dancing.

The ultimate brain booster? A bit of aerobic exercise (at least ten minutes) to increase levels of BDNF and other neurotransmitters, as well as all those other wonderful benefits of aerobic exercise, followed by a skill-based exercise to get the new brain cells creating new networks with each other.

TIP: Want to maximize the increased learning capacity of your brain? Don’t try to learn something while exercising (stop taking your study notes to the spin bike!) – blood flow increases to the brain post-exercise, while BDNF levels are still increased, meaning immediately after exercise is the perfect time to take in new information. Put on that French language podcast on the way home from the gym…

 

EXERCISE RIGHT’S FIVE FAVOURITE WAYS TO MOVE FOR MORE BDNF

  • 1. Indoor rock-climbing – especially if you actively commute to the rock wall!
  • 2. Trail running – something with twists, turns and great views is awesome
  • 3. Dancing – where you’re learning new moves and also working your fitness
  • 4. Functional movement – wait until the after school rush has finished then go check out (and play on) your nearest playground – think monkey bars, crawling through tunnels and balancing on beams
  • 5. Team sports – they require you to be getting great aerobic gains by running around, whilst also working your brain in terms of strategy and quick thinking

References:

Aisen, P. S. (2014). Serum brain-derived neurotrophic factor and the risk for dementia. JAMA, 311(16), 1684-1685. doi: 10.1001/jama.2014.3120

Binder, Devin K., & Scharfman, Helen E. (2004). Brain-derived Neurotrophic Factor. Growth factors (Chur, Switzerland), 22(3), 123-131. doi: 10.1080/08977190410001723308

Hagerman, Eric, & Ratey, Dr John J. (2010). Spark! How Exercise Will Improve the Performance of Your Brain (Kindle Edition ed.).

Source: Brain Derived Neurotrophic Factor (BDNF) and Exercise

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[Oral Presentation] Fitness-to-Drive Agreements after Stroke – Archives of Physical Medicine and Rehabilitation

Source: Fitness-to-Drive Agreements after Stroke – Archives of Physical Medicine and Rehabilitation

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[WEB SITE] New technology discovered for brain repair: Chemical transformation of human glial cells into neurons

For the first time, researchers have used a cocktail of small molecules to transform human brain cells, called astroglial cells, into functioning neurons for brain repair. The new technology opens the door to the future development of drugs that patients could take as pills to regenerate neurons and to restore brain functions lost after traumatic injuries, stroke, or diseases such as Alzheimer’s. Previous research, such as conventional stem cell therapy, requires brain surgery and therefore is much more invasive and prone to immune-system rejection and other problems. The research, led by Gong Chen, Professor of Biology and the Verne M. Willaman Chair in Life Sciences at Penn State University, will be published online in the journal Cell Stem Cell on Oct. 15th, 2015.

“We have discovered a cocktail of small molecules that can reprogram human brain astroglial cells into neuron-like cells after eight-to-ten days of chemical treatment,” Chen said. The neurons the researchers reprogrammed survived for more than five months in cell culture, where they formed functional synaptic networks. The scientists also injected the reprogrammed human neurons into the brains of living mice, where they integrated into the neural circuits and survived there for at least one month.

Astroglial cells before treatment with small-molecule cocktails in the lab of Gong Chen at Penn State University Credit: Gong Chen lab, Penn State University

Astroglial cells before treatment with small-molecule cocktails in the lab of Gong Chen at Penn State UniversityCredit: Gong Chen lab, Penn State University”The small molecules are not only easy to synthesize and package into drug pills, but also much more convenient for use by patients than other methods now being developed,” Chen said. Before the promise of the new technology results in pills at a pharmacy, the new research effort must first succeed through much development and testing in the laboratory and then through a series of clinical trials.

Continue —> New technology discovered for brain repair: Chemical transformation of human glial cells into neurons – Medical News Today

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[WEB SITE] Here’s an idea: Play your way to recovery – ideas.ted.com

As anyone who’s ever recovered from an injury knows, physical therapy can be painful, boring and slow. TED Fellow Cosmin Mihaiu is out to change that with MIRA, software that disguises physical therapy exercises as fun-to-play videogames. Here’s how it works.

Unlikely — fun! — physical therapy. “Traditionally, a patient doing physical therapy at home is, at most, looking in the mirror. There’s no other feedback or encouragement,” says Mihaiu. MIRA, built by his team in Romania and the United Kingdom, changes that. It’s a set of simple, fun-to-play videogames that encourage precise movement while offering audio and visual stimulus and a sense of achievement. By reaching their onscreen goals, patients also do their physical therapy exercises. So a patient recovering from a broken arm might fly a bee to gather pollen — while flexing and extending the arm. Someone recovering from a stroke might navigate a submarine through water to improve the precision of movement in the shoulder.

Off-the-shelf hardware and tailored exercises produce a personal experience. Each of the ten games offers a range of exercises that can be tailored to each patient’s needs; it’s up to the therapist to prescribe which ones to play, and for how long. Mihaiu and his team built software that can be played via a Kinect motion-sensing input device and a PC. Using readily available and relatively cheap hardware is one way they hope to promote adoption by clinics and hospitals — and eventually by patients at home.

BECAUSE PATIENTS KNOW THAT THEIR CLINICIANS CAN SEE WHETHER AND HOW THEY ARE DOING THE PRESCRIBED EXERCISES, THEY’RE MORE LIKELY TO COMPLY.

The inspiration for MIRA: a fall from a tree. When he was seven, Mihaiu fell out of a tree he’d used as a (poor) hiding place. “The doctors encased my arm and torso in a cast, and because I was stuck in that position for six weeks, I could no longer extend my elbow when the cast came off,” he says. A physical therapist prescribed exercises that called for him to flex and extend his elbow 100 times a day. Unsurprisingly, little Cosmin balked at such tedium. But that meant his recovery took far longer than it should have done. Years later, as a computer engineering student at the University of Babeș-Bolyai in Romania, Mihaiu remembered this childhood experience during a brainstorming session for the Microsoft Imagine Cup innovation competition. “We thought, what if we could get people to play their way to recovery?” he recalls. They didn’t win, but the idea stuck, and MIRA — which stands for Medical Interactive Recovery Assistant — was born.

VIDEO —> Cosmin Mihaiu: Physical therapy is boring — play a game instead

Continue —>  Here’s an idea: Play your way to recovery | ideas.ted.com.

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[WEB SITE] How healthy is your brain? Stand on one leg to find out

Here’s something you should do for your health: stand on one leg.

Can you do it for at least 20 seconds? If so, your brain’s probably in pretty good shape.

Japanese researchers have found this simple test is an excellent way to determine whether someone has cerebral small-vessel disease (SVD), reports Prevention magazine. SVD can be a factor in strokes, dementia and Parkinson’s disease. “Cerebral small vessel disease is a frequent finding on CT and MRI scans of elderly people and is related to vascular risk factors and cognitive and motor impairment, ultimately leading to dementia or Parkinsonism in some,” wrote an unrelated 2011 study published in BMC Neurology.

The Kyoto University study, published last December in the journal Stroke, observed some 1,400 men and women with an average age of 67 attempt to stand with one leg raised and eyes open. All of the participants later had MRI scans done of their brains.

Almost without exception, the study participants who had trouble maintaining balance on one leg had SVD; some of them had brain lesions or other brain disorders.

Those who successfully balanced on one leg generally had brains without any signs of disease. They also scored higher on other, more traditional mental tests.

via How healthy is your brain? Stand on one leg to find out | OregonLive.com.

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[ARTICLE] A Brief Overview and Assessment of the Role and Benefits of Cognitive Rehabilitation

Abstract

Cognition is one of our most important attributes. Arresting its decline whether in association with normal aging, a diagnosis of mild cognitive impairment, acquired brain injury or dementia concerns everyone-regardless of whether their role is that of spouse, child, or clinician. This paper provides a brief, and by necessity, somewhat superficial appraisal of the status of our knowledge of the benefits of cognitive rehabilitation in these conditions and the authors’ assessment of it strengths and weaknesses. In summary, there is support for the belief that participation in exercise as well as socially and cognitively stimulating activities (whether or not rehabilitative in nature) is beneficial for all but perhaps the most demented. Focused efforts at cognitive training/rehabilitation also appear potentially helpful but are best established for those with acquired brain injury. There are, however, caveats to this assessment. For example, cognitive retraining is resource and time intensive while, even for those most likely to benefit, its impact on their daily activities and quality of life remain unclear. In addition, responses to training may vary from person to person and are likely to be influenced by factors such as an individual’s acceptance of the need for assistance. Future research may benefit from continued efforts to treat the patient holistically, fit the treatment to those most likely to benefit, and encouraging the translation of training effects to functioning in the real world.

via A Brief Overview and Assessment of the Role and Benefits of Cognitive Rehabilitation – Archives of Physical Medicine and Rehabilitation.

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