Posts Tagged Depression

[WEB SITE] Electric Brain Stimulation No Better Than Meds For Depression: Study

Wednesday, June 28, 2017

HealthDay news imageWEDNESDAY, June 28, 2017 (HealthDay News) — For people who battle depression and can’t find relief, stimulating the brain with electric impulses may help. But a new study by Brazilian researchers says it’s still no better than antidepressant medication.

In a trial that pitted transcranial, direct-current stimulation (tDCS) against the antidepressant escitalopram (Lexapro), researchers found that lessening of depression was about the same for either treatment.

“We found that antidepressants are better than tDCS and should be the treatment of choice,” said lead researcher Dr. Andre Brunoni. He’s director of the Service of Interdisciplinary Neuromodulation at the University of Sao Paulo.

“In circumstances that antidepressant drugs cannot be used, tDCS can be considered, as it was more effective than placebo,” he said.

The researchers used the Hamilton Depression Rating Scale. This test has a score range of zero to 52, with higher scores indicating more depression.

People who received brain stimulation lowered their depression score by 9 points. Those taking Lexapro had depression scores drop by 11 points. Patients receiving placebo experienced a drop of 6 points in their depression score, the researchers found.

“tDCS has been increasingly used as an off-label treatment by physicians,” Brunoni said. “Our study revealed that it cannot be recommended as a first-line therapy yet and should be investigated further.”

The report was published June 29 in the New England Journal of Medicine.

Dr. Sarah Lisanby is director of the Division of Translational Research at the U.S. National Institute of Mental Health. “When you consider if this treatment adds anything to the ways we have to treat depression, you want to know that a new treatment is better than or at least as good as what’s available today,” she said.

“But this study failed to show that tDCS was better than medication,” said Lisanby, who wrote an accompanying journal editorial.

Lisanby pointed out that unapproved tDCS units are being sold on the internet. She cautioned that trying brain stimulation at home to relieve depression or enhance brain function is risky business, because side effects can include mania.

“There are people who are doing do-it-yourself tDCS,” she said. “People are trying to find ways to treat depression, but it’s important for them to know that tDCS is experimental and not proven to be as effective or more effective than antidepressant medications.”

To get a better idea of how well brain stimulation worked for depression, Brunoni and colleagues randomly assigned 245 patients suffering from depression to one of four groups. One group had brain stimulation plus a placebo pill, another had fake brain stimulation plus Lexapro. The third group had brain stimulation plus Lexapro, and the final group had fake brain stimulation plus a placebo.

Brain stimulation involved wearing sponge-covered electrodes on the head. The treatment was given for 15 consecutive days at 30 minutes each, then once a week for seven weeks.

Lexapro was taken daily for three weeks, after which the daily dose was increased from 10 milligrams (mg) to 20 mg for the next seven weeks.

After 10 weeks, patients receiving brain stimulation fared no better than those taking Lexapro. Patients receiving brain stimulation, however, suffered from more side effects, the researchers found.

Specifically, patients receiving brain stimulation had higher rates of skin redness, ringing in the ears and nervousness than those receiving fake brain stimulation.

In addition, two patients receiving brain stimulation developed new cases of mania. That condition can include elevated mood, inflated self-esteem, decreased need for sleep, racing thoughts, difficulty maintaining attention and excessive involvement in pleasurable activities.

Patients taking Lexapro reported more frequent sleepiness and constipation.

Brunoni, however, is not ready to write off brain stimulation as a treatment for depression based on this study.

“We did not test, in this study, the combined effects of tDCS with other techniques, such as cognitive behavior therapy and other antidepressant drugs,” he said.

“Previous findings from our group showed that tDCS increases the efficacy of antidepressant drugs, however, it should not be used alone, and its use must be supervised by physicians due to the side effects,” Brunoni said.

Lisanby said the tDCS dose in the study may be in question. She said it may have to be adjusted to each individual patient in terms of how strong the electrical stimulation should be. The treatment length also needs to be individualized, as does what part of the brain it should be directed toward.

Also, “we need larger studies to give us the definitive answer about whether tDCS is better than the treatments we have today,” Lisanby said.

SOURCES: Andre Brunoni, M.D., Ph.D., director, Service of Interdisciplinary Neuromodulation, University of Sao Paulo, Brazil; Sarah Lisanby, M.D., director, Division of Translational Research, U.S. National Institute of Mental Health; June 29, 2017, New England Journal of Medicine

Source: Electric Brain Stimulation No Better Than Meds For Depression: Study: MedlinePlus Health News

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[BLOG POST] UCLA offers transcranial magnetic stimulation to treat patients with depression

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Americans spend billions of dollars each year on antidepressants, but the National Institutes of Health estimates that those medications work for only 60 percent to 70 percent of people who take them. In addition, the number of people with depression has increased 18 percent since 2005, according to the World Health Organization, which this year launched a global campaign encouraging people to seek treatment.

The Semel Institute for Neuroscience and Human Behavior at UCLA is one of a handful of hospitals and clinics nationwide that offer a treatment that works in a fundamentally different way than drugs. The technique, transcranial magnetic stimulation, beams targeted magnetic pulses deep inside patients’ brains — an approach that has been likened to rewiring a computer.

TMS has been approved by the FDA for treating depression that doesn’t respond to medications, and UCLA researchers say it has been underused. But new equipment being rolled out this summer promises to make the treatment available to more people.

“We are actually changing how the brain circuits are arranged, how they talk to each other,” said Dr. Ian Cook, director of the UCLA Depression Research and Clinic Program. “The brain is an amazingly changeable organ. In fact, every time people learn something new, there are physical changes in the brain structure that can be detected.”

Nathalie DeGravel, 48, of Los Angeles had tried multiple medications and different types of therapy, not to mention many therapists, for her depression before she heard about magnetic stimulation. She discussed it with her psychiatrist earlier this year, and he readily referred her to UCLA.

Within a few weeks, she noticed relief from the back pain she had been experiencing; shortly thereafter, her depression began to subside. DeGravel says she can now react more “wisely” to life’s daily struggles, feels more resilient and is able to do much more around the house. She even updated her resume to start looking for a job for the first time in years.

During TMS therapy, the patient sits in a reclining chair, much like one used in a dentist’s office, and a technician places a magnetic stimulator against the patient’s head in a predetermined location, based on calibrations from brain imaging.

The stimulator sends a series of magnetic pulses into the brain. People who have undergone the treatment commonly report the sensation is like having someone tapping their head, and because of the clicking sound it makes, patients often wear earphones or earplugs during a session.

TMS therapy normally takes 30 minutes to an hour, and people typically receive the treatment several days a week for six weeks. But the newest generation of equipment could make treatments less time-consuming.

“There are new TMS devices recently approved by the FDA that will allow patients to achieve the benefits of the treatment in a much shorter period of time,” said Dr. Andrew Leuchter, director of the Semel Institute’s TMS clinical and research service. “For some patients, we will have the ability to decrease the length of a treatment session from 37.5 minutes down to 3 minutes, and to complete a whole course of TMS in two weeks.”

Leuchter said some studies have shown that TMS is even better than medication for the treatment of chronic depression. The approach, he says, is underutilized. “We are used to thinking of psychiatric treatments mostly in terms of either talk therapies, psychotherapy or medications,” Leuchter said. “TMS is a revolutionary kind of treatment.”

Bob Holmes of Los Angeles is one of the 16 million Americans who report having a major depressive episode each year, and he has suffered from depression his entire life. He calls the TMS treatment he received at UCLA Health a lifesaver.

“What this did was sort of reawaken everything, and it provided that kind of jolt to get my brain to start to work again normally,” he said.

Doctors are also exploring whether the treatment could also be used for a variety of other conditions including schizophrenia, epilepsy, Parkinson’s disease and chronic pain.

“We’re still just beginning to scratch the surface of what this treatment might be able to do for patients with a variety of illnesses,” Leuchter said. “It’s completely noninvasive and is usually very well tolerated.”

Source: UCLA offers transcranial magnetic stimulation to treat patients with depression

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[VIDEO] Brain Injury and Depression – YouTube

Why do people experience depression after brain injury? Learn about the connection between traumatic brain injury and depression in this video. Dr. Frank Lewis, Ph.D., a cognitive psychologist and NeuroRestorative’s Director of Clinical Outcomes, addresses the symptoms and causes of depression following brain injury. He provides advice to family members and treatment options to help individuals cope with depression and continue to heal from their injury.

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[Abstract] Use of Computer and Mobile Technologies in the Treatment of Depression

HIGHLIGHTS

  • Studies in technology-assisted self help for anxiety and depression found that therapist assisted treatment was optimal for clinical depression and technology-based treatment alone may be efficacious for subthreshold mood disorders.
  • There has been no robust evidence of health benefits from peer-to-peer electronic support groups, however, for patients who have social isolation, there may be some benefit.
  • Despite the preponderance of mental health apps and widespread acceptance, there is a significant lack of empirical data documenting likely uptake, best strategies for engagement, efficacy, or effectiveness of mHealth initiatives.
  • Biosensing technology offers the ability to reach an immense volume of people through automated monitoring which could lead to more widespread achievement of early diagnosis and intervention and ameliorate rising medical costs of acute or ineffective treatment.
  • mobile technologies can be used to record and monitor the type, intensity, frequency, and duration of exercise as a means to motivate users and enhance the potential effectiveness of exercise for treating depression.

ABSTRACT

Major depression (MDD) is a common and disabling disorder. Research has shown that most people with MDD receive either no treatment or inadequate treatment. Computer and mobile technologies may offer solutions for the delivery of therapies to untreated or inadequately treated individuals with MDD.

The authors review currently available technologies and research aimed at relieving symptoms of MDD. These technologies include computer-assisted cognitive-behavior therapy (CCBT), web-based self-help, Internet self-help support groups, mobile psychotherapeutic interventions (i.e., mobile applications or apps), technology enhanced exercise, and biosensing technology.

Source: Use of Computer and Mobile Technologies in the Treatment of Depression – Archives of Psychiatric Nursing

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[WEB SITE] MRI brain scans may help clinicians decide between CBT and drug treatment for depression

Researchers from Emory University have found that specific patterns of activity on brain scans may help clinicians identify whether psychotherapy or antidepressant medication is more likely to help individual patients recover from depression.

The study, called PReDICT, randomly assigned patients to 12 weeks of treatment with one of two antidepressant medications or with cognitive behavioral therapy (CBT). At the start of the study, patients underwent a functional MRI brain scan, which was then analyzed to see whether the outcome from CBT or medication depended on the state of the brain prior to starting treatment. The study results are published as two papers in the March 24 online issue of the American Journal of Psychiatry.

The MRI scans identified that the degree of functional connectivity between an important emotion processing center (the subcallosal cingulate cortex) and three other areas of the brain was associated with the treatment outcomes. Specifically, patients with positive connectivity between the brain regions were significantly more likely to achieve remission with CBT, whereas patients with negative or absent connectivity were more likely to remit with antidepressant medication.

“All depressions are not equal and like different types of cancer, different types of depression will require specific treatments. Using these scans, we may be able to match a patient to the treatment that is most likely to help them, while avoiding treatments unlikely to provide benefit,” says Helen Mayberg, MD, who led the imaging study. Mayberg is a Professor of Psychiatry, Neurology and Radiology and the Dorothy C. Fuqua Chair in Psychiatric Imaging and Therapeutics at Emory University School of Medicine.

Mayberg and co- investigators Boadie Dunlop, MD, Director of the Emory Mood and Anxiety Disorders Program, and W. Edward Craighead, PhD, J. Rex Fuqua Professor of Psychiatry and Behavioral Sciences, sought to develop methods for a more personalized approach to treating depression.

Current treatment guidelines for major depression recommend that a patient’s preference for psychotherapy or medication be considered in selecting the initial treatment approach. However, in the PReDICT study patients’ preferences were only weakly associated with outcomes; preferences predicted treatment drop-out but not improvement. These results are consistent with prior studies, suggesting that achieving personalized treatment for depressed patients will depend more on identifying specific biological characteristics in patients rather than relying on their symptoms or treatment preferences. The results from PReDICT suggest that brain scans may offer the best approach for personalizing treatment going forward.

In recruiting 344 patients for the study from across the metro Atlanta area, researchers were able to convene a more diverse group of patients than other previous studies, with roughly half of the participants self-identified as African-American or Hispanic.

“Our diverse sample demonstrated that the evidence-based psychotherapy and medication treatments recommended as first line treatments for depression can be extended with confidence beyond a white, non-Hispanic population,” says Dunlop.

“Ultimately our studies show that clinical characteristics, such as age, gender, etc., and even patients’ preferences regarding treatment, are not as good at identifying likely treatment outcomes as the brain measurement,” adds Mayberg.

Source: MRI brain scans may help clinicians decide between CBT and drug treatment for depression

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[WEB SITE] Transcranial magnetic stimulation Overview – Mayo Clinic

Overview

Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven’t been effective.

How it works

During a TMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. And it may activate regions of the brain that have decreased activity in people with depression.

Though the biology of why rTMS works isn’t completely understood, the stimulation appears to affect how this part of the brain is working, which in turn seems to ease depression symptoms and improve mood.

Treatment for depression involves delivering repetitive magnetic pulses, so it’s called repetitive TMS or rTMS.

Visit Site —> Transcranial magnetic stimulation Overview – Mayo Clinic

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[ARTICLE] Notes on Human Trials of Transcranial Direct Current Stimulation between 1960 and 1998 – Full Text

Background: Transcranial direct current stimulation (tDCS) is investigated to modulate neuronal function including cognitive neuroscience and neuropsychiatric therapies. While cases of human stimulation with rudimentary batteries date back more than 200 years, clinical trials with current controlled stimulation were published intermittently since the 1960s. The modern era of tDCS only started after 1998.

Objectives: To review methods and outcomes of tDCS studies from old literature (between 1960 and 1998) with intention of providing new insight for ongoing tDCS trials and development of tDCS protocols especially for the purpose of treatment.

Methods: Articles were identified through a search in PubMed and through the reference list from its selected articles. We included only non-invasive human studies that provided controlled direct current and were written in English, French, Spanish or Portuguese before the year of 1998, the date in which modern stimulation paradigms were implemented.

Results: Fifteen articles met our criteria. The majority were small-randomized controlled clinical trials that enrolled a mean of approximately 26 subjects (Phase II studies). Most of the studies (around 83%) assessed the role of tDCS in the treatment of psychiatric conditions, in which the main outcomes were measured by means of behavioral scales and clinical observation, but the diagnostic precision and the quality of outcome monitoring, including adverse events, were deficient by modern standards. Compared to modern tDCS dose, the stimulation intensities used (0.1–1 mA) were lower, however as the electrodes were typically smaller (e.g., 1.26 cm2), the average electrode current density (0.2 mA/cm2) was approximately 4× higher. The number of sessions ranged from one to 120 (median 14). Notably, the stimulation session durations of several minutes to 11 h (median 4.5 h) could markedly exceed modern tDCS protocols. Twelve studies out of 15 showed positive results. Only mild side effects were reported, with headache and skin alterations the most common.

Conclusion: Most of the studies identified were for psychiatric indications, especially in patients with depression and/or schizophrenia and majority indicated some positive results. Variability in outcome is noted across trials and within trials across subjects, but overall results were reported as encouraging, and consistent with modern efforts, given some responders and mild side effects. The significant difference with modern dose, low current with smaller electrode size and interestingly much longer stimulation duration may worth considering.

Introduction

Transcranial direct current stimulation (tDCS) consists of applying a weak direct current on the scalp, a portion of which crosses the skull (Datta et al., 2009) and induces cortical changes (Fregni and Pascual-Leone, 2007; Nitsche et al., 2008). The investigation of the application of electricity over the brain dates back to at least 200 years, when Giovanni Aldini (Zaghi et al., 2010) recommended galvanism for patients with deafness, amaurosis and “insanity”, reporting good results with this technique especially when used in patients with “melancholia”. Aldini also used tDCS in patients with symptoms of personality disorders and supposedly reported complete rehabilitation following transcranial administration of electric current (Parent, 2004).

These earliest studies used rudimentary batteries and so were constant voltage, where the resulting current depends on a variable body resistance. Over the 20th century, direct voltage continued to be used but most testing involved pulsed stimulation, starting with basic devices where a mechanical circuit that intermittently connected and broke the circuit between the battery and the subject and evolving to modern current control circuits including Cranial Electrotherapy Stimulation and its variants (Guleyupoglu et al., 2013). Interest in direct current stimulation (or tDCS) resurged with the studies of Priori et al. (1998) and Nitsche and Paulus (2000) that demonstrated weak direct current could change cortical response to Transcranial Magnetic Stimulation, thereby indicating that tDCS could change cortical “excitability”. Testing for clinical and cognitive modification soon followed (Fregni et al., 2005, 2006). Developments and challenges in tDCS research, including applications in the treatment of neuro-psychiatrics disease since 1998 have been reviewed in detailed elsewhere (Brunoni et al., 2012).

This historical note aims to explore earlier data on human trial using current controlled stimulation (tDCS) before 1998 with the goal of informing ongoing understanding and development of tDCS protocols. As expected, we found variability in the quality of trial design, data collection and reporting in these earlier studies. Nonetheless, many clinical findings are broadly consistent with modern efforts, including some encouraging results but also variability across subjects. We also describe a significant difference in dose with lower current, smaller electrodes and much longer durations (up to 11 h) than used in modern tDCS.

Figure 2. Summary of study parameters on human trials using transcranial direct current stimulation (tDCS) in old literature (from 1960 to 1998). Models of commonly used montages of tDCS in early studies (A); red: anode electrode(s), blue: cathode electrode(s). Total number of subjects in each group of patients participating in studies using aforementioned montages (B.1) and leading countries conducting tDCS studies in early stage with number of published articles (B.2).

Continue —> Frontiers | Notes on Human Trials of Transcranial Direct Current Stimulation between 1960 and 1998 | Frontiers in Human Neuroscience

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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

 

JKPT_28_355_fig_1.tif

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

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

Abstract

Study Design

Systematic review.

Introduction and Purpose of the Study

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

Methods

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

Results

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

Discussion and Conclusion

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

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

 

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[BLOG] Home After a Stroke – Work Smarter Instead of Harder

 

About Me

I am an occupational therapist (OT) who specialized in stroke rehab.  I continued my education by having a stroke in 2004 that paralyzed my dominant right side.  I still walk with a brace and cane, regained only partial use of my hemiplegic hand, and still have slurred speech when I’m tired.

I live alone so I am both the caregiver and the stroke survivor.  I am divorced and was not able to have children.  My two middle-aged bachelor brothers live 800 miles away and two life-long friends live 1,200 miles away.  My parents are dead.  Thank goodness I have a small army of local friends.

I had my stroke a year after I completed my doctorate in cognitive psychology.  My stroke rehab felt like my last major learning experience so I wrote a book called My Last Degree: A Therapist Goes Home After a StrokeMy sense of purpose continued to grow as I developed Power Point presentations for stroke survivor support groups, rehab professionals, and OT students.  I live in New Jersey, U.S.A.  E-mail me at homeafterastroke3@verizon.net.

The 2nd edition has 44 photos that make it easier to understand what I am describing.  This edition includes solutions to challenges that occur long after formal rehab is over.

There are reports of Amazon listing books as “out of stock” and imposing long delivery times.  You can order this book from the publisher at www.booklocker.com.

Source: Home After a Stroke

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