Posts Tagged Exercise

[Abstract] Efficacy of upper limb constraint-induced movement therapy in patients with stroke and impact on community activities: Outcomes of a pilot phase study



Constraint-Induced Movement Therapy (CIMT) is one of the techniques used to promote sensory-motor recovery of the upper limb in patients with stroke. The aim of this study was to design a pilot phase randomized controlled clinical trial to assess the efficacy of CIMT in the motor performance, and the incorporation of the affected upper limb in community tasks in stroke patients with less than 3 months of evolution.

Materials and methods

The sample was randomly assigned to either CIMT (n = 7) or a control group (n = 6). The outcome measures were assessed pre- and post-intervention by using the Fugl-Meyer Motor Assessment (FMA); dynamometry; Functional Independence Measure (FIM); Arm Motor Ability Test (AMAT); Motor Activity Log (MAL); and Community Activities Scale (CAS).


Both groups were similar on demographics, clinical and baseline outcome scales. Significant effects were noted post-intervention in the CIMT group on AMAT (P<.05), MAL (p<.05), and CAS (P=.05). There were no differences on FMA (P=.880), dynamometry (P=.356), and FIM (P=.508) scores. CAS scale was correlated with tests for assessing the functionality of the upper limb. The relationship was high with the FMA scale (rho=.673) and time (rho = –.627), functional ability (rho=.784) and quality of movement (rho = 735) subscales of AMAT.


CIMT is effective to improve the integration and quality of movement of the affected upper limb in daily life activities and community tasks in individuals with stroke.


via Eficacia de la terapia de movimiento inducido por restricción para miembros superiores en pacientes con accidente cerebrovascular y su impacto en actividades de la comunidad: resultados de la fase piloto – ScienceDirect


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[ARTICLE] Kinect-based individualized upper extremity rehabilitation is effective and feasible for individuals with stroke using a transition from clinic to home protocol – Full Text PDF

Purpose: To investigate the effectiveness and feasibility of Kinect-based upper
extremity rehabilitation on functional performance in chronic stroke survivors.
Methods: This was a single cohort pre-post test study. Participants (N=10; mean age =
62.5 ± 9.06) engaged in Kinect-based training three times a week for four to five weeks
in a university laboratory. To simulate a clinic to home transfer condition,
individualized guidance was given to participants at the initial three sessions followed
by independent usage. Outcomes included Fugl-Meyer assessment of upper extremity,
Wolf Motor Function Test, Stroke Impact Scale, Confidence of Arm and Hand
Movement and Active Range of Motion. Participant experience was assessed using a
structured questionnaire and a semi-structured interview.
Results. Improvement was found in Fugl-Meyer assessment scores (p=0.001), Wolf
Motor Function Test, (p=0.008), Active Range of Motion (p<0.05) and Stroke Impact
Scale-Hand function (p=0.016). Clinically important differences were found in FuglMeyer
assessment scores (Δ= 5.70 ± 3.47) and Wolf Motor Function Test (Δ Time= –
4.45 ± 6.02; ∆ Functional Ability Scores= 0.29 ± 0.31). All participants could use the
system independently and recognized the importance of exercise individualization by
the therapist.
Conclusions. The Kinect-based UE rehabilitation provided clinically important
functional improvements to our study participants.


Stroke is the leading cause of long-term adult disability in the United States [1].
More than a half of survivors continue suffering from upper-limb hemiparesis poststroke with only 5% of people recovering their full arm function [2]. The persistent
upper-limb dysfunction significantly impairs motor performance, and results in a
serious decline in functional ability as well as quality of life [3]. Intensive and repeated
practice with the paretic arm appears necessary to enhance arm recovery and facilitate
neural reorganization [4-7]. Nevertheless, the healthcare system provides limited
amounts and duration of therapy, making it difficult for stroke survivors to achieve
maximal arm recovery before discharge from outpatient rehabilitation or home care
[8,9]. Therefore, identifying novel modalities that are accessible and affordable to the
general public while allowing continued practice of the arm is imperative for improving
long-term upper-limb outcomes after stroke.
One potential approach is the use of low-cost virtual reality (VR)-based systems,
for example, the Microsoft Kinect system. The Kinect is a vision-based motion
capturing system that can detect gesture and movements of the body through its RGA
camera and depth sensors. It allows users to interact with the VR-based system without
holding or wearing specialized equipment or markers for tracking. Users can play
games or practice exercises using natural movements while observing the performance of their virtual avatars shown in real-time on the computer screen. Through this interactive observation and feedback, stroke survivors can correct their movements towards more normal patterns. Furthermore, the Kinect is small and portable, thus enabling stroke survivors to practice exercises in a familiar and private environment. […]

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[Abstract+References] A Computer-Assisted System with Kinect Sensors and Wristband Heart Rate Monitors for Group Classes of Exercise-Based Rehabilitation


Exercise-based rehabilitation for chronic conditions such as cardiovascular disease, diabetes, and chronic obstructive pulmonary disease, constitutes a key element in reducing patient symptoms and improving health status and quality of life. However, group exercise in rehabilitation programmes faces several challenges imposed by the diversified needs of their participants. In this direction, we propose a novel computer-assisted system enhanced with sensors such as Kinect cameras and wristband heart rate monitors, aiming to support the trainer in adapting the exercise programme on-the-fly, according to identified requirements. The proposed system design facilitates maximal tailoring of the exercise programme towards the most beneficial and enjoyable execution of exercises for patient groups. This work contributes in the design of the next-generation of computerised systems in exercise-based rehabilitation.


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via A Computer-Assisted System with Kinect Sensors and Wristband Heart Rate Monitors for Group Classes of Exercise-Based Rehabilitation | SpringerLink

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[ARTICLE] Effectiveness of a multimodal exercise rehabilitation program on walking capacity and functionality after a stroke – Full Text


The aim of this study was to determine the effectiveness of a 12-week multimodal exercise rehabilitation program on walking speed, walking ability and activities of daily living (ADLs) among people who had suffered a stroke. Thirty-one stroke survivors who had completed a conventional rehabilitation program voluntarily participated in the study. Twenty-six participants completed the multimodal exercise rehabilitation program (2 days/wk, 1 hr/session). Physical outcome measures were: walking speed (10-m walking test), walking ability (6-min walking test and functional ambulation classification) and ADLs (Barthel Index). The program consisted on: aerobic exercise; task oriented exercises; balance and postural tonic activities; and stretching. Participants also followed a program of progressive ambulation at home. They were evaluated at baseline, postintervention and at the end of a 6-month follow-up period. After the intervention there were significant improvements in all outcomes measures that were maintained 6 months later. Comfortable and fast walking speed increased an average of 0.16 and 0.40 m/sec, respectively. The walking distance in the 6-min walking test increased an average of 59.8 m. At the end of the intervention, participants had achieved independent ambulation both indoors and outdoors. In ADLs, 40% were independent at baseline vs. 64% at the end of the intervention. Our study demonstrates that a multimodal exercise rehabilitation program adapted to stroke survivors has benefits on walking speed, walking ability and independence in ADLs.
Keywords: Exercise, Physical activity, Stroke rehabilitation, Walking speed, Activities of daily living


As life expectancy increases, a larger number of persons may suffer from stroke. Stroke mortality rates have decreased, but the burden of stroke is increasing in terms of stroke survivors per year, correlated deaths and disability-adjusted life-years lost. These deficiencies are further highlighted by a trend towards more strokes in younger people (Feigin et al., 2014). Stroke not only causes permanent neurological deficits, but also a profound degradation of physical condition, which worsens disability and increases cardiovascular risk. Stroke survivors are likely to suffer functional decline due to reduction of aerobic capacity. This may involve further secondary complications such as progressive muscular atrophy, osteoporosis, peripheral circulation worsening and increased cardiovascular risk (Ivey et al., 2006). All these factors cause increased dependency, need of assistance from third parties in activities of daily living (ADLs) and a restriction on participation that can have a profound psychosocial impact (Carod-Artal and Egido, 2009). Gait capacity is one of the main priorities of persons who have suffered a stroke, but is often limited due to the high energy demands of hemiplegic gait and the poor physical condition of these persons (Ivey et al., 2006). Gait speed is a commonly used measure in patients who have suffered a stroke to differentiate the functional capacity to walk indoors or outdoors. Gait speed has been classified as: allowing indoor ambulation (<0.4 m/sec), limited outdoor ambulation (0.4–0.8 m/sec), and outdoor functional ambulation (>0.8 m/sec) (Perry et al., 1995). Gait speed can also help to establish the functional prognosis of the patient. It has been stated that improvements in walking speed correlate with improved function and quality of life (QoL) (Schmid et al., 2007). It is essential to achieve a proper gait speed for outdoors functional ambulation.
Falls are common among stroke survivors and are associated with a worsening of disability and QoL. Balance is a complex process that involves the reception and integration of afferent inputs and the planning and execution of movement. Stroke can impact on different systems involved in postural control. Multifactorial falls risk assessment and management, combined with fitness programs, are effective in reducing risk of falls and fear of falling (Stroke Foundation of New Zealand and New Zealand Guidelines Group, 2010). Falls often occur when getting in and out of a chair (Brunt et al., 2002). The 2013 Cochrane review (Saunders et al., 2013) recommends the repetitive practice of sit-to-stand in order to promote an ergonomic and automatic pattern of this movement. Recent studies demonstrate that exercises that improve trunk stability and balance provide a solid base for body and leg movements that entail an improved gait in people affected by stroke (Sharma and Kaur, 2017). Conventional rehabilitation programs after stroke focus on the subacute period. The aim is to recover basic ADLs, but they do not provide maintenance exercises to provide long-term health gains. Cardiac monitoring demonstrates that conventional physiotherapy exercises do not regularly provide adequate exercise intensity to modify the physical deconditioning, nor sufficient exercise repetition to improve motor learning (Ivey et al., 2006). Therapeutic physical exercise to optimize function, physical condition and cardiovascular health after a stroke is an emerging field within neurorehabilitation (Teasell et al., 2009). The wide range of difficulties experienced by stroke survivors justify the need to explore rehabilitation programs designed to promote an overall improvement and to maintain the gains obtained after rehabilitation programs. Numerous studies have demonstrated the efficacy of aerobic exercise (Saunders et al., 2016), but there are few data on the long term effects of multimodal programs that incorporate aerobic exercise, complemented by task-oriented training and balance exercises. Consequently, the aim of this study is to analyse the impact of a multimodal exercise rehabilitation program tailored to stroke survivors on walking speed, walking ability and ADLs. […]

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[ARTICLE] Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial – Full Text



What is the comparative cost-effectiveness of a gym-based maintenance exercise program versus a home-based maintenance program with telephone support for adults with chronic health conditions who have previously completed a short-term, supervised group exercise program?


A randomised, controlled trial with blinded outcome assessment at baseline and at 3, 6, 9 and 12 months. The economic evaluation took the form of a trial-based, comparative, incremental cost-utility analysis undertaken from a societal perspective with a 12-month time horizon.


People with chronic health conditions who had completed a 6-week exercise program at a community health service.


One group of participants received a gym-based exercise program and health coaching for 12 months. The other group received a home-based exercise program and health coaching for 12 months with telephone follow-up for the first 10 weeks.

Outcome measures

Healthcare costs were collected from government databases and participant self-report, productivity costs from self-report, and health utility was measured using the European Quality of Life Instrument (EQ-5D-3L).


Of the 105 participants included in this trial, 100 provided sufficient cost and utility measurements to enable inclusion in the economic analyses. Gym-based follow-up would cost an additional AUD491,572 from a societal perspective to gain 1 quality-adjusted life year or 1 year gained in perfect health compared with the home-based approach. There was considerable uncertainty in this finding, in that there was a 37% probability that the home-based approach was both less costly and more effective than the gym-based approach.


The gym-based approach was more costly than the home-based maintenance intervention with telephone support. The uncertainty of these findings suggests that if either intervention is already established in a community setting, then the other intervention is unlikely to replace it efficiently.


Chronic conditions that are related to physical inactivity, such as coronary heart disease, type II diabetes and stroke, are estimated to result in direct healthcare costs of over AUD377 million per year in Australia.1 ;  2 Implementing strategies to increase physical activity in adults with chronic health conditions may be an effective way of reducing the economic impact in Australia. Short-term (ie, 4 to 6 week) supervised interventions, such as cardiac and pulmonary phase II rehabilitation programs, have been shown to be effective in improving quality of life and reducing morbidity and healthcare costs.3 ;  4However, there is evidence to suggest that once the program is completed, adherence to exercise declines along with the health benefits obtained.5 Hence, there is a need to provide interventions to promote long-term exercise adherence after the completion of a short-term exercise program.

A recent review of this field identified two commonly investigated approaches to improve ongoing exercise adherence for adults with chronic health conditions: home-based exercise programs with telephone follow-up, and gym-based exercise programs.6 That review and meta-analysis found no difference in exercise adherence rates between these interventions. Furthermore, it identified no economic evaluations examining the comparative efficiency of the two approaches.

There is an ongoing need to identify efficient means of promoting adherence to exercise in the long term, in order to improve the quality of life of adults with chronic health conditions. The aim of the current study was to examine the economic efficiency of home-based maintenance with telephone follow-up compared with gym-based maintenance exercise amongst adults with a variety of chronic conditions who had completed a short-term supervised exercise program led by a health professional.

Therefore, the study question for this economic analysis of that randomised trial was:

What is the comparative cost-effectiveness of a gym-based maintenance exercise program versus a home-based maintenance program with telephone support for adults with chronic health conditions who have previously completed a short-term, supervised group exercise program?


Continue —> Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial

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[BLOG POST] Signs Your Loved One is Recovering From Stroke – Saebo

A stroke—no matter how severe—can be devastating. Not only does it have the potential to cause damage physically and mentally, but the recovery process can be equally as difficult to navigate. With countless hurdles to overcome, monitoring progress during stroke recovery can be very frustrating, but there are certain things that you or a loved one can do to improve the experience and see results.  

Make and Keep Recovery Goals in Mind

The best thing that you or a loved one can do to set the pace for a healthy recovery is to be honest and open about any limitations or weaknesses that have surfaced as a result of a stroke attack. This transparency will make it clear what obstacles lie ahead and help you set firm, achievable goals.

Another way to remain inspired by this strategy is to personalize your goals as much as possible. For example, if a stroke survivor is trying to regain mobility in their legs, one of their goals may be to dance with a spouse to their favorite song. With the assistance of a personal touch, following through with a plan of action can offer an extra boost of support as opposed to generic goals lacking emotional incentives.

If you’re unsure of your status, or you need help formulating a plan, make sure to speak with a doctor or therapist that can set you on the right course.

Track and Assess Progress

Trying to get a handle on how you or a loved one is recovering after a stroke is perhaps one of the hardest things to do. This is because there are usually multiple problems that need immediate attention, rather than just one issue to focus on.

To combat this overwhelming feeling, make it a habit to track your progress both mentally and physically. Be sure to document your developments each day you work on a specific area no matter how small they may be. For physical categories like strength, range of motion, endurance, and decreasing spasticity, make sure to begin each session by writing down pre-workout numbers, and then noting the post-workout numbers so that comparisons can be made over time. The simple act of recording information will show concrete evidence of improvements or shortcomings, and this information can be further discussed with a doctor or therapist to ensure a pathway to success.

Keep Regular Therapy Appointments

Creating a routine and following it on your own can be a great choice for those who are easily self-motivated, but let’s face it, many of us can get unfocused or unmotivated. If you find yourself falling under the latter, then scheduling regular therapy appointments is the perfect way to guarantee continual regiments, as well as consistent support. Especially during the early stages of stroke recovery, having a solid team of trained healthcare professionals can assist in establishing a foundation so that individual recovery can then take place.

Exercise at Home Every Day

Ultimately, the benefits of a recovery program will only be experienced if a stroke survivor keeps up with it. Even though a routine is created by a therapist or doctor, the responsibility of executing it falls entirely on the patient, so making sure to stay active and consistent is essential for progress.

In addition to following a schedule, a stroke survivor must also take into consideration the importance of repetition as it applies to the exercises themselves. Since the main objective for stroke recovery is to restore the body’s abilities, it’s necessary to repeat exercises efficiently and for the correct amount of time. In the way that maintaining a healthy diet requires you to eat nutritious foods every day at multiple times, the body requires repetitive motions to keep up functionality and regain power.

Rehab is an Opportunity

Regardless of where you are in your recovery or where you think you should be, know that all pathways of rehabilitation are different and that there are no expectations to meet besides the ones you set for yourself.

After reading this article, if you happen to discover something that you can work on, that’s great! Healing yourself after a stroke doesn’t have to be experienced as a chore or burden to carry around; better yet, it should be embraced as an opportunity to learn about the body and what can be done to improve it.

If you or a loved one feels that they could benefit from a routine of setting goals and tracking progress, speak with a therapist or doctor to help get started. With patience and understanding, recovery is certainly within reach.

via Signs Your Loved One is Recovering From Stroke | Saebo

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[BLOG POST] Strength training improves the nervous system’s ability to drive muscles

Imagine that the New Year has just begun. You’ve made a resolution to improve your physical fitness. In particular, you want to improve your muscle strength. You’ve heard that people with stronger muscles live longer and have less difficulty standing, walking, and using the toilet when they get older (Rantanen et al. 1999; Ruiz et al. 2008). So, you join a fitness centre and hire a personal trainer. The trainer assesses your maximal strength, and then guides you through a 4-week program that involves lifting weights which are about 80% of your maximum.

Sure enough, after the program, you become stronger (probably around 20% stronger) (Carroll et al. 2011). You think this is great – and it is! You are so excited, you decide to stand in front of your mirror, flex your biceps, and take a selfie (your plan is to post the picture to Facebook to show your friends how much bigger your muscles got). However, after examining the picture, you realise your muscles did not get bigger. Or perhaps they did get a little bigger, but not enough to explain your substantial improvement in strength. You are somewhat disappointed in this, but then you remember your goal was to get stronger, not necessarily bigger, so you post the picture, anyway.

Magnetic stimulation of the brain can be used to test how well a person can voluntarily drive their muscles.

Interestingly, the observations you made are completely consistent with the scientific literature. Within the first weeks of strength training, muscle strength can improve without a change in the size or architecture of the muscle (e.g., Blazevich et al. 2007). Consequently, researchers have speculated that initial improvements in muscle strength from strength training are due primarily to changes in the central nervous system. One hypothesis has been that strength training helps the nervous system learn how to better “drive” or communicate with muscles. This ability is termed voluntary activation, and it can be tested by stimulating the motor area of an individual’s brain while they perform a maximal contraction (Todd et al. 2003). If the stimulation produces extra muscle force, it means that the individual’s nervous system was not maximally activating their muscles. Currently, there is no consensus as to whether voluntary activation can actually be improved by strength training.

Therefore, we conducted a randomised, controlled trial in which one group of participants completed four weeks of strength training, while a control group did not complete the training (Nuzzo et al. in press). For the group who performed the training, each exercise session consisted of four sets of strong contractions of the elbow flexor muscles (i.e., the muscles that bend the elbow, such as the biceps). Before and after the four week intervention, both groups were tested for muscle strength, voluntary activation, and several other measures. The participants were healthy, university-aged, and they had limited or no experience with strength training.


Prior to the intervention, the strength training and control groups had similar levels of muscle strength and activation of the elbow flexor muscles. After the intervention, the group who performed the strength training improved their strength by 13%. They also improved their voluntary activation from 88.7% to 93.4%. The control group did not improve muscle strength or voluntary activation.


The results from our study show that four weeks of strength training improves the brain’s ability to “drive” the elbow flexor muscles to produce their maximal force. This helps to explain how muscles can become stronger, without a change in muscle size or architecture. Moreover, the results suggest that clinicians should consider strength training as a treatment for patients with motor impairments (e.g., stroke), as these individuals are likely to have poor voluntary activation (Bowden et al. 2014).


Nuzzo JL, Barry BK, Jones MD, Gandevia SC, Taylor JL. Effects of four weeks of strength training on the corticomotoneuronal pathway. Med Sci Sports Exerc,  doi: 10.1249/MSS.0000000000001367.


Blazevich AJ, Gill ND, Deans N, Zhou S. Lack of human muscle architectural adaptation after short-term strength training. Muscle Nerve 35: 78-86.

Bowden JL, Taylor JL, McNulty PA. Voluntary activation is reduced in both the more- and less-affected upper limbs after unilateral stroke.Front Neurol 5: 239, 2014.

Carroll TJ, Selvanayagam VS, Riek S, Semmler RG. Neural adaptations to strength training: moving beyond transcranial magnetic stimulation and reflex studies. Acta Physiol 202: 119-140, 2011.

Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD, White L. Midline hand grip strength as a predictor of old age disability.JAMA 281: 558-560, 1999.

Ruiz JR, Sui X, Lobelo F, Morrow Jr. JR, Jackson AW, Sjöström M, Blair SN. Association between muscular strength and mortality in men: prospective cohort study. BMJ 337: a439, 2008.

Todd G, Taylor JL, Gandevia SC. Measurement of voluntary activation of fresh and fatigued human muscles using transcranial magnetic stimulation. J Physiol 555: 661-671, 2003.


Jim Nuzzo is a Postdoctoral Fellow at Neuroscience Research Australia (NeuRA). His research investigates how strength training alters the neural connections between the brain and muscles. Click here to read Jim’s other blogs.

Source: Strength training improves the nervous system’s ability to drive muscles – Motor Impairment

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[WEB SITE] UC study explores how low risk stress reduction treatments may benefit epilepsy patients

Patients with epilepsy face many challenges, but perhaps the most difficult of all is the unpredictability of seizure occurrence. One of the most commonly reported triggers for seizures is stress.

A recent review article in the European journal Seizure, by researchers at University of Cincinnati Epilepsy Center at the UC Gardner Neuroscience Institute, looks at the stress-seizure relationship and how adopting stress reduction techniques may provide benefit as a low risk form of treatment.

The relationship between stress and seizures has been well documented over the last 50 years. It has been noted that stress can not only increase seizure susceptibility and in rare cases a form of reflex epilepsy, but also increase the risk of the development of epilepsy, especially when stressors are severe, prolonged, or experienced early in life.

“Studies to date have looked at the relationship from many angles,” says Michael Privitera, MD, director of the UC Epilepsy Center and professor in the Department of Neurology and Rehabilitation Medicine at the UC College of Medicine. “The earliest studies from the 1980s were primarily diaries of patients who described experiencing more seizures on ‘high-stress days’ than on ‘low-stress days.'”

Privitera and Heather McKee, MD, an assistant professor in the Department of Neurology and Rehabilitation Medicine, looked at 21 studies from the 1980s to present–from patients who kept diaries of stress levels and correlation of seizure frequency, to tracking seizures after major life events, to fMRI studies that looked at responses to stressful verbal/auditory stimuli.

“Most all [of these studies] show increases in seizure frequency after high-stress events. Studies have also followed populations who have collectively experienced stressful events, such as the effects of war, trauma or natural disaster, or the death of a loved one,” says Privitera. All of which found increased seizure risk during such a time of stress.

For example, a 2002 study evaluated the occurrence of epileptic seizures during the war in Croatia in the early 1990s. Children from war-affected areas had epileptic seizures more often than children not affected by the war. Additionally, the 10-year follow up showed that patients who had their first epileptic seizure during a time of stress were more likely to have controlled epilepsy or even be off medication years later.

“Stress is a subjective and highly individualized state of mental or emotional strain. Although it’s quite clear that stress is an important and common seizure precipitant, it remains difficult to obtain objective conclusions about a direct causal factor for individual epilepsy patients,” says McKee.

Another aspect of the stress-seizure relationship is the finding by UC researchers that there were higher anxiety levels in patients with epilepsy who report stress as a seizure precipitant. The researchers suggest patients who believe stress is a seizure trigger may want to talk with their health care provider about screening for anxiety.

“Any patient reporting stress as a seizure trigger should be screened for a treatable mood disorder, especially considering that mood disorders are so common within this population,” adds McKee.

The researchers report that while some small prospective trials using general stress reduction methods have shown promise in improving outcomes in people with epilepsy, large-scale, randomized, controlled trials are needed to convince both patients and providers that stress reduction methods should be standard adjunctive treatments for people with epilepsy.

“What I think some of these studies point to is that efforts toward stress reduction techniques, though somewhat inconsistent, have shown promise in reducing seizure frequency. We need future research to establish evidence-based treatments and clarify biological mechanisms of the stress-seizure relationship,” says Privitera.

Overall, he says, recommending stress reduction methods to patients with epilepsy “could improve overall quality of life and reduce seizure frequency at little to no risk.”

Some low risk stress reduction techniques may include controlled deep breathing, relaxation or mindfulness therapy, as well as exercise, or establishing routines.

Source: UC study explores how low risk stress reduction treatments may benefit epilepsy patients

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[Abstract] Exergaming for individuals with neurological disability: a systematic review

Introduction: Exergames have the potential to enable persons with disabilities to take part in physical activities that are of appropriate “dose-potency” and enjoyable within a relatively safe home environment. It overcomes some of the challenges regarding transportation difficulties in getting to commercial gymnasium facilities, reducing physical activities perceived as “boring” or getting access into the built environment that may be “wheelchair unfriendly”. Objective: This systematic review assessed available evidence whether “exergaming” could be a feasible modality for contributing to a recommended exercise prescription according to current ACSM™ or WHO guidelines for physical activity. Methods: Strategies used to search for published articles were conducted using separate search engines (Google Scholar™, PubMed™ and Web of Science™) on cardiometabolic responses and perceived exertion during exergaming among neurologically-disabled populations possessing similar physical disabilities. Each study was categorized using the SCIRE-Pedro evidence scale. Results: Ten of the 144 articles assessed were identified and met specific inclusion criteria. Key outcome measures included responses, such as energy expenditure, heart rate and perceived exertion. Twelve out of the 17 types of exergaming interventions met the ACSM™ or WHO recommendations of “moderate intensity” physical activity. Exergames such as Wii Jogging, Bicycling, Boxing, DDR and GameCycle reported moderate physical activity intensities. While Wii Snowboarding, Skiing and Bowling only produced light intensities. Conclusion: Preliminary cross-sectional evidence in this review suggested that exergames have the potential to provide moderate intensity physical activity as recommended by ACSM™ or WHO in populations with neurological disabilities. However, more research is needed to document exergaming’s efficacy from longitudinal observations before definitive conclusions can be drawn.

  • Implications for Rehabilitation
  • Exergaming can be deployed as physical activity or exercise using commercially available game consoles for neurologically disabled individuals in the convenience of their home environment and at a relatively inexpensive cost

  • Moderate-to-vigorous intensity exercises can be achieved during exergaming in this population of persons with neurological disabilities. Exergaming can also be engaging and enjoyable, yet achieve the recommended physical activity guidelines proposed by ACSM™ or WHO for health and fitness benefits.

  • Exergaming as physical activity in this population is feasible for individuals with profound disabilities, since it can be used even in sitting position for wheelchair-dependent users, thus providing variability in terms of exercise options.

  • In the context of comprehensive rehabilitation, exergaming should be viewed by the clinician as “at least as good as” (and likely more enjoyable) than traditional arm-exercise modalities, with equivalent aerobic dose-potency as “traditional” exercise in clinic or home environments.

Source: Exergaming for individuals with neurological disability: a systematic review: Disability and Rehabilitation: Vol 39, No 8

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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


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.

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