Posts Tagged healthcare.

[Abstract] Information Management in IoT Cloud-Based Tele-Rehabilitation as a Service for Smart Cities: Comparison of NoSQL Approaches

 

Abstract

Nowadays, recent advancements in ICT have sped up the development of new services for smart cities in different application domains. One of these is definitely healthcare. In this context, remote patient monitoring and rehabilitation activities can take place either in satellite hospital centres or directly in citizens’ homes. Specifically, using a combination of Cloud computing, Internet of Things (IoT) and big data analytics technologies, patients with motor disabilities can be remotely assisted avoiding stressful waiting times and overcoming geographical barriers. This paper focuses on the Tele-Rehabilitation as a Service (TRaaS) concept. Such a service generates healthcare big data coming from remote rehabilitation devices used by patients that need to be processed in the hospital Cloud. Specifically, after a feasibility analysis, by using a Lokomat dataset as sample, we measured and compared the performances of four of the major NoSQL DBMS(s) demonstrating that the document approach well suits our case study.

 

via Information Management in IoT Cloud-Based Tele-Rehabilitation as a Service for Smart Cities: Comparison of NoSQL Approaches – ScienceDirect

, , , , , , , , ,

Leave a comment

[WEB SITE] Top 10 Virtual Reality Applications In Today’s World

The premise of virtual reality has always been exciting. Slip-on a pair of goggles or a headset, and you’re on your way to another world. Unlike at the cinema or in front of your TV screen, you’re free to interact with your surroundings and wander wherever you please.

VR exploded into public consciousness around the same time as the personal computer in the late ‘80s and early ‘90s. Back in those days, however, the difference between the real world and the pixel-heavy digital landscapes of the time was too great for everyone but for the most hardcore fans. As a result, VR was more or less put on the backburner for a couple of decades.

However, the birth of the Oculus Rift in 2012 and its subsequent purchase by Facebook in 2014 led to a renewal of interest in virtual reality applications. It also served as an uptick in virtual reality recruitment as companies cottoned on to the medium’s vast potential.

How Does Virtual Reality Work?

So, how does virtual reality work? Nowadays, virtual reality is implemented using computer technology via tools such as headsets, goggles, treadmills, and handsets. These tools stimulate our senses to create an illusion of reality. This is far more complicated than it seems: human physiology is calibrated to provide a finely synchronized experience, and if anything is ‘odd’, our bodies will usually let us know via unpleasant sensations such as nausea or motion sickness. A successful virtual reality experience involves careful synchronicity of software, hardware, and of our senses. The most memorable virtual reality uses are those that enable us to interact naturally with our surroundings with no latency or glitches that could create a feeling of artificiality.

This leads us to ask ourselves, “Why do we go to all that trouble to create these highly technical worlds that just aim to imitate reality?” The truth is, virtual reality applications are numerous and beneficial across many fields.

How Does Virtual Reality Work?
Photo by Sales on New Gen Apps

 

Ten Most Exciting Applications Of Virtual Reality

1.  Entertainment

Entertainment is an obvious application of virtual reality. Who wouldn’t want to slip on a headset and escape into another world?

The first thing that comes to mind is gaming. It is a historical virtual reality application that is still very much among the main VR uses today. Other entertainment forms are however hot on its heels. While 3D cinema has been around for quite a while now, the rise of VR headsets is providing users with immersive cinema experiences without them even having to leave the house. Apps such as Oculus Cinema enable viewers to watch movies on their very own virtual screen. At the same time, developers are working on software that will enable sports fans to cheer on their favorite teams from the comfort of their couches. An example is LiveLike VR’s virtual stadium.

Using virtual reality, music lovers can attend concerts and festivals taking place on the other side of the world. Moreover, those who have been bitten by the travel bug can wander sunny beaches without leaving their front yard. What’s not to love?

Virtual Reality In Entertainment
Photo by Liza Brown on Filmora

2.  Training

It is essential for military personnel to gain first-hand experience of the terrain of their deployment. Likewise, when you get on a commercial flight, you assume your pilot has mastered the aircraft and can respond appropriately in any kind of emergency. But have you ever wondered how rookie soldiers and pilots get in their training hours without putting themselves in danger?

Some activities are just too dangerous, impractical, or expensive for beginners to be able to practice them from the get-go. This is where VR comes in. Virtual reality education companies offer software aimed at training new personnel. The US military uses virtual reality simulators to train soldiers before deployment. These VR simulators enable them to practice working together in the kind of environments they will come up against. Likewise, flight simulators are used to train new pilots or refresh their knowledge before they can get before the controls of a real-life plane.

Virtual Reality In Training
Photo by Premayogan on Pentoz

 

 3. Healthcare

With elevated costs, a tendency towards personnel shortages, and people’s lives at stake, the healthcare industry is generally quick to adopt exciting new tech that can boost efficiency and improve performance. Virtual reality is no exception.

Medical institutions can use VR to make diagnoses and define treatments. Some VR simulators are now able to use images from MRIs or CAT scans to create 3D models of a patient’s anatomy. The training applications of virtual reality enable trainee doctors to practice surgery with no risk to patients. Moreover, they can help more experienced ones to determine the safest way to operate.

There are other interesting virtual reality applications in the healthcare industry beyond surgery and diagnoses. For rehabilitation of stroke and brain injury victims, healthcare industries use VR. It provides virtual exercises to help patients gain independence in everyday activities, aided by real-time feedback.

Virtual Reality In Healthcare
Photo by Reenita Das on Forbes

 

4. The Arts

Fans of the performing arts will probably find the idea of a screen between the artist and audience a strange one. However, there are many exciting virtual reality applications when it comes to theatre, opera, dance, circus, and other performing art forms that are characterized by their fleetingness. That is, you have to be there on the night, or else, it’s gone forever. VR enables you to watch a live performance at any time you please. You can even be in the best seat in your house. Why not even from the middle of the stage if you’re feeling adventurous?

There are many other virtual reality applications when it comes to the arts. Directors can create a stage set before they build it. Applications such as Tvori enable you to create 3D animations that you can walk around. The possibilities are endless!

Virtual Reality In The Arts
Photo by Mark Foster on Unilad

 

5. Meditation

According to the World Health Organization, stress is the health epidemic of the 21st century. Furthermore, many seem to think that tech is part of the problem. But what if it was also part of the solution? Apps along the lines of Calm and Headspace already enable you to take a break wherever you happen to be. Moreover, VR is promising to add an extra dimension to your meditation experience.

One of the hardest things about meditation for people who are just starting their meditation journey is learning to just “let go”. Virtual reality meditation apps make that all easier by allowing you to slip on your headset and instantly slip into another world.

Virtual Reality in Meditation
Photo by Michael Gollust on Health

 

6. Mental Health

Virtual reality applications help you relax and let go. Likewise, its applications include therapeutic tools for people who have been through traumatizing experiences or suffer from debilitating stress, PTSD, or phobias.

Virtual reality can provide a safe virtual environment. This enables patients to come into contact with the source of their phobias or fears without endangering themselves. Moreover, interesting advances have already made notably in the field of treatment for war veterans suffering from PTSD.

Benefits Of Using Virtual Reality For Mental Health
Photo by Abbie Arce on LabRoots

 

7. Marketing

AI-powered data analysis is enabling digital marketers to tailor experiences to fit individual tastes like never before. At the same time, consumers are constantly bombarded with advertising. It means that banner blindness is becoming a real problem – and that’s before we even mention adblockers.

VR is a gamechanger for marketers. It enables them to provide exciting, immersive experiences with high entertainment value. In the UK, the cheese manufacturer, Boursin, recently offered a delightful virtual reality exhibit. Users were taken on a journey through a fridge filled with tasty treats, complete with wind simulators for an even more immersive experience.

8. Shopping

Imagine that you’re wandering through a fashionable SoHo boutique looking to pick out a new accessory, and at the same time on your couch several hundred miles away in your pajamas.

Online retailers are now part and parcel of our day-to-day life and are looking to get a make-over. Thanks to the power of VR. The VR start-up Trillenium creates virtual stores for online retailers and has already partnered with the likes of ASOS, one of Europe’s biggest online retailers. Instead of clicking their way through online catalogs, shoppers can go on a virtual tour of a store for a real-time shopping experience. They can even share it with their friends.

9. Journalism

Another exciting virtual reality application is on journalism and online media. VR is enabling media outlets to create immersive storytelling experiences that give the viewer the impression of truly being part of the action. Major players such as the Washington Post and the New York Times are now entering the VR field by offering 360° reports and documentaries. The New York Times made a big splash in 2014 by sending Google Cardboard headsets to its subscribers for them to use with their smartphones.

 10. Architecture

Another exciting application of virtual reality is in architecture. This is for being able to offer their clients virtual walkthroughs, a great way for firms to showcase their projects compared to more traditional 3D projection. It is by giving clients a true sense of space and design.

The potential uses of virtual reality are widespread and diverse, spanning everything from entertainment to healthcare and from journalism to digital marketing. With technology becoming cheaper and more widely available, we can expect to see many more exciting virtual reality applications in the years to come. Stay tuned!

 

via Top 10 Virtual Reality Applications In Today’s World | Robots.net

, , , , , , ,

Leave a comment

[NEWS] New guidance on use of valproate in women, girls of child bearing age with epilepsy published

Apr 2 2019

 

New guidance to support regulations around the use of valproate in women and girls of child bearing age with epilepsy has been published by specialists from 13 UK healthcare bodies including seven Royal Colleges.

And NICE has published a summary of updated guidance for healthcare professionals bringing together all its recommendations and other safety advice on the drug valproate.

The use of sodium valproate during pregnancy is associated with up to a 40 per cent risk of neuordevelopmental disorders and a 10 per cent risk of physical disabilities for an unborn child.

In March 2018, the Medicines and Healthcare products Regulatory Agency published guidelines which meant that valproate could no longer be prescribed for girls and women of childbearing age unless no other effective treatment was available.

Any girl or woman prescribed valproate should also be fully informed of the risks associated with the medication and the need for effective contraception.

But a year on, implementation of the guidelines have thrown up specific challenges with complex issues and individual situations where the best interests of the patient did not always appear to be met.

Claire Glazebrook, Director of Fundraising, Marketing and External Affairs at Epilepsy Society, said:

Over the last year our Helpline has received multiple calls from women, parents and healthcare professionals, all struggling to interpret the guidelines and what they mean for them as individuals. And we know that this experience is replicated across other patient organizations and clinics.

I hope this guidance will help to answer some of their questions and provide clarity in what can be a very emotional and challenging decision.

For some girls and women, they have no option but to take sodium valproate as it may be the only drug that will control their seizures. But that of course means there are some very important and potentially heartbreaking issues to consider around planning a family.

All these women and girls deserve consistency in the advice and information that they receive.”

The new pan-college guidance has been drawn up by Judy Shakespeare of the Royal College of General Practitioners and Sanjay Sisodiya of the Association of British Neurologists and Royal College of Physicians. Sanjay Sisodiya is also Director of Genomics at Epilepsy Society and Professor of Neurology at UCL.

He said: This work has come together through much valued contributions from specialists across all the national bodies involved.

“In some cases the new regulations have lead to situations where the best interests of the patients may not appear to be best served. Some of the points raised by the regulations are also complex ethical issues. We do not attempt to address all these issues in this document but hope that it will bring greater clarity for clinicians  leading to better care for women and girls with epilepsy. All women and girls have individual needs and where possible should be involved in the choices they make about their own health and plans to start a family.”

Writing in the guidance, Professor Dame Sally Davies, Chief Medical Officer for England said:

I am very pleased that the Medical Royal Colleges have come together to produce this important and helpful guidance, so that doctors and other healthcare professionals across primary and secondary care are on the same page regarding the use of sodium valproate – including around instances where its use is still appropriate.”

via New guidance on use of valproate in women, girls of child bearing age with epilepsy published

, , , , , , ,

Leave a comment

[WEB SITE] One Woman, 10 MRI Scans, 10 Different Diagnoses

Cultura RM Exclusive/Sigrid Gombert/Getty Images

An MRI scan is a lot more like a Rorschach test to your radiologist than you’d probably like to imagine.

That’s the summary of a study recently published in The Spine Journal. Researchers sent a 63-year-old woman with lower back pain and a specific set of other symptoms to MRI appointments with ten different radiologists. The radiologists collectively made 49 distinct findings. Zero, however, made it into all ten diagnoses, and only one was reported in nine out of the ten.

Even more alarming: The average report contained between nine and 16 errors, both false-positives and missed diagnoses (which were later found by experts in her specific spinal problem, the comparison points for the study’s researchers). Overall, the study found “poor overall agreement” in radiologists’ opinions of the woman’s condition.

The study differs from past ones in which radiologists viewed MRI results in a research setting and made diagnoses, says co-author Daniel Elgort, vice president of healthcare data analytics and research at the Spreemo Quality Research Institute. “[In those studies] they knew they were being studied, so they made a more careful diagnosis.” Radiologists seeing an average patient are apparently less thorough.

The point of the exercise was to disprove a common misconception among medical consumers. “There is this notion that there are no differences in quality in radiology services,” Elgort says, “that [one] should always decide by price and convenience.”

Radiologists, however, are not the oil change technicians or dry cleaners of the medical world— professions where there is not much difference in performance once one achieves professional-level competency. Instead, the results suggest that some radiology offices are in fact better than others.

While they do not have enough data to prove it, Elgort theorizes that the difference is in cost. Cheaper radiology offices probably employ less experienced staff, use older equipment, cram in appointments, and cut other corners.

“The takeaway should not be, ‘go get the most expensive MRI possible,'” Elgort says. “Healthcare in general isn’t a necessarily a correlation between price and quality. It should definitely be that not every healthcare provider is equally suited to give you the most accurate diagnosis.” He added that patients should seek out radiology labs with specialists in their specific issues.

As for where they found a middle-aged woman willing to get MRI after MRI for weeks, Elgort says they recruited the subject from contacts at the Hospital for Special Surgery in New York City, adding, “She’s a former nurse, so she knows the value of this kind of science.

 

via One Woman, 10 MRI Scans, 10 Different Diagnoses – Tonic

, , , , , ,

Leave a comment

[WEB SITE] Radiologist creates dramatic teaching tool using power of VR

Physicians, trainees and even laypeople can now stand right beside an expert radiologist as he performs one of the most difficult medical procedures of its kind – in virtual reality.

Ziv Haskal, MD, of the University of Virginia Health System, has created a dramatic teaching tool using the power of virtual reality. Whether watched on a high-end VR system or an inexpensive cardboard viewer, Haskal’s virtual procedure puts the viewer right next to him as he creates a new blood vessel in a patient’s liver through a small nick in the patient’s neck.

It’s a complicated procedure – Haskal calls it an “interventional radiology heptathlon” – and his use of VR is set to transform how it is taught. “The current means of teaching is a physical person has to arrive … and go over with the doc beforehand. Or they have to look at a lousy 2D animation on a screen,” Haskal said. “Once you put [VR] glasses on people, it’s like you walk them through a completely different door.”

IR in VR

From inside the VR goggles, viewers can look around in 360 degrees as the procedure, known as a transjugular intrahepatic portosystemic shunt, unfolds around them. Haskal guides them step-by-step through the entire procedure, and strategic use of picture-in-picture lets the viewer see both what Haskal is doing and what he is seeing.

Haskal designed the VR experience as a teaching tool for physicians and trainees, but he can foresee many other game-changing applications. VR might be used to show a patient what to expect during a procedure, to teach a nursing student what must be kept sterile in an operating room or to provide a refresher for physicians who have not performed the procedure recently.

“Watching it in a 2D animation, listening to a lecture, watching a physician on a video simply fails to convey the subtleties of the procedure,” Haskal said. “We’re putting the viewer in the actual environment, where they can return again and again.”

Lifting the Curtain

Haskal debuted the VR tool last weekend at the SIR 2018 Scientific Meeting in Los Angeles. He plans to make the VR publicly available to everyone, for free, on the Journal of Vascular and Interventional Radiology website. (Video clips from the VR video can’t do it justice, but to get a sneak peak at what it’s like, visit UVA’s Making of Medicine blog at https://makingofmedicine.virginia.edu/2018/03/13/into-the-or-in-vr/ )

Ultimately, Haskal hopes to create many more virtual-reality teaching tools for healthcare professionals. “With this approach,” he said, “doctors are simply going to be able to do things better.”

 

via Radiologist creates dramatic teaching tool using power of VR

, , , , , , , ,

Leave a comment

[Abstract] Knowledge Translation: The Bridging Function of Cochrane Rehabilitation

Abstract

Cochrane Rehabilitation is aimed to ensure that all rehabilitation professionals can apply Evidence Based Clinical Practice and take decisions according to the best and most appropriate evidence in this specific field, combining the best available evidence as gathered by high-quality Cochrane systematic reviews, with their own clinical expertise and the values of patients. This mission can be pursued through knowledge translation.

The aim of this article is to shortly present what knowledge translation is, how and why Cochrane (previously known as Cochrane Collaboration) is trying to reorganize itself in light of knowledge translation, and the relevance that this process has for Cochrane Rehabilitation and in the end for the whole world of rehabilitation. It is well known how it is difficult to effectively apply in everyday life what we would like to do and to apply the scientific knowledge in the clinical field: this is called the know-do gap.

In the field of evidence-based medicine, where Cochrane belongs, it has been proven that high-quality evidence is not consistently applied in practice. A solution to these problems is the so-called knowledge translation.

In this context, Cochrane Rehabilitation is organized to provide the best possible knowledge translation in both directions (bridging function), obviously toward the world of rehabilitation (spreading reviews), but also to the Cochrane community (production of reviews significant for rehabilitation). Cochrane is now strongly pushing to improve its knowledge translation activities, and this creates a strong base for Cochrane Rehabilitation work, focused not only on spreading the evidence but also on improving its production to make it more meaningful for the world of rehabilitation.

 

via Knowledge Translation: The Bridging Function of Cochrane Rehabilitation – ScienceDirect

, , , , ,

Leave a comment

[WEB SITE] Monthly cycles of brain activity linked to seizures in patients with epilepsy

January 8, 2018
UC San Francisco neurologists have discovered monthly cycles of brain activity linked to seizures in patients with epilepsy. The finding, published online January 8 in Nature Communications, suggests it may soon be possible for clinicians to identify when patients are at highest risk for seizures, allowing patients to plan around these brief but potentially dangerous events.

“One of the most disabling aspects of having epilepsy is the seeming randomness of seizures,” said study senior author Vikram Rao, MD, PhD, an assistant professor of neurology at UCSF and member of the UCSF Weill Institute for Neurosciences. “If your neurologist can’t tell you if your next seizure is a minute from now or a year from now, you live your life in a state of constant uncertainty, like walking on eggshells. The exciting thing here is that we may soon be able to empower patients by letting them know when they are at high risk and when they can worry less.”

Epilepsy is a chronic disease characterized by recurrent seizures — brief storms of electrical activity in the brain that can cause convulsions, hallucinations, or loss of consciousness. Epilepsy researchers around the world have been working for decades to identify patterns of electrical activity in the brain that signal an oncoming seizure, but with limited success. In part, Rao says, this is because technology has limited the field to recording brain activity for days to weeks at most, and in artificial inpatient settings.

At UCSF Rao has pioneered the use of an implanted brain stimulation device that can quickly halt seizures by precisely stimulating a patient’s brain as a seizure begins. This device, called the NeuroPace RNS® System, has also made it possible for Rao’s team to record seizure-related brain activity for many months or even years in patients as they go about their normal lives. Using this data, the researchers have begun to show that seizures are less random than they appear. They have identified patterns of electrical discharges in the brain that they term “brain irritability” that are associated with higher likelihood of having a seizure.

Related Stories

  • Adequate intake of choline during pregnancy could provide cognitive benefits for offspring
  • Powerful imaging technique sheds light on how the brain responds to vascular injury
  • Callous-unemotional traits linked to brain structure differences in boys, not girls

The new study, based on recordings from the brains of 37 patients fitted with NeuroPace implants, confirmed previous clinical and research observations of daily cycles in patients’ seizure risk, explaining why many patients tend to experience seizures at the same time of day. But the study also revealed that brain irritability rises and falls in much longer cycles lasting weeks or even months, and that seizures are more likely to occur during the rising phase of these longer cycles, just before the peak. The lengths of these long cycles differ from person to person but are highly stable over many years in individual patients, the researchers found.

The researchers show in the paper that when the highest-risk parts of a patient’s daily and long-term cycles of brain irritability overlap, seizures are nearly seven times more likely to occur than when the two cycles are mismatched.

Rao’s team is now using this data to develop a new approach to forecasting patients’ seizure risk, which could allow patients to avoid potentially dangerous activities such as swimming or driving when their seizure risk is highest, and to potentially take steps (such as additional medication doses) to reduce their seizure risk, similar to how people with asthma know to take extra care to bring their inhalers when pollen levels are high.

“I like to compare it to a weather forecast,” Rao said. “In the past, the field has focused on predicting the exact moment a seizure will occur, which is like predicting when lightning will strike. That’s pretty hard. It may be more useful to be able tell people there is a 5 percent chance of a thunderstorm this week, but a 90 percent chance next week. That kind of information lets you prepare.”

Source:
https://www.ucsf.edu/

via Monthly cycles of brain activity linked to seizures in patients with epilepsy

, , , , , , , , , , , ,

Leave a comment

[Abstract] How do patients describe their disabilities? A coding system for categorizing patients’ descriptions

Abstract

Background

To provide care that meets the values and preferences of patients with disabilities, health care providers need to understand patients’ perceptions and understanding of their disability. No studies have explored patients’ definitions of disability within the healthcare setting.

Objective

The aim of the study was to understand how patients’ define their disability in the healthcare setting and to develop a coding system for categorizing how they describe their disability.

Methods

In 2000 all new outpatients at Mayo Clinic, Rochester, MN completed a form that inquired if they had a disability and if so, to write in the disability. The research team categorized the responses by disability type (e.g.: visual or physical) and how the patient described his disability or “disability narrative” (e.g.: diagnosis or activity).

Results

Within 128,636 patients, 14,908 reported a disability. For adults, lower limb (26%) and chronic conditions (24%) were the most frequent disability type and activity limitations (56%) were the most frequent disability narrative category. For pediatric patients, developmental disabilities (43%) were the most frequently reported disability type and diagnoses (83%) were the most frequent disability narrative category. Patients used different disability narrative categories to describe different disability types. For example, most adults reporting a mental health listed a diagnosis (97%), compared to only 13% of those with lower limb disabilities.

Conclusions

Patients had diverse descriptions of their disabilities. In order for providers and healthcare organizations to provide high-quality care, they should engage patients in developing a consistent, patient-centered language around disability.

Source: How do patients describe their disabilities? A coding system for categorizing patients’ descriptions – Disability and Health Journal

, ,

Leave a comment

[WEB SITE] Findings reveal how seizures can have lasting detrimental effects on memory

October 16, 2017

Although it’s been clear that seizures are linked to memory loss and other cognitive deficits in patients with Alzheimer’s disease, how this happens has been puzzling. In a study published in the journal Nature Medicine, a team of researchers reveals a mechanism that can explain how even relatively infrequent seizures can lead to long-lasting cognitive deficits in animal models. A better understanding of this new mechanism may lead to future strategies to reduce cognitive deficits in Alzheimer’s disease and other conditions associated with seizures, such as epilepsy.

“It’s been hard to reconcile how infrequent seizures can lead to persistent changes in memory in patients with Alzheimer’s disease,” said corresponding author Dr. Jeannie Chin, assistant professor of neuroscience at Baylor College of Medicine. “To solve this puzzle, we worked with a mouse model of Alzheimer’s disease focusing on the genetic changes that seizures might trigger in the memory center of the brain, the hippocampus, that could lead to loss of memory or other cognitive deficits.”

The researchers measured the levels of a number of proteins involved in memory and learning and found that levels of the protein deltaFosB strikingly increase in the hippocampus of Alzheimer’s disease mice that had seizures. DeltaFosB already is well known for its association with other neurological conditions linked to persistent brain activity of specific brain regions, such as addiction. In this study, the researchers found that after a seizure, the deltaFosB protein remains in the hippocampus for an unusually long time; its half-life – the time it takes for the amount of protein to decrease by half – is eight days. Most proteins have a half-life that is between hours and a day or two.

“Interestingly, because deltaFosB is a transcription factor, meaning that its job is to regulate the expression of other proteins, these findings led us to predict that the increased deltaFosB levels might be responsible for suppressing the production of proteins that are necessary for learning and memory,” Chin said. “In fact, we found that when the levels of deltaFosB increase, those of other proteins, such as calbindin, decrease. Calbindin also has been known for a long time to be involved in Alzheimer’s disease and epilepsy, but its mechanism of regulation was not known. We then hypothesized that deltaFosB might be regulating the production of calbindin.”

Further investigations supported the researchers’ hypothesis. The scientists showed that deltaFosB can bind to the gene calbindin suppressing the expression of the protein. When they either prevented deltaFosB activity or experimentally increased calbindin expression in the mice, calbindin levels were restored and the mice improved their memory. And when researchers experimentally increased deltaFosB levels in normal mice, calbindin expression was suppressed and the animals’ memory deteriorated, demonstrating that deltaFosB and calbindin are key regulators of memory.

Connecting pieces of the puzzle

“Our findings have helped us answer the question of how even infrequent seizures can have such lasting detrimental effects on memory,” Chin said. “We found that seizures can increase the levels of deltaFosB in the hippocampus, which results in a decrease in the levels of calbindin, a regulator of memory processes. DeltaFosB has a relatively long half-life, therefore even when seizures are infrequent, deltaFosB remains in the hippocampus for weeks acting like a brake, reducing the production of calbindin and other proteins, and disrupting the consequent brain activity involved in memory. The regulation of gene expression far outlasts the actual seizure event that triggered it.”

The scientists found the same changes in deltaFosB and calbindin levels in the hippocampus of Alzheimer’s disease patients and in the temporal lobe of epilepsy patients. However, they underscore that it is too soon to know whether regulating deltaFosB or calbindin could improve or prevent memory problems or other cognitive deficits in people with Alzheimer’s disease. However, “now that we know that the levels of deltaFosB and calbindin are effective markers of brain activity in the hippocampus and memory function, we propose that these markers could potentially help assess clinical therapies for Alzheimer’s and other diseases with seizures,” Chin said.

Source: Findings reveal how seizures can have lasting detrimental effects on memory

, , , , , , , , , , , , , , , ,

Leave a comment

[WEB SITE] Undergoing physiotherapy exercises from home now a reality for patients

SINGAPORE: Patients from two healthcare institutions across Singapore will be able to carry out physiotherapy exercises in the comfort of their own homes, after a national tele-rehabilitation pilot was launched on Friday (May 5) by Integrated Health Information Systems (IHiS).

IHiS, Singapore’s healthcare technology agency, developed the system together with T-Rehab, a start-up founded by researchers from the National University of Singapore (NUS). 

To use the service, patients open an app on an iPad – called Smart Health TeleRehab – and put on neck and limb sensors, depending on which part of the body they are exercising. The instructions are available in five languages: English, Mandarin, Bahasa Melayu, Tamil and Tagalog. 

Video demonstrations of the exercises prescribed by the therapists will then be played via the app. The therapist is able to customise the level of difficulty of each exercise, from the number of repetitions to the angle of each limb movement.

The patient’s movements are also recorded for the therapist to review, and to motivate the patient to complete his or her exercises, the system designed to have gaming elements. For instance, there are coloured bars to indicate if the patient has achieved the desired exercise angle, and a counter for the number of repetitions completed. 

After the patient completes the exercises, a record of the patient’s performance is sent to the therapist.

The service is available to those deemed suitable to perform physiotherapy exercises without the physical supervision of a physiotherapist. This includes those recovering from strokes, lower limb joint replacements and amputations, falls and fractures. 

It is currently offered by NTUC Health and TOUCH Home Care. Twelve other institutions including Ang Mo Kio-Thye Hua Kwan Hospital, Khoo Teck Puat Hospital, and the National University Hospital will provide the service by end-2017.

There are 200 sets of tele-rehabilitation equipment available, which is rented out to the healthcare institutions for a fee. IHiS hopes to get 1,000 patients on the programme by the end of the two-year pilot and currently has around 11 patients on the service since February this year, said Mr Chua Chee Yong, director of IHiS’ planning group.

OVERCOMING INCONVENIENCE, HIGH COSTS

This service comes two-and-a-half years after clinical trials were conducted by the researchers from T-Rehab. 

A total of 100 stroke patients were recruited from Ang Mo Kio-Thye Hua Kwan Hospital and the Singapore General Hospital since January 2014, said Dr Gerald Koh, an associate professor and the director of medical undergraduate education at Saw Swee Hock School of Public Health at NUS. He is one of the founders of T-Rehab. 

They chose to develop a tele-rehab system after an earlier study he conducted found that only two out of five patients wanted to continue with rehabilitation after discharge, he said. This is despite close to four out of five of them stating that rehabilitation was useful.

According to Dr Koh, many of them cited inconvenience, high costs and difficulty getting to the rehab centre without a caregiver as the main reasons why they stopped going for rehabilitation.

“The very reason why I need rehabilitation is the very reason why I can’t get to the day rehab centre three times a week,” Dr Koh said of the issue of immobility faced by patients. 

His study found that those who got therapy through tele-rehabilitation recovered as well as those who did their exercises with a therapist present. 

This new service, Dr Koh added, will help to boost rehabilitation participation rate and remove the barriers to carrying out physiotherapy and this will prevent their conditions from deteriorating further.

One of the early adopters of the system, TOUCH Home Care, found that the service benefits both patients and its healthcare workers since it implemented the system in March 2017.

For TOUCH Home Care, the price per session is still the same as a home visit at S$18. However, as the patient is able to carry out the exercises more frequently and at their own time, the hope is that he or she will recover faster and overall, fewer therapy sessions are required, said a physiotherapist at TOUCH Home Care Vivian Lim.

The operator’s therapists have also been more productive.

So far, they spend about 50 minutes on each tele-rehabilitation session, which include prescribing the exercise via the system, reviewing the elderly client’s exercise records and conducting video consultations or calling the patients to provide feedback. A home visit will typically take about 100 minutes, including time to travel from one home to another.

The sessions are not meant to substitute home visits entirely, said Ms Lim, but can replace some of the weekly sessions.

However, not all clients are able to benefit from the new service, as those with conditions such as chronic giddiness and seizures will not be able to perform their exercises without direct supervision, said Ms Rachel Lim, a senior occupational therapist from TOUCH Home Care. 

Some of the seniors also “lack confidence” in using technology, while others may not have the right caregivers at home. “There are some caregivers are also elderly who are frail (themselves), with sensory deficits…they can’t help put on the sensors,” said the occupational therapist.

TOUCH Home Care hopes to get 90 of its 300 clients using the remote rehabilitation tool by the end of this year. It now has seven on board.

MEETING SINGAPORE’S HEALTHCARE NEEDS

The tele-rehabilitation service was developed in light of Singapore’s healthcare landscape, said IHiS’ Mr Chua.

“Our growing ageing population (means) we have more aged elderly in the community… more healthcare workers, including our therapists, are also getting older,” he said. This means that there will be greater demand for rehabilitation services, while there will be a growing need to “stretch our manpower resources”.

The service is one of three telemedicine initiatives that will begin this year. A remote vital signs monitoring system will launch later this year, while a national videoconferencing platform for healthcare services was launched in April.

Source: Undergoing physiotherapy exercises from home now a reality for patients

, , , , ,

Leave a comment

%d bloggers like this: