Posts Tagged neurological disorders

[WEB SITE] Virtual Reality: New Therapy for Neurological Disorders

Virtual Reality: New Therapy for Neurological Disorders

Emerging technology in the form of virtual reality (VR) may provide a new tool to aid treatment for neurological disorders such as autism, schizophrenia and Parkinson’s disease. A recent study suggests that playing games in VR could help individuals with these neurological conditions shift their perceptions of time, which their conditions lead them to perceive differently.

Researchers from the University of Waterloo discovered VR can help improve an individual’s perception of time. “The ability to estimate the passage of time with precision is fundamental to our ability to interact with the world,” says co-author Séamas Weech, a post-doctoral fellow in Kinesiology.

“For some individuals, however, the internal clock is maladjusted, causing timing deficiencies that affect perception and action. Studies like ours help us to understand how these deficiencies might be acquired, and how to recalibrate time perception in the brain.”

Researchers tested 18 females and 13 males with normal vision and no sensory, musculoskeletal or neurological disorders. The researchers used a virtual reality game, Robo Recall, to create a natural setting in which to encourage re-calibration of time perception.

The key manipulation of the study was that the researchers coupled the speed and duration of visual events to the participant’s body movements.

The researchers measured participants’ time perception abilities before and after they were exposed to the dynamic VR task. Some participants also completed non-VR time-perception tasks, such as throwing a ball, to use as a control comparison.

Investigators measured the actual and perceived durations of a moving probe in the time perception tasks. They discovered that the virtual reality manipulation was associated with significant reductions in the participants’ estimates of time, by around 15 percent.

“This study adds valuable proof that the perception of time is flexible, and that VR offers a potentially valuable tool for recalibrating time in the brain,” says Weech. “It offers a compelling application for rehabilitation initiatives that focus on how time perception breaks down in certain populations.”

Weech adds, however, that while the effects were strong during the current study, more research is needed to find out how long the effects last, and whether these signals are observable in the brain.

“For developing clinical applications, we need to know whether these effects are stable for minutes, days, or weeks afterward. A longitudinal study would provide the answer to this question.”

“Virtual reality technology has matured dramatically,” says Michael Barnett-Cowan, neuroscience professor and senior author of the paper.

“VR now convincingly changes our experience of space and time, enabling basic research in perception to inform our understanding of how the brains of normal, injured, aged and diseased populations work and how they can be treated to perform optimally.”

Source: University of Waterloo

 

via Virtual Reality: New Therapy for Neurological Disorders

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[WEB SITE] Functional Strokes – Rehabilitation: Can hypnotic (and allied) techniques help?

Professor Jon Stone started the day by talking about the diagnostic techniques, aetiology and treatment of Functional Motor Disorders. Rather than being a diagnosis formed by exclusion, Professor Stone showed that there are positive diagnostic signs of a functional disorder. Rather than being ‘all in the mind’, they are a disorder of function that may have a variety of psychogenic underpinnings and sometimes no obvious emotional or traumatic trigger. Functional Disorders are something that all humans experience to a greater or lesser extent, from such things as a tension headache to irritable bowel syndrome or functional stroke. Functional Neurological Disorders ‘are no longer assumed to be only the result of ‘conversion’ of psychological conflict but now understood as a complex interplay between physiological stimulus, expectation, learning and attention…. with biopsychosocial predisposing, triggering and perpetuating inputs’.1

Dr Ranjan Sanyal, a Consultant Stroke Physician, University Hospitals of North Midlands then described how he uses hypnosis with functional strokes. Functional disorders are very common and are responsible not only for a large amount of human suffering, but also a huge cost to the economy of over £14 billion.2 8.4% of all strokes are functional and the condition can be as debilitating as Parkinson’s or Multiple Sclerosis. Dr Sanyal described how he uses hypnosis very successfully with his patients, building rapport, using imagery, and giving appropriate suggestions in hypnosis. Dr Alastair Dobbin then talked about how positive and negative episodic memories that lie outside of conscious awareness can influence our feelings of autonomy, competence and relatedness. Someone with resilience has rapid access to positive emotions which speeds recovery from a threat, so our therapies should seed or prime a growth or recovery model in our patients.

Pauline Halliday, an Occupational Therapist and a Clinical Specialist in stroke, then gave a presentation as to how she used hypnosis to help a ‘difficult’ stroke patient with ‘functional overlay’. By means of a simple breathing induction and using imagery of a safe, calm place and a beach, that the patient could go to in her imagination, her agitation and anxiety were reduced. She was taught how to use this whenever she wanted to feel calmer. This also improved her sleep pattern. Pauline also uses hypnosis with patients with Thalamic or Central Pain Syndrome using the patient’s metaphors in hypnosis to help a change in perception (switches, water, warmth etc.) with a resultant reduction in analgesic medication. She has also used hypnosis successfully to manage fear of going into the MRI Scanner, during Carotid Endarterectomy, with Functional Stroke (mainly with vocal dysfunction), and generalised anxiety.

After lunch, Dr Jason Price, a prominent Consultant Neuropsychologist from South Tees Hospital NHS Trust talked about how the profile of hypnosis in the NHS suffers from ‘alternative therapy’ perception. Far from being an ‘alternative therapy’ Dr Price argues, hypnosis sits comfortably within the ‘3rd Wave’ cognitive therapies such as Mindfulness, Acceptance and Commitment Therapy, Compassion Focused Therapy, DBT and Transdiagnostic Therapy. There is also good evidence of ‘added value’ of hypnosis with other ‘mainstream’ therapies. He pointed out the importance of imagery, not only in hypnosis but also within these other therapeutic approaches. It works in a primary modality and is very powerful in re-scripting/ cognitive restructuring in trauma work.3Visual Imagery is recommended for post-stroke limb movement recovery (National Clinical Guideline for Stroke 5th edition, 2016) and there are similarities, as well as some differences between hypnosis and mindfulness4,5 and hypnosis and EMDR.6 Hypnosis can both reproduce and remove functional symptoms, ‘turn off’ the neural circuits involved in agency, the executive processes involved in self-monitoring and automatic neuropsychological processes.7 With EEG and fMRI evidence the development of cognitive neuroscientific understanding of hypnosis has developed alongside contemporary cognitive neuroscience understanding of Functional Neurological Disorders.8-11

Dr Paul Molyneux, a Consultant Neurologist from West Suffolk Hospital Trust and Addenbrookes, then reported how he uses hypnosis within an out-patient department treating Non-Epileptic Seizures and migraine. In a busy clinic there is very little time to make a diagnosis let alone treat the condition but informal hypnotic techniques can help. This involves using reflective listening, with attention to body language, confirming and explaining the diagnosis while building rapport, together with the careful use of language and metaphor, especially when breaking the diagnosis of Non-Epileptic Seizures.12 He stressed the importance of touch and giving reassurance by physical examination and then using a simple hypnotic induction to increase the effectiveness of the positive suggestions given. Dr Molyneux also described how he uses hypnosis and metaphorical imagery to help patients with migraines. Self-hypnosis gives the patient a life long tool.

This was followed by Devin Terhune from Goldsmith’s University of London describing his recent meta-analysis of hypnotic suggestibility in functional and dissociative disorders which support an increased hypnotic susceptibility. The limitations of methodology give rise to a weak scientific evidence base despite the fact that patients and doctors find hypnosis helpful and empowering.

The final presentation of the day was given by Professor Charles Warlow, Emeritus Professor of Medical Neurology at Western General Hospital, summarising why hypnosis has been underutilised in the past and how it could be used in the future.

A most fascinating day was ended by a general panel discussion between the presenters and the audience on the way forward for hypnosis in the management of Functional Neurological Disorders.

References

  1. Complex regional pain syndrome and functional neurological disorders: time for reconciliation. Popkirov S, Hoeritzauer I, Colvin L, Carson A & Stone J (2018) Journal of Neurology, Neurosurgery & Psychiatry. Published Online First: 24 October 2018. doi: 10.1136/jnnp-2018-318298
  2. The cost of somatisation among the working‐age population in England for the year 2008–2009. (2010) Bermingham S, Cohen A, Hague J & Parsonage M. Mental Health in Family Medicine. Vol 7(2): 71–84.
  3. Imagery re-scripting and reprocessing therapy after failed prolonged exposure for post-traumatic stress disorder following industrial injury. (2007) Grunert B K, Weis J M, Smucker M R, Christianson H F. Journal of Behaviour Therapy & Experimental Psychiatry. Vol 38 (4) 317-28.
  4. Do Hypnosis and Mindfulness Practices Inhabit a Common Domain? Implications for Research, Clinical Practice, and Forensic Science. (2012) Lynn S, Malaktaris A, Maxwell R, Mellinger D & van der Kloet D. Journal of Mind-Body Regulation. Vol 2 (1) 12-26
  5. Metacognition of intentions in mindfulness and hypnosis. (2016) Lush P, Naish P & Dienes Z. Neuroscience of Consciousness. Volume 2016, Issue 1, 1 January 2016
  6. Introduction to the Special Section: Hypnosis and EMDR. (2001) Frischholz J, Kowal J & Hammond, D. The American Journal of Clinical Hypnosis. Vol 43(3-4) 179-182
  7. Hypnosis as therapy for functional neurologic disorders. (2017) Deeley Q. Handbook of Clinical Neurology. Vol 139, 585-595
  8. Brain Activity and Functional Connectivity Associated with Hypnosis. (2017) Jiang H, White M, Greicius M, Waelde L & Spiegel D. Cerebral Cortex. Vol 27 (8) 4083-4093.
  9. Neuro-hypnotism: prospects for hypnosis and neuroscience. (2013) Kihlstrom J. Cortex. Vol 49 (2) 365-74.
  10. Hypnotic induction is followed by state-like changes in the organization of EEG functional connectivity in the theta and beta frequency bands in high-hypnotically susceptible individuals. (2014) Jamieson G & Burgess A. Frontiers in Human Neuroscience 2014 (8) 528.
  11. Improving working memory performance in brain-injured patients using hypnotic suggestion. (2017) Lindeløv J, Overgaard R & Overgaard M. Brain. Vol 140 (4) 1100- 1106.
  12. Acceptability and effectiveness of a strategy for the communication of the diagnosis of psychogenic nonepileptic seizures. (2010) Hall-Patch L, Brown R, House A, Howlett S, Kemp S, Lawton G, Mayor R, Smith P, Reuber M; NEST collaborators. Epilepsia. Vol 51(1) 70-8.

via Functional Strokes – Rehabilitation: Can hypnotic (and allied) techniques help? | ACNR | Online Neurology Journal

 

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[Abstract] Active exergames to improve cognitive functioning in neurological disabilities: a systematic review and meta-analysis

INTRODUCTION: Exergames represent a way to perform physical activity through active video games, serving as potentially useful tool in the field of neurorehabilitation. However, little is known regarding the possible role of exergames in improving cognitive functions in persons suffering from neurological disabilities.

 

EVIDENCE ACQUISITION: A search for relevant articles was carried out on PubMed/Medline, Scopus, PEDro, and Google Scholar. Only randomized controlled studies and non-randomized but controlled studies were retained. The following additional inclusion criteria were applied: studies focused on physical activity interventions carried out by means of exergames; populations targeted were affected by neurological disabilities; and reported results were related to cognitive outcomes. We calculated standardized mean differences (SMD) and pooled results using a random effects meta-analysis.

EVIDENCE SYNTHESIS: Of 520 abstracts screened, thirteen studies met the criteria to be included yielding a total of 465 participants, 233 randomized to exergames, and 232 allocated to the alternative or no intervention. The included studies varied in terms of studied populations (e.g., multiple sclerosis, post-stroke hemiparesis, Parkinson’s disease, dementia, dyslexia, Down syndrome), type and duration of interventions, and cognitive outcome measures. Exergames significantly improved executive functions (SMD=0.53, P=0.005; 8 studies, N.=380) and visuo-spatial perception (SMD=0.65, P<0.0001; 5 studies, N.=209) when compared to the alternative or no intervention. There were no significant differences for attention (SMD=0.57, P=0.07; 7 studies, N.=250) and global cognition (SMD=0.05, P=0.80; 6 studies, N.=161).

CONCLUSIONS: Exergames are a highly-flexible tool for rehabilitation of both cognitive and motor functions in adult populations suffering from various neurological disabilities and developmental neurological disorders. Additional high-quality clinical trials with larger samples and more specific cognitive outcomes are needed to corroborate these preliminary findings.

CLINICAL REHABILITATION IMPACT: Exergames could be considered either as a supplemental treatment to conventional rehabilitation, or as strategy to extend benefits of conventional programs at home.

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via Active exergames to improve cognitive functioning in neurological disabilities: a systematic review and meta-analysis – European Journal of Physical and Rehabilitation Medicine 2018 June;54(3):450-62 – Minerva Medica – Journals

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[VIDEO] Robotic Exoskeleton Helps People With Neurological Disorders – YouTube

This robotic exoskeleton helps people get their mobility back. Harmony, the robotic exoskeleton, can assist individuals who have had strokes or spinal injuries.

For more visit: https://reneu.robotics.utexas.edu/pro…

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[CORDIS] European stem cell consortium for neural cell replacement, reprogramming and functional brain repair – Projects and Results

From 2013-10-01 to 2017-09-30, closed project

Project details

Total cost: EUR 8 186 684,46

EU contribution: EUR 6 000 000

Coordinated in: Italy

Call for proposal:

FP7-HEALTH-2013-INNOVATION-1See other projects for this call

Funding scheme:

CP-FP – Small or medium-scale focused research project

via European Commission : CORDIS : Projects and Results : European stem cell consortium for neural cell replacement, reprogramming and functional brain repair

Objective

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[WEB SITE] Robot-Assisted Therapy: What Is Right for Your Clinic?

Published on 

One of the advantages of this gait training system is that it uses end-effector technology to assist patients in stepping, while a therapist provides manual facilitation. (Photo by Kevin Hentz)

by Rebecca Martin, OTR/L, OTD, and Dennis Tom-Wigfield, PT, DPT

Investment in therapeutic technologies spans a continuum from elastic bands that cost a few dollars to room-sized mobility and balance systems that require construction build-outs and additional staff. Inhabiting the middle to upper range of this continuum are robotic devices and associated technology, which have become increasingly popular. Though these advanced technologies deserve a thorough cost-benefit analysis and review of competing products prior to purchase, the payoff they may provide in outcomes and efficiency can make the investment well worth the effort.

Among the facility-based technologies that have grabbed recent headlines, robot-assisted therapy is one that may be attractive to healthcare organizations. Robot-assisted therapy is an efficacious method to remediate disability associated with a wide variety of neurological disorders, most notably stroke and spinal cord injury (SCI). Intensity and repetition has been repeatedly demonstrated to be necessary for central nervous system excitation and associated motor learning.1Massed practice, or high-volume repetition, has been shown to improve muscle strength and voluntary function.2 Robot-assisted therapy has the capacity to provide high numbers of specific movements with support or guidance as necessary, ensuring optimal conditions for motor learning and recovery of function.3 Changes can be observed in as little as 6 weeks and peak around 12 weeks of training.4

Nearly all robotic devices include some sort of computer interface, even a virtual reality component, providing the patient and therapist with real-time feedback to improve performance. Robotic devices also allow for quantitative monitoring; measuring changes in strength, range of motion, and trajectory; and illuminating patient engagement trends, time, and effort.3 As the body of literature expands and supports its use, patients are seeking clinics with these resources. Robotic technology has the potential to align patients’ interests in validated strategies with clinics’ interests in efficiency and payor-supported interventions. Clinics have an opportunity to improve patient outcomes and efficiency with which they reach those outcomes by investing in robotic devices. This investment is not trivial, however, and better understanding of the capacity and scope of different devices will help to make sure that everyone’s resources are utilized appropriately.

Assessment: Get the Complete Picture

Before it begins to investigate and trial devices, a clinic should do a careful self-assessment. Clinics should have a good understanding of their patient factors and needs: demographics, diagnoses, and payor mix. Equally important, clinics should have a good understanding of how much of their own resources—money, time, and space—they have to spend. Although money is often considered to be the limiting factor in the acquisition of technology, time and space deserve equal consideration. Nothing would be worse than investing in the perfect body weight support (BWS) gait trainer, only to find that your ceiling is too low to accommodate it. Similarly, clinics should anticipate that therapists will need time outside patient care to learn the devices and that efficiency will suffer in the early learning phase. Clinics will want to consider existing technology and therapist-driven interventions when deciding on their specific needs. Clinics would benefit from having a clear plan for acquisition and incorporation of robotic technology into existing practices. Acquiring too much technology too quickly is a sure way to reduce integration of devices and waste valuable resources.

 

Visit Site —> Robot-Assisted Therapy: What Is Right for Your Clinic? – Rehab Managment

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[Abstract] Active exergames to improve cognitive functioning in neurological disabilities: a systematic review and meta-analysis

INTRODUCTION: Exergames represent a way to perform physical activity through active video games, serving as potentially useful tool in the field of neurorehabilitation. However, little is known regarding the possible role of exergames in improving cognitive functions in persons suffering from neurological disabilities.
EVIDENCE ACQUISITION: A search for relevant articles was carried out on PubMed/Medline, Scopus, PEDro, and Google Scholar. Only randomized controlled studies and non-randomized but controlled studies were retained. The following additional inclusion criteria were applied: studies focused on physical activity interventions carried out by means of exergames; populations targeted were affected by neurological disabilities; and reported results were related to cognitive outcomes. We calculated standardized mean differences (SMD) and pooled results using a random effects meta-analysis.
EVIDENCE SYNTHESIS: Of 520 abstracts screened, thirteen studies met the criteria to be included yielding a total of 465 participants, 233 randomized to exergames, and 232 allocated to the alternative or no intervention. The included studies varied in terms of studied populations (e.g., multiple sclerosis, post-stroke hemiparesis, Parkinson’s disease, dementia, dyslexia, Down syndrome), type and duration of interventions, and cognitive outcome measures. Exergames significantly improved executive functions (SMD=0.53, p=0.005; 8 studies, n=380) and visuo-spatial perception (SMD=0.65, p<0.0001; 5 studies, n=209) when compared to the alternative or no intervention. There were no significant differences for attention (SMD=0.57, p=0.07; 7 studies, n=250) and global cognition (SMD=0.05, p=0.80; 6 studies, n=161).
CONCLUSIONS: Exergames are a highly-flexible tool for rehabilitation of both cognitive and motor functions in adult populations suffering from various neurological disabilities and developmental neurological disorders. Additional high-quality clinical trials with larger samples and more specific cognitive outcomes are needed to corroborate these preliminary findings.
CLINICAL REHABILITATION IMPACT: Exergames could be considered either as a supplemental treatment to conventional rehabilitation, or as strategy to extend benefits of conventional programs at home.

Full Text  PDF  

via Active exergames to improve cognitive functioning in neurological disabilities: a systematic review and meta-analysis – European Journal of Physical and Rehabilitation Medicine 2017 Oct 25 – Minerva Medica – Journals

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[Proceedings] Proceedings of the Third Neurological Disorders Summit (NDS-2017) – Journal of Neurology & Experimental Neuroscience – PDF file

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[Abstract] Linking of the quality of life in neurological disorders (Neuro-QoL) to the international classification of functioning, disability and health

Abstract

Background

The quality of life in neurological disorders (Neuro-QoL) is a U.S. National Institutes of Health initiative that produced a set of self-report measures of physical, mental, and social health experienced by adults or children who have a neurological condition or disorder.

Objective

To describe the content of the Neuro-QoL at the item level using the World Health Organization’s international classification of functioning, disability and health (ICF).

Methods

We assessed the Neuro-QoL for its content coverage of functioning and disability relative to each of the four ICF domains (i.e., body functions, body structures, activities and participation, and environment). We used second-level ICF three-digit codes to classify items into categories within each ICF domain and computed the percentage of categories within each ICF domain that were represented in the Neuro-QoL items.

Results

All items of Neuro-QoL could be mapped to the ICF categories at the second-level classification codes. The activities and participation domain and the mental functions category of the body functions domain were the areas most often represented by Neuro-QoL. Neuro-QoL provides limited coverage of the environmental factors and body structure domains.

Conclusions

Neuro-QoL measures map well to the ICF. The Neuro-QoL–ICF-mapped items provide a blueprint for users to select appropriate measures in ICF-based measurement applications.

Source: Linking of the quality of life in neurological disorders (Neuro-QoL) to the international classification of functioning, disability and health | SpringerLink

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[VIDEO] Robots help stroke victims regain use of arms – Euronews

http://www.euronews.com/embed/305482

Introduced two decades ago for patients with neurological disorders, rehabilitation robotics is now a relatively widespread recovery method for patients.

At the National Hospital for Neurology and Neurosurgery in London, robots are used to help stroke victims regain the use of their arms.

Exoskeletons are attached to computer games specially designed to exercise specific sets of upper body muscles. At least 500 repetitions of a movement are needed to make any lasting change.

“It adds variety to the rehabilitation that they’re receiving which adds interest, and patients need to focus on what they’re doing and they need to concentrate again in order to change to affect plasticity,” says Fran Brander, a clinical physiotherapist at the NHNN in London.

“But it’s not the be all and end all. We couldn’t just buy six robots and have no therapists, or nobody to do the hands-on stuff, because the robot won’t lengthen tight muscles, it won’t know which are the specifically weak muscles that need strengthening.”

Before starting the exercise, the patient’s ability to move his or her arm is fed into the computer. If they are unable to move their arm, the robot moves it for them. If they start to move, the robot provides adjustable levels of assistance to help out, helping the brain and arm to learn to work together again.

“You forget what the arm can do when it hasn’t been used for some time. So they teach you new skills and put you on this upper hand clinic (clinical device) to encourage you to be able to use the right arm again,” explains one patient.

While the introduction of such devices doesn’t mean traditional physiotherapy is no longer needed, it can leave the most repetitive exercises to machines, freeing up more time for other, more complex tasks by humans.

Source: Robots help stroke victims regain use of arms | Euronews

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