Posted by Kostas Pantremenos in Cognitive Rehabilitation, Educational on December 19, 2018
What’s the most transformative thing that you can do for your brain today? Exercise! says neuroscientist Wendy Suzuki. Get inspired to go to the gym as Suzuki discusses the science of how working out boosts your mood and memory — and protects your brain against neurodegenerative diseases like Alzheimer’s.
This talk was presented at an official TED conference, and was featured by our editors on the home page.
What if I told you there was something that you can do right now that would have an immediate, positive benefit for your brain including your mood and your focus? And what if I told you that same thing could actually last a long time and protect your brain from different conditions like depression, Alzheimer’s disease or dementia. Would you do it? Yes!
I am talking about the powerful effects of physical activity. Simply moving your body,has immediate, long-lasting and protective benefits for your brain. And that can last for the rest of your life. So what I want to do today is tell you a story about how I used my deep understanding of neuroscience, as a professor of neuroscience, to essentially do an experiment on myself in which I discovered the science underlying why exercise is the most transformative thing that you can do for your brain today. Now, as a neuroscientist, I know that our brains, that is the thing in our head right now, that is the most complex structure known to humankind. But it’s one thing to talk about the brain,and it’s another to see it.
So here is a real preserved human brain. And it’s going to illustrate two key areas that we are going to talk about today. The first is the prefrontal cortex, right behind your forehead, critical for things like decision-making, focus, attention and your personality.The second key area is located in the temporal lobe, shown right here. You have two temporal lobes in your brain, the right and the left, and deep in the temporal lobe is a key structure critical for your ability to form and retain new long-term memories for facts and events. And that structure is called the hippocampus. So I’ve always been fascinated with the hippocampus. How could it be that an event that lasts just a moment, say, your first kiss, or the moment your first child was born, can form a memory that has changed your brain, that lasts an entire lifetime? That’s what I want to understand. I wanted to start and record the activity of individual brain cells in the hippocampus as subjects were forming new memories. And essentially try and decode how those brief bursts of electrical activity, which is how neurons communicate with each other, how those brief bursts either allowed us to form a new memory, or did not.
But a few years ago, I did something very unusual in science. As a full professor of neural science, I decided to completely switch my research program. Because I encountered something that was so amazing, with the potential to change so many lives that I had to study it. I discovered and I experienced the brain-changing effects of exercise. And I did it in a completely inadvertent way. I was actually at the height of all the memory work that I was doing — data was pouring in, I was becoming known in my field for all of this memory work. And it should have been going great. It was, scientifically. But when I stuck my head out of my lab door, I noticed something. I had no social life. I spent too much time listening to those brain cells in a dark room, by myself. (Laughter) I didn’t move my body at all. I had gained 25 pounds. And actually, it took me many years to realize it, I was actually miserable. And I shouldn’t be miserable. And I went on a river-rafting trip — by myself, because I had no social life.And I came back —
thinking, “Oh, my God, I was the weakest person on that trip.” And I came back with a mission. I said, “I’m never going to feel like the weakest person on a river-rafting trip again.” And that’s what made me go to the gym. And I focused my type-A personalityon going to all the exercise classes at the gym. I tried everything. I went to kickbox, dance, yoga, step class, and at first it was really hard. But what I noticed is that after every sweat-inducing workout that I tried, I had this great mood boost and this great energy boost. And that’s what kept me going back to the gym. Well, I started feeling stronger. I started feeling better, I even lost that 25 pounds.
And now, fast-forward a year and a half into this regular exercise program and I noticed something that really made me sit up and take notice. I was sitting at my desk, writing a research grant, and a thought went through my mind that had never gone through my mind before. And that thought was, “Gee, grant-writing is going well today.” And all the scientists —
yeah, all the scientists always laugh when I say that, because grant-writing never goes well. It is so hard; you’re always pulling your hair out, trying to come up with that million-dollar-winning idea. But I realized that the grant-writing was going well,because I was able to focus and maintain my attention for longer than I had before.And my long-term memory — what I was studying in my own lab — seemed to be better in me. And that’s when I put it together.
Maybe all that exercise that I had included and added to my life was changing my brain. Maybe I did an experiment on myself without even knowing it. So as a curious neuroscientist, I went to the literature to see what I could find about what we knewabout the effects of exercise on the brain. And what I found was an exciting and a growing literature that was essentially showing everything that I noticed in myself.Better mood, better energy, better memory, better attention. And the more I learned,the more I realized how powerful exercise was. Which eventually led me to the big decision to completely shift my research focus. And so now, after several years of really focusing on this question, I’ve come to the following conclusion: that exercise is the most transformative thing that you can do for your brain today for the following three reasons.
Number one: it has immediate effects on your brain. A single workout that you do will immediately increase levels of neurotransmitters like dopamine, serotonin and noradrenaline. That is going to increase your mood right after that workout, exactly what I was feeling. My lab showed that a single workout can improve your ability to shift and focus attention, and that focus improvement will last for at least two hours.And finally, studies have shown that a single workout will improve your reaction timeswhich basically means that you are going to be faster at catching that cup of Starbucks that falls off the counter, which is very, very important.
But these immediate effects are transient, they help you right after. What you have to do is do what I did, that is change your exercise regime, increase your cardiorespiratory function, to get the long-lasting effects. And these effects are long-lasting because exercise actually changes the brain’s anatomy, physiology and function. Let’s start with my favorite brain area, the hippocampus. The hippocampus —or exercise actually produces brand new brain cells, new brain cells in the hippocampus, that actually increase its volume, as well as improve your long-term memory, OK? And that including in you and me.
Number two: the most common finding in neuroscience studies, looking at effects of long-term exercise, is improved attention function dependent on your prefrontal cortex. You not only get better focus and attention, but the volume of the hippocampus increases as well. And finally, you not only get immediate effects of mood with exercise but those last for a long time. So you get long-lasting increases in those good mood neurotransmitters.
But really, the most transformative thing that exercise will do is its protective effects on your brain. Here you can think about the brain like a muscle. The more you’re working out, the bigger and stronger your hippocampus and prefrontal cortex gets. Why is that important? Because the prefrontal cortex and the hippocampus are the two areas that are most susceptible to neurodegenerative diseases and normal cognitive decline in aging. So with increased exercise over your lifetime, you’re not going to cure dementia or Alzheimer’s disease, but what you’re going to do is you’re going to create the strongest, biggest hippocampus and prefrontal cortex so it takes longer for these diseases to actually have an effect. You can think of exercise, therefore, as a supercharged 401K for your brain, OK? And it’s even better, because it’s free.
And so I’m going to tell you the answer to that question. First, good news: you don’t have to become a triathlete to get these effects. The rule of thumb is you want to get three to four times a week exercise minimum 30 minutes an exercise session, and you want to get aerobic exercise in. That is, get your heart rate up. And the good news is, you don’t have to go to the gym to get a very expensive gym membership.Add an extra walk around the block in your power walk. You see stairs — take stairs.And power-vacuuming can be as good as the aerobics class that you were going to take at the gym.
So I’ve gone from memory pioneer to exercise explorer. From going into the innermost workings of the brain, to trying to understand how exercise can improve our brain function, and my goal in my lab right now is to go beyond that rule of thumb that I just gave you — three to four times a week, 30 minutes. I want to understand the optimum exercise prescription for you, at your age, at your fitness level, for your genetic background, to maximize the effects of exercise today and also to improve your brain and protect your brain the best for the rest of your life.
via The Brain-Changing Effects of Exercise
Posted by Kostas Pantremenos in Epilepsy on December 3, 2018
People with epilepsy (PWE) are less physically active compared with the general population. Explanations include prejudice, overprotection, unawareness, stigma, fear of seizure induction and lack of knowledge of health professionals. At present, there is no consensus on the role of exercise in epilepsy. This paper reviews the current evidence surrounding the risks and benefits associated with physical activity (PA) in this group of patients. In the last decade, several publications indicate significant benefits in physiological and psychological health parameters, including mood and cognition, physical conditioning, social interaction, quality of life, as well as potential prevention of seizure presentation. Moreover, experimental studies suggest that PA provides mechanisms of neuronal protection, related to biochemical and structural changes including release of β-endorphins and steroids, which may exert an inhibitory effect on the occurrence of abnormal electrical activity. Epileptic discharges can decrease or disappear during exercise, which may translate into reduced seizure recurrence. In some patients, exercise may precipitate seizures. Available evidence suggests that PA should be encouraged in PWE in order to promote wellbeing and quality of life. There is a need for prospective randomized controlled studies that provide stronger clinical evidence before definitive recommendations can be made.
Posted by Kostas Pantremenos in Paretic Hand on October 30, 2018
Posted by Kostas Pantremenos in Video Games/Exergames, Virtual reality rehabilitation on May 23, 2018
via Designing an augmented reality video game to assist stroke patients with independent rehabilitation
Posted by Kostas Pantremenos in REHABILITATION, Tele/Home Rehabilitation on May 23, 2018
There’s no place like home for engaging in the levels of physical activity (PA) that can aid in recovery poststroke—at least compared with the current hospital setting—according to a small study from Australia.
For the study, researchers used accelerometers and self-reports to track the PA and sitting time of 32 participants (mean age of 68, 53% male) who had experienced a stroke, comparing data gathered during their last week in the hospital with data gathered during their first week home. Participants were also assessed in a number of areas during their final week in the hospital, including physical function, functional independence, pain, anxiety, and depression.
The researchers were interested in finding out if an individual’s environment plays a role in PA poststroke—something they describe as “pivotal” to recovery—and whether other factors, such as depression, have an effect on any changes in PA levels. Results were e-published ahead of print in theArchives of Physical Medicine and Rehabilitation (abstract only available for free).
They found that environment does seem to make a difference—and a fairly big one at that. While the amount of time spent awake didn’t change much from hospital to home (13.1 hours a day in the hospital vs 13.5 hours per day at home), the amount of PA achieved—and time spent in sedentary behaviors—varied significantly. Participants sat for an average of 45 fewer minutes a day at home than they did in their last week in the hospital, were upright for 45 more minutes a day, spent 12 more minutes a day walking, and completed an average of 724 additional daily steps.
The results were similar when adjusted for demographic variables and didn’t seem to be significantly affected by any of the secondary factors assessed in the hospital, save one—depression, which when present was associated with no gains in PA at home.
The researchers don’t pin the improvement to any single factor but speculate that “the home environment may provide greater opportunity for activities of daily living such as cooking, cleaning, social and community activities, and there may be fewer external restrictions such as hospital routines and safety concerns around mobilization.”
Authors of the study also believe the gap between home and hospital PA poststroke could be closed if hospitals were to take more cues from the home environment.
“Physically, cognitively, and socially enriched stroke rehabilitation environments appear to increase activity by 20%,” they write. “Wards [that] include communal areas to promote more time spent upright, and the need to transport patients further for personal care may create opportunities for activity. The low activity levels in [the] hospital and at home found in our study, and in prior reports…indicate that there is clearly more work to be done in promoting activity after stroke.”
via Study: Home Is a Better Bet Than Hospitals for Achieving More PA Poststroke
Posted by Kostas Pantremenos in Cognitive Rehabilitation, Rehabilitation robotics, Uncategorized on May 6, 2018
Many participants in the University of Plymouth study praised the ‘non-judgmental’ nature of the humanoid NAO robot as it delivered its session — with one even saying they preferred it to a human.
Credit: University of Plymouth
Many participants in the University of Plymouth study praised the ‘non-judgemental’ nature of the humanoid NAO robot as it delivered its session — with one even saying they preferred it to a human.
Led by the School of Psychology, the study also showed that the robot achieved a fundamental objective of MI as it encouraged participants, who wanted to increase their physical activity, to articulate their goals and dilemmas aloud.
MI is a technique that involves the counsellor supporting and encouraging someone to talk about their need for change, and their reasons for wanting to change.
The role of the interviewer in MI is mainly to evoke a conversation about change and commitment, and the robot was programmed with a set script designed to elicit ideas and conversation on how someone could increase their physical activity.
When finished answering each question, the participant taped the top of NAO’s head to continue, with some sessions lasting up to an hour.
Lead academic Professor Jackie Andrade explained that, because they are perceived as nonjudgmental, robots may have advantages over more humanoid avatars for delivering virtual support for behavioral change.
“We were pleasantly surprised by how easily the participants adapted to the unusual experience of discussing their lifestyle with a robot,” she said. “As we have shown for the first time that a motivational interview delivered by a social robot can elicit out-loud discussion from participants.
“In addition, the participants perceived the interaction as enjoyable, interesting and helpful. Participants found it especially useful to hear themselves talking about their behaviour aloud, and liked the fact that the robot didn’t interrupt, which suggests that this new intervention has a potential advantage over other technology-delivered adaptations of MI.
“Concern about being judged by a human interviewer came across strongly in praise for the non-judgemental nature of the robot, suggesting that robots may be particularly helpful for eliciting talk about sensitive issues.
“The next stage is to undertake a quantitative study, where we can measure whether participants felt that the intervention actually increased their activity levels.”
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Journal Reference:
Posted by Kostas Pantremenos in Gait Rehabilitation - Foot Drop on January 14, 2018
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. […]
Posted by Kostas Pantremenos in Cognitive Rehabilitation on December 28, 2017
Could a walk in the park help to maintain cognitive health in old age?
As we grow older, memory problems can begin to set in. These could be a natural part of aging and a minor annoyance, but in some cases, the issues may indicate mild cognitive impairment and could even develop into dementia.
Regardless of how mild or severe these memory problems may be, they are definitely distressing and can affect an individual’s quality of life.
New research from the Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles suggests that there is a relatively easy way of keeping your brain in top shape as you grow older: take a moderately long walk every day.
This could boost your attention, the efficiency with which you process information, and other cognitive skills, say first study author Prabha Siddarth and colleagues.
The research findings were recently published the Journal of Alzheimer’s Disease.
Siddarth and team initially recruited 29 adults aged 60 and over, of which 26 completed the study over a 2-year period. The participants were split into two distinct groups:
All the participants reported a degree of memory complaints at baseline, but none of them had a dementia diagnosis.
In order to explore the potential effect of physical activity on cognitive ability, the researchers used MRI to determine the volume and thickness of the hippocampus, which is a brain region associated with memory formation and storage, and spatial orientation.
Previous research suggested that the size and volume of this brain region can tell us something about cognitive health. For instance, a higher hippocampal volume has been shown to indicate more effective memory consolidation.
“Few studies have looked at how physical activity affects the thickness of brain structures,” says Siddarth.
“Brain thickness,” she notes, “a more sensitive measure than volume, can track subtle changes in the brain earlier than volume and can independently predict cognition, so this is an important question.”
In addition to the MRI scans, the participants also underwent a set of neuropsychological tests, to consolidate the assessment of their cognitive capacity.
It was found that those in the high physical activity group — who walked more than 4,000 steps (approximately 3 kilometers) each day — had thicker hippocampi, as well as thicker associated brain regions, when compared with that of the those falling under the low physical activity category.
The highly active group was also found to have better attention, speedier information processing abilities, and more efficient executive function, which includes working memory. Working memory is the resource that we tap into on a daily basis when we need to make spontaneous decisions.
However, Siddarth and colleagues reported no significant differences between the high activity and low activity groups when it came to memory recall.
The next step from here, the researchers suggest, should be to undertake a longitudinal analysis in order to test the relationship between physical activity and cognitive ability over time.
They also note the need to better understand the mechanisms behind cognitive decline in relation to hippocampal atrophy.
via Walk 4,000 steps every day to boost brain function
Posted by Kostas Pantremenos in REHABILITATION on July 14, 2017
The aim of this study was to describe accelerometer-derived sleep duration, sedentary behavior, physical activity, and quality of life and their association with demographic and clinical factors within the first month after inpatient stroke rehabilitation.
Thirty people with stroke (mean ± standard deviation, age: 63.8 ± 12.3 years, time since stroke: 3.6 ± 1.1 months) wore an activPAL3 Micro accelerometer (PAL Technologies, Glasgow, Scotland) continuously for 7 days to measure whole-day activity behavior. The Stroke Impact Scale and the Functional Independence Measure were used to assess quality of life and function, respectively.
Sleep duration ranged from 6.6 to 11.6 hours/day. Fifteen participants engaged in long sleep greater than 9 hours/day. Participants spent 74.8% of waking hours in sedentary behavior, 17.9% standing, and 7.3% stepping. Of stepping time, only a median of 1.1 (interquartile range: .3-5.8) minutes were spent walking at a moderate-to-vigorous intensity (≥100 steps/minute). The time spent sedentary, the stepping time, and the number of steps differed significantly by the hemiparetic side (P < .05), but not by sex or the type of stroke. There were moderate to strong correlations between the stepping time and the number of steps with gait speed (Spearman r = .49 and .61 respectively, P < .01). Correlations between accelerometer-derived variables and age, time since stroke, and cognition were not significant.
People with stroke sleep for longer than the normal duration, spend about three quarters of their waking hours in sedentary behaviors, and engage in minimal walking following stroke rehabilitation. Our findings provide a rationale for the development of behavior change strategies after stroke.
Posted by Kostas Pantremenos in Books on June 5, 2017
As technology becomes an ever more prevalent part of everyday life and population-based physical activity programmes seek new ways to increase lifelong engagement with physical activity, so the two have become increasingly linked. This book offers a thorough, critical examination of emerging technologies in physical activity and health, considering technological interventions within the dominant theoretical frameworks, exploring the challenges of integrating technology into physical activity promotion and offering solutions for its implementation.
Technology in Physical Activity and Health Promotion occupies a broadly positive stance toward interactive technology initiatives and, while discussing some negative implications of an increased use of technology, offers practical recommendations for promoting physical activity through a range of media, including:
Offering a logical and clear critique of technology in physical activity and health promotion, this book will serve as an essential reference for upper-level undergraduates, postgraduate students and scholars working in public health, physical activity and health and kinesiology, and healthcare professionals.
Source: Technology in Physical Activity and Health Promotion – Google Books
TBI Rehabilitation 