Posts Tagged Safety

[ARTICLE] Adaptive Treadmill-Assisted Virtual Reality-Based Gait Rehabilitation for Post-Stroke Physical Reconditioning—a Feasibility Study in Low-Resource Settings – Full Text

Abstract

Objectives: Individuals with chronic stroke suffer from heterogeneous functional limitations, including cardiovascular dysfunction and gait disorders (associated with increased energy expenditure) besides psychological factors, e.g., motivation. To recondition their cardiovascular endurance and gait, rehabilitation exercises with gradually increasing exercise intensity suiting their individualized capabilities need to be offered. In principal accordance, here we (i) implemented an adaptive Virtual Reality (VR)-based treadmill-assisted platform sensitive to energy expenditure, (ii) investigated its safety and feasibility of use and (iii) examined the implications of gait exercise with this platform on cardiac and gait performance along with energy expenditure, clinical measures (to estimate physical reconditioning of subjects with stroke) and their views on community ambulation capabilities. Methods: Ten able-bodied subjects volunteered in a study to ensure its safety and feasibility of use. Nine subjects with chronic stroke underwent physical reconditioning over multiple exposures using our platform. We investigated the patients’ cardiac and gait performance prior and post exposure to our platform along with studying the clinical relevance of gait parameters in estimating their physical reconditioning. We collected the patients’ feedback. Results: We found statistical improvement in the gait parameters and reduction in energy expenditure during overground walk following ~1 month of gait exercise with our platform. They reported that the VR-based tasks were motivating. Conclusion: Results show that this platform can pave the way towards implementing home-based individualized exercise platform that can monitor one’s cardiac and gait performance capabilities while offering an adaptive and progressive gait exercise environment within safety thresholds suiting one’s exercise capabilities.
Physiological Cost Index sensitive Adaptive Response Technology (PCI-ART) for post-stroke physical reconditioning. Note: PCI- Physiological Cost Index; SST-Single Support Time; AL- Affected limb; UAL- Unaffected limb.

Physiological Cost Index sensitive Adaptive Response Technology (PCI-ART) for post-stroke physical reconditioning. Note: PCI- Physiological Cost Index; SST-Single Support Time; AL- Affected limb; UAL- Unaffected limb. 

SECTION I.

Introduction

Neurological disorders, such as stroke is a leading cause of disability with a prevalence rate of 424 in 100,000 individuals in India [1]. Often, these patients suffer from functional disabilities, heterogeneous physical deconditioning along with deteriorated cardiac functioning [2], [3] and a sedentary lifestyle immediately following stroke [4]. A deconditioned patient requires reconditioning of his/her cardiac capacity and ambulation capabilities that can be achieved through individualized rehabilitation [5]. This needs to be done under the supervision of a clinician who can monitor one’s functional capability, cardiac capacity and gait performance thereby recommending an appropriate dosage of the gait rehabilitation exercise intensity to the patient along with feedback. Such gait rehabilitation is crucial since about 80% of these patients have been reported to suffer from gait-related disorders [6] along with more energy expenditure than able-bodied individuals [7] often accompanied with reduced cardiac capacity [2], [4]. However, given the low doctor-to-patient ratio [8], lack of rehabilitation facilities and patients being released early from rehabilitation clinics followed by home-based exercise [9], particularly in developing countries like India, availing individualized rehabilitation services becomes difficult. Again, undergoing home-based exercises under clinician’s one-on-one supervision becomes difficult given the restricted healthcare resources, thereby limiting the rehabilitation outcomes [10]. Again, given the restricted healthcare resources, getting a clinician visiting the homes for delivering therapy sessions to patients is often costly causing the patients to miss the expert inputs on the exercise intensity suiting his/her exercise capability along with motivational feedback from the clinician [11]. This necessitates the use of a complementary technology-assisted rehabilitation platform that can be availed by the patient at his/her home [12] following a short stay at the rehabilitation clinic [13]. Again, it is preferred that this platform be capable of offering individualized gait exercise while varying the dosage of exercise intensity (based on the patient’s exercise capability) along with motivational feedback [14]. Additionally, exercise administered by this platform can be complemented with intermediate clinician-mediated assessments of rehabilitation outcomes, thereby reducing continuous demands on the restricted clinical resources. Thus, it is important to investigate the use of such technology-assisted gait exercise platforms that are capable of offering exercise based on one’s individualized capability along with motivational feedback.

Researchers have explored the use of technology-assisted solutions to offer rehabilitative gait exercises to these patients, along with presenting motivational feedback [15]–[16][17][18][19][20][21][22][23][24]. Specifically, investigators have used Virtual Reality (VR) coupled with a treadmill (having a limited footprint and making it suitable for home-based settings) while delivering individualized feedback [15] to the patient during exercise. Again, VR can help to project scenarios that can make the exercise engaging and interactive for a user [16]–[17][18][19]. In fact, Finley et al. have shown that the visual feedback offered by VR provides an optical flow that can induce changes in the gait performance (quantified in terms of gait parameters, e.g., Step Length, Step Symmetry, etc.) of such patients during treadmill-assisted walk [20]. Further, Jaffe et al. have reported positive implications of VR-based treadmill-assisted walking exercise on the gait performance of individuals with stroke [23], leading to improvement in their community ambulation [24]. These studies have shown the efficacy of the VR-based treadmill-assisted gait exercise platform to contribute towards gait rehabilitation of individuals suffering from stroke. Though promising, none of these platforms are sensitive to one’s individualized exercise capability and thus, in turn, could not decide an optimum dosage of exercise intensity suiting one’s capability, e.g., cardiac capacity and ambulation capability. This is particularly critical for individuals with stroke since they possess diminished exercise ability along with deteriorated cardiac functioning [2], [4].

From literature review, we find that after stroke, treadmill-assisted cardiac exercise programs can lead to one’s improved fitness and exercise capability [25]. For example, researchers have presented studies on Moderate-Intensity Continuous Exercise and High-Intensity Interval Training in which exercise protocols are individualized by a clinician based on one’s cardiac capacity while contributing to effective gait rehabilitation [26]–[27][28][29]. Though promising, these have not offered a progressive and adaptive exercise environment in which the dosage of exercise intensity is varied based on one’s cardiac capacity in real-time. Thus, the choice of optimum dosage of exercise intensity that can be individualized in real-time for a patient, still remains as inadequately explored [4]. For deciding the optimal dosage of rehabilitative exercise intensity, clinicians often refer to the guidelines recommended by the American College of Sports Medicine (ACSM) [30]. These guidelines suggest thresholds to decide the intensity of the exercise based on one’s metabolic energy consumption in terms of oxygen intake, heart rate, etc. Deciding the dosage of exercise intensity is crucial, particularly for individuals with stroke since their energy requirements have been reported to be 55-100% higher than that of their able-bodied counterparts [7]. Specifically, higher energy requirement often limits the capabilities of these patients and challenges their rehabilitation outcomes. This can be addressed if the technology-assisted gait exercise platform can offer individualized exercise (maintaining the safe exercise thresholds) based on the energy expenditure of the patients acquired in real-time during the exercise.

The energy expenditure can be defined as the cost of physical activity [4] and it is often expressed in terms of oxygen consumption or heart rate [31]. Thus, investigators have monitored the oxygen consumption and heart rate to estimate the energy expenditure of individuals with stroke during their walk [31], [32]. However, monitoring oxygen consumption during exercise requires a cumbersome setup [31], making it unsuitable for home-based rehabilitation. On the other hand, one’s heart rate (HR) can be monitored using portable solutions [33] that can be integrated with a treadmill in home-based settings. Researchers have explored treadmill-assisted gait exercise platforms that are sensitive to the user’s heart rate. For example, researchers have offered treadmill training to subjects with stroke in which some of them varied treadmill speed to achieve 45%-50% [34], while others varied speed to achieve 85% to 95% [35], [36] of one’s age-related maximum heart rate. Again, Pohl et al. have offered treadmill-assisted exercise to subjects with stroke while ensuring that the user’s heart rate settled to the respective resting-state heart rate [37]. Again of late, there had been advanced treadmills, available off-the-shelf, that can monitor one’s heart rate and vary the treadmill speed to maintain the user’s heart rate at a predefined level [38], [39]. Though one’s heart rate is an important indicator that needs to be considered during treadmill-assisted exercise, one’s walking speed while using the treadmill also offers important information on one’s exercise capability. This is because gait rehabilitation aims to improve one’s community ambulation that is related to one’s walking speed [40]. Thus, it would be interesting to explore the composite effect of one’s walking speed along with working and resting-state heart rates during treadmill-assisted gait exercise to study one’s energy expenditure, quantified in terms of a proxy index, namely Physiological Cost Index (PCI) [31].

Given that there are no existing studies that have used a treadmill-assisted gait exercise platform deciding the dosage of exercise intensity based on one’s PCI estimated in real-time during exercise, it might be interesting to explore the use of such an individualized gait exercise platform for individuals with stroke. Thus, we wanted to extend a treadmill-assisted gait exercise platform by making it adaptive to one’s individualized PCI. Additionally, we wanted to augment this platform with VR-based user interface to offer visual feedback to the user undergoing gait exercise. We hypothesized that such a gait exercise platform can recondition a patient’s exercise capability in terms of cardiac and gait performance to achieve improved community ambulation. The objectives of our research were three-fold, namely to (i) implement a novel PCI-sensitive Adaptive Response Technology (PCI-ART) offering VR-based treadmill-assisted gait exercise, (ii) investigate the safety and feasibility of use of this platform among able-bodied individuals before applying it to subjects with stroke and (iii) examine implications of undergoing gait exercise with this platform on the patients’ (a) cardiac and gait performance along with energy expenditure, (b) clinical measures estimating the physical reconditioning and (c) views on their community ambulation capabilities.

The rest of the paper is organized as follows: Section II presents our system design. Section III explains the experiments and procedures of this study. Section IV discusses the results. In Section V, we summarize our findings, limitations, and scope of future research.[…]

Continue —-> Adaptive Treadmill-Assisted Virtual Reality-Based Gait Rehabilitation for Post-Stroke Physical Reconditioning—a Feasibility Study in Low-Resource Settings – IEEE Journals & Magazine

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[WEB SITE] Is Stem Cell Therapy Effective?

Is stem cell therapy safe and effective?

Find out if the therapy is beneficial for a specific disease,
how and why it works and what the treatment involves

This article is written by Eremin Ilya – Vice Director for Science and Research at Swiss Medica clinic.

Swiss Medica specializes in the most cutting edge stem cell therapies for 8 years. Their head office is based in Switzerland and they have treatment centers in Russia, Moscow and Serbia, Belgrade.
As a result, patients have seen a halt in the progression and/or symptoms of a vast array of diseases, such as arthritis, diabetes, multiple sclerosis, autism, Parkinson’s and other hard to treat diseases.

What are stem cells?
Stem cells are the unique types of cells that are able to replicate itself and to launch the regeneration processes. Stem cells are circulating into the body and looking for damaged areas to repair them. They are also able to put out the inflammation.

This helps to eliminate the cause of the disorders, to reduce its symptoms or even to get a full recovery, depends on the initial condition. And the most important, stem cell treatment is a gentle way of healing that is safe and side-effect free in most cases.

When you undergo cell-based treatment, you get 100+ million viable stem cells in one dose. Cells are harvested from the patient’s body and then cultivated to this quantity. Donated stem cells can be also used for immediate treatment.

Not for all cases, but there is a high percentage of getting health improvements that can be reached in variety diseases.

 

What are the expected results?
Using stem cells in therapy helps to reduce symptoms and can even stop or reverse the progression of some diseases, mostly autoimmune and/or diseases associated with tissue damage. These types of cells trigger the healing process and help to:

– relieve inflammation;
– reduce pain;
– repair wounds and damaged tissues;
– stimulate the formation of neurons and new blood vessels;
– restore lost functions;
– eliminate the signs of aging.

Depending on the patient’s condition, we use cell products based on autologous (patient’s own) or donor cells. Activated stem cells can be administered in several ways, depending on the purpose of the therapy, the disease, and the patient’s condition (IV, intrathecal, intramuscular, retrobulbar or local injection).

 

It is important to understand that stem cells are not a guaranteed cure for every disease.The patient may be denied stem cell procedures for various reasons. The effectiveness of the therapy for a particular disease depends on multiple factors: duration of the illness, age of the patient, the existence of chronic conditions, hereditary predisposition, lifestyle, etc.

Applying only stem cells for some cases may be not enough. Cell therapy works more effectively when combined with other therapeutic methods that help decrease inflammation, restore mobility, activate the tissue repair process

 

How do stem cells work?
The main therapeutic effect of stem cells is their ability to produce cytokines and growth factors in the intercellular space. These special chemicals are able to activate the regenerative functions of distant cells and promote tissue recovery. This mechanism is called paracrine regulation.

Cytokines help block the signals of inflammation in various diseases, including autoimmune processes [1]. An important feature of these signal molecules is that their concentrations may be regulated by inflammation and may be strictly limited by the stage of tissue regeneration. We can boost the production of cytokines using cell products based on stromal cells, leading to improved function of the damaged tissue.

When stem cells are introduced into a patient’s body during therapy, they circulate in the blood system until they are attracted to proteins secreted around inflamed or damaged tissue. Stem cells then rush to that injured area and start producing:
– various growth factors (promoting tissue recovery);
– chemokines (helping cells to migrate);
– adhesion molecules (regulating cell interactions at the molecular level).

How the procedure is carried out?
First, the patient undergoes a full examination to determine the current state of health. Then specialist makes a conclusion about the appropriateness and expected effects of therapy.
Next, the question is whether self-sourced or donor stem cells will be used. In the first case, the biopsy is performed and stromal cells are isolated from the patient’s own biomaterial. Then the harvested cells are cultivated to the required volume. Usually, this takes 3-4 weeks depending on the proliferative potential of the MMSCs. After that, the cultivated cells can be used for therapy or stored in a cryobank for an unlimited period of time. In the case of donor cells, the cell product can be used immediately in the initial treatment.

The use of cell products is carried out under medical supervision. The volume of cell mass required for treatment is calculated depending on the patient’s body weight. Before use, a test for sterility and infectious/bacteriological safety is carried out. Then a passport of the cell product is drawn up. This passport indicates the name of the cell product, the source of cells, date of extraction, cells characteristics, description of final product formulation, etc.

When the cell product is ready for use, it can be administered in several ways, depending on the purpose of therapy, the disease, and the patient’s condition:

  • IV drip;
  • Intramuscularly;
  • Intrathecal (spinal tap);
  • Retrobulbar (in the eye area);
  • Locally (cutaneous covering, joint, cavernous bodies of the penis, etc.).

What are the indications, contraindications and side effects?

Treatment with cell products is usually appealed in cases where the standard therapy of the underlying disease is not adequately effective or is associated with complications.

Before therapy, it is necessary to exclude contraindications for cell treatment, including:
– Previous bad experience with cell products;
– Any acute infectious disease;
– Cancer or a precancerous condition;
– Stroke or transient ischemic attack in the last 3 months;
– Deviations of some indicators in blood tests;
– Mental disorders and addictions;
– Contraindications to anesthesia and/or high risk of bleeding and/or pathological processes in the area of the proposed biopsy (does not exclude the possibility of using donor cell products);
– Pregnancy and lactation, and some others.

Along with the expected improvements in cell therapy, unwanted side effects are rare and include allergic and pyrogenic posttransfusion reactions (short-term fever), which are both easily managed.

In a majority of cases, it is possible to decline the manifestations of the disease, weaken pain symptoms, and correct the function that was affected. The therapies generally improve the standard of living.

Safety of stem cell therapy
The procedures are usually well tolerated in the majority of patients. Clinical trial results confirmed the safety of local injections and treatment with MMSCs from the perspective of tumor formation after a follow-up period [6]. Individual intolerance (short-term fever), while rare, cannot be excluded. Swiss Medica specialists will monitor your condition for safer and more beneficial results. [2], [3].
When it comes to improvement?
It usually takes a few weeks or months until transplanted cells start to fully take effect, although the first improvements can be felt in the days after administration. Often, reduced pain, enhanced mobility of affected joints, improved energy and activity, improved indicators of diagnostic tests can be realized relatively quickly.

Transplanted stem cells are active for 3 months on average, 6 months as a maximum. After this period, the stem cells are no longer active, but the processes started by them continue. A complex effect is possible where not only the manifestations of the underlying disease are reduced, but also the general condition of the patient is improved.

Your doctor may recommend you to seek a second consultation after 3 and/or 6 months after cell introduction in order to assess the effectiveness of the therapy. To achieve a greater and more persistent effect, the therapy can be repeated after a recommended period of time. […]

 

For more visit site —->  Swiss Medica Article – Is Stem Cell Therapy Effective?

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[HelpGuide] Helping Someone with PTSD

Helping a Loved One While Taking Care of Yourself

Women embracingWhen someone you care about suffers from post-traumatic stress disorder (PTSD), it can leave you feeling overwhelmed. The changes in your loved one can worry or even frighten you. You may feel angry about what’s happening to your family and relationship, or hurt by your loved one’s distance and moodiness. But it’s important to know  that you’re not helpless. Your support can make all the difference for your partner, friend, or family member’s recovery. With your help, your loved one can overcome PTSD and move on with their life.

Living with someone who has PTSD

PTSD can take a heavy toll on relationships. It can be hard to understand your loved one’s behavior—why they are less affectionate and more volatile. You may feel like you’re walking on eggshells or living with a stranger. You may have to take on a bigger share of household tasks, deal with the frustration of a loved one who won’t open up, or even deal with anger or disturbing behavior. The symptoms of PTSD can also lead to job loss, substance abuse, and other problems that affect the whole family.

It’s hard not to take the symptoms of PTSD personally, but it’s important to remember that a person with PTSD may not always have control over their behavior. Your loved one’s nervous system is “stuck” in a state of constant alert, making them continually feel vulnerable and unsafe. This can lead to anger, irritability, depression, mistrust, and other PTSD symptoms that your loved one can’t simply choose to turn off. With the right support from friends and family, though, your loved one’s nervous system can become “unstuck” and they can finally move on from the traumatic event.

Helping someone with PTSD tip 1: Provide social support

It’s common for people with PTSD to withdraw from friends and family. While it’s important to respect your loved one’s boundaries, your comfort and support can help the person with PTSD overcome feelings of helplessness, grief, and despair. In fact, trauma experts believe that face-to-face support from others is the most important factor in PTSD recovery.

Knowing how to best demonstrate your love and support for someone with PTSD isn’t always easy. You can’t force your loved one to get better, but you can play a major role in the healing process by simply spending time together.

Don’t pressure your loved one into talking. It can be very difficult for people with PTSD to talk about their traumatic experiences. For some, it can even make them feel worse. Instead, let them know you’re willing to listen when they want to talk, or just hang out when they don’t. Comfort for someone with PTSD comes from feeling engaged and accepted by you, not necessarily from talking.

Do “normal” things with your loved one, things that have nothing to do with PTSD or the traumatic experience. Encourage your loved one to participate in rhythmic exercise, seek out friends, and pursue hobbies that bring pleasure. Take a fitness class together, go dancing, or set a regular lunch date with friends and family.

Let your loved one take the lead, rather than telling him or her what to do. Everyone with PTSD is different but most people instinctively know what makes them feel calm and safe. Take cues from your loved one as to how you can best provide support and companionship.

Manage your own stress. The more calm, relaxed, and focused you are, the better you’ll be able to help your loved one.

Be patient. Recovery is a process that takes time and often involves setbacks. The important thing is to stay positive and maintain support for your loved one.

Educate yourself about PTSD. The more you know about the symptoms, effects, and treatment options, the better equipped you’ll be to help your loved one, understand what they are going through, and keep things in perspective.

Accept (and expect) mixed feelings. As you go through the emotional wringer, be prepared for a complicated mix of feelings—some of which you’ll never want to admit. Just remember, having negative feelings toward your family member doesn’t mean you don’t love them.

Tip 2: Be a good listener

While you shouldn’t push a person with PTSD to talk, if they do choose to share, try to listen without expectations or judgments. Make it clear that you’re interested and that you care, but don’t worry about giving advice. It’s the act of listening attentively that is helpful to your loved one, not what you say.

A person with PTSD may need to talk about the traumatic event over and over again. This is part of the healing process, so avoid the temptation to tell your loved one to stop rehashing the past and move on.

Some of the things your loved one tells you might be very hard to listen to, but it’s important to respect their feelings and reactions. If you come across as disapproving or judgmental, they are unlikely to open up to you again.

Communication pitfalls to avoid

Don’t…

  • Give easy answers or blithely tell your loved one everything is going to be okay
  • Stop your loved one from talking about their feelings or fears
  • Offer unsolicited advice or tell your loved one what they “should” do
  • Blame all of your relationship or family problems on your loved one’s PTSD
  • Invalidate, minimize, or deny your loved one’s traumatic experience
  • Give ultimatums or make threats or demands
  • Make your loved one feel weak because they aren’t coping as well as others
  • Tell your loved one they were lucky it wasn’t worse
  • Take over with your own personal experiences or feelings

Tip 3: Rebuild trust and safety

Trauma alters the way a person sees the world, making it seem like a perpetually dangerous and frightening place. It also damages people’s ability to trust others and themselves. If there’s any way you can rebuild your loved one’s sense of security, it will contribute to their recovery.

Express your commitment to the relationship. Let your loved one know that you’re here for the long haul so they feel loved and supported.

Create routines. Structure and predictable schedules can restore a sense of stability and security to people with PTSD, both adults and children. Creating routines could involve getting your loved one to help with groceries or housework, for example, maintaining regular times for meals, or simply “being there” for the person.

Minimize stress at home. Try to make sure your loved one has space and time for rest and relaxation.

Speak of the future and make plans. This can help counteract the common feeling among people with PTSD that their future is limited.

Keep your promises. Help rebuild trust by showing that you’re trustworthy. Be consistent and follow through on what you say you’re going to do.

Emphasize your loved one’s strengths. Tell your loved one you believe they’re capable of recovery and point out all of their positive qualities and successes.

Encourage your loved one to join a support group. Getting involved with others who have gone through similar traumatic experiences can help some people with PTSD feel less damaged and alone.

Tip 4: Anticipate and manage triggers

A trigger is anything—a person, place, thing, or situation—that reminds your loved one of the trauma and sets off a PTSD symptom, such as a flashback. Sometimes, triggers are obvious. For example, a military veteran might be triggered by seeing his combat buddies or by the loud noises that sound like gunfire. Others may take some time to identify and understand, such as hearing a song that was playing when the traumatic event happened, for example, so now that song or even others in the same musical genre are triggers. Similarly, triggers don’t have to be external. Internal feelings and sensations can also trigger PTSD symptoms.

Common external PTSD triggers

  • Sights, sounds, or smells associated with the trauma
  • People, locations, or things that recall the trauma
  • Significant dates or times, such as anniversaries or a specific time of day
  • Nature (certain types of weather, seasons, etc.)
  • Conversations or media coverage about trauma or negative news events
  • Situations that feel confining (stuck in traffic, at the doctor’s office, in a crowd)
  • Relationship, family, school, work, or money pressures or arguments
  • Funerals, hospitals, or medical treatment

Common internal PTSD triggers

  • Physical discomfort, such as hunger, thirst, fatigue, sickness, and sexual frustration
  • Any bodily sensation that recalls the trauma, including pain, old wounds and scars, or a similar injury
  • Strong emotions, especially feeling helpless, out of control, or trapped
  • Feelings toward family members, including mixed feelings of love, vulnerability, and resentment

Talking to your loved one about PTSD triggers

Ask your loved one about how they may have coped with triggers in the past in response to an action that seemed to help (as well as those that didn’t). Then you can come up with a joint game plan for how you will respond in future.

Decide with your loved one how you should respond when they have a nightmare, flashback, or panic attack. Having a plan in place will make the situation less scary for both of you. You’ll also be in a much better position to help your loved one calm down.

How to help someone having a flashback or panic attack

During a flashback, people often feel a sense of disassociation, as if they’re detached from their own body. Anything you can do to “ground” them will help.

  • Tell your loved one they’re having a flashback and that even though it feels real, the event is not actually happening again
  • Help remind them of their surroundings (for example, ask them to look around the room and describe out loud what they see)
  • Encourage them to take deep, slow breaths (hyperventilating will increase feelings of panic)
  • Avoid sudden movements or anything that might startle them
  • Ask before you touch them. Touching or putting your arms around the person might make them feel trapped, which can lead to greater agitation and even violence

Tip 5: Deal with volatility and anger

PTSD can lead to difficulties managing emotions and impulses. In your loved one, this may manifest as extreme irritability, moodiness, or explosions of rage.

People suffering from PTSD live in a constant state of physical and emotional stress. Since they usually have trouble sleeping, it means they’re constantly exhausted, on edge, and physically strung out—increasing the likelihood that they’ll overreact to day-to-day stressors. For many people with PTSD, anger can also be a cover for other feelings such as grief, helplessness, or guilt. Anger makes them feel powerful, instead of weak and vulnerable. Others try to suppress their anger until it erupts when you least expect it.

Watch for signs that your loved one is angry, such as clenching jaw or fists, talking louder, or getting agitated. Take steps to defuse the situation as soon as you see the initial warning signs.

Try to remain calm. During an emotional outburst, try your best to stay calm. This will communicate to your loved one that you are “safe,” and prevent the situation from escalating.

Give the person space. Avoid crowding or grabbing the person. This can make a traumatized person feel threatened.

Ask how you can help. For example: “What can I do to help you right now?” You can also suggest a time out or change of scenery.

Put safety first. If the person gets more upset despite your attempts to calm him or her down, leave the house or lock yourself in a room. Call 911 if you fear that your loved one may hurt himself or others.

Help your loved one manage their anger. Anger is a normal, healthy emotion, but when chronic, explosive anger spirals out of control, it can have serious consequences on a person’s relationships, health, and state of mind. Your loved one can get anger under control by exploring the root issues and learning healthier ways to express their feelings.

Tip 6: Take care of yourself

Letting your family member’s PTSD dominate your life while ignoring your own needs is a surefire recipe for burnout and may even lead to secondary traumatization. You can develop your own trauma symptoms from listening to trauma stories or being exposed to disturbing symptoms like flashbacks. The more depleted and overwhelmed you feel, the greater the risk is that you’ll become traumatized.

In order to have the strength to be there for your loved one over the long haul and lower your risk for secondary traumatization, you have to nurture and care for yourself.

Take care of your physical needs: get enough sleep, exercise regularly, eat properly, and look after any medical issues.

Cultivate your own support system. Lean on other family members, trusted friends, your own therapist or support group, or your faith community. Talking about your feelings and what you’re going through can be very cathartic.

Make time for your own life. Don’t give up friends, hobbies, or activities that make you happy. It’s important to have things in your life that you look forward to.

Spread the responsibility. Ask other family members and friends for assistance so you can take a break. You may also want to seek out respite services in your community.

Set boundaries. Be realistic about what you’re capable of giving. Know your limits, communicate them to your family member and others involved, and stick to them.

Support for people taking care of veterans

If the person you’re caring for is a military veteran, financial and caregiving support may be available. In the U.S., visit VA Caregiver Support to explore your options, or call Coaching into Care at (888) 823-7458. For families of military veterans in other countries, see the section below for online resources.

Authors: Melinda Smith, M.A., and Lawrence Robinson. Last updated: June 2019.

via Helping Someone with PTSD – HelpGuide.org

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[Abstract] Efficacy and Safety of High-frequency Repetitive Transcranial Magnetic Stimulation for Post-Stroke Depression:A Systematic Review and Meta-Analysis

Abstract

Objective

To summarize and systematically review the efficacy and safety of high frequency repetitive transcranial magnetic stimulation (HF-rTMS) for depression in stroke patients.

Data Sources

Six databases (Wanfang, CNKI, PubMed, Embase, Cochrane Library, and Web of Science) were searched from inception until November 15, 2018.

Study Selection

Seventeen randomized controlled trials were included for meta-analysis.

Data Extraction

Two independent reviewers selected potentially relevant studies based on the inclusion criteria, extracted data, and evaluated the methodological quality of the eligible trials using the Physiotherapy Evidence Database (PEDro).

Data Synthesis

We calculated the combined effect size (standardized mean difference [SMD] and odds ratio [OR]) for the corresponding effects models. Physiotherapy Evidence Database scores ranged from 7 to 8 points (mean = 7.35). The study results indicated that HF-rTMS had significantly positive effects on depression in stroke patients. The effect sizes of the SMD ranged from small to large (SMD = −1.01; 95% confidence interval [95% CI], −1.36 to −0.66; P < .001; I2 = 85%; n = 1053), and the effect sizes of the OR were large (response rates: 58.43% VS 33.59%; OR = 3.31; 95% CI, 2.25 to 4.88; P < .001; I2 = 0%; n = 529; remission rates: 26.59% VS 12.60%; OR = 2.72; 95% CI, 1.69 to 4.38; P < .001; I2 = 0%; n = 529). In terms of treatment side-effects, the HF-rTMS group was more prone to headache than the control group (OR = 3.53; 95% CI, 1.85 to 8.55; P < .001; I2 = 0%; n = 496).

Conclusions

HF-rTMS is an effective intervention for post-stroke depression, although treatment safety should be further verified via large sample multi-center trials.

via Efficacy and Safety of High-frequency Repetitive Transcranial Magnetic Stimulation for Post-Stroke Depression:A Systematic Review and Meta-Analysis – Archives of Physical Medicine and Rehabilitation

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[Slideshow] Comparing the Safety of Antiepilepsy Drugs in Pregnancy

Comparing the Safety of Antiepilepsy Drugs in Pregnancy

Mar 26, 2018

What are the risks of birth defects and perinatal outcomes for infants exposed to various AEDs in utero?

Source: http://www.neurologytimes.com/slideshows/comparing-safety-antiepilepsy-drugs-pregnancy

 

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[Abstract] Efficacy and safety of NABOTA in post-stroke upper limb spasticity: A phase 3 multicenter, double-blinded, randomized controlled trial

Highlights

A phase III clinical trial was performed for a novel botulinum toxin A, NABOTA, on post-stroke upper limb spasticity.

NABOTA demonstrated non-inferiority on efficacy and safety compared to onabotulinum toxin A (Botox).

NABOTA may serve as an alternative for treatment of post-stroke upper limb spasticity using botulinum toxin A.

Abstract

Botulinum toxin A is widely used in the clinics to reduce spasticity and improve upper limb function for post-stroke patients. Efficacy and safety of a new botulinum toxin type A, NABOTA (DWP450) in post-stroke upper limb spasticity was evaluated in comparison with Botox (onabotulinum toxin A). A total of 197 patients with post-stroke upper limb spasticity were included in this study and randomly assigned to NABOTA group (n = 99) or Botox group (n = 98). Wrist flexors with modified Ashworth Scale (MAS) grade 2 or greater, and elbow flexors, thumb flexors and finger flexors with MAS 1 or greater were injected with either drug. The primary outcome was the change of wrist flexor MAS between baseline and 4 weeks post-injection. MAS of each injected muscle, Disability Assessment Scale (DAS), and Caregiver Burden Scale were also assessed at baseline and 4, 8, and 12 weeks after the injection. Global Assessment Scale (GAS) was evaluated on the last visit at 12 weeks. The change of MAS for wrist flexor between baseline and 4 weeks post-injection was − 1.44 ± 0.72 in the NABOTA group and − 1.46 ± 0.77 in the Botox group. The difference of change between both groups was 0.0129 (95% confidence interval − 0.2062–0.2319), within the non-inferiority margin of 0.45. Both groups showed significant improvements regarding MAS of all injected muscles, DAS, and Caregiver Burden Scale at all follow-up periods. There were no significant differences in all secondary outcome measures between the two groups. NABOTA demonstrated non-inferior efficacy and safety for improving upper limb spasticity in stroke patients compared to Botox.

 

via Efficacy and safety of NABOTA in post-stroke upper limb spasticity: A phase 3 multicenter, double-blinded, randomized controlled trial – ScienceDirect

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[REVIEW] Adverse events of tDCS and tACS: A review – Full Text

Highlights

  • No serious adverse effects have been reported in experiments using either tDCS or tACS.
  • Persistent adverse effects of tDCS are mainly skin problems; for tACS, none have been reported.
  • Further safety investigations are needed.

Abstract

Transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) have been applied to many research issues because these stimulation techniques can modulate neural activity in the human brain painlessly and non-invasively with weak electrical currents. However, there are no formal safety guidelines for the selection of stimulus parameters in either tDCS or tACS. As a means of gathering the information that is needed to produce safety guidelines, in this article, we summarize the adverse events of tDCS and tACS. In both stimulation techniques, most adverse effects are mild and disappear soon after stimulation. Nevertheless, several papers have reported that, in tDCS, some adverse events persist even after stimulation. The persistent events consist of skin lesions similar to burns, which can arise even in healthy subjects, and mania or hypomania in patients with depression. Recently, one paper reported a pediatric patient presenting with seizure after tDCS, although the causal relationship between stimulation and seizure is not clear. As this seizure is the only serious adverse events yet reported in connection with tDCS, tDCS is considered safe. In tACS, meanwhile, no persistent adverse events have been reported, but considerably fewer reports are available on the safety of tACS than on the safety of tDCS. Therefore, to establish the safety of tDCS and tACS, we need to scan the literature continuously for information on the adverse events of both stimulation techniques. Further safety investigations are also required.

1. Introduction

Since the first reports of transcranial direct current stimulation (tDCS) by Priori et al. (1998)) and Nitsche and Paulus, 2000, Nitsche and Paulus, 2001), tDCS has been applied to many research issues because it can modulate the neural networks in the human brain painlessly and non-invasively (Priori et al., 1998, Nitsche and Paulus, 2000, Nitsche and Paulus, 2001). In other words, tDCS can induce neural plasticity (Ugawa, 2012). Most of its adverse effects are mild and disappear soon after stimulation, but several papers have reported that some adverse effects, most commonly skin problems, can persist even after stimulation. Recently, since the invention of transcranial alternating current stimulation (tACS) by Antal et al. (2008)), tACS has also been applied in research for the modulation of neural activity through the entrainment on brain oscillations (Antal et al., 2008, Antal and Herrmann, 2016). As in tDCS, the adverse effects of tACS are mild and disappear just after stimulation. Yet there have been far fewer papers on safety issues or adverse events of tACS as compared to tDCS. To date, there are no formal safety guidelines for the selection of stimulus parameters in either tDCS or tACS (Fertonani et al., 2015). Therefore, we aim to summarize the adverse events of tDCS and tACS in this review. At present, the safety and ethical issues of both stimulation techniques should be considered by each institution due to the lack of certainty about their risks. This review may provide some useful information for these considerations. In addition, this review is expected to be useful for the establishment of safety guidelines in the near future.

Continue —> Adverse events of tDCS and tACS: A review – Clinical Neurophysiology Practice

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[WEB SITE] Researchers Are Developing a Mobile App to Assist Post-TBI Patients

A decision support mobile app to help facilitate safety and independent living among TBI patients after returning home from a treatment facility is being developed in collaboration between researchers from Alabama-based Shepherd Center and ChartAssist LLC.

To assist with decision-making, the mobile app will be engineered to help improve the assessment of functional mobility, household activities, sleep, and safety risk.

Such decisions include making differential diagnostic assessments, selecting the most appropriate home- and community-based services and supports, measuring progress, and updating healthcare and supervision needs, according to the researchers, in a media release from Shepherd Center.

The app will also feature the ability to provide multidisciplinary treatment recommendations for TBI patients, as well as to set goals and track outcomes.

“I am thankful to have the opportunity to work with Shepherd Center and Dr Ron Seel, director of brain injury research, to help people with TBI and their families,” says Daniel Joye, president of ChartAssist, in the release. “The need for a decision support app is clear, and our company’s work on multidisciplinary rehabilitation in the mental health community is a great fit for helping people with brain injuries, their families and rehabilitation professionals.”

“I was quickly impressed by the innovative software development work that ChartAssist has done in the mental health community, “ states Ron Seel, PhD, the O. Wayne Rollins Director of Brain Injury Research at Shepherd Center, per the release.

“The software that ChartAssist has developed to facilitate person-centered, multidisciplinary rehabilitation assessment and treatment has broad applicability to helping people with brain injuries, who share many of the same chronic cognitive, behavioral, physical and health conditions experienced by people with mental health disabilities. Leveraging this work to develop secure, user-friendly, evidence-based decision support applications is a natural fit and could greatly improve people’s lives.”

Grants from the National Institute on Disability, Independent Living and Rehabilitation Research, as well as the Shepherd Center Foundation, provided the seed money to develop the app.

[Source: Shepherd Center]

Source: Researchers Are Developing a Mobile App to Assist Post-TBI Patients – Rehab Managment

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[ARTICLE] High doses of incobotulinumtoxinA for the treatment of post-stroke spasticity: are they safe and effective? – Full Text 

1. Introduction

Botulinum toxin type A (BoNT-A) represents the gold standard therapy for focal spasticity and related disorders also in acquired brain injury including stroke. Since 1989, the effectiveness of BoNT-A in reducing poststroke spasticity showed reversibility and low prevalence of complications [1], obtaining the approval of U.S. Food and Drug Administration for upper limb spasticity after stroke in 2010. In the following years, many studies have been published demonstrating its safety and effectiveness [2,3]. However, the role of BoNT-A in the management of poststroke spasticity has been modified, changing from muscle chemodenervation (nerve block) to become an useful tool for improving limb posture, applying splint, consenting hygiene, standing, and walking in patients with spastic equino-varus foot deformities with also improvement joint range of motion and muscle extensibility or reduction of spasticity-related pain.
The correct evaluation of the patient to be injected is necessary to increase the efficacy of BoNT-A considering that there is a high response for improving passive function, but controversy also exists about the improvement in motor function relative to the improvement of spasticity. There are proposals on dosages, injection techniques, patient selection, and outcome measures, but a consensus about the employment of adjunctive therapies after the BoNT-A injection, considered necessary to increase the effect on spasticity reduction, has not been reached, considering the time to start, the duration of adjunctive therapies, and the type of rehabilitation procedures [4]. So, at present, the injection sites, the choice of muscles, the dosage, the dilution, and the rehabilitation programs after BoNT-A treatment are often identified by injector’s decision-making without specialized training.
BoNT-A has clearly been recommended as first-line treatment for focal spasticity by several European consensus statements and the American Academy of Neurology [4,5] and current guidelines suggested the employment of a dose up to 600 units (U) of onabotulinumtoxinA (Botox®, Allergan, Inc., Irvine, CA, USA) and incobotulinumtoxinA (Xeomin®, Merz Pharmaceuticals GmbH, Frankfurt, Germany) or up to 1500 U of abobotulinumtoxinA (Dysport®, Ipsen, Slough, UK/Galderma, Paris, France) per injection session to treat spasticity after stroke [5]. However, in recent years, higher doses have been used, especially in case of upper and lower limb severe spasticity considering the low prevalence of complications and the reversibility of the BoNT-A [6,7]. The possibility to employ high doses is strictly related to the precision of the injection. A correct muscle identification with instrumental guide (i.e. electrical stimulation or ultrasonography) may reduce the spread of the toxins to the nearby tissues and the risk of adverse effects.

Continue —> High doses of incobotulinumtoxinA for the treatment of post-stroke spasticity: are they safe and effective? – Expert Opinion on Drug Metabolism & Toxicology –

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