Effectiveness of the ISAAC cognitive prosthetic system for improving rehabilitation outcomes with neurofunctional impairment

Cognitive rehabilitation has the capacity to empower persons with brain-injuries and help them achieve heightened functional, personal, and social interactions within their environments. Interventions aimed at compensation for deficits and adaptation to cognitive disability can be aided through the use of assistive technology devices (ATD's). ATDs allow for their users to experience greater levels of independence, as well as social and vocational participation, which leads to a higher quality of life. The ISAAC system is a small, individualized, wearable cognitive prosthetic assistive technology system. Being fully individualized and very easy to use makes this system adaptable to, and appropriate for, patients with a wide variety of cognitive disabilities ranging from individuals with developmental disabilities to high functioning survivors of brain injury. The current article will discuss two cases that illustrate the effectiveness of the ISAAC system in assisting patients with generalization of rehabilitation to their home environments. Both patients incurred significant cognitive impairment, for which they were able to successfully compensate with the assistance of their ISAAC systems. These two case studies are typical examples of the functional independence that can be achieved through the use of the ISAAC system. When patients are properly selected for use of this system, appropriate content is authored, and sufficient training on the system is provided, the ISAAC system can prove very effective at improving patients' functional independence.     

Post-stroke depression and functional independence: a conundrum

Brown C, Hasson H, Thyselius V, Almborg A‐H. Post‐stroke depression and functional independence: a conundrum.
Acta Neurol Scand: 2012: 126: 45–51.
© 2011 John Wiley & Sons A/S. Objectives – People who suffer a stroke are at risk of developing post‐stroke depression (PSD). Not only does this lower their quality of life but it also increases their risk of another stroke or death. This study aimed to investigate the factors associated with PSD in order to better direct rehabilitation efforts aimed at cutting the incidence of PSD. Material and methods – This study was based on all patients admitted to the stroke unit of a hospital in southern Sweden from 1 October 2003 to 30 November 2005. The total number of patients involved was 181. Measures were collected at 2 ± 1 weeks after discharge from hospital, 3 ± 0.5 months after the occurrence of the stroke and 12 ± 1 months after the occurrence of the stroke. Information collected was results from the Center of Epidemiologic Studies Depression Scale and the Barthel Index together with demographic data including age, sex, time since stroke and relationship status. Results – Those patients involved in the study were mainly men (58–59%) and generally those either married or cohabiting (53–57%). The age of respondents ranged from 32 to 92 years with a mean age of 74.0 (95%CI 72.37–75.63) at 2 ± 1 weeks after discharge. The Barthel Index scores ranged from 15 to 100 with means of between 88.7 and 91.7. Between 15% and 19% of the group were clinically depressed during the time frame of the study. The Barthel Index, measuring functional independence in terms of need for assistance with personal activities of daily living (P‐ADL), was consistently associated with PSD. Conclusions – The differences found in levels of depression between those with lower functional independence after a stroke compared to those more independent in P‐ADL, raise the possibility that attention should be paid to therapeutic rehabilitation for stroke patients to help them recover as much functional independence as possible in order to improve their quality of life and lower their chances of developing PSD.     

Magnetoencephalography in stroke: a 1-year follow-up study

Recovery after stroke is closely linked to cerebral plasticity. Magnetoencephalography (MEG) is a non-invasive technique, which allows location of cerebral cells activities. In the present work, a cohort of patients has been studied with MEG. Twelve patients with a recent ischemic or hemorragic stroke were included as soon as possible after onset of stroke. Neurologic assessment, including standard neurologic examination, functional independence measure (FIM) and Orgogozo's scale was performed for 1 year in addition to a study of the somatosensory evoked field (SEF) using a 37-channel Biomagnetometer system. No response could be recorded in five patients at the first SEF exploration. In three cases, no response was ever recorded during the study. All these patients had a bad recovery. The location of the SEF sources was always in the normal non-infarcted cortex of the postcentral gyrus. Sensory recovery seemed to be linked to the reorganization of the persistent functional cortex, which was a limiting factor for recovery. These observations confirm the experimental results obtained in animal models. After stroke it can be assumed that in the case of incomplete lesion, an intensive sensory peripheral stimulation could maximize the use of residual sensory function and then contribute to improve the sensory deficit. In case of total sensory loss other techniques have to be used, such as visual monitoring of hand activity in order to improve hand function.     

可穿戴医疗设备在卒中高危人群和患者中的应用

卒中高危人群及患者数量庞大,传统的二级预防策略越来越难以满足这类人群的健康管 理需求。可穿戴医疗设备可无障碍跟踪穿戴者的健康信息,如果能采取穿戴式医疗技术将个体健康 状态数据化,并监测健康状况、控制卒中危险因素的发生、发展,可进一步避免脑血管意外的发生, 但目前这类设备仍然存在较大的优化空间。本文总结了可穿戴医疗设备在卒中高危人群及患者中的 应用,分析目前存在的如设备测量数据的准确性、穿戴的舒适度等问题,并对其未来进一步促进远 程医疗的发展进行展望。     

Toward mobile phone design for all: meeting the needs of stroke survivors

In the July-August 2008 issue of Topics in Stroke Rehabilitation, Greig and colleagues described a small, qualitative study of features of mobile phone handset design, documentation, and use that either enhance or hinder usability for people with aphasia. The authors noted that, despite considerable difficulties, study participants appreciated the social participation that mobile phones support. Findings to date of the Wireless RERC's Survey of User Needs (SUN) reinforce the importance of wireless technology to people with disabilities. Since 2001, the Wireless RERC has surveyed over 3,000 Americans with diverse cognitive, physical, and sensory disabilities about their needs for mobile wireless technologies. About 84% of respondents own or have access to a cell phone or other mobile wireless device. SUN findings also reveal critical features of wireless devices and services that affect usefulness and usability for this diverse population. In May 2010, the Wireless RERC revised the SUN and again began collecting data. Since then, 333 individuals have responded to the survey, 46 of them stroke survivors. This article compares the survey results with the findings of Greig et al. The analysis supports the feasibility of inclusive and universal design in meeting the needs of wireless customers of all age and abilities.     

神经干细胞标记及活体示踪的研究现状及前景

许多研究都表明神经干细胞具有冉生和修复中枢神经系统神经损伤的能力。采用有效的无创伤性技术来监测和追踪干细胞移植治疗的效果将对其在动物实验研究和临床应用方面起到促进作用。通过用细胞标记试剂标记干细胞，可以活体显示移植至脑内的干细胞并进而揭示干细胞在脑内的迁移情况。活体追踪神经干细胞的迁移将有助于我们选择最优的移植策略和了解干细胞促进神经功能恢复的机理。本文对目前在神经干细胞移植领域能够用于干细胞迁移追踪的标记物质种类和应用前景进行叫顾和展望。     

Mobile EEG in research on neurodevelopmental disorders: Opportunities and challenges

Mobile electroencephalography (mobile EEG) represents a next-generation neuroscientific technology – to study real-time brain activity – that is relatively inexpensive, non-invasive and portable. Mobile EEG leverages state-of-the-art hardware alongside established advantages of traditional EEG and recent advances in signal processing. In this review, we propose that mobile EEG could open unprecedented possibilities for studying neurodevelopmental disorders. We first present a brief overview of recent developments in mobile EEG technologies, emphasising the proliferation of studies in several neuroscientific domains. As these developments have yet to be exploited by neurodevelopmentalists, we then identify three research opportunities: 1) increase in the ease and flexibility of brain data acquisition in neurodevelopmental populations; 2) integration into powerful developmentally-informative research designs; 3) development of innovative non-stationary EEG-based paradigms. Critically, we address key challenges that should be considered to fully realise the potential of mobile EEG for neurodevelopmental research and for understanding developmental psychopathology more broadly, and suggest future research directions.     

Ethical issues when using social media for health outside professional relationships

Abstract

Social media have the potential to revolutionize health and healthcare, but fulfilling this potential requires attention to the ethical issues social media may raise. This article reviews the major ethical issues arising when social media are used for research, public health, mobile health applications, and global health. It focuses on social media use outside fiduciary relationships between healthcare professionals and patients. Emphasis is given to the potential of social media in these contexts, the ethical issues relatively unique to each, and where possible how existing ethical principles and frameworks could help navigate these issues. In some cases social media create the circumstance for particular ethical issues but also facilitate managing them, such as in informed consent for research. In other cases, disagreement exists about whether social media – despite their potential – should be used for certain purposes, such as in public health surveillance (where confidentiality represents a significant ethical concern). In still others, ethical uncertainty exists about how social media will affect ethical issues, such as inequality in global health. As social media technologies continue to develop, identifying and managing the ethical issues they raise will be critical to their success in improving health while preserving fundamental ethical values.     

Assessing level of consciousness and cognitive changes from vegetative state to full recovery

Although investigations addressing cognitive recovery from the vegetative state have been reported, to date there have been no detailed studies of these patients combining both neuropsychology and functional imaging to monitor and record the recovery of consciousness. This paper describes the recovery of a specific vegetative state (VS) case. The patient (OG) remained in the vegetative state for approximately two months, increasing her level of awareness to a minimally conscious state, where she continued for approximately 70 days. In the course of the ensuing 18 months, she was able to reach an acceptable level of cognitive functioning, with partial levels of independence. Throughout this two year period, she received continuous cognitive evaluation, for which several different tools were applied including coma and low functioning scales, full cognitive batteries, and structural and functional magnetic resonance imaging (MRI). We present here preliminary data on fMRI using a word presentation paradigm before and after recovery; we also discuss the difficulty of how to determine level of consciousness using the tools currently available, and the subsequent improvement in different cognitive domains. We confirm that accurate diagnosis and proper cognitive assessment are critical for the rehabilitation of patients with disorders of consciousness.     

Automatic Acute Stroke Symptom Detection and Emergency Medical Systems Alerting by Mobile Health Technologies: A Review

ObjectivesTo survey recent advances in acute stroke symptom automatic detection and Emergency Medical Systems (EMS) alerting by mobile health technologies.Materials and methodsNarrative reviewResultsDelayed activation of EMS for stroke symptoms by patients and witnesses deprives patients of rapid access to brain-saving therapies and occurs due to public unawareness of stroke features, cognitive and motor deficits produced by the stroke itself, and sleep onset. A promising emerging approach to overcoming the inherent biologic constraints of patient capacity to self-detect and respond to stroke symptoms is continuous monitoring by mobile health technologies with wireless sensors and artificial intelligence recognition systems. This review surveys 11 sensing technologies - accelerometers, gyroscopes, magnetometers, pressure sensors, touch screen and keyboard input detectors, artificial vision, and artificial hearing; and 10 consumer device form factors in which they are increasingly implemented: smartphones, smart speakers, smart watches and fitness bands, smart speakers/voice assistants, home health robots, smart clothing, smart beds, closed circuit television, smart rings, and desktop/laptop/tablet computers.ConclusionsThe increase in computing power, wearable sensors, and mobile connectivity have ushered in an array of mobile health technologies that can transform stroke detection and EMS activation. By continuously monitoring a diverse range of biometric parameters, commercially available devices provide the technologic capability to detect cardinal language, motor, gait, and sensory signs of stroke onset. Intensified translational research to convert the promise of these technologies to validated, accurate real-world deployments are an important next priority for stroke investigation.     

Strategies for non‐EEG seizure detection and timing for alerting and interventions with tonic–clonic seizures

Sudden unexpected death in epilepsy (SUDEP) is a common cause of death in epilepsy and frequently occurs following generalized tonic–clonic seizures (GTCS). Non–electroencephalography (EEG) seizure detection systems using mobile sensor devices permit caregivers to assist patients during seizures and may reduce risks for complications of seizures such as injuries and SUDEP. We review changes in accelerometry, electrodermal activity, and heart rate associated with tonic–clonic seizures and their use in detection systems, including multimodal detectors. We reviewed current and past publications reporting data on linkage between GTCS, post‐ictal generalized EEG suppression (PGES), and ventilatory dysfunction. The timing and duration of postictal immobility and respiratory dysfunction associated with convulsions help identify which patients might benefit the most from seizure monitoring and from benchmarks for the timing of seizure detection, caregiver alerting, and interventions.     

The promise of mHealth: daily activity monitoring and outcome assessments by wearable sensors

Mobile health tools that enable clinicians and researchers to monitor the type, quantity, and quality of everyday activities of patients and trial participants have long been needed to improve daily care, design more clinically meaningful randomized trials of interventions, and establish cost-effective, evidence-based practices. Inexpensive, unobtrusive wireless sensors, including accelerometers, gyroscopes, and pressure-sensitive textiles, combined with Internet-based communications and machine-learning algorithms trained to recognize upper- and lower-extremity movements, have begun to fulfill this need. Continuous data from ankle triaxial accelerometers, for example, can be transmitted from the home and community via WiFi or a smartphone to a remote data analysis server. Reports can include the walking speed and duration of every bout of ambulation, spatiotemporal symmetries between the legs, and the type, duration, and energy used during exercise. For daily care, this readily accessible flow of real-world information allows clinicians to monitor the amount and quality of exercise for risk factor management and compliance in the practice of skills. Feedback may motivate better self-management as well as serve home-based rehabilitation efforts. Monitoring patients with chronic diseases and after hospitalization or the start of new medications for a decline in daily activity may help detect medical complications before rehospitalization becomes necessary. For clinical trials, repeated laboratory-quality assessments of key activities in the community, rather than by clinic testing, self-report, and ordinal scales, may reduce the cost and burden of travel, improve recruitment and retention, and capture more reliable, valid, and responsive ratio-scaled outcome measures that are not mere surrogates for changes in daily impairment, disability, and functioning.     

Changes in ability,perceived difficulty and use of assistive devices in everyday life: a 4‐year follow‐up study in people with late effects of polio

Background – There are numbers of persons living in the community with late effects of polio, of which many develop new symptoms, but the course of progression is unclear. Objectives – To assess changes after 4 years in ability and perceived difficulty in persons with late effects of polio. Material and methods – Community dwelling persons from a polio clinic. Information was gathered by questionnaire and interview on demographics, age at polio onset, affected body parts, health problems, the use of assistive devices, housing condition and activities of daily living (ADL) function as well as perceived difficulties. Results – There were no significant increase in frequency of ADL dependency but perceived difficulties increased significantly and more used mobility devices. Conclusions – Over 4 years, more persons perceived difficulties and the use of assistive devices increased. This is might reflect adaptation and acknowledgement of problems previously ignored. Time is a factor in integrating knowledge and adaptation.     

Promoting axonal rewiring to improve outcome after stroke

A limited amount of functional recovery commonly occurs in the weeks and months after stroke, and a number of studies show that such recovery is associated with changes in the brain's functional organization. Measures that augment this reorganization in a safe and effective way may therefore help improve outcome in stroke patients. Here we review some of the evidence for functional and anatomical reorganization under normal physiological conditions, along with strategies that augment these processes and improve outcome after brain injury in animal models. These strategies include counteracting inhibitors of axon growth associated with myelin, activating neurons' intrinsic growth state, enhancing physiological activity, and having behavioral therapy. These approaches represent a marked departure from the recent focus on neuroprotection and may provide a more effective way to improve outcome after stroke.     

Accelerometers for objective evaluation of physical activity following spine surgery

With the potential of bias from subjective evaluation scores in spine surgery, there is a need for practical and accurate quantitative methods of analysing patient recovery. In recent years, technologies such as accelerometers and global positioning systems have been introduced as potential objective measures for pain and symptoms following spine surgery. Overall, this perspective article aims to discuss and critique currently utilised methods of monitoring spine surgical outcomes. After analysing current modalities it will briefly analyse new potential methods before examining the place for accelerometers in the field of spine surgery. A literature review was performed on the use of accelerometers for objective evaluation of symptoms and disability after spine surgery, and perspectives are summarised in this article. Physical activity measurement with the use of accelerometers following spine surgery patients is practical and quantitative. The currently available accelerometers have the potential to transform the way functional outcomes from spine surgery are assessed. One key advantage is the collection of standardised objective measurements across studies. Future studies should aim to validate accelerometer data in relation to traditional measures of functional recovery, patient outcomes, and physical activity.     

The post-stroke upper limb improvement effort survey (IMPETUS): a survey of individuals with chronic stroke

Background: There is a considerable literature on arm/hand dysfunction post stroke, but little information on the participants’ opinions about perceived and desired arm/hand strength, recovery, and function.

Objective: The objective of this study was to examine the perceptions of individuals with stroke about arm/hand function and training devices.

Methods: A 69-item survey was developed addressing: activity before and after stroke, involved arm/hand function, willingness to use a training device, and important device characteristics. The survey included items from the Hand Function and Strength Subscales of the Stroke Impact Scale (SIS). Face validity was established by physical therapists and individuals with stroke. The survey was administered via phone and online.

Results: 852 registry participants were recruited. Ninety-seven responded; 83 completed the survey. Subjects were 51 males, 31 females; mean age: 65 (25–95); meantime since stroke: 13 years (1–34; SD 6.678). There was a statistically significant difference between perceived and desired arm/hand strength, recovery, and function p<0.0001. Impairment factors, such as weakness and spasticity were greater barriers to recovery than socio-economic ones. Most participants (94%) were willing to use a device; functional gains during/following use were the most important characteristics.

Limitations: Participants had greater arm impairment and were more chronic than other studies.

Conclusions: Participants desired more arm/hand strength, function, and recovery that they perceived they had achieved. Impairment – level factors posed more barriers to arm recovery than socioeconomic ones. Most participants were interested in using arm/hand training devices; the most important device characteristic is functional gain.     

Early life stress exposure worsens adult remote microglia activation,neuronal death,and functional recovery after focal brain injury

Trauma to the central nervous system (CNS) is a devastating condition resulting in severe functional impairments that strongly vary among patients. Patients’ features, such as age, social and cultural environment, and pre-existing psychiatric conditions may be particularly relevant for determining prognosis after CNS trauma.Although several studies demonstrated the impact of adult psycho-social stress exposure on functional recovery after CNS damage, no data exist regarding the long-term effects of the exposure to such experience at an early age.Here, we assessed whether early life stress (ELS) hampers the neuroinflammatory milieu and the functional recovery after focal brain injury in adulthood by using a murine model of ELS exposure combined with hemicerebellectomy (HCb), a model of remote damage. We found that ELS permanently altered microglia responses such that, once experienced HCb, they produced an exaggerated remote inflammatory response – consistent with a primed phenotype – associated with increased cell death and worse functional recovery. Notably, prevention of microglia/macrophages activation by GW2580 treatment during ELS exposure significantly reduced microglia responses, cell death and improved functional recovery. Conversely, GW2580 treatment administered in adulthood after HCb was ineffective in reducing inflammation and cell death or improving functional recovery.Our findings highlight that ELS impacts the immune system maturation producing permanent changes, and that it is a relevant factor modulating the response to a CNS damage. Further studies are needed to clarify the mechanisms underlying the interaction between ELS and brain injury with the aim of developing targeted treatments to improve functional recovery after CNS damage.     

Mobile Applications for Mental Health Providers

Mobile devices such as smartphones and tablets have fundamentally changed the ways in which we interact with information. Far more than communication devices, smartphones and tablets are now indispensable tools in the pocket of healthcare providers. Mobile mental health applications (apps) provide instant access to up-to-date information on prevention, assessment and treatment. Self-help apps allow patients to take greater ownership of their own health and well-being. The past decade has seen an extraordinarily rapid proliferation of mobile medical apps. Though thousands of apps now exist, the challenge for healthcare providers and consumers alike has become sorting through mobile apps for those which provide accurate content delivered in the most user-friendly format. This article will review six mobile apps that can assist healthcare providers and consumers interested in enhancing mental health.     

Strategies for stroke rehabilitation

Rehabilitation after hemiplegic stroke has typically relied on the training of patients in compensatory strategies. The translation of neuroscientific research into care has led to new approaches and renewed promise for better outcomes. Improved motor control can progress with task-specific training incorporating increased use of proximal and distal movements during intensive practice of real-world activities. Functional gains are incorrectly said to plateau by 3-6 months. Many patients retain latent sensorimotor function that can be realised any time after stroke with a pulse of goal-directed therapy. The amount of practice probably best determines gains for a given level of residual movement ability. Clinicians should encourage patients to build greater strength, speed, endurance, and precision of multijoint movements on tasks that increase independence and enrich daily activity. Imaging tools may help clinicians determine the capacity of residual networks to respond to a therapeutic approach and help establish optimal dose-response curves for training. Promising adjunct approaches include practice with robotic devices or in a virtual environment, electrical stimulation to increase cortical excitability during training, and drugs to optimise molecular mechanisms for learning. Biological strategies for neural repair may augment rehabilitation in the next decade.     

Technology-enhanced monitoring in psychotherapy and e-mental health

Advances in technology increasingly facilitate data collection in the context of psychosocial and psychotherapeutic care. Such technology-enhanced assessments (e.g. via Internet-based systems and mobile devices) open new perspectives for research into processes related to mental health and well-being. The use of this knowledge for the development and refinement of (online and face-to-face) therapeutic interventions promises to contribute to an optimization of care. The aim of this paper is to provide an overview on how information and communication technologies may be used (a) to improve our understanding of illness development and recovery through longitudinal technology-enhanced assessment of symptoms and behaviors (e.g. outcome monitoring and ecological momentary assessment) and (b) to optimize care for mental disorders by integrating such monitoring assessments in specific interventions (e.g. ecological momentary interventions and supportive monitoring) in face-to-face or e-mental health settings.