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The role of virtual reality in improving motor performance as revealed by EEG: a randomized clinical trial
Background
Many studies have demonstrated the usefulness of repetitive task practice by using robotic-assisted gait training (RAGT) devices, including Lokomat, for the treatment of lower limb paresis. Virtual reality (VR) has proved to be a valuable tool to improve neurorehabilitation training. The aim of our pilot randomized clinical trial was to understand the neurophysiological basis of motor function recovery induced by the association between RAGT (by using Lokomat device) and VR (an animated avatar in a 2D VR) by studying electroencephalographic (EEG) oscillations.
Methods
Twenty-four patients suffering from a first unilateral ischemic stroke in the chronic phase were randomized into two groups. One group performed 40 sessions of Lokomat with VR (RAGT + VR), whereas the other group underwent Lokomat without VR (RAGT-VR). The outcomes (clinical, kinematic, and EEG) were measured before and after the robotic intervention.
Results
As compared to the RAGT-VR group, all the patients of the RAGT + VR group improved in the Rivermead Mobility Index and Tinetti Performance Oriented Mobility Assessment. Moreover, they showed stronger event-related spectral perturbations in the high-γ and β bands and larger fronto-central cortical activations in the affected hemisphere.
Conclusions
The robotic-based rehabilitation combined with VR in patients with chronic hemiparesis induced an improvement in gait and balance. EEG data suggest that the use of VR may entrain several brain areas (probably encompassing the mirror neuron system) involved in motor planning and learning, thus leading to an enhanced motor performance.
Trial registration
Retrospectively registered in Clinical Trials on 21-11-2016, n.
NCT02971371
.
Journal Article
Correction: The impact of post-stroke fatigue on inpatient rehabilitation outcomes: An observational study
[This corrects the article DOI: 10.1371/journal.pone.0302574.].
Journal Article
Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial
Concussion is a common injury in sport. Most individuals recover in 7-10 days but some have persistent symptoms. The objective of this study was to determine if a combination of vestibular rehabilitation and cervical spine physiotherapy decreased the time until medical clearance in individuals with prolonged postconcussion symptoms.
This study was a randomised controlled trial. Consecutive patients with persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion (12-30 years, 18 male and 13 female) were randomised to the control or intervention group. Both groups received weekly sessions with a physiotherapist for 8 weeks or until the time of medical clearance. Both groups received postural education, range of motion exercises and cognitive and physical rest until asymptomatic followed by a protocol of graded exertion. The intervention group also received cervical spine and vestibular rehabilitation. The primary outcome of interest was medical clearance to return to sport, which was evaluated by a study sport medicine physician who was blinded to the treatment group.
In the treatment group, 73% (11/15) of the participants were medically cleared within 8 weeks of initiation of treatment, compared with 7% (1/14) in the control group. Using an intention to treat analysis, individuals in the treatment group were 3.91 (95% CI 1.34 to 11.34) times more likely to be medically cleared by 8 weeks.
A combination of cervical and vestibular physiotherapy decreased time to medical clearance to return to sport in youth and young adults with persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion.
NCT01860755.
Journal Article
Strengths-based approaches to crime and substance use : from drugs and crime to desistance and recovery
Although there is a strong and growing literature in the two areas of desistance and addiction recovery, they have developed along parallel pathways with little systematic assessment of the empirical evidence about the co-occurrence of the relationship or how one area can learn from the other. This book aims to fill that gap by bringing together emerging literature on the relationship between offending and substance use. Instead of focusing on the active period of its onset and persistence, this book examines the mechanisms that support desistance, addiction recovery, and the common themes of reintegration and rehabilitation. With contributions from a wide range of international experts in the fields of desistance and addiction recovery, the book focuses on a strengths-based, relational and community-focused approach to long-term change in offending and drug-using populations, as well as the shared barriers to effective reintegration for both. This book will be highly informative for a wide audience, from academics and students interested in studying desistance and recovery to those working in addiction services and the criminal justice system as well as policy makers and the people undertaking their own journeys to desistance and recovery.
Book
Psychological Symptoms and Rates of Performance Validity Improve Following Trauma-Focused Treatment in Veterans with PTSD and History of Mild-to-Moderate TBI
Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.
Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).
Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.
Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.
Journal Article
Effektivität integrierter psychokardiologischer Rehabilitation
Einführung: Komorbiditäten kardialer und psychosomatischer Erkrankungen sind häufig, monodisziplinär schwierig zu behandeln und führen oft zu komplizierteren Verläufen, schlechterer Lebensqualität und erhöhter Mortalität (Albus et al., 2018), was zur Entwicklung fächerübergreifender Behandlungsansätze führte. Ein integriertes psychokardiologisches multimodales Rehabilitationsprogramm (PK) ist seit 2016 in Teltow implementiert, dessen Wirksamkeit in einer naturalistischen Studie im Vergleich zur monodisziplinären Rehabilitation in der Psychosomatik (PS) und der Kardiologie (K) überprüft wurde. Methodik: Nicht-randomisierte Effectiveness-Studie mit Interventionsgruppe (PK: N=234) und zwei Kontrollgruppen (PS: N=64 und K: N=49) mit 3 Messzeitpunkten (Reha-Verlauf sowie 6-Monats-Katamnese). Ergebnisparameter Depressivität (BDI- II), Herzangst (HAF) sowie gesundheitsbezogene Lebensqualität (LQ) (SF-12). Ergebnisse: Im BDI-II zeigt sich eine größere Verbesserung in der PS, im Reha- Verlauf signifikant (t(284)=-2.14, p=.017, d=-0.31). In der PK zeigt sich zur Katamnese eine größere Verbesserung im Vergleich mit der K, was allerdings knapp keine statistische Signifikanz erreicht (t(201)=1.90, p=.059, d=0.34). Im HAF zeigen sich größere Verbesserungen in der PK gegenüber der K zur Katamnese im HAF- Gesamtwert (t(194)=2.45, p=.015, d=0.45) sowie in der klinisch besonders relevanten Unterskala „herzangstbezogene Vermeidung\" (t(198)=2.50, p=.013, d=0.46). Im SF-12 verbessert sich die körperliche LQ in der PK sowohl im Reha-Verlauf als auch besonders zur Katamnese tendenziell stärker als in den Kontrollgruppen, vor allem im Vergleich mit der PS. Hinsichtlich der psychischen LQ zeigt sich die größere Verbesserung in der PS, allerdings ohne statistische Signifikanz. Diskussion: Im Reha-Verlauf kommt es in allen Behandlungsgruppen zu guten Verbesserungen hinsichtlich Depressivität, Herzangst und Lebensqualität. Die PK zeigt wie bereits in einer Pilotstudie (Priegnitz et al, 2000) ihre Stärke im Langzeitverlauf durch Überlegenheit hinsichtlich Verbesserung der körperlichen LQ sowie in der langfristigen Verbesserung der Herzangst im Vergleich zur K-Reha.
Journal Article