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Helping stroke survivors translate VR into real life

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"Our ambitions are in delivering improvements for them with their aphasia."

“Sat on elephant. Swam on turtle. Dancing in Tardis.”

While this may sound like something from a particularly crazy dream, for stroke survivors, this is a reality – or rather virtual reality – which is delivering measurable benefits to their recovery.

Through accessing EVA Park, the world’s first multi-user online world, people with aphasia across the globe are being given unique opportunities to re-learn and practice their speech, while also developing social connections and confidence.

So while social interactions and venturing out to the shops may seem a daunting prospect in everyday life, in EVA Park, users can enjoy a carefree trip to the hairdresser, bar or disco, or even go dancing in the Tardis, should they wish.

And by being enabled to do so in the safety of a virtual environment, evidence is showing that this progress with speech is, for many users, being replicated in the real world.

“That’s the holy grail, for people to practice the contexts and develop their skills and then introduce them into real life,” says Professor Jane Marshall, who has led the research from the beginning of the project in 2012.

“So if you want to go to a cafe, you can practice in EVA Park and then translate that into a real life environment.”

And the statistics are showing that to be the case, with studies revealing many people with aphasia see an improvement in functional communication after using EVA Park, which has been pioneered by City, University of London.

Through the creation of avatars, which then live out whatever adventures they wish in EVA Park, interacting with fellow avatars along the way, improvements are being seen in areas of speech including story telling skills and word retrieval.

“We’ve had a very positive response but I think a big part of it is because it’s a huge laugh, it’s very sunny and joyful, as well as being slightly bonkers,” says Professor Marshall, whose background is in speech and language therapy.

“While it’s a simulation of a real world environment, you can also get the opportunity to do crazy things, such as our participant who sat on the elephant, swam on the turtle and danced in the Tardis.

“Your avatar can be whoever you want to be. You can go wild. We have some rather matronly ladies in their 60s whose avatars have mohican haircuts, and why not?

“But I think the impact of that can be very powerful – one man told us it was like being on holiday, there is the same kind of escapism through being in EVA Park from experiencing aphasia in everyday life.

“Another, who had paralysis down one side of his body after his stroke, told us that he loved how this wasn’t who he was in EVA Park and his avatar could walk, fly and roller skate.”

The development of EVA Park came from the recognition that an online-based activity may bring people together in ways that would not always happen in real life – an approach typified by the restrictions caused by the COVID-19 pandemic.

“If you’re going to groups and have to travel some distance, that can be costly, and it can sometimes be difficult for therapists to get to patients if people live in remote areas of the world,” says Professor Marshall.

“In Australia, for example, we have people using EVA Park who live very remotely, so probably wouldn’t travel to use it, but because they can do it at home on their screen – it’s not an immersive experience, so they don’t even need a headset – it’s very accessible.

“Through operating in a virtual world, there are no restrictions, so it’s also a world away from the pandemic. And while many people have turned to technology over the past year, we have always recognised its benefits in therapy and that is why we created EVA Park.”

Since the development of EVA Park in 2012, the use of technology in therapy has become more widely recognised and used, which, says Professor Marshall, will continue to deliver benefits.

“I think technology in its widest sense has a huge contribution to make for people who have had a stroke,” she says.

“There are many mainstream technologies in use now, such as word prediction technology, which can help enormously. Therapists are using apps and technology much more than ever before, and that’s an important strand.

“And there are great benefits in delivering therapy sessions remotely through using Zoom, Skype or Teams, which are really being seen at the moment. So technology has a huge role to play.

“I think EVA Park occupies a place in that spectrum, but probably at the smaller end of the scale, and we inject a bit of fun in there too.”

While the platform has users from as far afield as the United States, Australia and the Bahamas and has been hailed for the quality of its creation and outcomes, Professor Marshall says the goal is improving the lives of its users rather than global expansion.

“We are international, but we are small. We’re university researchers rather than Apple and just don’t have the infrastructure to make the software available to a huge global user community,” she says.

“However, we are very happy with what we are doing and the groups we are working with, and our ambitions are in delivering improvements for them with their aphasia. If we are doing that, then we are very happy.”

News

No higher risk of pregnancy complications in women with MS – study

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Women with multiple sclerosis (MS) may not be at a higher risk of pregnancy complications like gestational diabetes, emergency caesarean section or stillbirth than women who do not have the disease, new research has found.

However, the study did find that babies born to mothers with MS had a higher chance of being delivered by elective caesarean section (c-section) or induced delivery, and of being small for their age when compared to babies of women who did not have the disease.

“Women with multiple sclerosis may be understandably concerned about the risks of pregnancy,” says study author Professor Melinda Magyari, of the University of Copenhagen.

“While previous research has shown there is no higher risk of birth defects for babies born to women with MS, there are still a lot of unknowns around pregnancy and MS.

“We wanted to find out if women with MS are at risk for a variety of pregnancy complications.

“We found overall their pregnancies were just as healthy as those of the mothers without MS.”

The study involved 2,930 pregnant women with MS who were compared to 56,958 pregnant women without MS. All women gave birth between 1997 and 2016.

Researchers found no difference in risk of several pregnancy complications between women with MS and women without it.

No differences were found in risk of pre-eclampsia, gestational diabetes, placenta complications, emergency c-section, instrumental delivery, stillbirth, pre-term birth, congenital malformations or low Apgar score. Apgar score is a test of a newborn’s health, including measures like heart rate, reflexes and muscle tone immediately after birth.

Researchers did find that 401 of the 2,930 women with MS, or 14 per cent, had an elective c-section, compared to 4,402 of the 56, 958 women without MS, or eight per cent, who had an elective c-section.

After adjusting for other factors that could increase the likelihood of having an elective c-section, such as prior c-section and mother’s age, women with MS were 89 per cent more likely to have an elective c-section.

Researchers also found women with MS were 15 per cent more likely to have an induced delivery than women without the disease.

Also, women with MS were found to be 29 per cent more likely to have babies that were born small for their gestational age compared to women without MS.

Overall, 3.4 per cent of women with MS had babies small for their gestational age, compared to 2.8 per cent of women without MS.

“We think the reason more women with MS have babies by elective c-section or induced delivery may have to do with MS-related symptoms such as muscle weakness, spasticity or fatigue that might affect the birth,” Professor Magyari says.

“Any of these could make a mother more tired and lead to delivery complications that could prompt the clinician and woman to take extra precautions.”

Researchers also found that mothers with MS were 13 per cent less likely to give birth to babies with signs of being deprived of oxygen, or asphyxia.

Professor Magyari said the higher prevalence of elective c-sections among women with MS most likely explains the corresponding lower odds of asphyxia.

A limitation of the study is the lack of data on the mothers’ smoking, which could cause babies to be born small for their gestational age.

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Neuro physio

Community neurorehab gym continues to expand

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The West Berkshire Therapy Centre was established on the back of £145,000 worth of fundraising

A community therapy centre which enables neuro patients access to the physio-led exercise which can support their recovery continues to expand in response to demand for its services.

West Berkshire Therapy Centre was opened in 2014 to bridge the gap in existing community resources, and initially opened for 20 hours a week with ten items of equipment.

Since that time, the Thatcham centre has expanded into premises twice the size of its initial home, and now has 17 items of equipment which clients can access 35 hours each week.

While the centre has been forced to close during lockdown periods, the investment in its offering has continued, with a further £17,500 being spent to upgrade equipment.

In addition to its regular clientele of around 260 people, around 200 more will be referred to the centre from the Berkshire Long COVID Integrated Service, led by Dr Deepak Ravindran, who has worked closely with the centre for several years.

As well as the anecdotal evidence from clients who attest the positive effect West Berkshire Therapy Centre has, the centre’s work has been proven to improve client mobility by an average of ten per cent, psychological outlook by 15 per cent and weight loss by three per cent.

All clients are assessed by the centre’s physio before being prescribed an individual exercise programme. The centre prides itself on its client-centred approach and some of the equipment in the gym has been designed and built specifically in response to what clients said were important to them.

West Berkshire Therapy Centre was created by the West Berkshire Neurological Alliance, a group of 23 local neuro charities, which recognised the need for greater specialist provision for people living with neurological conditions in the area.

John Holt was instrumental to the creation of both the Alliance and the Centre. Having supported his wife in living with MS for over 40 years, he took the lead on ensuring greater provision and support was there for those who needed it.

“I’m not from a medical background, I’m a food technologist, and while I was chair of a trade association during my career, I was used to working with competitors and business enemies, that was just what happened for the greater good of us all,” he says.

“So I was rather shocked when I got involved with the local voluntary sector and found that wasn’t the case. I was very proactive in all of our charities working together as I know the importance of working as one alliance.

“People who were living with neurological conditions were often having to fend for themselves when it came to community rehab, and that’s why we wanted to create the West Berkshire Therapy Centre.”

Having been established on the back of £145,000 in fundraising, five years later the demand for its services was such it had to expand into larger premises and invest in more equipment.

The centre – which is funded by voluntary contributions for sessions and through fundraising – now has eight part-time staff and a core of volunteers to support clients with whatever rehabilitation issues they have.

While most clients have neurological conditions – including stroke, Parkinson’s, MS and Post-Polio Syndrome – the centre has broadened its reach to include large numbers of people with arthritis, heart and lung conditions, sight impairments as well as amputees.

“We’re completely pan-disability and will support anyone who needs us. Our clients talk to us and we listen and adapt,” says John.

“I think many clients come to us because we are a safe place for them and they’re among people who understand the challenges they face.

“It is very important that we talk about things openly. For example, we talk about how hard it is when you can’t get to the bathroom in time and you wet yourself.

“When you face issues like that, it can be the start of a spiral downhill, you might then stop going to work or stop leaving the house, but we share these kinds of things.

“By having this interaction, it becomes a place people aren’t afraid to open up.”

With the centre having been closed for much of the past year, John and the team are ready to welcome back regular and new clients, including the many who are recovering from Long COVID.

“Many of our clients won’t have exercised for several months, but we hear very often that people have waited 20 years for a centre like this, so a few months hasn’t been long in comparison,” says John.

“But we are very much looking forward to re-opening and supporting our clients in regaining any progress and fitness they may have lost. Hopefully we are on the right track now after three lockdowns and clients can come back to us regularly.

“Long COVID is a new condition for us, as it has only come into being in the past few months, but we are ready to support people with their symptoms and in them using exercise as part of their recovery.”

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Brain tech company secures funding to increase support post COVID-19

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CBS Health will help clinicians utilise more digital services

An online brain assessment platform has secured funding to enable its work in telehealth to continue to support people as the world emerges from the COVID-19 pandemic.

Cambridge Brain Sciences (CBS) is planning to expand its operation through a funding round from Canadian Shield Capital, a Toronto-based private equity investment firm, closely aligned to Hatch, a global engineering consultancy.

The investment will allow Candian-based CBS to further its work in digital health, especially around mental health, and respond to the need for accurate and reliable quantified measures of brain function and brain health – hailed as being essential to so many people who have suffered psychologically from the effects of COVID-19.

The funds will allow CBS to grow its sales and customer support teams rapidly, which will enable it to roll out its flagship product, CBS Health, further.

It will also enable it to expand on CBS Health features to help continue to refine and develop its cognitive care platform for healthcare professionals treating the growing mental health, brain injury and ageing patient populations.

The COVID-19 global pandemic has seen many healthcare practitioners to adopt platforms such as CBS Health to manage patients remotely.

As a result of lockdowns and ‘stay at home’ guidance, there has been exponential growth in patients seeking treatment for mental health conditions brought on, or exacerbated by, the pandemic, as well as individuals recovering from COVID-19 suffering with longer term neurological symptoms.

CBS Health has also grown as a result, and offers a web-based platform or integration which allows healthcare professionals to administer the CBS tasks standalone or alongside other established and validated complementary assessments (such as the PHQ-9, a standard scale for assessing the severity of depressive symptoms).

Assessments can be combined into a single session and administered in person or remotely via email—an option from which clinicians have benefitted greatly throughout the COVID-19 global pandemic.

The investment also contemplates further collaboration between CBS and Hatch, building upon an earlier successful pilot for a dedicated CBS platform to address corporate workplace mental health and safety at large scale industrial operations, construction sites and infrastructure projects.

“CBS is excited to be closing this round of financing which builds upon a long-term relationship with Canadian Shield and an earlier successful pilot with Hatch,” says Marc Lipton, president and CEO of Cambridge Brain Sciences.

“The funding will allow us to further accelerate the growth of our core CBS Health product especially amongst mental health practitioners, as well as to strategically explore, with Hatch, large corporate applications for workplace mental health and safety.”

“CBS brings many years of academic discipline and rigorous digital measurement of cognitive health, with applications in mental health, brain injury recovery, healthy ageing, and soon workplace safety,” says Andrew W. Dunn, managing partner at Canadian Shield Capital.

“The growing awareness of, and attention to, mental health conditions and CBS’ engaging and efficient approach gives it enormous runway.”

James Marzocca, global managing director for project delivery at Hatch, adds: “We see great potential to apply CBS testing as a non-invasive diagnostic to assess fitness for duty for individuals reporting to worksites where mental alertness is essential for their own safety and the safety of others.”

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