“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.”
Robot with ‘potential to redefine neurorehab’ unveiled by Fourier
The ArmMotus™ EMU is the world’s first 3D back-drivable upper limb rehabilitation robot, setting a new benchmark for intelligent rehabilitation devices.
The robot, the latest world-leading addition to Fourier Intelligence’s portfolio, is said to have the potential to redefine human-machine interaction.
It is the first of its kind that applies the end-effector based concept into the 3D movement, bringing a new experience of robotics rehabilitation therapy.
The product – revealed during RehabWeek 2021 – revolves around a cable-driven mechanism, that combines with a four-linkage structure, which reduces the friction and inertia during the movement of the system. This design also enables the control system to respond and execute more efficiently.
Zen Koh, co-founder and Global Hub CEO of Fourier Intelligence, hailed the robot as helping to redefine the future.
“Current neurorehabilitation models primarily rely on extended hospital stays or regular therapy sessions which require close physical interactions between rehab professionals and patients,” he said.
“The ongoing COVID-19 pandemic situation has challenged this model and as a result, many neurological patients are not receiving sufficient therapy. There is an urgent need to rethink conventional neurorehabilitation therapy.
“The new ArmMotus™ EMU provides that solution. The EMU, equipped with clinical intelligence, provides personalised therapy, technology-based solutions, coaching capabilities and remote monitoring.
“The implementation of fun functional games with embedded artificial intelligence also provides clinically motivating therapy to patients as well as giving caregivers and healthcare practitioners confidence.”
The ArmMotus™ EMU, jointly built by Fourier Intelligence and the University of Melbourne Robotics Laboratory, has taken two years to bring to fruition and was led by Professor Denny Oetomo.
“The robot offers large workspace with very minimal resistance and reflected inertia of the robot on the patient. This would allow the patient to move freely”, said Prof Oetomo.
“Combined with the appropriate gravity compensation of the weight of the arm, patients with weak or little arm function, is able to carry out therapy without exertion.”
Another key person to the success of the ArmMotus™ EMU, Dr Marlena Klaic, the translational research lead at Royal Melbourne Hospital, gave further insight into why robotic rehabilitation is important.
“There’s a large and growing body of evidence suggesting that robotic devices can improve a patient’s outcome, including function, strength and ADL,” said Dr Klaic.
“This evidence is growing even more rapidly in these pandemic times as more people are exploring digital and remote prevision therapies.
“We conducted a user-based design study where we build and modify the robot based on the feedback from clinicians. Based on our results, we found that clinicians believe that robotic devices can be helpful in their practice. Patients and junior therapists are more frequently asking for robotic devices as part of their therapy session.”
Aside from exoskeleton and other one-dimension upper limb rehabilitation robots, EMU is based on terminal control and high technical content which is difficult to develop. It is China’s first breakthrough in this field.
EMU uses the industry-leading force feedback technology platform, which was independently developed by Fourier Intelligence, to simulate the force exerted by a therapist. It also provides a large 3D trajectory training space which allows rehabilitation movements to be more realistic and guides users to complete various complex rehabilitation training.
Product director of Fourier Intelligence, Daris Yang, also explained the importance of having interactive rehabilitation programmes.
“By equipping EMU with games such as table tennis, cooking, and fishing, this would simulate activities of daily living even more,” said Yang.
“The boring and repetitive training actions in traditional rehabilitation makes it boring for patients to train for a long time. Our EMU game settings have completely rewritten the rehabilitation scene.”
Brain Bank spearheads quest for CTE cure by 2040
Sportspeople are urged to play their role in making sport a safer place, as well as to follow the lead of Steve Thompson MBE in donating their brains to research
Professional sportspeople were today urged to play their role in making sport safer as a pioneering project was announced with the aim of preventing new cases of Chronic Traumatic Encephalopathy (CTE) within five years and of finding a cure by 2040.
The internationally-renowned Concussion Legacy Foundation has now come to the UK, following 14 years of research and advocacy that has led to change in sport, and support of players, around the world. Its founder, Dr Chris Nowinski, was instrumental in forcing NFL to change its protocols around head injury through his 2006 book ‘Head Games: Football’s Concussion Crisis’.
And through the creation of the Concussion Legacy Project, a new brain bank in partnership with the Jeff Astle Foundation, it hopes to gather more vital research in this area to protect future generations of sportspeople.
England Rugby World Cup winner Steve Thompson MBE announced he had become the first donor to the Project.
And Dr Nowinski called on sportspeople to take the lead in making sport a safer place for themselves, their teammates and future generations, as he bids to eradicate CTE.
Research has shown CTE develops through repeated hits to the head over a period of time, which can begin in childhood in many instances.
“This is the time for professional sports men and women to step up and join the fight to change the game, reduce the risk of CTE, change your destiny,” he told a press conference.
“Make no mistake – some of you already have CTE and every header or tackle will be making it worse. You will have teammates who will have, or will develop, CTE.
“Step forward and make a positive difference. Take advantage of this opportunity before it’s too late. It is too late for heroes like Jeff Astle and Rod Taylor, but it’s not too late for our children.”
Dr Nowinski, who is an advocate of non-contact sport until at least the age of 14, reiterated his fears for children if action is not taken now.
“We should not be giving children a preventable brain disease before they are old enough to drive, vote, or take many decisions for themselves,” he said.
“We need to stop hitting children in the head, we are giving them a life-long brain disease. The only way we know to prevent CTE is to limit the exposure to head impact and we have to do that.”
Dr Adam White was announced as executive director of the newly-created Concussion Legacy Foundation UK.
“We’ve long known about the relationship between sport and CTE, but we urgently need to better understand how CTE affects athletes and veterans, as well as their families, at every stage of their life,” said Dr White.
“We have reason for hope. CTE usually begins in a person’s teens or twenties, which means we have a lifetime to treat patients, educate people and support their families.
“We want to stop all new cases of CTE in the next five years and have a cure by 2040.”
Appeals were also made for sportspeople to donate their brains to the Concussion Legacy Project, following the brave lead of Steve Thompson.
The project builds on the lead of the VA-BU-CLF Brain Bank in Boston, which has created the world’s leading CTE research program. To date, more than 1,000 brains have been donated and 600 cases of CTE diagnosed, which comprises about 80 per cent of the world’s confirmed cases.
“I’m pledging my brain so the children of the people I love don’t have to go through what I have gone through,” said the former British Lion who was diagnosed with dementia at the age of 42.
“It’s up to my generation to pledge our brains so researchers can develop better treatments and ways to make the game safer.”
“Brain donation is the most valuable gift of all for future generations of footballers,” said Dawn Astle, daughter of Jeff Astle.
“It may be many years before this jigsaw is complete, but by adding each piece, one at a time, it is the only way we shall understand the true picture and so be able to make a better future for others.
“The Jeff Astle Foundation encourages families of athletes and veterans to donate the brain of their loved one to the Concussion Legacy Project.”
The Concussion Legacy Project will be led by Dr Gabriele DeLuca, associate professor in the Nuffield Department of Clinical Neurosciences, University of Oxford, and director of clinical neurosciences undergraduate education at Oxford Medical School.
“Brain donation will allow us to better understand the complexities of CTE so that we can develop tailored interventions and treatments to prevent its devastating consequences,” said Dr DeLuca.
In the next phase of the collaboration, Dr. DeLuca will lead clinical research efforts aimed at learning how best to treat common CTE-related symptoms, including problems with thinking and memory, mood, and sleep.
Athletes and veterans can pledge to donate their brains to CTE research at PledgeMyBrain.org.
The Concussion Legacy Foundation UK has created a 24-hour brain donation hotline for families to call and coordinate brain donations. Family members of athletes and military service members who wish to donate their loved one’s brain can contact the Concussion Legacy Project at 07534 029 223 and UK@concussionfoundation.org.
Sexual trauma ‘could lead to neurological conditions’
Traumatic experiences, including sexual violence, could be linked to dementia, stroke and other brain disorders in women, new research has indicated.
Links between such trauma and poor mental and cardiovascular health are already established – but a new study suggests they could also be linked to indicators of cerebrovascular risk that may be a precursor to neurological conditions.
To date, little research has been done to examine the relationship between traumatic experiences, including sexual assault, and indicators of small vessel disease in the brain.
But a new study from the University of Pittsburgh specifically investigated whether traumatic experiences were associated with white matter hyperintensities (WMHs), which are markers of brain small vessel disease.
WMHs can be detected decades before the onset of dementia, stroke, and other neurological risk and can serve as early markers.
Of the nearly 150 mid-life women involved in the study, 68 per cent reported having at least one trauma, with the most common trauma being sexual assault (23 per cent of the women).
After evaluating the data, researchers concluded that women with trauma exposure had greater WMH volume than women without trauma. The particular trauma significantly associated with WMH was sexual assault.
Associations between sexual assault and WMHs persisted even after adjusting for depressive or post-traumatic stress symptoms, suggesting that sexual assault may put women at greater risk for poor brain health.
“The results of this study are noteworthy in that sexual assault is an unfortunate, yet all-too-common, experience for women; national data indicates that, on average, up to a third of women have had this experience,” says Dr Rebecca Thurston from the University of Pittsburgh and lead author of the study.
“This distressing experience is not only important for women’s mental health, but also their brain health. This work is a major step toward identifying a novel risk factor for stroke and dementia among women.
“Not only do these results underscore the need for greater prevention of sexual assault, but also provide healthcare professionals with another indicator of who may be at most risk for stroke and dementia later in life.”
“Identifying early warning signs of stroke and dementia are critical to providing effective intervention,” says Dr. Stephanie Faubion, North American Menopause Society (NAMS) medical director.
“Studies like this one provide important information about the long-term effects of traumatic experiences on a woman’s overall well-being and mental health.”
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