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The importance of customisation in neurorehab

NeuronUP discuss how customised neurorehab can deliver greater adherence and better outcomes

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Due to the improvement of medicine and the consequent increase in overall life expectancy, the prevalence of neurological disorders and need for neurorehab among the population is becoming higher and higher.

These disorders include Alzheimer’s disease, the presence of brain damage due to stroke, traumatic brain injury or tumour, MS or epilepsy.

In all of them, there is usually long-term cognitive impairment, with the profile and severity of the deficit varying from case to case.

This has an impact on people’s daily functioning, even more than that caused by the physical limitations which are also present in many cases, which makes an appropriate intervention necessary in this field while trying to provide these people with a decent quality of life.

Due to this, in recent years there has been a greater awareness and several advances in the area of cognitive rehabilitation, involving different professionals such as neuropsychologists, occupational therapists or speech therapists.

One of the most relevant advances is related to the revolution in the field of technology and its application to neurorehabilitation, both at the level of intervention with the patient and monitoring of the process.

Numerous applications have emerged within this framework of new technologies, but care must be taken when choosing and knowing how to differentiate between those that really meet the necessary conditions for the professional to carry out an adequate intervention.

It is essential that it is based on a robust theoretical model of brain functioning and allows the professional to design an intervention that meets the following points:

– Be an adequately planned process in which the specific objectives to be achieved with each patient in the short, medium and long term will be established (the subject must also participate in some decisions in the planning of the intervention).

– Be an active and dynamic process, which will be adjusted to the patient’s needs as he or she evolves in the different areas (cognitive, emotional, functional and social).

Be individual and personalised, adjusting to the needs, interests and situation of each person

– Develop tasks with ecological validity and generalisable value, so that the learning achieved is transferred to the patient’s personal context. To this end, real situations must be worked on and, specifically, of the type that the person must face in their day-to-day life, so that the acquisition of skills will be useful in real life.

– Propose a hierarchical organization, since all the affected areas should be addressed, starting with the non-specific aspects until reaching the specific ones.

– Adapt the level of difficulty progressively, starting with tasks that require minimal demands and gradually progressing to higher levels of difficulty (always as far as the patient can tolerate).

– Be motivating and present appropriate reinforcement throughout the process. It is essential that the patient is aware of how he or she is doing during the process and understanding why each task is being done. It may be convenient to give examples from his or her real life.

– Make systematic records that allow us to assess how the patient evolves in the development of the rehabilitation process, which will allow us to know if the methods we are using lead to the expected result or if they need to be changed.

– Carry out a final evaluation of the effectiveness of the rehabilitation, which, compared with the previous evaluation, will tell us if we have really achieved our objectives.

On this occasion we are going to focus on the importance of personalisation, which will allow the intervention to be adjusted to the needs, interests and situation of each individual.

This is essential to motivate the patient and to achieve useful objectives in each situation (ecological value), which can vary immensely from one patient to another.

Let’s think for example of two patients with Alzheimer’s disease.

It might seem that both would have a similar profile and need the same intervention, but while one is in a nursing home, grew up in the countryside and cannot read or write, the other lives at home with his son and daughter-in-law, with two school-age grandchildren who spend a lot of time interacting with him, and during his working life he was a banker in the city.

Both their cultural background and experience, as well as their interests and daily circumstances, are totally different, so it is convenient to analyse what kind of content would be more practical and necessary to work with each of them.

With this premise in mind, the NeuronUP platform stands out, allowing numerous aspects to be customised and adapted, enabling the professional to quickly and easily design the most appropriate intervention in each case.

On the one hand, the general characteristics of the activity can be customised (maximum time, instructions, inactivity warnings in case the patient has attentional problems, errors allowed, etc).

On the other hand, the professional can choose the specific parameters of the activity, which allows the level to be adapted in a precise way (for example, in a task of memorising objects, the number of items that will appear and the time to memorise them could be chosen).

Materials can also be customised to make the activity more motivating and meaningful for the patient (in word search, one could choose the words to look for or in a social cognition activity include relevant situations of his daily life).

Finally, in appropriate cases, the adaptability when interacting with the game can be customised (if the patient has a touch screen, probably the most intuitive way is to drag the elements, but in case of mobility or mouse use problems, the professional can choose that the movement of elements is done by simple clicks).

The appropriate choice of all these possibilities has demonstrated better patient outcomes and greater adherence to the intervention.

 

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Non-invasive technique ‘could replace need for brain surgery’

The new PING approach could help treat some of the most challenging and complex neurological diseases

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A new non-invasive technique has been developed to remove faulty brain circuits that could allow medics to treat debilitating neurological diseases without the need for conventional brain surgery.

If successfully translated into operating theatres, the breakthrough has been hailed as potentially revolutionary in the treatment of some of the most challenging and complex neurological diseases, including epilepsy, movement disorders and others. 

The PING approach, developed by the University of Virginia and Stanford University, uses low intensity focused ultrasound waves combined with micro-bubbles to briefly penetrate the brain’s natural defences and allow the targeted delivery of a neurotoxin. 

This neurotoxin kills the culprit brain cells while sparing other healthy cells and preserving the surrounding brain architecture.

“This novel surgical strategy has the potential to supplant existing neurosurgical procedures used for the treatment of neurological disorders that don’t respond to medication,” said researcher Dr Kevin S. Lee, of UVA’s departments of neuroscience and neurosurgery and the Center for Brain Immunology and Glia (BIG). 

“This unique approach eliminates the diseased brain cells, spares adjacent healthy cells and achieves these outcomes without even having to cut into the scalp.”

PING has already demonstrated exciting potential in laboratory studies. For instance, one of the promising applications for PING could be for the surgical treatment of epilepsies that do not respond to medication. 

Around a third of patients with epilepsy do not respond to anti-seizure drugs, and surgery can reduce or eliminate seizures for some of them. 

Dr Lee and his team, along with their collaborators at Stanford, have shown that PING can reduce or eliminate seizures in two research models of epilepsy. 

Dr Kevin S. Lee

The findings raise the possibility of treating epilepsy in a carefully-targeted and non-invasive manner without the need for traditional brain surgery.

Another important potential advantage of PING is that it could encourage the surgical treatment of appropriate patients with epilepsy who are reluctant to undergo conventional invasive or ablative surgery.

A key advantage of the approach is its incredible precision. PING harnesses the power of magnetic-resonance imaging (MRI) to let scientists peer inside the skull so that they can precisely guide sound waves to open the body’s natural blood-brain barrier exactly where needed. 

“If this strategy translates to the clinic,” the researchers write in their new paper, “the noninvasive nature and specificity of the procedure could positively influence both physician referrals for and patient confidence in surgery for medically intractable neurological disorders.”

“Our hope is that the PING strategy will become a key element in the next generation of very precise, noninvasive, neurosurgical approaches to treat major neurological disorders,” said Dr Lee, who is part of the UVA Brain Institute.

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QEF’s accessible technology wins international awards

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The new Care and Rehabilitation Centre in Surrey, developed by Queen Elizabeth’s Foundation for Disabled People (QEF), has won 2 international CEDIA awards for its innovative use of accessible technology, which was supplied by technology solutions partner Imperium Building Systems Ltd.

These awards recognise the improvement technology can make to the lives of disabled people, which is reflected at a UN event that forms part of this year’s International Day for People with Disabilities. The global UN awareness day today (December 3) highlights the challenges and discrimination disabled people face around the world, and pushes for positive change towards greater inclusion, accessibility and equality for disabled people.

This year on December 3, the UN is co-hosting an event specifically looking at ‘Reducing Inequalities through Technologies’ noting that: ‘persons with physical, sensory, cognitive/learning or invisible disabilities represent nearly 15 per cent of the world population’ 1 and that ‘for some kinds of disabilities, assistive devices/technologies are key “equalizers” that promote inclusion and full participation in all industries and dimensions of life’. 1

The event also highlights that ‘One billion persons with some form of disability can benefit from assistive technologies that can facilitate their social, economic and political engagement, including their participation in decision-making processes that affect their lives and ambitions’ 1

QEF’s Care and Rehabilitation Centre provides neuro rehabilitation for people after an acquired brain injury, stroke, incomplete spinal injury or other neurological condition and clients are supported by expert staff to relearn core skills, so they can rebuild their lives and be as independent as possible.

QEF’s vision for the new Care and Rehabilitation Centre was to use technology to give each person greater control over their personal space, no matter what a person’s impairment may be. It’s easy to take for granted being able to close the blinds when the sun is in your eyes or turn the lights off when you want to go to sleep – until you can’t do it for yourself. QEF wanted a system that empowered clients to have a greater sense of self-determination and influence over everyday activities during their rehabilitation.

Imperium developed the project with QEF, producing a cost-effective ‘smart home’ solution, using easily available technology that is adaptable to each persons’ specific requirements. Five connected smart devices have been installed in each bedroom which can be controlled in different ways; either with standard voice commands, pre-programmed accessible switches or programmable text to talk commands.

Ann, a client at QEF’s Care and Rehabilitation Centre, says: “I wasn’t sure about it at first – it was odd to sit in my room on my own and talk to something, but now I use it all the time. You can have the blinds down, lights on or off or the TV on or off. It’s another step on the journey of independence, so I don’t have to ask someone to do it for me.”

Chris Thorne, director of Imperium, says: “The technology we have installed for QEF will allow service users to have control over the lights in their room, temperature, day light via shading blinds, and audio-visual equipment. So, someone could stay in one position and manage their entire room, either with switches or voice controls. It also needed to be technology that service users could easily access after they left the service; creating independence that could continue beyond QEF’s walls.”

The international CEDIA awards recognise technical excellence and product innovation in the home technology industry. Imperium’s project with QEF was announced in November 2021 as winners in the ‘Multi Dwelling Unit Design’ category and also went on to win the overall award for ‘Life Lived Best at Home’ which reflects the project that gives the best experience for a client.

Judges for the Life Lived Better at Home award said: “This entry is outstanding for its sensitive and pragmatic response to the brief and for the way the technology meets the changing needs of the users. And all this achieved on an extraordinarily tight budget. I hope there will be many more projects like this in the future!”

Karen Deacon, QEF’s chief executive, says: “Our new Care and Rehabilitation Centre gave us an opportunity to use technology in an innovative way that would directly benefit clients as they relearn core skills. Adapting to life after an acquired brain injury is challenging for anyone and if technology can help give someone back their sense of control over everyday activities then we wanted to be able to offer that as part of our neuro rehabilitation programme.”

  1. Reducing Inequalities Through Technologies: A Perspective on Disability Inclusive Development https://www.un.org/development/desa/disabilities/wp-content/uploads/sites/15/2021/11/IDPD2021ConceptNote.pdf

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Webinar to explore the future of brain injury rehab

Join our panel of expert guests as we discuss the challenges and opportunities in improving patients’ lives

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The future of brain injury rehabilitation and how patients can be supported in new ways is to be examined by leading experts from across the sector at an event held next week. 

Brain injury rehab has made huge strides over the years, innovating and developing to better meet the needs of people living with life-changing injuries. 

Through changes in technology, developments in medicine and the advances in neurorehabilitation, brain injury patients should face an outlook which is better than ever before. 

However, the lack of resource within health services, exacerbated by the ongoing impact of COVID-19 and mounting pressures on the NHS, mean that progress and change is not being seen at the rate many would hope for.  

In 2020, the British Society of Rehabilitation Medicine (BSRM) identified the increased pressure on neurorehabilitation, highlighting the “unquantifiable additional case-load of patients with post-Covid disability presenting with a wide range of problems due to cardio-pulmonary, musculoskeletal, neurological and psychological/ psychiatric complications of the disease.”

In an upcoming webinar – What does the future of brain injury rehabilitation look like? – to be held on Wednesday next week (December 8th) and organised by NRC Medical Experts in association with NR Times, this matter will be examined to assess the scale of the challenge, the opportunities that exist, and what more can be done to better support patients. 

The panel will comprise:

The live hour-long event, from 4.30pm to 5.30pm, will include a panel debate, with questions welcomed from the audience. 

“Health and social care services have been under increasing pressure from an ageing population for decades and this has now been exacerbated by the disruption created by COVID-19,” says Edmund. 

“Brain injury rehabilitation services have always been poorly resourced in the UK, and are now under increased strain while professionals are diverted into the acute management and rehabilitation of COVID-19 patients. 

“It is essential therefore that we consider how to improve service delivery models so that people with brain injury do not fall further behind in the queue. 

“Technological innovation in its many forms offers much potential here, but realising this will be a substantial undertaking for which we are as yet ill-prepared. 

“During this webinar we will explore some of the major opportunities and problems.”

To attend the webinar, registration is required in advance. To sign up, visit here 

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