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“This is the first opportunity for the neuroscience community to understand the virus”

COVID-19 and the brain study scientist Benedict Michael talks to NR Times.

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Senior clinician Benedict Michael hasn’t slept more than four hours a night since February. While many in the field would say science is a slow process, the opposite is true for Michael since he started leading groundbreaking research into the neurological complications caused by Covid-19.

“When it became apparent the virus had taken hold in Italy, I said to the guys, ‘We’ve got to get something up and running’,” Michael, from the University of Liverpool, tells NR Times.

Michael led a similar programme during the H1N1 epidemic over a decade ago, when he noticed that, while the number of people who developed neurological complications was low, they were often the most severe cases.

Michael wanted to find out: what is Covid-19 doing to the brain, how is it doing it, what makes a person more at risk of these complications, and how do these patients recover? And so, the National Surveillance Programme for Neurological Complications of COVID-19 was born – just in time for Covid-19 coming to the UK.

Michael and his team developed a way for doctors to record the symptoms of patients experiencing neurological and psychiatric complications through their membership organisations, collaborating with the Association of British Neurologists, British Paediatric Neurology Association, British Association of Stroke Physicians and the Royal College of Psychiatry.

Michael applied for permission to use the data, so he could see complications doctors were seeing, and developed a series of online portals that members of the four bodies could access, to fill out a form.

“We needed something quick and easy to use for busy doctors who are running around,” Michael says.

When the Spanish flu took hold 100 years ago, there were reports of patients developing neurological symptoms, Michael says, but they didn’t have the tools to understand what was going on in the patients.

They didn’t know, for example, if the virus was directly affecting the brain, or if it was the body’s immune response to the virus.

“This is our first opportunity as a neuroscience community to understand the role of the virus and the immune response,” Michael says.

The researchers first excluded easily recognisable causes for conditions, such as older patients with several existing conditions, who might already be confused and agitated.

The data, published in the Lancet journal, has revealed that 50 percent of patients with alterations in their mental state were under the age of 60, which Michael says are cases of unexplained neurological and psychological complications.

The most common reported brain complication was stroke, experienced by 77 of the total 125 cases researchers looked at. Most of these strokes were caused by a blood clot in the brain, while nine were caused by haemorrhage and one was caused by inflammation in the blood vessels of the brain. Seven patients showed inflammation in the brain (encephalitis).

There could be several mechanisms at play in cases where Covid-19 affects the brain in this way.

“We currently think the chances of the virus getting into the brain are rare We do see inflammation when looking at MRI brain scans, but no virus in the spinal fluid,” Michael says.

“We also don’t know to what extent the psychological pressures of being hospitalised during the context of the pandemic,” Michael says. “They can’t see their family, and doctors are gowned up and wearing masks. What does this do to the mental state of a person already at risk of developing a mental health disorder?”

While this is the first nationwide study of neurological complications associated with Covid-19, it’s important to remember that the findings are based only on cases that are serious enough to need hospitalisation.

However, Michael’s work is ongoing. Alongside his team, he plans to focus on looking at patients’ immune response, and carrying out geometric testing to try to understand genetic differences in patients who experience more severe symptoms.

The team also hopes to collaborate with other parts of the world.

“I’ve been contacted by patients and clinicians around the world, thinking about how to bring data sets together,” Michael says.

“The number of cases seems to be coming down in the UK, but colleagues in the US might be seeing a second peak and might be able to identify other patients, to help understand this mechanism.”

 

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Video: everyday vs specialist tech

Assistive technology Expert Andy Fell joins Irwin Mitchell law firm for an in-depth exploration of the very latest independence-boosting devices and platforms.

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Technology plays a day to day role in our lives and mobile phones, tablets, Alexa and Siri are common place.

Imagine the impact on your life if you were no longer able to interact with a touch screen or keyboard or give voice commands….

In this virtual event, Assistive Technology expert Andy Fell gives practical demonstrations of how everyday technology and specialist technology can be used to help give independence to those who need it most and why specialist technology may be needed.

During the event hosted by Lauren Haas, personal injury solicitor at Irwin Mitchell LLP, Andy goes into detail about what apps and gadgets are on the market, how everyday technology can be optimised such as the Amazon Alexa, and answered a number of questions ranging from touch screen sensitivity to smart watch reminders.

Case managers, ancillary medical professionals, as well as interested members in healthcare, social care, parents and clients may find this recording useful, as well as anyone caring for, working or living with people such as dementia sufferers or sufferers of other conditions which restrict their mobility.

Andy Fell is an independent disability and assistive technology (AT) consultant with almost twenty years’ experience working with all disabilities and age groups.

He is a qualified Rehabilitation Officer for the Visually Impaired and, since qualification, has lectured on the use of assistive technology and role of AT in the life of disabled people.

He has worked with a wide range of charitable organisations including British Dyslexia Association, was head of assistive technology for Guide Dogs for the Blind and National Disability Advisor for the Royal Yacht Association.

He has also worked for blue chip companies, the emergency services and various government departments including Department for Work and Pensions.

Andy is a fellow of the Royal Society of Arts, chairman and founding trustee of the Wetwheels Foundation and sat on the British Dyslexia Association – Workplace Assessors Professional Review Panel.

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The relationship between music and running

By Daniel Thomas, joint managing director of Chroma Therapies.

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By Daniel Thomas, joint managing director of Chroma Therapies

With its ability to produce new neural pathways, Neurologic Music Therapy is able to encourage movement, co-ordination, improve speech and language, and improve the ability to read/feel emotions, reactions and more, in people living with catastrophic injuries.

This is because music automatically connects to the brain. And this automaticity is what makes music so powerful.

Music also has to ability to push your training capabilities farther and faster especially in running.

This is why a running playlist is the ideal accompaniment to any runner.

Each songs tempo stimulates the brain, evoking a running response of either a faster pace or a steady rhythm depending on what you want to achieve.

For a faster pace, a good running playlist should contain songs with 150-180bpm.

Unfortunately, with not many songs out there using that speed (unless you enjoy rock, metal or speed garage for running) than the other option is to choose songs with 75-90bpm, as this tempo is perfect for a steady rhythm and maximising efficiency.

Do you recall an earlier blog where we discussed cadence and stride length using NMT for preventing falls in the elderly?

We suggested music with a high bpm count promotes movement, good cadence and walking speed, so songs like Nancy Sinatra’s ‘These Boots are Made for Walkin’, which has 85 bpm, is ideal.

BPM strongly correlates to step cadence.

Rhythmic Auditory Stimulation (RAS) is an important aspect of NMT.

Predictable rhythmic structure allows the sensori-motor system to move in sync with the beat.

This is, in essence, why music is important to runners, as it has the ability to communicate with the brain in order to help maintain a steady pace or increase speed depending on the bpm.

When it comes to mental wellbeing, we will always discuss music’s ability to improve mental wellbeing, and its effect can also be attributed to runners.

Music’s ability to improve stride, cadence and style, to produce better and better runs, and enable runners to achieve personal goals also have a positive effect upon mental wellbeing.

A sense of accomplishment. And with the right playlist, runners can end each run on a high.

We also like to discuss how NMT is more effective when it is personalised to that individual.

The same can be said in the case of a runner. A playlist that includes, not only songs with the ideal tempo for them, but also have some personal meaning, have the greatest positive effect upon runners.

The more enjoyable the run, the less fatigue is experienced. This may be due to the fact that music is able to interfere with the parts of the brain that communicate fatigue, essentially causing a distraction, so less fatigue is experienced.

For runners, the relationship between music and running can be seen to be just as effective and important as the relationship between music and recovering from a brain injury.

Its ability to improve running capability, speed, motivation, and promote mental wellbeing is what makes the difference between a run just being a run and reaching ‘Flow State’ – the mental state where the runner is in the moment of running – no distractions, and the run becomes…euphoric.

Read more: Running in the name of mental health

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Concussion could lead to depression, ADHD, dementia and Parkinson’s – study

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A new study has revealed a link between concussion and the risk of being diagnosed with attention-deficit hyperactivity disorder, mood and anxiety disorders, dementia and Parkinson’s disease later in life.

Despite ‘clinical recovery’ from concussion typically lasting one week, a team of researchers from the University of Manitoba suspected there may be longer term effects. They used 25 years of population-based health data between 1990 and 2015, involving almost 50,000 cases of concussion from people living in Manitoba, Canada.

They found that concussion was associated with an increased risk of being diagnosed with attention-deficit hyperactivity disorder (ADHD), mood and anxiety disorders (MADs), dementia and Parkinson’s disease.

After analysing the population data, they found that concussion was linked to an increased risk of diagnosis of ADHD, dementia and Parkinson’s.

Women who had a concussion were at greater risk of developing ADHD and MADs, but there were no differences between men and women for the risk of developing dementia or Parkinson’s.

Multiple concussions didn’t affect the risk of later being diagnosed with ADHD, but a second concussion increased the risk of dementia, while exposure to more than three concussions increased the risk of being diagnosed with MADs.

While previous studies have found links between concussion and ADHD, dementia, Parkinson’s and MADs, most have relied on patients self-reporting their symptoms, the researchers write.

However, this study can only show an association, not cause and effect.

The mechanism behind this increased risk is unknown, but the researchers state it’s possible that the pathways of some biomarkers that are dysregulated in ADHD, Mads, dementia and Parkinson’s, namely, cortisol, are also affected after a concussion.

The paper, published in the BMJ journal, states that future research is needed to explore the relationships between concussion and ADHD, MADs, dementia and Parkinson’s in other populations.

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