Mentally stimulating tasks you need to do 2x week to prevent dementia

 FYI.  I however do games on my smartphone.

video games (87 posts to March 2012)

Mentally stimulating tasks you need to do 2x week to prevent dementia

What activity has been shown to ward off dementia in a new study? Clue: It's one across and has nine letters.

In a recent study, doing a crossword at least twice a week was found to dramatically slow cognitive decline in older Americans compared to those who did this less often.

Other 'mentally stimulating' activities like reading a book, playing Sudoku or journaling also appeared to protect against the decline.

It's thought that these activities can help form new brain cells and boost connections in the brain responsible for memory. 

Researchers in Mississippi, Texas, and Illinois found that older Americans who did 'mentally stimulating' activities more than twice a week had a lower risk of cognitive decline than those who did so less often (stock image)

Researchers in three states followed nearly 6,000 adults over 50 for almost a decade and divided them into groups based on how often they participated in 'cognitively simulating' activities.  

Though all participants suffered memory decline with age, those who regularly picked up a book or a puzzle had consistently better memory and slower rates of cognitive decline over an eight-year period.

This lowered their risk of mild cognitive impairment (MCI), which can lead dementia in as many as nine in 10 patients. 

Dementia plagues more than 7million Americans per year, along with almost 1million Brits. And about 10million Americans and one in five Brits over 65 are diagnosed with MCI. 

Dr Jungjoo Lee, lead study author and assistant professor at the University of Southern Mississippi, told PsyPost the findings indicate that 'the cognitive care program needs a comprehensive design that includes physical activities, cognitively stimulating activities, and community engagements.

'Balanced therapeutic strategies incorporating all these healthy behaviors will boost cognitive health benefits rather than focusing on a single domain.' 

The study, published earlier this year in the Journal of Cognitive Enhancement, followed 5,932 adults recruited from the Health and Retirement Study (HRS), a database on aging Americans, from 2012 to 2020.

Participants ranged from 50 to 109 years old, with an average age of 68.

The team measured cognitive function by looking at memory, working memory, and attention and processing speed. 

Working memory is how long someone can hold on to temporary information, such as remembering an address while being given directions. 

Attention and processing speed measure how quickly the brain takes in information, such as letters while reading a book. 

Researchers measured these factors based on how fast they could recall words, basic math skills, and tasks like counting backwards. 

Participants were then divided into groups based on how often they did tasks like crossword puzzles or reading a book.

Though all participants saw memory declines, those who completed these activities more than twice a week 'consistently presented higher memory working memory, and attention than groups that participated less in the activities,' Dr Lee said.   

It's thought that brain games like crossword puzzles help stimulate brain cell growth and connections responsible for memory

It's unclear why exactly these activities slowed cognitive decline, but experts believe they may help stimulate brain cell growth and strengthen connections between brain cells responsible for memory.

There were several limitations to the research, with the main one being that researchers did not account for other factors that could have caused cognitive decline, such as other health issues, medication use, and unforeseen events like accidents. 

Additionally, there was a significant age range among the participants, with the youngest being just 50 and the oldest 109. As the risk of cognitive decline increases with age, this could have led to bias. 

Dr Lee said: 'Futher investigation is required to control internal and external confounders affecting healthy behaviors and each cognitive function.'  

Trauma, treatment and Tetris: video gaming increases hippocampal volume in male patients with combat-related posttraumatic stress disorder

 

Since there is a 23% chance of stroke survivors getting PTSD what is your doctor's prevention plan; not treatment plan, PREVENTION!

Trauma, treatment and Tetris: video gaming increases hippocampal volume in male patients with combat-related posttraumatic stress disorder

Oisin Butler ¹, Kerstin Herr ¹, Gerd Willmund ¹, Jürgen Gallinat ¹, Simone Kühn ^1,*,✉, Peter Zimmermann ^1,*

PMCID: PMC7828932  PMID: 32293830

Abstract

Background

Tetris has been proposed as a preventive intervention to reduce intrusive memories of a traumatic event. However, no neuroimaging study has assessed Tetris in patients with existing posttraumatic stress disorder (PTSD) or explored how playing Tetris may affect brain structure.

Methods

We recruited patients with combat-related PTSD before psychotherapy and randomly assigned them to an experimental Tetris and therapy group (n = 20) or to a therapy-only control group (n = 20). In the control group, participants completed therapy as usual: eye movement desensitization and reprocessing (EMDR) psychotherapy. In the Tetris group, in addition to EMDR, participants also played 60 minutes of Tetris every day from onset to completion of therapy, approximately 6 weeks later. Participants completed structural MRI and psychological questionnaires before and after therapy, and we collected psychological questionnaire data at follow-up, approximately 6 months later. We hypothesized that the Tetris group would show increases in hippocampal volume and reductions in symptoms, both directly after completion of therapy and at follow-up.

Results

Following therapy, hippocampal volume increased in the Tetris group, but not the control group. As well, hippocampal increases were correlated with reductions in symptoms of PTSD, depression and anxiety between completion of therapy and follow-up in the Tetris group, but not the control group.

Limitations

Playing Tetris may act as a cognitive interference task and as a brain-training intervention, but it was not possible to distinguish between these 2 potential mechanisms.

Conclusion

Tetris may be useful as an adjunct therapeutic intervention for PTSD. Tetris-related increases in hippocampal volume may ensure that therapeutic gains are maintained after completion of therapy.

Introduction

Recent work has provided evidence for the utility of the visuospatial video game Tetris as an early therapeutic intervention for posttraumatic stress disorder (PTSD).^1–3 Holmes and colleagues have shown that playing Tetris directly after trauma exposure can reduce subsequent intrusive memories of the traumatic event, and they have demonstrated the efficacy of this “cognitive vaccine” in both experimental¹ and real-world settings.^2–4

Following exposure to an event, the memory trace of that event must be consolidated into long-term memory for it to be accessible for later recall.⁵ Shortly after the event, the memory trace remains in a labile state as it is consolidated, and it is susceptible or vulnerable to interference.⁶ Performing an unrelated task while the memory for an event is in a labile state can reduce subsequent retrieval.⁷ In addition, it has been proposed that following reactivation, a memory again enters a labile state and must be reconsolidated into long-term memory.⁸ During this reconsolidation process, the memory trace is also vulnerable to interference. Holmes and colleagues¹ have proposed that by completing a demanding visuospatial task during memory consolidation or reconsolidation for a traumatic event, the memory trace is weakened because of competition for the cognitive resources required for consolidation.

To date, work using Tetris as an intervention has focused mainly on attempting to disrupt consolidation of the traumatic memory within the first 6 hours after the trauma exposure, ^1–3 or reconsolidation of the traumatic memory the next day.⁸ However, playing a video game in the direct aftermath of a traumatic event is neither practical nor possible in every case. It is estimated that approximately 8 million adults have PTSD in the United States alone.⁹ As such, interventions for those who are already experiencing posttraumatic symptoms are sorely needed.

One study to date has assessed a Tetris intervention in people with existing PTSD.⁴ In this study, specific intrusions were targeted based on the concepts of “concurrent task interference and memory reconsolidation.” After a reminder for a specific intrusive memory, patients played 25 minutes of Tetris. The authors found that after completion of the study, the frequency of targeted intrusions was lower than that of nontargeted intrusions. In the current study, we investigate the utility of Tetris as an adjunct therapeutic intervention for people with current PTSD.

Current therapeutic interventions for PTSD have a number of limitations related to response rates and long-term efficacy. A significant minority of people with PTSD will not show significant improvement in symptoms directly following therapy, with rates of nonresponders estimated to be as high as 35% to 50% in some studies.^10–12 In addition, the long-term prognosis for PTSD is poor: a majority of people continue to experience symptoms for months or years after initial diagnosis, and a substantial number never fully recovers.¹³ As such, there is a significant need for additional therapeutic interventions that may act as an adjunct to traditional psychotherapy for nonresponders and to ensure the long-term maintenance of therapy-related gains for responders.

The most widely used and most effective interventions for PTSD are psychotherapies such as trauma-focused cognitive behaviour therapy (CBT) and eye movement desensitization and reprocessing (EMDR) therapy. These therapies target memories of the traumatic event, along with the person’s cognitive and emotional interpretation of the event. Therapy with EMDR is particularly interesting, because it differs from other psychotherapies by incorporating a visuosensory attentional component.¹⁴ There are some inconsistencies in the literature regarding EMDR, particularly the therapeutic contribution of the visuosensory component:¹⁵ although reviews of studies comparing trauma-focused CBT and EMDR have failed to demonstrate increased efficacy for one over the other,^10,15 separate reviews have provided evidence that the addition of eye movements results in significant improvements to treatment outcomes.^16,17 As such, although EMDR is a common therapeutic intervention for the treatment of PTSD, the precise mechanisms underlying its efficacy remain somewhat unclear.

In the current study, we explored the use of Tetris as an adjunct to EMDR. Each EMDR session consisted of selecting a traumatic memory to work on. Given the visuosensory attentional component of EMDR, we considered that Tetris might complement EMDR better than other psychotherapeutic interventions, such as CBT.

At the neuroanatomical level, adult PTSD populations are characterized by smaller volumes in the hippocampus and in prefrontal regions, including the ventromedial prefrontal cortex and the anterior cingulate cortex.^18–20

The hippocampus is hypothesized to play a key role in PTSD symptomatology: smaller hippocampal volumes have been associated with increased risk and poorer prognosis in PTSD, and with poorer prognosis.^21–25 In addition, increases in grey matter volume in the hippocampus have been observed in response to psychological therapy, including EMDR^26,27 and pharmacological interventions, and increases in hippocampal volume have been linked to improvements in memory.²⁸

Training studies have demonstrated that increases in hippocampal volume can be produced with a wide variety of interventions, ^29,30 including video-gaming interventions.³¹ As such, we hypothesized that the video-gaming intervention Tetris would increase hippocampal volume, which would in turn reduce PTSD symptomatology.

Smaller prefrontal regions have also been commonly observed in people with PTSD.^18–20 Prefrontal regions have also been shown to increase in response to video-gaming interventions. ³¹ We therefore hypothesized that prefrontal regions in PTSD populations would also increase in response to therapeutic interventions, although the majority of relevant work in neuroplasticity and PTSD has demonstrated effects in the hippocampus rather than the prefrontal regions.

In the current study, we investigated the structural and behavioural effects of a Tetris intervention in people with PTSD who were undergoing psychotherapy, using a prospective design. We recruited people with combat-related PTSD and assessed them before and directly after EMDR therapy, as well as at follow-up, approximately 6 months later. We proposed that playing Tetris after therapy while the reactivated traumatic memory was in a labile state would weaken reconsolidation and aid recovery.⁸ It should be noted that playing Tetris has been shown to reduce the vivid, intrusive elements of a traumatic memory, but not of a declarative memory.¹ As such, we expected that Tetris would not affect memory of the therapy sessions, or interfere with the clinical efficacy of EMDR. In addition, spatial memory training and video gaming have been linked to increases in hippocampal volume,³¹ and increases in hippocampal volume have been associated with improvements in memory and reductions in symptoms in PTSD.³² As such, we expected that Tetris would aid in recovery from PTSD by weakening the memory of the traumatic event, and by increasing hippocampal volume. We hypothesized that the Tetris group would show increases in hippocampal volume and reductions in symptoms — directly after completion of therapy and at follow-up.

More at link.

BLOG: Video gaming may be good for your brain

Does your doctor have enough brain cells that function to extrapolate this to stroke survivors?

BLOG: Video gaming may be good for your brain

As someone who enjoys video games myself, I’ve always been a little skeptical of the conventional wisdom that playing video games has only negative cognitive and behavioral effects.

To better evaluate the effects of gaming on cognition and brain activity, my colleagues and I studied a subset of participants from the Adolescent Brain Cognitive Development (ABCD) study, a long-term study of brain development and child health in which about 20,000 children from across the U.S. undergo brain imaging every 2 years through early adulthood.

Video gamers were found to outperform non-gamers in cognitive tasks. Source: Adobe Stock

Bader Chaarani

Focusing on baseline data from 1,217 children aged 9 to 10 years, we compared brain imaging and cognitive performance on two tests of working memory and response inhibition in children who played at least 21 hours per week of video games (VG group) to those who played no video games (nonvideo gamers [NVG group]). All children underwent functional MRI (fMRI) testing while engaged in the two cognitive tasks.

What we found may be surprising to any parent who has yelled at their children to get off the gaming system: The gamers outperformed the non-gamers in both cognitive tasks. The VG group had faster reaction times, indicating greater attention and control, than their NVG peers and they demonstrated less activation in the visual cortex on fMRI testing of blood oxygen level-dependent signals, which are a proxy for oxygen consumption in the brain.

This indicates that the visual cortex was more efficient and required less power to perform the same tasks in the VG group compared with children who never played video games. A gamer needs to be aware of multiple visual stimuli at once and pay close attention to and quickly react to movement to succeed at fast-paced action games, so it makes sense that lots of practice at processing all those visual elements seems to make the visual system more efficient.

The cognitive effects remained when we controlled for video watching, suggesting that the changes in brain activation we saw in the VG group are associated with active engagement with the video content, not merely passively watching television or YouTube videos. We also found that the observed effects held true for both sexes: That is, female VGs outperformed female NVGs, even though there were fewer female than male VGs in the study.

The children self-reported the amount of time they spent on video gaming and other screen-time activities. While self-reporting is prone to error in any study population, children tend to be more honest than adults, and there is evidence that children’s self-reports of screen time are more accurate than their parents’ reports.

Our study confirms the findings of smaller studies that had previously shown VGs are less susceptible to distracted attention. Does this mean that children should start gaming to improve their brains? Not at all. We still see higher mental health symptom scores among VGs than NVGs. And we don’t know yet whether the neuroimaging results translate into real-life outcomes. That is, do better working memory and more efficient visual processing lead to better grades or quality-of-life outcomes? We don’t know. To reach any conclusions on real-world effects, we need more data points as we track this cohort of children through early adulthood.

Given the choice, physical activity should always be considered better than screen time of any sort for overall mental and physical health. But our study does suggest that video gaming — unlike other forms of screen time — is not necessarily bad for cognition.

Reference:

• Chaarani B, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.35721.

For more information:

Bader Chaarani, PhD, has a doctoral degree in biomedical engineering and medical image processing in neurodegenerative diseases. He is assistant professor at the University of Vermont in Burlington, where he serves as a member of the IMAGEN consortium and co-investigator in the ABCD study, the largest neuroimaging and behavioral longitudinal study conducted in Europe and the U.S. His research involves examining the structural and functional neural correlates for psychiatric diseases, video gaming and youth substance use, as well as the application of machine-learning techniques to large data sets.

Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.

The Surprising Mental Health Benefits of Video Games

 Does your hospital have these for you to play? You'll need to build persistence since your doctor knows nothing about actual stroke recovery and you will have to persist on your own.

The Surprising Mental Health Benefits of Video Games

Benefits are found even across first-person shooter games, which often spark controversy due to their violent content.

By Darren IncorvaiaMay 9, 2022 1:00 PM

(Credit: SolidMaks/Shutterstock)

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Video games tend to get a bad rap.

They’ve been blamed for countless violent crimes, including the 1999 Columbine high school massacre, and video game addiction was listed as an official medical condition by the World Health Organization in the latest revision of the International Classification of Diseases. Concerns about video games turning children into either violent criminals or antisocial outcasts permeate our pop culture now more than ever, but researchers have studied video game addiction and its negative health effects since the 1980s. What does the science say? Is playing video games actually bad for you?

The short answer: Not only is playing video games not inherently bad for you, but there are many mental health benefits that can come from gaming. “The vast majority of the research around video games is on the negative impact,” says Isabela Granic, a psychologist at McMaster University in Canada and director of the Games for Emotional and Mental Health Lab. “After a couple of meta-analyses, it’s pretty clear that there is no causation [between video games and real-world violence].” In fact, research by Granic and others has instead found consistent evidence for cognitive, motivational, emotional and social benefits.

Even first-person shooter games — like the Doom series that received a large share of the blame for the Columbine massacre — can give players “increases in abilities for spatial reasoning and spatial cognition in general, hand-eye coordination, multi-level problem solving, and so on,” explains Granic. “For the cognitive domain there’s probably at least two decades of good, solid research showing the benefits.” These benefits are found across shooter games like Halo, Call of Duty and Grand Theft Auto, despite these games often sparking the most controversy due to their violent content.

Try, Try, Try Again

From a motivational standpoint, many video games reward persistence and effort when it comes to solving puzzles or defeating bosses. These traits also have benefits outside of games. The “try, try and try again” mindset that video games reinforce can lead to academic benefits, and also promotes a view of intelligence that values effort over innate ability.

One example is the video game Cuphead, which received praise for its high level of difficulty that rewards patience, persistence and effort. This well-earned fun provides emotional benefits to gamers that are ultimately the point. As philosopher Bernard Suits put it in his 1978 book The Grasshopper, “playing a game is the voluntary attempt to overcome unnecessary obstacles.” It feels good to win, especially when you must work for it.

Community Over Content

On the other hand, many have written about online harassment in video games, and researchers recognize it as a problem. “There are plenty of people who play [massive multiplayer games like] League of Legends and hate the toxicity that goes along with it,” says Granic. “And they either stop playing or play with that in the background.” However, there are social benefits to playing games with others too: team-building, leadership skills and civic mindsets.

Playing games cooperatively has been shown to increase subsequent real-world cooperation, even when the game itself involves violent acts like shooting aliens. Even the most controversial games like Grand Theft Auto don’t seem to lead to more antisocial behavior. When it comes to playing these multiplayer games, the community is more important than the content. And some games, like Granic’s favorite, Journey, completely remove any direct communication between cooperating players. “I love that game, it was this great experience … it’s a social game, but you don’t have any talking,” she says.

Playful Experimentation

Beyond helping us work with others, video games can also help us look inward to learn more about ourselves. The games serve as escapist fantasies, in which we can play with aspects of ourselves that we might not be comfortable playing with in the real world.

A 2016 study, for example, looked at four individuals struggling with gender dysphoria and showed how gaming can help people come to terms with their gender identities in a safe way — such as by playing as a character with a gender expression different from their own. “That kind of playful experimentation and fantasy serves a real purpose in people’s lives when they can’t do it in their otherwise daily lives,” explains Granic.

Video games have been surrounded by stigma since Pong debuted in 1972 and launched them into the cultural mainstream. But negative press is not the same as evidence of negative effects. “Something like 97 percent of kids by the time they reach 18 are playing them daily, or certainly regularly,” says Granic. “It’s basically ubiquitous. Everybody is playing video games.”

Rather than serve as harbingers of the end of society, video games have blossomed into an art form that challenges us to play, fail, learn, work together and become more comfortable with ourselves. Just don’t listen too closely to what those people in the Call of Duty lobby are saying!

 

Stroke Therapy Video Game Just As Effective As In-Person Rehab

 So it is just as ineffective? Since no one ever factually discusses recovery percentages, this is not reassuring.

Stroke Therapy Video Game Just As Effective As In-Person Rehab

 

---

Mar 23, 2022

Photo: Getty Images

Here's today's feel-good story:

Having a stroke can inhibit a person's ability to have feeling in their arm, or have unexpected weakness and reduced movement.

While traditional rehab can be time-consuming, expensive, and tough to travel to, a team of researchers at the University of Missouri have utilized motion-sensing technology to develop Recovery Rapids, a video game that helps stroke victims recover.

“As an occupational therapist, I have seen patients from rural areas drive more than an hour to come to an in-person clinic three to four days a week, where the rehab is very intensive, taking three to four hours per session, and the therapist must be there the whole time,” said assistant professor in the MU School of Health Professions, Rachel Proffitt.

“With this new at-home gaming approach, we are cutting costs for the patient and reducing time for the therapist while still improving convenience and overall health outcomes, so it’s a win-win. By saving time for the therapists, we can also now serve more patients and make a broader impact on our communities.”

Read more here.

Video-Game-Based Stroke Therapy is as Effective as In-Person Rehab

So in other more truthful words it is also a complete failure at getting to 100% recovery. Tell the truth when you write titles. 

Video-Game-Based Stroke Therapy is as Effective as In-Person Rehab

After a stroke, patients may lose feeling in an arm or experience weakness and reduced movement that limits their ability to complete basic daily activities.

Traditional rehabilitation therapy is very intensive, time-consuming, and can be both expensive and inconvenient, especially for rural patients travelling long distances to in-person therapy appointments.

That’s why a team of researchers, including one at the University of Missouri, utilized a motion-sensor video game, Recovery Rapids, to allow patients recovering from a stroke to improve their motor skills and affected arm movements at home while checking in periodically with a therapist via telehealth.

The researchers found the game-based therapy led to improved outcomes similar to a highly regarded form of in-person therapy, known as constraint-induced therapy, while only requiring one-fifth of the therapist hours. This approach saves time and money while increasing convenience and safety as telehealth has boomed in popularity during the COVID-19 pandemic.

“As an occupational therapist, I have seen patients from rural areas drive more than an hour to come to an in-person clinic three to four days a week, where the rehab is very intensive, taking three to four hours per session, and the therapist must be there the whole time,” said Rachel Proffitt, assistant professor in the MU School of Health Professions.

“With this new at-home gaming approach, we are cutting costs for the patient and reducing time for the therapist while still improving convenience and overall health outcomes, so it’s a win-win. By saving time for the therapists, we can also now serve more patients and make a broader impact on our communities.”

MORE: Coffee and Tea Drinking May be Associated With Reduced Rates of Stroke and Dementia

Traditional rehab home exercises tend to be very repetitive and monotonous, and patients rarely adhere to them. The Recovery Rapids game helps patients look forward to rehabilitation by completing various challenges in a fun, interactive environment, and the researchers found that the patients adhered well to their prescribed exercises.

“The patient is virtually placed in a kayak, and as they go down the river, they perform arm motions simulating paddling, rowing, scooping up trash, swaying from side to side to steer, and reaching overhead to clear out spider webs and bats, so it’s making the exercises fun,” Proffitt said. “As they progress, the challenges get harder, and we conduct check-ins with the participants via telehealth to adjust goals, provide feedback and discuss the daily activities they want to resume as they improve.”

Nearly 800,000 Americans have a stroke each year according to the CDC, and two-thirds of stroke survivors report they cannot use their affected limbs to do normal daily activities, including making a cup of coffee, cooking a meal or playing with one’s grandchildren.

RELATED: In Learning to Use Her Left Hand Following a Stroke 60-Year Old Chen Lie Discovers She’s an Expert Painter

“I am passionate about helping patients get back to all the activities they love to do in their daily life,” Proffitt said. “Anything we can do as therapists to help in a creative way while saving time and money is the ultimate goal.”

This research was recently published in eClinicalMedicine, an open-access journal from The Lancet.

Source: University of Missouri

 

Can a virtual kayak ride speed up stroke recovery?

Of course it can. But what do you think the chances are of your hospital acquiring this? I'd say zero. I still think the cockroach stomping game is better at least for balance and lower limbs.  But I bet your hospital doesn't have that and they should have known about it for almost 10 years.

Can a virtual kayak ride speed up stroke recovery?

A new motion-sensor video game can help patients recovering from a stroke improve their motor skills and affected arm movements at home while checking in periodically with a therapist via telehealth.

After a stroke, patients may lose feeling in an arm or experience weakness and reduced movement that limits their ability to complete basic daily activities.

Traditional rehabilitation therapy is very intensive, time-consuming, and can be both expensive and inconvenient, especially for rural patients traveling long distances to in-person therapy appointments.

The game-based therapy, called Recovery Rapids, led to improved outcomes similar to a highly regarded form of in-person therapy, known as constraint-induced therapy, while only requiring one-fifth of the therapist hours. The approach saves time and money while increasing convenience and safety as telehealth has boomed in popularity during the COVID-19 pandemic.

“As an occupational therapist, I have seen patients from rural areas drive more than an hour to come to an in-person clinic three to four days a week, where the rehab is very intensive, taking three to four hours per session, and the therapist must be there the whole time,” says Rachel Proffitt, assistant professor in the University of Missouri School of Health Professions.

“With this new at-home gaming approach, we are cutting costs for the patient and reducing time for the therapist while still improving convenience and overall health outcomes, so it’s a win-win. By saving time for the therapists, we can also now serve more patients and make a broader impact on our communities.”

Traditional rehab home exercises tend to be very repetitive and monotonous, and patients rarely adhere to them. The Recovery Rapids game helps patients look forward to rehabilitation by completing various challenges in a fun, interactive environment, and the researchers found that the patients adhered well to their prescribed exercises.

“The patient is virtually placed in a kayak, and as they go down the river, they perform arm motions simulating paddling, rowing, scooping up trash, swaying from side to side to steer, and reaching overhead to clear out spider webs and bats, so it’s making the exercises fun,” Proffitt says.

“As they progress, the challenges get harder, and we conduct check-ins with the participants via telehealth to adjust goals, provide feedback and discuss the daily activities they want to resume as they improve.”

Nearly 800,000 Americans have a stroke each year according to the Centers for Disease Control, and two-thirds of stroke survivors report they cannot use their affected limbs to do normal daily activities, including making a cup of coffee, cooking a meal, or playing with grandchildren.

“I am passionate about helping patients get back to all the activities they love to do in their daily life,” Proffitt says. “Anything we can do as therapists to help in a creative way while saving time and money is the ultimate goal.”

The study appears in the journal eClinicalMedicine.

Source: University of Missouri

Original Study DOI: 10.1016/j.eclinm.2021.101239

 

Mapping the human brain

 Since your doctor hasn't gotten you 100% recovered maybe you want to play this game to help other neuroscientists figure out the brain.

Mapping the human brain

 

Comparison of neuromuscular and cardiovascular exercise intensity and enjoyment between standard of care, off-the-shelf and custom active video games for promotion of physical activity of persons post-stroke

 I see no specific recommendations or protocols on what should occur post stroke to get recovered, so useless.

Comparison of neuromuscular and cardiovascular exercise intensity and enjoyment between standard of care, off-the-shelf and custom active video games for promotion of physical activity of persons post-stroke

• Judith E. Deutsch,
• Aurora James-Palmer,
• Harish Damodaran &
• Urska Puh 

Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 63 (2021) Cite this article

• Metrics details

Abstract

Background

Active video games have been embraced for the rehabilitation of mobility and promotion of physical activity for persons post-stroke. This study seeks to compare carefully matched standard of care stepping activities, off-the-shelf (non-custom) active video games and custom active video games that are either self-paced or game-paced for promoting neuromuscular intensity and accuracy, cardiovascular intensity, enjoyment and perceived effort.

Methods

Fifteen persons (ages 38–72) with mild to moderate severity in the chronic phase post-stroke (average 8 years) participated in a single group counter balanced repeated measures study. Participants were included if they were greater than 6 months post-stroke, who could walk 100 feet without assistance and stand unsupported for three continuous minutes. They were excluded if they had cardiac, musculoskeletal or neurologic conditions that could interfere with repeated stepping and follow instructions. In a single session located in a laboratory setting, participants executed for 8.5 min each: repeated stepping, the Kinect-light race game, two custom stepping games for the Kinect, one was repeated and self-paced and the other was random and game paced. Custom video games were adjusted to the participants stepping volume. Ten-minute rest periods followed the exercise during which time participants rested and completed the PACES an enjoyment questionnaire. Participants were instrumented with a metabolic cart and heart rate sensor for collection of cardiovascular intensity (METs and % of max HR) data. Stepping frequency, accuracy and pattern were acquired via video. Data were analyzed using a RMANOVA and post-hoc comparison with a Holm's/Sidak correction.

Results

Neuromuscular intensity (repetitions) was significantly greater for the off-the-shelf and self-paced custom game, however accuracy was greater for the custom games. Cardiovascular intensity for all activities took place in the moderate intensity exercise band. Enjoyment (measured with a questionnaire and rankings) was greater for the custom active video games and rate of perceived exertion was lower for the custom active video games.

Conclusions

Custom active video games provided comparable intensity but better accuracy, greater enjoyment and less perceived exertion than standard of care stepping activities and a carefully matched off-the-shelf (non-custom) video game. There were no differences between the game-paced and self-paced custom active video games.

Trial registration: NCT04538326.

Background

Activity and participation are often limited for persons-post stroke. Mobility problems are reported by 58% of people in chronic stage after stroke, fatigue in 52%, and falls in 44% [1]. Low cardiorespiratory fitness and other impairments, such as decreased balance and muscle strength interact to drive post-stroke activity limitations and participation restriction [2]. People post-stroke may only manage to walk short distances, walk slowly, fatigue more often during everyday activities and are at greater risk for falls. Their sedentary lifestyle is related not only to decreased walking ability, but it also increases risk for another stroke and other cardio-vascular diseases, depression, psychosocial disfunctions and decreased quality of life [3]. Physical exercise programmes may serve to increase physical fitness and mobility of people post-stroke [2, 4].

Active video games (AVGs) became available for movement focused rehabilitation when gaming consoles such as the Play Station II (PS2) with the Eye Toy camera, the Nintendo Wii and the Microsoft Xbox with the Kinect camera were trialed by clinicians and tested by researchers [5,6,7]. Analyses of the non-custom AVGs associated with the consoles identified elements of motor learning and therapeutic exercise in order to guide the application of AVGs into physical therapy practice, as well as rehabilitation research [8,9,10,11]. Recent surveys of virtual reality and AVGs confirm that AVGs have become part of the repertoire of rehabilitation tools used for persons post-stroke. Physical and occupational therapists, surveyed about virtual reality and video games in both in Canada and the United States, report primarily using non-custom AVGs for commercial consoles such as the Nintendo Wii and the Microsoft Kinect to treat balance and fitness for persons post-stroke. [12] Boyne and colleagues [13] reported AVGs were used to promote aerobic exercise for persons post-stroke in a variety of clinical settings. AVGs appear to meet the need for rehabilitation of mobility and fitness deficits experienced by persons post-stroke.

Evidence to support these non-custom AVGs has been increasing with their potential application for rehabilitation of upper limb use, [14] balance and mobility [15] as well as promotion of physical activity (PA) [16, 17] for persons post-stroke. There has also been an interest in developing active custom games for upper limb use [18] and balance [19,20,21]. A rationale often proposed for incorporating AVGs into stroke rehabilitation is their potential to increase participant motivation. Several elements of AVGs may account for increasing or be associated with motivation; these include game mechanics (such as scoring), performance feedback, “the right level of challenge” and enjoyment [22]. In persons post-stroke in an inpatient setting who played upper limb games using a manipulandum to control a game displayed on a tv, the use of feedback was shown to be superior in improving movement speed and smoothness to games that did not provide performance feedback. Importantly, they also had greater motivation (measured with the interest and enjoyment subscale of the Intrinsic Motivation Inventory) with the game play [23]. Game mechanics that involved scoring and “operant conditioning” both yielded higher performance metrics when playing an upper limb labyrinth game with those features [24].

Enjoyment is proposed as an important construct to recommend AVG play [25]. It has been measured by the same group of investigators while persons post-stroke: (1) interacted with the PS2 Eye Toy, [5] (2) compared enjoyment while playing the PS2 and the Wii [26] and (3) played Kinect Sports and Adventure games [11]. Across all three studies, enjoyment was reported by persons post-stroke. Enjoyment was also identified as an important construct linking engagement for motor learning in virtual environments [27]. It is speculated that enjoyment is a factor that also promotes motivation and may lead to sustained and intense activity required for neural, musculoskeletal and cardiovascular plasticity required for stroke rehabilitation. In fact, several groups have shown that persons post-stroke exercising in virtual environments and AVGs achieve high levels of repetitions [28] and a higher number of repetitions (a measure of intensity) compared to standard therapy [29].

While the non-custom AVGs have shown promise and they are appealing because of their low-cost, high quality graphics and variety, they have several important limitations for incorporating them into therapy. Often, they are not user-centered, do not meet therapeutic goals, nor provide performance metrics, nor promote desirable movement patterns [30, 31]. One of the consistent limitations, of these off-the-shelf consoles and their games, reported by both clinicians and persons post-stroke, is the lack of control in adjusting exercise parameters such as speed or difficulty [32]. The lack of game control is especially true for game-paced, rather than player or self-paced games. AVGs and virtual environments may also not reliably promote optimal movement patterns [33,34,35]. This is particularly important for persons post-stroke who exhibit asymmetrical movements. The promise that some of these limitations could be addressed with games that were specifically designed for rehabilitation was heralded with the open development kit of the Kinect (STK). The combination of markerless motion capture with customized software could overcome some of the limitations of non-custom off-the shelf games as well the cost of more specialized systems. Several groups have developed custom games with the Kinect primarily for balance that allow customization and clinician control and have been shown to efficacious in rehabilitation post stroke [19] or superior to off -the-shelf analogs in older adults [36]. There are however, to our knowledge no studies that carefully compare movement performance, energetics and enjoyment of off-the-shelf video games with custom games as well as standard of care activities for persons with stroke.

Therefore, in this study we sought to compare if carefully matched standard of care activities and off-the-shelf AVG with customized AVGs produced a desirable exercise intensity and player experience for persons post-stroke. The specific purpose of this study was to determine if: (1) Movement outcomes of neuromuscular intensity (repetitions) and movement accuracy were superior when playing an off-the-shelf AVG, compared to custom AVGs or standard of care therapy, (2) Cardiovascular intensity outcomes of (METs and % of HR_max) were superior when playing an off-the-shelf AVGs, compared to custom AVGs or standard of care therapy, (3) enjoyment, game preference and perceived effort differed when playing an off-the-shelf AVG, compared to custom AVGs or standard of care therapy and (4) there was a difference in neuromuscular and cardiovascular intensity as well as enjoyment and game preference between the two customized AVGs that are self-paced compared to game-paced. We hypothesized that neuromuscular and cardiovascular intensity, would differ between custom AVGs, off-the shelf AVGs and standard of care; and that enjoyment would be greater and perceived effort lower for the custom AVGs compared to the off-the-shelf AVG and standard of care.

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