Data mining applied to neurorehabilitation data

Tese de mestrado integrado, Engenharia Biomédica e Biofísica (Engenharia Clínica e Instrumentação Médica) Universidade de Lisboa, Faculdade de Ciências, 2017Apesar de não serem a principal causa de morte no Mundo, as lesões cerebrais são talvez a principal razão de existirem tantos casos de pessoas que veem a sua vida quotidiana afetada. Tal acontece devido a grandes dificuldades cognitivas que podem ser derivadas de um acidente de automóvel, de uma queda, da presença de um tumor, de um acidente vascular cerebral, da exposição a substâncias tóxicas ou de uma outra qualquer situação que tenha envolvido uma lesão do cérebro. De entre este tipo de lesões podem considerar-se aquelas que são provenientes de traumas por forças externas, ou seja, as chamadas lesões cerebrais traumáticas ou traumatismos crânio-encefálicos. É precisamente em pessoas que sofreram uma lesão desse tipo que se foca este estudo. Em pessoas que, depois dessas lesões, foram sujeitas a um tratamento de neuro reabilitação. Este tratamento, baseado na realização de tarefas especialmente desenhadas para estimular a reorganização das ligações neuronais, permite que os doentes tenham a possibilidade de voltar a conseguir realizar tarefas do dia-a-dia com a menor dificuldade possível. O objetivo da realização destas tarefas é a estimulação da capacidade de plasticidade cerebral, responsável pelo desenvolvimento das conexões sinápticas desde o nascimento e que permite ao cérebro voltar a estabelecer o seu funcionamento normal depois de uma lesão. Naturalmente, o grau de afetação de uma pessoa depende do tipo de lesão e tem uma grande influência não só no tempo de recuperação física e mental, como também no seu estado final. O estudo documentado neste relatório de estágio constitui um meio para atingir um objetivo comum a outros trabalhos de investigação nesta área; pretende-se que os tratamentos de neuro reabilitação possam vir a ser personalizados para cada paciente, para que a sua recuperação seja otimizada. A ideia é que, conhecendo alguns dos dados pessoais de um doente, considerando informação sobre o seu estado inicial e através dos resultados de testes realizados, seja possível associá-lo a um determinado perfil disfuncional, de características bastante específicas, para o terapeuta poder adaptar o seu tratamento. O Institut Guttmann, em Barcelona, foi o primeiro hospital espanhol a prestar cuidados a doentes de lesões medulares. Hoje em dia, um dos seus muitos projetos chama-se GNPT Guttmann NeuroPersonalTrainer e leva a casa dos seus doentes uma plataforma que lhes permite realizar as tarefas definidas pelos terapeutas, no âmbito dos seus tratamentos de neuro reabilitação. Dados desses doentes, incluindo informação démica e resultados de testes realizados antes e depois dos tratamentos, foram cedidos pelo Institut Guttmann ao Grupo de Biomédica e Telemedicina (GBT) sob a forma de bases de dados. Através da sua análise e utilizando ferramentas de Data Mining foi possível obter perfis gerais de disfunção cognitiva e descrever a evolução desses perfis, o principal objetivo desta dissertação. Encontrar padrões em grandes volumes de dados é a principal função de um processo de Data Mining, tratando o assunto de forma muito genérica. Na verdade, é este o conceito utilizado quando são abordados temas de extração de conhecimento a partir de grandes quantidades de dados. Há diversas técnicas que o permitem fazer, que utilizam algoritmos baseados em funções estatísticas e redes neuronais e que têm vindo a ser melhoradas ao longo dos últimos anos, desde que surgiu a primeira necessidade de lidar com grandes conjuntos de elementos. O propósito é sempre o mesmo: que a análise feita a partir destas técnicas permita converter a informação oculta dos dados em informação que pode ser depois utilizada para caracterizar populações, tomar decisões ou para validar resultados. Neste caso, foram utilizados algoritmos de Clustering, um método de Data Mining que permite obter grupos de elementos semelhantes entre si, os clusters, considerando as características de cada um destes elementos. Dados de 698 doentes que sofreram um traumatismo craniano e cuja informação disponível nas bases de dados fornecidas pelo Institut Guttmann satisfazia todas as condições necessárias para serem considerados no estudo, foram integrados num Data Warehouse - um depósito de armazenamento de dados - e depois estruturados. A partir de funções criadas em SQL - a principal linguagem de consultas e organização de bases de dados relacionais - foram obtidas as pontuações correspondentes aos testes realizados pelos doentes, antes do início do tratamento e depois de este ser terminado. Estes testes visaram avaliar, utilizando cinco diferentes níveis de pontuação correspondentes a cada grau de afetação (0 para sem afetação, 1 para afetação suave, 2 para afetação moderada, 3 para afetação severa e 4 para afetação aguda), três funções estritamente relacionadas com o nível cognitivo, a atenção, a memória e algumas funções executivas. As pontuações obtidas para cada uma das funções constituem uma média ponderada da pontuação cada uma das subfunções (atenção dividida, atenção seletiva, memória de trabalho, entre outras), calculadas por pelo menos um dos 24 itens de avaliação a que cada pessoa foi sujeita. De seguida, foram determinados os grupos iniciais e finais, recorrendo a uma ferramenta muito útil para encontrar correlações em grandes conjuntos de dados, o software SPSS. Para determinar a constituição dos clusters iniciais foi aplicado um algoritmo de Clustering designado K-means e, para os finais, um outro denominado TwoStep. A principal característica desta técnica descritiva de Data Mining é a utilização da distância como medida de verificação da proximidade entre dois elementos de um cluster. Os seus algoritmos diferem no tipo de dados a que se aplicam e também na forma como calculam os agrupamentos de elementos. Para cada um dos clusters, e de acordo com cada uma das funções, foi observada a distribuição das pontuações, através de gráficos de barras. Foram também confrontados ambos os conjuntos de clusters para se poder interpretar a relação entre eles. Os clusters, que neste contexto correspondem a perfis de afetação cognitiva, foram validados, e concluiu-se que permitem descrever bem a população em estudo. Por um lado, os seis clusters iniciais determinados representam de uma forma fiel, e com muito sentido do ponto de vista clínico, os conjuntos de pessoas com características suficientemente definidas que os distinguem entre si. Já os três clusters finais, usados para retratar a população no final do tratamento e analisar as evoluções dos pacientes, retratam perfis bastante opostos, o que permitiu, de certa forma interpretar com maior facilidade para que pacientes o efeito da neuro-reabilitação foi mais ou menos positivo. Alguns estudos citados no estado de arte revelaram que algumas variáveis são suscetíveis de influenciar o estado final de um doente. Aproveitando a existência de dados suficientes para tal, foi observado se, tendo em conta os clusters finais, se poderia fazer alguma inferência sobre o efeito de algumas das variáveis – incluindo a idade, o nível de estudos, o intervalo de tempo entre a lesão e o início do tratamento e a sua duração – em cada um destes. No final, considerando apenas as pontuações dos testes em cada função, antes e depois dos tratamentos, foram analisados e interpretados, recorrendo a gráficos, os desenvolvimentos e a evolução global de cada doente. Como desenvolvimentos possíveis, foram tidos em conta os casos em que houve melhorias, agravamentos e também os casos em que os doentes mantiveram o seu estado. Fazendo uso da informação sobre a forma como evoluíram os pacientes, foi possível verificar se, de facto, utilizando apenas os valores das pontuações obtidas nos testes, se poderia ou não confirmar que outras variáveis poderiam ter efeitos na determinação do estado final de um paciente. Os gráficos obtidos demonstraram que há diferenças muito subtis considerando algumas das variáveis, principalmente entre os dos doentes que melhoraram e os dos doentes que viram a sua condição agravada. Concluiu-se que o facto de os clusters agruparem pessoas com tipos de evolução diferentes levou a que o efeito de outras variáveis se mostrasse muito disperso. O tipo de investigação sugerido para futuros desenvolvimentos inclui: (i) o estudo das outras hipóteses de perfis apresentados pelo software usado (SPSS); (ii) considerar os diferentes aspetos das funções avaliadas a um nível mais detalhado; (iii) ter em conta outras variáveis com possíveis efeitos no estado final de um doente.Although they are not the leading cause of death in the world, brain injuries are perhaps the main reason why there are so many cases of people who see their daily lives affected. This is due to the major cognitive difficulties that appear after brain lesion. Brain injuries include those that are derived from traumas due to external forces – the traumatic brain injuries. This study is focused in people who, after these injuries, were subjected to a neuro rehabilitation treatment. The treatment, based on tasks specially designed to stimulate the reorganization of neural connections, allows patients to regain their abilities to perform their everyday tasks with the least possible difficulty. These tasks aim to stimulate the brain plasticity capacity, responsible for the development of synaptic connections which allows the brain to re-establish its normal functioning after an injury. The study documented in this internship report constitutes another step for a major goal, common to other studies in this area: that neuro rehabilitation treatments can be personalized for each patient, so that their recovery is optimized. Knowing some of the personal data of a patient, considering information about their initial state and through the results of tests performed, it is possible to assign a person to a certain dysfunctional profile, with specific characteristics and for the therapist to adapt treatment. One of his many projects of the Institut Guttmann (IG) is called GNPT Guttmann NeuroPersonalTrainer and brings into its patients’ home a platform that allows them to perform the tasks set by the therapists in the context of their neurorehabilitation treatments. Data from these patients, including clinical information and test results performed before and after the treatment, were provided by the IG to the Biomedical and Telemedicine Group (GBT) as databases. Through its analysis and using Data Mining techniques it was possible to obtain general profiles of cognitive dysfunction and to characterize the evolution of these profiles, the objective of this work. Finding patterns and extracting knowledge from large volumes of data are the main functions of a Data Mining process. An analysis performed using these techniques enables the conversion of information hidden in data into information that can later be used to make decisions or to validate results. In this case, Clustering algorithms, which build groups of elements with the similar characteristics called clusters, were used. Also, data from 698 patients who suffered brain trauma and whose information available in the databases provided by the IG satisfied all the conditions considered necessary were integrated into a Data Warehouse and then structured. The scores corresponding to the tests performed before and after the treatment were calculated, for each patient. These tests aimed to evaluate, using five different punctuation levels corresponding to each degree of affectation, three functions strictly related to cognitive level: attention, memory and some executive functions (cognitive processes necessary for the cognitive control of behavior). The initial and final clusters, representing patients’ profiles, were determined, using the SPSS software. The distribution of the scores over the clusters was observed through bar graphs. Both groups of clusters were also confronted to interpret the relationship between them. The clusters, which in this context correspond to profiles of cognitive affectation, were validated, and it was concluded that, at this moment, they represent well the state of patients under study. As some variables, like age and study level, are likely to influence the final state of a patient, it was observed if, given the final clusters, some inference could be made about the effect of those variables. No valuable conclusions were taken from this part. Also, considering the tests scores, patients’ evolution was identified as improvements, aggravations and cases where the conditions is maintained. Using that information, conclusions were extracted, regarding the population and the variables effect. The plots obtained allowed us to correctly describe the patients’ evolution and also to see if the variables considered were good descriptors of that evolution. A simple interpretation from of the facts allows to conclude that the calculated are good general, but not perfect descriptors of the population. The type of research suggested for future developments includes: (i) the study of the other hypothesis of profiles presented by the Data Mining software; (ii) consider the different aspects of the functions evaluated at a more detailed level; (iii) take into account other variables with possible effects on describing the final state of a patient

Psychosocial subtyping and brain metabolism in children with epilepsy.

Past research has indicated that psychosocial dysfunction in children with epilepsy is a significant area of concern. Psychosocial functioning in children with epilepsy has typically been broadly defined in relation to various control groups. The present investigation provided a more multidimensional classification to examine psychosocial functioning in these children. In Study 1, behavioural ratings from the Personality Inventory for Children-Revised (PIC-R) were subjected to cluster analyses, yielding a psychosocial typology. Based on clinical scale elevations of the mean PIC-R profiles, the participants were classified into six subtypes of psychosocial functioning: Cognitive-Somatic, Cognitive-Internalized, Cognitive-Externalized, Cognitive-Social Isolation, Internalized Psychopathology, and Somatic Concern. A second study was conducted to examine the relation between PET indices of brain metabolism and the psychosocial subtypes derived in Study 1. The finding indicated that four of the psychosocial subtypes were differentiated from controls by decreased glucose metabolism in specific brain areas. The heterogeneity of psychosocial deficits in children with epilepsy and the possible neural substrate contributing to such pattern of deficits were discussed.Dept. of Psychology. Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis2003 .C657. Source: Dissertation Abstracts International, Volume: 65-10, Section: B, page: 5453. Adviser: Byron P. Rourke. Thesis (Ph.D.)--University of Windsor (Canada), 2003

Rehabilitation treatments for adults with behavioral and psychosocial disorders following acquired brain injury: a systematic review.

This review was aimed at systematically investigating the treatment efficacy and clinical effectiveness of neurobehavioral rehabilitation programs for adults with acquired brain injury and making evidence-based recommendations for the adoption of these rehabilitation trainings. Using a variety of search procedures, 63 studies were identified and reviewed using a set of questions about research methods, treatments, results and outcomes for the 1,094 participants. The 63 studies included treatments falling into three general categories: approaches based on applied behavior analysis, interventions based on cognitive-behavior therapy (CBT), and comprehensive-holistic rehabilitation programs (CHRPs). Considerable heterogeneity exists in the reviewed literature among treatment methods and within reported sample subjects. Despite the variety of methodological concerns, results indicate that the greatest overall improvement in psychosocial functioning is achieved by CHRP that can be considered a treatment standard for adults with behavioral and psychosocial disorders following acquired brain injury. Both approaches based on applied behavior analysis and CBT can be said to be evidence-based treatment options. However, findings raise questions about the role of uncontrolled factors in determining treatment effects and suggest the need for rigorous inclusion/exclusion criteria, with greater specification of theoretical basis, design, and contents of treatments for both interdisciplinary-comprehensive approaches and single-case methodologies

Functional and Biochemical Alterations of the Medial Frontal Cortex in Obsessive-Compulsive Disorder

Context: The medial frontal cortex (MFC), including the dorsal anterior cingulate (dAC) and supplementary motor area (SMA), is critical for adaptive and inhibitory control of behaviour. Abnormally high MFC activity has been a consistent finding in functional neuroimaging studies of obsessive-compulsive disorder (OCD). However, the precise regions and the neural alterations associated with this abnormality remain unclear. Objective: To examine the functional and biochemical properties of the MFC in patients with OCD. Design: Cross-sectional design combining volume localized proton magnetic resonance spectroscopy (1H-MRS) and functional MRI (fMRI) with an inhibitory control paradigm (the Multi-Source Interference Task; MSIT) designed to activate the MFC. Setting: Healthy control participants and OCD patients recruited from the general community. Participants: Nineteen OCD patients (10 male, and 9 female) and nineteen age, gender, education and intelligence-matched healthy control participants. Main Outcome Measures: Psychometric measures of symptom severity, MSIT behavioural performance, blood-oxygen-level-dependent (BOLD) activation and 1H-MRS brain metabolite concentrations. Results: MSIT behavioural performance did not differ between OCD patients and control subjects. Reaction-time interference and response errors were correlated with BOLD activation in the dAC region in both groups. Relative to control subjects, OCD patients showed hyper- activation of the SMA during high response-conflict (incongruent > congruent) trials and hyper-activation of the rostral anterior cingulate (rAC) region during low response- conflict (incongruent < congruent) trials. OCD patients also showed reduced levels of neuronal N-acetylaspartate in the dAC region, which was negatively correlated with their BOLD activation of the region. Conclusions: Our findings suggest that hyper-activation of the medial frontal cortex in OCD patients may be a compensatory response to neural pathology in the region. This relationship may partly explain the nature of inhibitory control deficits that are frequently seen in this group and may serve as a focus of future treatment studies

Cognitive development of children with non-progressive unilateral brain lesion

http://www.ester.ee/record=b4336575~S1*es

Frontal lobe dysfunction, as measured by the frontal systems behavioural scale, in the context of HIV infection and heavy episodic drinking

Background: The frontal lobe of the human brain is integral in regulating behaviour. Behavioural disturbances such as apathy, disinhibition, and dysexecutive function are well-known consequences of frontal lobe pathology, leading to significant impairment. Heavy episodic drinking (HED) and HIV are common conditions that impair the frontal lobe, with disinhibition frequently being seen in people with HED, apathy in HIV positive patients and both HIV and HED leading to executive dysfunction. There is a paucity of research on the interplay between HIV and HED and how this impacts behaviour associated with frontal lobe dysfunction. The Frontal Systems Behaviour Scale (FrSBe) is a questionnaire designed to measure problematic behaviour associated with frontal systems impairment. It has been used in a range of clinical populations. It consists of a total score and three subscale scores, namely apathy (Scale A), disinhibition (Scale D) and executive dysfunction (Scale E). This tool is easy to administer and has the potential to provide clinically useful information that could guide management of patients with these conditions. Aim: As a first step to knowing more about the complex interplay between HIV and HED and its effects on frontal lobe function, the aim of this study was to determine the relationship between HIV status, HED and frontal-systems behavioural dysfunction (impulsivity, apathy, and executive dysfunction) as measured by the FrSBe. Methods: Participants for this quantitative, cross-sectional, and analytical study were recruited from the Nolungile Clinic in Khayelitsha, Cape Town. They were grouped according to their HIV- and HED status. Relevant demographic and clinical data were obtained. Participants completed the Substance Abuse and Mental Illness Symptoms Screener (SAMISS) questionnaires and the FrSBe self-report measure that was translated into isiXhosa. Both measures were scored and the FrSBe raw scores were converted to T-scores. Results: A total of the 99 participants met the inclusion criteria, of which 25 were in the HED only group, 22 in the HIV+ only group, 26 in the dual group, and 26 were in the control group. The mean age (SD) of the sample was 37.92 (8.8) years. There was a statistical difference between groups for the total drinking score on the SAMISS (p = 65), were present on the FrSBe Total Score in 29 of the participants. On the apathy subscale score, 36 participants had clinically significant (T-score >= 65) deficits, 14 had deficits on the disinhibition subscale, and 34 had on the executive dysfunction subscale. There were no statistically significant differences in the proportion of participants with clinically significant deficits between groups for any FrSBe scores. Conclusions: This study shows that people with HED have more dysfunctional behaviour associated with frontal system impairment and are more disinhibited. HIV status does not appear to influence frontal system behaviour. These finding needs to be interpreted with caution as the study FrSBe was administered in isiXhosa, in which it has not been validated, and no normative data was available for the study population. Future studies validating the FrSBe in a South African context and deriving normative data for South African populations would be a first step into developing the FrSBe into a clinically useful tool. This could, in turn, potentially lead to improved care and treatment in these conditions by identifying specific impairments and problematic behaviours as targets for intervention

Lesion Loci of Impaired Affective Prosody: A Systematic Review of Evidence from Stroke

Affective prosody, or the changes in rate, rhythm, pitch, and loudness that convey emotion, has long been implicated as a function of the right hemisphere (RH), yet there is a dearth of literature identifying the specific neural regions associated with its processing. The current systematic review aimed to evaluate the evidence on affective prosody localization in the RH. One hundred and ninety articles from 1970 to February 2020 investigating affective prosody comprehension and production in patients with focal brain damage were identified via database searches. Eleven articles met inclusion criteria, passed quality reviews, and were analyzed for affective prosody localization. Acute, subacute, and chronic lesions demonstrated similar profile characteristics. Localized right antero-superior (i.e., dorsal stream) regions contributed to affective prosody production impairments, whereas damage to more postero-lateral (i.e., ventral stream) regions resulted in affective prosody comprehension deficits. This review provides support that distinct RH regions are vital for affective prosody comprehension and production, aligning with literature reporting RH activation for affective prosody processing in healthy adults as well. The impact of study design on resulting interpretations is discussed

Do informal caregivers of people with dementia mirror the cognitive deficits of their demented patients?:A pilot study

Recent research suggests that informal caregivers of people with dementia (ICs) experience more cognitive deficits than noncaregivers. The reason for this is not yet clear. Objective: to test the hypothesis that ICs ‘mirror' the cognitive deficits of the demented people they care for. Participants and methods: 105 adult ICs were asked to complete three neuropsychological tests: letter fluency, category fluency, and the logical memory test from the WMS-III. The ICs were grouped according to the diagnosis of their demented patients. One-sample ttests were conducted to investigate if the standardized mean scores (t-scores) of the ICs were different from normative data. A Bonferroni correction was used to correct for multiple comparisons. Results: 82 ICs cared for people with Alzheimer's dementia and 23 ICs cared for people with vascular dementia. Mean letter fluency score of the ICs of people with Alzheimer's dementia was significantly lower than the normative mean letter fluency score, p = .002. The other tests yielded no significant results. Conclusion: our data shows that ICs of Alzheimer patients have cognitive deficits on the letter fluency test. This test primarily measures executive functioning and it has been found to be sensitive to mild cognitive impairment in recent research. Our data tentatively suggests that ICs who care for Alzheimer patients also show signs of cognitive impairment but that it is too early to tell if this is cause for concern or not

An Exploration of the Relationship Between Personality Traits and Cognitive Functioning in Neuropschological Outpatients in Community Based Treatment

This study examined whether behavioral disturbances in obsessive compulsive personality disorder and borderline personality disorder were related to executive functioning. An archival database was used; this consisted of 104 subjects who had been given the Millon Clinical Multiaxial Inventory-III (MCMI-III) and the Wisconsin Card Sorting Test (WCST) at a local neuropsychology practice. Comparisons in executive functioning abilities were made between groups of subjects identified as reporting obsessive compulsive personality disorder traits or borderline personality disorder traits, and also between groups of subjects identified as reporting both obsessive compulsive personality traits and borderline personality traits. Findings concluded that a relationship does not exist between personality traits and executive functioning. Although the study‟s findings revealed no statistically significant results, the study generated significant discussion points pertinent to future research