Reabilitação neurocognitiva com recurso a realidade virtual em doentes com a perturbação do uso de álcool

Orientação : Pedro Gamito ; co-orientação: Jorge OliveiraExistem cerca de 2 mil milhões de pessoas que consomem bebidas alcoólicas sendo que destas 76,3 milhões possuem problemas derivados ao consumo de álcool. O consumo excessivo de álcool está associado a diversas doenças. A Perturbação do Uso do Álcool (PUA) tem impacto a nível cognitivo, traduzindo-se em deficiências no funcionamento do lobo frontal, especialmente nas funções executivas. Entre os modelos de tratamento destaca-se o Modelo de Minnesota que se baseia numa abordagem multidisciplinar. De forma a auxiliar na recuperação cognitiva dos doentes é essencial realizar estimulação cognitiva, nesse aspeto, destaca-se a Realidade Virtual (RV), uma vez que oferece mais vantagens que os métodos tradicionais de estimulação de papel e lápis, onde entre outas, se evidencia a repetição e a validade ecológica. Este estudo compreende uma amostra de 16 doentes de ambos sexos, em regime de internamento, que foram divididos em dois grupos, o grupo experimental que realizou o tratamento na instituição e realizou um programa de estimulação cognitiva através de RV (PEC) e grupo controlo que apenas realizou o tratamento. Foram aplicadas provas neuropsicológicas a ambos os grupos no início e no fim do tratamento de forma a inferir a eficácia do PEC. Foram encontradas melhorias significativas a nível cognitivo, concretamente na atenção, memória, velocidade de processamento, processamento e habilidades visuoespaciais entre os gruposThere are around 2 billion people who consume alcohol and 76.3 million of these people have problems derived from alcohol consumption. Excessive consumption of alcohol is associated with several diseases. Alcohol Use Disorder (PUA) has a cognitive impact, specifically on deficits in frontal lobe functioning, especially in executive functions. Among the treatment models, highlight the Minnesota Model, which is based on a multidisciplinary approach. In order to aid in the cognitive recovery of patients it is essential to perform cognitive stimulation, in this aspect, Virtual Reality (VR) stands out, since it offers more advantages than the traditional methods of stimulation of paper and pencil, where among others, highlights the repetition and ecological validity. This study comprised a sample of 16 patients of both sexes, hospitalized, who were divided into two groups, the experimental group that underwent treatment at the institution and performed a cognitive stimulation program through VR (PEC) and control group that only performed the treatment. Neuropsychological tests were applied to both groups at baseline and at the end of treatment in order to infer the efficacy of the PEC. Significant improvements were found between the groups at the cognitive level, namely attention, memory, processing speed, processing and visuospatial abilities

Effectiveness of intensive physiotherapy for gait improvement in stroke: systematic review

Introduction: Stroke is one of the leading causes of functional disability worldwide. Approximately 80% of post-stroke subjects have motor changes. Improvement of gait pattern is one of the main objectives of physiotherapists intervention in these cases. The real challenge in the recovery of gait after stroke is to understand how the remaining neural networks can be modified, to be able to provide response strategies that compensate for the function of the affected structures. There is evidence that intensive training, including physiotherapy, positively influences neuroplasticity, improving mobility, pattern and gait velocity in post-stroke recovery. Objectives: Review and analyze in a systematic way the experimental studies (RCT) that evaluate the effects of Intensive Physiotherapy on gait improvement in poststroke subjects. Methodology: Were only included all RCT performed in humans, without any specific age, that had a clinical diagnosis of stroke at any stage of evolution, with sensorimotor deficits and functional gait changes. The databases used were: Pubmed, PEDro (Physiotherapy Evidence Database) and CENTRAL (Cochrane Center Register of Controlled Trials). Results: After the application of the criteria, there were 4 final studies that were included in the systematic review. 3 of the studies obtained a score of 8 on the PEDro scale and 1 obtained a score of 4. The fact that there is clinical and methodological heterogeneity in the studies evaluated, supports the realization of the current systematic narrative review, without meta-analysis. Discussion: Although the results obtained in the 4 studies are promising, it is important to note that the significant improvements that have been found, should be carefully considered since pilot studies with small samples, such as these, are not designed to test differences between groups, in terms of the effectiveness of the intervention applied. Conclusion: Intensive Physiotherapy seems to be safe and applicable in post-stroke subjects and there are indications that it is effective in improving gait, namely speed, travelled distance and spatiotemporal parameters. However, there is a need to develop more RCTs with larger samples and that evaluate the longterm resultsN/

Eficácia de uma abordagem integrada de intervenção neurolinguística na afasia progressiva primária

In the past few years, primary progressive aphasia has been acknowledged as an emerging field of practice. Considered a neurodegenerative-based syndrome, primary progressive aphasia requires a singular pathway that addresses the associated characteristics of the syndrome. Among the several treatment approaches that have been investigated, behavioural interventions seem to offer some promise. Despite evidence suggests that intervention should capitalize on spared language abilities and improve communication performance to increase functioning levels, a large number of interventions has focused on remediating impaired skills. Accordingly, the present work aimed to design, implement and evaluate the effects of an intervention that targets the maintenance of a core vocabulary and the training of communication strategies along with the use of augmentative and alternative communication devices. Particularly, this case report aimed to analyse the effect of a neurolinguistic intervention on naming performance for trained and untrained words, and quality of life. Two patients diagnosed with primary progressive aphasia participated in this study that took place over the period of five months. Data collection occurred before intervention, during intervention every two-week interval, immediately after the intervention and one month after treatment was complete. Outcome measures consisted of formal and standardized instruments, adapted and validated to Portuguese population. The intervention approach used in this study produced a limited but promising impact on participants. One participant improved naming accuracy and both participants retained therapy gains. Several methodological aspects limited the outcomes representativeness and generalization of conclusions to clinical practice, namely the reduced number of participants, the presence of different diagnosis and the design. This study provides preliminary data on the effects of combined intervention approaches and their impact on patients’ quality of life. The involvement of close family members on therapy sessions is highlighted as beneficial.A afasia progressiva primária tem sido reconhecida como uma área de intervenção emergente nos últimos anos. Considerando-se uma síndrome de origem neurodegenerativa, a afasia progressiva primária requer uma resposta diferenciada que vá ao encontro das características inerentes a esta condição. Várias abordagens de intervenção têm sido exploradas, de entre as quais se destacam as intervenções comportamentais, pelos resultados promissores que têm oferecido. Embora se defenda cada vez mais que a intervenção se deva focar na manutenção de competências linguísticas residuais e na maximização das competências comunicativas, no sentido de aumentar os níveis de funcionalidade da pessoa, grande parte das intervenções têm valorizado a reaprendizagem de competências perdidas. Neste sentido, o presente trabalho teve como principal objetivo desenhar, implementar e avaliar os efeitos de uma intervenção que promove a manutenção de um vocabulário funcional e o treino de estratégias comunicativas a par da utilização de meios de comunicação aumentativa e alternativa. Especificamente, este estudo de caso visou analisar o efeito de uma intervenção neurolinguística na capacidade de nomeação de palavras treinadas e não treinadas, e qualidade de vida. Dois pacientes diagnosticados com afasia progressiva primária participaram no estudo que teve uma duração total de cinco meses. Foram recolhidos dados antes da intervenção, durante a intervenção a cada duas semanas, imediatamente após a intervenção e um mês após o fim do tratamento. Para tal foram utilizados instrumentos de medida formais e estandardizados, adaptados e aferidos à população portuguesa. A abordagem de intervenção implementada teve um impacto limitado, mas promissor, nos participantes. Registou-se uma melhoria das competências de nomeação num dos casos, e manutenção de competências adquiridas em ambos os casos. Vários fatores metodológicos limitaram a representatividade dos resultados obtidos e aplicabilidade das conclusões à prática clínica, nomeadamente o reduzido número de participantes, a heterogeneidade no diagnóstico e o desenho do estudo. Os resultados deste estudo providenciam dados preliminares acerca do efeito de abordagens integradas de intervenção e impacto na qualidade de vida das pessoas com afasia progressiva primária. Destaca-se a importância do envolvimento de familiares diretos nas sessões terapêuticas, como fator facilitador.Programa Doutoral em Psicologi

Efficacy and Moderators of Virtual Reality for Cognitive Training in People with Dementia and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

Background: Mild cognitive impairment (MCI) and dementia result in cognitive decline which can negatively impact everyday functional abilities and quality of life. Virtual reality (VR) interventions could benefit the cognitive abilities of people with MCI and dementia, but evidence is inconclusive. Objective: To investigate the efficacy of VR training on global and domain-specific cognition, activities of daily living and quality of life. To explore the influence of priori moderators (e.g., immersion type, training type) on the effects of VR training. Adverse effects of VR training were also considered. Methods: A systematic literature search was conducted on all major databases for randomized control trial studies. Two separate meta-analyses were performed on studies with people with MCI and dementia. Results: Sixteen studies with people with MCI and four studies with people with dementia were included in each meta-analysis. Results showed moderate to large effects of VR training on global cognition, attention, memory, and construction and motor performance in people with MCI. Immersion and training type were found to be significant moderators of the effect of VR training on global cognition. For people with dementia, results showed moderate to large improvements after VR training on global cognition, memory, and executive function, but a subgroup analysis was not possible. Conclusion: Our findings suggest that VR training is an effective treatment for both people with MCI and dementia. These results contribute to the establishment of practical guidelines for VR interventions for patients with cognitive decline

Distributed Computing and Monitoring Technologies for Older Patients

This book summarizes various approaches for the automatic detection of health threats to older patients at home living alone. The text begins by briefly describing those who would most benefit from healthcare supervision. The book then summarizes possible scenarios for monitoring an older patient at home, deriving the common functional requirements for monitoring technology. Next, the work identifies the state of the art of technological monitoring approaches that are practically applicable to geriatric patients. A survey is presented on a range of such interdisciplinary fields as smart homes, telemonitoring, ambient intelligence, ambient assisted living, gerontechnology, and aging-in-place technology. The book discusses relevant experimental studies, highlighting the application of sensor fusion, signal processing and machine learning techniques. Finally, the text discusses future challenges, offering a number of suggestions for further research directions

Profile, determinants and mechanisms of cerebral injury and cognitive impairment following stroke

PhD ThesisOne in three people over a life time will develop a stroke, dementia or both but little is known about stroke - related cognitive impairment despite current epidemiologic transition in sub - Saharan Africa. The CogFAST Study was established in Newcastle to unmask risk factors, pathological substrates and cellular mechanisms underlying cerebral injury and cognitive impairment following stroke. The overall aim of this thesis was to establish a comparative cohort in Nigerian African stroke survivors and explore mechanisms in post - mortem brains accrued from the Newcastle cohort. Two hundred and twenty Nigerian African stroke survivors were screened three months after index stroke out of whom 143 eligible participants underwent cognitive assessment in comparison with 74 stroke - free healthy controls. We found a high frequency (49.3%) of early vascular cognitive impairment and significant association with older age and low education. Pre-stroke daily fish intake and moderate – to - heavy physical activity were inversely associated. The frequency of vascular cognitive impairment no dementia (vCIND) in the cohort (39.9%) was relatively higher than earlier report from Newcastle (32%) but neuroimaging studies revealed significant findings of MTLA and correlative white matter changes in tandem with previous reports from the Newcastle cohort. Given these, we investigated neurodegenerative hippocampal Alzheimer pathology and synaptic changes, as well as frontal and temporal white matter abnormalities in post - mortem brain tissue from the Newcastle cohort. We found increased Alzheimer pathology in the post - stroke groups but largely this did not differ between the demented (PSD) and non - demented (PSND) sub - groups. However, we found significantly higher hippocampal expression of synaptic markers (vesicular glutamate transporter – 1 and Drebrin) but lower expression of microglial, astrocytic and axonal injury markers in PSND compared to PSD subjects. The protective effect of educational attainment, pre-stroke physical activity and fish intake have public brain health implications.ORS Award from Newcastle University, a Research Fellowship from the International Brain Research Organization (IBRO) and laboratory visit support from the International Society of Neurochemistry (ISN)

Lateralization of the visual word form area in patients with alexia after stroke

Background Knowledge of the process by which visual information is integrated into the brain reading system promotes a better understanding of writing and reading models. Objective This study aimed to use functional Magnetic Resonance Imaging (fMRI) to explore whether the Blood-oxygen-level dependent (BOLD) contrast imaging patterns, of putative cortical region of the Visual Word Form Area (VWFA), are distinct in aphasia patients with moder- ate and severe alexia. Methods Twelve chronic stroke patients (5 patients with severe alexia and 7 pa- tients with moderate alexia) were included. A word categorization task was used to examine responses in the VWFA and its right homolog re- gion. Patients performed a semantic decision task in which words were contrasted with non-verbal fonts to assess the lateralization of reading ability in the ventral occipitotemporal region. Results A fixed effects (FFX) general linear model (GLM) multi-study from the contrast of patients with moderate alexia and those with severe alexia (FDR, p = 0.05, corrected for multiples comparisons using a Threshold Estimator plugin (1000 Monte Carlo simulations), was per- formed. Activation of the left VWFA was robust in patients with mod- erate alexia. Aphasia patients with severe reading deficits also activated the right homolog VWFA. Conclusions This bilateral activation pattern only in patients with severe alexia could be interpreted as a result of reduced recruitment of the left VWFA for reading tasks due to the severe reading deficit. This study provides some new insights about reading pathways and possible neuroplasti- city mechanisms in aphasia patients with alexia. Additional reports could explore the predictive value of right VWFA activation for reading recovery and aid language therapy in patients with aphasia.N/