Noninvasive brain stimulation techniques can modulate cognitive processing

Recent methods that allow a noninvasive modulation of brain activity are able to modulate human cognitive behavior. Among these methods are transcranial electric stimulation and transcranial magnetic stimulation that both come in multiple variants. A property of both types of brain stimulation is that they modulate brain activity and in turn modulate cognitive behavior. Here, we describe the methods with their assumed neural mechanisms for readers from the economic and social sciences and little prior knowledge of these techniques. Our emphasis is on available protocols and experimental parameters to choose from when designing a study. We also review a selection of recent studies that have successfully applied them in the respective field. We provide short pointers to limitations that need to be considered and refer to the relevant papers where appropriate

Nonpharmacological Interventions for Mild Cognitive Impairment in Parkinson’s Disease

This research examined mild cognitive impairment in Parkinson’s Disease (PD-MCI) and the therapeutic potential of nonpharmacological interventions (e.g., cognitive training and transcranial direct current stimulation) for improving cognition, activities of daily living, and quality of life for people with PD-MCI. The results from this research suggest that cognitive training, tDCS, and cognitive training combined with tDCS may involve stimulation and compensation-focussed strategies that improve cognition, activities of daily living, and quality of life in PD-MCI

Virtual Reality-Assisted Physiotherapy for Visuospatial Neglect Rehabilitation: A Proof-of-Concept Study

This study explores a VR-based intervention for Visuospatial neglect (VSN), a post-stroke condition. It aims to develop a VR task utilizing interactive visual-audio cues to improve sensory-motor training and assess its impact on VSN patients' engagement and performance. Collaboratively designed with physiotherapists, the VR task uses directional and auditory stimuli to alert and direct patients, tested over 12 sessions with two individuals. Results show a consistent decrease in task completion variability and positive patient feedback, highlighting the VR task's potential for enhancing engagement and suggesting its feasibility in rehabilitation. The study underlines the significance of collaborative design in healthcare technology and advocates for further research with a larger sample size to confirm the benefits of VR in VSN treatment, as well as its applicability to other multimodal disorders.Comment: 29 pages, 8 figures, 5 table

GOLIAH: A Gaming Platform for Home-Based Intervention in Autism – Principles and Design

Meeting the required intensive intervention hour for treating children with autism is challenging in terms of trained manpower needed and costs. Advances in Information Communication Technology and computer gaming may help in this respect by creating a nomadically deployable closed loop intervention system involving the child and active participation of parents and therapists.An automated serious gaming platform enabling intensive intervention in nomadic settings has been developed by mapping two pivotal skills in autism spectrum disorder: Imitation and Joint Attention (JA). Eleven games – seven Imitation and four JA – were derived from the Early Start Denver Model. The games involved application of visual and audio stimuli with multiple difficulty levels and a wide variety of tasks and actions pertaining to the Imitation and JA. The platform runs on mobile devices and allows the therapist to (1) characterize the child’s initial difficulties/strengths, ensuring tailored and adapted intervention by choosing appropriate games and (2) investigate and track the temporal evolution of the child’s progress through a set of automatically extracted quantitative performance metrics. The platform allows the therapist to change the game or its difficulty levels during the intervention depending on the child’s progress. Performance of the platform was assessed in a 3-month open trial with 10 children with autism. The children and the parents participated in 80% of the sessions both at home (77.5%) and at hospital (90%). All children went through all games but, given the diversity of the games and the heterogeneity of children profiles and abilities, for a given game the number of sessions dedicated to the game varied and could be tailored through automatic scoring. Parents (N = 10) highlighted enhancement in the child’s concentration, flexibility and self-esteem in 78%, 89% and 44% of the cases respectively and 56% observed an enhanced parents-child relationship. This pilot study shows the feasibility of using the developed gaming platform for home-based intensive intervention. However, the overall capability of the platform in delivering intervention needs to be assessed in a bigger open trial

Upper limb children action-observation training (UP-CAT): a randomised controlled trial in Hemiplegic Cerebral Palsy

BACKGROUND: Rehabilitation for children with hemiplegic cerebral palsy (HCP) aimed to improve function of the impaired upper limb (UL) uses a wide range of intervention programs. A new rehabilitative approach, called Action-Observation Therapy, based on the recent discovery of mirror neurons, has been used in adult stroke but not in children. The purpose of the present study is to design a randomised controlled trial (RCT) for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with HCP.METHODS/DESIGN: The trial is designed according to CONSORT Statement. It is a randomised, evaluator-blinded, match-pair group trial. Children with HCP will be randomised within pairs to either experimental or control group. The experimental group will perform an Action-Observation Therapy, called UP-CAT (Upper Limb-Children Action-Observation Training) in which they will watch video sequences showing goal-directed actions, chosen according to children UL functional level, combined with motor training with their hemiplegic UL. The control group will perform the same tailored actions after watching computer games. A careful revision of psychometric properties of UL outcome measures for children with hemiplegia was performed. Assisting Hand Assessment was chosen as primary measure and, based on its calculation power, a sample size of 12 matched pairs was established. Moreover, Melbourne and ABILHAND-Kids were included as secondary measures. The time line of assessments will be T0 (in the week preceding the onset of the treatment), T1 and T2 (in the week after the end of the treatment and 8 weeks later, respectively). A further assessment will be performed at T3 (24 weeks after T1), to evaluate the retention of effects. In a subgroup of children enrolled in both groups functional Magnetic Resonance Imaging, exploring the mirror system and sensory-motor function, will be performed at T0, T1 and T2.DISCUSSION: The paper aims to describe the methodology of a RCT for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with hemiplegia. This study will be the first to test this new type of treatment in childhood. The paper presents the theoretical background, study hypotheses, outcome measures and trial methodology

New techniques for neuro-rehabilitation: Transcranial Electric Stimulation and Virtual Reality

Recovery of motor and cognitive performances after a neurological illness remains a significant challenge for rehabilitation specialists. The traditional rehabilitative interventions are usually delivered using a multidisciplinary approach, whose results are not always satisfactory. These limitations in functional recovery have led researchers to consider alternative approaches. The hypothesis of providing new therapeutic possibilities in the different patients treated is, as a rehabilitator, very rewarding and represents a challenge for the future. The application of simple and low-cost techniques, defined by the literature as "unconventional" or “novel”, can provide new ideas not only in the field of research but above all of application in clinical reality.A suitable approach to improve the rehabilitation outcome is to utilize these novel rehabilitation techniques that act as a substitute or an addition to the traditional ones. In this context, some recent approaches have been proposed that might increase the effectiveness of a traditional treatment. Among them, two techniques have been demonstrated to be very promising, namely non-invasive brain stimulation (NIBS) and Virtual Reality (VR).In light of the foregoing, my thesis has been divided into two main lines of research, namely: a) the study of the effects of transcranial direct current stimulation (tDCS) in different neurological conditions; b) the application of VR (used alone or combined with tDCS) in the treatment of some neurocognitive disorders. A semi-immersive VR tool (ReMOVES system) has been used as a user-friendly platform providing activities based on exergames

Music Therapy and Autism Spectrum Disorder: Literature Review

Autism spectrum disorder is a complex neurobiological disorder that affects social interaction, communication, and behavior. While there is no cure, MT has emerged as one of the most effective ways to improve the quality of life for individuals with autism. Music can help with communication, emotional expression, and reducing anxiety, providing a structured and predictable environment. MT can be used as a tool for self-expression, learning new concepts, and improving motor control. However, more research is needed to develop disease-modifying therapies that target the core deficits of the disorder.A perturbação do espectro do autismo é uma condição neurobiológica complexa que afeta a comunicação, a interação social e o comportamento. As causas exatas desta condição não são totalmente compreendidas, mas está estabelecido que se baseiam numa combinação de fatores genéticos e ambientais. Nos últimos anos, a prevalência da perturbação do espetro do autismo aumentou, gerando mais atenção e pesquisas. Atualmente não há cura para o autismo, mas existem muitas maneiras de controlar e tratar os sintomas associados, por exemplo através da musicoterapia. Este tipo de abordagem surgiu como uma intervenção promissora que pode ajudar indivíduos com autismo a melhorar sua qualidade de vida, especialmente a desenvolver capacidades sociais a nível de comunicação e interação com outras pessoas, dentro ou fora do círculo familiar. Os musicoterapeutas usam uma variedade de instrumentos e ferramentas para ajudar estes indivíduos a expressar as suas emoções e comunicar os seus sentimentos. Além disso, a música fornece um ambiente organizado e previsível que pode ajudar a melhorar o foco e, consequentemente, reduzir a ansiedade. A musicoterapia também pode ser usada como meio de ensino ativo ou passivo, visando explorar e desenvolver a autoconsciência e a autoexpressão. Do ponto de vista neurofisiológico, a música pode também ser um caminho para desenvolver a plasticidade cortical em indivíduos autistas, ou seja, pode ajudar a reconectar os circuitos sensoriomotores cerebelares e cerebrais, melhorando o controle motor e reduzindo comportamentos repetitivos. Isto deve-se ao facto da música ter a capacidade de fortalecer as conexões sinápticas entre diferentes áreas corticais somatossensoriais do cérebro, destacando a importância do sistema de neurônios-espelho e da ínsula anterior. Embora os mecanismos do funcionamento da musicoterapia ainda não sejam totalmente compreendidos, a pesquisa sugere que pode influenciar positivamente a comunicação, a interação social e a expressão emocional em indivíduos com autismo, e isso deve motivar a novas investigações, mais precisas e direcionadas ao indivíduo em questão

Cognitive training as a resolution for early executive function difficulties in children with intellectual disabilities

Core executive functions (EF) such as attention, and working memory have been strongly associated with academic achievement, language development and behavioral stability. In the case of children who are vulnerable to cognitive and learning problems because of an underlying intellectual disability, EF difficulties will likely exacerbate an already compromised cognitive system. The current review examines cognitive training programs that aim to improve EF, specifically focusing on the potential of this type of intervention for children who have intellectual disabilities. We conclude that despite considerable discrepancies regarding reported intervention effects, these inconsistencies can be attributed to flaws in both program and study design. We discuss the steps needed to address these limitations and to facilitate the advancement of non-pharmaceutical interventions for children with intellectual disabilities

Translating novel findings of perceptual-motor codes into the neuro-rehabilitation of movement disorders

The bidirectional flow of perceptual and motor information has recently proven useful as rehabilitative tool for re-building motor memories. We analyzed how the visual-motor approach has been successfully applied in neurorehabilitation, leading to surprisingly rapid and effective improvements in action execution. We proposed that the contribution of multiple sensory channels during treatment enables individuals to predict and optimize motor behavior, having a greater effect than visual input alone. We explored how the state-of-the-art neuroscience techniques show direct evidence that employment of visual-motor approach leads to increased motor cortex excitability and synaptic and cortical map plasticity. This super-additive response to multimodal stimulation may maximize neural plasticity, potentiating the effect of conventional treatment, and will be a valuable approach when it comes to advances in innovative methodologies

Computer-Based Cognitive Retraining for Individuals with Chronic Acquired Brain Injury: A Pilot Study

Objective: The purpose of this study was to evaluate the effectiveness of a computer-based cognitive retraining program, the Parrot Software, on improving cognitive deficits in memory and attention in individuals with a chronic acquired brain injury (ABI). Research Design: This study utilized a quantitative quasi-experimental one-group pretest-posttest design. Participants: Eleven adults over 18 years of age who sustained a chronic ABI two or more years prior to participation in the study and demonstrated deficits in memory and attention were included. Only individuals with ABI due to traumatic brain injury, hemorrhagic cerebrovascular accident, or ischemic cerebrovascular accident were included. Method and Procedures: The study was conducted over a period of five months, during which participants completed a total of eight 60-minute sessions using the Parrot Software. The participants completed eight sub-programs in memory and attention. Pretest and posttest data were collected using the paper version of the Cognistat Assessment (2009). In order to control for bias and create inter-rater reliability, each researcher was trained in administering the standardized Cognistat Assessment (2009) and the Parrot software, and participated in the process of data collection and analysis. Results: A significant improvement was found in both memory and attention scores post-intervention. No significant correlations were found between memory or attention changes and age, years since injury, and education level. Conclusion: Computer-based cognitive retraining programs, such as the Parrot Software, may be effective in improving cognitive deficits in memory and attention in individuals with chronic acquired brain injury; however, further research is recommended to strengthen these findings and to investigate transfer to functional performance