The effectiveness of virtual reality interventions for improvement of neurocognitive performance post-traumatic brain injury: a systematic review

Objective: To evaluate current evidence for the effectiveness of virtual reality (VR) interventions in improving neurocognitive performance in individuals who have sustained a traumatic brain injury (TBI). Methods: A systematic literature search across multiple databases (PubMed, EMBASE, Web of Science) for articles of relevance. Studies were evaluated according to study design, patient cohort, VR intervention, neurocognitive parameters assessed, and outcome. VR interventions were evaluated qualitatively with respect to methodology and extent of immersion and quantitatively with respect to intervention duration. Outcomes: Our search yielded 324 articles, of which only 13 studies including 132 patients with TBI met inclusion criteria. A wide range of VR interventions and cognitive outcome measures is reported. Cognitive measures included learning and memory, attention, executive function, community skills, problem solving, route learning, and attitudes about driving. Several studies (n = 10) reported statistically significant improvements in outcome, and 2 studies demonstrated successful translation to real-life performance. Conclusions: VR interventions hold significant potential for improving neurocognitive performance in patients with TBI. While there is some evidence for translation of gains to activities of daily living, further studies are required to confirm the validity of cognitive measures and reliable translation to real-life performance

Virtual Reality for Enhanced Ecological Validity and Experimental Control in the Clinical, Affective and Social Neurosciences

This article highlights the potential of virtual reality environments for enhanced ecological validity in the clinical, affective, and social neurosciences

Aivovamman vaikutus aivokuoren rytmiseen toimintaan

Mild traumatic brain injuries (mTBI) are common, and while most patients recover well, there is a minority of patients suffering from prolonged symptoms lasting over three months. Pathological processes provoke low-frequency (0.5 - 7 Hz) oscillatory brain activity, measurable with electroencephalography (EEG) and magnetoencephalography (MEG). After mTBI, low frequency activity (LFA) is hypothesized to arise from cortical neurons suffering from de-afferentation after traumatic axonal injury. The natural evolution and prognostic value of low-frequency activity (LFA) measured with MEG, however, is not yet firmly established and reliable biomarkers for cognitive complaints after mTBI are lacking. The aim of this thesis was to examine the occurrence and natural evolution of low frequency activity (LFA) after mild traumatic brain injury (mTBI), and to assess its prognostic value in predicting those with prolonged symptoms. Additionally, we wanted to examine the effect of mTBI to brain oscillatory activity during cognitive tasks and find indicators for altered processing. The existence of LFA in healthy subjects might, however, hamper its’ diagnostic value. Therefore, in Study I we created a reference database of resting-state oscillatory brain activity and observed LFA in only 1,4% of healthy subjects’ MEG recordings. The Study II assessed the occurrence and evolution of LFA in resting-state MEG recordings of mTBI patients. At a single-subject level, 7/26 patients presented aberrant 4–7 Hz (theta) band activity; 3/7 patients with abnormal theta activity were without any detectable lesions in MRI. Of the twelve patients with follow-up measurements, five showed abnormal theta activity in the first recording, but only two in the second measurement, implying the importance of early measurements in clinical settings. The presence of LFA was not, however, correlated with the prevalence of self-reported symptoms. The Study III concentrated on the modulation of oscillatory activity during cognitive tasks, Paced Auditory Serial Addition Test (PASAT) and a vigilance test. Attenuation of cortical activity at alpha band (8 – 14 Hz) during PASAT compared with rest was stronger in patients than in controls (p≤0.05, corrected). Furthermore, the patients presented significant attenuation of oscillatory activity also in the left superior frontal gyrus and right prefrontal cortices which was not detected in controls. Spectral peak amplitudes of areal mean oscillatory activity at the alpha band were negatively correlated with the patients’ neuropsychological performance (p<0.01, uncorrected). Areal alpha frequency modulation during PASAT compared with rest was altered in patients: While the alpha peak frequency increased occipitally and remained stable parietally in controls, it was stable occipitally and decreased parietally in mTBI patients (p=0.012). According to our studies, LFA, especially theta-band oscillatory activity can provide an early objective sign of brain dysfunction after mTBI, and cortical oscillatory activity during a demanding cognitive task (PASAT) is altered after mTBI. Our observations suggest that both aberrant theta-band activity and the altered alpha activity during cognitive tasks may offer clinically relevant indicators of changes in neural processing after mTBI.Aivovamma on aivojen rakenteellinen tai toiminnallinen vaurio, joka syntyy kun päähän kohdistuu voimakas ulkoinen energia, tai äkillinen kiihtyvyys-hidastuvuusvoima (kuten äkkipysäyksissä). Aivovamma aiheuttaa tajunnanhäiriön tai muun neurologisen oireiston, joka voi olla ohimenevä tai pysyvä. Lievät aivovammat ovat yleisiä, ja vaikka suurin osa loukkaantuneista toipuu hyvin, kärsii pieni vähemmistö pitkäaikaisista jälkioireista. Lievä aivovamma ei aina aiheuta todennettavia diagnostisia muutoksia, eikä siitä toipumista ennustavia tekijöitä juuri tunneta. Aivosairaudet, myös aivovammat, muuttavat aivojen sähköistä toimintaa ja aiheuttavat matalataajuista rytmistä toimintaa (0.5 – 7 Hz), joka voidaan tunnistaa aivosähkökäyrän (EEG) tai magnetoenkefalografian (MEG) avulla. Aivovamman jälkeisen hidasaaltotoiminnan ajatellaan johtuvan hermosolujen viejähaarakkeiden vaurion aiheuttamasta hermosolujen poikkeavasta sähköisestä toiminnasta. Koska lievän- keskivaikean aivovamman todentaminen voi olla vaikeaa, tutkimme MEG:n mahdollisuuksia diagnostiikan apuvälineenä. Hidasaaltotoiminnan esiintyminen terveillä henkilöillä voisi vähentää löydöksen diagnostista merkitystä vamman jälkeen. Sen vuoksi selvitimme poikkeavan hidasaaltotoiminnan esiintyvyyttä 139:llä terveellä koehenkilöllä ja havaitsimme poikkeavia hidasaaltoja vain kahdella (1.4%). Lievän aivovamman saaneista 26:sta potilaasta hidasaaltotoimintaa (4-7 Hz) esiintyi 7:llä (27%). Kolmella heistä ei pystytty havaitsemaan poikkeavia muutoksia aivojen rakenteellisessa magneettikuvauksessa. Seurantamittaus kuuden kuukauden kuluttua saatiin tehtyä 12 potilaalle. Heistä viidellä (42%) havaittiin hidasaaltotoimintaa ensimmäisessä mittauksessa, mutta seurantamittauksessa vain kahdella. Aikainen mittausajankohta vamman jälkeen vaikuttaa siten parantavan tutkimuksen herkkyyttä. Alkuvaiheen hidasaaltotoiminta ei vaikuttanut ennustavan mahdollisen jälkioireiston kehittymistä, mutta pieni otoskoko vaikeuttaa löydöksen arvioimista. Tarkkaavaisuuden ja muistin häiriöt ovat tavallisimpia oireita aivovamman jälkeen. Tästä syystä tarkastelimme myös muisti- ja tarkkaavaisuustehtävien vaikutusta potilaiden aivojen rytmiseen toimintaan ja mahdollisten muutosten yhteyttä havaittuihin oireisiin. Havaitsimme haastavan muistitehtävän aikana potilaiden rytmisen toiminnan vaimentuvan lepotilanteeseen verrattuna voimakkaammin ja useammilla alueilla ns. alfa-taajuuskaistalla (8-14 Hz) kuin kontrollihenkilöiden. Rytmisen toiminnan voimakkaampi vaimentuminen potilailla oli yhteydessä parempaan neuropsykologiseen testisuoriutumiseen. Myös alueelliset huipputaajuudet käyttäytyivät eri tavoin kontrollihenkilöillä ja potilailla. Kontrollihenkilöillä tehtävän aikana takaraivolohkon alfa-taajuus nousi päälakilohkon taajuuden pysyessä vakaana verrattuna lepotilaan. Potilailla tehtävän aikana alfataajuus käyttäytyi päinvastoin; takaraivolohkon alfa-taajuus säilyi ennallaan, mutta päälakilohkon huipputaajuus laski verrattuna lepotilaan. Tutkimuksemme perusteella pian vamman jälkeen todettava hidasaaltotoiminta voi osoittaa objektiivisesti aivotoiminnan häiriön. Potilailla aivojen rytminen toiminta vaativan kognitiivisen tehtävän aikana erosi kontrolleista. Havaintojemme perusteella sekä hidasaaltotoiminnan esiintyminen, että rytmisen toiminnan muuntuminen kognitiivisten tehtävien aikana voivat jatkossa tarjota kliinisesti merkityksellisiä välineitä arvioitaessa tiedonkäsittelyn tehottomuutta lievän aivovamman jälkeen. Lisätutkimukset laajemmalla aineistolla havaintojemme vahvistamiseksi ovat tarpeellisia aivovamman diagnostiikan kehittämiseksi

Effects of Diversity and Neuropsychological Performance in an NFL Cohort

Objective: The aim of this study was to examine the effect of ethnicity on neuropsychological test performance by comparing scores of white and black former NFL athletes on each subtest of the WMS. Participants and Methods: Data was derived from a de-identified database in South Florida consisting of 63 former NFL white (n=28, 44.4%) and black (n=35, 55.6%) athletes (Mage= 50.38; SD= 11.57). Participants completed the following subtests of the WMS: Logical Memory I and II, Verbal Paired Associates I and II, and Visual Reproduction I and II. Results: A One-Way ANOVA yielded significant effect between ethnicity and performance on several subtests from the WMS-IV. Black athletes had significantly lower scores compared to white athletes on Logical Memory II: F(1,61) = 4.667, p= .035, Verbal Paired Associates I: F(1,61) = 4.536, p = .037, Verbal Paired Associates: II F(1,61) = 4.677, p = .034, and Visual Reproduction I: F(1,61) = 6.562, p = .013. Conclusions: Results suggest significant differences exist between white and black athletes on neuropsychological test performance, necessitating the need for proper normative samples for each ethnic group. It is possible the differences found can be explained by the psychometric properties of the assessment and possibility of a non-representative sample for minorities, or simply individual differences. Previous literature has found white individuals to outperform African-Americans on verbal and non-verbal cognitive tasks after controlling for socioeconomic and other demographic variables (Manly & Jacobs, 2002). This highlights the need for future investigators to identify cultural factors and evaluate how ethnicity specifically plays a role on neuropsychological test performance. Notably, differences between ethnic groups can have significant implications when evaluating a sample of former athletes for cognitive impairment, as these results suggest retired NFL minorities may be more impaired compared to retired NFL white athletes

Distinguishing Performance on Tests of Executive Functions Between Those with Depression and Anxiety

Objective: To see if there are differences in executive functions between those diagnosed with Major Depressive Disorder (MDD) and those with Generalized Anxiety Disorder (GAD).Participants and Methods: The data were chosen from a de-identified database at a neuropsychological clinic in South Florida. The sample used was adults diagnosed with MDD (n=75) and GAD (n=71) and who had taken the Halstead Category Test, Trail Making Test, Stroop Test, and the Wisconsin Card Sorting Test. Age (M=32.97, SD=11.75), gender (56.7% female), and race (52.7% White) did not differ between groups. IQ did not differ but education did (MDD=13.41 years, SD=2.45; GAD=15.11 years, SD=2.40), so it was ran as a covariate in the analyses. Six ANCOVAs were run separately with diagnosis being held as the fixed factor and executive function test scores held as dependent variables. Results: The MDD group only performed worse on the Category Test than the GAD group ([1,132]=4.022, p\u3c .05). Even though both WCST scores used were significantly different between the two groups, both analyses failed Levene’s test of Equality of Error Variances, so the data were not interpreted. Conclusions: Due to previous findings that those diagnosed with MDD perform worse on tests of executive function than normal controls (Veiel, 1997), this study wanted to compare executive function performance between those diagnosed with MDD and those with another common psychological disorder. The fact that these two groups only differed on the Category Test shows that there may not be much of a difference in executive function deficits between those with MDD and GAD. That being said, not being able to interpret the scores on the WCST test due to a lack of homogeneity of variance indicates that a larger sample size is needed to compare these two types of patients, as significant differences may be found. The results of this specific study, however, could mean that the Category Test could be used in assisting the diagnosis of a MDD patient

The Effect of Ethnicity on Neuropsychological Test Performance of Former NFL Athletes

Objective: To investigate the effect of ethnicity on neuropsychological test performance by specifically exploring differences between white and black former NFL athletes on subtests of the WAIS-IV. Participants and Methods: Data was derived from a de-identified database in Florida consisting of 63 former NFL athletes (Mage=50.38; SD=11.57); 28 white and 35 black. Participants completed the following subtests of the WAIS-IV: Block Design, Similarities, Digit Span, Matrix Reasoning, Arithmetic, Symbol Search, Visual Puzzles, Coding, and Cancellation. Results: One-Way ANOVA yielded a significant effect between ethnicity and performance on several subtests. Black athletes had significantly lower scaled scores than white athletes on Block Design F(1,61)=14.266, p\u3c.001, Similarities F(1,61)=5.904, p=.018, Digit Span F(1,61)=8.985, p=.004, Arithmetic F(1,61)=16.07, p\u3c.001 and Visual Puzzles F(1,61)=16.682, p\u3c .001. No effect of ethnicity was seen on performance of Matrix Reasoning F(1,61)=2.937, p=.092, Symbol Search F(1,61)=3.619, p=.062, Coding F(1,61)=3.032, p=.087 or Cancellation F(1,61)=2.289, p=.136. Conclusions: Results reveal significant differences between white and black athletes on all subtests of the WAIS-IV but those from the Processing Speed Scale and Matrix Reasoning. These findings align with previous literature that found white individuals to outperform African-Americans on verbal and non-verbal tasks after controlling for socioeconomic and demographic variables (Manly & Jacobs, 2002). These differences may also be a reflection of the WAIS-IV’s psychometric properties and it is significant to consider the normative sample used may not be appropriate for African-Americans. This study highlights the need for future research to identify how ethnicity specifically influences performance, sheds light on the importance of considering cultural factors when interpreting test results, and serves as a call to action to further understand how and why minorities may not be accurately represented in neuropsychological testing

Regional Cerebral Blood Flow Patterns in Children vs. Adults with ADHD Combined and Inattentive Types: A SPECT Study

Objective: The current study sought to determine whether ADHD Combined Type (ADHD-C) and ADHD Primarily Inattentive Type (ADHD-PI) showed differential regional cerebral blood flow (rCBF) patterns in children vs. adults. Participants and Methods: The overall sample (N=1484) was effectively split into four groups: adults with ADHD-PI (n=519), adults with ADHD-C (n=405), children with ADHD-PI (n=192), children with ADHD-C (n=368). All participants were void of bipolar, schizophrenia, autism, neurocognitive disorders, and TBI. The data were collected from a de-identified archival database of individuals who underwent SPECT scans at rest. Results: Using αConclusions: Overall, the current study suggested that children may show rCBF differences between different ADHD subtypes, but adults may not. The current study did not find significance in any of the 17 brain regions examined when comparing adults with ADHD-C to adults with ADHD-PI. All significant findings were attributed to the children with ADHD-C group showing aberrant blood flow rate than at least one other group. Previous research has supported that the differentiation of these subtypes as distinctive disorders is difficult to make in adults (Sobanski et al., 2006). Other research has indicated the potential of imaging techniques to differentiate the two in children (Al-Amin, Zinchenko, & Geyer, 2018). The current findings support nuanced ways in which rCBF patterns of ADHD-C and ADHD-PI differ between children and adults

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

The Use of a Visual Motor Test to Identify Lingering Deficits in Concussed Collegiate Athletes

Context: 1.6 to 3.8 million sports-related concussions occur annually. Athletes who have suffered a concussion but are symptom free and have returned to baseline on conventional tests may not necessarily be recovered from the effects of the concussion. The premature return to play of an unrecovered athlete may increase the risk of a subsequent concussion. Measurement of upper-limb visual motor coordination has identified lingering deficits following concussion and so it may provide clinicians with a more sensitive means of tracking recovery. Objective: The purpose of this study was to determine if a visual motor coordination test would identify lingering deficits in a concussed population of collegiate student-athletes who have returned to baseline on conventional assessments when compared to healthy controls. Design: Prospective cross-sectional. Setting: The biomechanics laboratory of a large southeastern university. Participants: 13 recently concussed intercollegiate student-athletes, and 13 matched, healthy, control participants. Intervention(s): Each group completed two testing sessions on a visual motor exam. Main Outcome Measure(s): Average score, visual quadrant reaction time, simple visual reaction time and movement time. Results: There was no group interaction in A* score, quadrant response time, SVRT reaction time and SVRT movement time. There was a significant improvement in A* score, quadrant response time, SVRT reaction time and SVRT movement time in both groups between the two sessions. Conclusions: There appears to be no deficit in the visual motor coordination of recently concussed student-athletes after they have recovered according to the standard assessments. The visual motor coordination exam may not provide a useful means of tracking recovery following concussion, due to a substantial practice effect. Key Words: Concussion, visual motor, coordination, Dynavision, deficits, reaction time