Usability of therapy controllers in elderly patients with deep brain stimulation

<p>Abstract</p> <p>Background</p> <p>Technical devices are becoming more prevalent in society and also in medical care. Older adults need more support to learn new technologies than younger subjects. So far, no research has been done on the usability of patient controllers in deep brain stimulation in an elderly population. The aim of the study was to investigate the factors influencing the performance of elderly DBS patients with respect to usability aspects of Medtronic Access therapy controllers.</p> <p>Methods</p> <p>Time, mistakes and frequency of use of the controller were compared in 41 elderly DBS patients who prior to the study had already owned a therapy controller for more than six years. One group (n = 20, mean age = 66.4 years) was watching an instructional video and then completed practical assignments on a model implantable pulse generator (IPG). The other group (n = 21, mean age = 65.9 years) completed the tasks without having seen the video before. Any errors that patients made were documented and also corrected so that all of them received hands-on training. After six months all patients were re-evaluated on the dummy IPG in order to compare the effects of hands-on alone vs. video-based training combined with hands-on.</p> <p>Results</p> <p>The group that had seen the video before significantly outperformed the control group at both assessments with respect to number of errors. Both groups performed faster after six months compared to baseline and tend to use the controller more often than at baseline.</p> <p>Conclusion</p> <p>Our results indicate that elderly DBS patients who have been using the controller for several years still have various difficulties in operating the device. However, we also showed that age-specific training may improve the performance in older adults. In general, the design of DBS patient controllers should focus on the specific needs of the end-users. But as changes to medical devices take a long time to be implemented, video instructions with age-specific content plus hands-on training may improve learning for older adults.</p

E-Mental Health und klinisch-therapeutische Intervention für Ältere

Ältere Menschen haben sich sowohl im wirtschaftlichen als auch im wissenschaftlichen Bereich als interessante Zielgruppe für technische Unterstützung zur Förderung der physischen und psychischen Gesundheit entwickelt. Selbstbestimmtes Leben und Wohnen, aber auch verbesserter Zugang zu Informationen und Unterstützungsangeboten im Internet stehen dabei im Vordergrund. Der Bereich Informationsvermittlung im Internet wird anhand von Beispielen zu Informations- und Entlastungsangeboten für Angehörige von Alzheimer Patienten vorgestellt. Weiters werden Beratungs- und Therapieangebote im Internet diskutiert, die vor allem für Personen mit PTBS und komplizierter Trauer entwickelt wurden. Darüber hinaus werden im Internet weitere Interventionsformen, wie computergestützte Selbsthilfeprogramme für eine ganze Reihe psychischer Störungen angeboten. Abschließend wird auf das so genannte Butler-System eingegangen, das älteren Menschen die Möglichkeit bietet virtuelle Welten zu besuchen, die darauf abzielen depressive oder ängstliche Stimmung zu verbessern. Vor- und Nachteile dieser internetbasierten Angebote sowie Fragen der Wirksamkeit und Akzeptanz werden abschließend aus einer psychologischen Perspektive diskutiert

Immediate and delayed neuroendocrine responses to social exclusion in males and females

Social exclusion is a complex phenomenon, with wide-ranging immediate and delayed effects on well-being, hormone levels, brain activation and motivational behavior. Building upon previous work, the current fMRI study investigated affective, endocrine and neural responses to social exclusion in a more naturalistic Cyberball task in 40 males and 40 females. As expected, social exclusion elicited well-documented affective and neural responses, i.e., increased anger and distress, as well as increased exclusion-related activation of the anterior insula, the posterior-medial frontal cortex and the orbitofrontal cortex. Cortisol and testosterone decreased over the course of the experiment, whereas progesterone showed no changes. Hormone levels were not correlated with subjective affect, but they were related to exclusion-induced neural responses. Exclusion-related activation in frontal areas was associated with decreases in cortisol and increases in testosterone until recovery. Given that results were largely independent of sex, the current findings have important implications regarding between-sex vs. within-sex variations and the conceptualization of state vs. trait neuroendocrine functions in social neuroscience