Tracking EEG changes to alpha and beta binaural beats

A binaural beat can be produced by presenting two tones of differing frequency, one to each ear. Such auditory stimulation has been suggested to influence behaviour and cognition via the process of cortical entrainment. However, research so far has only shown frequency following responses in the traditional EEG frequency ranges of delta, theta and gamma. Hence a primary aim of this research was to ascertain whether it would be possible to produce clear changes in the EEG in either the alpha or beta frequency ranges. Such changes, if possible, would have a number of important implications as well as potential applications. A secondary goal was to track any observable changes in EEG throughout the entrainment epoch to gain some insight into the nature of the entrainment effects any changes in an effort to identify more effective entrainment regimes. Twenty two healthy participants were recruited and randomly allocated to one of two groups, each of which was exposed to a distinct binaural beat frequency for ten 1-minute epochs. The first group listened to an alpha binaural beat of 10Hz and the second to a beta binaural beat of 20Hz. EEG was recorded from the left and right temporal regions during pre-exposure baselines, stimulus exposure epochs and post-exposure baselines. Analysis of changes in broad-band and narrow-band amplitude, and frequency showed no effect of either binaural beat frequency eliciting a frequency following effect in the EEG. Possible mediating factors are discussed and a number of recommendations are made regarding future studies, exploring entrainment effects from binaural beat presentation

Wearable technologies to measure clinical outcomes in multiple sclerosis: A scoping review

Wearable technology refers to any sensor worn on the person, making continuous and remote monitoring available to many people with chronic disease, including multiple sclerosis (MS). Daily monitoring seems an ideal solution either as an outcome measure or as an adjunct to support rater-based monitoring in both clinical and research settings. There has been an increase in solutions that are available, yet there is little consensus on the most appropriate solution to use in either MS research or clinical practice. We completed a scoping review (using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines) to summarise the wearable solutions available in MS, to identify those approaches that could potentially be utilised in clinical trials, by evaluating the following: scalability, cost, patient adaptability and accuracy. We identified 35 unique products that measure gait, cognition, upper limb function, activity, mood and fatigue, with most of these solutions being phone applications

An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial

Objective To evaluate the clinical efficacy of an established programme of occupational therapy in maintaining functional activity and reducing further health risks from inactivity in care home residents living with stroke sequelae. Design Pragmatic, parallel group, cluster randomised controlled trial. Setting 228 care homes (>10 beds each), both with and without the provision of nursing care, local to 11 trial administrative centres across the United Kingdom. Participants 1042 care home residents with a history of stroke or transient ischaemic attack, including those with language and cognitive impairments, not receiving end of life care. 114 homes (n=568 residents, 64% from homes providing nursing care) were allocated to the intervention arm and 114 homes (n=474 residents, 65% from homes providing nursing care) to standard care (control arm). Participating care homes were randomised between May 2010 and March 2012. Intervention Targeted three month programme of occupational therapy, delivered by qualified occupational therapists and assistants, involving patient centred goal setting, education of care home staff, and adaptations to the environment. Main outcome measures Primary outcome at the participant level: scores on the Barthel index of activities of daily living at three months post-randomisation. Secondary outcome measures at the participant level: Barthel index scores at six and 12 months post-randomisation, and scores on the Rivermead mobility index, geriatric depression scale-15, and EuroQol EQ-5D-3L questionnaire, at all time points. Results 64% of the participants were women and 93% were white, with a mean age of 82.9 years. Baseline characteristics were similar between groups for all measures, personal characteristics, and diagnostic tests. Overall, 2538 occupational therapy visits were made to 498 participants in the intervention arm (mean 5.1 visits per participant). No adverse events attributable to the intervention were recorded. 162 (11%) died before the primary outcome time point, and 313 (30%) died over the 12 months of the trial. The primary outcome measure did not differ significantly between the treatment arms. The adjusted mean difference in Barthel index score at three months was 0.19 points higher in the intervention arm (95% confidence interval −0.33 to 0.70, P=0.48). Secondary outcome measures also showed no significant differences at all time points. Conclusions This large phase III study provided no evidence of benefit for the provision of a routine occupational therapy service, including staff training, for care home residents living with stroke related disabilities. The established three month individualised course of occupational therapy targeting stroke related disabilities did not have an impact on measures of functional activity, mobility, mood, or health related quality of life, at all observational time points. Providing and targeting ameliorative care in this clinically complex population requires alternative strategies

Is there a standard procedure for assessing and providing assistive devices for people with neuro-disabling conditions in United Kingdom? A nation-wide survey

Background: Assistive devices are currently provided to people with neuro-disabling conditions to promote or maintain independence in activities of daily living. However, it is unclear whether assessment procedures performed by health care professionals to guide the provision of assistive devices are standardized.  Objective: To explore the assessment and service-delivery processes of assistive devices for people with multiple sclerosis, cerebrovascular disease and Parkinson's disease experiencing physical disability by health care professionals in the United Kingdom.  Methods: A survey was conducted among UK health care professionals working with people with neuro-disabling conditions. Descriptive and content analyses were used to code survey data.  Results: In total, 231 health care professionals completed the survey: 93 occupational therapists, 136 physiotherapists and 2 assistant practitioners. Less than half of the respondents (46%) reported use of local, national, or combined guidelines when assessing a service user's suitability or need for assistive devices. When guidelines were used, they were not consistent and not specifically for assistive devices. The respondents stated that when users were allocated small and portable assistive devices, they were supplied within four weeks. This period increased for large equipment, major home adaptions or if external specialist services and/or funding was needed.  Conclusions: Standardized operating procedures for assistive device provision are not being carried out within the UK. Variable access to assistive devices supplied by the state indicates inequity across regions. Future research should explore potential benefits of developing standardized assessment procedures for the provision of assistive devices and devise methods to reduce current variability in service delivery

Orientation and verbal fluency in the English Longitudinal Study of Ageing: modifiable risk factors for falls?

OBJECTIVES: To determine the relationship between falls and deficits in specific cognitive domains in older adults. DESIGN: An analysis of the English Longitudinal Study of Ageing (ELSA) cohort SETTING: United Kingdom Community-Based PARTICIPANTS: 5197 community-dwelling older adults recruited to a prospective longitudinal cohort study. MEASUREMENTS: Data on the occurrence of falls and number of falls which occurred during a 12-month follow-up period were assessed against the specific cognitive domains of memory, numeracy skills, and executive function. Binomial logistic regression was performed to evaluate the association between each cognitive domain and the dichotomous outcome of falls in the preceding 12 months using unadjusted and adjusted models. RESULTS: Of the 5197 participants included in the analysis, 1308 (25%) reported a fall in the preceding 12 months. There was no significant association between the occurrence of a fall and specific forms of cognitive dysfunction after adjusting for self-reported hearing, selfreported eyesight and functional performance. After adjustment, only orientation (odds ratio (OR): 0.80; 95% confidence intervals (CI): 0.65-0.98, p=0.03) and verbal fluency (adjusted OR: 0.98; 95% CI: 0.96-1.00; p=0.05) remained significant for predicting recurrent falls. CONCLUSIONS: The cognitive phenotype rather than cognitive impairment per se may predict future falls in those presenting with more than one fall.</p

On your marks, get set, pause: what care home teams should consider before partnering with a trial research group

Research has the potential to inform and enhance the care and experiences of people living and working in care homes. While there is a growing interest in research relevant for care homes, there is also a need to ensure that staff, residents and their families and friends are supported when considering taking part in research; particularly in a type of research called a ‘trial’. Trials are a type of research study that can help guide decisions about the best treatment, care and support for both residents (and their families and friends) and care home staff. While potentially important, trials are demanding for both care homes and trial research teams. Before agreeing to support a trial, there are questions a care home manager, staff, residents and their families and friends can consider. These questions are outlined in this article, and the answers to these will help a care home to determine whether they have the capacity, readiness and relationships to support a trial. By taking the time to ‘pause’ and ask ‘are we ready?’, care teams can support both care and science