Evidence of the effectiveness of virtual reality (VR) in motor and cognitive rehabilitation for traumatic brain injury (TBI) continues to be mixed. Therefore, we conducted a systematic literature ...review in accordance with PRISMA guidelines to strategically evaluate the strength of evidence supporting the use of VR as a rehabilitation tool for motor function and cognition in patients with TBI.
The van Tulder criteria were modified to determine the quality of the outcomes of studies deemed eligible for inclusion in the review.
Twelve studies were considered eligible for inclusion in the systematic review. These studies utilized methods of varying quality such as case and quasi-experimental studies and found moderately positive support for the effectiveness of VR-enhanced rehabilitation for both motor skills and cognitive deficits.
The varying quality of the included studies provides moderate support for use of VR-enhanced rehabilitation techniques per the van Tulder criteria. This highlights the continued gap in the literature for robust studies that enable providers, policy makers, and the public to draw conclusions about the effectiveness of VR-enhanced rehabilitation for traumatic brain injury. Continued pursuit of analyses in the context of newer immersive VR-enhanced rehabilitation is recommended.
The neural circuitry underlying behavior in reward loss situations is poorly understood. We considered two such situations: reward devaluation (from large to small rewards) and reward omission (from ...large rewards to no rewards). There is evidence that the central nucleus of the amygdala (CeA) plays a role in the negative emotion accompanying reward loss. However, little is known about the function of the basolateral nucleus (BLA) in reward loss. Two hypotheses of BLA function in reward loss, negative emotion and reward comparisons, were tested in an experiment involving pretraining excitotoxic BLA lesions followed by training in four tasks: consummatory successive negative contrast (cSNC), autoshaping (AS) acquisition and extinction, anticipatory negative contrast (ANC), and open field testing (OF). Cell counts in the BLA (but not in the CeA) were significantly lower in animals with lesions vs. shams. BLA lesions eliminated cSNC and ANC, and accelerated extinction of lever pressing in AS. BLA lesions had no effect on OF testing: higher activity in the periphery than in the central area. This pattern of results provides support for the hypothesis that BLA neurons are important for reward comparison. The three affected tasks (cSNC, ANC, and AS extinction) involve reward comparisons. However, ANC does not seem to involve negative emotions and it was affected, whereas OF activity is known to involve negative emotion, but it was not affected. It is hypothesized that a circuit involving the thalamus, insular cortex, and BLA is critically involved in the mechanism comparing current and expected rewards.
Over the past several decades, there has been much interest regarding the effects of video game play. Research has evaluated the behavioral, cognitive, and psychological effects of video game play, ...and found individuals who play games using complex and dynamic game settings and require focused attention with quick responses, such as action video games, demonstrate improved cognitive performance. Action video game training has also yielded rehabilitation efficacy for a myriad of patients, such as stroke patients and individuals with vestibular and balance deficits. Recently, new technology platforms have been developed such as mixed reality (MR); however, little to no research has been conducted examining the effects of advanced technology platforms. The purpose of the current study was to explore whether MR game training improved visuo-motor reaction time and balance performances. Fourteen participants (11 male; 18–50 years of age) underwent baseline and post-intervention assessments, and then complete 8 h of MR action game training. Visuo-motor reaction times were obtained via computerized Automated Neurocognitive Assessment Metric testing and balance measures were obtained via Sensory Organizational Testing. Baseline and post-intervention comparisons were analyzed using Wilcoxon signed-rank tests. Baseline and post-intervention visuo-motor reaction time and balance comparisons revealed that MR game training yielded significant reaction time improvements (
p
< 0.05) and vestibular performances (
p
< 0.05) following game training. Our results suggest visuo-motor reaction time and balance performances were significantly improved following of 8 h of action MR game training.
In this review, we discuss the comorbidity of traumatic brain injury (TBI) and pain among civilians and military members, the common causes of pain resulting from TBI, and offer insight about the ...therapeutic management of TBI symptoms and pain. Traumatic brain injury (TBI) is a debilitating health problem and one of the most common post-TBI symptoms is pain, which can contribute to psychological issues such as Post-traumatic stress disorder (PTSD) and depression. Headache pain appears to be the most common type of pain that results from TBI, yet pain can also be more widespread. Managing TBI symptoms and pain simultaneously is difficult because extensive randomized control and clinical studies assessing the effectiveness of therapeutic approaches are lacking. Pharmacological agents such as antidepressants and Triptans and nonpharmacological therapies such as cognitive rehabilitation and physical therapies are commonly used yet it is unknown how effective these therapies are in the long-term. A combination of pharmacological and non-pharmacological therapies is often more effective for managing TBI symptoms and pain than either treatment alone. However, future research is needed to determine the most therapeutic approaches for managing the comorbidity of pain and TBI symptoms in the long term. This review offers suggestions for such future studies.
Highlights • DMS lesions eliminated enhanced lever pressing during reward uncertainty. • DMS lesions enhanced goal entries during reward uncertainty. • These lesions had no effects on reward ...devaluation and reward omission. • Emotional activation during reward uncertainty requires DMS output.
Does recovery from reward devaluation or partial reinforcement (PR) involve the counterconditioning of frustration? Transfer among tasks involving reward loss was used to uncover frustration ...counterconditioning. In Experiment 1, Phase 1 training in consummatory successive negative contrast (cSNC; 32-to-4% sucrose devaluation) eliminated Phase 2 iSNC in one-way avoidance (40-to-3 s safety-time reduction), but the opposite sequence generated no detectable transfer. In Experiment 2, transfer from Phase 1 cSNC to Phase 2 autoshaping extinction after continuous reinforcement increased lever pressing in previously downshifted animals relative to unshifted controls. However, Phase 1 training in autoshaping under partial reinforcement (PR) had no effect on Phase 2 cSNC. Transfer from PR to cSNC also failed when sucrose pellets were used in autoshaping (Experiment 3), when autoshaping acquisition was extended from 100 to 300 trials (Experiment 4), and when preshift training in cSNC was extended from 10 to 20 sessions (Experiment 5). In Experiment 6, Phase 1 training in PR for licking enhanced Phased 2 cSNC, also involving licking, and in Experiment 7 Phase 1 PR training in autoshaping enhanced Phase 2 cSNC after a 22-to-4% sucrose downshift. Whereas prior exposure to cSNC (consummatory task) increased resistance to extinction in autoshaped lever pressing, prior training in one-way avoidance, PR in autoshaping, or PR in taste conditioning (all anticipatory tasks) either had no effect or they enhanced the cSNC effect. Frustration counterconditioning developed during these tasks, but the type of transfer effect depends on task sequence.
Contemporary goals of rehabilitation after traumatic brain injury (TBI) aim to improve cognitive and motor function by applying concepts of neuroplasticity. This can be challenging to carry out in ...TBI patients with motor, balance, and cognitive impairments.
To determine whether use of dynamic body-weight support (DBWS) would allow safe administration of intensive motor therapy during inpatient rehabilitation and whether its use would yield greater improvement in functional recovery than standard-of-care (SOC) therapy in adults with TBI.
Data in this retrospective cohort study was collected from patients with TBI who receive inpatient rehabilitation incorporating DBWS (n = 6) and who received inpatient rehabilitation without DBWS (SOC, n = 6). The primary outcome measure was the change in Functional Independence Measures (FIM) scores from admission to discharge.
There was significant improvement in total FIM scores at discharge compared to admission for both the DBWS (p = 0.001) and SOC (p = 0.005) groups. Overall, the DBWS group had greater improvement in total FIM score and FIM subscales compared to the SOC group.
Our results suggest DBWS has the potential to allow a greater intensity of therapy during inpatient rehabilitation and yield better outcomes compared to SOC in patients with TBI.
Several different types of exposure have the potential to produce olfactory and gustatory deficits related to neurotoxicity. Although the literature contains relatively few studies of such ...chemoreceptive dysfunction in the context of toxic exposure, this review explores the strength of such published associations. Several studies collectively demonstrated moderately strong evidence for an association between manganese dust exposure and olfactory deficits. Evidence of associations between individual chemicals, therapeutics, and composites, such as World Trade Center debris, and olfactory and gustatory deficits remains limited or mixed. Further need for controlled studies for clinical management, exposure limits, and policy development is identified.
This study examined the relationships between post-traumatic headache (PTH) and mental health symptoms after concussions to inform adolescent concussion management. Headache is the most common ...complaint following adolescent concussion. In this sample of 123 adolescents with concussion, there was a 5-fold increase in odds of clinically elevated anxiety, as well as increased mental health symptoms (anxiety, depression, anger, and disruptive behaviours), among adolescents with PTH relative to those without PTH. Adolescents with headache following concussions are vulnerable to worse mental health outcomes, particularly anxiety, and may benefit from routine monitoring of mental health symptoms for early detection and intervention.
•Green monkeys’ alarm calls convey information regarding predators’ mode of attack.•Alarm calls were played to green monkeys that have been isolated from predators.•Study population retained memory ...of meaning of alarm call despite no predators.
Vervet monkeys (Chlorocebus pygerythrus) produce alarm calls and anti-predator behaviors that are specific to a threatening predator's mode of attack. Upon hearing a leopard alarm, the monkeys will run up trees where they are relatively safe. In contrast, eagle alarms prompt the monkeys to run under bushes and snake alarms stimulate bipedal standing. Early researchers proposed that the meaning of each alarm call is conveyed by observational learning. If this true then absence of the predator that elicits the alarm call may lead to alteration or decay of the alarm's meaning since there is no longer opportunity for observational learning to occur. The present study tested this hypothesis by presenting alarm calls to a closely related species of monkeys (Chlorocebus sabaeus) that have been isolated from their ancestral predators for more than 350 years. The monkeys ran up trees in response to a leopard alarm, but not when the same alarm was played backwards and not in response to a snake alarm. Snake alarms failed to reliably elicit bipedal standing. These results suggest that the leopard alarm call conveys the same information to Barbados green monkeys as West African green monkeys despite generations of isolation from leopards.
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