Cognitive neurorehabilitation

认知神经康复
  • 文章类型: Journal Article
    背景:人工智能(AI)领域的新兴和先进技术代表了预测和诊断神经退行性疾病的有前途的方法,比如痴呆症。通过使用多模态方法,机器学习(ML)似乎可以更好地了解痴呆症发作的病理机制。这篇综述的目的是讨论当前ML在神经心理学和电生理学领域的应用,探索其对不同形式痴呆的预测和诊断结果,如阿尔茨海默病(AD),血管性痴呆(VaD),路易体痴呆(DLB),和额颞叶痴呆(FTD)。
    方法:针对每种类型的痴呆,分析了基于ML的主要论文,重点是神经心理学评估和脑电图(EEG)研究。
    结果:在ML训练的所有神经生理学和电生理学结果中观察到70-90%甚至更多的准确性。在所有形式的痴呆症中,最显著的发现是AD.相关结果主要与诊断有关,而不是与预测有关。由于缺乏具有适当随访时间的纵向研究。然而,目前尚不清楚哪种ML算法在诊断或预测痴呆方面表现更好.
    结论:神经心理学和电生理学测量,与ML分析一起,可以被认为是早期发现痴呆症的可靠工具。
    BACKGROUND: Emerging and advanced technologies in the field of Artificial Intelligence (AI) represent promising methods to predict and diagnose neurodegenerative diseases, such as dementia. By using multimodal approaches, Machine Learning (ML) seems to provide a better understanding of the pathological mechanisms underlying the onset of dementia. The purpose of this review was to discuss the current ML application in the field of neuropsychology and electrophysiology, exploring its results in both prediction and diagnosis for different forms of dementia, such as Alzheimer\'s disease (AD), Vascular Dementia (VaD), Dementia with Lewy bodies (DLB), and Frontotemporal Dementia (FTD).
    METHODS: Main ML-based papers focusing on neuropsychological assessments and electroencephalogram (EEG) studies were analyzed for each type of dementia.
    RESULTS: An accuracy ranging between 70 % and 90 % or even more was observed in all neurophysiological and electrophysiological results trained by ML. Among all forms of dementia, the most significant findings were observed for AD. Relevant results were mostly related to diagnosis rather than prediction, because of the lack of longitudinal studies with appropriate follow-up duration. However, it remains unclear which ML algorithm performs better in diagnosing or predicting dementia.
    CONCLUSIONS: Neuropsychological and electrophysiological measurements, together with ML analysis, may be considered as reliable instruments for early detection of dementia.
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  • 文章类型: Systematic Review
    目的:癫痫患者可能从使用虚拟现实(VR)和虚拟环境(VE)观察到的报酬中受益,特别是在与视觉空间导航相关的认知困难(记忆,注意,和处理速度)。
    目的:本系统评价中考虑的研究问题与作为癫痫的认知康复实践的VE效率以及癫痫患者的特定VR方法相关。为了符合标准,研究包括患有任何形式的癫痫的参与者和结构化康复计划/模型的方法学设计。数据是在网上收集的,使用学术数据库。
    结果:14项研究纳入文献综述,6项纳入统计分析。实施ROBINS-I方案以评估偏倚风险。对差异的汇总估计进行了逆方差分析(随机效应),以连续数据的形式。尽管研究存在异质性,他们都同意VR和VE在认知康复中与视觉空间记忆有关的有益方面,注意,和信息处理速度。
    结论:我们建议癫痫患者可以从VR认知康复干预中获益,关于视觉空间记忆,注意,和信息处理速度。然而,需要进一步研究,以便更好地了解通过VE进行认知康复的机制,并建立有效和动态的康复方案.
    OBJECTIVE: Epilepsy patients could possibly benefit from the remuneration observed in the use of virtual reality (VR) and virtual environments (VEs), especially in cognitive difficulties associated with visuospatial navigation (memory, attention, and processing speed).
    OBJECTIVE: Research questions under consideration in the present systematic review are associated to VEs\' efficiency as a cognitive rehabilitation practice in epilepsy and the particular VR methods indicated for epilepsy patients. To meet criteria, studies included participants suffering from any form of epilepsy and a methodological design with a structured rehabilitation program/model. Data were collected online, using academic databases.
    RESULTS: Fourteen studies were included in the literature review and 6 in the statistical analysis. ROBINS-I protocol was implemented to assess the risk of bias. An inverse variance analysis (random effects) of pooled estimates of differences was implemented, in the form of continuous data. Despite the heterogeneity of the studies, all of them agree on the beneficial aspects of VR and VEs in cognitive rehabilitation in relation to visuospatial memory, attention, and information processing speed.
    CONCLUSIONS: We suggest that patients suffering from epilepsy may benefit from the use of VR cognitive rehabilitation interventions, concerning visuospatial memory, attention, and information processing speed. However, further investigation is needed in order to gain a better understanding of the mechanisms involved in cognitive rehabilitation via VEs and establish efficient and dynamic rehabilitation protocols.
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  • 文章类型: Journal Article
    Aphasia is one of the most common clinical features of functional impairment after a stroke. Approximately 21-40% of stroke patients sustain permanent aphasia, which progressively worsens one\'s quality of life and rehabilitation outcomes. Post-stroke aphasia treatment strategies include speech language therapies, cognitive neurorehabilitation, telerehabilitation, computer-based management, experimental pharmacotherapy, and physical medicine. This review focuses on current evidence of the effectiveness of impairment-based aphasia therapies and communication-based therapies (as well as the timing and optimal treatment intensities for these interventions). Moreover, we present specific interventions, such as constraint-induced aphasia therapy (CIAT) and melodic intonation therapy (MIT). Accumulated data suggest that using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) is safe and can be used to modulate cortical excitability. Therefore, we review clinical studies that present TMS and tDCS as (possible) promising therapies in speech and language recovery, stimulating neuroplasticity. Several drugs have been used in aphasia pharmacotherapy, but evidence from clinical studies suggest that only nootropic agents, donepezil and memantine, may improve the prognosis of aphasia. This article is an overview on the current state of knowledge related to post-stroke aphasia pharmacology, rehabilitation, and future trends.
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  • 文章类型: Journal Article
    随着上世纪下半叶认知范式的到来,神经康复的理论和科学基础与认知神经心理学和认知神经科学中发展的知识有关。尽管这些学科产生的知识对神经治疗做出了相关贡献,他们的理论前提可能会在治疗过程中造成限制。本手稿有两个主要目的:第一,明确阐述认知神经康复的理论基础,并批判性地分析这些前提在临床实践中产生的影响;第二,提出积极的范式来重新解释对脑损伤患者及其治疗(评估和治疗)的观点。该分析将显示(1)神经康复作为一种疗法,未充分利用身体起源的资源,这些资源有助于从神经后遗症中恢复(痛苦疗法);(2)治疗过程完全基于亚个人解释模型(亚个人疗法);和(3),神经康复不考虑每个人在自己的康复过程中的主观性(反主观疗法)。随后,为了减弱或解决脆弱的概念,次个人和反主观疗法,我支持将积极的范式纳入神经损伤的康复中。它是在一个新的术语下提出的,“经验性神经康复。“这项提议将神经系统疾病及其后遗症视为身体结构与环境之间动态相互作用的改变,其中经验的含义也发生了变化。因此,当一个人不能走路时,记住过去,传达一个想法,或保持有效的自我照顾,它们的损伤不仅是特定大脑区域或信息处理中变化的产物;相反,他们病情的后遗症源于整个生命系统的变化及其与环境的动态关系。体验式神经康复的目标是恢复人的独特和具体的经验,由身体和主观生活属性组成。
    With the arrival of the cognitive paradigm during the latter half of the last century, the theoretical and scientific bases of neurorehabilitation have been linked to the knowledge developed in cognitive neuropsychology and cognitive neuroscience. Although the knowledge generated by these disciplines has made relevant contributions to neurological therapy, their theoretical premises may create limitations in therapeutic processes. The present manuscript has two main objectives: first, to explicitly set forth the theoretical bases of cognitive neurorehabilitation and critically analyze the repercussions that these premises have produced in clinical practice; and second, to propose the enactive paradigm to reinterpret perspectives on people with brain damage and their therapy (assessment and treatment). This analysis will show that (1) neurorehabilitation as a therapy underutilizes body-originated resources that aid in recovery from neurological sequelae (embrained therapy); (2) the therapeutic process is based exclusively on subpersonal explanation models (subpersonal therapy); and (3), neurorehabilitation does not take subjectivity of each person in their own recovery processes into account (anti-subjective therapy). Subsequently, and in order to attenuate or resolve the conception of embrained, subpersonal and anti-subjective therapy, I argue in support of incorporating the enactive paradigm in rehabilitation of neurological damage. It is proposed here under a new term, \"experiential neurorehabilitation.\" This proposal approaches neurological disease and its sequelae as alterations in dynamic interaction between the body structure and the environment in which the meaning of the experience is also altered. Therefore, when a person is not able to walk, remember the past, communicate a thought, or maintain efficient self-care, their impairments are not only a product of an alteration in a specific cerebral area or within information processing; rather, the sequelae of their condition stem from alterations in the whole living system and its dynamics with the environment. The objective of experiential neurorehabilitation is the recovery of the singular and concrete experience of the person, composed of physical and subjective life attributes.
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  • 文章类型: Journal Article
    Vascular dementia is the second most common cause of dementia, with clinical features that depend on neural substrates affected by the vascular lesions. Like most neurological disorders, it involves alterations that range from the molecular level to neuronal networks. Such alterations begin as compensatory mechanisms that reshape every subsystem involved in the brain\'s homeostasis. Although there have been recent huge advances in understanding the pathophysiology of cognitive dysfunction, a suitable therapeutic approach to vascular dementia remains elusive. Pharmacological interventions have failed to sustainably improve cognitive function, and it is a well-known fact that there is a need to change the current view for providing neuroprotection and enhancing neurorecovery after stroke. Studies regarding cognitive training are also faced with the difficulty of drawing up protocols that can embrace a holistic approach in cognitively impaired patients.
    This review will present a brief synthesis of current results from basic research data and clinical studies regarding pharmacological and non-pharmacological interventions in vascular dementia and will offer an integrated view from the perspective of systems biology.
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