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The only way is up

An idea conceived by a psychologist in northern Spain is now helping to transform rehab outcomes across the world. NR Times reports on NeuronUP.

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Iñigo Fernández de Piérola followed in his mother’s footsteps and studied psychology.

Shortly after finishing his studies he joined his mother and a few other psychologists in opening a psychology clinic in a medium sized city in the north of Spain in the heart of wine country.

During his time as a practicing psychologist he was working with individuals with deficits in cognitive functioning related to Alzheimer’s, Parkinson’s, traumatic brain injury, neurodegenerative diseases, neurodevelopmental disorders and others.

He realised that he and his colleagues were spending an awful lot of time and energy creating and looking for materials to use with these individuals to help with the rehabilitation process.

At that time, the material that could be found on the web was minimal and most of it was cartoony and geared towards children.

Looking online for a platform or collection of materials brought less than desirable results so he decided to set out and create his own platform.

In 2011, NeuronUP was created and launched as a rudimentary collection of materials geared towards professionals working with individualsin need of neurorehabilitation and cognitive stimulation therapies.

Now eight years later, NeuronUP is a fully formed multifaceted tool for the professional rehabilitator.

It is an online platform with no need for downloading software.

If you have a laptop, desktop, tablet, digital whiteboard – and an internet connection – you’re all set.

The activities are classified into over 40 different cognitive processes and areas of occupation allowing the professional to easily find appropriate material to work with the individual in front of them.

For NeuronUP novices there are over 10,000 different activities to choose from and long-time clients can benefit from the new materials released every two weeks.

Rehabilitation needs are unique for each and every person, with that in mind NeuronUP has materials of different difficulty levels ranging from basic to advance.

Many of the activities are customisable as well providing relevant and significant materials for the intervention.

Many of NeuronUP activities are based on activities of daily living, which many of our rehabilitation clients are striving to reclaim.

NeuronUP loves getting suggestions from their professional clients for materials for the platform allowing NeuronUP and its clients to build the platform together.

During its first five years NeuronUP worked diligently with professionals in psychology, occupational therapy and speech language therapy to create content that would be relevant and impactful for those doing the therapies.

In 2016, NeuronUP got its first facelift. After trial and error, after many conversations with clients regarding the features they wanted to see, after seeing what types of activities were most utilised a big update was pushed out to create a more complex and complete tool for professionals.

In this update the patient management feature was improved and by popular request the ability for the professional to group together activities to create sessions was implemented into the platform.

These sessions can then be worked in clinic or sent to the clients’ homes.

The system saves the results of the activity and the professional can keep track of how their client is performing to determine quickly and easily the next course of action.

In June of 2019 NeuronUP released the newest update making the platform more intuitive to use.

The update gave way to a more visual design allowing even the least technically savvy professional to better manage sessions and quickly analyse therapy results.

NeuronUP is currently being used in over 25 countries by over 2,000 rehabilitation professionals.

Being a platform strictly for professional, with a subscription the professional can use the platform with an unlimited number of clients.

Apart from the platform, another thing NeuronUP offers for professionals is NeuronUP Academy.

With the idea that professionals expand their knowledge, professionals working in the sector of cognitive health are invited to give presentations in an online setting for other professionals and students in the sector.

It is completely free to attend, with the opportunity to tune in and listen and interact with the presenter in the form of Q&A at the end of the lecture.

Visit the NeuronUP blog to learn more, sign up for upcoming presentation or view the videos of the past presentations.  If you’re interested in participating as a presenter, please get in touch with NeuronUP.

Professionals interested in learning more about NeuronUP or trying a 15 day free trial are welcome to visit www.neuronup.com or email brian@neuronup.com.

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Repeated head injuries linked to depression – study

Repeated head impacts may be associated with depression symptoms and worse cognitive function later in life, new research suggests.

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It’s well established that a traumatic brain injury (TBI) can cause memory and cognitive problems, as well as depression, but now, researchers have looked at the consequences of repetitive head impacts.

They found that people exposed to repetitive head impacts may be more likely to experience difficulties with cognitive functioning and depression years later.

The researchers analysed data from the Brain health Registry on 13,000 adults, five per cent of whom reported having had repetitive head impacts through contact sports, abuse or military service.

They were asked about depressive symptoms and completed cognitive tests.

The paper, by researchers at Boston University and the University of California, San Francisco, reveals that participants who’d had repetitive head impacts and TBI reported greater depression symptoms than those who hadn’t.

Repetitive head injuries were a stronger predictor of depression than TBI, and those who had a history of repetitive head impacts and TBI with loss of consciousness reported the most depressive symptoms.

“The findings underscore that repetitive hits to the head, such as those from contact sport participation or physical abuse, might be associated with later-life symptoms of depression.

“It should be made clear that this association is likely to be dependent on the dose or duration of repetitive head impacts and this information was not available for this study,” said Michael Alosco, associate professor of neurology at BU School of Medicine (BUSM).

Those who’d experienced repetitive head impacts or TBI also performed worse in some of the cognitive tests.

“It should be noted that not all people with a history of repetitive hits to the head will develop later-life problems with cognitive functioning and depression,” says Study author Robert Stern, professor of neurology, neurosurgery and anatomy & neurobiology at BUSM.

“However, results from this study provide further evidence that exposure to repetitive head impacts, such as through the routine play of tackle football, plays an important role in the development in these later-life cognitive and emotional problems.”

The researchers point out, however, that one limitation of the research is that researchers didn’t have data on the extent of participants’ injuries.

Last year, BUSM researchers found that longer someone was exposed to tackle football, the higher the risk of developing the degenerative brain disease chronic traumatic encephalopathy.

For every year of exposure to the sport, footballers had a 30 per cent increased chance of having the disease.

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City dwellers “more likely to die in hospital” after stroke – US study

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Compared to those living in urban areas, stroke patients treated at rural hospitals were one third less likely to undergo a procedure to remove a blood clot that caused the stroke and were more likely to die of stroke before leaving the hospital.

Researchers examined national data on almost 800,000 adults hospitalised after a stroke between 2012 and 2017.

In their paper, published in the American Stroke Association’s Stroke journal, the researchers warn that this urban-rural divide may be getting worse. This gap, the paper states, could be caused by the slower take-up of newer treatments and technologies, and because rural hospitals are less well-resourced and have poorer access to specialist care. Rural hospitals may also be more likely to lack specialised clinical support, such as dedicated stroke units.

Other causes for poorer stroke care could be a lack of clinical expertise in urban areas, due to difficulties attracting and retaining experienced staff, and poorer access to emergency services and longer responses to emergency calls due to distance.

“The lack of access to specialists is often a limiting factor in adequate care for rural stroke patients, and in this case, that could mean a neurologist to guide the initial care, an interventional neurologist or radiologist to do a procedure, or having a neurosurgeon available for backup in case of any complications,” said Gmerice Hammond, author of the study and a cardiology fellow at Washington University School of Medicine.

“Clinicians need to work to improve access to high-quality stroke care for individuals in rural areas. That means partnerships between hospitals for rapid transfer, as well as telehealth when appropriate. And clinical leaders and policymakers should prioritize improving access, care and outcomes for stroke in rural communities.”

The study had some limitations, including a lack of data on the severity of patients’ strokes, or factors that would determine whether a patient received advanced therapies, sich as the size of the clot and where it is located.

Karen Joynt Maddox, senior author of the study and assistant professor of medicine at Washington University School of Medicine, calls the differences in care, and the lack of improvement over the five-year period, ‘striking’.

“Future studies using more detailed clinical data will be important to follow up on our findings and to determine why patients in rural areas aren’t receiving advanced therapies. Is it because their stroke severity is different? Or because delays in getting to the hospital meant they weren’t eligible by the time they arrived?

“Those questions can’t be answered with administrative data, but they’re very important to look into so that we can develop effective solutions.”

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One charity’s challenging move to online group sessions

Since lockdown began in March, many people recovering from brain injuries have had to adapt to remote sessions with health workers.

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But it’s not just outpatients that have seen a change. One neuropsychologist in York is trying to sustain momentum with her support group, but navigating the new online world with patients has brought its challenges.

Just before lockdown, Diana Toseland, consultant clinical neuropsychologist, was celebrating. Her charity, Café Neuro York, became officially registered. Café Neuro is a social support network that allows people with long term neurological conditions in York to learn new skills, help others and learning to be mindful, after they’re discharged from health services.

Group members were meeting face-to-face for morning and evening meetings, and once a month on Thursday evenings there was an interactive presentation for members to enjoy. When lockdown began, Toseland wanted to continue her twice-weekly sessions online.

But adjusting hasn’t been easy – Toseland had built up a loyal user base, but sessions were very much based offline. Adjusting hasn’t been easy.

“People need this in York. People with a neurological condition need ongoing support,” Toseland says. “People with brain injuries found it helpful to come along to meet people without having to explain – they can just be who they are. It’s about what people can do, not about their condition or disability.

Since lockdown, Toseland has been struggling to know how to support people.

“I’ve got up to speed with Zoom. This week we had six people call in, but their difficulties are quite profound and they’re finding it hard to get onto Zoom. Some call in late because they forget or find it difficult, others call in with help from families.”

Toseland has found there are many technical difficulties to overcome before the sessions can begin.

“You need so many things – good internet connection, distraction-free environment, working microphones and speakers.

“One woman managed to set it up herself, her career before the injury was IT, but then she didn’t have sound. Then she tried headphones, which worked, but then she took them off and couldn’t get the microphone on the computer to work without the headphones – she was the most successful in that meeting.

“Another has poor signal so she has to sit under a tree in her garden, which means she can only do it when the weather’s good.”

Once the call is up and running, Toseland says some members find it difficult to navigate the conversation, which has entirely different unspoken social rules than offline conversations.

“They’ve found it difficult because you can’t have two people having a conversation, it’s got to be one person at a time, which requires intense concentration. People can’t sustain that level of attention long enough to fully participate in the conversation.

“Some go quiet, it leaves people with headaches, it’s fraught with disaster. They might dominate the conversation and not pick up on cues; one finds it’s too much stimulation, so she closes her eyes.”

But Toseland hopes to continue the groups, as when it does work, it works well.

“On the other hand, for those who have joined it, they’ve used it as a bit of a lifeline.”

But Toseland is looking forward to getting meetings back into the real world. She’s been runnin Café Neuro for over a year and a half, and she’s seen more progress in some members than they ever made coming to her clinical practice.

“It’s made a difference in ways I couldn’t have predicted, and an impact wider and quicker than I could’ve possibly hoped for,” she says.

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