A Low-Cost Point-of-Care Testing System for Psychomotor Symptoms of Depression Affecting Standing Balance: A Preliminary Study in India

Physical Fitness for Depression in Adolescents and Adults: A Meta-Analysis

Background

Depression has been recognized as one of the most significant factors affecting mental health status. For this reason, several efforts to prevent and reduce depression in all ages have been made in various domains to identify the relevant factors as well as the causes of depression. The objective of this meta-analysis was to examine the effect size between physical fitness and depression in adolescents and adults.

Methods

A systematic search for meta-analysis (2009-2020) was performed using PubMed, Scopus, Web of Science, and RISS, with key terms such as depression, depressive illness, and physical fitness or fitness. Overall, 19 out of 448 articles were included in the meta-analysis with strict inclusion criteria.

Results

The effect size is a medium between physical fitness and depression in adolescents and adults. Two fitness factors, namely cardiovascular endurance and muscle strength, are more relevant for alleviating depression in adolescents and adults, whereas agility was not related to depression. In particular, the cardiovascular fitness factor has an impact on almost all ages; however, muscular strength has less impact on depression in young adolescents, but has a great impact on older adults' depression.

Conclusion

The effect size in this study is a medium between physical fitness and depression in adolescents and adults. Thus, more longitudinal and clinical studies with larger sample sizes are needed to clarify the relationship between physical fitness and depression.

Deep Cerebellar Transcranial Direct Current Stimulation of the Dentate Nucleus to Facilitate Standing Balance in Chronic Stroke Survivors-A Pilot Study

Objective: Cerebrovascular accidents are the second leading cause of death and the third leading cause of disability worldwide. We hypothesized that cerebellar transcranial direct current stimulation (ctDCS) of the dentate nuclei and the lower-limb representations in the cerebellum can improve functional reach during standing balance in chronic (>6 months’ post-stroke) stroke survivors. Materials and Methods: Magnetic resonance imaging (MRI) based subject-specific electric field was computed across a convenience sample of 10 male chronic (>6 months) stroke survivors and one healthy MRI template to find an optimal bipolar bilateral ctDCS montage to target dentate nuclei and lower-limb representations (lobules VII–IX). Then, in a repeated-measure crossover study on a subset of 5 stroke survivors, we compared 15 min of 2 mA ctDCS based on the effects on successful functional reach (%) during standing balance task. Three-way ANOVA investigated the factors of interest– brain regions, montages, stroke participants, and their interactions. Results: “One-size-fits-all” bipolar ctDCS montage for the clinical study was found to be PO9h–PO10h for dentate nuclei and Exx7–Exx8 for lobules VII–IX with the contralesional anode. PO9h–PO10h ctDCS performed significantly (alpha = 0.05) better in facilitating successful functional reach (%) when compared to Exx7–Exx8 ctDCS. Furthermore, a linear relationship between successful functional reach (%) and electric field strength was found where PO9h–PO10h montage resulted in a significantly (alpha = 0.05) higher electric field strength when compared to Exx7–Exx8 montage for the same 2 mA current. Conclusion: We presented a rational neuroimaging based approach to optimize deep ctDCS of the dentate nuclei and lower limb representations in the cerebellum for post-stroke balance rehabilitation. However, this promising pilot study was limited by “one-size-fits-all” bipolar ctDCS montage as well as a small sample size.

Common themes and emerging trends for the use of technology to support mental health and psychosocial well-being in limited resource settings: A review of the literature

There are significant disparities in access to mental health care. With the burgeoning of technologies for health, digital tools have been leveraged within mental health and psychosocial support programming (eMental health). A review of the literature was conducted to understand and identify how eMental health has been used in resource-limited settings in general. PubMed, Ovid Medline and Web of Science were searched. Six-hundred and thirty full-text articles were identified and assessed for eligibility; of those, 67 articles met the inclusion criteria and were analyzed. The most common mental health use cases were for depression (n = 25) and general mental health and well-being (n = 21). Roughly one-third used a website or Internet-enabled intervention (n = 23) and nearly one-third used an SMS intervention (n = 22). Technology was applied to enhance service delivery (n = 32), behavior change communication (n = 26) and data collection (n = 8), and specifically dealt with adherence (n = 7), ecological momentary assessments (n = 7), well-being promotion (n = 5), education (n = 8), telemedicine (n = 28), machine learning (n = 5) and games (n = 2). Emerging trends identified wearables, predictive analytics, robots and virtual reality as promising areas. eMental health interventions that leverage low-tech tools can introduce, strengthen and expand mental health and psychosocial support services and can be a starting point for future, advanced tools.

Virtual reality and brain computer interface in neurorehabilitation

The potential benefit of technology to enhance recovery after central nervous system injuries is an area of increasing interest and exploration. The primary emphasis to date has been motor recovery/augmentation and communication. This paper introduces two original studies to demonstrate how advanced technology may be integrated into subacute rehabilitation. The first study addresses the feasibility of brain computer interface with patients on an inpatient spinal cord injury unit. The second study explores the validity of two virtual environments with acquired brain injury as part of an intensive outpatient neurorehabilitation program. These preliminary studies support the feasibility of advanced technologies in the subacute stage of neurorehabilitation. These modalities were well tolerated by participants and could be incorporated into patients' inpatient and outpatient rehabilitation regimens without schedule disruptions. This paper expands the limited literature base regarding the use of advanced technologies in the early stages of recovery for neurorehabilitation populations and speaks favorably to the potential integration of brain computer interface and virtual reality technologies as part of a multidisciplinary treatment program.

Post-stroke balance rehabilitation under multi-level electrotherapy: a conceptual review

Stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function, and connections is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. It has been shown that active cortical participation in a closed-loop brain machine interface (BMI) can induce neuroplasticity in cortical networks where the brain acts as a controller, e.g., during a visuomotor task. Here, the motor task can be assisted with neuromuscular electrical stimulation (NMES) where the BMI will act as a real-time decoder. However, the cortical control and induction of neuroplasticity in a closed-loop BMI is also dependent on the state of brain, e.g., visuospatial attention during visuomotor task performance. In fact, spatial neglect is a hidden disability that is a common complication of stroke and is associated with prolonged hospital stays, accidents, falls, safety problems, and chronic functional disability. This hypothesis and theory article presents a multi-level electrotherapy paradigm toward motor rehabilitation in virtual reality that postulates that while the brain acts as a controller in a closed-loop BMI to drive NMES, the state of brain can be can be altered toward improvement of visuomotor task performance with non-invasive brain stimulation (NIBS). This leads to a multi-level electrotherapy paradigm where a virtual reality-based adaptive response technology is proposed for post-stroke balance rehabilitation. In this article, we present a conceptual review of the related experimental findings.

Stability of daily home-based measures of postural control over an 8-week period in highly functioning older adults

PURPOSE

The focus of this study was to monitor daily objective measures of standing postural control over an 8-week period, recorded in a person's home, in a population of healthy older adults. Establishing natural patterns of variation in the day-to-day signal, occurring in the relative absence of functional decline or disease, would enable us to determine thresholds for changes in postural control from baseline that could be considered clinically important.

METHODS

Eighteen community-dwelling older adults (3 M, 15 F, 72 ± 6 years) participated in a home-based trial where each day they were asked to complete a technology-enabled routine consisting of a short questionnaire, as well as a quiet standing balance trial. Centre of pressure (COP) excursions were calculated over the course of each daily balance trial to generate variables such as postural sway length and mean sway frequency.

RESULTS

The data demonstrated large differences between subjects in centre of pressure measures (coefficients of variation ranging 37-107 %, depending on the variable). Each participant also exhibited variations in their day-to-day trials (e.g. coefficients of variation across 8 weeks ranging ~17-56 %, within person for mean COP distance). Inter- and intra-subject differences were not strongly related to functional tests, suggesting that these variations were not necessarily aberrant movement patterns, but are seemingly representative of natural movement variability.

CONCLUSIONS

The idea of applying a group-focused approach at an individual level may result in misclassifying important changes for a particular individual. Early detection of deterioration can only be achieved through the creation of individual trajectories for each person, that are inherently self referential.