Smartphone technology for fostering goal-directed ambulation and object use in people with moderate Alzheimer's disease.

Purpose: This study was aimed at assessing a smartphone-based intervention to help 11 individuals with moderate Alzheimer's disease and ambulation problems to manage goal-directed, walker-assisted ambulation and object use (i.e., to reach specific destinations and put away objects at those destinations independently).Method: The study was carried out according to a non-concurrent multiple baseline design across participants. Two measures were recorded, that is, the number of target responses performed correctly (with each target response consisting of reaching a destination and putting away an object), and the number of observation intervals with indices of enjoyment/appreciation (e.g., smiles and positive comments). During baseline, the participants were provided with a walker and three objects that were to be transported to and put away at specific destinations. During the intervention, the participants also had the smartphone-based technology that provided them with instructions about the destinations and objects, praise, and preferred stimulation.Results: During baseline, the mean frequency of correct target responses was virtually zero. The mean frequency of intervals with indices of enjoyment/appreciation ranged from zero to close to one. During the intervention, the mean frequencies for the two measures were slightly below three and just over three, respectively. The maximum frequencies possible were three and four, respectively.Conclusions: A smartphone-based intervention may be suitable to foster goal-directed, walker-assisted ambulation and object use as well as enjoyment/appreciation in participants like those involved in this study.IMPLICATIONS FOR REHABILITATIONA smartphone-based intervention may be used to promote goal-directed, walker-assisted ambulation and object use as well as indices of enjoyment/appreciation in persons with moderate Alzheimer disease.The technology for such intervention might involve (a) a smartphone with Android operating system, light sensor, Bluetooth v4.0, and MacroDroid, (b) Bluetooth headphones or earpieces, and (c) battery-powered light sources.The technology may provide the participants with instructions about the destinations to reach and the objects to put away at those destinations, and with praise and brief periods of preferred stimulation at the target destinations.The technology may be considered easy to access, friendly for the participants, and suitable for use by staff within daily contexts.

Smartphone-Based Interventions to Foster Simple Activity and Personal Satisfaction in People With Advanced Alzheimer's Disease.

OBJECTIVES: This study assessed a smartphone-based program to promote practical and mildly demanding arm responses and personal satisfaction and increase physical exertion (heart rates) in people with advanced Alzheimer's disease. METHODS: The program relied on a Samsung Galaxy A3 smartphone with Android 6.0 operating system. Two groups of 10 and 11 participants, respectively, were assigned different responses (ie, placing cards into an elevated box and moving bottles with water from a table into a container). Responses activated the smartphone, which produced brief periods of preferred stimulation. Lack of responding led the smartphone to produce a verbal prompt. RESULTS: All participants had significant increases in independent response frequencies, level of personal satisfaction, and heart rates during program sessions as opposed to baseline or control sessions. CONCLUSION: A smartphone-based program may help people with advanced Alzheimer's disease increase independent occupation with possible benefits in terms of satisfaction and physical condition.

Technology-Based Behavioral Interventions for Daily Activities and Supported Ambulation in People With Alzheimer's Disease.

OBJECTIVES: These 2 studies evaluated technology-based behavioral interventions for promoting daily activities and supported ambulation in people with mild-to-moderate and moderate-to-severe Alzheimer's disease, respectively. METHODS: Study 1 included 8 participants who were taught to start and carry out daily activities on their own using a tablet or smartphone device, which provided activity reminders, step instructions, and praise. Study 2 included 9 participants who were taught to engage in brief periods of ambulation using a walker combined with a tilt microswitch and a notebook computer, which monitored step responses and provided stimulation and prompts. RESULTS: The participants of study 1 succeeded in starting the activities independently and carrying them out accurately. The participants of study 2 largely increased their ambulation levels and also showed signs of positive involvement (eg, smiles and verbalizations). CONCLUSION: The aforementioned technology-based interventions may represent practical means for supporting people with Alzheimer's disease.

Promoting supported ambulation in persons with advanced Alzheimer's disease: a pilot study.

PURPOSE: This study assessed the effects of an intervention program, which combined the use of a walker with assistive technology, on the ambulation and indices of positive involvement of persons with advanced Alzheimer's disease. A social validation assessment of the program was also carried out. METHOD: The study included 10 participants with moderate to severe Alzheimer's disease and inability to walk independently. During baseline, the participants sat in their chair or were provided with a walker. During the intervention, the participants were provided with the walker and assistive technology, which delivered (a) preferred stimulation contingent on step responses and (b) encouragements to ambulate if needed. RESULTS: The participants' mean step frequencies were between 17 and 45 per session during the baseline and between 83 and 127 per session during the intervention. Sessions lasted 3 min. Most participants also had an increase in indices of positive involvement during the intervention sessions, thus showing an interest in those sessions. The social validation assessment showed that staff personnel rated the program favorably. CONCLUSIONS: A program combining the use of a walker with assistive technology may be a practical resource for improving ambulation and positive involvement of persons with advanced Alzheimer's disease. Implications for rehabilitation A program based on relatively simple technology combined to a walker device may support ambulation in participants with advanced Alzheimer's disease who are no longer able to walk independently. The same program may also help increase the indices of positive involvement (i.e., improve the general attention/activity and mood) of most participants. The staff's positive ratings of the program suggest that there may be a favorable attitude toward the acceptance and application of the program in daily contexts.

Supporting Simple Activity Engagement in Persons With Moderate to Severe Alzheimer's Disease Through a Technology-Aided Program.

OBJECTIVES: These 2 studies assessed a technology-aided program to support mild physical exercise or simple occupational activity in participants with moderate to severe Alzheimer's disease. METHODS: Study 1 included 11 participants who were to perform a leg-raising response. Study 2 included 10 participants who were to sort objects into different containers. The program ensured that they received positive stimulation contingent on the responses and reminders/prompts after periods of nonresponding. Each study was carried out according to a nonconcurrent multiple baseline design across participants. RESULTS: The program was successful in supporting mild physical exercise and activity with objects in the 2 groups of participants, respectively. The participants also showed signs of positive involvement (eg, smiles and verbalizations) during the sessions. Moreover, staff personnel rated the program and its impact positively. CONCLUSION: The program may be considered a practical resource for supporting positive engagement in persons with moderate to severe Alzheimer's disease.

Italians do it worse. Montreal Cognitive Assessment (MoCA) optimal cut-off scores for people with probable Alzheimer's disease and with probable cognitive impairment.

Montreal cognitive assessment (MoCA) is a test providing a brief screening for people with cognitive impairment due to aging or neurodegenerative syndromes. In Italy, as in the rest of the world, several validation studies of MoCA have been carried out. This study compared, for the first time in Italy, a sample of people with probable Alzheimer's Disease (AD) with healthy counterparts. The study also compared two community-dwelling groups of aged participants with and without probable cognitive impairment, as discriminated by two cut-off points of adjusted MMSE score. All the comparisons were carried out according to ROC statistics. Optimal cutoff for a diagnosis of probable AD was a MoCA score ≤14. Optimal cutoff for the discrimination of probable cognitive impairment was a MoCA score ≤17 (associated to MMSE cutoff of 23.8). Results confirm the substantial discrepancy in cut-off points existing between Italian and other international validation studies, showing that Italian performance on MoCA seems to be globally lower than that in other Countries. Characteristics of population might explain these results.

Persons With Advanced Alzheimer's Disease Engage in Mild Leg Exercise Supported by Technology-Aided Stimulation and Prompts.

This study assessed whether nine persons with advanced Alzheimer's disease would learn to engage in leg responses (exercise) with the support of a technology-aided program, which provided (a) preferred stimulation contingent on the leg responses and (b) verbal reminders/prompts in case of no responding. The study was conducted according to a non-concurrent multiple baseline design across participants and involved sessions of 5 min. During the baseline, the participants' mean frequencies of leg responses ranged from zero to slightly above two per session. During the intervention, those frequencies ranged from nearly 10 to nearly 17 per session. The mean frequencies of prompts varied across participants from about two to more than seven per session. In addition to the increase in leg responses, participants showed an increase in signs of positive personal involvement (e.g., smiles and positive verbalizations) during the intervention sessions as compared with the baseline sessions. The applicability and potential benefits of the program in daily contexts are discussed.

The Sarah evaluation scale for children and adolescents with cerebral palsy: description and results.

BACKGROUND: Assessments of motor-functional aspects in cerebral palsy are crucial to rehabilitation programs. OBJECTIVE: To introduce the Sarah motor-functional evaluation scale and to report the initial results of its measurement properties. This scale was created based on the experience of the Sarah Network of Rehabilitation Hospitals in the care of children and adolescents with cerebral palsy. METHOD: Preliminary results concerning the measurement properties of the scale were obtained via assessment of 76 children and adolescents with cerebral palsy. Experts' opinions were used to determine an expected empirical score by age group and to differentiate severity levels. RESULTS: The scale exhibited a high Cronbach's alpha coefficient (0.95). Strong correlation was observed with experts' classification for severity levels (0.81 to 0.97) and with the scales Gross Motor Function Measure and Pediatric Evaluation of Disability Inventory (0.80 to 0.98). Regression analysis detected a significant relationship between the scale score and the severity of the child's motor impairment. The inter-rater reliability was also strong (intraclass correlation coefficient ranging from 0.98 to 0.99). The internal responsiveness of the scale score was confirmed by significant differences between longitudinal evaluations (paired Student's t test with p<0.01; standardized response mean of 0.60). CONCLUSION: The Sarah scale provides a valid measure for assessing the motor skills and functional performance of children and adolescents with cerebral palsy. The preliminary results showed that the Sarah scale has potential for use in routine clinical practice and rehabilitation units.

S100B protein and neuron-specific enolase as predictors of cognitive dysfunction after coronary artery bypass graft surgery: A prospective observational study.

BACKGROUND: Postoperative cognitive dysfunction (POCD) may be related to the systemic inflammatory response and an increase in serum markers of brain injury such as S100B protein and neuron-specific enolase (NSE). OBJECTIVE: The study aims to evaluate the association between POCD and serum levels of S100B and NSE after coronary artery bypass grafting surgery (CABG). DESIGN: Prospective observational study. SETTING: Single university teaching hospital. PATIENTS: We investigated 88 patients undergoing CABG. MAIN OUTCOMES MEASURES: Cognitive function was measured preoperatively, and at the 21st and 180th postoperative days (i.e. 6 months after surgery). S100B protein and NSE serum levels were evaluated preoperatively, after induction of anaesthesia, at the end of surgery and at 6 and 24 h after surgery. RESULTS: The incidence of POCD was 26.1% at 21 days after surgery and 22.7% at 6 months after surgery. Increased serum levels of S100B protein and NSE were observed postoperatively and may indicate brain damage. CONCLUSION: Although serum levels of S100B protein and NSE are both significantly increased postoperatively, our findings indicate that serum levels of S100B protein may be more accurate than NSE in the detection of POCD after CABG. TRIAL REGISTRATION: NCT01550159.

The Sarah evaluation scale for children and adolescents with cerebral palsy: description and results

ABSTRACT Background Assessments of motor-functional aspects in cerebral palsy are crucial to rehabilitation programs. Objective To introduce the Sarah motor-functional evaluation scale and to report the initial results of its measurement properties. This scale was created based on the experience of the Sarah Network of Rehabilitation Hospitals in the care of children and adolescents with cerebral palsy. Method Preliminary results concerning the measurement properties of the scale were obtained via assessment of 76 children and adolescents with cerebral palsy. Experts' opinions were used to determine an expected empirical score by age group and to differentiate severity levels. Results The scale exhibited a high Cronbach’s alpha coefficient (0.95). Strong correlation was observed with experts’ classification for severity levels (0.81 to 0.97) and with the scales Gross Motor Function Measure and Pediatric Evaluation of Disability Inventory (0.80 to 0.98). Regression analysis detected a significant relationship between the scale score and the severity of the child’s motor impairment. The inter-rater reliability was also strong (intraclass correlation coefficient ranging from 0.98 to 0.99). The internal responsiveness of the scale score was confirmed by significant differences between longitudinal evaluations (paired Student’s t test with p<0.01; standardized response mean of 0.60). Conclusion The Sarah scale provides a valid measure for assessing the motor skills and functional performance of children and adolescents with cerebral palsy. The preliminary results showed that the Sarah scale has potential for use in routine clinical practice and rehabilitation units.

Technology-Aided Programs to Support Positive Verbal and Physical Engagement in Persons with Moderate or Severe Alzheimer's Disease.

Pilot studies using technology-aided programs to promote verbal reminiscence and mild physical activity (i.e., positive forms of engagement) in persons with moderate or severe Alzheimer's disease have provided promising results (Lancioni et al., 2015a,b). The present two studies were aimed at upgrading and/or extending the assessment of those programs. Specifically, Study 1 upgraded the program for verbal reminiscence and assessed it with eight new participants. The upgraded version automatically monitored the participants' verbal behavior during the sessions, in which photos and brief videos were used to foster verbal reminiscence. Monitoring allowed computer approval and reminders to be consistent with the participants' behavior. Study 2 extended the assessment of the program for promoting mild physical activity with 10 new participants for whom arm-raising responses were targeted. The results of Study 1 showed that the participants' mean percentages of intervals with verbal engagement/reminiscence were below 10 during baseline and control sessions and between above 50 and nearly 80 during the intervention. The results of Study 2 showed that the mean frequencies of arm-raising responses were about or below four and between about 10 and 19 per session during the baseline and the intervention, respectively. The general implications of the aforementioned results and the need for new research in the area were discussed.

Definition and application of neuropsychological test battery to evaluate postoperative cognitive dysfunction.

OBJECTIVE: To investigate the adequacy of the neuropsychological test battery proposed by the International Study of Postoperative Cognitive Dysfunction to evaluate this disorder in Brazilian elderly patients undergoing surgery under general anesthesia. METHODS: A neuropsychological assessment was made in patients undergoing non-cardiac surgery under general anesthesia, aged over 65 years, literate, with no history of psychiatric or neurological problems and score on the Mini Mental State Examination at or above the cutoff point for the Brazilian population (>18 or >23) according to the schooling level of the subject. Eighty patients were evaluated by a trained team of neuropsychologists up to 24 hours before elective surgery. RESULTS: Among the patients evaluated, one was excluded due to score below the cutoff point in the Mini Mental State Examination and two did not complete the test battery, thus remaining 77 patients in the study. The mean age was 69±7.5 years, and 62.34% of the subjects had ±4 years of study. The subjects had significantly lower averages than expected (p<0.001) for normative tables on neuropsychological tests. CONCLUSION: The study demonstrated the applicability of the instruments in the Brazilian elderly and low schooling level population, but suggested the need to determine cutoff points appropriate for these individuals, ensuring the correct interpretation of results. This battery is relevant to postoperative follow-up evaluations, favoring the diagnosis of postoperative cognitive dysfunction in patients undergoing different types of surgery and anesthetic techniques.

Definition and application of neuropsychological test battery to evaluate postoperative cognitive dysfunction / Definição e aplicação de bateria de testes neuropsicológicos para avaliação de disfunção cognitiva pós-operatória

Objective To investigate the adequacy of the neuropsychological test battery proposed by the International Study of Postoperative Cognitive Dysfunction to evaluate this disorder in Brazilian elderly patients undergoing surgery under general anesthesia. Methods A neuropsychological assessment was made in patients undergoing non-cardiac surgery under general anesthesia, aged over 65 years, literate, with no history of psychiatric or neurological problems and score on the Mini Mental State Examination at or above the cutoff point for the Brazilian population (>18 or >23) according to the schooling level of the subject. Eighty patients were evaluated by a trained team of neuropsychologists up to 24 hours before elective surgery. Results Among the patients evaluated, one was excluded due to score below the cutoff point in the Mini Mental State Examination and two did not complete the test battery, thus remaining 77 patients in the study. The mean age was 69±7.5 years, and 62.34% of the subjects had ±4 years of study. The subjects had significantly lower averages than expected (p<0.001) for normative tables on neuropsychological tests. Conclusion The study demonstrated the applicability of the instruments in the Brazilian elderly and low schooling level population, but suggested the need to determine cutoff points appropriate for these individuals, ensuring the correct interpretation of results. This battery is relevant to postoperative follow-up evaluations, favoring the diagnosis of postoperative cognitive dysfunction in patients undergoing different types of surgery and anesthetic techniques. .

Objetivo Investigar a adequação da bateria neuropsicológica proposta pelo International Study of Postoperative Cognitive Dysfunction para a avaliação de disfunção cognitiva pós-operatória em pacientes idosos brasileiros submetidos à cirurgia sob anestesia geral. Métodos Foi realizada uma avaliação neuropsicológica em pacientes submetidos a cirurgias não cardíacas sob anestesia geral, com idade >65 anos, alfabetizados, sem histórico de problemas psiquiátricos ou neurológicos e com pontuação no Miniexame do Estado Mental igual ou superior ao ponto de corte para a população brasileira (>18 ou >23) de acordo com a escolaridade do sujeito. Oitenta pacientes foram avaliados por equipe treinada de neuropsicólogos até 24 horas antes da cirurgia de caráter eletivo. Resultados Dentre os pacientes avaliados, um foi excluído por apresentar pontuação abaixo do ponto de corte no Miniexame do Estado Mental e dois não completaram a bateria de testes, permanecendo 77 pacientes no estudo. A média de idade foi de 69±7,5 anos, com 62,34% dos sujeitos, com ±4 anos de estudo. Os sujeitos apresentaram médias significativamente inferiores ao esperado (p<0,001) para tabelas normativas nos testes neuropsicológicos. Conclusão O estudo demonstrou a aplicabilidade dos instrumentos na população brasileira idosa e de baixa escolaridade, mas sugeriu a necessidade de determinação de pontos de corte adequados a essa população, garantindo a correta interpretação de resultados. Tal bateria é relevante para avaliações de seguimento pós-cirúrgico, favorecendo o diagnóstico de disfunção cognitiva pós-operatória em pacientes submetidos a diferentes tipos de cirurgia e técnicas anestésicas. .

Persons with moderate Alzheimer's disease use simple technology aids to manage daily activities and leisure occupation.

Two studies assessed technology-aided programs to support performance of daily activities and selection/activation of music items with patients with moderate Alzheimer's disease. In Study I, four patients were presented with activity-related pictorial instructions via a computer fitted with inexpensive, commercial software. In Study II, four patients were (a) presented with different music options and (b) allowed to select and activate the preferred option via a microswitch response. Study I showed that each patient learned to perform the two activities available with percentages of correct responses exceeding 85 by the end of the intervention. Study II showed that all patients learned to choose and activate music options. Psychology students, employed in a social validation check, scored the patients' behavior within the program better than their behavior in a control situation. The relevance and usability of simplified pictorial-instruction programs and music choice programs for patients with moderate Alzheimer's disease were discussed.

Supporting daily activities and indoor travel of persons with moderate Alzheimer's disease through standard technology resources.

These two studies were aimed at evaluating standard technology resources for supporting activity and travel among patients with moderate Alzheimer's disease. Specifically, Study I assessed a pictorial instruction program relying on the use of a portable computer and a commercially available and inexpensive video editing software for supporting the performance of daily activities with three patients. Study II assessed the indoor travel performance of four patients (i.e., the three involved in Study I and a fourth patient with no previous research exposure) using a commercially available, basic doorbell system with sound and light cues. The percentages of correct activity steps obtained with the instruction program used in Study I were relatively high and largely similar to the percentages reported in previous studies using more sophisticated technology. During Study II, the percentages of correct travels of two patients matched the data of the most successful patients involved in previous studies with more sophisticated technology. The percentages of the other two patients tended to be lower than those obtained previously, but were still practically relevant. The implications of the results of the two studies and a number of issues for new research are discussed.

Assessing the impact and social perception of self-regulated music stimulation with patients with Alzheimer's disease.

We assessed the impact and social rating of an active and a passive music condition implemented with six patients with Alzheimer's disease. In the active condition, the patients used a simple hand response and a microswitch to self-regulate music stimulation inputs. In the passive condition, music stimulation was automatically presented throughout the sessions. Active and passive stimulation sessions were preceded and followed by control (non-stimulation) sessions. The active condition sessions showed an increase in the patients' indices of positive participation (e.g., singing or music-related movements, and smiles) greater than that observed in the passive condition sessions for five of the six patients. Positive intervention effects could also spread to the post-intervention sessions. Social raters (42 care and rehabilitation staff members working with persons with multiple disabilities) favored the active condition on a six-item questionnaire dealing with, among others, conditions' suitability, respect of patients' dignity and independence, and practicality. The implications of the findings as to the plausibility/desirability of an active stimulation condition were discussed.

Self-regulated music stimulation for persons with Alzheimer's disease: impact assessment and social validation.

OBJECTIVE: To assess the impact and the social rating of an active music condition (in which 10 patients with Alzheimer's disease regulated their music input) vs. a passive music condition. METHOD: In the active condition, the patients used a simple hand response and a microswitch to activate music stimulation periods. In the passive condition, music stimulation was prearranged and continued through the sessions. The active and passive stimulation sessions were preceded and followed by control (non-stimulation) sessions. RESULTS: The active condition sessions showed an increase in the patients' indices of positive participation (e.g., singing or music-related movements, and smiles) similar to that observed in the passive condition sessions. Social raters (140 psychology students) favored the active condition on a six-item questionnaire dealing, among others, with conditions' suitability, respect of patients' dignity and independence, and practicality. CONCLUSION: An active music stimulation condition can be viable, effective, and socially preferable.

Persons with Alzheimer's disease make phone calls independently using a computer-aided telephone system.

This study assessed whether four patients with a diagnosis of Alzheimer's disease could make independent phone calls via a computer-aided telephone system. The study was carried out according to a non-concurrent multiple baseline design across participants. All participants started with baseline during which the telephone system was not available, and continued with intervention in which such system was used. It involved a net-book computer provided with specific software, a global system for mobile communication modem (GSM), a microswitch, and photos of the persons available for the phone calls. All participants learned to use the system and made phone calls independently to a variety of partners such as family members, friends and staff personnel. The positive implications of the system were discussed in relation to previous data in this area and the possibility of helping persons with Alzheimer's disease restore an important, instrumental daily ability and engage in communication with distant partners.

Technology-aided pictorial cues to support the performance of daily activities by persons with moderate Alzheimer's disease.

We developed a technology-aided intervention strategy relying on pictorial cues alone or in combination with verbal instructions and assessed these two versions of the strategy with three persons with moderate Alzheimer's disease. In Section I of the study, the strategy version with pictorial cues plus verbal instructions was compared with an existing technology-based strategy with verbal instructions. Each strategy was used with one specific activity. In Section II of the study, the strategy version with pictorial cues alone was compared with the aforementioned strategy with verbal instructions. Again, each strategy was used with one activity. Both strategy versions were effective with all three participants. The percentages of correct activity performance observed with those versions increased to above 90, and were comparable with those obtained with the existing verbal instructions strategy. A social validation assessment of the version with pictorial cues alone and the existing strategy with verbal instructions (employing university psychology students as raters) showed differences in favor of the latter strategy in terms of practicality and in favor of the former in terms of respect of participants' dignity. The implications of the findings were discussed.

Change in platelet count in patients with hypersplenism subjected to liver transplantation.

CONTEXT: Most patients subjected to liver transplantation presents hypersplenism, which is reversed after the operation. However, some patients remain with moderate to intense hypersplenism. OBJECTIVES: To study the effect of liver transplantation on platelet count in patients with hypersplenism. METHOD: Of a total of 233 patients who underwent liver transplantation, 162 were excluded from the present study because of occurrence of steroid-resistant rejection, absence of hypersplenism before the transplantation, absence of follow-up for at least 2 years or incomplete exams data. The electronic study protocols of the remaining 71 patients were reviewed to determine the demographics, etiology of cirrhosis, and results of pathologic examination of the explanted liver. Serial platelet count was obtained from the study protocol on the day before liver transplantation and 1, 2, 4, and 6 months and 1 year after liver transplantation. Statistical analysis was performed using the Student's t-test, chi-square test, and Spearman's correlation test. RESULTS: Posttransplant platelet count at all time intervals was significantly higher than the pretransplant value (P<0.001 for all time intervals). Thrombocytopenia was reversed (platelet count >100,000/mm(3)) in 58 patients (81.7%) 1 month after liver transplantation. Twelve patients (16.9%) remained with thrombocytopenia 1 year after liver transplantation. Three patients (4.2%) had recurrence of thrombocytopenia within 1 year after liver transplantation. There was no correlation between pretransplant platelet count and the Child-Pugh class or the MELD score. CONCLUSION: Liver transplantation reverses hypersplenism in most patients.