Background: Transcranial direct current stimulation (tDCS) is a promising tool for improving post-stroke cognitive function. Home-based rehabilitation is increasingly required for patients with stroke, and additional benefits are expected if supplemented with remotely supervised tDCS (RS-tDCS). We evaluated the cognitive improvement effect and feasibility of RS-tDCS in patients with chronic stroke. Methods: Twenty-six patients with chronic stroke and cognitive impairment (Korean version of the Montreal Cognitive Assessment [K-MoCA] score <26) were randomized into real and sham RS-tDCS groups and underwent concurrent computerized cognitive training and RS-tDCS. Patients and caregivers underwent training to ensure correct tDCS self-application, were monitored, and treated 5 d/wk for 4 weeks. We investigated several cognition tests including K-MoCA, Korean version of the Dementia Rating Scale-2, Korean-Boston Naming Test, Trail Making Test, Go/No Go, and Controlled Oral Word Association Test at the end of the training sessions and one month later. Repeated-measures ANOVA was used for comparison between the groups and within each group. The adherence rate of the appropriate RS-tDCS session was also investigated. Results: In within-group comparison, unlike the sham group, the real group showed significant improvement in K-MoCA ( P real =0.004 versus P sham =0.132), particularly in patients with lower baseline K-MoCA (K-MoCA 10–17 ; P real =0.001 versus P sham =0.835, K-MoCA 18–25 ; P real =0.060 versus P sham =0.064) or with left hemispheric lesions (left; P real =0.010 versus P sham =0.454, right; P real =0.106 versus P sham =0.128). In between-group comparison, a significant difference was observed in K-MoCA in the lower baseline K-MoCA subgroup (K-MoCA 10–17 ; P time×group =0.048), but no significant difference was found in other cognitive tests. The adherence rate of successful application of the RS-tDCS was 98.4%, and no serious adverse effects were detected. Conclusions: RS-tDCS is a safe and feasible rehabilitation modality for post-stroke cognitive dysfunction. Specifically, RS-tDCS is effective in patients with moderate cognitive decline. Additionally, these data demonstrate the potential to enhance home-based cognitive training, although significant differences were not consistently found in between-group comparisons; therefore, further larger studies are needed. REGISTRATION: URL: https://cris.nih.go.kr ; Unique identifier: KCT0003427.
Many studies have suggested the possibility of using functional near-infrared spectroscopy (fNIRS) devices as neuroimaging tools in various patients. We aimed to evaluate whether fNIRS to measure the prefrontal cortex (PFC fNIRS) is suitable as a screening tool for cognitive impairments. Sixty participants, divided into normal, mild cognitive impairment, and dementia groups, were instructed to wear an fNIRS device during cognitive assessments to assess whether there is a significant difference in the PFC activity between the groups. A significant difference in PFC activity between the groups was observed during the verbal fluency test. Moreover, the PFC activity during the verbal fluency test significantly correlated with the existing cognitive screening tool score. These results suggested that PFC fNIRS can be used as a cognitive impairment screening tool for mild cognitive impairment and dementia. A larger sample size is needed to validate the potential of PFC fNIRS as a cognitive impairment screening tool.
Objectives:The present study intended to identify the needs and development directions of a serious vocal training game for better motivation and commitment of patients with voice disorder to voice therapy. Methods: A literature review, a survey of stakeholders' needs, and a benchmarking analysis of three vocal training games (Visi Pitch, Dr. Speech, and Vox System) was conducted. Results: From the literature review, thirteen game user experience scales (usability, narratives, play engrossment, enjoyment, creative freedom, audio aesthetics, personal gratification, social connectivity, visual aesthetics, accuracy, customization, game analytics, and therapy continuity) were identified for vocal training games and then applied to evaluation of the existing games. From the user experience scales, features not commonly implemented in the existing games include creative freedom (average satisfaction score, 2.5 to 4.3 out of 7), social connectivity (2.4 to 4.4), therapy continuity (1.7 to 4.7), and customization (2.5 to 5.0). Conclusion: The user experience scales would be of use to assess vocal training games, and new serious games need to be developed to complement the existing games in terms of the four scales found relatively lacking.
BackgroundCognitive impairment after stroke is an unfavorable factor for long-term functional independence. Transcranial direct current stimulation (tDCS) is a promising tool for improving cognitive function in patients with stroke. Home-based rehabilitation is increasingly required for patients with stroke, with greater benefits expected if supplemented with remotely supervised tDCS (RS-tDCS). We evaluated cognitive improvement and the feasibility of RS-tDCS in patients with chronic stroke.MethodsThirty chronic stroke patients with cognitive impairment (K-MoCA <26) received a computerized cognitive training package (ComcogTM, Neofact, Seoul, Korea), and were randomized into real RS-tDCS and sham RS-tDCS groups according to the application of tDCS. Participants were treated 5 days/week for 4 weeks. To ensure correct self-application of tDCS (Mindd Stim®, Ybrain Inc., Korea), patients and caregivers received training and were monitored. Several cognitive evaluations were performed. Rate of adherence to the appropriate RS-tDCS session was also investigated. ResultsAmong the 30 participants, 2 chose to withdraw and 2 were excluded due to noncompliance. In the within-group comparison, unlike the sham group (n= 14), the real group (n=12) showed a significant improvement in K-MoCA (intra-p=0.004 vs. 0.132), particularly in patients with moderate cognitive impairment (K-MoCA: 10–17; intra-p=0.001 vs. 0.835, K-MoCA: 18-25; intra-p=0.060 vs. 0.064). However, in K-DRS2, Stoop and K-BNT, both groups showed significant improvement, but there was no group time interaction. In the Trail Making Test, Go/no Go, and Controlled Oral Word Association Test, both groups did not show statistically significant improvement. A total of 551 of the 560 sessions conducted by 28 people were successfully performed (adherence rate: 98.4%) and no serious adverse effects were detected.ConclusionRS-tDCS is a safe and feasible rehabilitation modality for post-stroke cognitive dysfunction. It has the potential to enhance the effect of home-based CT. RS-tDCS seems to be particularly effective in patients with relatively more severe cognitive impairment who are capable of home-based training. Trial registration: Clinical Research information Service (KCT0003427). Registered 26 June 2018, https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=12363
Background Cognitive impairment after stroke is an unfavorable factor for long-term functional independence. Transcranial direct current stimulation (tDCS) is a promising tool for improving cognitive function in patients with stroke. Home-based rehabilitation is increasingly required for patients with stroke, with greater benefits expected if supplemented with remotely supervised tDCS (RS-tDCS). We evaluated cognitive improvement and the feasibility of RS-tDCS in patients with chronic stroke. Methods Thirty chronic stroke patients with cognitive impairment (K-MoCA <26) received a computerized cognitive training package (ComcogTM, Neofact, Seoul, Korea), and were randomized into real RS-tDCS and sham RS-tDCS groups according to the application of tDCS. Participants were treated 5 days/week for 4 weeks. To ensure correct self-application of tDCS (Mindd Stim®, Ybrain Inc., Korea), patients and caregivers received training and were monitored. Several cognitive evaluations were performed. Rate of adherence to the appropriate RS-tDCS session was also investigated. Results Among the 30 participants, 2 chose to withdraw and 2 were excluded due to noncompliance. In the within-group comparison, unlike the sham group (n= 14), the real group (n=12) showed a significant improvement in K-MoCA (intra-p=0.004 vs. 0.132), particularly in patients with moderate cognitive impairment (K-MoCA: 10–17; intra-p=0.001 vs. 0.835, K-MoCA: 18-25; intra-p=0.060 vs. 0.064). However, in K-DRS2, Stoop and K-BNT, both groups showed significant improvement, but there was no group time interaction. In the Trail Making Test, Go/no Go, and Controlled Oral Word Association Test, both groups did not show statistically significant improvement. A total of 551 of the 560 sessions conducted by 28 people were successfully performed (adherence rate: 98.4%) and no serious adverse effects were detected. Conclusion RS-tDCS is a safe and feasible rehabilitation modality for post-stroke cognitive dysfunction. It has the potential to enhance the effect of home-based CT. RS-tDCS seems to be particularly effective in patients with relatively more severe cognitive impairment who are capable of home-based training. Trial registration: Clinical Research information Service (KCT0003427). Registered 26 June 2018, https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=12363
Background: The Kay Pentax Nasometer uses a separator plate that touches the philtrum of a patient to separate the nasal and oral sound energies for nasalance measurement. However, the separator plate could restrict the natural movement of the patient’s upper lip and generate an unpleasant pressure to the patient’s philtrum. The present study was intended to measure nasalance scores without touching the philtrum for better comfort during speech assessment and therapy.Methods: Nasalance scores of 10 males and 10 females having no speech disorders were measured under four levels (0, 5, 10, and 15 mm) of the gap between the plate and the philtrum (denoted as plate-to-philtrum gap) using Nasometer II 6450 for nasal (Nasal Sentences) and oral (Zoo Passage) stimuli. Regression formulas were established to examine the relationships between nasalance score and plate-to-philtrum gap for the Nasal Sentences and the Zoo Passge, respectively. To provide equivalent nasalance scores measured under the 5-mm plate-to-philtrum gap to those measured under the conventional contact measurement condition (i.e., the 0-mm plate-to-philtrum gap in the present study), compensation factors were identified as the ratio of the mean nasalance measured under the 0-mm gap to that measured under the 5-mm gap for the Nasal Sentences and the Zoo Passge, respectively. The validation of the identified compensation factors was examined.Results: The nasalance scores were significantly different between the four different plate-to-philtrum gaps for the stimuli. Nonlinear and linear regression formulas were established for the relationships between nasalance score and plate-to-philtrum gap for the Nasal Sentences and the Zoo Passage, respectively. Compensation factors for the Nasal Sentences and the Zoo Passage were identified as 1.17 and 0.71, respectively. Validation results showed that the adjusted nasalance scores after mutiplying the identified compensation factors were similar to those measured under the conventional contact measurement condition for both the oral and nasal stimuli.Conclusions: The 5-mm plate-to-philtrum gap condition after multiplying the compensation factors can provide equivalent nasalance scores to the conventional contact measurement condition and better comfort in speech assessment and therapy.
Objective: The Kay Pentax nasometer uses a separator plate that touches the philtrum of a patient to separate the nasal and oral sound energies for nasalance measurement. However, the separator plate can restrict the natural movement of the patient’s upper lip and generate unpleasant pressure on the patient’s philtrum. The present study was intended to measure nasalance scores without touching the philtrum for better comfort during speech assessment and therapy. Methods: Nasalance scores of 10 males and 10 females having no speech disorders were measured under 4 levels (0, 5, 10, and 15 mm) of the gap between the plate and the philtrum (denoted as plate-to-philtrum gap) using Nasometer II 6450 for nasal (Nasal Sentences) and oral (Zoo Passage) stimuli. Regression formulas were established to examine the relationships between nasalance score and plate-to-philtrum gap for the stimuli. To provide nasalance scores equivalent to those measured for the contact condition, compensation factors for the 5 mm plate-to-philtrum gap measurement condition were identified for the stimuli. Results: The nasalance scores were significantly different between the 4 different plate-to-philtrum gaps for the stimuli. Compensation factors for the Nasal Sentences and the Zoo Passage were identified as 1.17 and 0.71, respectively. Conclusions: The 5 mm plate-to-philtrum gap condition after multiplying the compensation factors can provide equivalent nasalance scores to the conventional contact measurement condition which may provide better comfort in speech assessment and therapy.
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