Shimon Shiri

A Novel Virtual Reality System Integrating Online Self-Face Viewing and Mirror Visual Feedback for Stroke Rehabilitation: Rationale and Feasibility

Abstract Purpose: To introduce the rationale of a novel virtual reality system based on self-face viewing and mirror visual feedback, and to examine its feasibility as a rehabilitation tool for poststroke patients. Method: A novel motion capture virtual reality system integrating online self-face viewing and mirror visual feedback has been developed for stroke rehabilitation.The system allows the replacement of the impaired arm by a virtual arm. Upon making small movements of the paretic arm, patients view themselves virtually performing healthy full-range movements. A sample of 6 patients in the acute poststroke phase received the virtual reality treatment concomitantly with conservative rehabilitation treatment. Feasibility was assessed during 10 sessions for each participant. Results: All participants succeeded in operating the system, demonstrating its feasibility in terms of adherence and improvement in task performance. Patients’ performance within the virtual environment and a set of clinical-functional measures recorded before the virtual reality treatment, at 1 week, and after 3 months indicated neurological status and general functioning improvement. Conclusions: These preliminary results indicate that this newly developed virtual reality system is safe and feasible. Future randomized controlled studies are required to assess whether this system has beneficial effects in terms of enhancing upper limb function and quality of life in poststroke patients.

Positive and Negative Psychological Impact After Secondary Exposure to Politically Motivated Violence Among Body Handlers and Rehabilitation Workers

The positive and negative psychological impact of secondary exposure to politically motivated violence was examined among body handlers and hospital rehabilitation workers, 2 groups that differed in their proximity and immediacy to violent events. Survivors of politically motivated violence served as a comparison group. Body handlers experienced high levels of positive psychological impact and traumatic stress symptoms. Levels of positive psychological impact among on-scene body handlers were higher than those experienced by rehabilitation workers. Traumatic stress symptoms predicted positive psychological impact among body handlers. These findings indicate that proximity to stressors is associated with higher levels of positive and negative psychological impact. Physical proximity is a major contributory factor to both positive and negative psychological effects of secondary exposure to trauma.

Positive psychological impact of treating victims of politically motivated violence among hospital-based health care providers.

Background: Health care personnel treating victims of politically motivated violence are at risk for traumatic stress symptoms. Few studies have assessed the positive psychological impact of politically motivated violence on health care workers. In this study, the level of positive psychological impact among health care workers with recurrent exposure to victims of politically motivated violence was examined. Methods: A validated questionnaire survey of health care personnel treating victims of politically motivated violence during 2000–2005 in two hospital settings was conducted. Positive psychological impact was assessed by the Posttraumatic Growth Inventory and traumatic stress symptoms were assessed using the Revised Posttraumatic Stress Disorder Inventory. Subjects included physicians (surgeons and anesthesiologists), nurses, and psychotherapists. Results: The rate of response to the mail-in questionnaires was 68.3% (n = 138). The sample consisted of 70 physicians, 37 nurses, and 31 hospital-based psychotherapists. Positive psychological impact was noted for the entire sample and among all professions. Traumatic stress symptoms predicted positive psychological impact for the entire sample and for each profession, and there was a curvilinear relationship between traumatic stress symptoms and positive psychological impact. Women experienced greater levels of positive psychological impact. Conclusions: Hospital-based health care providers treating victims of politically motivated violence experience both positive and negative psychological impact. Individuals who are more traumatized by their experience are more likely to also have a positive psychological impact.

Post-polio syndrome: impact of hope on quality of life

Purpose: To determine the effect of future-oriented coping strategies on the quality of life (QOL) of individuals with post-polio syndrome (PPS). Methods: A correlative study, in which a cohort of 61 patients was surveyed and a group of 40 healthy, age-matched individuals served as controls. Patients were surveyed as to their QOL, levels of hope and utilization of proactive coping, employment status and degree of functionality. Results: PPS patients had lower total, physical and mental QOL indices compared to controls. Future-oriented coping strategies associated with hope were positively associated with physical and mental QOL in the PPS group, but not in the controls. In a multivariate analysis, hope and employment status predicted higher QOL among those with PPS. Conclusions: Future-oriented coping strategies, particularly hope are distinctively associated with improved QOL benefits in PPS patients. Fostering future-oriented coping related to hope may improve the self-perceived mental and physical status of patients with PPS. Implications for Rehabilitation Coping styles of individuals with post-polio can be conceptualized in terms of positive-optimistic psychological constructs rather than the traditional negative frame of reference. Hope is distinctively associated with improved quality of life among post-polio patients. Enhancing hope through psychotherapy may improve mental and physical health of individuals with postpolio.

Cognitive Orientation Is Predictive of Posttraumatic Growth After Secondary Exposure to Trauma

The purpose of the study was to explore the motivational basis for posttraumatic growth following secondary trauma among rescuers, nurses, and rehabilitation teams. The authors chose the framework of the cognitive orientation theory, which defines motivation as a function of beliefs of four types (about goals, norms, oneself, and reality) relevant to themes identified with posttraumatic growth. Regression analyses showed that the majority of variables associated with posttraumatic growth were predicted by the scores of the four belief types and thematic factors. These findings support the validity of cognitive orientation theory for assessing motivation for growth following secondary exposure to trauma.

VirHab - A virtual reality system for treatment of chronic pain and disability

In recent years several lines of research have provided scientific evidence for the therapeutic value of non-invasive methods based on visual feedback and motor imagery. Clinical studies have demonstrated their potential to benefit some patient populations such as cerebrovascular accident (CVA) and complex regional pain syndrome (CRPS). This type of intervention appears appropriate for implementation using virtual reality (VR) technology which can provide the required stimuli. The present study proposes a new VR system based on a motion capture platform, and is currently targeted at treating pain and impairment of upper extremities. The system employs image processing algorithms so the patient sees himself on a screen within a virtual environment. His impaired arm, however, is replaced by a virtual arm. Thus upon making small movements of his paretic arm, he can view his image performing healthy full-range movements with the virtual arm. We hypothesize that this would facilitate plastic changes in the brain, leading to reduced pain and improved function of the impaired limb.

The association between reality-based beliefs and indirectly experienced traumatization

The purpose of the study was to examine the association between belief types and the magnitude of indirect traumatization. Specific types of beliefs were defined in terms of the cognitive orientation theory, which is a cognitive-motivational approach to the understanding, predicting, and changing of behaviors. Belief types that were analyzed included beliefs about self, general beliefs, beliefs about norms, and goal beliefs as they relate to personal growth. Study participants included 38 rescuers (body handlers), 37 nurses, and 31 rehabilitation workers who treated injured civilians that had been exposed to politically motivated violence. The Cognitive Orientation for Posttraumatic Growth Scale was used to assess beliefs about personal growth. The Revised Posttraumatic Stress Disorder Inventory was administered to evaluate indirect traumatization. The results indicate that three of the four belief types related to personal growth were associated with the level of indirect traumatization. Optimistic and positive beliefs about self and general beliefs were associated with a lower level of indirect traumatization symptomatology, suggesting that these types of beliefs may counteract indirect traumatization. On the other hand, stronger goal beliefs were associated with greater indirect traumatization. The negative association between positive goal beliefs and indirect trauma may be related to the gap the individual perceives between the hoped-for ideals and the trauma-stricken reality. These results indicate the importance of cognitive beliefs and their possible role in determining the response to indirect traumatization.

STRESS-RELATED GROWTH AND RESILIENCE AMONG CAREGIVERS OF ALZHEIMER’S PATIENTS RECEIVING CHOLINOMIMETIC TREATMENT

OAs (n1⁄41795) received CDR ratings, and a subset (n1⁄4591) had CSF biomarker measurements. Cox proportional hazards models and Kaplan-Meier survival curves were used to analyze differences in CDR and biomarker groups as predictors of time to driving cessation. Results: Participants with higher CDR scores and more abnormal biomarker measurements had a shorter time to driving cessation. After adjusting for multiple comparisons, there was a statistically significant difference in time to driving cessation between CDR 0 and CDR 0.5 (p<.0001) participants, between CDR 0 and CDR 1 (p<.0001) participants, and between CDR 0.5 and CDR 1 (p1⁄40.005) participants. In the Cox proportional hazards model testing the effect of tau/Ab42, only the effect of the biomarker ratio (HR1⁄42.04; 95% CI1⁄41.28-3.22; p<0.003), age (HR1⁄41.08; 95% CI1⁄41.04-1.11; p<.0001), and CDR (CDR 0.5 vs. 0: HR1⁄43.44, 95% CI1⁄42.10-5.63; CDR 1 vs. 0: HR1⁄45.80, 95% CI1⁄42.59-12.99; p<0.001) had a significant effect on driving cessation. Similar results were found when testing the effects of ptau/Ab42. Conclusions:While preclinical AD does not appear to have a measurable cognitive impact, it is not benign, as it seems to have an impact on complex activities like driving. Higher levels of AD biomarkers, including in preclinical AD, and higher CDR scores, lead to earlier driving cessation. Negative functional outcomes of preclinical AD show a non-benign phase of the disease.

Poster 272 Postpolio Syndrome: Impact of Hope on Quality of Life

different but good life. After about a year, they had a sense of control, had accepted life with PPS, had established new habits and taken on a changed valued self, and thereby could look at their future with confidence. Conclusions: Individuals with PPS can experience improved participation and autonomy after a comprehensive interdisciplinary rehabilitation program, and those with a more pronounced disability at admission seem to benefit most from the rehabilitation program with regard to self-perceived participation restrictions. Overall, the program leads to positive changes in the management of daily activities and in the individuals’ view of their PPS and disability, their future and their self.