ORCID Profile
0000-0003-3929-9778
Current Organisation
Nanyang Technological University
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Publisher: Wiley
Date: 27-09-2021
DOI: 10.1111/EJN.15467
Abstract: Neuroplasticity underpins motor learning, with abnormal neuroplasticity related to age‐associated motor declines. Bilateral transfer of motor learning, through rehabilitation, may mitigate these declines however, the magnitude of transfer may be reduced in older populations. This study investigated excitatory and inhibitory pathways in the trained and untrained hemispheres following unilateral training of a complex finger‐tapping task across ageing. Fifteen young (26.2 ± 3.8 years) and 11 older adults (63.7 ± 15.4 years) received transcranial magnetic stimulation, although surface electromyography was recorded from the extensor digitorum communis (EDC) and abductor pollicis brevis (APB), before and after practicing a complex finger‐tapping task with the dominant hand. Excitability, inhibition (expressed as percent change scores from pre‐ to post‐training), motor task performance and bilateral transfer were assessed between groups. Investigation of hemispheric differences within each group was completed for measures that significantly differed between groups. There were no between‐group differences in task performance or bilateral transfer, with task performance improving post‐training irrespective of group for both hands ( p 0.05). Pre‐ to post‐inhibition change scores of the untrained EDC muscle increased ( p = 0.034) in older compared with younger adults, indicating reduced inhibition in older adults. Inhibition change scores significantly differed between hemispheres for the young group only ( p = 0.037). Only the younger group presented with hemispheric lateralisation, providing some support for the Hemispheric Asymmetry Reduction in OLDer adults (HAROLD) hypothesis. Whether this reduction is evidence of de‐differentiation or compensation will need to be confirmed with additional measures.
Publisher: Wiley
Date: 07-08-2015
DOI: 10.1111/BIRT.12182
Abstract: Across Australia there are substantial disparities in uptake of antenatal testing for fetal anomalies, with very low uptake observed among Aboriginal women. The reasons behind these disparities are unclear, although poorer access to testing has been reported in some communities. We interviewed health care practitioners to explore the perceived barriers to providing fetal anomaly screening to Aboriginal women. In 2009 and 2010, in-depth interviews were undertaken with 59 practitioners in five urban and remote sites across the Northern Territory (NT) of Australia. Data were analyzed thematically. Maximum variation s ling, independent review of findings by multiple analysts, and participant feedback were undertaken to strengthen the validity of findings. Participants included midwives (47%), Aboriginal health practitioners (AHP) (32%), general practitioners (12%), and obstetricians (9%) almost all (95%) were female. Participants consistently reported difficulties counseling women. Explaining the concept of "risk" (of abnormalities and the screening test result) was identified as particularly challenging, because of a perceived lack of an equivalent concept in Aboriginal languages. While AHPs could assist with overcoming language barriers, they are underutilized. Participants also identified impediments to organizing testing including difficulties establishing gestational age, late presentation for care, and a lack of standardized information and training. The availability of fetal anomaly testing is challenged by communication difficulties, including a focus on culturally specific biomedical concepts, and organizational barriers to arranging testing. Developing educational activities that address the technical aspects of screening and communication skills will assist in improving access. These activities must include AHPs.
Publisher: MDPI AG
Date: 26-04-2019
Abstract: Previous research showed that children’s physical activity is positively related to executive functions, whilst screen time shows negative associations. However, it is unclear how school-based sitting time and transitions from sitting to standing relate to cognition. We investigated the relationship between class time sitting/stepping/sit-to-stand transitions and cognitive functions in Grade 1–2 children. Overall, 149 children (7.7 ± 0.6 years old, 54% boys) participated. Measures included class time sitting/stepping/sit-to-stand transitions and: (i) response inhibition (i.e., response time and accuracy) (ii) lapses of attention (iii) working memory and (iv) brain activity (cortical haemodynamic response). Linear mixed-models, adjusting for age, sex, and clustering at the classroom level, found that more sitting time was associated with higher lapses of attention (β = 0.12, p 0.05). Children who stepped more had quicker inhibition response time (β = −0.95, p 0.01) however, they were less accurate in their responses (β = −0.30, p 0.05) and this was also observed with sit-to-stand transitions (β = −0.26, p 0.05). No associations were found with brain activity. In conclusion, reducing and breaking up sitting may help keep children focused, but the evidence regarding response inhibition is unclear.
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.NEUROSCIENCE.2012.06.048
Abstract: The performance of a repetitive index finger flexion-extension task at maximal voluntary rate (MVR) begins to decline just a few seconds into the task and we have previously postulated that this breakdown has a central origin. To test this hypothesis, we have combined two objectives to determine whether motor practice can lessen the performance deterioration in an MVR task, and whether further gains can be achieved with a transcranial magnetic stimulation (TMS) protocol that increases corticomotor excitability (CME). Eleven right-handed subjects participated in a randomized crossover study design that consisted of a 15-min interventional TMS at I-wave periodicity (ITMS) and single-pulsed Sham intervention prior to six 10-s practice sets of a repetitive finger flexion-extension task at MVR. Motor-evoked potentials (MEPs) were recorded from the first dorsal interosseous muscle. The starting movement rate, and the percentage decline in rate by the end of the MVR were quantitated. Training of the MVR task improved the sustainability of the task by reducing the decline in movement rate. CME increased steadily after each training bout, and this increase was maintained up to 20 min after the last bout. ITMS further increased CME, and was associated with an increase in both the starting rate of the MVR task and its sustainability, when compared to Sham. The results implicate central motor processes in the performance and sustainability of the MVR task, and indicate that MVR kinematics can improve with short-term training and with non-invasive neuro-modulation.
Publisher: Walter de Gruyter GmbH
Date: 23-09-2022
DOI: 10.1515/REVNEURO-2022-0073
Abstract: Current literature lacks consolidated evidence for the impact of stimulation parameters on the effects of transcranial direct current stimulation (tDCS) in enhancing upper limb motor learning. Hence, we aim to synthesise available methodologies and results to guide future research on the usage of tDCS on upper limb motor learning, specifically in older adults and Parkinson’s disease (PD). Thirty-two studies (Healthy older adults, N = 526, M = 67.25, SD = 4.30 years PD, N = 216, M = 66.62, SD = 6.25 years) were included in the meta-analysis. All included studies consisted of active and sham protocols. Random effect meta-analyses were conducted for (i) subjects (healthy older adults and PD) (ii) intensity (1.0, 1.5, 2 mA) (iii) electrode montage (unilateral anodal, bilateral anodal, unilateral cathodal) (iv) stimulation site (cerebellum, frontal, motor, premotor, SMA, somatosensory) (v) protocol (online, offline). Significant tDCS effect on motor learning was reported for both populations, intensity 1.0 and 2.0 mA, unilateral anodal and cathodal stimulation, stimulation site of the motor and premotor cortex, and both online and offline protocols. Regression showed no significant relationship between tDCS effects and density. The efficacy of tDCS is also not affected by the number of sessions. However, studies that reported only single session tDCS found significant negative association between duration with motor learning outcomes. Our findings suggest that different stimulation parameters enhanced upper limb motor learning in older adults and PD. Future research should combine tDCS with neuroimaging techniques to help with optimisation of the stimulation parameters, considering the type of task and population.
Publisher: CRC Press
Date: 29-05-2015
DOI: 10.1201/B18563-16
Publisher: Springer Science and Business Media LLC
Date: 11-2017
DOI: 10.1038/S41598-017-13260-Z
Abstract: Parkinson's disease (PD) is a neurodegenerative disorder affecting motor and cognitive abilities. There is no cure for PD, therefore identifying safe therapies to alleviate symptoms remains a priority. This meta-analysis quantified the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and transcranial electrical stimulation (TES) to improve motor and cognitive dysfunction in PD. PubMed, EMBASE, Web of Science, Google Scholar, Scopus, Library of Congress and Cochrane library were searched. 24 rTMS and 9 TES studies ( n = 33) with a sham control group were included for analyses. The Physiotherapy Evidence Database and Cochrane Risk of Bias showed high quality (7.5/10) and low bias with included studies respectively. Our results showed an overall positive effect in favour of rTMS (SMD = 0.394, CI [0.106–0.683], p = 0.007) and TES (SMD = 0.611, CI [0.188–1.035], p = 0.005) compared with sham stimulation on motor function, with no significant differences detected between rTMS and TES (Q [1] = 0.69, p = 0.406). Neither rTMS nor TES improved cognition. No effects for stimulation parameters on motor or cognitive function were observed. To enhance the clinical utility of non-invasive brain stimulation (NBS), in idual prescription of stimulation parameters based upon symptomology and resting excitability state should be a priority of future research.
Publisher: Frontiers Media SA
Date: 03-2016
Publisher: JMIR Publications Inc.
Date: 20-10-2022
Abstract: nderstanding older people’s health-seeking behavior (HSB) is crucial for uncovering their health needs and priorities and developing appropriate policies to address them and avert their disease progression. Technologies play an active role in our daily lives and have been incorporated into health activities to support the older population and facilitate their HSB. However, previous studies of HSB have mainly focused on behaviors during illness, and there are limited studies on how technologies have been used in older people’s health-seeking activities. his study aimed to investigate HSB and the associated technology use among the older population, ultimately proposing implications for practice to address their unmet health needs. his paper presents partial data from a large qualitative study, which has been approved by the institutional review board and used a phenomenological approach. Semistructured interviews were conducted between April 2022 and July 2022, either via Zoom (Zoom Video Communications Inc) or face-to-face sessions. Inclusion criteria were being aged ≥50 years, long-term residence in Singapore, and being able to speak English or Mandarin. The interviews were manually transcribed verbatim, and thematic analysis was performed, with the in idual as the unit of analysis to understand the patterns of behaviors. n total, 15 interviews were conducted to reach thematic saturation. We identified 5 main consequences of HSB, which were aligned with the original HSB model. Regarding technology use in health seeking, 4 themes were extracted: the most widely used digital technologies are the mobile health apps and wearable devices with the associated wellness programs launched by the government and local companies, and they have the potential to enhance health communication, promote health maintenance, and increase access to health services information communication technologies and social media, though not primarily designed for health purposes, play a substantial role in easing the process of seeking health information and managing symptoms. Although the outbreak of the COVID-19 pandemic has resulted in some alterations to older adults’ well-being, it has catalyzed the adoption of telehealth as a complement to access health care services, and older adults have different considerations when selecting technologies to facilitate their health seeking and fulfill their health needs. Moreover, 4 archetypes were proposed based on our findings and the insights gained from our participants’ observations in their social networks. These findings led to several implications for practice regarding health communication and promotion, health education, technology design and improvement, telemonitoring service implementation, and solutions to address the needs of each proposed archetype. nlike the commonly held belief that older adults resist technologies and lack technological proficiency, our findings showed that technologies could play a promising role in facilitating older adults’ health seeking. Our findings have implications for the design and implementation of health services and policies.
Publisher: IEEE
Date: 07-2013
Publisher: Elsevier BV
Date: 07-2019
Publisher: Springer Science and Business Media LLC
Date: 16-07-2018
Publisher: Elsevier BV
Date: 03-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2015
Publisher: Informa UK Limited
Date: 18-11-2021
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.GAITPOST.2015.03.346
Abstract: Postural instability is a major source of disability in idiopathic Parkinson's disease (IPD). Deep brain stimulation of the globus pallidus internus (GPI-DBS) improves clinician-rated balance control but there have been few quantitative studies of its interactive effects with levodopa (L-DOPA). The purpose of this study was to compare the short-term and interactive effects of GPI-DBS and L-DOPA on objective measures of postural stability in patients with longstanding IPD. Static and dynamic posturography during a whole-body leaning task were performed in 10 IPD patients with bilateral GPI stimulators under the following conditions: untreated (OFF) L-DOPA alone DBS alone DBS+L-DOPA, and in 9 healthy Control subjects. Clinical status was assessed using the UPDRS and AIMS Dyskinesia Scale. Static sway was greater in IPD patients in the OFF state compared to the Control subjects and was further increased by L-DOPA and reduced by GPI-DBS. In the dynamic task, L-DOPA had a greater effect than GPI-DBS on improving Start Time, but reduced the spatial accuracy and directional control of the task. When the two therapies were combined, GPI-DBS prevented the L-DOPA induced increase in static sway and improved the accuracy of the dynamic task. The findings demonstrate GPI-DBS and L-DOPA have differential effects on temporal and spatial aspects of postural control in IPD and that GPI-DBS counteracts some of the adverse effects of L-DOPA. Further studies on larger numbers of patients with GPI stimulators are required to confirm these findings and to clarify the contribution of dyskinesias to impaired dynamic postural control.
Publisher: JMIR Publications Inc.
Date: 04-05-2023
DOI: 10.2196/43709
Abstract: Understanding older people’s health-seeking behavior (HSB) is crucial for uncovering their health needs and priorities and developing appropriate policies to address them and avert their disease progression. Technologies play an active role in our daily lives and have been incorporated into health activities to support the older population and facilitate their HSB. However, previous studies of HSB have mainly focused on behaviors during illness, and there are limited studies on how technologies have been used in older people’s health-seeking activities. This study aimed to investigate HSB and the associated technology use among the older population, ultimately proposing implications for practice to address their unmet health needs. This paper presents partial data from a large qualitative study, which has been approved by the institutional review board and used a phenomenological approach. Semistructured interviews were conducted between April 2022 and July 2022, either via Zoom (Zoom Video Communications Inc) or face-to-face sessions. Inclusion criteria were being aged ≥50 years, long-term residence in Singapore, and being able to speak English or Mandarin. The interviews were manually transcribed verbatim, and thematic analysis was performed, with the in idual as the unit of analysis to understand the patterns of behaviors. In total, 15 interviews were conducted to reach thematic saturation. We identified 5 main consequences of HSB, which were aligned with the original HSB model. Regarding technology use in health seeking, 4 themes were extracted: the most widely used digital technologies are the mobile health apps and wearable devices with the associated wellness programs launched by the government and local companies, and they have the potential to enhance health communication, promote health maintenance, and increase access to health services information communication technologies and social media, though not primarily designed for health purposes, play a substantial role in easing the process of seeking health information and managing symptoms. Although the outbreak of the COVID-19 pandemic has resulted in some alterations to older adults’ well-being, it has catalyzed the adoption of telehealth as a complement to access health care services, and older adults have different considerations when selecting technologies to facilitate their health seeking and fulfill their health needs. Moreover, 4 archetypes were proposed based on our findings and the insights gained from our participants’ observations in their social networks. These findings led to several implications for practice regarding health communication and promotion, health education, technology design and improvement, telemonitoring service implementation, and solutions to address the needs of each proposed archetype. Unlike the commonly held belief that older adults resist technologies and lack technological proficiency, our findings showed that technologies could play a promising role in facilitating older adults’ health seeking. Our findings have implications for the design and implementation of health services and policies.
Publisher: Informa UK Limited
Date: 16-09-2019
DOI: 10.1080/02640414.2019.1661561
Abstract: This study investigated effects of total sleep deprivation on self-paced endurance performance, and heart rate (HR) indices of athletes' "readiness to perform". Endurance athletes (n = 13) completed a crossover experiment comprising a normal sleep (NS) and sleep deprivation (SD) condition. Each required completion of an endurance time-trial (TT) on consecutive days (D1, D2) separated by normal sleep or total sleep deprivation. Finishing time, perceived exertion (RPE), mood, psychomotor vigilance (PVT), and HR responses were assessed. Time on D2 of SD was 10% slower than D2 of NS (64 ± 7 vs 59 ± 4 min, P < 0.01), and 11% slower than D1 of SD (58 ± 5 min, P < 0.01). Subjective to objective (RPE:mean HR) intensity ratio was higher on D2 of SD compared with D2 of NS and D1 of SD (P < 0.01). Mood disturbance and PVT mean response time increased on D2 of SD compared with D2 of NS and D1 of SD. Anaerobic threshold and change in TT time were correlated (R = -0.73, P < 0.01). Sleep helps to optimise endurance performance. Subjective to objective intensity ratios appear sensitive to effects of sleep on athletes' readiness. Research examining more subtle sleep manipulation is required.
Publisher: Springer Science and Business Media LLC
Date: 29-10-2012
DOI: 10.1007/S00221-011-2906-6
Abstract: Transcranial magnetic stimulation has been used to study changes in central excitability associated with motor tasks. Recently, we reported that a finger flexion-extension task performed at a maximal voluntary rate (MVR) could not be sustained and that this was not due to muscle fatigue, but was more likely a breakdown in central motor control. To determine the central changes that accompany this type of movement task, we tracked motor-evoked potential (MEP) litude from the first dorsal interosseous (FDI) and abductor pollicis brevis (APB) muscles of the dominant hand in normal subjects for 20 min after a 10 sec index finger flexion-extension task performed at MVR and at a moderate sustainable rate (MSR) and half the MSR (MSR(/2)). The FDI MEP litude was reduced for up to 6-8 min after each of the tasks but there was a greater and longer-lasting reduction after the MSR and MSR(/2) tasks compared to the MVR task. There was a similar reduction in the litude of the FDI MEP after a 10 sec cyclic index finger abduction-adduction task when the FDI was acting as the prime mover. The litude of the MEP recorded from the inactive APB was also reduced after the flexion-extension tasks, but to a lesser degree and for a shorter duration. Measurements of short-interval cortical inhibition revealed an increase in inhibition after all of the finger flexion-extension tasks, with the MSR task being associated with the greatest degree of inhibition. These findings indicate that a demanding MVR finger movement task is followed by a period of reduced corticomotor excitability and increased intracortical inhibition. However, these changes also occur with and are greater with slower rates of movement and are not specific for motor demand, but may be indicative of adaptive changes in the central motor pathway after a period of repetitive movement.
Publisher: BMJ
Date: 2018
Publisher: Wiley
Date: 17-03-2020
DOI: 10.1002/BRB3.1578
Publisher: Wiley
Date: 12-01-2014
DOI: 10.1016/J.PMRJ.2014.01.006
Abstract: In the past 3 decades, interest has increased in brain-computer interface (BCI) technology as a tool for assisting, augmenting, and rehabilitating sensorimotor functions in clinical populations. Initially designed as an assistive device for partial or total body impairments, BCI systems have since been explored as a possible adjuvant therapy in the rehabilitation of patients who have had a stroke. In particular, BCI systems incorporating a robotic manipulanda to passively manipulate affected limbs have been studied. These systems can use a range of invasive (ie, intracranial implanted electrodes) or noninvasive neurophysiologic recording techniques (ie, electroencephalography [EEG], near-infrared spectroscopy, and magnetoencephalography) to establish communication links between the brain and the BCI system. Trials are most commonly performed on EEG-based BCI in comparison with the other techniques because of its high temporal resolution, relatively low setup costs, portability, and noninvasive nature. EEG-based BCI detects event-related desynchronization/synchronization in sensorimotor oscillatory rhythms associated with motor imagery (MI), which in turn drives the BCI. Previous evidence suggests that the process of MI preferentially activates sensorimotor regions similar to actual task performance and that repeated practice of MI can induce plasticity changes in the brain. It is therefore postulated that the combination of MI and BCI may augment rehabilitation gains in patients who have had a stroke by activating corticomotor networks via MI and providing sensory feedback from the affected limb using end-effector robots. In this review we examine the current literature surrounding the feasibility of EEG-based MI-BCI systems in stroke rehabilitation. We also discuss the limitations of using EEG-based MI-BCI in patients who have had a stroke and suggest possible solutions to overcome these limitations.
Publisher: Springer Science and Business Media LLC
Date: 02-10-2018
DOI: 10.1038/S41598-018-32924-Y
Abstract: Evidence from small-scale studies indicates that impairments in postural stability are an early and disabling feature of Huntington’s disease (HD) and may be a useful clinical endpoint for disease modifying trials. Larger studies are needed to confirm these preliminary findings and the suitability of postural stability outcomes as clinical endpoints. Static and dynamic postural stability were evaluated in 54 premanifest HD, 36 manifest HD and 45 healthy in iduals using the Sensory Organization Test (SOT) and Limits of Stability (LOS) test. Manifest HD displayed significantly lower scores on all SOT conditions and on the SOT composite score and had more falls than healthy and premanifest HD (p 0.05). Premanifest and manifest HD demonstrated significantly lower endpoint excursion (p 0.001), maximum excursion (p ≤ 0.001), and directional control (p ≤ 0.004) values than healthy in iduals on the LOS test. Deficits in LOS were found to manifest on the left side of premanifest HD. Significant but low associations were observed between UHDRS-TMS, disease burden score, diagnostic confidence level, SOT conditions and SOT composite score. We confirm here that in iduals with premanifest and manifest HD display significant impairments in static and dynamic postural stability. Dynamic posturography assessments should be considered as clinical endpoints for future disease modifying trials.
Publisher: Wiley
Date: 17-01-2023
DOI: 10.1111/EJN.15897
Abstract: Cross‐education is the phenomenon where training of one limb can cause neuromuscular adaptations in the opposite untrained limb. This effect has been reported to be greater after eccentric (ECC) than concentric (CON) strength training however, the underpinning neurophysiological mechanisms remain unclear. Thus, we compared responses to transcranial magnetic stimulation (TMS) in both motor cortices following single sessions of unilateral ECC and CON exercise of the elbow flexors. Fourteen healthy adults performed three sets of 10 ECC and CON right elbow flexor contractions at 75% of respective maximum on separate days. Elbow flexor maximal voluntary isometric contraction (MVIC) torques were measured before and after exercise, and responses to single‐ and paired‐pulse TMS were recorded from the non‐exercised left and exercised right biceps brachii. Pre‐exercise and post‐exercise responses for ECC and CON were compared by repeated measures analyses of variance (ANOVAs). MVIC torque of the exercised arm decreased ( p 0.01) after CON (−30 ± 14%) and ECC (−39 ± 13%) similarly. For the non‐exercised left biceps brachii, resting motor threshold (RMT) decreased after CON only (−4.2 ± 3.9% of maximum stimulator output [MSO], p 0.01), and intracortical facilitation (ICF) decreased (−15.2 ± 20.0%, p = 0.038) after ECC only. For the exercised right biceps, RMT increased after ECC (8.6 ± 6.2% MSO, p = 0.014) but not after CON (6.4 ± 8.1% MSO, p = 0.066). Thus, unilateral ECC and CON elbow flexor exercise modulated excitability differently for the non‐exercised hemisphere. These findings suggest that responses after a single bout of exercise may not reflect longer term adaptations.
Publisher: Frontiers Media SA
Date: 06-10-2016
Publisher: Springer Science and Business Media LLC
Date: 18-05-2013
DOI: 10.1007/S00221-013-3491-7
Abstract: Repetitive finger tapping is a well-established clinical test for the evaluation of parkinsonian bradykinesia, but few studies have investigated other finger movement modalities. We compared the kinematic changes (movement rate and litude) and response to levodopa during a conventional index finger-thumb-tapping task and an unconstrained index finger flexion-extension task performed at maximal voluntary rate (MVR) for 20 s in 11 in iduals with levodopa-responsive Parkinson's disease (OFF and ON) and 10 healthy age-matched controls. Between-task comparisons showed that for all conditions, the initial movement rate was greater for the unconstrained flexion-extension task than the tapping task. Movement rate in the OFF state was slower than in controls for both tasks and normalized in the ON state. The movement litude was also reduced for both tasks in OFF and increased in the ON state but did not reach control levels. The rate and litude of movement declined significantly for both tasks under all conditions (OFF/ON and controls). The time course of rate decline was comparable for both tasks and was similar in OFF/ON and controls, whereas the tapping task was associated with a greater decline in MA, both in controls and ON, but not OFF. The findings indicate that both finger movement tasks show similar kinematic changes during a 20-s sustained MVR, but that movement litude is less well sustained during the tapping task than the unconstrained finger movement task. Both movement rate and litude improved with levodopa however, movement rate was more levodopa responsive than litude.
Publisher: Informa UK Limited
Date: 26-07-2023
Publisher: JMIR Publications Inc.
Date: 18-04-2023
DOI: 10.2196/40460
Abstract: Aging is becoming a major global challenge. Compared with younger adults, the older population has greater health needs but faces inadequate access to appropriate, affordable, and high-quality health care. Telehealth can remove geographic and time boundaries, as well as enabling socially isolated and physically homebound people to access a wider range of care options. The impacts of different telehealth interventions in terms of their effectiveness, cost, and acceptability in aging care are still unclear. This scoping review of systematic reviews aimed to provide an overview of the domains of telehealth implemented in aging care synthesize evidence of telehealth’s feasibility, effectiveness, cost benefits, and acceptability in the context of aging care identify gaps in the literature and determine the priorities for future research. Guided by the methodological framework of the Joanna Briggs Institute, we reviewed systematic reviews concerning all types of telehealth interventions involving direct communication between older users and health care providers. In total, 5 major electronic databases, PubMed, Embase (Ovid), Cochrane Library, CINAHL, and PsycINFO (EBSCO), were searched on September 16, 2021, and an updated search was performed on April 28, 2022, across the same databases as well as the first 10 pages of the Google search. A total of 29 systematic reviews, including 1 post hoc subanalysis of a previously published large Cochrane systematic review with meta-analysis, were included. Telehealth has been adopted in various domains in aging care, such as cardiovascular diseases, mental health, cognitive impairment, prefrailty and frailty, chronic diseases, and oral health, and it seems to be a promising, feasible, effective, cost-effective, and acceptable alternative to usual care in selected domains. However, it should be noted that the generalizability of the results might be limited, and further studies with larger s le sizes, more rigorous designs, adequate reporting, and more consistently defined outcomes and methodologies are needed. The factors affecting telehealth use among older adults have been categorized into in idual, interpersonal, technological, system, and policy levels, which could help direct collaborative efforts toward improving the security, accessibility, and affordability of telehealth as well as better prepare the older population for digital inclusion. Although telehealth remains in its infancy and there is a lack of high-quality studies to rigorously prove the feasibility, effectiveness, cost benefit, and acceptability of telehealth, mounting evidence has indicated that it could play a promising complementary role in the care of the aging population.
Publisher: JCDR Research and Publications
Date: 2014
Publisher: Springer Science and Business Media LLC
Date: 21-08-2021
DOI: 10.1007/S40279-021-01535-5
Abstract: Resistance exercise is used extensively in athletic and general populations to induce neuromuscular adaptations to increase muscle size and performance. Exercise parameters such as exercise frequency, intensity, duration and modality are carefully manipulated to induce specific adaptations to the neuromuscular system. While the benefits of resistance exercise on the neuromuscular system are well documented, there is growing evidence to suggest that resistance exercise, even when performed acutely, can lead to neuroplastic changes within the central nervous system (CNS) and improve cognitive functioning. As such, resistance exercise has been proposed as a novel adjuvant rehabilitation strategy in populations that suffer from neurological or neurocognitive impairments (i.e. Parkinson's and Alzheimer's dementia) or even to attenuate age-related declines in cognitive health. In this review, we present evidence for the neuroplastic effects and cognitive benefits of resistance exercise and propose some of the underlying mechanisms that drive neuroplasticity following resistance training. We will further discuss the effects of exercise parameters, in particular exercise frequency, intensity, duration and modality to improve cognitive health. Lastly, we will highlight some of the existing limitations in the literature surrounding the use of resistance exercise to improve cognitive function and propose considerations to improve future studies in this field. In summary, the current evidence supports the role of resistance exercise, as a stand alone or in combination with aerobic exercise, for benefiting cognitive health and that it should be considered as an adjuvant therapy to treat age- or disease-related cognitive declines.
Publisher: Wiley
Date: 03-12-2019
DOI: 10.1111/SMS.13334
Abstract: Differences in the neural mechanisms underpinning eccentric (ECC) and concentric (CON) contractions exist however, the acute effects of fatiguing muscle contractions on intracortical and corticospinal excitability are not well understood. Therefore, we compared maximal ECC and CON contractions of the right biceps brachii (BB) muscle for changes in corticospinal excitability, short- (SICI) and long-interval intracortical inhibition (LICI) and intracortical facilitation (ICF) up to 1 hour post-exercise. Fourteen right-handed adults (11 M/3F 26.8 ± 2.9 year) undertook a single session of 3 sets of 10 maximal ECC or CON contractions (180-second rest between sets) on an isokinetic dynamometer (40°/s) separated by 1 week, in a randomized crossover study. Maximum voluntary isometric contraction torque (MVIC), maximal muscle compound waves (M
Publisher: MDPI AG
Date: 22-12-2022
Abstract: This systematic review investigated the effects of high-intensity exercise (HIE) on lower limb (LL) function in acute and subacute stroke patients. A systematic electronic search was performed in PubMed, CINAHL and the Web of Science from inception to 30 June 2022. Outcomes examined included LL function and measures of activities of daily living such as the Barthel index, 6 min walk test (6MWT), gait speed and Berg balance scale (BBS), adverse events and safety outcomes. The methodological quality and the quality of evidence for each study was assessed using the PEDro scale and the Risk of Bias 2 tool (RoB 2). HIE was defined as achieving at least 60% of the heart rate reserve (HRR) or VO2 peak, 70% of maximal heart rate (HRmax), or attaining a score of 14 or more on the rate of perceived exertion Borg scale (6–20 rating scale). This study included randomized controlled trials (RCTs) which compared an intervention group of HIE to a control group of lower intensity exercise, or no intervention. All participants were in the acute (0–3 months) and subacute (3–6 months) stages of stroke recovery. Studies were excluded if they were not RCTs, included participants from a different stage of stroke recovery, or if the intervention did not meet the pre-defined HIE criteria. Overall, seven studies were included that used either high-intensity treadmill walking, stepping, cycling or overground walking exercises compared to either a low-intensity exercise (n = 4) or passive control condition (n = 3). Three studies reported significant improvements in 6MWT and gait speed performance, while only one showed improved BBS scores. No major adverse events were reported, although minor incidents were reported in only one study. This systematic review showed that HIE improved LL functional task performance, namely the 6MWT and gait speed. Previously, there was limited research demonstrating the efficacy of HIE early after stroke. This systematic review provides evidence that HIE may improve LL function with no significant adverse events report for stroke patients in their acute and subacute rehabilitation stages. Hence, HIE should be considered for implementation in this population, taking into account the possible benefits in terms of functional outcomes, as compared to lower intensity interventions.
Publisher: Springer Science and Business Media LLC
Date: 19-07-2016
Publisher: Elsevier BV
Date: 07-2020
Publisher: Informa UK Limited
Date: 08-2023
Publisher: Elsevier BV
Date: 06-2023
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.CLINPH.2013.09.004
Abstract: In healthy subjects, fatiguing exercises induce a period of post-exercise corticomotor depression (PECD) that is absent in Parkinson's disease (PD). Our objective is to determine the time-course of corticomotor excitability changes following a 10-s repetitive index finger flexion-extension task performed at maximal voluntary rate (MVR) and a slower sustainable rate (MSR) in PD patients OFF and ON levodopa. In 11 PD patients and 10 healthy age-matched controls, motor evoked potentials (MEPs) were recorded from the extensor indicis proprius (EIP) and first dorsal interosseous (FDI) muscles of the dominant arm immediately after the two tasks and at 2-min intervals for 10 min. In the OFF condition the PECD was absent in the two test muscles after both the MVR and MSR tasks. In the ON condition finger movement kinematics improved and a period of PECD comparable to that in controls was present after both tasks. The absence of PECD in PD subjects off medication indicates a persisting increase in corticomotor excitability after non-fatiguing repetitive finger movement that is reversed by levodopa. Dopamine depletion is associated with impaired modulation of corticomotor excitability after non-fatiguing repetitive finger movement.
Publisher: Informa UK Limited
Date: 17-08-2023
Publisher: Springer Science and Business Media LLC
Date: 23-08-2017
DOI: 10.1038/S41598-017-08928-5
Abstract: Brain-computer interface-assisted motor imagery (MI-BCI) or transcranial direct current stimulation (tDCS) has been used in stroke rehabilitation, though their combinatory effect is unknown. We investigated brain plasticity following a combined MI-BCI and tDCS intervention in chronic subcortical stroke patients with unilateral upper limb disability. Nineteen patients were randomized into tDCS and sham-tDCS groups. Diffusion and perfusion MRI, and transcranial magnetic stimulation were used to study structural connectivity, cerebral blood flow (CBF), and corticospinal excitability, respectively, before and 4 weeks after the 2-week intervention. After quality control, thirteen subjects were included in the CBF analysis. Eleven healthy controls underwent 2 sessions of MRI for reproducibility study. Whereas motor performance showed comparable improvement, long-lasting neuroplasticity can only be detected in the tDCS group, where white matter integrity in the ipsilesional corticospinal tract and bilateral corpus callosum was increased but sensorimotor CBF was decreased, particularly in the ipsilesional side. CBF change in the bilateral parietal cortices also correlated with motor function improvement, consistent with the increased white matter integrity in the corpus callosum connecting these regions, suggesting an involvement of interhemispheric interaction. The preliminary results indicate that tDCS may facilitate neuroplasticity and suggest the potential for refining rehabilitation strategies for stroke patients.
Publisher: Wiley
Date: 15-03-2021
DOI: 10.1111/JIR.12826
Abstract: Classroom‐based active breaks can help typically developing children reduce sitting, increase physical activity and improve cognitive functions and on‐task behaviour. Yet, this strategy has not been tested in children with intellectual disability (ID) – a population who are insufficiently active. This study aimed to investigate the effects of a 5‐week active breaks intervention on cognitive functions and on‐task behaviour in schoolchildren with ID. Twenty‐four children, aged between 8 and 12 years (37.5% girls), were recruited. Children's cognitive functions (response inhibition, lapses of attention, interference and working memory) were measured at baseline and end of trial using computer‐based tests. Sitting, standing and movement patterns were assessed with inclinometers, and on‐task behaviour was directly observed in the classroom before and after active breaks, at baseline, mid‐trial and end of trial. Linear mixed models were used to investigate the intervention effects on cognitive functions and sedentary patterns generalised linear mixed models were used to analyse on‐task behaviour data. A significant time × group interaction was found for working memory favouring the intervention ( B = 11.56, 95% confidence interval [1.92, 21.21]). No significant effects were found in relation to the other measures of children's cognition or on‐task behaviour. Stepping time and bouts of sitting were positively affected. Classroom‐based active breaks can increase physical activity and reduce sedentary behaviour in children with ID and might also benefit their working memory. Further research is required to clarify the effects on cognition and to investigate whether this strategy has other benefits in this population.
Publisher: Wiley
Date: 19-09-2018
DOI: 10.1002/BRB3.1109
Publisher: JMIR Publications Inc.
Date: 21-06-2022
Abstract: ging is becoming a major global challenge. Compared with younger adults, the older population has greater health needs but faces inadequate access to appropriate, affordable, and high-quality health care. Telehealth can remove geographic and time boundaries, as well as enabling socially isolated and physically homebound people to access a wider range of care options. The impacts of different telehealth interventions in terms of their effectiveness, cost, and acceptability in aging care are still unclear. his scoping review of systematic reviews aimed to provide an overview of the domains of telehealth implemented in aging care synthesize evidence of telehealth’s feasibility, effectiveness, cost benefits, and acceptability in the context of aging care identify gaps in the literature and determine the priorities for future research. uided by the methodological framework of the Joanna Briggs Institute, we reviewed systematic reviews concerning all types of telehealth interventions involving direct communication between older users and health care providers. In total, 5 major electronic databases, PubMed, Embase (Ovid), Cochrane Library, CINAHL, and PsycINFO (EBSCO), were searched on September 16, 2021, and an updated search was performed on April 28, 2022, across the same databases as well as the first 10 pages of the Google search. total of 29 systematic reviews, including 1 post hoc subanalysis of a previously published large Cochrane systematic review with meta-analysis, were included. Telehealth has been adopted in various domains in aging care, such as cardiovascular diseases, mental health, cognitive impairment, prefrailty and frailty, chronic diseases, and oral health, and it seems to be a promising, feasible, effective, cost-effective, and acceptable alternative to usual care in selected domains. However, it should be noted that the generalizability of the results might be limited, and further studies with larger s le sizes, more rigorous designs, adequate reporting, and more consistently defined outcomes and methodologies are needed. The factors affecting telehealth use among older adults have been categorized into in idual, interpersonal, technological, system, and policy levels, which could help direct collaborative efforts toward improving the security, accessibility, and affordability of telehealth as well as better prepare the older population for digital inclusion. lthough telehealth remains in its infancy and there is a lack of high-quality studies to rigorously prove the feasibility, effectiveness, cost benefit, and acceptability of telehealth, mounting evidence has indicated that it could play a promising complementary role in the care of the aging population.
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.NEUROSCIENCE.2012.03.021
Abstract: Previous studies on handedness have often reported functional asymmetries in corticomotor excitability (CME) associated with voluntary movement. Recently, we have shown that the degree of post-exercise corticomotor depression (PED) and increase in short-interval cortical inhibition (SICI) after a repetitive finger movement task was less when the task was performed at a maximal voluntary rate (MVR) than when it was performed at a submaximal sustainable rate (SR). In the current study, we have compared the time course of PED and SICI in the dominant (DOM) and nondominant (NDOM) hands after an MVR and SR finger movement task to determine the influence of hand dominance and task demand. We tracked motor-evoked potential (MEP) litude from the first dorsal interosseous muscle of the DOM and NDOM hand for 20 min after a 10-s index finger flexion-extension task at MVR and SR. For all hand-task combinations, we report a period of PED and increased SICI lasting for up to 8 min. We find that the least demanding task, one that involved index finger movement of the DOM hand at SR, was associated with the greatest change in PED and SICI from baseline (63.6±5.7% and 79±2%, P<0.001, PED and SICI, respectively), whereas the most demanding task (MVR of the NDOM hand) was associated with the least change from baseline (PED: 88.1±3.6%, SICI: 103±2% P<0.001). Our findings indicate that the changes in CME and inhibition associated with repetitive finger movement are influenced both by handedness and the degree of demand of the motor task and are inversely related to task demand, being smallest for an MVR task of the NDOM hand and greatest for an SR task of the DOM hand. The findings provide additional evidence for differences in neuronal processing between the dominant and nondominant hemispheres in motor control.
Publisher: Wiley
Date: 12-10-2021
DOI: 10.1111/EJN.14989
Location: Australia
No related grants have been discovered for Wei-Peng Teo.