1
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Acevedo BP, Dattatri N, Marhenke R. Sensory processing sensitivity, memory and cognitive training with neurofeedback. Behav Brain Res 2023; 452:114601. [PMID: 37499911 DOI: 10.1016/j.bbr.2023.114601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
Sensory processing sensitivity (SPS) is a biological trait associated with enhanced awareness of and responsivity to the environment, as well as depth of cognitive processing. However, only a few studies have investigated how contextual factors impact cognition as a function of SPS. Thus, this study examined whether SPS is associated with differential changes in cognitive function resulting from participation in a 4-week app-based cognitive training program with neurofeedback (CT-NF). Participants (M age = 66 years) were randomized to either a treatment (CT-NF) or control group (Tetris). They completed a self-report measure of SPS (the Highly Sensitive Person Scale), and cognitive tests at pre- and post-intervention. Results revealed that individuals with higher levels of SPS in the treatment group showed superior improvements in memory (MEM) and visual memory (VSM), relative to other participants and other measures of cognition. These findings are consistent with theories of SPS and studies showing that enhanced visual perceptiveness and memory are associated with the trait. Moreover, they highlight the cognitive mechanisms that might be especially important for SPS. In conclusion, these findings suggest that those with high SPS may experience enhancements in MEM and VSM, resulting from a 4-week app-based CT-NF program.
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Affiliation(s)
- Bianca P Acevedo
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, USA.
| | - Novia Dattatri
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, USA
| | - Robert Marhenke
- Department of General Psychology, University of Innsbruck, Innsbruck, Austria
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2
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Mark IT, Wren-Jarvis J, Xiao J, Cai LT, Parekh S, Bourla I, Lazerwitz MC, Rowe MA, Marco EJ, Mukherjee P. Neurite orientation dispersion and density imaging of white matter microstructure in sensory processing dysfunction with versus without comorbid ADHD. Front Neurosci 2023; 17:1136424. [PMID: 37492404 PMCID: PMC10363610 DOI: 10.3389/fnins.2023.1136424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/19/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction Sensory Processing Dysfunction (SPD) is common yet understudied, affecting up to one in six children with 40% experiencing co-occurring challenges with attention. The neural architecture of SPD with Attention Deficit and Hyperactivity Disorder (ADHD) (SPD+ADHD) versus SPD without ADHD (SPD-ADHD) has yet to be explored in diffusion tensor imaging (DTI) and Neurite Orientation Dispersion and Density Imaging (NODDI) has yet to be examined. Methods The present study computed DTI and NODDI biophysical model parameter maps of one hundred children with SPD. Global, regional and voxel-level white matter tract measures were analyzed and compared between SPD+ADHD and SPD-ADHD groups. Results SPD+ADHD children had global WM Fractional Anisotropy (FA) and Neurite Density Index (NDI) that trended lower than SPD-ADHD children, primarily in boys only. Data-driven voxelwise and WM tract-based analysis revealed statistically significant decreases of NDI in boys with SPD+ADHD compared to those with SPD-ADHD, primarily in projection tracts of the internal capsule and commissural fibers of the splenium of the corpus callosum. Conclusion We conclude that WM microstructure is more delayed/disrupted in boys with SPD+ADHD compared to SPD-ADHD, with NODDI showing a larger effect than DTI. This may represent the combined WM pathology of SPD and ADHD, or it may result from a greater degree of SPD WM pathology causing the development of ADHD.
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Affiliation(s)
- Ian T. Mark
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, United States
| | - Jamie Wren-Jarvis
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, United States
| | - Jaclyn Xiao
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, United States
| | - Lanya T. Cai
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, United States
| | - Shalin Parekh
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, United States
| | - Ioanna Bourla
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, United States
| | - Maia C. Lazerwitz
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, United States
- Cortica Healthcare, San Rafael, CA, United States
| | - Mikaela A. Rowe
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, United States
- Cortica Healthcare, San Rafael, CA, United States
| | | | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, United States
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3
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Simon AJ, Gallen CL, Ziegler DA, Mishra J, Marco EJ, Anguera JA, Gazzaley A. Quantifying attention span across the lifespan. Front Cognit 2023; 2:1207428. [PMID: 37920687 PMCID: PMC10621754 DOI: 10.3389/fcogn.2023.1207428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Introduction Studies examining sustained attention abilities typically utilize metrics that quantify performance on vigilance tasks, such as response time and response time variability. However, approaches that assess the duration that an individual can maintain their attention over time are lacking. Methods Here we developed an objective attention span metric that quantified the maximum amount of time that a participant continuously maintained an optimal "in the zone" sustained attention state while performing a continuous performance task. Results In a population of 262 individuals aged 7-85, we showed that attention span was longer in young adults than in children and older adults. Furthermore, declines in attention span over time during task engagement were related to clinical symptoms of inattention in children. Discussion These results suggest that quantifying attention span is a unique and meaningful method of assessing sustained attention across the lifespan and in populations with inattention symptoms.
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Affiliation(s)
- Alexander J. Simon
- Neuroscape Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences & Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Courtney L. Gallen
- Neuroscape Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences & Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - David A. Ziegler
- Neuroscape Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences & Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Jyoti Mishra
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Elysa J. Marco
- Department of Neurodevelopmental Medicine, Cortica Healthcare, San Rafael, CA, United States
- Department of Radiology, University of California, San Francisco, San Francisco, CA, United States
| | - Joaquin A. Anguera
- Neuroscape Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences & Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Adam Gazzaley
- Neuroscape Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences & Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
- Department of Physiology, University of California, San Francisco, San Francisco, CA, United States
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4
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Bocci F, Ferrari A, Sarini M. Putting the Gaming Experience at the Center of the Therapy-The Video Game Therapy ® Approach. Healthcare (Basel) 2023; 11:1767. [PMID: 37372884 DOI: 10.3390/healthcare11121767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Video games have been increasingly used as a form of therapy for various mental health conditions. Research has shown that video games can be used to treat conditions such as depression, anxiety, PTSD, and addiction. One of the main benefits of video games in therapy is that they can provide a sense of engagement and immersion that traditional therapy methods may lack. Additionally, video games can teach valuable skills such as problem solving, decision making, and coping strategies. Video games can also simulate real-life scenarios, allowing individuals to practice and improve social skills in a safe and controlled environment. Furthermore, video games can provide feedback and track progress objectively and quantifiably. This paper proposes an approach, the Video Game Therapy® (VGT®) approach, where game experience is put at the center of the therapy in a tailored way, connecting the individual patient's personality, the therapy's goals, and the suggested type of video game through the Myers Briggs Type Indicator (MBTI).VGT®'s core assumption is that playing video games could facilitate patients in reaching conditions where traditional methodologies and therapeutic approaches could work best. VGT® was elaborated according to the Adlerian therapy vision and, consequently, the different phases of Adlerian therapy and VGT® match. Despite the use of video games in psychotherapy might have some adverse effects in specific cases, VGT® is currently used in three associations with positive results in promoting emotional experimentation and literacy, social feeling, sense of identity, and activating cognitive processes. Future developments include expanding the use of VGT® further to validate such results from a statistical point of view.
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Affiliation(s)
- Francesco Bocci
- Playability Association, Via Sersane, 56, 25050 Ome, Italy
- Game Science Research Center, Via San Ponziano, 6, 55100 Lucca, Italy
| | - Ambra Ferrari
- Playability Association, Via Sersane, 56, 25050 Ome, Italy
| | - Marcello Sarini
- Game Science Research Center, Via San Ponziano, 6, 55100 Lucca, Italy
- Department of Psychology, University of Milano, Bicocca Piazza Ateneo Nuovo 1, 20126 Milano, Italy
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5
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Anguera JA, Rowe MA, Volponi JJ, Elkurdi M, Jurigova B, Simon AJ, Anguera-Singla R, Gallen CL, Gazzaley A, Marco EJ. Enhancing attention in children using an integrated cognitive-physical videogame: A pilot study. NPJ Digit Med 2023; 6:65. [PMID: 37046040 PMCID: PMC10097690 DOI: 10.1038/s41746-023-00812-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Inattention can negatively impact several aspects of a child's life, including at home and school. Cognitive and physical interventions are two promising non-pharmaceutical approaches used to enhance attention abilities, with combined approaches often being marketed to teachers, therapists, and parents typically without research validation. Here, we assessed the feasibility of incorporating an integrated, cognitive-physical, closed-loop video game (body-brain trainer or 'BBT') as an after-school program, and also evaluated if there were attention benefits following its use. Twenty-two children (7-12 years of age) with a range of attention abilities were recruited to participate in this proof of concept, single-arm, longitudinal study (24 sessions over 8 weeks, ~30 min/day). We interrogated attention abilities through a parent survey of their child's behaviors, in addition to objective performance-based and neural measures of attention. Here we observed 95% compliance as well as, significant improvements on the parent-based reports of inattention and on cognitive tests and neural measures of attention that were comparable in scale to previous work. Exploratory measures of other cognitive control abilities and physical fitness also showed similar improvement, with exploratory evaluation of retained benefits on the primary attention-related outcomes being present 1-year later. Lastly, there was no correlation between the baseline parent-rated inattention score and the improvement on the primary task-based measures of attention, suggesting that intervention-based benefits were not solely attained by those who stood the most to gain. These pilot findings warrant future research to replicate and extend these findings.
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Affiliation(s)
- J A Anguera
- Neuroscape Center, Department of Neurology, University of California, San Francisco, USA.
- Department of Psychiatry, University of California, San Francisco, USA.
| | - M A Rowe
- Department of Neurodevelopmental Medicine, Cortica Healthcare, San Rafael, USA
| | - J J Volponi
- Neuroscape Center, Department of Neurology, University of California, San Francisco, USA
- Department of Psychiatry, University of California, San Francisco, USA
| | - M Elkurdi
- Department of Neurodevelopmental Medicine, Cortica Healthcare, San Rafael, USA
| | - B Jurigova
- Department of Psychiatry, University of California, San Francisco, USA
| | - A J Simon
- Neuroscape Center, Department of Neurology, University of California, San Francisco, USA
- Department of Psychiatry, University of California, San Francisco, USA
| | - R Anguera-Singla
- Neuroscape Center, Department of Neurology, University of California, San Francisco, USA
- Department of Psychiatry, University of California, San Francisco, USA
| | - C L Gallen
- Neuroscape Center, Department of Neurology, University of California, San Francisco, USA
| | - A Gazzaley
- Neuroscape Center, Department of Neurology, University of California, San Francisco, USA
- Department of Psychiatry, University of California, San Francisco, USA
| | - E J Marco
- Department of Neurodevelopmental Medicine, Cortica Healthcare, San Rafael, USA
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6
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Anguera JA, Volponi JJ, Simon AJ, Gallen CL, Rolle CE, Anguera-singla R, Pitsch EA, Thompson CJ, Gazzaley A. Integrated cognitive and physical fitness training enhances attention abilities in older adults. npj Aging 2022; 8:12. [PMID: 36042247 PMCID: PMC9427998 DOI: 10.1038/s41514-022-00093-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
Preserving attention abilities is of great concern to older adults who are motivated to maintain their quality of life. Both cognitive and physical fitness interventions have been utilized in intervention studies to assess maintenance and enhancement of attention abilities in seniors, and a coupling of these approaches is a compelling strategy to buttress both cognitive and physical health in a time- and resource-effective manner. With this perspective, we created a closed-loop, motion-capture video game (Body-Brain Trainer: BBT) that adapts a player’s cognitive and physical demands in an integrated approach, thus creating a personalized and cohesive experience across both domains. Older adults who engaged in two months of BBT improved on both physical fitness (measures of blood pressure and balance) and attention (behavioral and neural metrics of attention on a continuous performance task) outcome measures beyond that of an expectancy matched, active, placebo control group, with maintenance of improved attention performance evidenced 1 year later. Following training, the BBT group’s improvement on the attention outcome measure exceeded performance levels attained by an untrained group of 20-year olds, and showed age-equilibration of a neural signature of attention shown to decline with age: midline frontal theta power. These findings highlight the potential benefits of an integrated, cognitive-physical, closed-loop training platform as a powerful tool for both cognitive and physical enhancement in older adults.
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7
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Jones KT, Smith CC, Gazzaley A, Zanto TP. Research outside the laboratory: Longitudinal at-home neurostimulation. Behav Brain Res 2022; 428:113894. [DOI: 10.1016/j.bbr.2022.113894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/14/2022] [Accepted: 04/11/2022] [Indexed: 11/02/2022]
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8
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Duffey MM, Ayuku D, Ayodo G, Abuonji E, Nyalumbe M, Giella AK, Hook JN, Tran TM, McHenry MS. Translation and Cultural Adaptation of NIH Toolbox Cognitive Tests into Swahili and Dholuo Languages for Use in Children in Western Kenya. J Int Neuropsychol Soc 2022; 28:414-23. [PMID: 34027848 DOI: 10.1017/S1355617721000497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Performing high-quality and reliable cognitive testing requires significant resources and training. As a result, large-scale studies involving cognitive testing are difficult to perform in low- and middle-income settings, limiting access to critical knowledge to improve academic achievement and economic production in these populations. The NIH Toolbox® is a collection of cognitive, motor, sensory, and emotional tests that can be administered and scored using an iPad® tablet, reducing the need for training and quality monitoring; and thus, it is a potential solution to this problem. METHODS We describe our process for translation and cultural adaptation of the existing NIH Toolbox tests of fluid cognition into the Swahili and Dholuo languages for use in children aged 3-14 years in western Kenya. Through serial forward and back translations, cognitive interviews, group consensus, outside feedback, and support from the NIH Toolbox team, we produced translated tests that have both face validity and linguistic validation. RESULTS During our cognitive interviews, we found that the five chosen tests (one each of attention, cognitive flexibility, working memory, episodic memory, and processing speed) were generally well understood by children aged 7-14 years in our chosen populations. The cognitive interviews informed alterations in translation as well as slight changes in some images to culturally adapt the tests. CONCLUSIONS This study describes the process by which we translated five fluid cognition tests from the NIH Toolbox into the Swahili and Dholuo languages. The finished testing application will be available for future studies, including a pilot study for assessment of psychometric properties.
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9
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Choi E, Yoon EH, Park MH. Game-based digital therapeutics for children and adolescents: Their therapeutic effects on mental health problems, the sustainability of the therapeutic effects and the transfer of cognitive functions. Front Psychiatry 2022; 13:986687. [PMID: 36523871 PMCID: PMC9744939 DOI: 10.3389/fpsyt.2022.986687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/20/2022] [Indexed: 11/30/2022] Open
Abstract
Mental health problems in childhood and adolescence (e. g., attention deficits, problems in emotional understanding and subclinical levels of anxiety) are reported to develop further in adulthood and/or to increase the risk of developing mental health disorders in adulthood. Although it is important to provide treatment or prevention interventions for children and adolescents in order to reduce the risk of the further development of mental health problems, the pharmacological and behavioral treatments for this age group have limitations (e.g., limited access, unsustainable treatment effects and the lack of engagement in intervention). In order to overcome the limitations of conventional treatments, the use of digital technology, especially video games for this age group, is suggested. In order to be accepted as clinical interventions, objective evidence for the therapeutic effects of digital therapeutic that used video games to treat or prevent targeted mental health problems are required. Thus, this review aims to explore whether game-based digital therapeutics (DTx) for children and adolescents showed therapeutic effects on targeted mental health problems. As game-based DTx are suggested to show sustained therapeutic effects and the transfer of cognitive functions, it also reviews the maintenance of the therapeutic effects of DTx and the extent of the transfer of cognitive functions. Game-based DTx that are developed to treat or prevent mental health problems (e.g., attention deficit, depression) in children and adolescents are found to show therapeutic effects on targeted mental health problems despite the limitations (e.g., small sample size, limited investigation of the sustainability). This review would contribute to the understanding of whether there is objective evidence of the therapeutic effects of digital therapeutics using video games that deliver treatment or prevention interventions for mental health problems in children and adolescents.
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Affiliation(s)
- Eunhye Choi
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Eun-Ha Yoon
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Min-Hyeon Park
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
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10
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Gallen CL, Anguera JA, Gerdes MR, Simon AJ, Cañadas E, Marco EJ. Enhancing neural markers of attention in children with ADHD using a digital therapeutic. PLoS One 2021; 16:e0261981. [PMID: 34972140 DOI: 10.1371/journal.pone.0261981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/28/2021] [Indexed: 11/19/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition characterized by diminished attentional control. Critically, these difficulties are related to negative consequences in real-life functioning both during development and into adulthood. There is now growing evidence that modulating the underlying neural circuits related to attention can improve behavior and brain function in children with ADHD. We have previously shown that game-based digital therapeutics targeting a key neural marker of attention-midline frontal theta (MFT)-yield positive effects on attentional control in several populations. However, the effects of such digital therapeutics in children with ADHD and no other comorbidities has not been yet examined. To address this gap, we assessed a sample of 25 children with ADHD (8-12 years old) on neural, behavioral, and clinical metrics of attention before and after a 4-week at-home intervention on an iPad targeting MFT circuitry. We found that children showed enhancements on a neural measure of attention (MFT power), as well as on objective behavioral measures of attention and parent reports of clinical ADHD symptoms. Importantly, we observed relationships between the neural and behavioral cognitive improvements, demonstrating that those children who showed the largest intervention-related neural gains were also those that improved the most on the behavioral tasks indexing attention. These findings provide support for using targeted, digital therapeutics to enhance multiple features of attentional control in children with ADHD. Study registration: ClinicalTrials.gov registry (NCT03844269) https://clinicaltrials.gov/ct2/show/NCT03844269.
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11
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Hsu WY, Rowles W, Anguera JA, Anderson A, Younger JW, Friedman S, Gazzaley A, Bove R. Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study. J Med Internet Res 2021; 23:e25748. [PMID: 34967751 PMCID: PMC8759021 DOI: 10.2196/25748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/29/2021] [Accepted: 11/16/2021] [Indexed: 01/23/2023] Open
Abstract
Background Cognitive impairment (CI) is one of the most prevalent symptoms of multiple sclerosis (MS). However, it is difficult to include cognitive assessment as part of MS standard care since the comprehensive neuropsychological examinations are usually time-consuming and extensive. Objective To improve access to CI assessment, we evaluated the feasibility and potential assessment sensitivity of a tablet-based cognitive battery in patients with MS. Methods In total, 53 participants with MS (24 [45%] with CI and 29 [55%] without CI) and 24 non-MS participants were assessed with a tablet-based cognitive battery (Adaptive Cognitive Evaluation [ACE]) and standard cognitive measures, including the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). Associations between performance in ACE and the SDMT/PASAT were explored, with group comparisons to evaluate whether ACE modules can capture group-level differences. Results Correlations between performance in ACE and the SDMT (R=–0.57, P<.001), as well as PASAT (R=–0.39, P=.01), were observed. Compared to non-MS and non-CI MS groups, the CI MS group showed a slower reaction time (CI MS vs non-MS: P<.001; CI MS vs non-CI MS: P=.004) and a higher attention cost (CI MS vs non-MS: P=.02; CI MS vs non-CI MS: P<.001). Conclusions These results provide preliminary evidence that ACE, a tablet-based cognitive assessment battery, provides modules that could potentially serve as a digital cognitive assessment for people with MS. Trial Registration ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618
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Affiliation(s)
- Wan-Yu Hsu
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - William Rowles
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - Joaquin A Anguera
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.,Neuroscape, University of California, San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Annika Anderson
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - Jessica W Younger
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.,Neuroscape, University of California, San Francisco, CA, United States
| | - Samuel Friedman
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - Adam Gazzaley
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.,Neuroscape, University of California, San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, CA, United States.,Department of Physiology, University of California, San Francisco, CA, United States
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
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12
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Penev Y, Dunlap K, Husic A, Hou C, Washington P, Leblanc E, Kline A, Kent J, Ng-Thow-Hing A, Liu B, Harjadi C, Tsou M, Desai M, Wall DP. A Mobile Game Platform for Improving Social Communication in Children with Autism: A Feasibility Study. Appl Clin Inform 2021; 12:1030-1040. [PMID: 34788890 PMCID: PMC8598393 DOI: 10.1055/s-0041-1736626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background
Many children with autism cannot receive timely in-person diagnosis and therapy, especially in situations where access is limited by geography, socioeconomics, or global health concerns such as the current COVD-19 pandemic. Mobile solutions that work outside of traditional clinical environments can safeguard against gaps in access to quality care.
Objective
The aim of the study is to examine the engagement level and therapeutic feasibility of a mobile game platform for children with autism.
Methods
We designed a mobile application,
GuessWhat
, which, in its current form, delivers game-based therapy to children aged 3 to 12 in home settings through a smartphone. The phone, held by a caregiver on their forehead, displays one of a range of appropriate and therapeutically relevant prompts (e.g., a surprised face) that the child must recognize and mimic sufficiently to allow the caregiver to guess what is being imitated and proceed to the next prompt. Each game runs for 90 seconds to create a robust social exchange between the child and the caregiver.
Results
We examined the therapeutic feasibility of
GuessWhat
in 72 children (75% male, average age 8 years 2 months) with autism who were asked to play the game for three 90-second sessions per day, 3 days per week, for a total of 4 weeks. The group showed significant improvements in Social Responsiveness Score-2 (SRS-2) total (3.97,
p
<0.001) and Vineland Adaptive Behavior Scales-II (VABS-II) socialization standard (5.27,
p
= 0.002) scores.
Conclusion
The results support that the
GuessWhat
mobile game is a viable approach for efficacious treatment of autism and further support the possibility that the game can be used in natural settings to increase access to treatment when barriers to care exist.
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Affiliation(s)
- Yordan Penev
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Kaitlyn Dunlap
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Arman Husic
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Cathy Hou
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Peter Washington
- Department of Bioengineering, Stanford University, Stanford, California, United States
| | - Emilie Leblanc
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Aaron Kline
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - John Kent
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Anthony Ng-Thow-Hing
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Bennett Liu
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Christopher Harjadi
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Meagan Tsou
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Manisha Desai
- Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Dennis P Wall
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
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13
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Abstract
BACKGROUND AND OBJECTIVES Digital therapeutics are an emerging type of medical therapy and are defined as evidence-based therapeutic interventions for patients by means of qualified software programs to prevent, manage, or treat medical conditions. Today, digital therapeutics products are on the market or under development for a wide range of medical conditions such as diabetes, oncology treatment management, and neuropsychiatric disorders including anxiety disorder, depression, and substance use disorder. Digital therapeutics can be more flexible than other treatment methods to address patients' individual needs. METHODS AND RESULTS The advantages of digital therapeutics fall in line with market demand; thus, the digital therapeutics market is expanding globally, focusing on advanced medical markets. There are many digital therapeutics products such as Sleepio for insomnia, Daylight for anxiety, Livongo and Omada products for diabetes, pre-diabetes, hypertension, etc. None of these are cleared by the Food and Drug Administration (FDA), but all are commercially available through health insurance or employers. The EU, including Germany, and a number of Asian countries, including Korea, Japan, and China, are also introducing policies for the regulation of new fields and digital therapeutics. CONCLUSIONS The adoption of digital therapeutics is intricate and often involves various interests in numerous fields, decision-making processes, and individual or organizational value judgments. For digital therapeutics to be thoroughly introduced into real life, technical aspects must be supported, and an approach that considers users must be further investigated.
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Affiliation(s)
- Ji Sun Hong
- Department of Psychiatry, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea.
| | | | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea.
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14
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15
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Miller LJ, Marco EJ, Chu RC, Camarata S. Editorial: Sensory Processing Across the Lifespan: A 25-Year Initiative to Understand Neurophysiology, Behaviors, and Treatment Effectiveness for Sensory Processing. Front Integr Neurosci 2021; 15:652218. [PMID: 33897385 PMCID: PMC8063042 DOI: 10.3389/fnint.2021.652218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/24/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lucy Jane Miller
- Department of Pediatrics (Emeritus), University of Colorado, Denver, CO, United States.,Sensory Therapies and Research Institute for Sensory Processing Disorder, Centennial, CO, United States
| | - Elysa J Marco
- Cortica (United States), San Diego, CA, United States
| | - Robyn C Chu
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States.,Growing Healthy Children Therapy Services, Rescue, CA, United States
| | - Stephen Camarata
- School of Medicine, Vanderbilt University, Nashville, TN, United States
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16
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Kollins SH, Childress A, Heusser AC, Lutz J. Effectiveness of a digital therapeutic as adjunct to treatment with medication in pediatric ADHD. NPJ Digit Med 2021; 4:58. [PMID: 33772095 DOI: 10.1038/s41746-021-00429-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/25/2021] [Indexed: 11/08/2022] Open
Abstract
STARS-Adjunct was a multicenter, open-label effectiveness study of AKL-T01, an app and video-game-based treatment for inattention, as an adjunct to pharmacotherapy in 8-14-year-old children with attention-deficit/hyperactivity disorder (ADHD) on stimulant medication (n = 130) or not on any ADHD medication (n = 76). Children used AKL-T01 for 4 weeks, followed by a 4-week pause and another 4-week treatment. The primary outcome was change in ADHD-related impairment (Impairment Rating Scale (IRS)) after 4 weeks. Secondary outcomes included changes in IRS, ADHD Rating Scale (ADHD-RS). and Clinical Global Impressions Scale-Improvement (CGI-I) on days 28, 56, and 84. IRS significantly improved in both cohorts (On Stimulants: -0.7, p < 0.001; No Stimulants: -0.5, p < 0.001) after 4 weeks. IRS, ADHD-RS, and CGI-I remained stable during the pause and improved with a second treatment period. The treatment was well-tolerated with no serious adverse events. STARS-Adjunct extends AKL-T01's body of evidence to a medication-treated pediatric ADHD population, and suggests additional treatment benefit.
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17
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Anguera JA, Schachtner JN, Simon AJ, Volponi J, Javed S, Gallen CL, Gazzaley A. Long-term maintenance of multitasking abilities following video game training in older adults. Neurobiol Aging 2021; 103:22-30. [PMID: 33789209 DOI: 10.1016/j.neurobiolaging.2021.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/18/2022]
Abstract
The use of cognitive interventions to remediate deficient cognitive functions, or to enhance or preserve intact cognitive abilities, has been explored for some time, especially in older adults. However, few studies have investigated the long-term persistence of any positive benefits, with none examining whether changes in functional brain activity persist several years later. Here, we assessed whether enhanced cognitive abilities and potential underlying neural changes attained via the use of a custom-made video game (NeuroRacer) played by older adults (60-85 years old) continued to be elevated beyond control participants 6 years later. The NeuroRacer group continued to show reduced multitasking costs beyond control participants, with a neural signature of cognitive control, midline frontal theta power, also continuing to show heightened activity. However, previously evidenced performance benefits that had extended to untrained cognitive control abilities (i.e., enhanced sustained attention and working memory) did not persist, highlighting sustainability limitations. These findings continue to demonstrate the robust plasticity of the prefrontal cognitive control system in the aging brain, a potential neural mechanism underlying enhanced performance over time, and the possible long-term impact that digital therapeutics can have.
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Affiliation(s)
- Joaquin A Anguera
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA.
| | - Jessica N Schachtner
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA
| | - Alexander J Simon
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA
| | - Joshua Volponi
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA
| | - Samirah Javed
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA
| | - Courtney L Gallen
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA
| | - Adam Gazzaley
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Physiology, University of California, San Francisco, CA, USA
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18
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Jurigova BG, Gerdes MR, Anguera JA, Marco EJ. Sustained benefits of cognitive training in children with inattention, three-year follow-up. PLoS One 2021; 16:e0246449. [PMID: 33539468 PMCID: PMC7861383 DOI: 10.1371/journal.pone.0246449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/19/2021] [Indexed: 11/19/2022] Open
Abstract
The goal of this study was to test for long-term benefits three years after the completion of a cognitive training intervention (Project: EVO™) in a subset of children with Sensory Processing Dysfunction (SPD). Our initial findings revealed that children with SPD who also met research criteria for Attention Deficit Hyperactivity Disorder (SPD+IA) showed a significant decrease in parent-observed inattentive behaviors, which remained stable in a nine-month follow-up assessment. Forty nine caregivers of participants who completed the Project: EVO™ training were contacted to be included in this follow up study. Each was emailed an invitation to complete the Vanderbilt ADHD Diagnostic Parent Rating Scale, which yielded a completion rate of 39/49 (80%). A Generalized Estimating Equations analysis was used to assess changes in symptoms over time, specifically to determine whether the initial improvements were retained. The SPD+IA cohort continued to show sustained benefits on their parent-reported scores of inattention, with 54% of SPD+IA individuals no longer meeting criteria for ADHD three years following intervention. These findings provide initial insights into the potential long-term benefits of a digital health intervention for children with attention-based issues.
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Affiliation(s)
- Barbora G. Jurigova
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, California, United States of America
| | - Molly R. Gerdes
- Research Division, Cortica Healthcare, San Rafael, California, United States of America
| | - Joaquin A. Anguera
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
| | - Elysa J. Marco
- Research Division, Cortica Healthcare, San Rafael, California, United States of America
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19
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Hsu WY, Rowles W, Anguera J, Zhao C, Anderson A, Alexander A, Sacco S, Henry R, Gazzaley A, Bove R. Application of an Adaptive, Digital, Game-Based Approach for Cognitive Assessment in Multiple Sclerosis: Observational Study. J Med Internet Res 2021; 23:e24356. [PMID: 33470940 PMCID: PMC7840186 DOI: 10.2196/24356] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/14/2020] [Accepted: 10/28/2020] [Indexed: 01/19/2023] Open
Abstract
Background Cognitive impairment is one of the most debilitating manifestations of multiple sclerosis. Currently, the assessment of cognition relies on a time-consuming and extensive neuropsychological examination, which is only available in some centers. Objective To enable simpler, more accessible cognitive screening, we sought to determine the feasibility and potential assessment sensitivity of an unsupervised, adaptive, video game–based digital therapeutic to assess cognition in multiple sclerosis. Methods A total of 100 people with multiple sclerosis (33 with cognitive impairment and 67 without cognitive impairment) and 24 adults without multiple sclerosis were tested with the tablet game (EVO Monitor) and standard measures, including the Brief International Cognitive Assessment for Multiple Sclerosis (which included the Symbol Digit Modalities Test [SDMT]) and Multiple Sclerosis Functional Composite 4 (which included the Timed 25-Foot Walk test). Patients with multiple sclerosis also underwent neurological evaluations and contributed recent structural magnetic resonance imaging scans. Group differences in EVO Monitor performance and the association between EVO Monitor performance and standard measures were investigated. Results Participants with multiple sclerosis and cognitive impairment showed worse performance in EVO Monitor compared with participants without multiple sclerosis (P=.01) and participants with multiple sclerosis without cognitive impairment (all P<.002). Regression analyses indicated that participants with a lower SDMT score showed lower performance in EVO Monitor (r=0.52, P<.001). Further exploratory analyses revealed associations between performance in EVO Monitor and walking speed (r=–0.45, P<.001) as well as brain volumetric data (left thalamic volume: r=0.47, P<.001; right thalamic volume: r=0.39, P=.002; left rostral middle frontal volume: r=0.28, P=.03; right rostral middle frontal volume: r=0.27, P=.03). Conclusions These findings suggest that EVO Monitor, an unsupervised, video game–based digital program integrated with adaptive mechanics, is a clinically valuable approach to measuring cognitive performance in patients with multiple sclerosis. Trial Registration ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618
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Affiliation(s)
- Wan-Yu Hsu
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - William Rowles
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Joaquin Anguera
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Neuroscape, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Chao Zhao
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Annika Anderson
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Amber Alexander
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Simone Sacco
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Roland Henry
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Adam Gazzaley
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Neuroscape, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.,Department of Physiology, University of California, San Francisco, San Francisco, CA, United States
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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20
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Lane AE. Practitioner Review: Effective management of functional difficulties associated with sensory symptoms in children and adolescents. J Child Psychol Psychiatry 2020; 61:943-958. [PMID: 32166796 DOI: 10.1111/jcpp.13230] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sensory symptoms are defined as atypical behavioral responses to daily sensory stimuli that impact on the performance of everyday routines. Sensory symptoms have been observed in young people with and without developmental concerns. There is uncertainty, however, regarding the best way to identify and manage sensory symptoms. The aim of this paper is to provide a review of current best evidence regarding measurement of and interventions for sensory symptoms. METHODS A narrative review methodology is adopted to address the aims of this paper. First, sensory symptoms are defined, and then, an overview of the evidence for the relationship between sensory symptoms and childhood function is provided. Second, commonly used sensory assessment tools are summarized and evaluated. Finally, an overview and critique of the evidence for sensory and nonsensory-based interventions addressing sensory symptoms are given. RESULTS The terminology used to describe sensory symptoms varies by discipline, and several conceptual taxonomies including sensory subtypes have been proposed. There is ample evidence to support the association of sensory symptoms with childhood function including social engagement, repetitive behaviors, anxiety, and participation in self-care routines. Measurement of sensory symptoms is dominated by proxy-report instruments, and few single instruments assess the entire domain of sensory symptomatology. The evidence for interventions for sensory symptoms is emerging but still limited by low quantity and methodological concerns. CONCLUSIONS Effective management of sensory symptoms may mitigate the burden of neurodevelopmental disability and mental illness in young people. Identification of sensory symptoms should be conducted by a skilled practitioner utilizing multiple measurement methods. Intervention protocols for sensory symptoms should be informed by current best evidence which is strongest for Ayres Sensory Integration® , Qigong massage, the Alert Program® , and Social Stories. To make significant progress in this field, however, new intervention studies must address the question of 'what intervention works for whom?'.
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Affiliation(s)
- Alison E Lane
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
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21
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Abstract
Abstract
Some evidence suggests that experiencing a given scenario using virtual reality (VR) may engage greater attentional resources than experiencing the same scenario on a 2D computer monitor. However, the underlying neural processes associated with these VR-related effects, especially those pertaining to current consumer-friendly head-mounted displays of virtual reality (HMD-VR), remain unclear. Here, two experiments were conducted to compare task performance and EEG-based neural metrics captured during a perceptual discrimination task presented on two different viewing platforms. Forty participants (20–25 years old) completed this task using both an HMD-VR and traditional computer monitor in a within-group, randomized design. Although Experiment I (n = 20) was solely behavioral in design, Experiment II (n = 20) utilized combined EEG recordings to interrogate the neural correlates underlying potential performance differences across platforms. These experiments revealed that (1) there was no significant difference in the amount of arousal measured between platforms and (2) selective attention abilities in HMD-VR environment were enhanced from both a behavioral and neural perspective. These findings suggest that the allocation of attentional resources in HMD-VR may be superior to approaches more typically used to assess these abilities (e.g., desktop/laptop/tablet computers with 2D screens).
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Affiliation(s)
- Gang Li
- Shanghai Jiao Tong University
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22
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Li G, Zhou S, Kong Z, Guo M. Closed-Loop Attention Restoration Theory for Virtual Reality-Based Attentional Engagement Enhancement. Sensors (Basel) 2020; 20:E2208. [PMID: 32295136 DOI: 10.3390/s20082208] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 11/24/2022]
Abstract
Today, as media and technology multitasking becomes pervasive, the majority of young people face a challenge regarding their attentional engagement (that is, how well their attention can be maintained). While various approaches to improve attentional engagement exist, it is difficult to produce an effect in younger people, due to the inadequate attraction of these approaches themselves. Here, we show that a single 30-min engagement with an attention restoration theory (ART)-inspired closed-loop software program (Virtual ART) delivered on a consumer-friendly virtual reality head-mounted display (VR-HMD) could lead to improvements in both general attention level and the depth of engagement in young university students. These improvements were associated with positive changes in both behavioral (response time and response time variability) and key electroencephalography (EEG)-based neural metrics (frontal midline theta inter-trial coherence and parietal event-related potential P3b). All the results were based on the comparison of the standard Virtual ART tasks (control group, n = 15) and closed-loop Virtual ART tasks (treatment group, n = 15). This study provides the first case of EEG evidence of a VR-HMD-based closed-loop ART intervention generating enhanced attentional engagement.
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23
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Gough N, Brkan L, Subramaniam P, Chiuccariello L, De Petrillo A, Mulsant BH, Bowie CR, Rajji TK. Feasibility of remotely supervised transcranial direct current stimulation and cognitive remediation: A systematic review. PLoS One 2020; 15:e0223029. [PMID: 32092069 PMCID: PMC7039434 DOI: 10.1371/journal.pone.0223029] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/08/2020] [Indexed: 01/02/2023] Open
Abstract
With technological advancements and an aging population, there is growing interest in delivering interventions at home. Transcranial Direct Current Stimulation (tDCS) and Cognitive Remediation (CR) as well as Cognitive Training (CT) have been widely studied, but mainly in laboratories or hospitals. Thus, the objectives of this review are to examine feasibility and the interventions components to support the domiciliary administration of tDCS and CR. We performed a systematic search of electronic databases, websites and reference lists of included articles from the first date available until October 31, 2018. Articles included had to meet the following criteria: original work published in English using human subjects, majority of tDCS or CR intervention administered remotely. A total of 39 studies were identified (16 tDCS, 23 CR/CT, 5 using both tDCS & CT). Four studies were single case studies and two were multiple case studies. The remaining 33 studies had a range of 9-135 participants. Five tDCS and nine CR/CT studies were double blind randomized controlled trials. Most studies focused on schizophrenia (8/39) and multiple sclerosis (8/39). Literature examined suggests the feasibility of delivering tDCS or CR/CT remotely with the support of information and communication technologies.
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Affiliation(s)
- Nicole Gough
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Lea Brkan
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Ponnusamy Subramaniam
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Health Psychology Program & Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Lina Chiuccariello
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Alessandra De Petrillo
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Benoit H. Mulsant
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Christopher R. Bowie
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
| | - Tarek K. Rajji
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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24
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Choi E, Shin SH, Ryu JK, Jung KI, Kim SY, Park MH. Commercial video games and cognitive functions: video game genres and modulating factors of cognitive enhancement. Behav Brain Funct 2020; 16:2. [PMID: 32014027 PMCID: PMC6996164 DOI: 10.1186/s12993-020-0165-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background Unlike the emphasis on negative results of video games such as the impulsive engagement in video games, cognitive training studies in individuals with cognitive deficits showed that characteristics of video game elements were helpful to train cognitive functions. Thus, this study aimed to have a more balanced view toward the video game playing by reviewing genres of commercial video games and the association of video games with cognitive functions and modulating factors. Literatures were searched with search terms (e.g. genres of video games, cognitive training) on database and Google scholar. Results video games, of which purpose is players’ entertainment, were found to be positively associated with cognitive functions (e.g. attention, problem solving skills) despite some discrepancy between studies. However, the enhancement of cognitive functions through video gaming was limited to the task or performance requiring the same cognitive functions. Moreover, as several factors (e.g. age, gender) were identified to modulate cognitive enhancement, the individual difference in the association between video game playing and cognitive function was found. Conclusion Commercial video games are suggested to have the potential for cognitive function enhancement. As understanding the association between video gaming and cognitive function in a more balanced view is essential to evaluate the potential outcomes of commercial video games that more people reported to engage, this review contributes to provide more objective evidence for commercial video gaming.
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Affiliation(s)
- Eunhye Choi
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, Republic of Korea
| | - Suk-Ho Shin
- Dr. Shin's Child and Adolescent Psychiatry Clinic, Seoul, Republic of Korea
| | - Jeh-Kwang Ryu
- Institute for Cognitive Science, Seoul National University, Seoul, Republic of Korea
| | - Kyu-In Jung
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, Republic of Korea
| | - Shin-Young Kim
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, Republic of Korea
| | - Min-Hyeon Park
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, Republic of Korea.
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25
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Brandes-Aitken A, Anguera JA, Chang YS, Demopoulos C, Owen JP, Gazzaley A, Mukherjee P, Marco EJ. White Matter Microstructure Associations of Cognitive and Visuomotor Control in Children: A Sensory Processing Perspective. Front Integr Neurosci 2019; 12:65. [PMID: 30692921 PMCID: PMC6339953 DOI: 10.3389/fnint.2018.00065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/11/2018] [Indexed: 01/08/2023] Open
Abstract
Objective: Recent evidence suggests that co-occurring deficits in cognitive control and visuomotor control are common to many neurodevelopmental disorders. Specifically, children with sensory processing dysfunction (SPD), a condition characterized by sensory hyper/hypo-sensitivity, show varying degrees of overlapping attention and visuomotor challenges. In this study, we assess associations between cognitive and visuomotor control abilities among children with and without SPD. In this same context, we also examined the common and unique diffusion tensor imaging (DTI) tracts that may support the overlap of cognitive control and visuomotor control. Method: We collected cognitive control and visuomotor control behavioral measures as well as DTI data in 37 children with SPD and 25 typically developing controls (TDCs). We constructed regressions to assess for associations between behavioral performance and mean fractional anisotropy (FA) in selected regions of interest (ROIs). Results: We observed an association between behavioral performance on cognitive control and visuomotor control. Further, our findings indicated that FA in the anterior limb of the internal capsule (ALIC), the anterior thalamic radiation (ATR), and the superior longitudinal fasciculus (SLF) are associated with both cognitive control and visuomotor control, while FA in the superior corona radiata (SCR) uniquely correlate with cognitive control performance and FA in the posterior limb of the internal capsule (PLIC) and the cerebral peduncle (CP) tract uniquely correlate with visuomotor control performance. Conclusions: These findings suggest that children who demonstrate lower cognitive control are also more likely to demonstrate lower visuomotor control, and vice-versa, regardless of clinical cohort assignment. The overlapping neural tracts, which correlate with both cognitive and visuomotor control suggest a possible common neural mechanism supporting both control-based processes.
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Affiliation(s)
- Annie Brandes-Aitken
- Neuroscape Center, Departments of Neurology, Pediatrics, Physiology, Radiology, and Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Joaquin A Anguera
- Neuroscape Center, Departments of Neurology, Pediatrics, Physiology, Radiology, and Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Yi-Shin Chang
- Neuroscape Center, Departments of Neurology, Pediatrics, Physiology, Radiology, and Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Carly Demopoulos
- Neuroscape Center, Departments of Neurology, Pediatrics, Physiology, Radiology, and Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Julia P Owen
- Neuroscape Center, Departments of Neurology, Pediatrics, Physiology, Radiology, and Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Adam Gazzaley
- Neuroscape Center, Departments of Neurology, Pediatrics, Physiology, Radiology, and Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Pratik Mukherjee
- Neuroscape Center, Departments of Neurology, Pediatrics, Physiology, Radiology, and Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Elysa J Marco
- Neuroscape Center, Departments of Neurology, Pediatrics, Physiology, Radiology, and Psychiatry, University of California, San Francisco, San Francisco, CA, United States
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Yerys BE, Bertollo JR, Kenworthy L, Dawson G, Marco EJ, Schultz RT, Sikich L. Brief Report: Pilot Study of a Novel Interactive Digital Treatment to Improve Cognitive Control in Children with Autism Spectrum Disorder and Co-occurring ADHD Symptoms. J Autism Dev Disord 2018; 49:1727-1737. [DOI: 10.1007/s10803-018-3856-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bruggers CS, Baranowski S, Beseris M, Leonard R, Long D, Schulte E, Shorter A, Stigner R, Mason CC, Bedrov A, Pascual I, Bulaj G. A Prototype Exercise-Empowerment Mobile Video Game for Children With Cancer, and Its Usability Assessment: Developing Digital Empowerment Interventions for Pediatric Diseases. Front Pediatr 2018; 6:69. [PMID: 29686977 PMCID: PMC5900044 DOI: 10.3389/fped.2018.00069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/08/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Medical advances continue to improve morbidity and mortality of serious pediatric diseases, including cancer, driving research addressing diminished physical and psychological quality of life in children with these chronic conditions. Empowerment enhances resilience and positively influences health, disease, and therapy understanding. We describe the development and usability assessment of a prototype Empower Stars! mobile video game grounded in behavioral and exercise theories with the purpose of coupling physical exercise with empowerment over disease in children with cancer. METHODS Academic faculty, health-care providers, and community video game developers collaborated in this project. The iPadAir was selected as a delivery platform for its accelerometer and gyroscope features facilitating exercise design. Unity multiplatform technology provided animation and audiovisual features for immediate player feedback. Javascript, C#, Photoshop, Flash, and SketchUp were used for coding, creating graphical assets, Sprite sheets, and printing files, respectively. 3D-printed handles and case backing were used to adapt the iPad for physical exercise. Game usability, engagement, and enjoyment were assessed via a multilevel study of children undergoing cancer chemotherapy, their parents, and pediatric cancer health-care providers. Feedback crucial for ongoing game development was analyzed. RESULTS A prototype Empower Stars! mobile video game was developed for children 7-14 years old with cancer. Active, sedentary, educational, and empowerment-centered elements intermix for 20 min of exercise within a 30 min "one-day treatment" gameplay session involving superheroes, space exploration, metaphorical cancer challenges, life restoration on a barren planet, and innumerable star rewards. No player "dies." Usability assessment data analyses showed widespread enthusiasm for integrating exercise with empowerment over cancer and the game itself. Favorite elements included collecting star rewards and planet terraforming. Traveling in space and the Healthy Food Choice game were least liked. The need for improved gameplay instructions was expressed by all groups. The usability study provided essential feedback for converting the prototype into alpha version of Empower Stars! CONCLUSION Adapting exercise empowerment-promoting video game technology to mobile platforms facilitates usability and widespread dissemination for children with cancer. We discuss broader therapeutic applicability in diverse chronic pediatric diseases, including obesity, asthma, cystic fibrosis, diabetes, and juvenile idiopathic arthritis.
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Affiliation(s)
- Carol S Bruggers
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Primary Children's Hospital, Salt Lake City, UT, United States
| | | | | | | | - Derek Long
- Spy Hop Youth Media, Salt Lake City, UT, United States
| | | | | | - Rowan Stigner
- Spy Hop Youth Media, Salt Lake City, UT, United States
| | - Clinton C Mason
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Alisa Bedrov
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Ian Pascual
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States.,Juan Diego Catholic High School, Draper, UT, United States
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
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