Impact of Adolescents' Screen Time and Nocturnal Mobile Phone-Related Awakenings on Sleep and General Health Symptoms: A Prospective Cohort Study.

Nocturnal media use has been linked to adolescents' sleeping problems in cross-sectional studies which do not address reverse causality. To prospectively assess the new occurrence of sleep problems or health symptoms in relation to electronic media use and nocturnal mobile phone use, we used data from the longitudinal Swiss HERMES (Health Effects Related to Mobile phone usE in adolescentS) cohort on 843 children from 7th to 9th grade. Logistic regression models were fitted and adjusted for relevant confounders. Adolescents reporting at baseline and follow-up at least one nocturnal awakenings from their own mobile phone per month were more likely to have developed restless sleep (Odds Ratio (OR): 5.66, 95% Confidence Interval: 2.24⁻14.26) and problems falling asleep (3.51, 1.05⁻11.74) within one year compared to adolescents without nocturnal awakenings. A similar pattern was observed for developing symptoms, although somewhat less pronounced in terms of the magnitude of the odds ratios. With respect to high screen time at baseline and follow-up, associations were observed for falling asleep (2.41, 1.41⁻4.13), exhaustibility (1.76, 1.02⁻3.03), lack of energy (1.76, 1.04⁻2.96) and lack of concentration (2.90, 1.55⁻5.42). Our results suggest a detrimental effect of screen time and mobile phone-related awakenings on sleep problems and related health symptoms. However, the results should be interpreted cautiously with respect to adolescents' natural changes in circadian rhythm, which may coincidence with an increase in mobile phone and media use.

Intensive virtual reality-based training for upper limb motor function in chronic stroke: a feasibility study using a single case experimental design and fMRI.

PURPOSE: To evaluate feasibility and neurophysiological changes after virtual reality (VR)-based training of upper limb (UL) movements. METHOD: Single-case A-B-A-design with two male stroke patients (P1:67 y and 50 y, 3.5 and 3 y after onset) with UL motor impairments, 45-min therapy sessions 5×/week over 4 weeks. Patients facing screen, used bimanual data gloves to control virtual arms. Three applications trained bimanual reaching, grasping, hand opening. Assessments during 2-week baseline, weekly during intervention, at 3-month follow-up (FU): Goal Attainment Scale (GAS), Chedoke Arm and Hand Activity Inventory (CAHAI), Chedoke-McMaster Stroke Assessment (CMSA), Extended Barthel Index (EBI), Motor Activity Log (MAL). Functional magnetic resonance imaging scans (FMRI) before, immediately after treatment and at FU. RESULTS: P1 executed 5478 grasps (paretic arm). Improvements in CAHAI (+4) were maintained at FU. GAS changed to +1 post-test and +2 at FU. P2 executed 9835 grasps (paretic arm). CAHAI improvements (+13) were maintained at FU. GAS scores changed to -1 post-test and +1 at FU. MAL scores changed from 3.7 at pre-test to 5.5 post-test and 3.3 at FU. CONCLUSION: The VR-based intervention was feasible, safe, and intense. Adjustable application settings maintained training challenge and patient motivation. ADL-relevant UL functional improvements persisted at FU and were related to changed cortical activation patterns. Implications for Rehabilitation YouGrabber trains uni- and bimanual upper motor function. Its application is feasible, safe, and intense. The control of the virtual arms can be done in three main ways: (a) normal (b) virtual mirror therapy, or (c) virtual following. The mirroring feature provides an illusion of affected limb movements during the period when the affected upper limb (UL) is resting. The YouGrabber training led to ADL-relevant UL functional improvements that were still assessable 12 weeks after intervention finalization and were related to changed cortical activation patterns.

Using mixed methods to evaluate efficacy and user expectations of a virtual reality-based training system for upper-limb recovery in patients after stroke: a study protocol for a randomised controlled trial.

BACKGROUND: In recent years, virtual reality has been introduced to neurorehabilitation, in particular with the intention of improving upper-limb training options and facilitating motor function recovery. METHODS/DESIGN: The proposed study incorporates a quantitative part and a qualitative part, termed a mixed-methods approach: (1) a quantitative investigation of the efficacy of virtual reality training compared to conventional therapy in upper-limb motor function are investigated, (2a) a qualitative investigation of patients' experiences and expectations of virtual reality training and (2b) a qualitative investigation of therapists' experiences using the virtual reality training system in the therapy setting. At three participating clinics, 60 patients at least 6 months after stroke onset will be randomly allocated to an experimental virtual reality group (EG) or to a control group that will receive conventional physiotherapy or occupational therapy (16 sessions, 45 minutes each, over the course of 4 weeks). Using custom data gloves, patients' finger and arm movements will be displayed in real time on a monitor, and they will move and manipulate objects in various virtual environments. A blinded assessor will test patients' motor and cognitive performance twice before, once during, and twice after the 4-week intervention. The primary outcome measure is the Box and Block Test. Secondary outcome measures are the Chedoke-McMaster Stroke Assessments (hand, arm and shoulder pain subscales), the Chedoke-McMaster Arm and Hand Activity Inventory, the Line Bisection Test, the Stroke Impact Scale, the MiniMentalState Examination and the Extended Barthel Index. Semistructured face-to-face interviews will be conducted with patients in the EG after intervention finalization with a focus on the patients' expectations and experiences regarding the virtual reality training. Therapists' perspectives on virtual reality training will be reviewed in three focus groups comprising four to six occupational therapists and physiotherapists. DISCUSSION: The interviews will help to gain a deeper understanding of the phenomena under investigation to provide sound recommendations for the implementation of the virtual reality training system for routine use in neurorehabilitation complementing the quantitative clinical assessments. TRIAL REGISTRATION: Cliniclatrials.gov Identifier: NCT01774669 (15 January 2013).