A Serious Game for Cognitive Stimulation of Older People With Mild Cognitive Impairment: Design and Pilot Usability Study.

Background: Cognitive stimulation of older people helps prevent, and even treat, age-related diseases, such as mild cognitive impairment. Playing games reduces the probability of experiencing this pathology, which is related to the loss of the ability to carry out some instrumental activities of daily living. Objective: This work describes the design and development of a serious game for the cognitive stimulation of older people, with exercises related to the daily life task of shopping. A pilot study for its preliminary usability validation is also presented. Methods: The designed serious game includes 4 exercises consisting of shopping in a hypermarket, ordering products, making payments, and organizing the purchase, thus dealing with the most frequent cognitive problems of older people associated with episodic declarative memory, naming, calculation, and organization, respectively. Results: A total of 19 older people participated in the pilot study for the usability validation of the serious game. They indicated that they like the aesthetic and interesting topic of the game. They reported that it provides a high level of entertainment and could be useful in daily life for mental stimulation. The participants found the serious game to be intuitive, but the ease of use and readability of the instructions could be improved. Conclusions: This study suggests that the innovative serious game developed could be accepted by older people for their cognitive stimulation to prevent or treat mild cognitive impairment, although a long-term intervention study should be performed as future work. Its ecological validity design, with everyday tasks, adaptable levels of difficulty, and motivational mechanisms, is a differentiating factor compared to similar serious games.

Effects of a Cognitive Stimulation Program in Institutionalized Patients with Dementia.

Background: The advances achieved by the available research that focus on understanding memory operation and cognitive functions have helped the development of specific treatment approaches. These can help to maintain or improve the cognitive function and well-being of people with dementia. The use of cognitive stimulation in dementia has a long history. There are multiple studies that have demonstrated its benefits on the cognitive levels of patients with mild to moderate dementia. However, all of the studies on this type of non-pharmacological intervention conclude that there is a need for more clinical trials in order to give more solidity to the evidence already found. The objective of this pilot study was to assess the effects of an occupational therapy cognitive training program on the cognitive function of institutionalized older adults with dementia. Methods: The study was a pilot randomized clinical controlled trial. A total of 58 participants with major neurocognitive disorder or dementia were randomized to the occupational therapy cognitive training program group or to the conventional occupational therapy group twice a week for 5 weeks. The cognitive level was measured with the Global Deterioration Scale (GDS) and the Lobo's Cognitive Mini Test (LCMT), which is the Mini-Mental Status Examination in Spanish. Measures were taken at baseline (week 0), after 5 weeks of treatment (week 5), and after 6 weeks of follow up (week 12). A value of p < 0.05 was considered as statistically significant. Results: There were no statistical differences between groups in the LCMT global scores at baseline or after the intervention at week 5. However, the analysis of the specific cognitive areas assessed in the Lobo's Cognitive Mini Test indicated that that the intervention group significantly improved comprehension of verbal commands and praxis (p = 0.021). At the follow-up measure, the differences obtained in relation to verbal commands and praxis maintained the statistical differences significantly (p = 0.009). Conclusions: Occupational therapy based on cognitive training shows positive effects on the maintenance of the global cognitive state of institutionalized older adults with dementia and improves significantly the comprehension of verbal commands and praxis.

Orthopaedic Disorders in Cerebral Palsy in International Cooperation Projects: A Descriptive Cross-Sectional Study.

BACKGROUND: In international cooperation projects that are carried out in less developed and developing countries, a large number of children with disabilities present cerebral palsy (CP). Orthopaedic disorders are frequent complications associated with this disorder. Their prevention and early intervention are essential to achieve an appropriate therapeutic approach for children with PC and to improve their quality of life. OBJECTIVE: To describe the treatment approach that is currently used in international cooperation projects for the rehabilitation management of the orthopaedic disorders in children with cerebral palsy. METHODS: This is an observational, descriptive, cross-sectional study, carried out by means of an online questionnaire to professionals in the field of Physiotherapy and Rehabilitation working in international cooperation projects. The inclusion criteria were professionals working in the rehabilitation field in development aid, humanitarian action or emergency projects that provided rehabilitation services, working with children with cerebral palsy from 0 to 18 years old. RESULTS: Ninety-eight questionnaires were analysed. The average age of the participants was 33.2 years, they were mainly working in development cooperation projects (83.33%) that were implemented in rehabilitation centres and through community-based rehabilitation services (60%). The projects were located in countries all over the world but mainly on the Asian continent (71.4%). Physiotherapists and orthopaedic technicians (72.22%) were the main professionals working in these projects, followed by occupational therapists and social workers (55.56%). The results indicated that the orthopaedic disorders were very frequent in the sample (66.67%), with hip subluxation (50%), scoliosis (77.78%), kyphosis (61.1%), clubfoot (88.7%) and varus foot (61.11%) standing out. The most commonly used treatment approaches were positioning (88.89%) and the Bobath concept (83.33%). The technical aids that were used by the professionals were ankle foot orthosis (AFO) (94.44%), bracing (66.67%), standing frames (83.33%), moulded seats (100%), corner seats (93.75%) and adapted seats (92.85%). CONCLUSIONS: In international cooperation projects, the rehabilitation treatment of children with cerebral palsy is based on a holistic approach. This is reflected in the interventions that are carried out to treat their orthopaedic disorders and in locally produced devices, awareness raising and community education. However, the professionals surveyed considered that the aids or orthoses used are insufficient in the treatment and prevention of orthopaedic disorders in cerebral palsy.

Effects of a Cognitive Rehabilitation Programme on the Independence Performing Activities of Daily Living of Persons with Dementia-A Pilot Randomized Controlled Trial.

BACKGROUND: In all types of dementia, cognitive abilities are affected, behaviour is altered and functional capacity is progressively lost. This cognitive deterioration manifests in the decrease of abilities required to perform the activities of daily living (ADL). The objective of this pilot study was to assess the effect of an Occupational Therapy programme based on the training of ADL through cognitive stimulation on the independence of ADL of persons with dementia. METHODS: Institutionalized older adults with major neurocognitive disorder or dementia (N = 58) were randomly allocated to receive either the Occupational Therapy ADL cognitive stimulation programme or conventional Occupational Therapy. The cognitive level and the independence level performing ADL were measured at baseline (week 0), after 5 weeks of treatment (week 5) and after 6 weeks of follow up (week 12). A value of p < 0.05 and α = 0.0025 (Bonferroni correction) was considered as statistically significant. RESULTS: The results obtained showed improvements in the level of independence performing ADLs in the intervention group compared to the control group (p = 0.006). The improvements were seen in relation to feeding (p = 0.001), dressing (p = 0.005) and bladder and bowel incontinence (p = 0.003), the changes observed in feeding are statistically significant. However, those improvements were not maintained after the follow up period. There were no significant changes in relation to the cognitive level (p = 0.741). CONCLUSIONS: Occupational Therapy based on ADL cognitive stimulation can have a positive effect, increasing the independence of subjects with major neurocognitive disorder or dementia who are institutionalised.

Quantitative ultrasound measurements of the calcaneus and hand phalanges in elderly Spanish men: relationship with peripheral bone mineral density of the hand phalanges.

OBJECTIVES: The aims of this pilot study were to describe quantitative ultrasound (US) measurements and peripheral bone mineral density (BMD) of the hand phalanges on dual-energy x-ray absorptiometry and to examine the correlations between them in elderly Spanish men. METHODS: We studied 199 healthy men (mean age ± SD, 73.31 ± 5.10 years). The participants were not taking any medications, and they reported no diseases, including diseases that are associated with abnormalities in mineral metabolism. Phalangeal and calcaneal quantitative US measurements and phalangeal BMD measurements were performed in all participants. RESULTS: A bivariate correlation analysis showed no association between quantitative US assessments at the phalanges or the calcaneus (P = .409). After adjustment for potential confounders, the correlation between phalangeal BMD and phalangeal quantitative US measurements was r = 0.417 (P < .0001), and the correlation for calcaneal quantitative US was r = 0.26 (P = .001). Further adjustment by percentage of body fat increased quantitative US correlations with phalangeal BMD: r = 0.450 (P < .0001) at the phalanges; r = 0.291 (P = .001) at the calcaneus. CONCLUSIONS: There is a small correlation between quantitative US measurements at the calcaneus and phalangeal BMD that increases to a moderate level with quantitative US measurements at the phalanges in elderly Spanish men.

Bone mass of Spanish school children: impact of anthropometric, dietary and body composition factors.

The purpose of this study was to: (a) determine the relationship between quantitative ultrasound (QUS) results and anthropometric, dietary and body composition factors and establish reference ranges for amplitude-dependent speed of sound (Ad-SoS) in the phalanges and broadband ultrasound attenuation (BUA) in the calcaneus of children from Extremadura, Spain, and (b) to present reference curves for this population. Healthy children (n = 245), aged 4-16 years, were included (124 girls and 121 boys). Phalangeal and calcaneal QUS measurements were performed using DBM Sonic Bone Profiler and McCue CUBA Clinical ultrasound devices, respectively. Weight, height and body mass index (BMI) were evaluated by anthropometric methods. Fat percentage, fat mass, lean mass (FFM) and total body water (TBWater) were evaluated by bioelectrical impedance measurements using a Holtain body composition analyzer. Food intake was evaluated by a 7-day food record. A gender analysis revealed that Ad-SoS and BUA parameters increased significantly with age and that both positively correlated with age, weight, height, BMI, FFM and TBWater. For both genders, Ad-SoS showed significant and positive correlations with age, weight, height, BMI, FFM, BUA and TBWater.

Effect of beer drinking on ultrasound bone mass in women.

OBJECTIVE: To study the effect of beer consumption on bone mass in a group of healthy women, by using phalangeal bone ultrasound to evaluate the amplitude-dependent speed of sound. METHODS: This was a cross-sectional study of 1697 healthy women (mean age 48.4 y, body mass index (BMI) 19.0-32.0 kg/m(2)), recruited in a clinical convenience sample and screened for the existence of disease and/or medication that would affect calcium metabolism. Of this total, 710 were premenopausal, 176 were perimenopausal, and 811 were postmenopausal. The women recruited completed a questionnaire that contained detailed sections on current cigarette, alcohol, caffeine, and nutrient consumption. In terms of current alcohol intake, the subjects were classified as moderate drinkers, light drinkers, and nondrinkers. Drinkers were also analyzed according to the kind of alcohol consumed: wine or beer. RESULTS: Quantitative bone ultrasound values were greater in the beer drinkers compared with the no beer and/or wine drinkers. Taking the amplitude-dependent speed of sound as a dependent variable, and age, BMI, gonadal status, intake of beer and wine, and number of cigarettes per day as independent variables, we found age (beta = -1.52), BMI (beta = -3.86), gonadal status (beta = -27.47), and beer intake (beta = 1.06) to be significant. CONCLUSION: The greater bone density found in women beer drinkers might be a result of the phytoestrogen content of this alcoholic drink; this requires further investigation.