Assessment and Brain Training of Patients Experiencing Head and Facial Pain with a Distortion of Orofacial Somatorepresentation: A Narrative Review

The management of patients experiencing chronic orofacial pain is a great challenge, due to the complexity of chronic pain itself, combined with an increased peripheral sensitization in the craniofacial itself. Therefore, patients with orofacial pain may present a clear distortion of the somatorepresentation after some time. In this review, the authors develop a neurophysiological explanation of orofacial distortion, as well as propose assessment and treatment options, based on scarcely available scientific evidence and their own clinical experience. The assessments of facial somatosensory, cognitive-affective and motor dysfunctions are crucial to establish the most accurate treatment; the assessment tools are described in the article. Two-point discrimination, laterality recognition and emotion recognition are altered in patients with orofacial pain. Other sensorimotor assessment tools, such as motor acuity and auditory acuity, are also explained. Finally, the authors review their treatment proposals, based on the integration of brain training techniques and biobehavioral interventions. Somatosensory reintegration (tactile acuity training), facial emotion recognition, movement representation techniques, orofacial motor training and therapeutic patient education are explained in detail, and this may challenge new directions in rehabilitation and research.

Effects of Persistent Concussion Symptoms on Executive Function in Working-aged Adults using a Novel Sensorimotor Assessment Tool

ObjectiveTo examine neurocognitive performance of persistent concussion symptom patients using a novel sensorimotor technology.BackgroundIn patients with persistent concussion symptoms, neurocognitive deficits have been routinely identified; however, most of the current literature focuses on athletes and military veterans. Middle aged community members face unique challenges related to jobs, family, and transportation which can all be adversely affected by neurocognitive deficits.Design/MethodsThirteen adults (44.3 ± 12.6 years) with self-reported persistent-concussion symptoms (PCS) at least 3 months post-injury, and thirteen sex and age matched healthy controls (37.5 ± 8.8 years) were recruited. Participants performed the Trail-Making Test A (TMT-A) and Trail-Making Test B (TMT-B) on a novel sensorimotor assessment tool, the KINARM (BKIN Technologies, Kingston, ON, Canada). Using their dominant hand, TMT-A required participants to connect numbered dots in ascending order as quickly as possible. TMT-B required connecting dots with either a number or letter inside, in an alternating number-letter fashion (i.e.,: 1-A-2-B-3-C…). Total number of symptoms and a symptom severity score were assessed using the Rivermead Post Concussion Symptoms Questionnaire (RPQ). An independent samples t-test was used to analyze group differences of total time to completion, dwell time, and number of errors.ResultsAs expected, PCS patients had a significantly higher number of symptoms and severity score (PCS: 13.4 ± 2.3 and 36.2 ± 14.5, respectively; Controls: 3.4 ± 3.7 and 5.3 ± 5.6, respectively, p < 0.001). PCS patients were significantly slower on TMT-A (46.3 ± 20.1 sec; and 34.7 ± 6.5 sec respectively, p = 0.047). There were no group differences in TMT-B.ConclusionsOur results suggest that neurocognitive function may remain unaffected by persistent concussion symptoms in working-aged adults. The lack of task performance differences may be a result of neurocognitive function recovery, or the need for a more sensitive task to assess neurocognitive function in this population.

SITAR: a system for independent task-oriented assessment and rehabilitation

Introduction Over recent years, task-oriented training has emerged as a dominant approach in neurorehabilitation. This article presents a novel, sensor-based system for independent task-oriented assessment and rehabilitation (SITAR) of the upper limb. Methods The SITAR is an ecosystem of interactive devices including a touch and force–sensitive tabletop and a set of intelligent objects enabling functional interaction. In contrast to most existing sensor-based systems, SITAR provides natural training of visuomotor coordination through collocated visual and haptic workspaces alongside multimodal feedback, facilitating learning and its transfer to real tasks. We illustrate the possibilities offered by the SITAR for sensorimotor assessment and therapy through pilot assessment and usability studies. Results The pilot data from the assessment study demonstrates how the system can be used to assess different aspects of upper limb reaching, pick-and-place and sensory tactile resolution tasks. The pilot usability study indicates that patients are able to train arm-reaching movements independently using the SITAR with minimal involvement of the therapist and that they were motivated to pursue the SITAR-based therapy. Conclusion SITAR is a versatile, non-robotic tool that can be used to implement a range of therapeutic exercises and assessments for different types of patients, which is particularly well-suited for task-oriented training.

Surgical Performance Assessment

This article focuses on human skill understanding in the context of surgical assessment and training which has enormous and immediate application potential to enhance healthcare delivery. Surgical procedural performance involves interplay of a highly dynamic system of inter-coupled perceptual, sensory, and cognitive components. Computer-Integrated Surgery systems are a quintessential part of modern surgical workflow owing to developments in miniaturization, sensors and computation. Robotic Minimally Invasive Surgery, and the engendered computer-integration, offers unique opportunities for quantitative computer-based surgical-performance evaluation. The skill evaluation metrics as discussed need a variety of sensory data that limits the application to very specific robotic devices. The ability to couple quantitative, validated and stable metrics for surgical performance would lead to improvements in assessment and subsequently, training methods. Cognitive assessment can now be extended to also include sensorimotor assessment, with capacity to monitor and track skill across time.