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Child Neuropsychology

A blog by Dr Jonathan Reed

  • I am a avid user of Twitter and find all sorts of interesting information on there. As with the web, however it is difficult to sort out what is important. It also moves so fast that it is hard to keep track. This post highlights some important tweets I have seen regarding advances in neuroscience in the last two weeks.

    1. Repairing brain cells- Researchers at the Montreal NeurologicaI Institute and Hospital (The Neuro) and McGill University group at Montral University have developed a new technique to help repair damaged nerve cells. The study was in the October 7 issue of Journal of Neuroscience. They show that it is possible to use plastic beads coated with a substance that encourages adhesion to help cells grow and form new synapses. You can read about this study here

    2 Gene therapy. A study reported in Nature News investigated possible gene therapy for Parkinson’s disease. Parkinson’s disease is a neurological condition affecting motor control and is associated with a depleted neurotransmitter, dopamine. Stéphane Palfi, a neurosurgeon at the French Atomic Energy Commission’s Institute of Biomedical Imaging in Orsay, and his colleagues simulated Parkinson’s disease in monkeys and then injected the monkeys’ brains with three genes essential for synthesizing dopamine. They saw significant improvements in motor behaviour after just two weeks, without any visible adverse effects. “We don’t see any problems in these monkeys,” says Palfi. One animal even exhibited sustained recovery more than 3.5 years later. You can read about this study here.

    3. Understanding brain development. Researchers at the Stanford University School of Medicine have identified a key molecular player in guiding the formation of synapses. The paper, published online Oct. 8 in the journal Cell, looks at the interaction between neurons and astrocytes. The relationship is complicated but to quote from the report in science daily “It is commonly agreed that the precise placement and strength of each person’s trillions of synaptic connections closely maps with that person’s cognitive, emotional and behavioral makeup. But exactly why a particular synapse is formed in a certain place at a certain time has largely remained a mystery. In 2005, Barres took a big step toward explaining this process when he and his colleagues discovered that a protein astrocytes secrete, called thrombospondin, is essential to the formation of this complex brain circuitry.

    In this new study, Barres, lead author Cagla Eroglu, PhD, and their colleagues demonstrate how thrombospondin binds to a receptor found on neurons’ outer membranes. The role of this receptor, known as alpha2delta-1, had been obscure until now. But in an experiment with mice, the scientists found that neurons lacking alpha2delta-1 were unable to form synapses in response to thrombospondin stimulation.

    The researchers stimulated neurons with thrombospondin and found, those neurons produced twice as many synapses in response to stimulation than did their ummodified counterparts. Understanding this key mechanism could help explain children’s brains development and why this goes wrong for some children. Understanding the biochemistry holds out hope for future treatments. You can read the full report here.

    4. Computer games and rehabilitation. Every week there are reports on how computer games can help learning. As you will see from previous posts on this blog I am great believer in the potential of computer games for rehabilitation and learning. Just one interesting post this week shows an initiative to help individuals with strokes to regain movement using computer game technology. Read about it here.

    This is just a small selection of the information I am finding on Twitter. It shows some of the advances that are being made to understand and help individuals with neurological illness. You can follow me on Twitter here.

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  • I have just seen the preliminary findings of the first independent research study on Neurogames, the games I have developed to help reading and maths. The study was undertaken on 20 children aged 4 to 6. 10 children were given the computer games to play for 20 mins twice a week for 13 weeks at school. 10 children were not given the game and received normal teaching in a different class. Both groups were tested on standardized reading and maths tests (WIAT) before and after the intervention. The results show that the computer game group had an average maths score of 102 (average) before using the games which rose to 123 (above average) after playing the game for 13 weeks. The average group reading score before playing the games was 101.7, which increased to 114.9 after the game. In contrast the children not playing the game started with a reading score of 106.4 and this increased to 109.1 over time. Their maths score started at 103.6 and increased to 109.9. Therefore the study shows that exposure to the Neurogames for 13 weeks lead to substantial increases in maths and reading compared to the control group. These are preliminary findings and they need to be independently reviewed and published but they indicate what may be possible with computer based learning.

    I think that this also shows the importance of scientifically evaluating computer games based on learning. At present whilst there are many educational or brain training games on the market very few are being scientifically evaluated to see if they are effective. There are lots of games that look very good and claim to be brain training or educational but don’t seem to me to have any rationale let alone any evidence. For computer games based learning to develop in my opinion more research has to happen. Computer games lend themselves to scientific study given that they can be seen as a standardised intervention (i.e. they are the same each time they are given) and are easy and ethical to administer. Games can also be developed to incorporate the lasted scientific knowledge- see previous post for discussion on this. I intend to encourage other researchers (please contact me if interested) to independently evaluate the Neurogames with a larger number of children next and also with children with different neurodevelopmental disorders such as dyslexia and dyscalculia. I hope that over the next few years there will be an increasing body of research showing which games and which elements of games are effective in learning and neuropsychological development. This could lead to a revolution in education and rehabilitation.

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  • There is a lot of debate particularly in the media about the pros and cons about computer use with children. I believe that there are some fantastic potential benefits in developing computer games to teach children. Here are 5 of them:

    1. Dissemination of information- Our knowledge about child neuropsychological development is increasing all the time. But there is a problem communicating this to teachers and parents and applying this knowledge. Computer game based learning allows this knowledge to be disseminated to a large number of children. An example is dyslexia (by this I mean difficulties in learning to read). As neuropsychologists we know how reading develops, what part of the brain is involved, how to intervene to improve reading and how this changes the brain areas involved. And yet there are thousands of children who leave school every year unable to read. Developing computer games to address dyslexia using up to date knowledge is possible. Simple computer based learning can spread best practice to everyone (national and international).
    2. Motivation-One of the problems in teaching is in motivating children who find learning difficult or unrewarding. Computer games designers are the experts in motivation especially for kids. I rarely see kids even with severe ADHD who can’t sustain motivation for computer games. Computer game based learning allows educators to combine these motivating factors with learning.
    3. Effectiveness-It is possible to test the effectiveness of computer games based learning programmes in easier ways than it is to assess human taught programmes. Computer games are a standardised procedure that can be easily tested. In this way we combine scientific method with education to determine which programmes are most effective. This in turn will drive development resulting in more effective games over time. This fits with government priorities in producing evidence based learning interventions.
    4. Addressing reasons for learning difficulties. As well as targeting a direct area such as reading it is possible to address indirect reasons for learning difficulties using computer games. A prime candidate is working memory. Whilst it is possible to target and improve working memory directly (see post), it is also possible to use computer games to minimize the demand on working memory with learning programmes by using techniques such as error free learning. It is possible to reduce the need for verbal instructions for children who find listening difficult. It is also possible to reduce attention demands by using visually stimulating action based games.
    5. Computer are patient. As a teacher or parent it can be very frustrating teaching the same thing to a child who just ‘doesn’t get it’. The child also picks up on this and is often anxious about failure. Computers can be very patient. They will repeat the same procedure in the same tone time and time again. Some clever games can lower or raise the demands on the child automatically depending on how the child is doing. The child can work at their own pace and level.

    Therefore in my opinion for all these reasons it makes a lot of sense to develop computer game based learning on a widespread basis. At the moment I think the field is in it’s infancy. To produce good computer game based learning requires a combination of great games design, cleaver programming to build in some of the important factors discussed above and expertise in teaching/ child neuropsychological development. There are thousands of learning games out there but very few based on knowledge of neuropsychological development, with good game play and research to show their effectiveness. I hope that this will change- it could change a lot of children’s lives.

    For an example of a computer game based learning using neuropsychological knowledge visit my games site- Neurogames.

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  • One of the most distressing symptoms for many of the children and young people I see clinically after a traumatic brain injury or stroke is the physical disability caused by the neurological injury. Most parents, children and young people hold out most hope for a physical recovery. The physical disability is the most visible symptom to the patient, their families and to other people. At present the main therapy to help with this is physiotherapy. Physiotherapy requires repeated exercise to try and improve physical function. Recent research has shown that physiotherapy is more effective in treating adult stoke patients than no therapy, although the type of physiotherapy used didn’t seem to make a difference. However, even with a disorder as physically treatable as stroke about 50-60% of individuals do not make a full physical recovery. I think the numbers for TBI based injury who don’t make a recovery would probably be higher. The other problem with a behavioural based phsyiotherapy is that it is difficult to maintain particularly for children and young people with neurological based injury. The exercises tend to be repetitive, lack meaning and often require the individual to remember and practice the therapy on a daily basis. This is a particular problem when children are discharged from hospital and may only see the physiotherapist on a weekly basis. An additional problem maintaining therapy occurs for children and adults with other neurological symptoms such as executive function difficulties (i.e difficulties with initiation, self monitoring, motivation etc) and memory difficulties. Therefore there is a need to develop other treatment approaches. A special edition of the Journal of NeuroEngineering and Rehabilitation out last month is devoted to innovative ways to treat neurologically based physical disability. These are mainly based on non invasive brain stimulation. One approach is Transcranial Magnetic Stimulation. This is based on stimulating the brain using powerful magnets. The neuroscience behind this is explained in detail here. It is believed to enhance the process of plasticity. In terms of outcome this article concludes that ‘There has been some modest functional improvement reported after some NBS interventions, however the longer-term clinical benefits remain unproven’.

    Another approach discussed in this article is the use of robotics e.g using a robotic arm/ exoskeleton to deliver the physical therapy. This takes the effort away from the person and could deliver very precise exercises. It also seems to rely on implicit (rather than explicit) learning which is the way that individuals with brain injury seem to learn best – see this post. The authors describe the outcome research as follows “In a systematic review of eight robotic neurorehabilitation trials, Prange and colleagues concluded that robotic therapies led to long-term improvement in motor control by increasing speed, muscle activation patterns and movement selection, although no consistent benefit was found with ADL (Activities of Daily Living) measures (note the authors explain why this may be the case). There could also be the possibility of combining the robotics with virtual reality and computer games to make physical rehabilitation motivating, fun and engaging. This would make it much more likely for children and young people to benefit from the therapy.

    In all it is still very early in terms of this research to recommend new types of treatment now, but it does show that there are a number of new techniques on the horizon. These techniques would be especially relevant for children and young people with a neurologically based physical disability.

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  • You can now try Neurogames for free with the demos online for the basic maths game Nutty Numbers and the reading game Letter Lilies. The games are specially formulated to help children who find learning difficult including children with dyslexia, dyscalculia, ADHD and Learning difficulties. However, they are based on normal child development and so can be used by anyone learning to read or learning maths. I use them clinically in my practice and I have had great feedback from children of different abilities who have played the games. I believe that using games to help children learn holds great promise for the future. So try the games for free here and let me know what you think.

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  • Scientific and technological knowledge is developing very fast. This post is about some of the ways in which we could use this knowledge to help children develop in ways that will help them and change society in the long term. These are just a few examples of what we know and what we could do.

    1. Eliminate dyslexia- not being able to read as well as being difficult for the individual involved also is associated with significant social problems for example approximately 50 % of adult in prison in the UK have difficulty reading and 80% have difficulty with writing. We know how to treat dyslexia (see this post) Eliminating dyslexia has been attempted in one school district in Scotland with great success. Why can’t we do this everywhere?

    2. Teach children how to be happy- There is a large literature on the science of happiness. For example see Paul Martin’s book Making Happy People: The Nature of Happiness and Its Origins in Childhood. We could use this science to teach children how to live happy lives. Helping children develop in this way early on could set up life long patterns. Imagine the effect on society.

    3. Introduce safe internet based social networking for all children. The potential power of computer based social networks is immense. With twitter, facebook and email we can now talk, communicate and work with people from all walks of life and from all over the world. These have the power to expand social networks and work against isolation and xenophobia. School children could from an early age learn to communicate and work with other children all over the world. There are risks for children in terms of social networking which are often highlighted in the media i.e. abuse online- but the key is to develop safe social networks, for example see Moshi Monsters. Developing safe social networks for children at school could have massive benefits for how they see the world from a social perspective.

    4. Improve children’s working memory (short term memory) – see post. Working memory involves holding information in mind and manipulating it. It is involved in listening to instructions, formulating thoughts, planning etc. It is linked with academic and intellectual development. It is a key skill to have as an adult. Difficulties with working memory are also associated with children with neurodevelopmental problems such as ADHD. We have the tools to help improve working memory in children. This is brain training at it’s best. Could this be part of regular school exercises in the same way as PE is?

    5. Develop Computer based learning- so many children become disillusioned with learning and give up. Computer based learning has the power to engage children and deliver learning in new specialized ways. Games designers have worked out with great success how to motivate children. Neuroscientists know how children learn. If we combine knowledge in these two areas we could revolutionize learning. I have started on this process in with Neurogames. Also see the Consularium blog for examples of how this has been tried in innovative ways in schools in Scotland.

    These are just some ideas, but imagine if we could produce a generation of children who were happy, with optimal brain development, with a broad social network, whose brains are primed to learn and think. What would this do for the next generation and for society in the future. We have the knowledge to do this. Could we make it happen? Let me know what you think?

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  • Does brain training work? There are a number of conflicting studies in the literature see Guardian games blog for example. There has recently been a lot of interest in the Ninetendo DS brain training game although I am not aware of any published work on it’s effectiveness (but see this BBC site article for some anecdotal evidence.) I have just come across a good study in the British Journal of Educational Technology by Miller and Robertson 2009 showing improvements in self esteem, and accuracy and speed of mental maths using the DS brain training games (Also see comment from Derek Robinson below). I note that in this study only the specific task of mental maths improved, which is partly what the DS program trains.  I don’t think there is evidence that the DS BT works across different areas to train the brain as a whole.  Nintendo brain training does not train specific brain areas or functions and does not fit with contemporary neuropsychological theory.  It is a more broad brush approach.   In reality the brain has numerous functions linked to different anatomical areas and trying to train the whole thing at once is, I think nonsensical. Brain training will have to become a lot more targeted if it is to work.

    There is some evidence that targeting specific areas can be effective. The key candidate at the moment is working memory. Working memory is the ability to hold information in mind i.e mental arithmetic , remembering lists of instructions etc. Working memory is associated with the dorsal-lateral pre- frontal cortex in the brain. There is an interesting paper in PNAS that shows that training working memory resulted in increased IQ levels. You can access the training site and try it for yourself here for free. Also there is some interesting new research on improving working memory using a computer game, which is due to be published soon and which I will report on here.

    The key to brain training is to know how the brain works and how it develops and then to target set areas. My own company Neurogames produces brain training games based on the science of brain and psychological development. The games are targeted on areas where I think we should be able to produce change and where I think brain plasticity exists. It is important to understand how the brain and it’s functions develop as this holds the key to what can potentially change. I am carrying out research on this at the moment. If we can show through good science and based on solid neuropsychological theory that change can occur and how it occurs, then there is the possibility to revolutionize how we learn.

    Note: Update 20.4.10 a new large scale study published in Nature suggests that Nintendo brain training is not effective in producing transferable cognitive benefits.  Initial nature study is published here

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  • I have just developed a new concept combining my knowledge of neuropsychology with computer games. It is called Neurogames and the games are available for purchase on my new website neurogames.co.uk. At present I have developed four games helping children to develop maths and numeracy. The games are based on the science of the development of reading and numeracy drawing on some of the work from the contributors writing in our book Child Neuropsychology as well as some of the research studies highlighted in this blog. The games take a developmental course mirroring the normal developmental sequence of reading and maths acquisition. The games also draw on my clinical expertise in terms of what helps children with neurodevelopmental difficulties. This includes errorless learning, frequent extrinsic rewards, visual based learning with bright attractive graphics and short game sequences with clear indicators to help children with short attention span. Computer games are also not critical and therefore the social pressure on learning is eliminated. Finally games are fun and Neurogames provides a new fun way of learning. I hope that the games will be helpful for children who find learning difficult whether it be because of a specific difficulty such as dyslexia or dyscalculia or because of a general difficulty such as ADHD, learning disability or brain injury. The games are easily to download and can be purchsed direct from the site. I also hope over the next year to develop more games to help with language and memory development. Let me know what you think.

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  • Technology is developing very fast and I think there are increasing applications for children and young people with neurological or neurodevelopmental difficulties. Recently I have recommended the Apple system for several of my clients. I am fairly new to Apple but I am very impressed by its applicability in rehabilitation. Theses are some of the areas where it can benefit:

    Executive function- Individuals with executive difficulties have difficulties with planning and organisation, working memory, self monitoring, flexibility etc. This typically occurs after a brain injury but is also seen in ADHD and other neurodevelopmental disorders. What I like about the Apple imac and Apple iphone is that it doesn’t rely on planning. It is very visual and intuitive. The menus open out across the page so you can see where you are and where to go rather than as in Windows having to work out where to find what you are looking for and remembering where it is. It is very visually icon based. The calendar feature allows parents, support worker and young people to produce colour coded structured timetables which help with planning, initiation, flexibility issues etc. It is also possible to set reminders of tasks to do.

    Memory difficulties- As well as the calendar which can be on both the imac and the iphone ,the mobile me feature allows you automatically synch timetables, diaries and to do lists. If the iphone is lost there is an automatic back up. You don’t need to remember to back up. The reminders feature gives prompts regarding what to do next. I also like the photo albums on the iphone. These can be used as a memory prompts when set up right. The Google maps feature is useful when lost!

    Social difficulties- I have found the photo albums very helpful for individuals who are unsure what to say in social situations (either because of social difficulties or memory difficulties). Showing someone what you have been doing (through photos) is a good way to start a conversation. There is also the possibility of using social network sights such as Facebook and Bebo which is great for individuals with disability. The photos can also be used for children with communication problems and children who rely on visual based learning and organisation.

    Finally there are an increasing number of applications for learning and fun which can be downloaded quickly. I think that the potential benefits of these systems and technology in general for rehabilitation are great and I will be reviewing this over time.

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