Different Levels Of Impairment Research Articles

Characterizing cognitive phenotypes and clinical correlates in type 2 diabetes using fuzzy clustering and decision tree analysis

Cognitive impairment is frequently seen in patients with type 2 diabetes (T2DM), ranging from mild impairment to dementia. However, our knowledge of the specific profiles and risk factors for these different levels of impairment is limited. In this study involving 152 patients with T2DM, cognitive function was assessed using the Montreal Cognitive Assessment test. The Fuzzy C-means clustering algorithm was utilized to group individuals with similar cognitive characteristics. The study evaluated how well clinical parameters could classify characteristics of clusters using the Classification and Regression Trees algorithm. ROC analysis was then used to assess the classification success. Three distinct cognitive clusters were identified. Cluster 1 had the poorest cognitive performance and was characterized by more women, lower education levels, and lower levels of iron, hemoglobin, and creatine. Cluster 3, the amnestic cluster, was distinguished by low TSH levels. The decision tree model highlighted several parameters, including education level, hemoglobin, duration of diabetes mellitus (DM), iron, TSH, gender, family history of diabetes, and microalbumin/creatinine ratio, as significantly affecting the distinction of cognitive clusters. Diabetes-associated cognitive impairment stems from multifaceted pathophysiological mechanisms influenced by complex risk factors, resulting in diverse types of cognitive deficits.

Neuro-orthopaedic check-up and walking in people with multiple sclerosis: toward a more specific assessment to improve rehabilitation results.

The rehabilitation process of people with multiple sclerosis (PwMS) is a challenge, and decision-making requires a thorough assessment to increase the chances of success in rehabilitation planning. The aim of this study was to investigate the importance of the neuroorthopaedic check-Up (NOChU) for gait prognosis. Participated in the study 105 PwMS with different levels of impairment. The NOChU includes measurements of passive range of motion (ROM), muscle strength, and spasticity. Additionally, was carried out the spatial-temporal analysis of the walking, Timed Up and Go test, and 6-min walk test. ROM remained relatively preserved to perform daily life activities except for ankle dorsiflexion. Muscle strength was also relatively preserved. Spasticity affected especially the ankle muscles, clearly the sural triceps. Among the NOChU measurements the catch seemed to have the most impact on walking on its different phases and on other activities. Accurate NOChU measurements play a crucial role in clinical settings, guiding informed decisions in rehabilitation planning. Future research endeavours could focus on exploring the correlations between NOChU deficiencies and the decline in walking capabilities among PwMS, with the goal of proposing personalized treatment strategies that address their specific requirements.

How does classification score affect falls in wheelchair basketball? A video-based cross-sectional study on the Italian national team during the European Para Championships 2023

ObjectivesThe aim of this study was to investigate the mechanism of falls in male elite wheelchair basketball (WB) players and to analyse the falls characteristics considering their classification score which ranges from 1.0 to 4.5 and it is related to their functional capacity and particularly to their volume of action. DesignA cross-sectional video analysis was conducted using European para championships 2023official match videos. SettingPlayers of the sample team were divided into 2 groups according to their classification point: low-point players (LPP) and high-point players (HPP). Every occurred fall was systematically analysed focusing on falling related characteristics and game circumstances. ParticipantsTwelve WB players of the Italian national team. Main outcomeNumber of falls and mechanism of falls. ResultsThe results showed a higher number of falls for HPP and highlighted a statistically significant differences between LPP and HPP for the fall direction, the playing time and the first anatomical site in contact with the floor. ConclusionResults reported significant differences between LPP and HPP in terms of mechanism of fall. Further studies should focus on the development of new preventive training strategies tailored to WB players with different levels of impairments to reduce fall related injuries.

BrainAGE: Revisited and reframed machine learning workflow.

Since the introduction of the BrainAGE method, novel machine learning methods for brain age prediction have continued to emerge. The idea of estimating the chronological age from magnetic resonance images proved to be an interesting field of research due to the relative simplicity of its interpretation and its potential use as a biomarker of brain health. We revised our previous BrainAGE approach, originally utilising relevance vector regression (RVR), and substituted it with Gaussian process regression (GPR), which enables more stable processing of larger datasets, such as the UK Biobank (UKB). In addition, we extended the global BrainAGE approach to regional BrainAGE, providing spatially specific scores for five brain lobes per hemisphere. We tested the performance of the new algorithms under several different conditions and investigated their validity on the ADNI and schizophrenia samples, as well as on a synthetic dataset of neocortical thinning. The results show an improved performance of the reframed global model on the UKB sample with a mean absolute error (MAE) of less than 2 years and a significant difference in BrainAGE between healthy participants and patients with Alzheimer's disease and schizophrenia. Moreover, the workings of the algorithm show meaningful effects for a simulated neocortical atrophy dataset. The regional BrainAGE model performed well on two clinical samples, showing disease-specific patterns for different levels of impairment. The results demonstrate that the new improved algorithms provide reliable and valid brain age estimations.

Enhancing prompt perception in dementia: a comparative study of mixed reality cue modalities.

Dementia impacts millions worldwide and is challenging individuals' ability to engage in daily activities. Active living is crucial in mitigating dementia's neurodegenerative effects, yet people with dementia often struggle to initiate and complete tasks independently. Technologies offer promising solutions to engage people with dementia in activities of active living and improving their quality of life through prompting and cueing. It is anticipated that developments in sensor and wearable technologies will result in mixed reality technology becoming more accessible in everyday homes, making them more deployable. The possibility of mixed reality technologies to be programmed for different applications, and to adapt them to different levels of impairments, behaviours and contexts, will make them more scalable. The study aimed to develop a better understanding of modalities of prompts that people with dementia perceive successfully and correctly in mixed reality environments. It investigated interactions of people with dementia with different types of visual (graphics, animation, etc.) and sound (human voice, tones, etc.) prompts in mixed reality technologies. We used the Research through Design (RtD) method in this study. This paper describes the findings from the user research carried out in the study. We conducted observation studies with twenty-two people with dementia playing games on off-the-shelf mixed reality technologies, including both Augmented Reality (HoloLens, ArKit on iPhone) and Augmented Virtuality (Xbox Kinect and Osmo) technologies. The interactions with the technologies during the gameplay were video recorded for thematic analysis in Noldus Observer XT (version 16.0) for successful and correct perception of prompts. A comparison of the probability estimates of correct perception of the prompts by people with dementia suggests that human voice, graphic symbols and text are the most prominently perceived modalities of prompts. Feedback prompts for every action performed by people with dementia on the technology are critical for successful perception and should always be provided in the design. The study has resulted in recommendations and guidelines for designers to design prompts for people with dementia in mixed-reality environments. The work lays the foundation for considering mixed reality technologies as assistive tools for people with dementia, fostering discussions on their accessibility and inclusive design in technology development.

Design and Characterization of a Self-Aligning End-Effector Robot for Single-Joint Arm Movement Rehabilitation

Traditional end-effector robots for arm rehabilitation are usually attached at the hand, primarily focusing on coordinated multi-joint training. Therapy at an individual joint level of the arm for severely impaired stroke survivors is not always possible with existing end-effector robots. The Arm Rehabilitation Robot (AREBO)—an end-effector robot—was designed to provide both single and multi-joint assisted training while retaining the advantages of traditional end-effector robots, such as ease of use, compactness and portability, and potential cost-effectiveness (compared to exoskeletons). This work presents the design, optimization, and characterization of AREBO for training single-joint movements of the arm. AREBO has three actuated and three unactuated degrees of freedom, allowing it to apply forces in any arbitrary direction at its endpoint and self-align to arbitrary orientations within its workspace. AREBO’s link lengths were optimized to maximize its workspace and manipulability. AREBO provides single-joint training in both unassisted and adaptive weight support modes using a human arm model to estimate the human arm’s kinematics and dynamics without using additional sensors. The characterization of the robot’s controller and the algorithm for estimating the human arm parameters were performed using a two degrees of freedom mechatronic model of the human shoulder joint. The results demonstrate that (a) the movements of the human arm can be estimated using a model of the human arm and robot’s kinematics, (b) AREBO has similar transparency to that of existing arm therapy robots in the literature, and (c) the adaptive weight support mode control can adapt to different levels of impairment in the arm. This work demonstrates how an appropriately designed end-effector robot can be used for single-joint training, which can be easily extended to multi-joint training. Future work will focus on the evaluation of the system on patients with any neurological condition requiring arm training.

Dysarthria detection using convolution neural network

Dysarthria patients have difficulty controlling their speaking muscles, resulting in incomprehensible speech. A number of studies have looked into speech impairments; however, more research is needed to consider speakers with the same impairment but different levels of impairment. The type of impairment and severity level will aid in determining the dysarthria's progression as well as treatment planning. The use of a Convolutional Neural Network-based model to detect dysarthria is proposed in this paper. Early detection is the first step toward better impairment management. For the analysis of speech signals, the proposed model uses a number of speech features such as zero crossing rates, MFCCs, spectral centroids, and spectral roll off. For training and testing, the proposed model is used the TORGO speech signal database. With an accuracy score of 93.87%, CNN shows promising results in early dysarthric speech diagnosis.

Novel Platform for Quantitative Assessment of Functional Object Interactions After Stroke.

Many persons with stroke exhibit upper extremity motor impairments. These impairments often lead to dysfunction and affect performance in activities of daily living, where successful manipulation of objects is essential. Hence, understanding how upper extremity motor deficits manifest in functional interactions with objects is critical for rehabilitation. However, quantifying skill in these tasks has been a challenge. Traditional rehabilitation assessments require highly trained clinicians, are time-consuming, and yield subjective scores. This paper introduces a custom-designed device, the "MAGIC Table", that can record real-time kinematics of persons with stroke during interaction with objects, specifically a 'cup of coffee'. The task and its quantitative assessments were derived from previous basic-science studies. Six participants after stroke and six able-bodied participants moved a 3D-printed cup with a rolling ball inside, representing sloshing coffee, with 3 levels of difficulty. Movements were captured via a high-resolution camera above the table. Conventional kinematic metrics (movement time and smoothness) and novel kinematic metrics accounting for object interaction (risk and predictability) evaluated performance. Expectedly, persons with stroke moved more slowly and less smoothly than able-bodied participants, in both simple reaches and during transport of the cup-and-ball system. However, the more sensitive metric was mutual information, which captured the predictability of interactions, essential in cup transport as shown in previous theoretical research. Predictability sensitively measured differences in performance with increasing levels of difficulty. It also showed the best intraclass consistency, promising sensitive differentiation between different levels of impairment. This study highlights the feasibility of this new device and indicates that examining dynamic object interaction may provide valuable insights into upper extremity function after stroke useful for assessment and rehabilitation.

Identifying Subtypes of Alzheimer’s Disease: An analysis of possible cognitive subgroups through the life span

AbstractBackgroundTypical Alzheimer’s disease (AD) is linked to memory impairment and medial temporal lobe atrophy. However, different patterns of cognitive decline in individuals with AD have been described in the literature (e.g., Murray et al., 2011; Lam et al., 2013; Scheltens et al., 2015). The variability of AD is also observed throughout the life span, as aging processes develop (Ferreira et al., 2017), which highlights the importance of investigating changes over time and establishing possible stages and therapeutic windows.MethodThe Toronto Cognitive Assessment (TorCA) was used to provide a characterization of cognitive profiles including orientation, immediate recall, delayed recall, delayed recognition, visuospatial function, executive control and language in 609 individuals with possible AD. Normative data for the TorCA (Freedman et al., 2018) suggest different levels of impairment can be identified depending on age groups. The present study investigated 27 neuropsychological subtests within the TorCA. Scores were summed based on cognitive domains and transformed into z‐scores. Further, the dataset was split into 4 age groups (Group 1 = less than 59; Group 2 = 60 to 69; Group 3 = 70 to 79; and Group 4 = over 80 years of age). The scores were analyzed with latent profile analyses (LPA) to identify cluster memberships among subjects.ResultDifferent AD subtypes were identified in each age group characterized by patterns of cognitive impairment as follows:a) Group 1:1. Cluster 1: mild;2. Cluster 2: amnestic;3. Cluster 3: executive;4. Cluster 4: moderate diffuse.b) Group 2:1. Cluster 1: mild diffuse;2. Cluster 2: executive / visuospatial;3. Cluster 3: moderate with preserved orientation and visuospatialc) Group 3:1. Cluster 1: moderate executive;2. Cluster 2: mild diffuse;3. Cluster 3: amnestic;4. Cluster 4: moderate diffuse.d) Group 4:1. Cluster 1: severe diffuse;2. Cluster 2: mild diffuse.ConclusionThese findings suggest that different subtypes of AD can be identified throughout the life span. Further investigation of these differences will aid in the development of clinical tools to diagnose and treat subgroups, in the development of protocols that stratify this population for better research recruitment, and establishing relevant neuropsychological and clinical tools.

Handedness did not affect motor skill acquisition by the dominant hand or interlimb transfer to the non-dominant hand regardless of task complexity level

Patients undergoing unilateral orthopedic or neurological rehabilitation have different levels of impairments in the right- or left-dominant hand. However, how handedness and the complexity of the motor task affect motor skill acquisition and its interlimb transfer remains unknown. In the present study, participants performed finger key presses on a numeric keypad at 4 levels of sequence complexities with each hand in a randomized order. Furthermore, they also performed motor sequence practice with the dominant hand to determine its effect on accuracy, reaction time, and movement time. The NASA-TLX at the end of each block of both testing and practice was used to confirm participants’ mental workload related to sequence complexity. Both right- and left-handed participants performed the motor sequence task with faster RT when using their right hand. Although participants had increasing RT with increasing sequence complexity, this association was unrelated to handedness. Motor sequence practice produced motor skill acquisition and interlimb transfer indicated by a decreased RT, however, these changes were independent of handedness. Higher sequence complexity was still associated with longer RT after the practice, moreover, both right- and left-handed participants’ RT increased with the same magnitude with the increase in sequence complexity. Similar behavioral pattern was observed in MT as in RT. Overall, our RT results may indicate left-hemisphere specialization for motor sequencing tasks, however, neuroimaging studies are needed to support these findings. On the other hand, handedness did not affect motor skill acquisition by the dominant hand or interlimb transfer to the non-dominant hand regardless of task complexity level.

Restorative rehabilitation robotics to promote function, independence and dignity: users’ perspectives on clinical applications

People with mobility impairments have reported that improving their walking is one of the most important goals of their rehabilitation. Novel robotic technologies using powered exoskeletons for the lower limb could potentially offer efficient and less labour-intensive approaches to rehabilitation with shorter recovery times. To gather users’ and carers’ perspectives of assistive device use to provide information to design personalised and safe mobility rehabilitation technology. Semi-structured interviews were carried out with people with experience of mobility impairments. Iterative data collection was used to gather information about the social phenomena surrounding patient interaction and requirements for assistive devices for mobility impairments. Cycles of continuous data collection and thematic analysis using a theoretical, semantic approach was used to develop key themes within the data. We interviewed eight people: six people with mobility impairments and two carers. We identified five main themes: relationship with assistive technology, requirements for assistive technology, function and goal setting, personal factors to assistive device use and psychosocial factors to assistive device use. There was variability in the importance placed on each theme, particularly in the trade-off between the function and comfort of assistive technology. Patients emphasised the need for assistive technology to be personalised; they reported the ability to stand, control spasticity and involvement in community roles as key goals of their rehabilitation. These results highlight the variation in requirements for assistive technology between people with different mobility impairments; individuals’ experiences are unique and future prototypes need to account for different levels of impairments and personal goals. These findings will also inform the user evaluation stage of assistive device testing. The acceptability of assistive devices is dependent upon a number of factors, including personalisation, comfort and function. Future pilot studies should gather qualitative data to determine the acceptability of actual device use.

Patterns of impairment in decision-making capacity in Alzheimer's disease and its relationship with cognitive and clinical variables.

Objectives:To investigate the patterns of impairment in decision-making abilities and their relationship with cognitive and clinical symptoms in people with Alzheimer’s disease. We hypothesized that decision-making abilities would not be impaired at the same level and would be related to impairment of global cognition and other clinical symptoms of the disease.Methods:Using a cross-sectional design, we included a consecutive sample of 102 people with Alzheimer’s disease and their respective caregivers. We investigated the relationship between decision-making capacity and quality of life (QoL), disease awareness, mood, functionality, neuropsychiatric symptoms, and cognition.Results:Different levels of impairment were observed in the participants’ decision-making abilities. Understanding, appreciation, and reasoning were correlated, but expressing a choice was only correlated with appreciation. Deficits in understanding were related to impaired disease awareness, lower self-reported QoL, and lower comprehension of spoken language. Better appreciation was related to better orientation and lower age. Better reasoning was related to better orientation and better self-reported QoL. Deficits in expressing a choice were related to lower self-reported QoL.Conclusion:The pattern of impairment in decision-making abilities was not linear. Each decision-making ability was related to different cognitive and clinical deficits. Therefore, cognitive functioning is an insufficient criterion for judging an individual’s decision-making ability.

Recovery after stroke: the severely impaired are a distinct group

IntroductionStroke causes different levels of impairment and the degree of recovery varies greatly between patients. The majority of recovery studies are biased towards patients with mild-to-moderate impairments, challenging a unified...

Experiences of Family Members of Children with Autism

Introduction: Autism spectrum disorder is characterized by the change in the behavior-interaction-communication, with different levels of impairment. Objectives: This study aims to describe the experiences of family members of children with autism and discuss strategies to improve the quality of life of family members. Methods: A descriptive, exploratory study with a qualitative approach was carried out in a self-help association for autism, located in the city of Teresina/PI, Brazil. Data collection took place in September and October 2019 through the application of a semi-structured interview. Eighteen (18) family members of children with autism in the Association of Friends of Autistic Individuals (AMA) participated in the study. Bardin’s content analysis was the technique used for data analysis. Results: The results showed experiences of negative feelings on the part of family members who lived with autistic children, such as frustration and pain, but also positive feelings of affection and dedication and state of neutrality. The daily life of family members involved the experience of difficulties due to the care of the autistic children, in addition to the lack of information regarding different cases of autism. Therefore, it is necessary to include family members and children in support networks with the objective of making them a part of society with the help of the multidisciplinary team. Conclusion: The present research showed that the experiences of family members of children with autism are difficult at first, but with daily learning and interaction, they become rewarding. The study also reinforces the importance of team in the care of autistic children and highlighted the relevance of improving the family’s quality of life, which can also reflect on the quality of care of that individual.

Use of the International Classification of Functioning, Disability and Health (ICF) to expand and standardize the assessment of quality-of-life following a stroke: proposal for the use of codes and qualifiers

Purpose Propose a way of coding and qualifying HRQoL following a stroke using the codes and qualifiers of the International Classification of Functioning, Disability and Health (ICF). Methods An observational, cross-sectional study was conducted involving 51 individuals with hemiparesis resulting from a stroke. ICF codes related to the Stroke Specific Quality of Life (SS-QOL) scale were listed and subsequently classified using the generic ICF qualifiers, which range from .0 – no impairment to .4 – complete impairment. A simple mathematic calculation was proposed to convert the SS-QOL scores into ICF qualifiers. Results The use of the ICF qualifiers revealed that the individuals exhibited a moderate level (.2) of quality of life, with mild impairment (.1) regarding upper limb function, language, self-care, and vision as well as severe impairment (.3) regarding social relations. Conclusions The proposal presented in this study allowed qualifying 43 ICF codes related to quality of life after a stroke in a simple, standardized manner, enabling the identification of different levels of impairment on each of the domains of the SS-QOL scale. This coding standardizes the evaluation, facilitates communication between healthcare providers, and systematizes the collection of data and information on health. Implications for rehabilitation Proposal for qualifying concepts related to body functions, activity & participation, and environmental factors in a simple, standardized manner. The proposed mathematic calculation is simple and easy to understand, which minimizes the occurrence of errors. Possibility to identify different levels of impairment in each of the domains of the Stroke Specific Quality of Life scale, facilitating the establishment of individualized, longitudinal care. The ICF codes standardize the evaluation, facilitate communication between healthcare providers, and systematize the collection of data and information on health and functioning.

Prefrontal Cortex Activation During Verbal Fluency Task and Tower of London Task in Schizophrenia and Major Depressive Disorder.

Background: Cognitive dysfunction is a common clinical feature of mental disorders. A number of functional near-infrared spectroscopy (fNIRS) studies have shown reduced prefrontal activation during the verbal fluency task (VFT) in schizophrenia (SZ) and major depressive disorder (MDD). However, no studies have examined and compared the brain activation patterns during the Tower of London (TOL), which is another classic, high-sensitivity executive function testing tool, in these two serious mental disorders. This study aimed to assess the characteristics of brain activation during the two different cognitive tasks in SZ and MDD patients.Methods: This study recruited 30 patients with SZ, 30 patients with MDD, and 30 demographically matched healthy controls (HCs). The hemodynamic changes of the prefrontal cortex (PFC) were measured using 32-channel fNIRS during performance of the TOL task and VFT task.Results: SZ patients showed poorer VFT performance than MDD patients and HCs, and the two patient groups showed poorer TOL performance than HCs. Compared to HCs, both of the patient groups exhibited a significant decreased activation in the extensive PFC. Particularly in certain channels in the dorsolateral PFC (DLPFC), SZ patients exhibited significantly decreased hemodynamic changes than the MDD patients.Conclusions: Patients with SZ and MDD have different levels of impairment in different cognitive domains and different patterns of brain activation during the two cognitive tasks. Further research is needed to determine the use of fNIRS for clinical evaluation and diagnosis.

Characterization of Two Variants at Met 1 of the Human LDLR Gene Encoding the Same Amino Acid but Causing Different Functional Phenotypes.

Familial hypercholesterolemia (FH) is the most common genetic disorder of lipid metabolism, characterized by increased levels of total and LDL plasma cholesterol, which leads to premature atherosclerosis and coronary heart disease. FH phenotype has considerable genetic heterogeneity and phenotypic variability, depending on LDL receptor activity and lifestyle. To improve diagnosis and patient management, here, we characterized two single nucleotide missense substitutions at Methionine 1 of the human LDLR gene (c.1A>T/p.(Met1Leu) and c.1A>C/p.(Met1Leu)). We used a combination of Western blot, flow cytometry, and luciferase assays to determine the effects of both variants on the expression, activity, and synthesis of LDLR. Our data show that both variants can mediate translation initiation, although the expression of variant c.1A>T is very low. Both variants are in the translation initiation codon and codify for the same amino acid p.(Met1Leu), yet they lead to different levels of impairment on LDLR expression and activity, corroborating different efficiencies of the translation initiation at these non-canonical initiation codons. The functional data of these variants allowed for an improved American College of Medical Genetics (ACMG) classification for both variants, which can allow a more personalized choice of the lipid-lowering treatment and dyslipidemia management, ultimately improving patients’ prognosis.

Psychometric properties of Addenbrooke's Cognitive Examination III (ACE-III): An item response theory approach.

The Addenbrooke’s Cognitive Examination III is one of the most widely used tests to assess cognitive impairment. Although previous studies have shown adequate levels of diagnostic utility to detect severe impairment, it has not shown sensitivity to detect mild decline. The aim of this study was to evaluate the psychometric properties of Addenbrooke’s Cognitive Examination III in a large sample of elderly people through Item Response Theory, due to the lack of studies using this approach. A cross-sectional study was conducted with 1164 people from the age of 60 upwards, of which 63 had a prior diagnosis of Alzheimer dementia. The results showed that, globally, the Addenbrooke’s Cognitive Examination III possesses adequate psychometrics properties. Furthermore, the information function test shows that the subscales have different sensitivity to different levels of impairment. These results can contribute to determining patterns of cognitive deterioration for the adequate detection of different levels of dementia. An optimized version is suggested which may be an economic alternative in the applied field.

Cognitive heterogeneity in the offspring of patients with schizophrenia or bipolar disorder: a cluster analysis across family risk

BackgroundNeurocognitive impairment is considered to lie on a continuum of severity across schizophrenia (SZ) and bipolar disorder (BP), possibly reflecting a gradient of neurodevelopmental load. Cluster analyses have identified different levels of impairment across the two disorders, from none to widespread and severe. We for the first time used this approach to examine cognitive function pooling together children and adolescents at familial risk of SZ or BP. Methods220 participants, 49 offspring of individuals with schizophrenia (SZO), 90 offspring of individuals with bipolar disorder (BPO) and 81 offspring of healthy control parents (HC), aged 6 to 17 years, underwent a comprehensive clinical and cognitive assessment. Cognitive measures were used to group SZO and BPO using K-means clustering. Cognitive performance within each of the clusters was compared to that of HC and clinical variables were compared between clusters. ResultsWe identified three cognitive subgroups: a moderate impairment group, a mild impairment group, and a cognitively intact group. Both SZO and BPO were represented in each of the clusters, yet not evenly, with a larger proportion of the SZO in the moderately impaired cluster, but also a subgroup of BPO showing moderate cognitive dysfunction. LimitationsParticipants have yet to reach the age of onset for the examined disorders. ConclusionsThe findings point to a range of neurodevelopmental loadings across youth at familial risk of both SZ and BP. They have therefore important implications for the stratification of cognitive functioning and the possibility to tailor interventions to individual levels of impairment.

A Scoping Review of Studies on Virtual Reality for Individuals with Intellectual Disabilities

The goals for this scoping review were to evaluate interventions using virtual reality (VR) environments for individuals with intellectual disabilities (IDs) and to discuss these interventions in terms of their educational value. The authors conducted a scoping review of articles examining VR interventions for individuals with IDs. The authors searched seven databases between 2000 and 2019 using virtual reality and intellectual disability/disabilities as search terms. The search yielded 123 articles and 15 articles were reviewed. A search of critical journals in 2020 yielded one additional article for review. Interventions addressed different skills, such as increasing physical activity, teaching letter and number literacy, preparing individuals for court testimony, and learning routes. Researchers need to assess participants for level of cognitive functioning and understand how to modify interventions for individuals with different levels of impairment. Moreover, examining whether interventions are related to improvement of skills in in vivo situations will be important for understanding generalizability of skills. The review revealed positive findings for use of VR interventions, with a need for caregiver support and possible technology support to implement interventions. Using a participatory approach may improve abilities to implement interventions in real-world settings. Directions for future research include examining what interventions work for individuals with different levels of impairment and defining when and how to implement interventions.