Effects of therapeutic instrumental music performance and motor imagery on chronic post-stroke cognition and affect: A randomized controlled trial.

BACKGROUND: The burden of post-stroke cognitive impairment, as well as affective disorders, remains persistently high. With improved stroke survival rates and increasing life expectancy, there is a need for effective interventions to facilitate remediation of neurocognitive impairments and post-stroke mood disorders. OBJECTIVE: To investigate the effects of Therapeutic Instrumental Music Performance (TIMP) training with and without Motor Imagery on cognitive functioning and affective responding in chronic post-stroke individuals. METHODS: Thirty chronic post-stroke, community-dwelling participants were randomized to one of three experimental arms: (1) 45 minutes of active TIMP, (2) 30 minutes of active TIMP followed by 15 minutes of metronome-cued motor imagery (TIMP+cMI), (3) 30 minutes of active TIMP followed by 15 minutes of motor imagery without cues (TIMP+MI). Training took place three times a week for three weeks, using a selection of acoustic and electronic instruments. Assessments, administered at two baselines and post-training, included the Trail Making Test (TMT) - Part B to assess mental flexibility, the Digit Span Test (DST) to determine short-term memory capacity, the Multiple Affect Adjective Checklist - Revised (MAACL-R) to ascertain current affective state, and the General Self-Efficacy Scale (GSE) to assess perceived self-efficacy. The Self-Assessment Maniqin (SAM) was also administered prior to and following each training session. RESULTS: Thirty participants completed the protocol, ten per arm [14 women; mean age = 55.9; mean time post-stroke = 66.9 months]. There were no statistically significant differences between pooled group baseline measures. The TIMP+MI group showed a statistically significant decrease in time from pre-test 2 to post-test on the TMT. The TIMP group showed a significant increase on MAACL sensation seeking scores, as well as on the Valence and Dominance portions of the SAM; TIMP+cMI showed respective increases and decreases in positive and negative affect on the MAACL, and increases on the Valence, Dominance, and Arousal portions of the SAM. No statistically significant association between cognitive and affective measures was obtained. CONCLUSIONS: The mental flexibility aspect of executive functioning appears to be enhanced by therapeutic instrumental music training in conjunction with motor imagery, possibly due to multisensory integration and consolidation of representations through motor imagery rehearsal following active practice. Active training using musical instruments appears to have a positive impact on affective responding; however, these changes occurred independently of improvements to cognition.

The Multiple Uses of Guided Imagery.

Guided imagery is a therapeutic approach that has been used for centuries. Through the use of mental imagery, the mind-body connection is activated to enhance an individual's sense of well-being, reduced stress, and reduced anxiety, and it has the ability to enhance the individual's immune system. There are research and data to support the use of guided imagery for these patient outcomes.

Developing thinking around mental health science: the example of intrusive, emotional mental imagery after psychological trauma.

INTRODUCTION: One route to advancing psychological treatments is to harness mental health science, a multidisciplinary approach including individuals with lived experience and end users (e.g., Holmes, E. A., Craske, M. G., & Graybiel, A. M. (2014). Psychological treatments: A call for mental-health science. Nature, 511(7509), 287-289. doi:10.1038/511287a). While early days, we here illustrate a line of research explored by our group-intrusive imagery-based memories after trauma. METHOD/RESULTS: We illustrate three possible approaches through which mental health science may stimulate thinking around psychological treatment innovation. First, focusing on single/specific target symptoms rather than full, multifaceted psychiatric diagnoses (e.g., intrusive trauma memories rather than all of posttraumatic stress disorder). Second, investigating mechanisms that can be modified in treatment (treatment mechanisms), rather than those which cannot (e.g., processes only linked to aetiology). Finally, exploring novel ways of delivering psychological treatment (peer-/self-administration), given the prevalence of mental health problems globally, and the corresponding need for effective interventions that can be delivered at scale and remotely for example at times of crisis (e.g., current COVID-19 pandemic). CONCLUSIONS: These three approaches suggest options for potential innovative avenues through which mental health science may be harnessed to recouple basic and applied research and transform treatment development.

Thumbs up: Imagined hand movements counteract the adverse effects of post-surgical hand immobilization. Clinical, behavioral, and fMRI longitudinal observations.

Motor imagery (M.I.) training has been widely used to enhance motor behavior. To characterize the neural foundations of its rehabilitative effects in a pathological population we studied twenty-two patients with rhizarthrosis, a chronic degenerative articular disease in which thumb-to-fingers opposition becomes difficult due to increasing pain while the brain is typically intact. Before and after surgery, patients underwent behavioral tests to measure pain and motor performance and fMRI measurements of brain motor activity. After surgery, the affected hand was immobilized, and patients were enrolled in a M.I. training. The sample was split in those who had a high compliance with the program of scheduled exercises (T+, average compliance: 84%) and those with low compliance (T-, average compliance: 20%; cut-off point: 55%). We found that more intense M.I. training counteracts the adverse effects of immobilization reducing pain and expediting motor recovery. fMRI data from the post-surgery session showed that T+ patients had decreased brain activation in the premotor cortex and the supplementary motor area (SMA); meanwhile, for the same movements, the T- patients exhibited a reversed pattern. Furthermore, in the post-surgery fMRI session, pain intensity was correlated with activity in the ipsilateral precentral gyrus and, notably, in the insular cortex, a node of the pain matrix. These findings indicate that the motor simulations of M.I. have a facilitative effect on recovery by cortical plasticity mechanisms and optimization of motor control, thereby establishing the rationale for incorporating the systematic use of M.I. into standard rehabilitation for the management of post-immobilization syndromes characteristic of hand surgery.

Image Guidance for Ventricular Shunt Surgery: An Analysis of Hospital Charges.

BACKGROUND: Image guidance for shunt surgery results in more accurate proximal catheter placement. However, reduction in shunt failure remains unclear in the literature. There have been no prior studies evaluating the cost effectiveness of neuronavigation for shunt surgery. OBJECTIVE: To perform a cost analysis using available hospital charges of hypothetical shunt surgery performed with/without electromagnetic neuronavigation (EMN). METHODS: Hospital charges were collected for physician fees, radiology, operating room (OR) time and supplies, postanesthesia care unit, hospitalization days, laboratory, and medications. Index shunt surgery charges (de novo or revision) were totaled and the difference calculated. This difference was compared with hospital charges for shunt revision surgery performed under 2 clinical scenarios: (1) same hospital stay as the index surgery; and (2) readmission through the emergency department. RESULTS: Costs for freehand de novo and revision shunt surgery were $23 946.22 and $23 359.22, respectively. For stealth-guided de novo and revision surgery, the costs were $33 646.94 and $33 059.94, a difference of $9700.72. The largest charge increase was due to additional OR time (34 min; $4794), followed by disposable EMN equipment ($2672). Total effective charges to revise the shunt for scenarios 1 and 2 were $34 622.94 and $35 934.94, respectively. The cost ratios between the total revision charges for both scenarios and the difference in freehand vs EMN-assisted shunt surgery ($9700.72) were 3.57 and 3.70, respectively. CONCLUSION: From an economic standpoint and within the limitations of our models, the number needed to prevent must be 4 or less for the use of neuronavigation to be considered cost effective.

Benefits of a Home Treatment Program Using Guided Imagery Relaxation Based on Audio Recordings for People With Fibromyalgia.

Despite the plethora of treatments available for patients with fibromyalgia, there is insufficient evidence to date as to what the ideal treatment approach is. This study sought to determine the effectiveness of a home program of audio-recorded guided imagery relaxation on people with fibromyalgia. This experimental 8-week longitudinal trial design was undertaken with 60 people diagnosed with fibromyalgia who were randomly assigned to either a guided imagery intervention group or a control group. Pain at tender points, anxiety, self-efficacy, quality of sleep, quality of life, and the impact of the fibromyalgia were determined at baseline, at 4 weeks, and at 8 weeks. After the guided imagery intervention, we found significant differences regarding trait anxiety, sleep quality, and tenderness at some of the tender points. There is a need, therefore, to develop and evaluate interventions that may enhance the quality of life of those affected by this disorder.

Electroencephalographic Motor Imagery Brain Connectivity Analysis for BCI: A Review.

Recent research has reached a consensus on the feasibility of motor imagery brain-computer interface (MI-BCI) for different applications, especially in stroke rehabilitation. Most MI-BCI systems rely on temporal, spectral, and spatial features of single channels to distinguish different MI patterns. However, no successful communication has been established for a completely locked-in subject. To provide more useful and informative features, it has been recommended to take into account the relationships among electroencephalographic (EEG) sensor/source signals in the form of brain connectivity as an efficient tool of neuroscience. In this review, we briefly report the challenges and limitations of conventional MI-BCIs. Brain connectivity analysis, particularly functional and effective, has been described as one of the most promising approaches for improving MI-BCI performance. An extensive literature on EEG-based MI brain connectivity analysis of healthy subjects is reviewed. We subsequently discuss the brain connectomes during left and right hand, feet, and tongue MI movements. Moreover, key components involved in brain connectivity analysis that considerably affect the results are explained. Finally, possible technical shortcomings that may have influenced the results in previous research are addressed and suggestions are provided.

Early brain changes associated with psychotherapy in major depressive disorder revealed by resting-state fMRI: evidence for the top-down regulation theory.

BACKGROUND: Major depressive disorder (MDD) is associated with dysfunction of the emotional circuitry in the brain. Psychotherapy and antidepressant treatment both aid in modulating this dysfunction, albeit probably through different mechanisms. A plausible "top-down" emotional regulation mechanism for psychotherapy has been described in previous studies, but the underlying findings are still contradictory. METHODS: A total of 23 MDD patients and 20 healthy controls were enrolled. The early neural effects within 5 weeks of guided imagery-a psychotherapeutic method for treating depression-were assessed through resting-state functional magnetic resonance imaging using the regional homogeneity analytical method. RESULTS: At baseline, regional homogeneity was reduced in cortical regions and increased in limbic areas in the pre-treatment scans of MDD patients as compared to controls. After 5 weeks of guided imagery therapy, regional homogeneity in the ventromedial prefrontal cortex and the anterior cingulate gyrus both increased. Higher pre-treatment regional homogeneity in the dorsal anterior cingulate gyrus was positively correlated with an improved response to guided imagery therapy. CONCLUSION: The changes in regional homogeneity induced by guided imagery therapy demonstrate that this method of psychotherapy takes effect through a "top-down" mechanism. Future studies comparing various psychotherapeutic methodologies across multiple time points in the treatment course should yield more valuable insights on this topic.

Visual mental imagery in psychopathology--implications for the maintenance and treatment of depression.

Negative mental images are a common feature in a range of mental disorders as well as in healthy subjects. Intrusive negative mental images have only recently become a focus of attention in clinical research on depression. Research so far indicates that they can be an important factor regarding the onset and chronicity of affective disorders. This article is the first to provide an extensive overview of the current state of research in the field of visual mental images in depression. It aims to investigate disorder-specific characteristics, as well as the role of imagery as a maintaining factor. A detailed definition and description of empirical results about mental images in depressive disorders is followed by a presentation and analysis of treatment studies using imagery techniques in depressed samples. Additionally, methodological issues like small sample sizes and the lack of control groups are pointed out and implications for future research are discussed. Case vignettes are included in the appendix to exemplify the importance of negative mental images in patients suffering from depression.

Avances en la utilización de imágenes: microscopio digital y pico proyector / Developments in the utilization of images: digital microscope and pico projector

Existe una tendencia evolutiva hacia la digitalización de toda documentación: textos imágenes, sonidos. Toda esta documentación digitalizada puede ser presentada o expuesta mediante dispositivos digitales. Con el presente trabajo nos hemos propuesto dar a conocer los avances en la utilización de imágenes empleado el microscopio digital y el pico proyector digital, mencionando sus ventajas, desventajas, metodología y mostrando la experiencia inicial. Así tenemos que la digitalización de imágenes ha permitido la transferencia a medios de depósito o archivo. La observación de proceso fantástico que raya en lo mágico. Mientras que los proyectores digitales han sido un pilar sólido en la demostarción de material educativo, docente, investigación, u otro, su miniaturización ha revelado el ingenio humano

There is an evolutionary toward the digitalization of all documents, texts, images, sounds. All these documents can be scanned or exposed and presented by digital devices. With this work we intend to disclose developments in the use of images using the digital microscope and digital pico pocket projector, with their advantages, disadvantages, methodology and showing our initial experience. Thus, the digitization of images has allowed the tranfer to storege media or file. The observation of micro images and their immediate scanning is a great process that borders on the magic. While digital projectors have been a solid pillar in the proof of educational materials, teaching, research, or other, miniaturization has revealed human ingenuity

Ultrasonography in pain medicine: a critical review.

Recently, ultrasonography has been increasingly used in the field of regional anesthesia to assure reliable blockade of peripheral nerves and to visualize neuroaxial structures. As its popularity is steadily increasing, it may become a standard of care for both intraoperative analgesia and postoperative pain control. The application of ultrasound in chronic pain management, however, remains underutilized. Multiple reasons can be suggested to explain this situation. Nonetheless, numerous articles have been published and some interventionalists have gained experience and started to spread their knowledge through hands-on workshops and medical meetings. It, therefore, seems timely to describe the techniques of ultrasound-guided injections for chronic pain, to review accumulated experience in this field, to reappraise the scientific and clinical value of this method, and to outline potential future developments.

Estudio de validez del Test de las Fotos en el cribado de Deterioro Cognitivo en Atención Primaria / Validity study of the Photo Test in Screening for Cognitive Impairment in Primary Care

Objetivos. Evaluar la utilidad del test de las fotos (TF) en el cribado de deterioro cognitivo en población mayor de 65 años. Diseño. Estudio de validez de pruebas diagnósticas. Emplazamiento. Realizado en 10 consultas de Atención Primaria (AP) en un centro urbano. Participantes: El tamaño muestral fue de 241 sujetos con edad mayor o igual a 65 años, obtenida mediante muestreo aleatorio simple. Se consideran criterios de exclusión los sujetos con déficit sensoriales no corregibles, así como la no autorización verbal. Intervenciones. Se cumplimentó una hoja de recogida de datos con las variables sociodemográficas. Se realizó una anamnesis siguiendo los criterios diagnósticos de demencia de la DSM IV. A todos los sujetos se les pasó el test psicométrico (TF). La prueba diagnóstica y el criterio de referencia se realizaron de forma ciega. Mediciones y resultados. La edad media fue de 76,67 años con una distribución por sexos de 57,6% mujeres y 42,3% hombres. La proporción de alfabetizados fue del 54,4%. El tiempo empleado en la realización del TF fue inferior a 5 min en el 97,5% de los sujetos. La prevalencia de demencia fue del 10,4 %. El TF presenta una sensibilidad del 84% (IC 95% 81,91-86,06) y una especificidad del 85,65% (IC 95% 85,39-85,91) para el diagnóstico de deterioro cognitivo. El VPP es de 40,38% y el VPN de 97,88%. El cociente de probabilidad positiva es de 5,85 y el cociente de probabilidad negativa de 0,19. Conclusiones. El TF es un buen instrumento para el cribado de deterioro cognitivo, de fácil y rápida aplicabilidad, constituyendo una alternativa en Atención Primaria a los test psicométricos actualmente empleados (AU)

Objectives. To assess the value of the Photo Test (PhT) in screening for cognitive impairment in a population over 65 years old. Design. Validity study of diagnostic tests. Setting. Carried out in ten Primary Care (PC) clinics in a city centre. Participants: The sample was composed of 241 subjects of 65 years or older, obtained by simple random sampling. Exclusion criteria included subjects with noncorrectable sensory deficit, and no verbal authorisation. Interventions. A clinical record form was completed with the sociodemographic variables. An anamnesis was carried out following the diagnostic criteria for DSM IV dementia. All subjects took the pscyhometric test (PhT). The diagnostic test and the standard criteria were applied blindly. easurements and results. The mean age was 76.67 years with 57.6% women and 42.3% male; 54.4% of the sample was literate. The PhT was carried out in less than 5 min in 97.5% of subjects, 10.4% of the sample had dementia. The PhT had a sensitivity of 84% (95% CI, 81.91-86.06) and a specificity of 85.65% (95% CI, 85.39-85.91) for the diagnosis of cognitive impairment. The PPV is 40.38% and the NPV 97.88%. The positive probability ratio is 5.85 and the negative probability ratio 0.19. Conclusions. PhT is a good instrument to screen for cognitive impairment. It is easy and quick to use and is an alternative in Primary Care to the psychometric tests used to date (AU)

Motor imagery in physical therapist practice.

Motor imagery is the mental representation of movement without any body movement. Abundant evidence on the positive effects of motor imagery practice on motor performance and learning in athletes, people who are healthy, and people with neurological conditions (eg, stroke, spinal cord injury, Parkinson disease) has been published. The purpose of this update is to synthesize the relevant literature about motor imagery in order to facilitate its integration into physical therapist practice. This update also will discuss visual and kinesthetic motor imagery, factors that modify motor imagery practice, the design of motor imagery protocols, and potential applications of motor imagery.

Mental practice in chronic stroke: results of a randomized, placebo-controlled trial.

BACKGROUND AND PURPOSE: Mental practice (MP) of a particular motor skill has repeatedly been shown to activate the same musculature and neural areas as physical practice of the skill. Pilot study results suggest that a rehabilitation program incorporating MP of valued motor skills in chronic stroke patients provides sufficient repetitive practice to increase affected arm use and function. This Phase 2 study compared efficacy of a rehabilitation program incorporating MP of specific arm movements to a placebo condition using randomized controlled methods and an appropriate sample size. Method- Thirty-two chronic stroke patients (mean=3.6 years) with moderate motor deficits received 30-minute therapy sessions occurring 2 days/week for 6 weeks, and emphasizing activities of daily living. Subjects randomly assigned to the experimental condition also received 30-minute MP sessions provided directly after therapy requiring daily MP of the activities of daily living; subjects assigned to the control group received the same amount of therapist interaction as the experimental group, and a sham intervention directly after therapy, consisting of relaxation. Outcomes were evaluated by a blinded rater using the Action Research Arm test and the upper extremity section of the Fugl-Meyer Assessment. RESULTS: No pre-existing group differences were found on any demographic variable or movement scale. Subjects receiving MP showed significant reductions in affected arm impairment and significant increases in daily arm function (both at the P<0.0001 level). Only patients in the group receiving MP exhibited new ability to perform valued activities. CONCLUSIONS: The results support the efficacy of programs incorporating mental practice for rehabilitating affected arm motor function in patients with chronic stroke. These changes are clinically significant.

A strategy for computer-assisted mental practice in stroke rehabilitation.

OBJECTIVE: To investigate the technical and clinical viability of using computer-facilitated mental practice in the rehabilitation of upper-limb hemiparesis following stroke. DESIGN: A single-case study. SETTING: Academic-affiliated rehabilitation center. PARTICIPANT: A 46-year-old man with stable motor deficit of the upper right limb following subcortical ischemic stroke. INTERVENTION: Three computer-enhanced mental practice sessions per week at the rehabilitation center, in addition to usual physical therapy. A custom-made virtual reality system equipped with arm-tracking sensors was used to guide mental practice. The system was designed to superimpose over the (unseen) paretic arm a virtual reconstruction of the movement registered from the nonparetic arm. The laboratory intervention was followed by a 1-month home-rehabilitation program, making use of a portable display device. MAIN OUTCOME MEASURES: Pretreatment and posttreatment clinical assessment measures were the upper-extremity scale of the Fugl-Meyer Assessment of Sensorimotor Impairment and the Action Research Arm Test. Performance of the affected arm was evaluated using the healthy arm as the control condition. RESULTS: The patient's paretic limb improved after the first phase of intervention, with modest increases after home rehabilitation, as indicated by functional assessment scores and sensors data. CONCLUSION: Results suggest that technology-supported mental training is a feasible and potentially effective approach for improving motor skills after stroke.

Conciencia esquizofrénica, experiencia espiritual y distinción entre imágenes, palabras y cosas / Schizophrenic consciousness, spiritual experience, and the borders between images, words and things

Partiendo de una intuición del clásico de la psiquiatría francesa Henri Ey, este trabajo analiza la pérdida de la distinción entre cosas, imágenes y palabras en la conciencia esquizofrénica. El análisis se apoya en la experiencia de cosijicación de las palabras de los cabalistas y en la obras filosóficas de Cassirer (Lenguaje y mito), Platón (Crátilo), Foucault (Las palabras y las cosas), Husserl, Scheler y Heidegger. El concepto fenomenológico de epojé, en su versión radical de Scheler, permite reducir las cosas a esencias y transformarlas en imágenes «desencamadas». La representación residual de esta operación es similar a la que se encuentra en la conciencia esquizofrénica

With an intuition of Henry Ey, a classic of French psychiatry, for a starting point, this work analyzes the fading of the distinction between things, images, and words in schizophrenic consciousness. The analysis is based on the cabalists' experience of treating words like objects and on the philosophical works of Cassirer (Language and Myth), Plato (Cratylus), Foucault (Words and Things), Husserl, Scheler, and Heidegger. The phenomenological concept of epojé, in Scheler's radical version of it, makes it posible to reduce things to essences and transform them into «disembodied» images. The residual representation of this operation is similar to that found in schizophrenic consciousnessWith an intuition of Henry Ey, a classic of French psychiatry, for a starting point, this work analyzes the fading of the distinction between things, images, and words in schizophrenic consciousness. The analysis is based on the cabalists' experience of treating words like objects and on the philosophical works of Cassirer (Language and Myth), Plato (Cratylus), Foucault (Words and Things), Husserl, Scheler, and Heidegger. The phenomenological concept of epojé, in Scheler's radical version of it, makes it posible to reduce things to essences and transform them into «disembodied» images. The residual representation of this operation is similar to that found in schizophrenic consciousness

Eye Movement Desensitization and Reprocessing (EMDR) and the anxiety disorders: clinical and research implications of an integrated psychotherapy treatment.

Four recent, independent, rigorously controlled studies of Eye Movement Desensitization and Reprocessing (EMDR) have reported that 84 to 100% of single-trauma victims no longer maintain the posttraumatic stress disorder diagnosis after the equivalent of three 90-minute sessions. The rapidity of EMDR treatment effects makes many ancillary research opportunities available. Specifically, the increased number of cases resolved in a relatively short period of time allows investigation of neurophysiological phenomena, patterns of cognitive and emotional processing, component analyses of a large range of procedural factors, and evaluation of the efficacy of application to diverse clinical populations. Unfortunately, some research has been conducted that has been severely hampered by insufficient treatment fidelity and lack of clinical validity. Consequently, this article will attempt to describe the procedures and protocols that are believed to contribute to EMDR's clinical effects and are, therefore, suggested for the EMDR treatment and research of the anxiety disorders. This is particularly relevant given the misconceptions that have abounded due to the unfortunate naming of the procedure after the eye movements, which have proved to be only one of many useful types of stimulation, and only one of many components of this complex, integrated treatment.

Traumatic memories, eye movements, phobia, and panic: a critical note on the proliferation of EMDR.

In the past years, Eye Movement Desensitization and Reprocessing (EMDR) has become increasingly popular as a treatment method for Posttraumatic Stress Disorder (PTSD). The current article critically evaluates three recurring assumptions in EMDR literature: (a) the notion that traumatic memories are fixed and stable and that flashbacks are accurate reproductions of the traumatic incident; (b) the idea that eye movements, or other lateralized rhythmic behaviors have an inhibitory effect on emotional memories; and (c) the assumption that EMDR is not only effective in treating PTSD, but can also be successfully applied to other psychopathological conditions. There is little support for any of these three assumptions. Meanwhile, the expansion of the theoretical underpinnings of EMDR in the absence of a sound empirical basis casts doubts on the massive proliferation of this treatment method.