Unexplored Aspects of Neurorehab

8/10/2019 Unexplored Aspects of Neurorehab

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The UnexploredAspects ofNeurorehabilitation

Ishika SharmaMScRRPT StudentDalhousie University


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Overview

Brain disease/injury

Brain Plasticity

Creativity and arts

Aesthetics

Enriched environment

Future Direction


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Brain disease/injury

Trauma Brain Insult

Infection

Genetic andCongenital

Degeneration


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Creativity and Arts

State of brain that generates action that are novel anduseful to a community (the 3 factor definition; Flaherty etal, 2011).

Associated with creative problem solving, arts,abstraction etc.


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Brain illness and creativity

Increased creative drive seen for patients withfrontotemporal dementia, bipolar disorder and peoplewith autism (Savant syndrome: detail orientedprocessing skill).

Increased creative drive after pharmacologicaltreatment of Parkinson's Disease. Creativity is associated with goal driven approach

motivation associated with dopamine. (Flaherty et al,2011).


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Brain areas associated withcreativity

Hemispheric lateralization and fronto-temporal connections-Interact to create conceptual schemes

Right brain and temporal lobe- Skill in novelty detection(more active in people untrained in arts).

Left brain and Frontal lobe- generate new patterns of action

from novel perception (more active in people trained inarts). (Martin 1999, Berkowitz et al 2010)


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Two studies (Maxwell et al 2007, Harmon-Jones2004) further showed that right lobe is associatedwith avoidance and left lobe with curiosity andpursuit. So, right lobe is possibly associated withavoidance of catering to novelty.

Greater creativity is associated with bilateral brain

activation. Greater hemispheric dominanceassociated with lesser creativity.


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Evidence of brain activity changeassociated with creative thinking

Mashal et al 2007.

Analysed brain activation using fMRI associated withcreative thinking. Also studied reaction times.

Groups tested for recognizing: literal phrases, conventional,novel and unrelated metaphors.

Least reaction time andgreatest relativesignificant signal changefor novel metaphors.Primarily right side.


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Arts and neuroscience (Puretic,2009)

Studies have shown visual arts to be associated withchanges in brain activation on fMRI and effect of rhythmand melody on frontal lobe.

Larger motor cortex size associated with piano training innovice players.

Plastic effects seen within minutes of practice. If these arts

are associated with brain, can they be used to train thebrain??


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Johansson BB (2006) reviewed that music is capableof inducing brain plastic processes.

Bengtsson et al (2005) carried out diffuse tensorimaging in children, adolescents and adults whounderwent music training on a piano. Greaterpyramidal tract organization associated with training,especially in children. Could this suggest that earlycreative training has greater impact on white matterorganization?


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Mozart effect

Rauscher et al (1993) studied that in a group listening toMozart's sonata K448 for 10 minutes the scores of spatialreasoning were greater than those for the group listening torelaxation music.

Many studies, since, have been able to replicate this effect.So does the nature of art an individual is exposed to have adifferent effect on their cognition?


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Evidence of improvement in motordysfunction in Stroke associated withmusic therapy

Altenmuller et al, 2009.

Acute stroke incidence- grouped into control and music therapygroup.

Conventional treatment compared against 15 sessions of 30minutes of music supported therapy for 3 weeks.

Use of MIDI piano and electronic drum. Played same set of 8tones on either or both instruments.

Treatment increased in complexity in stepwise manner.

EEG analyses of ERD alongwith motor skills tests was done foranalysis.


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Lower power inalpha and beta

band for ERDprior toresponse.


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Greater coherence amongst neuronal populationsseen for MG.

Behavioural analyses significant onlyfor MG and not CG. Small effect sizeseen for pronation/supination and 9hole peg test.


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More evidence: ParkinsonDisease

Thaut et al (1996) tested three groups (receiving musicassociated exercises/EX, self paced exercises/SPT and notraining) for gait quality and EMG variables for a training periodof 3 weeks.

Significant improvement seen in gait parameters in EX vs SPTand EX vs no training.

Tibialis anterior showed lower variability and greater symmetry of

response for EX group.

Could the effect in gait velocity in EX be associated with use offaster rhythm of music?


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Whole brain function: Responseto creative arts like painting

Bogousslavsky (2005)


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Evidence: Neural responses todancingVan de Winckel et al (2004) did a study on 25 women withdementia. 15 did dance therapy while 10 were in control group (3months period), selected by coin flip!!

A significant change in MMSE scores was observed for dancing

group with a main effect of group and time interaction.

Significant post training increase in fluency score of AmsterdamDementia Screening test-6 was seen for dancing group.

Mechanism: Temporary arousal state stimulating cognitiveactivity.

Limitation: Coin flip!! Arousal due to association of music to movements ordue to movements only?


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Dancing alone: Agilando

Katenstroth et al (2013) studied the effect of Agilando training(n=25) compared to control (n=10) on 35 healthy elderlysubjects. Agilando includes 20 min of warm up before 40 min ofdancing.

Duration and frequency: 24 weeks (1 hr/ week).

Tested domains: Attention, Fluid Intelligence, Reaction time onvisuo-tactile task, Posture, Motor performance on task by Kalisch

et al in 2006, Tactile performance and Cardio-pulmonaryperformance.


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The improvement in Motor performance and Posture wereexpected. Improvement in Cognition is associated with useof greater attention and planning associated with learningnovel steps.

Could this be a possible whole body training approach?


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Aesthetics

Nieminen et al (2011) suggest in a review that mirror neuronsystem is associated with motor response to music. TheMNS in inferior prefrontal cortex is associated withunderstanding meaning and intention of signal evoking

representation in the perceiver's brain.

Aesthetics depend on perception of individual brain andhence can affect motor skills.

Zinetti et al (1991) have shown significant change inaesthetics with age as well. Can the age related change inskills be associated with this?

Could the aesthetics associated with creative arts affect skills?


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Enriched Environment

Brain function can be affected by the nature of feedbackobtained from the environment.

Stimulating or Inhibiting environment.

Can the environment in which the individual is trained affect theoutcomes?


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Evidence in rats

Yang et al (2013) tested two groups of rats: EE and SE to analysepossible delay in loss of myelin fibres in white matter of rats.

Results suggested that EE-induced an increase in myelinated fibers inthe white matter of aging rats primarily due to marked remyelinationand some ongoing myelination.


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Similar to this, enriched environment hasshown effect in humans. Spatial memorydecline, which is associated with whitematter decline, has been shown to improvewith enriched environment provision.


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Looking for evidence in Stroke

A trial was started in 2012 by Janssen et al registered underaustralian-new zealand clinical trial recovery.

The authors will carry out behavioral mapping of inpatient stroke

subjects for 19 days: one group in standard environment andanother in an individual and communally enriched environment.They will do pre and post test analyses of domains like boredom,activity and cognition.


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Future prospects

More evidence on role of painting. Determine best mode of delivering

training. Establish role of aesthetics. Combine enriched environment with

creative training.

Associate methods of engagement andmotivation in therapy.


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Unexplored Aspects of Neurorehab

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