The amazing functions of listening to music have been expanded to determine if daily music exposure can aid in the recovery of traumatic brain injury, specifically after a stroke. The effects of music upon cognitive functions and mood have been studied among patients who had a specific type of stroke affecting the middle cerebral artery (MCA).

Patients affected by a MCA stroke were randomly exposed to music, audio books, or did not receive auditory treatment (control group). All three groups received consistent standard medical treatment and rehabilitation; the only differing variable in their treatment was the type of audio therapy they were exposed to.

At 3 month and 6 month intervals post stroke, the patients were evaluated via cognitive assessment. The results of the assessment showed that the individuals who listened to music demonstrated an obvious increase in verbal skills, memory and focused attention when compared to the audio book and control group. The patients who listened to music also showed a decrease in depression and confused mood.

The findings show that exposure to music after a MCA type stroke can help in the recovery of brain processes and increase the quality of life for the sufferers. It is amazing that something as simple as listening to music can make such a large difference in the recovery of severe brain trauma.

Music can drastically improve the overall cognitive functioning and mood and seems like a simple yet extremely effective way of improving an individual’s quality of life and can amazingly repair brain performance after a devastating brain injury. Perhaps musical therapy can be utilized for future treatment of specific brain trauma, such as MCA-type strokes, and can be researched even further to expose other possible benefits.

Reference

T. Sarkamo, M. Tervaniemi, S. Laitinen, A. Forsblom, S. Soinila, M. Mikkonen, T. Autti, H. M. Silvennoinen, J. Erkkila, M. Laine, I. Peretz, M. Hietanen (2008). Music listening enhances cognitive recovery and mood after middle cerebral artery stroke Brain, 131 (3), 866-876 DOI: 10.1093/brain/awn013

In mirror therapy, a mirror is placed beside the unaffected limb, blocking the view of the affected limb. This creates the illusion that both limbs are functioning properly. Mirror theory is based on evidence that action observation activates the same motor areas of the brain as action execution. Observed actions lead to the generation of intended actions, engaging motor planning and execution. Further, evidence suggests that damaged areas of the brain’s motor cortex may improve by viewing movements of intact, functioning limbs.

Strokes can cause much neurological impairment, which may lead to a reduction in the performance of activities of daily living. Current rehabilitation techniques focus on occupational and physical therapy, using guided limb manipulation and task-oriented training. These exercises combine passive and active movement in an attempt to rebuild neuronal connections damaged by the stroke. Adding mirror therapy to traditional therapy enlists visual stimulation showing proper functioning. This points to a large cognitive role in rehabilitation, rather than just physical.

In the current study, 14 stroke patients with lower-limb hemiplegia were randomized to begin traditional rehabilitation therapies with or without the addition of mirror therapy. The study was a crossover design, and patients crossed to the other treatment arm after an initial treatment period. The subjects sat in a chair with a mirrored box placed over their lower limbs. They stepped over a 3-cm high step 10 times, and the angle of the ankle joint, as well as the time required to complete the task, were calculated.

Among this group of patients, the time required to complete the task was significantly shorter in the mirror therapy group, 2.80 seconds compared with 3.19 seconds in the non-mirror group. This translates to an approximate 12% acceleration of movement in the mirror therapy group. There was no significant difference in ankle flexion between the groups.

This is not the first study to report the positive effects of added mirror therapy in stroke patients. A randomized, controlled 4-week trial of 40 stroke patients concluded that hand functioning improved more after the addition of mirror therapy compared to conventional stroke rehabilitation programs. This study measured motor functioning and spasticity using standard instruments for recording physical rehabilitation, including the Modified Ashworth Scale (MAS) and the Functional Independence Measure (FIM). Additionally, a similar study of another 40 stroke patients found mirror therapy enhanced lower-extremity motor recovery. This study measured motor functioning and spasticity using the MAS, the FIM, and measured walking ability. The study presented at the World Stroke Congress is among the first to report speed of movement as a result.

Interestingly, the principles of mirror therapy have been applied to other techniques for stroke rehabilitation and used to develop virtual-reality based therapy systems for physical therapy programs. A recent study reported positive preliminary results from such a method that combines action observation with goal-directed movement imagery.

Hemiplegia is one of the most common consequences of strokes and presents great challenges for rehabilitation. With more evidence focused on visual and cognitive techniques to enhance traditional therapies, the mental and intellectual processes involved in rehabilitation are recognized as important factors in physical recovery. Now, a simple optical illusion could reflect great strides in stroke recovery.

References

Kynan Eng, Ewa Siekierka, Pawel Pyk, Edith Chevrier, Yves Hauser, Monica Cameirao, Lisa Holper, Karin Hägni, Lukas Zimmerli, Armin Duff, Corina Schuster, Claudio Bassetti, Paul Verschure, Daniel Kiper (2007). Interactive visuo-motor therapy system for stroke rehabilitation Medical & Biological Engineering & Computing, 45 (9), 901-907 DOI: 10.1007/s11517-007-0239-1

D ERTELT, S SMALL, A SOLODKIN, C DETTMERS, A MCNAMARA, F BINKOFSKI, G BUCCINO (2007). Action observation has a positive impact on rehabilitation of motor deficits after stroke NeuroImage, 36 DOI: 10.1016/j.neuroimage.2007.03.043

S SUTBEYAZ, G YAVUZER, N SEZER, B KOSEOGLU (2007). Mirror Therapy Enhances Lower-Extremity Motor Recovery and Motor Functioning After Stroke: A Randomized Controlled Trial Archives of Physical Medicine and Rehabilitation, 88 (5), 555-559 DOI: 10.1016/j.apmr.2007.02.034

G YAVUZER, R SELLES, N SEZER, S SUTBEYAZ, J BUSSMANN, F KOSEOGLU, M ATAY, H STAM (2008). Mirror Therapy Improves Hand Function in Subacute Stroke: A Randomized Controlled Trial Archives of Physical Medicine and Rehabilitation, 89 (3), 393-398 DOI: 10.1016/j.apmr.2007.08.162

For a large part of the previous century, it was believed that people with stroke would have to lead a largely dependent life, confined to the wheelchair. They were even discouraged from moving their limbs or exercising. Over the years, rehabilitation for patients with stroke has come a long way. Focus has shifted from basic interventions utilizing strengthening exercises to more advance techniques based on the theories of motor learning and neuroplasticity. This included manual techniques by skilled clinicians as well as the use of equipment such as electrical stimulation modalities, and specialized bikes and treadmill systems — all aimed at optimizing function in patients with impairments. In the past few years, a major step for the field of rehabilitation has been the integration of fields such as assistive technology, robotics and computer sciences with the science of rehabilitation. The amalgam of the above has led to potentially powerful systems that will enhance the functional outcome in patients greatly. The latest entrant into the filed of rehabilitation is virtual reality (VR) systems for rehabilitation. Many of the systems have been tested, released and are now available to hospitals and clinics for use. Clinical trials are ongoing, for upgrading existing technology and for invention of new systems for recovery and rehabilitation.

In 2002, the engineers at Rutgers University have created a VR system that included therapeutic activities aimed at recovery of function in patients with stroke. There are now many versions of this system available, and clinical trials are ongoing to evaluate the extent of efficacy of these systems in recovery of function. Like any VR gaming system, patients will see themselves in a simulated environment. Only, games will be replaced by targeted exercises that will work target various functional muscle groups in the arms and hands. Patients can complete fine motor tasks such as picking up objects, stacking objects, and gross motor tasks such as tapping balloons, catching objects and even reach for objects out of their base of support, thus encouraging balance retraining.

Of late, VR rehabilitation systems are also being evaluated for their use in decreasing neglect in patients with hemiplegia. This is achieved by the system providing visual cues from the affected side, to increase awareness and enhance adaptive relearning. A recent published case study (four participants) suggested that VR systems had the potential for decreasing neglect in patients with stroke. In addition to improvements on the objective tests that were administered, participants also subjectively reported that VR training sessions were helpful and enjoyable. VR systems can even simulate day-to-day situations like crossing a street, cooking, opening doors, etc. This will provide very specific learning of the tasks that are essential activities of daily living. The VR systems are effective as they emphasize active participation by the patient and provide varied environments for task practice while providing immediate feedback of quality. All of these fulfill the requirements of ideal motor practice and motor learning.

Stroke survivors, in my experience, are people who have the most enthusiasm to recover; their zest to go back to doing things they used to love serves as a wonderful motivator at rehabilitation sessions. Preserved cognition, high motivations levels, and a firm conviction to go back to their old routine makes patients with stroke ideal candidates for unique rehabilitation tools. I look forward to the day when these systems are available to most hospitals at an affordable price, with simpler user interfaces so that more and more patients will benefit from the systems.

Reference

Smith, J., Hebert, D., Reid, D. (2007). Exploring the effects of virtual reality on unilateral neglect caused by stroke: Four case studies. Technology and Disability, 19(1), 29-40.

Vegetative States – a hot topic (once again)!

Ever wonder if one is actually conscious when under the knife? Or, if vegetative patients are more awake then we think? Blogger Pete Mandik from the Brain Hammer was interviewed for Sharon Begley’s post in Wall Street Journal entitled “There may be more to a vegetative state than science thought.” Mandik comments on Begley’s piece, pointing out cautions for those who stray off the scientific path in reaching conclusions.

Pure Pedantry’s Jake Young analyzes a study published in Science Magazine and points out diagnostic and philosophical issues. Young wants the reader to take away two major points: the need better diagnostic criterion for the persistent vegetative state and not to over-correlate signs of activity of a vegetative patient with improved chance of recovery and prognosis.

Neurobiology

From fruit flies to chicks, perhaps our neural induction pathways have been largely conversed throughout evolution. This is a strong indication of an effective and working system where generations of propagations have selectively retained this wonderful function! The Neurophilosopher examines a recent publication unraveling this “ancient” neural mechanism. A particular protein, Dpp, may affect molecular mechanisms in neuronal induction, growth, and development. The senior author of study comments on neurophilosopher’s post, essentially indicating further research to confirm their results.

Now that the brain is developed with Dpp and likely thousands of other biochemical mediators, how do neurons control proliferative capacity? Chris Patil of Ouroboros focuses his post to the biology of aging in respect to another protein, p16INK4a. Though its name may be weird, without it you may not be able to control cancerous cells. By limiting proliferative potential, p16INK4a is a tumor suppressor. It is just one player in the constant tug between proliferative capacity (with increased risk for cancer) and tumor protection (which prevent recovery from cell loss and injury).

Psychiatry

Are schizophrenics more rational than unaffected individuals? Perhaps they are, at least for betting. Sandy G covers the recent studies that suggest that increased dopamine may enhance learning and probability of winning in The Mouse Trap. We may posses a feed-forward mechanism where winning events trigger dopamine release, increasing winning chances, causing dopamine surges and the process loops. Further, Sandy concludes that blocking areas of emotional decision making may also improve gambling wins.

Sandy, however, does not dwelve into why schizophrenics may have maximized gambling skills, although it is mentioned in her post title (and my introduction to this section). At present, the medical community is familiar with pathological alterations of the dopamine, serotonin, acetylcholine, and glutamate systems. Studies into the use of substances that induce psychosis (e.g., amphetamines) have revealed enhanced reuptake of dopamine. These findings initiated the dopamine hypothesis, which states hyperactive dopamine transmission in schizophrenia, perhaps in response to stress. The brain is essentially overly sensitive (hyperactive) to stimuli and fails to properly regulate its response through normal inhibitory mechanisms. Therefore, based on the suggested correlation between dopamine levels and winning events, schizophrenics may have the better odds over unaffected individuals. However, for the sake of meticulousness, a host of psychiatric symptoms, for instance, weakened fundamental emotions, distortions of normal functions, and reduced psychomotor speed, may limit winning potential for schizophrenics dependent on the game played.

Mental Health Stigmatization

I want to conclude on a pressing problem being practiced unchecked: widespread societal stigma against mental illness. Our very own Brain Blogger posts a thorough report that defines the problem, its massive effects, and methods to solve it with full academic references. We have also posted many personal stories of individuals with mental and neurological disorders as part of an anti-stigmatization campaign, most notably and recently “A Child’s Bipolar Story – ‘Helpless’” and “Prisoner of the Mind: Living with Depression.” If the stigmatization of mentally ill individuals is not countered and eliminated, our collective progress towards improving the overall mental health of our society by biochemical or neuro-psychological research will always be hindered.

That concludes this round of the Synapse. The next edition will be hosted by Mind Hacks on October 1st. Please remember to submit your entries one day before this date. Submission guidelines for this great neuroscience carnival are available online. Thank you.