Examining the relationship among measures of global cognition, executive function, and instrumental activities of daily living: can they all just get along?

The subtle nature of executive function deficits makes them difficult to identify in a clinical context and to measure how they impact an individual’s daily life. Clinical neuropsychological assessments alone are often unable to measure how executive deficiencies impact an individual’s daily life. The present study investigated the relationship among clinical screening measures of global cognition, measures of executive function, and instrumental activities of daily living (IADLs). Adults with Parkinson’s disease and neurologically healthy adults completed a battery of assessments including a clinical measure of general functional ability, the Texas Functional Living Scale (TFLS), and a naturalistic shopping task, the University of Tennessee Chattanooga Multiple Errands Test (UTC-MET). TFLS performance was better able to identify functional impairment, while the UTC-MET was able to distinguish inefficient behavior in Parkinson’s disease participants. Findings stress a symbiotic relationship among clinical and naturalistic measures and highlights the important role executive function plays in both

Treatment effects of attention process training for an individual with idiopathic Parkinson\u27s disease

Purpose: The purpose of this study was to determine the treatment efficacy of the Attention Process Training (APT; Sohlberg & Mateer, 2005), a therapeutic protocol designed for individuals who have sustained a traumatic brain injury (TBI), on a person with Parkinson’s disease to determine if improvement of various attention processes and memory recall could be improved. Methods: We designed a phase I, multiple baseline A1-B-A2-A3, single-subject study with one participant diagnosed with idiopathic PD and self-reported attention impairments. We used Attention Process Training (APT) protocol (Sohlberg & Mateer, 2005) to train attention process 120-minutes per session, one time per week for 6 sessions. Results: The participant demonstrated a large improvement in sustained attention for both percent accuracy (A1 to A2 d=5.196; A1 to A3 d = 13.279; A2 to A3 d=1.443) and timed performance (A1 to A2 d=2.952; A1 to A3 d = 3.153; A2 to A3 d=0.287). While treating sustained attention, we continued to probe selective, alternating and divided attention. Carryover improvement was noted with selective attention percent accuracy (A1 to A2 d=.091; A1 to A3 d=2.817; A2 to A3 d=1.299) and timed performance (A1 to A2 d=.690; A1 to A3 d=1.044; A2 to A3 d=1.598), and divided attention percent accuracy (A1 to A2 d=1.225; A1 to A3 d = 1.225; A2 to A3 d=2.860) and timed performance (A1 to A2 d=2.041; A1 to A3 d = 1.225; A2 to A3 d=1.155). The results of the TEA indicated an improvement or maintenance in the scaled scores of each subtest. Performance increased in the following scores: OSPAN absolute scores, accuracy errors, and math errors; RSPAN speed errors, math errors, and total correct. Discussion: Results demonstrated that training sustained attention using the APT tasks resulted in sizeable effects when delivered at high intensity (120 minutes per session) one time per week for six weeks. We saw improvement on the untrained selective and divided attention, but not alternating attention, which should have been easier, according the APT hierarchy. We cannot generalize these findings. However, the results give us evidence to continue treatment development

Evaluation of principles of motor learning in speech and non-speech-motor learning tasks

Principles of motor learning (PMLs) refer to a set of concepts which are considered to facilitate the process of motor learning. PMLs can be broadly grouped into principles based on (1) the structure of practice/treatment, and (2) the nature of feedback provided during practice/treatment. Application of PMLs is most evident in studies involving non-speech- motor tasks (e.g., limb movement). However, only a few studies have investigated the application of PMLs in speech-motor tasks. Previous studies relating to speech-motor function have highlighted two primary limitations: (1) Failure to consider whether various PMLs contribute equally to learning in both non-speech and speech-motor tasks, (2) Failure to consider whether PMLs can be effective in a clinical cohort in comparison to a healthy group. The present research was designed to shed light on whether selected PMLs can indeed facilitate learning in both non-speech and speech-motor tasks and also to examine their efficacy in a clinical group with Parkinson’s disease (PD) in comparison to a healthy group. Eighty healthy subjects with no history of sensory, cognitive, or neurological abnormalities, ranging 40-80 years of age, and 16 patients with PD, ranging 58-78 years of age, were recruited as participants for the current study. Four practice conditions and one feedback condition were considered in the training of a speech-motor task and a non-speech- motor task. The four practice conditions were (1) constant practice, (2) variable practice, (3) blocked practice, and (4) random practice. The feedback was a combination of low-frequency, knowledge of results, knowledge of performance, and delayed feedback conditions, and was paired with each of the four practice conditions. The participants in the clinical and non-clinical groups were required to practise a speech and a non-speech-motor learning task. Each participant was randomly and equally assigned to one of the four practice groups. The speech-motor task involved production of a meaningless and temporally modified phrase, and the non-speech-motor task involved practising a 12-note musical sequence using a portable piano keyboard. Each participant was seen on three consecutive days: the first two days served as the acquisition phase and the third day was the retention phase. During the acquisition phase, the participants practised 50 trials of the speech phrase and another 50 trials of the musical tune each day, and each session lasted for 60-90 min. Performance on the speech and non-speech tasks was preceded by an orthographic model of the target phrase/musical sequence displayed on a computer monitor along with an auditory model. The participants were instructed to match their performance to the target phrase/musical sequence exactly. Feedback on performance was provided after every 10th trial. The nature of practice differed among the four practice groups. The participants returned on the third day for the retention phase and produced 10 trials of the target phrase and another 10 trials of the musical sequence. Feedback was not provided during or after the retention trials. These final trials were recorded for later acoustic analyses. The analyses focused on spatial and temporal parameters of the speech and non-speech tasks. Spatial analysis involved evaluating the production accuracy of target phrase/tune by calculating the percentage of phonemes/keystrokes correct (PPC/PKC). The temporal analysis involved calculating the temporal synchrony of the participant productions (speech phrase & tune) during the retention trials with the target phrase and tune, respectively, through the phi correlation. The PPC/PKC and phi correlation values were subjected to a series of mixed model ANOVAs. In the healthy subjects, the results of the spatial learning revealed that the participants learned the speech task better than the non-speech (keyboard) task. In terms of temporal learning, there was no difference in learning between the speech and non-speech tasks. On an overall note, the participants performed better on the spatial domain, rather than on the temporal domain, indicating a spatial-temporal trade-off. Across spatial as well as temporal learning, participants in the constant practice condition learned the speech and non-speech tasks better than participants in the other practice conditions. Another interesting finding was that there was an age effect, with the younger participants demonstrating superior spatial and temporal learning to that of the older participants, except for temporal learning on the keyboard task for which there was no difference. In contrast, the PD group showed no significant differences on spatial or temporal learning between any of the four practice conditions. Furthermore, although the PD patients had poorer performances than the healthy subjects on both the speech and keyboard tasks, they showed very similar pattern of learning across all four practice conditions to that of the healthy subjects. The findings in the current study tend to have potential applications in speech-language therapy, and are as follows: (1) a constant practice regime could be beneficial in developing speech therapy protocols to treat motor-based communication disorders (e.g., dysarthria), (2) speech therapists need to exercise caution in designing speech therapy goals incorporating similar PMLs for younger and older adults, as the application of similar PMLs in younger and older adults may bring about different learning outcomes, (3) and finally, it could be beneficial for patients to practise speech tasks which would require them to focus either on the spatial or temporal aspect, rather than focussing on both the aspects simultaneously

PATIENT AND THERAPIST PERCEPTIONS OF RESPIRATORY FUNCTIONING DUE TO SPINAL CORD INJURY: IMPLICATIONS FOR MUSIC THERAPISTS

Decreased respiratory functioning is a common symptom of spinal cord injury (SCI) and can impact individuals’ personal, professional, and social lives. In spite of this, researchers have not explored the use of music in the lives of individuals with SCIs or music’s role in their healthcare professionals’ treatment plans to improve respiratory functioning. The purpose of this qualitative study was to better understand how decreased respiratory functioning affects individuals with SCIs and healthcare professionals through a multiple case study design. Participants were two individuals with SCIs and three healthcare professionals (physical therapist, recreational therapist, and music therapist) who worked with individuals with SCIs. Findings showed that decreased respiratory functioning affected many aspects of life for participants living with SCIs and multiple factors of treatment goals for healthcare professionals. Anxiety, stress, sexual functioning, and trouble sleeping were among the factors affecting participants with SCIs, while decreased treatment times and lightheadedness/loss of consciousness were included in considerations for healthcare professionals. Most participants only used music for entertainment, but some noted the value of singing with preferred music and music for anxiety reduction. Individuals with SCIs may benefit from music therapy interventions to decrease anxiety and improve their quality of life

Spinocerebellar Ataxia

This book is about spinocerebellar ataxia (SCA), which is among the most challenging pathologies in the neurological landscape. It covers basic concepts, functional classification, and new approaches to medical and non-medical treatment including rehabilitation/palliative care approaches. The volume also describes a wide spectrum of generalities and particularities about various forms of clinical and genetic presentations of ACS that have life-threatening characteristics and long-standing presentation with tremendous variability in presentation and clinical severity. In addition, the book presents important aspects of cerebellar anatomy, nutrition impact, genetic subtypes, and functional classification of medical and non-medical interventions related to stem cells, rehabilitation, and palliative care

Application of deep learning techniques for biomedical data analysis

Deep learning and machine learning methods have been used for addressing the problems in the biomedical applications, such as diabetic retinopathy assessment and Parkinson's disease diagnosis. The severity of diabetic retinopathy is estimated by the expert's examination of fundus images based on the amount and location of three diabetic retinopathy signs (i.e., exudates, hemorrhages, and microaneurysms). An automatic and accurate system for detection of these signs can significantly help clinicians to make the best possible prognosis can result in reducing the risk of vision loss. For Parkinson's disease diagnosis, analysis of a speech voice is considered as the earliest symptom with the advantage of being non-intrusive and suitable for online applications. While some reported outcomes of the developed techniques have shown the good results and ongoing progress for these two applications, designing new algorithms is a thriving research field to overcome the poor sensitivity and specificity of the outcomes as well as the limitations such as dataset size and heuristic selection of the network parameters. This thesis has comprehensively studied and developed various deep learning frameworks for detection of diabetic retinopathy signs and diagnosis of Parkinson's disease. To improve the performance of the current systems, this work has had an investigation on different techniques: (i) color space investigation, (ii) examination of various deep learning methods, (iii) development of suitable pre/post-processing algorithms and (iv) appropriate selection of deep learning architectures and parameters. For diabetic retinopathy assessment, this thesis has proposed the new color space as the input for the deep learning models that obtained better replicability compared with the conventional color spaces. This has also shown the pre-trained model can extract more relevant features compared to the models which were trained from scratch. This has also presented a deep learning framework combined with the suitable pre and post-processing algorithms that increased the performance of the system. By investigation different architectures and parameters, the suitable deep learning model has been presented to distinguish between Parkinson's disease and healthy speech signal

The effects of person-centred active rehabilitation on symptoms of suspected Chronic Traumatic Encephalopathy: A mixed methods single case design

Background: For almost a century, cases of former contact sport athletes who have developed cognitive impairments, changes in mood/behaviour, or motor dysfunction have been reported within scientific journals and major news outlets. In 2015, Chronic Traumatic Encephalopathy (CTE) was established as a unique neurodegenerative pathology linked to the repeated exposure to mild traumatic brain injury. Due to the observed long-term effects, multiple generations of former athletes are at-risk of developing symptoms of CTE. With no pathology-led intervention yet established, these athletes remain vulnerable and unsupported. Aim: The aims of the thesis included (1) to establish the potential for active rehabilitation as an intervention strategy for the management of symptoms associated with suspected CTE, and (2) to equally consider evidence-based medicine (EBM) and person-centred care (PCC) when designing and evaluating a programme for the management of suspected CTE. Methods: An umbrella review was carried out to examine the effect that active rehabilitation had on symptoms of tauopathies. Six mixed-method n-of-1 studies were carried out to assess the effect that a person-centred active rehabilitation programme had on symptoms of suspected CTE. Results: The umbrella provided preliminary evidence to support the use of active rehabilitation in the management of tauopathies, with specific implications for the management of suspected CTE. A key observation was the positive effect of active rehabilitation on motor and cognitive symptoms in tauopathies. The mixed methods single case series provided preliminary evidence of a positive effect on some symptoms of suspected CTE. A positive effect was primarily seen in cognitive functioning, with mood and behavioural symptoms (e.g., anxiety, depression, loneliness, irritability, and insomnia) largely reporting a mix of positive and inconclusive effects. Conclusions: For the first time, this thesis has offered preliminary evidence which suggests active rehabilitation may offer some benefit to individuals with symptoms of suspected CTE. This is supported by the findings of a one-year observational study which demonstrated positive effects across a range of symptoms utilising a person-centred rehabilitation approach. Further, this thesis has illustrated the benefit of PCC in clinical research and practice

An evaluation of cognitive deficits in a rat-model of Huntington's disease

The purpose of this thesis was to develop methodology by which treatments for the cognitive impairments in Huntington’s disease (HD) could be tested. As such, the thesis focused mainly on evaluating rats with quinolinic acid (QA) lesions of the striatum, as this manipulation mimics some aspects of the neural damage in Huntington’s disease, to try to identify cognitive deficits of HD resulting from cell loss in the striatum. In the first part (Chapters 3-5), the role of the striatum in implicit memory was investigated. Chapter 3 compared the performance of rats and humans on a reaction time task that evaluated implicit memory by presenting visual stimuli with differing probabilities which change over time. Although rats made higher percentage of incorrect responses and late errors, both groups showed a similar pattern of reaction times. Chapter 4 investigated whether implicit memory (the computation of probabilities to predict the location of a stimulus) was affected by selective blockade of dopaminergic transmission at the D1 or D2 receptors by SCH-23390 and raclopride, respectively. Reaction times were slower with SCH-23390 and raclopride, but only SCH-23390 reduced errors to the least probable target location. Chapter 5 used the same task to evaluate implicit memory in rats with QA lesions of the dorsomedial striatum (DMS). Implicit memory was not affected by lesions of the DMS, which suggested that once a task that requires implicit memory has been learned, the DMS was not involved in sustaining the performance of the task. The second part of this thesis (Chapter 6), explored the contribution of the DMS in habit formation. DMS lesioned rats did not show habitual responding, and were not impaired in learning a new goal-directed behaviour. The third part (Chapters 7 and 8), investigated the role of the dorsal striatum in reversal learning, attentional set-formation, and set-shifting. Dorsal striatum lesioned rats were not impaired in reversal learning, but had a diminished shift-cost, which suggested that dorsal striatum lesions disrupted the formation of attentional sets. These results showed that although QA lesions of the dorsal striatum mimic some aspects of the neural damage in HD, they did not result in the same cognitive deficits observed in patients with HD, at least using the tasks presented in this thesis. However, other animal models of HD could be evaluated using the different tasks presented in this thesis to continue the search of a reliable animal model of HD in which treatments for the disease could be evaluated

Chemo brain and prospective memory in breast cancer patients: A mixed methods study

Some breast cancer patients report memory deficits after undergoing cancer treatment. This deficit has been given the term chemo brain. Patients who report such deficits usually complain about attention and concentration problems, such as forgetting to take their medication, or taking it twice, forgetting doctor’s appointments, reduced ability to multitask, and difficulties with driving, among others. These difficulties can significantly affect their quality of life. Most of the research to date has focused on examining a global neuropsychological aspect of chemo brain, and in the last decade , attention has been directed to the use of neuroimaging techniques. The major question addressed in this study is whether chemo brain in breast cancer patients specifically a prospective memory deficit, and whether neuropsychological assessment lacks ecological validity to measure chemo brain. It is also suggested that biological factors such as sleep and sleepiness are altered during the course of cancer treatment, and those factors may also be playing a role in the cognitive impairment of cancer patients. The method used to examine these questions included a mixed methods design in which a quantitative study was conducted using a neuropsychological battery and physiological measures as well as a qualitative study, which involved thematic analyses and case studies, aided by semi-structured interviews and questionnaires. Overall, the results of this study confirmed that breast cancer patients have poorer prospective memory than controls, and that patients’ self-reports are inconsistent with results derived from the objective neuropsychological battery. This implies that more sensitive measures for the assessment of chemo brain should be developed, and that more emphasis needs to be placed on the study of prospective memory and chemo brain to provide patients with the most efficient care and psychological treatment in order to improve their quality of life