Horticultural therapy may reduce psychological and physiological stress in adolescents with anorexia nervosa: a pilot study

Studies in psychiatric populations have found a positive effect of Horticultural therapy (HCT) on reductions in stress levels. The main objective of the present pilot study was to evaluate the impact of the addition of HCT to conventional clinical treatment (Treatment as Usual, TaU) in a sample of six female adolescents with anorexia nervosa restricting type (AN-R), as compared to six AN-R patients, matched for sex and age, under TaU only. This is a prospective, non-profit, pilot study on patients with a previous diagnosis of AN-R and BMI < 16, recruited in 2020 in clinical settings. At enrolment (T0) and after treatment completion (TF), psychiatric assessment was performed. At T0, all the patients underwent: baseline electrocardiogram acquisition with a wearable chest strap for recording heart rate and its variability; skin conductance registration and thermal mapping of the individual’s face. An olfactory identification test was administered both to evaluate the olfactory sensoriality and to assess the induced stress. One-way analyses of variance (ANOVAs) were performed to analyze modifications in clinical and physiological variables, considering time (T0, TF) as a within-subjects factor and group (experimental vs. control) as between-subjects factors. When the ANOVA was significant, post hoc analysis was performed by Paired Sample T-tests. Only in the HCT group, stress response levels, as measured by the biological parameters, improved over time. The body uneasiness level and the affective problem measures displayed a significant improvement in the HCT subjects. HCT seems to have a positive influence on stress levels in AN-R

The construction of motor spaces through typical development and in cerebral palsy

This doctoral thesis has a wide scope, resulting from a research effort made in three directions: to understand innate motor behaviour, to observe the shaping of voluntary motor actions through development, and to trace back the entanglement between movement and cognition in locomotor navigation. As it usually occurs in scientific investigation, the result was by no means comparable with the effort, but nonetheless all worth it. The observation of spontaneous motor activity as a diagnostic tool In the first place, I have been involved as a child neurologist in the early diagnosis and prognosis of motor disorders. A deep change of paradigm has taken place in neonatal and infant neurology in the last thirty years, from adult-derived, analytical examination protocols to a more age-specific, global and qualitative approach: Prechtl's method on the qualitative assessment of general movements (GMs) (Cioni, Ferrari & Prechtl 1989; Einspieler et al. 2005a). This has become a clinical gold standard, in particular for the early diagnosis of cerebral palsy, thanks to its high reliability and non-invasiveness (Prechtl et al. 1997). Chapter 2 in this thesis is an account of the state of the art of the methodology, its clinical application and functional meaning (Cioni et al., in press). Motor development from spontaneous variability to goal-oriented optimisation The speculative interest of GM assessment is of no less momentum than its clinical power, for at least two reasons. Firstly, on the examiner's side, it provides a crystal-clear instance of how the global and qualitative judgement can outperform the analytical and quantitative one, when properly trained. This is an intensely pursued and beloved result of GM history, whose expectation dates back to when Heinz Prechtl was taught the power of Gestalt perception by his mentor, Konrad Lorenz (1959). Secondly, on the infant's side, it definitely points out the richness of innate motor repertoire, its strict correlation with brain well-being and with the quality of later development. It must be stressed, and it will be never enough, that the power of GM assessment, and in general of Gestalt perception, relies on the global, phenomenological appreciation of movement quality, not on the analysis of particular items and much the less on movement quantity. What contributes the most to a positive judgement is the variability of motor patterns, i.e. their neverending variation in shape, speed, force, anatomical distribution and sequential organisation. In other words, normal GMs can be regarded as a sort of motor babbling, featuring the widest possible range of variation in almost all kinesiological features. On the opposite side, severely abnormal GMs feature a complete lack of variation. In this perspective, GM assessment is in perfect agreement with the theory of neuronal group selection (Edelman 1977; Sporns & Edelman 1993): voluntary, goal-oriented motor actions would emerge from the selection of successful spontaneous motor patterns, by means of an on-going trial-and-error sensorimotor loop. Variability in innate motor behaviour (or, maybe better, "variation", as proposed by Hadders-Algra in a recent review, 2010) should be then considered the foundation of the later flexibility and optimisation of motor solutions. As explained in the next paragraph and more in detail in Chapter 3, one of the key signs of optimal motor coordination in adults is kinematic stereotypy, which, in a sense, is the opposite of variation. Stereotypy is however only one side of the coin, whereas the other is flexibility: only their integration allows to select the best solution to attain a goal (optimisation). In conclusion, the best imaginable motor repertoire in a mature individual is made up of accurately selected, and therefore stereotyped, motor patterns, integrated in a vast repertoire of coping solutions. On the other hand, an "optimality concept" was coined by Prechtl in 1980, to indicate the best imaginable neurological condition at birth, which can be now identified with the best possible quality of GMs, i.e. the maximal amount of variation. The "optimal" motor development is then a journey from "optimal" variation to "optimal" selection. The formation of motor trajectories: a bridge between different spaces Edelman's theory of neuronal group selection is a possible answer to the question raised by Nikolaj Bernstein in 1935 (Bernstein 1967, first English translation): how does the brain cope with the huge number of degrees of freedom offered by a multi-articulated body (Sporns & Edelman, 1993)? The degrees of freedom problem is still central in modern movement science. Two simple observations are at its basis: 1) more than one motor signal can lead to the same spatial trajectory of a given end-effector, e.g. a hand (redundancy); 2) different end-effectors, e.g. a hand, a foot or the whole body, can easily produce topologically identical trajectories, even those body parts that were not associated with that action during training (motor equivalence). In other words, it is not the biomechanical chain to be encoded at the highest level of control, but the Gestalt of the motor action (Bernstein, 1967). This raises a yet unsettled question: is there a role for spatial cognition in motor coordination, or are movements produced by a direct stimulus-response coupling? The former hypothesis has been adopted by Alain Berthoz and his co-workers at the Collège de France, with whom I have collaborated in the second and third parts of my thesis. Their description of the close analogies between hand- and locomotor trajectories, from both a geometric and a kinematic point of view, unveils a common computational module for movements of such different biomechanical implementations (Vieilledent et al. 2005; Hicheur et al. 2005b). Two fundamental principles govern the formation of locomotor trajectories in adults: 1) the walking direction is always anticipated by head- and eye-orientation (Grasso et al. 1998b; Bernardin et al. 2012), and 2) trajectory geometry and kinematics are highly stereotyped in a world-centred spatial reference frame (Hicheur et al. 2007). Both findings point to the existence of a top-down, feed-forward control loop for locomotor optimisation, strongly related to the cognitive representation of the external space (Pham et al. 2007; Pham & Hicheur 2011). In Chapter 3, the first systematic investigation into the typical development of head anticipation and trajectory formation in goal-oriented locomotion is presented (Belmonti et al., submitted). Our major finding is that both behaviours are consolidated as late as in early adolescence, i.e. well after the maturation of gait biomecanichal patterns and in a period when spatial cognition definitely shifts to a preferential allocentric strategy (Bullens et al. 2010). From locomotion to navigation, from action to cognition Finally, having realized the strong entanglement between action, perception and cognition, we have investigated the development of locomotor navigation in healthy children and in children with cerebral palsy. Navigation is the process or activity of accurately ascertaining one's position and planning and following a route (OED). It is a complex function, requiring several basic motor, perceptual and cognitive skills, and relying on different, sometimes concurrent cognitive strategies (Berthoz et al. 1995; Berthoz 1997; Maguire et al. 1998; O'Keefe et al. 1998; Chapter 4 in this thesis, for a review). To this respect, the comparison between hand movements and locomotion has taught us another lesson: encoding locations in the locomotor space is by no means the same as encoding locations in the reaching space. Inspired by previous work by Laura Piccardi, Cecilia Guariglia and their co-workers at the University La Sapienza in Rome (Piccardi et al. 2008; 2011; 2012), a new computerized tool for the presentation and recording of spatial sequences in the locomotor space has been devised: the Magic Carpet. The Magic Carpet employs the same spatial layout of the classical Corsi Block-tapping Test for visual-spatial memory, but enlarged to room size and with tiles to walk on instead of blocks to tap. It is equipped with pressure sensors and LEDs under tiles, to record and cue the subject's displacement. In Chapter 4, the results of its first application in typical development and in cerebral palsy are presented (Belmonti et al., in preparation). On the basis of previous reports and of our findings on trajectory formation, we hypothesized that navigational strategies would show major changes during school age. The comparison of memory performance on the table Corsi and on the Magic Carpet, however, did not reveal a major transition between 6 and 12 years, but only a slow trend towards a relative advantage in navigation with increasing age and intellectual level. In cerebral palsy, navigational skills were more often preserved than visual-spatial memory in the reaching space. Only children with temporal brain lesions were less favoured in navigation. In summary, navigation seems more an opportunity than a complication for most children with cerebral palsy, which is probably due to its multi-sensory and multi-strategy nature, at least when all sources of spatial information are available

Anticipatory control and spatial cognition in locomotion and navigation through typical development and in cerebral palsy

Behavioural evidence, summarized in this narrative review, supports a developmental model of locomotor control based on increasing neural integration of spatial reference frames. Two consistent adult locomotor behaviours are head stabilization and head anticipation: the head is stabilized to gravity and leads walking direction. This cephalocaudal orienting organization aligns gaze and vestibula with a reference frame centred on the upcoming walking direction, allowing anticipatory control on body kinematics, but is not fully developed until adolescence. Walking trajectories and those of hand movements share many aspects, including power laws coupling velocity to curvature, and minimized spatial variability. In fact, the adult brain can code trajectory geometry in an allocentric reference frame, irrespective of the end effector, regulating body kinematics thereafter. Locomotor trajectory formation, like head anticipation, matures in early adolescence, indicating common neurocomputational substrates. These late-developing control mechanisms can be distinguished from biomechanical problems in children with cerebral palsy (CP). Children's performance on a novel navigation test, the Magic Carpet, indicates that typical navigation development consists of the increasing integration of egocentric and allocentric reference frames. In CP, right-brain impairment seems to reduce navigation performance due to a maladaptive left-brain sequential egocentric strategy. Spatial integration should be considered more in rehabilitation. What this paper adds: Head stabilization to gravity and head anticipation of walking direction are fully developed around 11-13 years of age In adolescence, locomotor trajectories become smooth and consistent as a result of their planning in allocentric space. The Magic Carpet is a novel navigation task, showing that school-age children do not yet integrate egocentric and allocentric reference frames The motor and the cognitive aspects of locomotion can be differently affected and dissociated in children with cerebral palsy Early right-brain lesions reduce Magic Carpet performance inducing inefficient egocentric solving strategies Developmental Medicine and Child Neurology

Switching from reaching to navigation: differential cognitive strategies for spatial memory in children and adults

Switching from reaching to navigation: differential cognitive strategies for spatial memory in children and adult

Dysperceptive forms

In over thirty years of clinical observation of cerebral palsied (CP) children, especially among premature babies with bilateral motor damage, we have repeatedly found a group of patients with a unique combination of clinical characteristics which, we believe, could represent a specific group within the CP categorization. For convenience, we have termed them dysperceptive and we have been studying their behavior in a fairly large group of patients in order to see if some phenomena, unmistakably observed in single cases, were recognizable, also in different degrees, in larger groups. We have maintained the term perceptual disturbance or dysperception for the first and most interesting hypothesis that the errors performed by these children could happen during the collection, interpretation, and re-elaboration of information, especially of the sense of movement, even if other fascinating theories can be found especially in the field of psychology. These complex behaviors, for example fear, can be observed during clinical examination or physiotherapeutic treatments. In addition, parents and older children often describe some specific situations, which are recurrent and typical, that take place in everyday life in different settings (at school, on holiday, with friends, etc.), often underlining the limitations produced by these phenomena regarding motor independence and quality of life. These signs can be observed in CP children with diverse motor damage (diplegia, tetraplegia, but not hemiplegia) and at different development levels. In order to explore consistency and recurrence of the more important or frequent dysperceptive signs, describe them in detail and collect evidence by suitable instruments, we have been and are still employing video recording sessions (natural history of these signs). \ua9 2010 Springer-Verlag Milan

Cognitive strategies for locomotor navigation in normal development and cerebral palsy

Cognitive strategies for locomotor navigation in normal development and cerebral pals

Navigation strategies as revealed by error patterns on the Magic Carpet test in children with cerebral palsy

Short-term memory develops differently in navigation vs. manual space. The Magic Carpet (MC) is a novel navigation test derived from the Walking Corsi Test and the manual Corsi Block-tapping Task (CBT). The MC requires mental rotations and executive function. In Cerebral Palsy (CP), CBT, and MC scores relate differently to clinical and lesional factors. Hypotheses of this study are: that frontal lesion specifically affect navigation in CP; that brain lesions affect MC cognitive strategies

Does the assessment of general movements without video observation reliably predict neurological outcome?

Objective: To assess the clinical value of a modified version, not employing video recording, of Precthl's method on the qualitative assessment of general movements (GMs) in preterm, term and young infants at neurological risk. Materials and methods: One-hundred and fifteen infants consecutively enrolled in our follow-up program were selected for the study (103 preterm and 12 term infants). While being video recorded, each infant's spontaneous motor activity was directly observed and documented using a written proforma. An evaluation of the video was later performed by a different assessor blind to the infant's clinical history. Results: The correlation between the two techniques was significant both at writhing age (birth to 6 weeks post-term age) and at fidgety age (9-15 weeks post-term age). Both methods showed a very high sensitivity for the prediction of cerebral palsy, as no false negatives were observed. The direct assessment showed a lower specificity, particularly during the writhing period. Conclusions: These results support the use of the direct assessment of GMs when the full application of the standard video observation cannot be routinely applied, restraining the use of video recordings to the abnormal or doubtful cases. This may facilitate the wished integration of the assessment of spontaneous motility into more general protocols of neurological examination and into clinical follow-up programs. (C) 2007 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved

Visual-perceptual impairment in children with cerebral palsy: a systematic review

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