Effects of Music Training on Cortical Plasticity: : Cognitive Rehabilitation of Patients with Traumatic Brain Injury

The aim of this thesis was to explore the neuroplastic effects of playing the piano on patients with cognitive impairment following a mild traumatic brain injury (mTBI). It was hypothesised that playing the piano would stimulate neural networks to re-route neural connections and link up cortical circuits that had been functionally inhibited due to minor disruption of brain tissue. The objective of the intervention was to restore the patients’ cognitive processing to pre-injury levels. The study was designed as a pilot study with three experimental groups: (1) 7 patients with cognitive deficits following mTBI two years post-injury (Group 1), (2) 11 healthy subjects (Group 2), and (3) 12 further healthy subjects (Group 3). A between-group design and a longitudinal (pre-post-intervention) within-subject design were applied. Groups 1 and 2 were given eight weeks of piano training. A combination of cognitive and functional neuroimaging (task-based and resting-state fMRI) in addition to neuropsychological tests were performed pre- and post-intervention for all three groups. The results concurrently demonstrated in two independent analyses and fMRI datasets that longitudinal changes in functional connectivity took place within the orbitofrontal cortex (OFC) in the mTBI patient group only, showing increased connectivity between the OFC regions post-intervention involved in executive functions (EF), social cognition and emotional regulation. This finding provides support for the contribution of the OFC as a key mechanism that potentially drives the cognitive benefit of piano training in TBI, and further suggests a network of other connected frontal regions that may be linked to this. The key findings of this study could suggest a causal relationship between musical training and a functional reorganisation of neural networks that promotes enhanced cognitive performance. These results might hold promise as regards adding a novel music-based intervention to the cognitive rehabilitation of mTBI patients.Doktorgradsavhandlin

Effects of Music Training on Cortical Plasticity: : Cognitive Rehabilitation of Patients with Traumatic Brain Injury

The aim of this thesis was to explore the neuroplastic effects of playing the piano on patients with cognitive impairment following a mild traumatic brain injury (mTBI). It was hypothesised that playing the piano would stimulate neural networks to re-route neural connections and link up cortical circuits that had been functionally inhibited due to minor disruption of brain tissue. The objective of the intervention was to restore the patients’ cognitive processing to pre-injury levels. The study was designed as a pilot study with three experimental groups: (1) 7 patients with cognitive deficits following mTBI two years post-injury (Group 1), (2) 11 healthy subjects (Group 2), and (3) 12 further healthy subjects (Group 3). A between-group design and a longitudinal (pre-post-intervention) within-subject design were applied. Groups 1 and 2 were given eight weeks of piano training. A combination of cognitive and functional neuroimaging (task-based and resting-state fMRI) in addition to neuropsychological tests were performed pre- and post-intervention for all three groups. The results concurrently demonstrated in two independent analyses and fMRI datasets that longitudinal changes in functional connectivity took place within the orbitofrontal cortex (OFC) in the mTBI patient group only, showing increased connectivity between the OFC regions post-intervention involved in executive functions (EF), social cognition and emotional regulation. This finding provides support for the contribution of the OFC as a key mechanism that potentially drives the cognitive benefit of piano training in TBI, and further suggests a network of other connected frontal regions that may be linked to this. The key findings of this study could suggest a causal relationship between musical training and a functional reorganisation of neural networks that promotes enhanced cognitive performance. These results might hold promise as regards adding a novel music-based intervention to the cognitive rehabilitation of mTBI patients

The importance of gender of patients and general practitioners in relation to treatment practices for overweight.

BACKGROUND: Several studies suggest that men and women are treated differently for similar disease including diabetes and cardiovascular disease. Differences in attitudes and treatment practices towards men and women with obesity are not well recognized. OBJECTIVE: To investigate the attitudes and treatment practices among Danish general practitioners (GPs), in relation to treatment of overweight, while taking gender of both the patients and practitioners into account. DESIGN: Questionnaire inventory covertly examining attitudes and practices among Danish general practitioners towards treatment of overweight. All 3.637 general practitioners from the Danish Medical Association register were invited to participate in the survey. In total 1.136 participated. RESULTS: The GPs found weight loss to be more important for overweight male than overweight female patients. They also treated complications to overweight more rigorously among male than female patients, and recommended lipid lowering medicine more often to male than female overweight patients. In addition, the younger female GPs and older male GPs more often said that they would treat an overweight patient with lipid lowering medicine. CONCLUSION: Among general practitioners in Denmark, treatment for weight loss is more often practiced for overweight male than overweight female patients presenting with same symptoms. In addition, hyperlipidemia among overweight males is also more often treated with lipid lowering medicine than hyperlipidemia among overweight females

Case report: Odds and CI’s for GPs advising weight loss to overweight patients.

<p>Note: Reference category: Male patients, Male GP’s. Values shown: Odds Ratio, CI and P-value.</p

Distribution of GPs gender, age, practice type, region and size of practice by patients gender.

<p>The total number GPs may not be 1136 in all categories because of missing data.</p

Case report: Distribution of GP’s finding a specific treatment important/not important for male and female patients.

<p>Case report: Distribution of GP’s finding a specific treatment important/not important for male and female patients.</p

Case report: Fraction of overweight female and male patients for whom it was thought to be important/not important to use lipid lowering medicine by age and gender of GPs.

<p>Case report: Fraction of overweight female and male patients for whom it was thought to be important/not important to use lipid lowering medicine by age and gender of GPs.</p

Case report: Fraction of overweight female and male patients for whom weight loss was thought to be important/not important by age and gender of GPs.

<p>Case report: Fraction of overweight female and male patients for whom weight loss was thought to be important/not important by age and gender of GPs.</p

Case report: Odds and CI’s for GP’s advising weight loss or treatment with lipid lowering medicine to overweight patients.

<p>Note: Reference category: Male patients, Male GP’s. Values shown: Odds Ratio, CI and P-value.</p

Case report: Odds and CI’s for GPs advising treatment with lipid lowering medicine to overweight patients.

<p>Note: Reference category: Male patients, Male GP’s. Values shown: Odds Ratio, CI and P-value.</p