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| Ventral brainstem lesion in the locked-in syndrome as shown by MRI (A); graphical representation of interrupted efferent corticospinal and corticocerebellar tracts (in black) and preserved afferent spinocerebellar tracts (in red) in LIS patients (B); hypothesized mechanism by which Sonoception technology may contribute to reduce the mismatch between the efferent (defective) and the afferent (healthy) pathways in LIS and to restore properly working forward programs (C).
Contexts in source publication
Context 1
... Medicine: Mens Sana in Corpore Virtuale Sano by Riva, G., Serino, S., Di Lernia, D., Pavone, E. F., and Dakanalis, A. (2017 We read with interest the recently published paper about the potential role of "embodied medicine" ( Riva et al., 2017). Authors suggest the use of advanced technologies for altering the experience of being in a body, with the goal of improving the well-being of patients. This paradigm is intriguingly summarized through the key message "Mens Sana in Corpore Virtuale Sano" and is recommended for patients with different neurological and psychiatric disorders including neglect, chronic pain, schizophrenia, depression and eating disorders. Here we report about a neurological syndrome which, in our opinion, might greatly benefit from the proposed approach and from simulation/stimulation technologies able to modulate the inner body dimension. This is the Locked-in Syndrome (LIS) characterized by a condition of severe motor entrapment due to the interruption of corticospinal, corticobulbar and cortico-cerebellar pathways as a result of a ventral brainstem lesion (Figures 1A,B). Patients are completely entrapped within their body because of quadriplegia, anarthria and lower cranial nerve paralysis, and communicate with the environment only through vertical eye movements and blinking which are the only motor outputs preserved. Despite this, consciousness and sensory pathways (exteroception, proprioception, vestibular inputs, and interoception) are completely conserved. Although cognition is also traditionally considered unaffected, due to the preservation of supratentorial structures, we recently described some non-motor symptoms in these patients, including motor imagery defects, selective emotional dysfunctions and pathological laughter and crying, and interpreted them as a consequence of a body representation disorder Sacco et al., 2008;Pistoia et al., 2010). This fits with later volumetric data obtained in these patients, revealing the presence of an unexpected cortical loss involving areas typically associated with the mirror neuron system and the body matrix ( Pistoia et al., 2016). As reminded by the authors, an accurate body representation is the result of the effective integration of multisensory (somatosensory, visual, auditory, vestibular, visceral) and motor signals, which provides an evolutionary advantage by maintaining a homeostatic protective milieu for human beings. This system, subserved by cortico-ponto-cerebellar pathways, matches bodily sensations and motor intentions in order to protect the body by triggering perceptual and behavioral programs (effectors) when something alters the body and the space around it ( Riva et al., 2017). In patients with LIS, the lack of functioning efferent pathways, both at corticospinal and cortico-cerebellar level, may interfere with the body representation system, weaken the boundaries of the body and lead to unexpected symptoms in cognitive domains. Specifically patients are less accurate than healthy control subjects in recognizing others' negative facial expressions, thus confirming that voluntary activation of mimicry is a high-level simulation mechanism crucially involved in explicit attribution of emotions ( Pistoia et al., 2010). Similarly, patients with LIS show motor imagery defects including difficulties in mentally manipulating the hands thus endorsing the view that motor imagery is subserved by activation of motor information ). Finally, they can suffer from a pathological laughter and crying syndrome, as a result of a continuous disagreement between preserved centripetal bodily sensations and affected centrifugal motor outputs ( Sacco et al., 2008). All these symptoms may be interpreted as the result of a body matrix disorder (Conson et al., 2009Babiloni et al., 2010;Pistoia et al., ...
Context 2
... date, when reasoning about embodiment, much consideration has been given to the integration of various sensory modalities (somatosensory, visual, auditory, vestibular, visceral) while less attention has been paid to the role that efferent pathways play in shaping the body's inner dimension and representation (Ehrsson, 2007;Lenggenhager et al., 2007;Petkova and Ehrsson, 2008;Guterstam et al., 2015). Patients with LIS may represent an experimental model to better investigate the role of efferent pathways in embodied simulation mechanisms and become a target population for innovative rehabilitative approaches aimed at reducing the percentage of disagreement within the body matrix computational processes. These approaches can include virtual reality and haptic technologies, bio/neuro-feedback strategies and brain/body stimulation paradigms. In patients with LIS, the technology used by Sonoception may be used in the attempt to reduce the mismatch between the efferent (defective) and the afferent (healthy) pathways. For instance, as shown in Figure 1C, vibrotactile transducers may be applied to a physically immobile limb of patients, in order to generate a sensation of arm displacement and to train the self-monitoring of patients. In fact, in healthy subjects, self-monitoring is based on the proper working of an internal forward model: every time that a motor command arises in the motor cortex, this information also reaches the cerebellum where a copy about the command is registered (Wolpert et al., 1995;Ito, 2008). The information transfer is subserved by the corticocerebellar pathways. In this way the cerebellum is able to predict the sensorial consequences of the action resulting from the command and to compare these sensory predictions to the actual sensory feedback received through the spinocebellar tracts ( Wolpert et al., 1995;Ito, 2008). If the mismatch between sensory predictions and sensory feedback is little, this confirms that the action is self-generated and leads to an attenuation of the intensity of the sensation associated with the action itself. On the other hand, if the discrepancy between sensory predictions and sensory feedback is high, it is likely that the action is not self-generated and this leads to a relative increase in the intensity of the sensation associated with the stimulus. In patients with LIS the interruption of both corticospinal and corticocerebellar pathways, against the preservation of spinocerebellar pathways, interferes with the proper working of the forward model by producing a continuous mismatch between sensory predictions and sensory feedback. Providing a sensation of arm displacement in these patients may contribute to reduce this mismatch and to restore the functional coupling between motor intentions and sensory feedback. A specific training based on this approach may, in the long term, promote a partial motor recovery, especially when a small proportion of corticospinal fibers had survived the initial injury. This might contribute to improving the well-being of a population of patients whose chances of recovery have always been considered exceedingly ...
Citations
... Some individual cases reveal moderate and selective cognitive impairment in LIS of vascular origin (e.g. [150,170,187]), but others illustrate the prevailing outcome, where personality, cognition and decisional capacity are preserved (e.g. [3,26,27,136,193]). 2 Reaching a diagnosis of LIS requires regular patient assessment and a combination of methods (see overview by [114] and the recent case report by [207]). ...
... 17 LIS sometimes appears only as a Bconfounding neurological state^in the context of diagnosing DOC ( [175], 144,149). Going further, Walter Glannon explains that whereas Bpatients in a permanent VS no longer exist as persons^and MCS patients lack the capacity Bto adequately consider the reasons for or against life-sustaining treatment,^locked-in individuals do not suffer such incapacitating Bcognitive impairment^( [75], 172,157,167,170). They may vary in how they judge their situation and make different choices about their life, but there is no doubt that they judge and choose with the autonomy attributed to persons. ...
There is no systematic knowledge about how individuals with Locked-in Syndrome (LIS) experience their situation. A phenomenology of LIS, in the sense of a description of subjective experience as lived by the ill persons themselves, does not yet exist as an organized endeavor. The present article takes a step in that direction by reviewing various materials and making some suggestions. First-person narratives provide the most important sources, but very few have been discussed. LIS barely appears in bioethics and neuroethics. Research on Quality of Life (QOL) provides relevant information, one questionnaire study explores the sense of personal continuity in LIS patients, and LIS has been used as a test case of theories in “embodied cognition” and to explore issues in the phenomenology of illness and communication. A systematic phenomenology of LIS would draw on these different areas: while some deal directly with subjective experience, others throw light on its psychological, sociocultural and materials conditions. Such an undertaking can contribute to the improvement of care and QOL, and help inform philosophical questions, such as those concerning the properties that define persons, the conditions of their identity and continuity, or the dynamics of embodiment and intersubjectivity.
... As a fourth element, one can mention the positive role that physical activity plays on cognitive control. With this construct we mean a series of executive functions that have a significant impact on learning, such as attention, reasoning ability, planning ability, problem solving ability, decision-making ability, cognitive flexibility, inhibitory control of distracting stimuli and short-term memory (Marinelli et al, 2017;Mura et al, 2010;Niewada, Michel, 2016;Pistoia et al, 2010;Pistoia et al, 2017;Pistoia, Sacco, Carolei, 2013a). ...
... In reality, they can show additional symptoms, including emotional dysfunctions and motor imagery impairments, the pathophysiology of which is still a matter of debate (6)(7)(8)(9)(10)(11). Moreover, when investigated using advanced techniques for cortical volumetric analyses, some patients show specific patterns of volumetric cortical changes beyond the initial brainstem damage (12,13). Among non-motor symptoms, hallucinations and delusions are rarely described in LIS and their presence may be underestimated as a result of the extremely limited communication channel. ...
Previous evidence suggests that hallucinations and delusions may be detected in patients with the most severe forms of motor disability including locked-in syndrome (LIS). However, such phenomena are rarely described in LIS and their presence may be underestimated as a result of the severe communication impairment experienced by the patients. In this study, we retrospectively reviewed the clinical history and the neuroimaging data of a cohort of patients with LIS in order to recognize the presence of hallucinations and delusions and to correlate it with the pontine damage and the presence of any cortical volumetric changes. Ten patients with LIS were included (5 men and 5 women, mean age 50.1 ± 14.6). According to the presence of indicators of symptoms, these patients were categorized as hallucinators (n = 5) or non-hallucinators (n = 5). MRI images of patients were analyzed using Freesurfer 6.0 software to evaluate volume differences between the two groups. Hallucinators showed a selective cortical volume loss involving the fusiform (p = 0.001) and the parahippocampal (p = 0.0008) gyrus and the orbital part of the inferior frontal gyrus (p = 0.001) in the right hemisphere together with the lingual (p = 0.01) and the fusiform gyrus (p = 0.01) in the left hemisphere. Moreover, a volumetric decrease of bilateral anterior portions of the precuneus was recognized in the hallucinators (right p = 0.01; left p = 0.001) as compared to non-hallucinators. We suggested that the presence of hallucinations and delusions in some LIS patients could be accounted for by the combination of a damage of the corticopontocerebellar pathways with cortical changes following the primary brainstem injury. The above areas are embedded within cortico-cortical and cortico-subcortical loops involved in self-monitoring and have been related to the presence of hallucinations in other diseases. The two main limitations of our study are the small sample of included patients and the lack of a control group of healthy individuals. Further studies would be of help to expand this field of research in order to integrate existing theories about the mechanisms underlying the generation of hallucinations and delusions in neurological patients.
... Patients with LIS, showing a condition of coma in the acute stage of their disease, are also frequently asked to report about NDE (Charland-Verville et al., 2015). Patients with LIS, although being traditionally described as cognitively intact, often show a series of non-motor symptoms that can be interpreted in the framework of an embodiment disorder Babiloni et al., 2010;Pistoia et al., 2010Pistoia et al., , 2017. Intriguingly, some of these symptoms seem to share common features and similar underlying neurophysiological mechanisms with some NDEs phenomena, especially those involving out-of-body perceptions and emotional engagement. ...
Near-death experiences (NDEs) have been defined as any conscious perceptual experience occurring in individuals pronounced clinically dead or who came very close to physical death. They are frequently reported by patients surviving a critical injury and, intriguingly, they show common features across different populations. The tool traditionally used to assess NDEs is the NDE Scale, which is available in the original English version. The aim of this study was to develop the Italian version of the NDE Scale and to assess its reliability in a specific clinical setting. A process of translation of the original scale was performed in different stages in order to obtain a fully comprehensible and accurate Italian translation. Later, the scale was administered to a convenience sample of patients who had experienced a condition of coma and were, at the time of assessment, fully conscious and able to provide information as requested by the scale. Inter-rater and test–retest reliability, assessed by the weighted Cohen’s kappa (Kw), were estimated. A convenience sample of 20 subjects [mean age ± standard deviation (SD) 51.6 ± 17.1, median time from injury 3.5 months, interquartile range (IQR) 2–10] was included in the study. Inter-rater [Kw 0.77 (95% CI 0.67–0.87)] and test–retest reliability [Kw 0.96 (95% CI 0.91–1.00)] showed good to excellent values for the total scores of the Italian NDE Scale and for subanalyses of each single cluster of the scale. An Italian Version of the NDE Scale is now available to investigate the frequency of NDE, the causes for NDE heterogeneity across different life-threatening conditions, and the possible neural mechanisms underlying NDE phenomenology.
... They learn to interact with the environment using eye-coded communication. Moreover, recent evidence suggests that they also show a functional impairment of cortical neuronal synchronization mechanisms (Babiloni et al., 2010) and suffer from non-motor cognitive symptoms that can be interpreted as signs of an embodiment disorder (Sacco et al., 2008;Conson et al., 2010;Pistoia et al., 2010Pistoia et al., , 2017. Rehabilitative approaches based on the observation of motor performances by others may help patients to overcome their selective motor imagery defects and to promote a virtuous cycle of movement observation, planning, and execution. ...
El objetivo de este estudio es describir la percepción sobre la imagen corporal de universitarios de la ciudad de Medellín. Para ello, se realizó una investigación de tipo descriptivo con un diseño transversal y se contó con una muestra de 452 estudiantes (123 hombres y 329 mujeres) de las diferentes facultadas de la Universidad Católica Luis Amigó a quienes se les aplicó el Cuestionario Multidimensional sobre la Imagen Corporal (MBSRQ) (Ribas, Botella y Benito, 2008) el cual evalúa 4 componentes de la imagen corporal: (1) importancia subjetiva de la corporalidad (ISC); conductas orientadas a mantener la forma física (COMF); (3) atractivo físico autoevaluado (AFA); y (4) cuidado del aspecto físico (CAF). Como principales resultados se encontró que las personas suelen considerar importante la realización de conductas para mantenerse en forma, pero esto no se relaciona con la valoración sobre el atractivo físico percibido. Así mismo, se evidenció que las personas que valoran positivamente el cuidado del aspecto físico, también le otorgan importancia a la corporalidad y al desarrollo de conductas que les permitan mantener adecuadamente su aspecto físico.
The aim of this chapter is to review the state of the art of BCI-based expressive arts, and review the possibilities as well as challenges involved in artistic expression and therapeutic applications of BCIs. We introduce the field of artistic BCI, its history, most common taxonomies and points of intersection with expressive arts-based therapies. We then discuss matching the artistic BCI technologies with different modalities of art-based interventions, and with different client categories, with the focus on mind-body alignment. We will conclude with a list of open problems and recommendations crucial for establishing a beneficial impact of BCI technology on artistic expression and therapeutic efforts.
