Neural correlates of a single-session massage treatment

Effects of Parent-Delivered Traditional Thai Massage on Gait and Heart Rate Variability in Children with Autism: A Randomized Controlled Trial

Aim: To examine the effects of parent-delivered traditional Thai massage (TTM) intervention on heart rate variability (HRV) and gait in children with autism. Methods: This was a two-armed, randomized controlled trial conducted at the Haikou Special Education School in Haikou Province, China, between October 2021 and March 2022. A total of 48 children with autism, aged between 7 and 12 years, were selected from the school and randomly divided into either the parent-delivered TTM group or the control group (no intervention) in a 1:1 ratio. In addition to their regular daily school routines, the TTM group received 16 TTM interventions (twice a week), with each session lasting ∼50 min. HRV and gait parameters were measured at baseline, completion of the 8-week intervention, and 2 months follow-up. Results: The results of this study showed that the TTM intervention had a notable positive effect on HRV, with a significant reduction in low-frequency value (p = 0.001), and increased high-frequency value (p = 0.001), compared with the controls, and the advantages persisted during the follow-up period. However, only the stride length in the TTM group was significantly longer than that in the control group at the post-test (p = 0.039) and follow-up test (p = 0.043), while none of the other parameters of gait comparison showed statistical significance. Conclusions: Parent-delivered Thai massage increased HRV levels and stride length in comparison to the control group, and some effects of the intervention were maintained over the follow-up period. Clinical Trials Registry Identifier ChiCTR2100051355; September 21, 2021.

Impact of the practice of touch-massage® by a nurse on the anxiety of patients with hematological disorders hospitalized in a sterile environment, a randomized, controlled study

CONTEXT

In addition to curative care, supportive care is beneficial in managing the anxiety symptoms common in patients in sterile hematology unit. We hypothesize that personal massage can help the patient, particularly in this isolated setting where physical contact is extremely limited. The main objective of this study was to show that anxiety could be reduced after a touch-massage® performed by a nurse trained in this therapy.

METHODS

A single-center, randomized, unblinded controlled study in the sterile hematology unit of a French university hospital, validated by an ethics committee. The patients, aged between 18 and 65 years old, and suffering from a serious and progressive hematological pathology, were hospitalized in sterile hematology unit for a minimum of three weeks, patients were randomized into either a group receiving 15-minute touch-massage® sessions or a control group receiving an equivalent amount of quiet time once a week for three weeks. In the treated group, anxiety was assessed before and after each touch-massage® session, using the State-Trait Anxiety Inventory questionnaire with subscale state (STAI-State). In the control group, anxiety was assessed before and after a 15-minute quiet period. For each patient, the difference in the STAI-State score before and after each session (or period) was calculated, the primary endpoint was based on the average of these three differences. Each patient completed the Rosenberg Self-Esteem Questionnaire before the first session and after the last session.

RESULTS

Sixty-two patients were randomized. Touch-massage® significantly decreased patient anxiety: a mean decrease in STAI-State scale score of 10.6 [7.65-13.54] was obtained for the massage group (p ≤ 0.001) compared with the control group. The improvement in self-esteem score was not significant.

CONCLUSION

This study provides convincing evidence for integrating touch-massage® in the treatment of patients in sterile hematology unit.

TRIAL REGISTRATION

NCT02343965.

Brief Myofascial Intervention Modulates Visual Event-Related Potential Response to Emotional Photographic Contents: A Pilot Study

The use of touch for the treatment of psychiatric disorders is increasingly investigated, as it is shown that cognitive symptoms can be improved by various forms of massage. To investigate if the effect of massage is measurable using classical visual event-related potential components (P1, P2, late positive potential (LPP)), we performed a preliminary study on six participants using myofascial induction massage. Participants were shown emotionally valenced or neutral images before and after a 20 min myofascial massage. We found general increases in P2 amplitude following the intervention across all conditions (both neutral and affective), indicating increased attention or salience to visual stimuli. The magnitude of change was visibly larger for unpleasant stimuli, suggesting that visual perception and attention were modulated specifically in response to unpleasant visual images. The LPP showed reductions in amplitude after myofascial massage, suggesting increased emotional modulation following intervention, as a result of possible DMN alterations, consistent with region and function. We conclude that brief myofascial intervention supports other research in the field, finding that physical touch and massage techniques can alter cognition and perception. We posit further research to investigate its future use as an intervention for both physical and cognitive modulation. Importantly, we provide preliminary evidence that the neural processes that resonate with this type of massage involve complex feedforward and backward cortical pathways, of which a significant portion participate in modulating the visual perception of external stimuli.

Resting-state functional magnetic resonance imaging reveals brain remodeling after Tuina therapy in neuropathic pain model

Tuina, a method of traditional Chinese manual manipulation, is an effective alternative therapy for neuropathic pain (NP), but its analgesic mechanism remains unclear. In this study, we used resting-state functional magnetic resonance imaging (R-fMRI) to explore the analgesic mechanism of Tuina in an NP rat model. After undergoing surgery to induce chronic compression of the dorsal root ganglion (CCD), one group of rats underwent Tuina at the ipsilateral BL40 acupoint once a day for 10 min during the 25 days following surgery while another group did not. Behavioral tests were performed at baseline, on the third day following surgery, and once a week for the next 4 weeks. R-fMRI was performed at baseline and 7 days and 28 days following surgery. Behavioral testing revealed that the Tuina group presented a significant response improvement to mechanical and thermal nociception stimuli compared to the untreated group 2 weeks following CCD surgery. Interestingly, rats submitted to Tuina presented higher measures of spontaneous neuronal activity in basal forebrain region, primary somatosensory cortex barrel field, dentate gyrus, secondary somatosensory cortex, striatum, descending corticofugal pathways, and globus pallidum of the left hemisphere 4 weeks after the CCD surgery compared to rats having undergone CCD only. In addition, on the 28th day, the ALFF signals of the left dentate gyrus, left secondary somatosensory cortex, left striatum, and bilateral primary cingulate cortex were significantly increased while those in the right dentate gyrus and bilateral periaqueductal gray were significantly decreased compared to those on the 7th day. Correlation analysis showed that the ALFF values of the left descending corticofugal pathways and globus pallidum had a positive correlation with mechanical withdrawal threshold and paw withdrawal thermal latency tests. Altogether, these results indicate that NPP induced by CCD surgery affects the plasticity of the cerebral cortex, and that Tuina alleviate pain behavior by promoting cortical remodeling.

Ischemic preconditioning and exercise performance: are the psychophysiological responses underestimated?

The findings of the ischemic preconditioning (IPC) on exercise performance are mixed regarding types of exercise, protocols and participants' training status. Additionally, studies comparing IPC with sham (i.e., low-pressure cuff) and/or control (i.e., no cuff) interventions are contentious. While studies comparing IPC versus a control group generally show an IPC significant effect on performance, sham interventions show the same performance improvement. Thus, the controversy over IPC ergogenic effect may be due to limited discussion on the psychophysiological mechanisms underlying cuff maneuvers. Psychophysiology is the study of the interrelationships between mind, body and behavior, and mental processes are the result of the architecture of the nervous system and voluntary exercise is a behavior controlled by the central command modulated by sensory inputs. Therefore, this narrative review aims to associate potential IPC-induced positive effects on performance with sensorimotor pathways (e.g., sham influencing bidirectional body-brain integration), hemodynamic and metabolic changes (i.e., blood flow occlusion reperfusion cycles). Overall, IPC and sham-induced mechanisms on exercise performance may be due to a bidirectional body-brain integration of muscle sensory feedback to the central command resulting in delayed time to exhaustion, alterations on perceptions and behavior. Additionally, hemodynamic responses and higher muscle oxygen extraction may justify the benefits of IPC on muscle contractile function.

Medicine Insufficient Evidence for the Efficacy of Massage as Intervention for Autism Spectrum Disorder: A Systematic Review

The efficacy of massage therapy in the treatment of children with autism spectrum disorder (ASD) remains unclear. This study systematically reviewed the impact of massage therapy on children with ASD according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) declaration guidelines. A literature search of the PubMed, Web of Science, Science Direct, Scopus, Google Scholar, and China National Knowledge Infrastructure (CNKI) electronic databases from inception to December 20, 2020, was conducted using the term “autistic/autism” along with one of the following terms, “massages,” and “Tui na.” The risk of bias was assessed using the Cochrane risk of bias Tool. Eight randomized controlled trials examining the impact of massage on children with ASD were included. Interventions combining Qigong massage or Tui na with the control group treatments from once a day to twice a week, for a duration of 15–30 mins, and lasting for six weeks to five months were the main interventions. All reviewed studies reported significant improvement in children with ASD who received massage, especially in the sensory domain, and that massage in combination with control treatment was superior to control treatment alone. However, the overall quality of the available studies is poor with a high degree of heterogeneity. The majority of studies showed a high risk of bias with poor study design, inconsistency in massage protocols, and subjective outcome measures. Assessment bias was a common weakness of these studies. Therefore, there is insufficient evidence to conclude that massage is effective for ASD. Future studies should include large sample sizes, incorporate double-blind designs, employ appropriate outcome measures, and allow for long observation and follow-up periods. Furthermore, consensus must be reached on standardized treatments and additional therapies in order to provide better quality evidence for the treatment of ASD.

Remote Conditioning by Rhythmic Compression of Limbs Ameliorated Myocardial Infarction by Downregulation of Inflammation via A2 Adenosine Receptors

Background

Remote ischemic conditioning (RIC) is a cardioprotective phenomenon, yet transient ischemia is not a requisite trigger for remote cardioprotection. In fact, RIC is a stimulus compound containing interruption of the blood vessel and tissue compression. In this study, we evaluate the effects of remote tissue compression on infarct size after myocardial infarction and explore its preliminary mechanisms.

Methods and Results

We used a murine model of myocardial infarction to assess ischemia injury and identified remote conditioning by rhythmic compression on forelimb as a novel cardioprotective intervention. We show that the cardioprotective signal transduction of remote conditioning from the trigger limb to the heart involves the release of adenosine. Our results demonstrate that A2a and A2b receptors are indispensable parts for cardioprotection of remote conditioning, which is linked to its anti-inflammatory properties by the subsequent activation of cAMP/PKA/NF-κB axis.

Conclusion

Our results establish a new connection between remote tissue compression and cardiovascular diseases, which enhances our cognition about the role of tissue compression on RIC cardioprotection.

Remote cyclic compression ameliorates myocardial infarction injury in rats via AMPK-dependent pathway

BACKGROUND

Remote ischemic conditioning (RIC) displays a cardioprotective role in acute myocardial infarction (AMI). Since interruption of blood vessel is not an essential trigger of remote cardioprotection, tissue compression may play a prominent part in the effect. The purpose of this study was to confirm the protective effect of tissue compression on AMI and the underlying mechanisms.

METHODS AND RESULTS

Rat model of AMI was induced by ligation of the left anterior descending coronary artery. Remote cyclic compression (RCC) on forelimb was applied to AMI rats for 3 days after the operation. RCC postconditioning displayed cardioprotective effects against AMI injury by limiting infarct size, alleviating cardiac dysfunction, and suppressing cardiomyocyte apoptosis. In addition, RCC postconditioning induced myocardial autophagy as evidenced by increased LC3-II and Beclin-1 and reduced mTOR levels. Furthermore, RCC treatment upregulated AMPK phosphorylation in the context of AMI hearts. AMPK inhibitor Compound C administration markedly abrogated RCC-mediated cardioprotective effect, as evidenced by decreased infarct size and cardiac function.

CONCLUSION

Our results indicated that RCC postconditioning could attenuate AMI injury through inhibiting apoptosis and promoting autophagy via AMPK signaling pathway. The research provided a novel perspective for studying the cardioprotection of RIC and possible therapeutic strategy for managing AMI injury.

The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies

Virtual reality (VR) and augmented reality (AR) have been combined with physical rehabilitation and psychological treatments to improve patients' emotional reactions, body image, and physical function. Nonetheless, no detailed investigation assessed the relationship between VR or AR manual therapies (MTs), which are touch-based approaches that involve the manipulation of tissues for relieving pain and improving balance, postural stability and well-being in several pathological conditions. The present review attempts to explore whether and how VR and AR might be integrated with MTs to improve patient care, with particular attention to balance and to fields like chronic pain that need an approach that engages both mind and body. MTs rely essentially on touch to induce tactile, proprioceptive, and interoceptive stimulations, whereas VR and AR rely mainly on visual, auditory, and proprioceptive stimulations. MTs might increase patients' overall immersion in the virtual experience by inducing parasympathetic tone and relaxing the mind, thus enhancing VR and AR effects. VR and AR could help manual therapists overcome patients' negative beliefs about pain, address pain-related emotional issues, and educate them about functional posture and movements. VR and AR could also engage and change the sensorimotor neural maps that the brain uses to cope with environmental stressors. Hence, combining MTs with VR and AR could define a whole mind-body intervention that uses psychological, interoceptive, and exteroceptive stimulations for rebalancing sensorimotor integration, distorted perceptions, including visual, and body images. Regarding the technology needed to integrate VR and AR with MTs, head-mounted displays could be the most suitable devices due to being low-cost, also allowing patients to follow VR therapy at home. There is enough evidence to argue that integrating MTs with VR and AR could help manual therapists offer patients better and comprehensive treatments. However, therapists need valid tools to identify which patients would benefit from VR and AR to avoid potential adverse effects, and both therapists and patients have to be involved in the development of VR and AR applications to define truly patient-centered therapies. Furthermore, future studies should assess whether the integration between MTs and VR or AR is practically feasible, safe, and clinically useful.

Brain plasticity after peripheral nerve injury treatment with massage therapy based on resting-state functional magnetic resonance imaging

Massage therapy is an alternative treatment for chronic pain that is potentially related to brain plasticity. However, the underlying mechanism remains unclear. We established a peripheral nerve injury model in rats by unilateral sciatic nerve transection and direct anastomosis. The experimental rats were treated over the gastrocnemius muscle of the affected hindlimb with a customized massage instrument (0.45 N, 120 times/min, 10 minutes daily, for 4 successive weeks). Resting-state functional magnetic resonance imaging revealed that compared with control rats, the amplitude of low-frequency fluctuations in the sensorimotor cortex contralateral to the affected limb was significantly lower after sciatic nerve transection. However, amplitudes were significantly higher in the massage group than in a sham-massage group. These findings suggest that massage therapy facilitated adaptive change in the somatosensory cortex that led to the recovery of peripheral nerve injury and repair. This study was approved by the Animal Ethics Committee of Shanghai University of Traditional Chinese Medicine of China (approval No. 201701001) on January 12, 2017.

Can foot reflexology be a complementary therapy for sleep disturbances? Evidence appraisal through a meta-analysis of randomized controlled trials

AIMS

To systematically summarize and quantify the effects of foot reflexology on improvements in sleep disturbances.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Datasets including PubMed, Web of Science, Scopus, EMBASE, Cochrane Library, Google Scholar, CINAHL and two Chinese electronic databases (i.e., AiritiLibrary and China National Knowledge Infrastructure) were used to search from their inception to 31 January 2019.

REVIEW METHODS

Studies which were randomized controlled trials that reported changes in sleep disturbances after the intervention among adults over 18 years old and written in the English or Chinese language were included. Two reviewers' independently assessed the eligibility, extracted data, and conducted a quality assessment. Based on the extracted data, two separate meta-analyses were performed.

RESULTS

Forty-two articles with a total sample of 3,928 participants were included in the systematic review and were eligible for the meta-analysis. The most commonly employed outcome measurement tool was the Pittsburgh Sleep Quality Index, followed by the therapeutic effect between the intervention and control groups (as evaluated by participants with sleep problems compared with those without sleep problems in each group after the intervention). Results revealed that foot reflexology resulted in a greater reduction in the sleep quality score compared with the controls (Hedges' g = -1.37; 95% confidence interval (CI) = -1.81~-0.94). As for the therapeutic effect, participants in the intervention group were less likely to have sleep problems than those in the control group (pooled odds ratio = 0.25; 95% CI = 0.19 ~ 0.31).

CONCLUSION

The findings suggested that foot reflexology produced significant improvements in sleep disturbances.

IMPACT

Foot reflexology is a non-invasive and convenient intervention and regularly receiving foot reflexology can be considered complementary therapy to improve the sleep quality of adults with sleep disturbances. Furthermore, healthcare providers can actively press the solar plexus and heart zones to alleviate sleep disturbances when performing foot reflexology.

The Effects of Intranasal Oxytocin on Neural and Behavioral Responses to Social Touch in the Form of Massage

Manually-administered massage can potently increase endogenous oxytocin concentrations and neural activity in social cognition and reward regions and intranasal oxytocin can increase the pleasantness of social touch. In the present study, we investigated whether intranasal oxytocin modulates behavioral and neural responses to foot massage applied manually or by machine using a randomized placebo-controlled within-subject pharmaco-fMRI design. 46 male participants underwent blocks of massage of each type where they both received and imagined receiving the massage. Intranasal oxytocin significantly increased subjective pleasantness ratings of the manual but not the machine massage and neural responses in key regions involved in reward (orbitofrontal cortex, dorsal striatum and ventral tegmental area), social cognition (superior temporal sulcus and inferior parietal lobule), emotion and salience (amygdala and anterior cingulate and insula) and default mode networks (medial prefrontal cortex, parahippocampal gyrus, posterior cingulate, and precuneus) as well as a number of sensory and motor processing regions. Both neural and behavioral effects of oxytocin occurred independent of whether subjects thought the massage was applied by a male or female masseur. These findings support the importance of oxytocin for enhancing positive behavioral and neural responses to social touch in the form of manually administered massage and that a combination of intranasal oxytocin and massage may have therapeutic potential in autism.

CLINICAL TRIALS REGISTRATION

The Effects of Oxytocin on Social Touch; registration ID: NCT03278860; URL: https://clinicaltrials.gov/ct2/show/NCT03278860.

Effects of massage on outcomes of adult intensive care unit patients: a systematic review

BACKGROUND

The critical care experience is particularly stressful for patients, which can result in a number of physiological and psychological consequences, including haemodynamic instability, increased pain, agitation and delirium, leading to prolonged mechanical ventilation, length of stay and subsequent complications. Massage therapy encompasses different techniques to promote relaxation and to counter stress, therefore potentially affecting several patients' outcomes.

AIMS

To systematically review evidence on the effects of massage on outcomes of adult critically ill patients. The outcome measures included pain, vital signs (VS), haemodynamic measurements, level of consciousness, sleep quality, muscle tension, anxiety, feelings of calm and relaxation, coping, arterial blood gases and serum biomarkers.

METHOD

This was a systematic review based on focused literature searches (PubMed, CINAHL, Scopus, EMBASE-Ovid databases, Google Scholar). The Cochrane Collaboration's tool was used to assess the risk of bias. Eligibility criteria included published experimental and quasi-experimental studies reporting on the physiological and psychological outcomes of critically ill patients.

RESULTS

Based on the selection criteria, 12 studies were included in the review. The main findings are as follows: 8 of 12 studies used randomized control designs with high internal validity, and there was a high level of evidence of favourable effects with respect to improvements in VS and a reduction in pain and anxiety. Outcomes that need to be more rigorously pursued include quality of sleep, analgesic and sedative dosages and level of consciousness.

CONCLUSION

The results suggest that massage interventions can have positive effects on critically ill patients' outcomes. However, there are several gaps in the literature, along with methodological limitations, that require further consideration in critical care settings.

RELEVANCE TO CLINICAL PRACTICE

The results of this systematic review can inform implementation of massage interventions in critical care, which can be challenging as a result of several barriers.

Foot massage evokes oxytocin release and activation of orbitofrontal cortex and superior temporal sulcus

Massage may be an important method for increasing endogenous oxytocin concentrations and of potential therapeutic benefit in disorders with social dysfunction such as autism where basal oxytocin levels are typically reduced. Here we investigated oxytocin release and associated neural responses using functional near infrared spectroscopy (fNIRS) during hand- or machine-administered massage. 40 adult male subjects received 10 min of light foot massage either by hand or machine in a counterbalanced order and then rated pleasure, intensity, arousal and how much they would pay for the massage. Blood samples were taken before and after each massage condition to determine plasma oxytocin concentrations. Neural responses from medial and lateral orbitofrontal cortex, superior temporal sulcus and somatosensory cortex were measured (fNIRS oxy-Hb) together with skin conductance responses (SCR), ratings of the massage experience, autistic traits and sensitivity to social touch. Results showed subjects gave higher ratings of pleasure, but not intensity or arousal, after hand- compared with machine-administered massage and there were no differential effects on SCR. Subjects were also willing to pay more for the hand massage. Plasma oxytocin increased after both massage by hand or machine, but more potently after massage by hand. Both basal oxytocin concentrations and increases evoked by hand-, but not machine-administered massage, were negatively associated with trait autism and attitudes towards social touch, but massage by hand-evoked changes were significant in higher as well as lower trait individuals. Increased neural responses to hand vs. machine-administered massage were found in posterior superior temporal sulcus and medial/lateral orbitofrontal cortex but not somatosensory cortex. Orbitofrontal cortex and superior temporal cortex activation during hand massage was associated with the amount of money subjects were willing to pay and between orbitofrontal cortex activation and autism scores. Thus, hand-administered massage can potently increase oxytocin release and activity in brain regions involved in social cognition and reward but not sensory aspects of affective touch. Massage by hand induced changes in both oxytocin concentrations and neural circuits involved in processing social affective trust may have therapeutic potential in the context of autism.

The Effect of Single-Dose Massage Session on Autonomic Activity, Mood, and Affective Responses in Major Depressive Disorder

Background: Massage therapy (MT) is a holistic procedure that includes hand pressure (HP), therapeutic communication (TC), and attentive care (AC); together, these procedures could decrease symptoms of depression. Purpose: To study the influence of TC and AC during MT. Methods: Within-subject experimental design with counterbalancing order of treatment. Comparison analysis of the effect of a typical Swedish massage session (SM) with a "sham" massage (ShM; without HP) on the heart rate variability (HRV) mood and affective responses of patients with major depressive disorder (N = 11). During the ShM, clay stones were randomly placed on the body, and the patients were informed about the (sham) therapeutic effect of stones. Findings: A main effect of time showed that after intervention, both SM and ShM increased the HRV (high-frequency power; F[1, 10] = 7.58, p = .02) and reduced scores for anxiety (F[1, 10] = 37.57, p < .001), other feelings (F[1, 10] = 22.64, p = .001), and physical sedation (F[1, 10] = 10.72, p = .008). The SM was associated with more positive affective responses than ShM (qualitative analysis). Conclusions: AC and TC included in MT session improved mood and HRV in the absence of HP. Additional effect on affective responses was observed owing to the HP.

Synergistic immunoreaction of acupuncture-like dissolving microneedles containing thymopentin at acupoints in immune-suppressed rats

Dissolving microneedles carried drug molecules can effectively penetrate the stratum corneum of skin to improve the transdermal drug delivery. The traditional Chinese medicine acupuncture is based on the needle stimulation at a specific location (acupoint) to generate and transmit biochemical and physiological signals which alter the pathophysiological state of patients. However, the pain associated with conventional acupuncture needles and the requirement of highly trained professionals limit the development of acupuncture in non-Asian countries. The purpose of this study is to investigate whether the dissolving microneedles can be utilized as a self-administered painless replacement for acupuncture and locally released drug molecules can achieve expected therapeutic outcomes. Immunosuppressive rats were treated with acupuncture at Zusanli (ST36) acupoint using microneedles containing thymopentin. The immune functions and psychological mood of the immunosuppressed animals were examined. The proliferation of splenocytes was examined by CCK-8 assay. CD4 and CD8 expression patterns in spleen cells were detected by flow cytometry. The current study showed that use of either microneedles containing thymopentin or conventional acupuncture both resulted in immune cell proliferation, which was confirmed by flow cytometry. Furthermore, either conventional acupuncture or microneedles were able to effectively mitigate the anxiety caused by immune-suppression when applied on the ST36.

Massage Therapy for Psychiatric Disorders

This article reviews the current state of knowledge of the role of massage therapy in the treatment of common psychiatric disorders and symptoms. It briefly discusses the prevalence of psychiatric disorders and the popularity of complementary and integrative treatments in the general population. The authors touch on the growing literature describing the biology and neurobiology of massage therapy. The impact of massage as both a therapy for major psychiatric disorders and a treatment for psychiatric symptoms is reviewed, and how massage therapists conceptualize and treat their patients with psychiatric complaints is discussed. If psychiatrists are going to partner with massage therapists, they need to understand how massage therapists' perspectives differ from those of traditional practitioners of allopathic medicine. A model of how psychiatrists and other mental health professionals can work with massage therapists to care for patients is proposed, followed by a summary of the article's key points.

Unisensory and multisensory Self-referential stimulation of the lower limb: An exploratory fMRI study on healthy subjects

BACKGROUND

The holistic view of the person is the essence of the physiotherapy. Knowledge of approaches that develop the whole person promotes better patient outcomes. Multisensory Self-referential stimulation, more than a unisensory one, seems to produce a holistic experience of the Self ("Core-Self").

OBJECTIVES

(1) To analyze the somatotopic brain activation during unisensory and multisensorial Self-referential stimulus; and (2) to understand if the areas activated by multisensorial Self-referential stimulation are the ones responsible for the "Core-Self."

METHODS

An exploratory functional magnetic resonance imaging (fMRI) study was performed with 10 healthy subjects, under the stimulation of the lower limbs with three Self-referential stimuli: unisensory auditory-verbal, unisensory tactile-manual, and multisensory, applying the unisensory stimuli simultaneously.

RESULTS

Unisensory stimulation elicits bilateral activations of the temporoparietal junction (TPJ), of the primary somatosensory cortex (S1), of the primary motor cortex (BA4), of the premotor cortex (BA6) and of BA44; multisensory stimulation also elicits activity in TPJ, BA4, and BA6, and when compared with unisensory stimuli, activations were found in: (1) Cortical and subcortical midline structures-BA7 (precuneus), BA9 (medial prefrontal cortex), BA30 (posterior cingulated), superior colliculum and posterior cerebellum; and (2) Posterior lateral cortex-TPJ, posterior BA13 (insula), BA19, and BA37. Bilateral TPJ is the one that showed the biggest activation volume.

CONCLUSION

This specific multisensory stimulation produces a brain activation map in regions that are responsible for multisensory Self-processing and may represent the Core-Self. We recommend the use of this specific multisensory stimulation as a physiotherapy intervention strategy that might promote the Self-reorganization.

Massage-like stroking boosts the immune system in mice

Recent clinical evidence suggests that the therapeutic effect of massage involves the immune system and that this can be exploited as an adjunct therapy together with standard drug-based approaches. In this study, we investigated the mechanisms behind these effects exploring the immunomodulatory function of stroking as a surrogate of massage-like therapy in mice. C57/BL6 mice were stroked daily for 8 days either with a soft brush or directly with a gloved hand and then analysed for differences in their immune repertoire compared to control non-stroked mice. Our results show that hand- but not brush-stroked mice demonstrated a significant increase in thymic and splenic T cell number (p < 0.05; p < 0.01). These effects were not associated with significant changes in CD4/CD8 lineage commitment or activation profile. The boosting effects on T cell repertoire of massage-like therapy were associated with a decreased noradrenergic innervation of lymphoid organs and counteracted the immunosuppressive effect of hydrocortisone in vivo. Together our results in mice support the hypothesis that massage-like therapies might be of therapeutic value in the treatment of immunodeficiencies and related disorders and suggest a reduction of the inhibitory noradrenergic tone in lymphoid organs as one of the possible explanations for their immunomodulatory function.

Somatosensory pleasure circuit: from skin to brain and back

The skin senses serve a discriminative function, allowing us to manipulate objects and detect touch and temperature, and an affective/emotional function, manifested as itch or pain when the skin is damaged. Two different classes of nerve fibre mediate these dissociable aspects of cutaneous somatosensation: (i) myelinated A-beta and A-delta afferents that provide rapid information about the location and physical characteristics of skin contact; and (ii) unmyelinated, slow-conducting C-fibre afferents that are typically associated with coding the emotional properties of pain and itch. However, recent research has identified a third class of C-fibre afferents that code for the pleasurable properties of touch - c-tactile afferents or CTs. Clinical application of treatments that target pleasant, CT-mediated touch (such as massage therapy) could, in the future, provide a complementary, non-pharmacological means of treating both the physical and psychological aspects of chronic skin conditions such as itch and eczema.

The physiological and biochemical outcomes associated with a reflexology treatment: a systematic review

Background. Reflexology is one of the top forms of complementary and alternative medicine in the UK and is used for healthcare by a diverse range of people. However, it is offered by few healthcare providers as little scientific evidence is available explaining how it works or any health benefits it may confer. The aim of this review was to assess the current evidence available from reflexology randomised controlled trials (RCTs) that have investigated changes in physiological or biochemical outcomes. Methods. Guidelines from the Cochrane Handbook of Systematic Reviews of Interventions were followed: the following databases were searched from inception to December 2013: AMED, CAM Quest, CINAHL Plus, Cochrane Central Register of Controlled Trials, Embase, Medline Ovid, Proquest, and Pubmed. Risk of bias was assessed independently by two members of the review team and overall strength of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation guidelines. Results. Seventeen eligible RCTs met all inclusion criteria. A total of 34 objective outcome measures were analysed. Although twelve studies showed significant changes within the reflexology group, only three studies investigating blood pressure, cardiac index, and salivary amylase resulted in significant between group changes in favour of reflexology. The overall quality of the studies was low.

Endogenous neuromodulation at infralow frequencies

Neuromodulation in the bioelectrical domain is an attractive option for the remediation of functionally based deficits. Most of the interest to date has focused on exogenous methods, such as repetitive transcranial magnetic stimulation, transient direct current stimulation, vagus nerve stimulation, and deep brain stimulation. Much less attention has been given to endogenous methods of exploiting latent brain plasticity. These have reached a level of sophistication and maturity that invites attention. Over the last 7 years, the domain of infralow frequencies has been exploited productively for the enhancement of neuroregulation. The principal mechanism is putatively the renormalization of functional connectivity of our resting-state networks. The endogeneous techniques are particularly attractive for the pediatric population, where they can be utilized before dysfunctional patterns of brain behavior become consolidated and further elaborated into clinical syndromes.

Activity in the primary somatosensory cortex induced by reflexological stimulation is unaffected by pseudo-information: a functional magnetic resonance imaging study

BACKGROUND

Reflexology is an alternative medical practice that produces beneficial effects by applying pressure to specific reflex areas. Our previous study suggested that reflexological stimulation induced cortical activation in somatosensory cortex corresponding to the stimulated reflex area; however, we could not rule out the possibility of a placebo effect resulting from instructions given during the experimental task. We used functional magnetic resonance imaging (fMRI) to investigate how reflexological stimulation of the reflex area is processed in the primary somatosensory cortex when correct and pseudo-information about the reflex area is provided. Furthermore, the laterality of activation to the reflexological stimulation was investigated.

METHODS

Thirty-two healthy Japanese volunteers participated. The experiment followed a double-blind design. Half of the subjects received correct information, that the base of the second toe was the eye reflex area, and pseudo-information, that the base of the third toe was the shoulder reflex area. The other half of the subjects received the opposite information. fMRI time series data were acquired during reflexological stimulation to both feet. The experimenter stimulated each reflex area in accordance with an auditory cue. The fMRI data were analyzed using a conventional two-stage approach. The hemodynamic responses produced by the stimulation of each reflex area were assessed using a general linear model on an intra-subject basis, and a two-way repeated-measures analysis of variance was performed on an intersubject basis to determine the effect of reflex area laterality and information accuracy.

RESULTS

Our results indicated that stimulation of the eye reflex area in either foot induced activity in the left middle postcentral gyrus, the area to which tactile sensation to the face projects, as well as in the postcentral gyrus contralateral foot representation area. This activity was not affected by pseudo information. The results also indicate that the relationship between the reflex area and the projection to the primary somatosensory cortex has a lateral pattern that differs from that of the actual somatotopical representation of the body.

CONCLUSION

These findings suggest that a robust relationship exists between neural processing of somatosensory percepts for reflexological stimulation and the tactile sensation of a specific reflex area.

Thai traditional massage increases biochemical markers of bone formation in postmenopausal women: a randomized crossover trial

Background

The effect of massage therapy on bone metabolism in adults has only scarcely been explored. In a randomized crossover trial, we investigated the skeletal effect of Thai traditional massage by examining the changes in biochemical markers of bone turnover.

Methods

Forty-eight postmenopausal women participated in the study. All volunteers were randomized to a 2-hour session of Thai traditional massage twice a week for 4 weeks and a 4-week control period after a 2-week washout, or vice versa. Twenty-one subjects were allocated to receiving Thai traditional massage first, followed by the control period, while 27 were initially allocated to the control period.

Results

Serum P1NP increased significantly after Thai traditional massage (P <0.01), while there was no change in serum osteocalcin or CTX. During the control period, there was no significant change in P1NP, osteocalcin or CTX compared to baseline. When age and height were taken into account, P1NP in postmenopausal women whose ages were in the middle and higher tertiles and whose heights were in the lower and middle tertiles (n = 22) had a 14.8 ± 3.3% increase in P1NP after massage (P <0.001), while no change in P1NP was found in the rest of the women (n = 26).

Conclusions

Thai traditional massage results in an increase in bone formation as assessed by serum P1NP, particularly in postmenopausal women who are older and have a smaller body build. Future studies with larger samples and additional design features are warranted.

Trial registration

ClinicalTrials.gov : NCT01627028