Visuospatial exploration and art therapy intervention in patients with Parkinson's disease: an exploratory therapeutic protocol

Visualizing simultaneous eye-hand movements in a MATLAB dashboard

Eye-hand coordination (EHC) is crucial to our daily activities, and its underlying mechanisms are being intensely studied. The analysis of simultaneous eye and hand movements can provide valuable insights into EHC, particularly for individuals struggling with dexterous control, such as might be caused by stroke or traumatic brain injuries. Despite advancements in motion-capture and eye tracking technologies, there is currently no automated method for visualizing concurrent eye- and hand-movement data. To address this need, we have developed a MATLAB-based dashboard designed for near instantaneous analysis and visualization of eye and hand-tracking data. This paper introduces the design of the dashboard and presents experimental results obtained from its application, leveraging simulated data inspired by our recent work in stroke. This testing suggests that our solution has the potential to significantly aid in understanding and investigating EHC by providing side-by-side and time-locked comparison of eye/hand movements along with their timing and spatio-temporal errors, offering novel opportunities for research and clinical applications.•Continuous eye movement data is collected throughout the experiment•Continuous hand movement data is collected throughout the experiment•Combine datasets and display time-locked eye-hand data in a single dashboard.

A conceptual framework for a neurophysiological basis of art therapy for PTSD

Post-traumatic stress disorder (PTSD) is a heterogeneous condition that affects many civilians and military service members. Lack of engagement, high dropout rate, and variable response to psychotherapy necessitates more compelling and accessible treatment options that are based on sound neuroscientific evidence-informed decision-making. Art therapy incorporates elements proven to be effective in psychotherapy, such as exposure, making it a potentially valuable treatment option. This conceptual paper aims to inform the neurophysiological rationale for the use of art therapy as a therapeutic approach for individuals with PTSD. A narrative synthesis was conducted using literature review of empirical research on the neurophysiological effects of art therapy, with supporting literature on neuroaesthetics and psychotherapies to identify art therapy factors most pertinent for PTSD. Findings were synthesized through a proposed framework based on the triple network model considering the network-based dysfunctions due to PTSD. Art therapy's active components, such as concretization and metaphor, active art engagement, emotion processing and regulation, perspective taking and reframing, and therapeutic alliance, may improve symptoms of PTSD and prompt adaptive brain functioning. Given the scarcity of rigorous studies on art therapy's effectiveness and mechanisms of alleviating PTSD symptoms, the suggested framework offers a neurophysiological rationale and a future research agenda to investigate the impact of art therapy as a therapeutic approach for individuals with PTSD.

Are neuroaesthetic principles applied in art therapy protocols for neurorehabilitation? A systematic mini-review

Art is an instrument created by humans as an alternative way of expression. For this reason, it has found its use in clinical contexts to improve mood, increase participation in therapy, or improve communication for patients with different pathologies. In this systematic mini-review, the Preferred Reporting Item for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were adopted. Internet-based bibliographic searches were conducted via major electronic databases (Web of Science and PubMed). We analyzed the quantitative studies in which art figures as a neurorehabilitation treatment to identify whether standard art therapy protocols exist and whether these are based on the principles of neuroaesthetics. Our review identified 8 quantitative and 18 qualitative studies. Although art therapy has been used for more than 20 years as a clinical tool, there are no standard protocols to refer to when planning interventions. Although the effectiveness of using arts as therapy has been reported in many qualitative or feasibility studies, there is still a lack of quantitative studies in which the outcomes of art therapy are directly based on the principles of neuroaesthetics.

Art therapy as a comprehensive complementary treatment for Parkinson's disease

Introduction

Parkinson's disease (PD) is the second most prevalent neurodegenerative disease. Complementary and alternative therapies are increasingly utilized to address its complex multisystem symptomatology. Art therapy involves motoric action and visuospatial processing while promoting broad biopsychosocial wellness. The process involves hedonic absorption, which provides an escape from otherwise persistent and cumulative PD symptoms, refreshing internal resources. It involves the expression in nonverbal form of multilayered psychological and somatic phenomena; once these are externalized in a symbolic arts medium, they can be explored, understood, integrated, and reorganized through verbal dialogue, effecting relief and positive change.

Methods

42 participants with mild to moderate PD were treated with 20 sessions of group art therapy. They were assessed before and after therapy with a novel arts-based instrument developed to match the treatment modality for maximum sensitivity. The House-Tree-Person PD Scale (HTP-PDS) assesses motoric and visuospatial processing-core PD symptoms-as well as cognition (thought and logic), affect/mood, motivation, self (including body-image, self-image, and self- efficacy), interpersonal functioning, creativity, and overall level of functioning. It was hypothesized that art therapy will ameliorate core PD symptoms and that this will correlate with improvements in all other variables.

Results

HTP-PDS scores across all symptoms and variables improved significantly, though causality among variables was indeterminate.

Discussion

Art therapy is a clinically efficacious complementary treatment for PD. Further research is warranted to disentangle causal pathways among the aforementioned variables, and additionally, to isolate and examine the multiple, discrete healing mechanisms believed to operate simultaneously in art therapy.

Complex Rehabilitation of Patients with Parkinson’s Disease

Aim: To assess the clinical effectiveness of a comprehensive rehabilitation program for patients with Parkinson’s disease Materials and Methods: The study was conducted in the regional center for movement disorders (Odesa, Ukraine). 90 patients with 1-2.5 Hoehn-Yahr stage were examined. Patients were randomly assigned to three groups (I (n=30) – standard drug therapy, II (n=30) – standard drug therapy +physical therapy, III (n=30) – standard drug therapy +physical therapy+ art therapy). The effectiveness of the therapy was assessed using the UPDRS questionnaires, Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MoCA), and Pegboard Test. The follow-up period was 12 months. Results: Patients of the II and III groups noted an improvement in mood after physical exertion. They observed a decrease in daytime sleepiness, a decrease in tremors, and a decrease in the intensity of anxiety and fear. During the observation period, signs of disease progression were observed only in 4 (13.3%) patients of group II, in 2 (6.7%) patients of group III and in 12 (40.0%) ) patients of the control group (respectively, χ2 = 4.18 p = 0.04 and χ2 = 7.55 p = 0.006) Conclusions: 1. The use of complex rehabilitation allows to reduce the severity of motor and non-motor manifestations of Parkinson's disease. 2. The inclusion of art therapy in the complex rehabilitation program allows to halve the number of cases of disease progression. 3. The positive effect of the use of comprehensive rehabilitation is maintained throughout the observation period.

A Systematic Review of the Use of Art in Virtual Reality

Brain injuries can create life-altering challenges and have the potential to leave people with permanent disabilities. Art therapy is a popular method used for treating many of the disabilities that can accompany a brain injury. In a systematic review, an assessment of how art is being used in virtual reality (VR) was conducted, and the feasibility of brain injury patients to participate in virtual art therapy was investigated. Studies included in this review highlight the importance of artistic subject matter, sensory stimulation, and measurable performance outcomes for assessing the effect art therapy has on motor impairment in VR. Although there are limitations to using art therapy in a virtual environment, studies show that it can feasibly be used in virtual reality for neurorehabilitation purposes.

Using mobile brain/body imaging to advance research in arts, health, and related therapeutics

The uses of mobile brain/body imaging (MoBI) are expanding and allow for more direct study of the neurophysiological signals associated with behavior in psychotherapeutic encounters. Neuroaesthetics is concerned with the cognitive and neural basis of art appreciation, and scientific correlations are being made in the field that might help to clarify theories claimed in the creative arts therapies. Yet, most neuroaesthetics studies are confined to the laboratory and do not propose a translation for research methods and clinical applications. The creative arts therapies have a long history of clinical success with various patient populations and will benefit from increased scientific explanation to support intervention strategies. Examining the brain dynamics and motor behaviors that are associated with the higher complex processes involved in artistic expression offers MoBI as a promising instrumentation to move forward in linking ideas from neuroaesthetics to the creative arts therapies. Tracking brain dynamics in association with behavioral change allows for more objective and quantitative physiological monitors to evaluate, and together with subjective patient reports provides insight into the psychological mechanisms of change in treatment. We outline a framework that shows how MoBI can be used to study the effectiveness of creative arts therapy interventions motivated by the 4E approach to cognition with a focus on visual art therapy. The article illuminates how a new partnership among the fields of art therapy, neuroscience, and neuroaesthetics might work together within the 4E/MoBI framework in efforts to advance transdisciplinary research for clinical health populations.

Art therapy for Parkinson's disease

OBJECTIVE

To explore the potential rehabilitative effect of art therapy and its underlying mechanisms in Parkinson's disease (PD).

METHODS

Observational study of eighteen patients with PD, followed in a prospective, open-label, exploratory trial. Before and after twenty sessions of art therapy, PD patients were assessed with the UPDRS, Pegboard Test, Timed Up and Go Test (TUG), Beck Depression Inventory (BDI), Modified Fatigue Impact Scale and PROMIS-Self-Efficacy, Montreal Cognitive Assessment, Rey-Osterrieth Complex Figure Test (RCFT), Benton Visual Recognition Test (BVRT), Navon Test, Visual Search, and Stop Signal Task. Eye movements were recorded during the BVRT. Resting-state functional MRI (rs-fMRI) was also performed to assess functional connectivity (FC) changes within the dorsal attention (DAN), executive control (ECN), fronto-occipital (FOC), salience (SAL), primary and secondary visual (V1, V2) brain networks. We also tested fourteen age-matched healthy controls at baseline.

RESULTS

At baseline, PD patients showed abnormal visual-cognitive functions and eye movements. Analyses of rs-fMRI showed increased functional connectivity within DAN and ECN in patients compared to controls. Following art therapy, performance improved on Navon test, eye tracking, and UPDRS scores. Rs-fMRI analysis revealed significantly increased FC levels in brain regions within V1 and V2 networks.

INTERPRETATION

Art therapy improves overall visual-cognitive skills and visual exploration strategies as well as general motor function in patients with PD. The changes in brain connectivity highlight a functional reorganization of visual networks.