Embodiment in the aging mind

Keeping up with ourselves: Multimodal processes underlying body ownership across the lifespan

The sense of a bodily self is thought to depend on adaptive weighting and integration of bodily afferents and prior beliefs. While the physical body changes in shape, size, and functionality across the lifespan, the sense of body ownership remains relatively stable. Yet, little is known about how multimodal integration underlying such sense of ownership is altered in ontogenetic periods of substantial physical changes. We aimed to study this link for the motor and the tactile domain in a mixed-realty paradigm where participants ranging from 7 to 80 years old saw their own body with temporally mismatching multimodal signals. Participants were either stroked on their hand or moved it, while they saw it in multiple trials with different visual delays. For each trial, they judged the visuo-motor/tactile synchrony and rated the sense of ownership for the seen hand. Visual dependence and proprioceptive acuity were additionally assessed. The results show that across the lifespan body ownership decreases with increasing temporal multisensory mismatch, both in the tactile and the motor domain. We found an increased sense of ownership with increasing age independent of delay and modality. Delay sensitivity during multisensory conflicts was not consistently related to age. No effects of age were found on visual dependence or proprioceptive accuracy. The results are at least partly in line with an enhanced weighting of top-down and a reduced weighting of bottom-up signals for the momentary sense of bodily self with increasing age.

Tactile memory impairments in younger and older adults

Human tactile memory allows us to remember and retrieve the multitude of somatosensory experiences we undergo in everyday life. An unsolved question is how tactile memory mechanisms change with increasing age. We here use the ability to remember fine-grained tactile patterns passively presented to the fingertip to investigate age-related changes in tactile memory performance. In experiment 1, we varied the degree of similarity between one learned and several new tactile patterns to test on age-related changes in the "uniqueness" of a stored tactile memory trace. In experiment 2, we varied the degree of stimulus completeness of both known and new tactile patterns to test on age-related changes in the weighting between known and novel tactile information. Results reveal that older adults show only weak impairments in both precision and bias of tactile memories, however, they show specific deficits in reaching peak performance > 85% in both experiments. In addition, both younger and older adults show a pattern completion bias for touch, indicating a higher weighting of known compared to new information. These results allow us to develop new models on how younger and older adults store and recall tactile experiences of the past, and how this influences their everyday behavior.

Repeated context-specific actions disrupt feedforward adjustments in motor commands in younger and older adults

The flexibility of the motor system to adjust a planned action before or during the execution of the movement in response to sensory information is critical for preventing errors in motor control. As individuals age, this function declines, leading to an increased incidence of motor errors. Although sensory processing and cognitive decline are known contributors to this impairment, here, we test the hypothesis that repetition of context-specific planned actions interferes with the adjustment of feedforward motor commands. Younger and older participants were instructed to grasp and lift a T-shaped object with a concealed, off-sided center of mass and minimize its roll through anticipatory force control, relying predominantly on predictive model-driven planning (i.e., sensorimotor memories) developed through repeated lifts. We selectively manipulate the number of trial repeats with the center of mass on one side before switching it to the other side of the T-shaped object. The results showed that increasing the number of repetitions improved performance in manipulating an object with a given center of mass but led to increased errors when the object's center of mass was switched. This deleterious effect of repetition on feedforward motor adjustment was observed in younger and older adults. Critically, we show these effects on an internal model-driven motor planning task that relies predominantly on sensorimotor memory, with no differences in sensory inputs from the repetition manipulation. The findings indicate that feedforward motor adjustments are hampered by repetitive stereotyped planning and execution of motor behavior.NEW & NOTEWORTHY Adjusting planned actions in response to sensory stimuli degrades with age contributing to increased incidence of errors ranging from clumsy spills to catastrophic falls. Multiple factors likely contribute to age-related motor inflexibility, including sensory- and cognition-supporting system declines. Here, we present compelling evidence for repetition to disrupt feedforward adjusting of motor commands in younger and older adults, which suggests increases in stereotypy as a deleterious potentiator of motor control errors.

Influence of age and cognitive demand on motor decision making under uncertainty: a study on goal directed reaching movements

In everyday life, we constantly make decisions about actions to be performed subsequently. Research on motor decision making has provided empirical evidence for an influence of decision uncertainty on movement execution in young adults. Further, decision uncertainty was suggested to be increased in older adults due to limited cognitive resources for the integration of information and the prediction of the decision outcomes. However, the influence of cognitive aging on decision uncertainty during motor decision making and movement execution has not been investigated, yet. Thus, in the current study, we presented young and older adults with a motor decision making task, in which participants had to decide on pointing towards one out of five potential targets under varying cognitive demands. Statistical analyses revealed stronger decreases in correctly deciding upon the pointing target, i.e. task performance, from low to higher cognitive demand in older as compared to young adults. Decision confidence also decreased more strongly in older adults with increasing cognitive demand, however, only when collapsing across correct and incorrect decision trials, but not when considering correct decision trials, only. Further, older adults executed reaching movements with longer reaction times and increased path length, though the latter, again, not when considering correct decision trials, only. Last, reaction time and variability in movement execution were both affected by cognitive demand. The outcomes of this study provide a differentiated picture of the distinct and joint effects of aging and cognitive demand during motor decision making.

The tool effect is lower in older adults with or without cognitive impairments than in young adults

Grabbing a phone from a table or stepping over an obstacle on the ground are daily activities that require the brain to take account of both object and the body's parameters. Research has shown that a person's estimated maximum reach is temporarily overestimated after using a tool, even when the tool is no longer in hand. This tool effect reflects the high plasticity of the perceptual-motor system (e.g., body schema updating)-at least in young individuals. The objective of the present study was to determine whether the tool effect is smaller in older adults. Forty-four young adults, 37 older adults without cognitive impairment and 30 older adults with cognitive impairment took part in the experiment. The task consisted in visually estimating the ability to reach (using the index finger) a target positioned at different locations on a table, both before and after using a rake. We observed a strong after-effect of tool use in the young adults only. Conversely, a tool effect was similarly absent in the older adults without and with cognitive impairment. Moreover, even before the tool was used, the maximum reach was overestimated in each of the three groups, although the overestimation was greatest in the two groups of older adults. In summary, we showed that the tool effect, observed in young adults, was absent in older adults; this finding suggests that with advancing age, the perceptual-motor system is less able to adapt to novel sensorimotor contexts. This lack of adaptation might explain (at least in part) the overestimation of motor skills often reported in the elderly.

Predictive power of gait and gait-related cognitive measures in amnestic mild cognitive impairment: a machine learning analysis

Introduction

Gait disorders and gait-related cognitive tests were recently linked to future Alzheimer's Disease (AD) dementia diagnosis in amnestic Mild Cognitive Impairment (aMCI). This study aimed to evaluate the predictive power of gait disorders and gait-related neuropsychological performances for future AD diagnosis in aMCI through machine learning (ML).

Methods

A sample of 253 aMCI (stable, converter) individuals were included. We explored the predictive accuracy of four predictors (gait profile plus MMSE, DSST, and TMT-B) previously identified as critical for the conversion from aMCI to AD within a 36-month follow-up. Supervised ML algorithms (Support Vector Machine [SVM], Logistic Regression, and k-Nearest Neighbors) were trained on 70% of the dataset, and feature importance was evaluated for the best algorithm.

Results

The SVM algorithm achieved the best performance. The optimized training set performance achieved an accuracy of 0.67 (sensitivity = 0.72; specificity = 0.60), improving to 0.70 on the test set (sensitivity = 0.79; specificity = 0.52). Feature importance revealed MMSE as the most important predictor in both training and testing, while gait type was important in the testing phase.

Discussion

We created a predictive ML model that is capable of identifying aMCI at high risk of AD dementia within 36 months. Our ML model could be used to quickly identify individuals at higher risk of AD, facilitating secondary prevention (e.g., cognitive and/or physical training), and serving as screening for more expansive and invasive tests. Lastly, our results point toward theoretically and practically sound evidence of mind and body interaction in AD.

Enhancing spatial navigation skills in mild cognitive impairment patients: a usability study of a new version of ANTaging software

Introduction

Mild Cognitive Impairment (MCI) often presents challenges related to spatial navigation and retention of spatial information. Navigating space involves intricate integration of bodily and environmental cues. Spatial memory is dependent on two distinct frame of reference systems for organizing this information: egocentric and allocentric frames of reference. Virtual Reality (VR) has emerged as a promising technology for enhancing spatial navigation skills and spatial memory by facilitating the manipulation of bodily, environmental, and cognitive cues.

Methods

This usability study was based on a fully within-subjects design in which seven MCI patients underwent two kinds of VR conditions: participants were required to complete the ANTaging demo both in Oculus Rift S (immersive condition) and in Samsung UHD 4K monitor (semi-immersive condition). Participants were seated and they had to use a foot-motion pad to navigate and explore the environment to collect and relocate some objects in the virtual environment. Post-interaction, users provided feedback on their experiences. Additionally, usability, potential side effects, data analysis feasibility, and user preferences with immersive and semi-immersive technologies were assessed through questionnaires.

Results

Results indicated higher usability ratings for the semi-immersive setup, with fewer negative effects reported compared to the immersive counterpart. According to qualitative analyses of the interviews, patients do seem to like both VR apparatuses even though the semi-immersive condition was perceived as the most suitable choice because of the size of the screen. Patients generally found it difficult to remember object locations. Participants expressed the need for more practice with the foot-motion pad, despite an overall positive experience. They generally would like to use this system to improve their memory.

Discussion

Identifying these key aspects was crucial for refining the system before the upcoming clinical trial. This study sheds light on the potential of semi-immersive VR in aiding individuals with MCI, paving the way for enhanced spatial navigation interventions.

Bodily and Visual-Cognitive Navigation Aids to Enhance Spatial Recall in Mild Cognitive Impairment

Background

Individuals with mild cognitive impairment (MCI) syndrome often report navigation difficulties, accompanied by impairments in egocentric and allocentric spatial memory. However, studies have shown that both bodily (e.g., motor commands, proprioception, vestibular information) and visual-cognitive (e.g., maps, directional arrows, attentional markers) cues can support spatial memory in MCI.

Objective

We aimed to assess navigation cues for innovative spatial training in aging.

Methods

Fifteen MCI patients were recruited for this study. Their egocentric and allocentric memory recall performances were tested through a navigation task with five different virtual reality (VR) assistive encoding navigation procedures (bodily, vision only, interactive allocentric map, reduced executive load, free navigation without cues). Bodily condition consisted of an immersive VR setup to engage self-motion cues, vision only condition consisted of passive navigation without interaction, in the interactive allocentric map condition patients could use a bird-view map, in the reduced executive load condition directional cues and attentional markers were employed, and during free navigation no aid was implemented.

Results

Bodily condition improved spatial memory compared to vision only and free navigation without cues. In addition, the interactive allocentric map was superior to the free navigation without cues. Surprisingly, the reduced executive load was comparable to vison only condition. Moreover, a detrimental impact of free navigation was observed on allocentric memory across testing trials.

Conclusions

These findings challenge the notion of an amodal representation of space in aging, suggesting that spatial maps can be influenced by the modality in which the environment was originally encoded.

Prognostic relevance of gait-related cognitive functions for dementia conversion in amnestic mild cognitive impairment

BACKGROUND

Increasing research suggests that gait abnormalities can be a risk factor for Alzheimer's Disease (AD). Notably, there is growing evidence highlighting this risk factor in individuals with amnestic Mild Cognitive Impairment (aMCI), however further studies are needed. The aim of this study is to analyze cognitive tests results and brain-related measures over time in aMCI and examine how the presence of gait abnormalities (neurological or orthopedic) or normal gait affects these trends. Additionally, we sought to assess the significance of gait and gait-related measures as prognostic indicators for the progression from aMCI to AD dementia, comparing those who converted to AD with those who remained with a stable aMCI diagnosis during the follow-up.

METHODS

Four hundred two individuals with aMCI from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database were included. Robust linear mixed-effects models were used to study the impact of gait abnormalities on a comprehensive neuropsychological battery over 36 months while controlling for relevant medical variables at baseline. The impact of gait on brain measures was also investigated. Lastly, the Cox proportional-hazards model was used to explore the prognostic relevance of abnormal gait and neuropsychological associated tests.

RESULTS

While controlling for relevant covariates, we found that gait abnormalities led to a greater decline over time in attention (DSST) and global cognition (MMSE). Intriguingly, psychomotor speed (TMT-A) and divided attention (TMT-B) declined uniquely in the abnormal gait group. Conversely, specific AD global cognition tests (ADAS-13) and auditory-verbal memory (RAVLT immediate recall) declined over time independently of gait profile. All the other cognitive tests were not significantly affected by time or by gait profile. In addition, we found that ventricles size increased faster in the abnormal gait group compared to the normal gait group. In terms of prognosis, abnormal gait (HR = 1.7), MMSE (HR = 1.09), and DSST (HR = 1.03) covariates showed a higher impact on AD dementia conversion.

CONCLUSIONS

The importance of the link between gait and related cognitive functions in terms of diagnosis, prognosis, and rehabilitation in aMCI is critical. We showed that in aMCI gait abnormalities lead to executive functions/attention deterioration and conversion to AD dementia.

Tool-use training in augmented reality: plasticity of forearm body schema does not predict sense of ownership or agency in older adults

In young adults (YA) who practised controlling a virtual tool in augmented reality (AR), the emergence of a sense of body ownership over the tool was associated with the integration of the virtual tool into the body schema (BS). Agency emerged independent of BS plasticity. Here we aimed to replicate these findings in older adults (OA). Although they are still able to learn new motor tasks, brain plasticity and learning capacity are reduced in OA. We predicted that OA would be able to gain control over the virtual tool indicated by the emergence of agency but would show less BS plasticity as compared to YA. Still, an association between BS plasticity and body ownership was expected. OA were trained in AR to control a virtual gripper to enclose and touch a virtual object. In the visuo-tactile (VT) but not the vision-only (V) condition, vibro-tactile feedback was applied through a CyberTouch II glove when the tool touched the object. BS plasticity was assessed with a tactile distance judgement task where participants judged distances between two tactile stimuli applied to their right forearm. Participants further rated their perceived ownership and agency after training. As expected, agency emerged during the use of the tool. However, results did not indicate any changes in the BS of the forearm after virtual tool-use training. Also, an association between BS plasticity and the emergence of body ownership could not be confirmed for OA. Similar to YA, the practice effect was stronger in the visuo-tactile feedback condition compared with the vision-only condition. We conclude that a sense of agency may strongly relate to improvement in tool-use in OA independent of alterations in the BS, while ownership did not emerge due to a lack of BS plasticity.

The 3D Structural Architecture of the Human Hand Area Is Nontopographic

The functional topography of the human primary somatosensory cortex hand area is a widely studied model system to understand sensory organization and plasticity. It is so far unclear whether the underlying 3D structural architecture also shows a topographic organization. We used 7 Tesla (7T) magnetic resonance imaging (MRI) data to quantify layer-specific myelin, iron, and mineralization in relation to population receptive field maps of individual finger representations in Brodman area 3b (BA 3b) of human S1 in female and male younger adults. This 3D description allowed us to identify a characteristic profile of layer-specific myelin and iron deposition in the BA 3b hand area, but revealed an absence of structural differences, an absence of low-myelin borders, and high similarity of 3D microstructure profiles between individual fingers. However, structural differences and borders were detected between the hand and face areas. We conclude that the 3D structural architecture of the human hand area is nontopographic, unlike in some monkey species, which suggests a high degree of flexibility for functional finger organization and a new perspective on human topographic plasticity.SIGNIFICANCE STATEMENT Using ultra-high-field MRI, we provide the first comprehensive in vivo description of the 3D structural architecture of the human BA 3b hand area in relation to functional population receptive field maps. High similarity of precise finger-specific 3D profiles, together with an absence of structural differences and an absence of low-myelin borders between individual fingers, reveals the 3D structural architecture of the human hand area to be nontopographic. This suggests reduced structural limitations to cortical plasticity and reorganization and allows for shared representational features across fingers.

The temporal precision of audiovisual integration is associated with longitudinal fall incidents but not sensorimotor fall risk in older adults

Sustained multisensory integration over long inter-stimulus time delays is typically found in older adults, particularly those with a history of falls. However, the extent to which the temporal precision of audio-visual integration is associated with longitudinal fall or fall risk trajectories is unknown. A large sample of older adults (N = 2319) were grouped into longitudinal trajectories of self-reported fall incidents (i.e., decrease, stable, or increase in number) and, separately, their performance on a standard, objective measure of fall risk, Timed Up and Go (TUG; stable, moderate decline, severe decline). Multisensory integration was measured once as susceptibility to the Sound-Induced Flash Illusion (SIFI) across three stimulus onset asynchronies (SOAs): 70 ms, 150 ms and 230 ms. Older adults with an increasing fall number showed a significantly different pattern of performance on the SIFI than non-fallers, depending on age: For adults with increasing incidents of falls, those aged 53-59 years showed a much smaller difference in illusion susceptibility at 70 ms versus 150 ms than those aged 70 + years. In contrast, non-fallers showed a more comparable difference between these SOA conditions across age groups. There was no association between TUG performance trajectories and SIFI susceptibility. These findings suggests that a fall event is associated with distinct temporal patterns of multisensory integration in ageing and have implications for our understanding of the mechanisms underpinning brain health in older age.

Usability of an Embodied CAVE System for Spatial Navigation Training in Mild Cognitive Impairment

Individuals with mild cognitive impairment (MCI) usually report navigation and spatial memory impairments. Spatial navigation is an embodied process that requires the active involvement of both physical (e.g., motor commands and proprioception) and cognitive (e.g., decision-making and mental rotation) information. Immersive virtual reality (IVR) is a valuable tool that employs this information as real-world navigation does. Given the crucial impact of spatial navigation on daily life, research should focus on ways to enhance it. Though they are still in their development, contemporary IVR methods for spatial navigation training in MCI seem promising. In this usability study, eight patients with MCI syndrome tested an IVR spatial navigation training demo and interacted with the CAVE using active stereo glasses, a foot-motion pad, and a joypad. During the demo, users were asked to report their impressions on the IVR training using the thinking-aloud procedure. Moreover, questionnaires regarding usability, presence and cybersickness were administered at the end of the experience. Our results show that the first version of this system is usable by the patients even if most of them did not have experience with PC/IVR. The system provided a moderate sense of spatial presence and limited negative effects. Issues found during the thinking-aloud procedure concerned the visual aspects, which affected the interaction user-system. Participants reported that they needed more practice with the foot-motion pad even though the overall experience was positively evaluated. Identifying these critical features was essential to develop an improved version of the current system.

Effects of age simulation and age on motor sequence learning: Interaction of age-related cognitive and motor decline

Aging is known to lead to decrements in sensory and cognitive functioning and motor performance. The purpose of the present experiment was twofold: a) We assessed the influence of wearing an age simulation suit on motor sequence learning, cognitive speed tasks and far visual acuity in healthy, younger adults. b) We evaluated the interaction of cognitive aging and declining motor sequence learning in older adults. In a between-subjects design we tested 11 younger adults (M_age = 23.6 years) without the age suit, 12 younger adults wearing the age suit (M_age = 23.2 years), and 23 older adults (M_age = 72.6 years). All participants learned a simple, spatial-temporal movement sequence on two consecutive days, and we assessed perceptual processing speed (Digit Symbol Substitution test and Figural Speed test) and far visual acuity. Wearing an age simulation suit neither affected the learning of the simple motor sequence nor the performance at the cognitive speed tasks in younger adults. However, far visual acuity suffered from wearing the suit. Younger adults with and without the suit showed better motor sequence learning compared to older adults. The significant correlations between the cognitive speed tests and the motor learning performance in older adults indicated that cognitive aging partially explains some of the variance in age-related motor learning deficits.

Advanced aging effects on implicit motor imagery and its links to motor performance: An investigation via mental rotation of letters, hands, and feet

This study focuses on changes in implicit motor imagery during advanced aging and these changes’ co-occurrences with physical motor deficits. We administered a mental rotation (MR) task with letters, hands, and feet to 28 young adults (20–27 years) and to 71 older adults (60–87 years), and assessed motor skills (gait mobility and hand dexterity) and neuropsychological performance. Compared to young adults, older adults showed lower MR performance for all stimuli and stronger biomechanical constraint effects on both hand and foot rotation. Moreover, the foot biomechanical constraint effect continued to increase during late adulthood, and declines in hand and foot motor imagery emerged at earlier old ages than declines in visual imagery. These results first demonstrated distinct aging trajectories of hand motor imagery, foot motor imagery, and visual imagery. Exploratory partial correlation analysis for older adults showed positive associations of low-level perceptual-motor skills (Trail Making Test-A performance) with hand and foot MR performance and positive associations of mobility (Timed Up and Go test performance) with foot and letter MR performance. These associations exhibited somewhat different patterns from those of young adults and raised the possibility that age-related declines in motor (and visual) imagery co-occur with declines in motor functioning.

Contribution of cognitive and bodily navigation cues to egocentric and allocentric spatial memory in hallucinations due to Parkinson's disease: A case report

Parkinson's disease (PD) manifestations can include visual hallucinations and illusions. Recent findings suggest that the coherent integration of bodily information within an egocentric representation could play a crucial role in these phenomena. Egocentric processing is a key aspect of spatial navigation and is supported by the striatum. Due to the deterioration of the striatal and motor systems, PD mainly impairs the egocentric rather than the allocentric spatial frame of reference. However, it is still unclear the interplay between spatial cognition and PD hallucinations and how different navigation mechanisms can influence such spatial frames of reference. We report the case of A.A., a patient that suffers from PD with frequent episodes of visual hallucinations and illusions. We used a virtual reality (VR) navigation task to assess egocentric and allocentric spatial memory under five navigation conditions (passive, immersive, map, path decision, and attentive cues) in A.A. and a PD control group without psychosis. In general, A.A. exhibited a statistically significant classical dissociation between the egocentric and allocentric performance with a greater deficit for the former. In particular, the dissociation was statistically significant in the “passive” and “attentive cues” conditions. Interestingly in the “immersive” condition, the dissociation was not significant and, in contrast to the other conditions, trends showed better performance for egocentric than allocentric memory. Within the theories of embodiment, we suggest that body-based information, as assessed with VR navigation tasks, could play an important role in PD hallucinations. In addition, the possible neural underpinnings and the usefulness of VR are discussed.

When action prediction grows old: An fMRI study

Predicting the unfolding of others' actions (action prediction) is crucial for successfully navigating the social world and interacting efficiently. Age-related changes in this domain have remained largely unexplored, especially for predictions regarding simple gestures and independent of contextual information or motor expertise. Here, we evaluated whether healthy aging impacts the neurophysiological processes recruited to anticipate, from the observation of implied-motion postures, the correct conclusion of simple grasping and pointing actions. A color-discrimination task served as a control condition to assess the specificity of the age-related effects. Older adults showed reduced efficiency in performance that was yet not specific to the action prediction task. Nevertheless, fMRI results revealed task-specific age-related differences: while both groups showed stronger recruitment of the lateral occipito-temporal cortex bilaterally during the action prediction than the control task, the younger participants additionally showed a higher bilateral engagement of parietal regions. Importantly, in both groups, the recruitment of visuo-motor processes in the right posterior parietal cortex was a predictor of good performance. These results support the hypothesis of decreased involvement of sensorimotor processes in cognitive tasks when processing action- and body-related stimuli in healthy aging. These results have implications for social interaction, which requires the fast reading of others' gestures.

Mental rotation of hands and objects in ageing and Parkinson's disease: differentiating motor imagery and visuospatial ability

Motor imagery supports motor learning and performance and has the potential to be a useful strategy for neurorehabilitation. However, motor imagery ability may be impacted by ageing and neurodegeneration, which could limit its therapeutic effectiveness. Motor imagery can be assessed implicitly using a hand laterality task (HLT), whereby laterality judgements are slower for stimuli corresponding to physically more difficult postures, as indicated by a “biomechanical constraint” effect. Performance is also found to differ between back and palm views of the hand, which may differentially recruit visual and sensorimotor processes. Older adults and individuals with Parkinson’s disease (PD) have shown altered performance on the HLT; however, the effects of both ageing and PD on laterality judgements for the different hand views (back and palm) have not been directly examined. The present study compared healthy younger, healthy older, and PD groups on the HLT, an object-based mental rotation task, and an explicit motor imagery measure. The older and PD groups were slower than the younger group on the HLT, particularly when judging laterality from the back view, and exhibited increased biomechanical constraint effects for the palm. While response times were generally similar between older and PD groups, the PD group showed reduced accuracy for the back view. Letter rotation was slower and less accurate only in the PD group, while explicit motor imagery ratings did not differ significantly between groups. These results suggest that motor imagery may be slowed but relatively preserved in both typical ageing and neurodegeneration, while a PD-specific impairment in visuospatial processing may influence task performance. The findings have implications for the use of motor imagery in rehabilitation protocols.

What the study of spinal cord injured patients can tell us about the significance of the body in cognition

Although in the last three decades philosophers, psychologists and neuroscientists have produced numerous studies on human cognition, the debate concerning its nature is still heated and current views on the subject are somewhat antithetical. On the one hand, there are those who adhere to a view implying 'disembodiment' which suggests that cognition is based entirely on symbolic processes. On the other hand, a family of theories referred to as the Embodied Cognition Theories (ECT) postulate that creating and maintaining cognition is linked with varying degrees of inherence to somatosensory and motor representations. Spinal cord injury induces a massive body-brain disconnection with the loss of sensory and motor bodily functions below the lesion level but without directly affecting the brain. Thus, SCI may represent an optimal model for testing the role of the body in cognition. In this review, we describe post-lesional cognitive modifications in relation to body, space and action representations and various instances of ECT. We discuss the interaction between body-grounded and symbolic processes in adulthood with relevant modifications after body-brain disconnection.

Age-related changes in visuo-proprioceptive processing in perceived body position

This study investigated age-related change in visuo-proprioceptive processing in the perceived body position using mirror hand/foot illusions, focusing on its temporal characteristics, its dependency on body parts, and its association with older adults’ fall risk. Either immediately or 15 s after the exposure to the mirror-induced inconsistency of visuo-proprioceptive signals regarding the right hand or foot position, participants performed a reaching task using the unseen, illusion-affected hand or foot. Results showed clear age group differences. Specifically, older adults exhibited larger reaching errors than younger adults in the hand condition, and after the 15 s delay in the foot condition. Further, the reaching errors were constant across time for older adults but decreased after the delay in young adults, regardless of the tested body part. Particularly, older adults’ risk of falling, which was assessed by the timed up-and-go test, was negatively correlated with the reduction of reaching error across time. This suggests that older adults, especially those with a high risk of falling, face difficulties in appropriately processing visual and proprioceptive information for body perception in accordance with their external environment.

Embodied Prevention

Evidence-based recommendations for lifestyles to promote healthy cognitive aging (exercise, education, non-smoking, balanced diet, etc.) root in reductionistic studies of mostly physical measurable factors with large effect sizes. In contrast, most people consider factors like autonomy, purpose, social participation and engagement, etc. as central to a high quality of life in old age. Evidence for a direct causal impact of these factors on healthy cognitive aging is still limited, albeit not absent. Ultimately, however, individual lifestyle is a complex composite of variables relating to both body and mind as well as to receiving input and generating output. The physical interventions are tied to the more subjective and mind-related aspects of lifestyle and wellbeing in the idea of the “embodied mind,” which states that the mind is shaped by and requires the body. The causality is reciprocal and the process is dynamic, critically requiring movement: the “embodied mind” is a “embodied mind in motion.” Hiking, playing musical instruments, dancing and yoga are examples of body–mind activities that assign depth, purpose, meaning, social embedding, etc. to long-term beneficial physical “activities” and increase quality of life not only as delayed gratification. The present motivational power of embodied activities allows benefiting from the side-effects of late-life resilience. The concept offers an access point for unraveling the mechanistic complexity of lifestyle-based prevention, including their neurobiological foundations.

Consciousness Beyond Neural Fields: Expanding the Possibilities of What Has Not Yet Happened

In the field theories in physics, any particular region of the presumed space-time continuum and all interactions between elementary objects therein can be objectively measured and/or accounted for mathematically. Since this does not apply to any of the field theories, or any other neural theory, of consciousness, their explanatory power is limited. As discussed in detail herein, the matter is complicated further by the facts than any scientifically operational definition of consciousness is inevitably partial, and that the phenomenon has no spatial dimensionality. Under the light of insights from research on meditation and expanded consciousness, chronic pain syndrome, healthy aging, and eudaimonic well-being, we may conceive consciousness as a source of potential energy that has no clearly defined spatial dimensionality, but can produce significant changes in others and in the world, observable in terms of changes in time. It is argued that consciousness may have evolved to enable the human species to generate such changes in order to cope with unprecedented and/or unpredictable adversity. Such coping could, ultimately, include the conscious planning of our own extinction when survival on the planet is no longer an acceptable option.

Self-body recognition and attitudes towards body image in younger and older women

Despite the fact that ageing causes dramatic changes in bodily appearance, little is known about how self-body recognition changes across life span. Here, we investigated whether older, compared to younger women, differed in the ability of recognising their own than other women's body parts and whether this effect was associated to negative body image dispositions. Twenty-eight young (M_age: 25.93 years, SD_age = 4.74) and 25 middle-aged (M_age: 54.36 years, SD_age = 4.54) women completed an implicit task consisting of visual matching of self and others' body parts and an explicit self-other body discrimination task. Stimuli comprised of images of body parts of the participant and of other age- and BMI-matched models, which were presented in the original size or modified to look rounder or thinner. Measures of adiposity (i.e. BMI), body image concerns and appearance-related worries for specific body parts and for the whole body were also collected. Whilst both groups showed a self-body advantage in the implicit, but not in the explicit task, the advantage was notably bigger for the younger group. However, the implicit self-advantage was higher in those middle-aged women that displayed more body image concerns and worries for specific body parts. Furthermore, the two groups were comparably less able in recognising their body parts when presented thinner as compared to rounder or in their actual size. Overall, these findings open the possibility that, as women age, their implicit self-recognition abilities may decline in association with more negative body image dispositions.

Virtual Hand Illusion in younger and older adults

Introduction

Embodiment involves experiencing ownership over our body and localizing it in space and is informed by multiple senses (visual, proprioceptive and tactile). Evidence suggests that embodiment and multisensory integration may change with older age. The Virtual Hand Illusion (VHI) has been used to investigate multisensory contributions to embodiment, but has never been evaluated in older adults. Spatio-temporal factors unique to virtual environments may differentially affect the embodied perceptions of older and younger adults.

Methods

Twenty-one younger (18–35 years) and 19 older (65+ years) adults completed the VHI paradigm. Body localization was measured at baseline and again, with subjective ownership ratings, following synchronous and asynchronous visual-tactile interactions.

Results

Higher ownership ratings were observed in the synchronous relative to the asynchronous condition, but no effects on localization/drift were found. No age differences were observed. Localization accuracy was biased in both age groups when the virtual hand was aligned with the real hand, indicating a visual mislocalization of the virtual hand.

Conclusions

No age-related differences in the VHI were observed. Mislocalization of the hand in VR occurred for both groups, even when congruent and aligned; however, tactile feedback reduced localization biases. Our results expand the current understanding of age-related changes in multisensory embodiment within virtual environments.

Examining the Academic Trends in Neuropsychological Tests for Executive Functions Using Virtual Reality: Systematic Literature Review

Background

In neuropsychology, fully immersive virtual reality (VR) has been spotlighted as a promising tool. It is considered that VR not only overcomes the existing limitation of neuropsychological tests but is also appropriate for treating executive functions (EFs) within activities of daily living (ADL) due to its high ecological validity. While fully immersive VR offers new possibilities of neuropsychological tests, there are few studies that overview the intellectual landscape and academic trends in the research related to mainly targeted EFs with fully immersive VR.

Objective

The objective of this study is to get an overview of the research trends that use VR in neuropsychological tests and to analyze the research trends using fully immersive VR neuropsychological tests with experimental articles.

Methods

This review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were searched in three web databases using keywords related to VR, EFs, and cognitive abilities. The study was conducted in two steps, keyword analysis and in-depth systematic review. In the web database search from 2000 to 2019, 1167 articles were initially collected, of which 234 articles in the eligibility phase were used to conduct keyword analysis and a total of 47 articles were included for systematic review.

Results

In keyword analysis, the number of articles focused on dementia including the keywords “MCI,” “SCD,” and “dementia” were highlighted over the period, rather than other symptoms. In addition, we identified that the use of behavioral and physiological data in virtual environments (VEs) has dramatically increased in recent studies. In the systematic review, we focused on the purpose of study, assessment, treatment, and validation of usability and structure. We found that treatment studies and uncategorized studies including presence and cybersickness issues have emerged in the recent period. In addition, the target symptoms and range of participants were diversified.

Conclusions

There has been a continuously increasing interest in dealing with neuropsychology by using fully immersive VR. Target cognitive abilities have been diversified, as well as target symptoms. Moreover, the concept of embodied cognition was transplanted in this research area.

Impaired remapping of social relationships in older adults

Social relationships are a central aspect of our everyday life, yet our ability to change established social relationships is an under-investigated topic. Here, we use the concept of cognitive mapping to investigate the plasticity of social relationships in younger and older adults. We describe social relationships within a 'social space', defined as a two-dimensional grid composed of the axis 'power' and 'affiliation', and investigate it using a 3D virtual environment with interacting avatars. We show that participants remap dimensions in 'social space' when avatars show conflicting behavior compared to consistent behavior and that, while older adults show similar updating behavior than younger adults, they show a distinct reduction in remapping social space. Our data provide first evidence that older adults show more rigid social behavior when avatars change their behavior in the dimensions of power and affiliation, which may explain age-related social behavior differences in everyday life.

Age-related changes in time perception: The impact of naturalistic environments and retrospective judgements on timing performance

Reduced timing abilities have been reported in older adults and are associated with pathological cognitive decline. However, time perception experiments often lack ecological validity. Especially the reduced complexity of experimental stimuli and the participants' awareness of the time-related nature of the task can influence lab-assessed timing performance and thereby conceal age-related differences. An approximation of more naturalistic paradigms can provide important information about age-related changes in timing abilities. To determine the impact of higher ecological validity on timing experiments, we implemented a paradigm that allowed us to test (1) the effect of embedding the to-be-timed stimuli within a naturalistic visual scene and (2) the effect of retrospective time judgements, which are more common in real life than prospective judgements. The results show that compared with out-of-context stimuli, younger adults benefit from a naturalistic embedding of stimuli (reflected in higher precision and less errors), whereas the performance of older adults is reduced when confronted with naturalistic stimuli. Differences between retrospective and prospective time judgements were not modulated by age. We conclude that, potentially driven by difficulties in suppressing temporally irrelevant environmental information, the contextual embedding of naturalistic stimuli can affect the degree to which age influences the performance in time perception tasks.

Building Embodied Spaces for Spatial Memory Neurorehabilitation with Virtual Reality in Normal and Pathological Aging

Along with deficits in spatial cognition, a decline in body-related information is observed in aging and is thought to contribute to impairments in navigation, memory, and space perception. According to the embodied cognition theories, bodily and environmental information play a crucial role in defining cognitive representations. Thanks to the possibility to involve body-related information, manipulate environmental stimuli, and add multisensory cues, virtual reality is one of the best candidates for spatial memory rehabilitation in aging for its embodied potential. However, current virtual neurorehabilitation solutions for aging and neurodegenerative diseases are in their infancy. Here, we discuss three concepts that could be used to improve embodied representations of the space with virtual reality. The virtual bodily representation is the combination of idiothetic information involved during virtual navigation thanks to input/output devices; the spatial affordances are environmental or symbolic elements used by the individual to act in the virtual environment; finally, the virtual enactment effect is the enhancement on spatial memory provided by actively (cognitively and/or bodily) interacting with the virtual space and its elements. Theoretical and empirical findings will be presented to propose innovative rehabilitative solutions in aging for spatial memory and navigation.

A Developmental Framework for Embodiment Research: The Next Step Toward Integrating Concepts and Methods

Embodiment research is at a turning point. There is an increasing amount of data and studies investigating embodiment phenomena and their role in mental processing and functions from across a wide range of disciplines and theoretical schools within the life sciences. However, the integration of behavioral data with data from different biological levels is challenging for the involved research fields such as movement psychology, social and developmental neuroscience, computational psychosomatics, social and behavioral epigenetics, human-centered robotics, and many more. This highlights the need for an interdisciplinary framework of embodiment research. In addition, there is a growing need for a cross-disciplinary consensus on level-specific criteria of embodiment. We propose that a developmental perspective on embodiment is able to provide a framework for overcoming such pressing issues, providing analytical tools to link timescales and levels of embodiment specific to the function under study, uncovering the underlying developmental processes, clarifying level-specific embodiment criteria, and providing a matrix and platform to bridge disciplinary boundaries among the involved research fields.

Repeated Exposure to Illusory Sense of Body Ownership and Agency Over a Moving Virtual Body Improves Executive Functioning and Increases Prefrontal Cortex Activity in the Elderly

We previously showed that the illusory sense of ownership and agency over a moving body in immersive virtual reality (displayed in a first-person perspective) can trigger subjective and physiological reactions on the real subject’s body and, therefore, an acute improvement of cognitive functions after a single session of high-intensity intermittent exercise performed exclusively by one’s own virtual body, similar to what happens when we actually do physical activity. As well as confirming previous results, here, we aimed at finding in the elderly an increased improvement after a longer virtual training with similar characteristics. Forty-two healthy older subjects (28 females, average age = 71.71 years) completed a parallel-group randomized controlled trial (RCT; UMIN000039843, umin.ac.jp) including an adapted version of the virtual training previously used: while sitting, participants observed the virtual body in a first-person perspective (1PP) or a third-person perspective (3PP) performing 20 min of virtual high-intensity intermittent exercise (vHIE; the avatar switched between fast and slow walking every 2 min). This was repeated twice a week for 6 weeks. During the vHIE, we measured the heart rate and administered questionnaires to evaluate illusory body ownership and agency. Before the beginning of the intervention, immediately after the first session of vHIE, and at the end of the entire intervention, we evaluated the cognitive performance at the Stroop task with online recording of the hemodynamic activity over the left dorsolateral prefrontal cortex. While we confirm previous results regarding the virtual illusion and its physiological effects, we did not find significant cognitive or neural improvement immediately after the first vHIE session. As a novelty, in the 1PP group only, we detected a significant decrease in the response time of the Stroop task in the post-intervention assessment compared to its baseline; coherently, we found an increased activation on left dorsolateral prefrontal cortex (lDLPFC) after the entire intervention. While the current results strengthen the impact of the virtual full-body illusion and its physiological consequences on the elderly as well, they might have stronger and more established body representations. Perhaps, a longer and increased exposure to those illusions is necessary to initiate the cascade of events that culminates to an improved cognitive performance.

Bodily ownership and agency sensations in a natural state

Our bodily sensation is a fundamental cue for our self-consciousness. Whereas experimental studies have uncovered characteristics of bodily sensation, these studies investigated bodily sensations through manipulating bodily sensations to be apart from one's own body and to be assigned to external, body-like objects. In order to capture our bodily sensation as it is, this questionnaire survey study explored the characteristics of bodily sensation using a large population-based sample (N = 580, comprising 20s to 70s age groups) without experimental manipulations. We focused on the sensations of ownership, the feeling of having a body part as one's own, and agency, the feeling of controlling a body part by oneself, in multiple body parts (the eyes, ears, hands, legs, nose, and mouth). The ownership and agency sensations were positively related to each other in each body part. Interestingly, the agency sensation of the hands and legs had a positive relationship with the ownership sensations of the other body parts. We also found the 60s age group had a unique internal configuration, assessed by the similarity of rating scores, of the body parts for each bodily sensation. Our findings revealed the existence of unique characteristics for bodily sensations in a natural state.

Age-related differences in functional tool-use are due to changes in movement quality and not simply motor slowing

Age-related declines in fine motor control may impact tool-use and thereby limit functional independence. Most previous research has, however, focused on the effect of aging on gross motor tasks. Few studies have investigated the effects of aging on the strategy or quality of fine motor skills, especially in tool-use, which may better reflect how age impacts complex movement capability. Twenty-two young (ages 19-35) and 18 older adults (ages 58-87) performed a timed upper extremity task using a tool to acquire and transport objects to different locations. Overall task performance was divided into two phases based on 3-D position of the tool: a gross motor phase (object transport) and a fine motor phase (object acquisition). Overall, older adults took longer to complete the task. A linear model indicated that this was due to the duration of the fine motor phase more so than the gross motor phase. To identify age-related differences in the quality of the fine motor phase, we fit three-dimensional ellipsoids to individual data and the calculated the ellipsoid volume. Results demonstrated a significant volume-by-age interaction, whereby increased ellipsoid volume (space the tool occupied) related to increased mean dwell time for the older adult group only; younger adults did not demonstrate this relationship. Additionally, older adults with longer movement times during the fine motor phase also had lower cognitive scores. No age-related differences were observed for the gross motor phase, suggesting that age-related declines in tool-use may be due to changes in fine motor control and cognitive status.

Temporal context effects are associated with cognitive status in advanced age

The perception of temporal intervals changes during the life-span, and especially older adults demonstrate specific impairments of timing abilities. Recently, we demonstrated that timing performance and cognitive status are correlated in older adults, suggesting that timing tasks can serve as a behavioral marker for the development of dementia. Easy-to-administer and retest-capable timing tasks therefore have potential as diagnostic tools for tracking cognitive decline. However, before being tested in a clinical cohort study, a further validation and specification of the original findings is warranted. Here we introduce several modifications of the original task and investigated the effects of temporal context on time perception in older adults (> 65 years) with low versus high scores in the Montreal Cognitive Assessment survey (MoCA) and a test of memory functioning. In line with our previous work, we found that temporal context effects were more pronounced with increasing memory deficits, but also that these effects are stronger for realistic compared to abstract visual stimuli. Furthermore, we show that two distinct temporal contexts influence timing behavior in separate experimental blocks, as well as in a mixed block in which both contexts are presented together. These results replicate and extend our previous findings. They demonstrate the stability of the effect for different stimulus material and show that timing tasks can reveal valuable information about the cognitive status of older adults. In the future, these findings could serve as a basis for the development of a diagnostic tool for pathological cognitive decline at an early, pre-clinical stage.

Egocentric and Allocentric Spatial Memory in Mild Cognitive Impairment with Real-World and Virtual Navigation Tasks: A Systematic Review

BACKGROUND

Spatial navigation is the ability to estimate one's position on the basis of environmental and self-motion cues. Spatial memory is the cognitive substrate underlying navigation and relies on two different reference frames: egocentric and allocentric. These spatial frames are prone to decline with aging and impairment is even more pronounced in Alzheimer's disease (AD) or in mild cognitive impairment (MCI).

OBJECTIVE

To conduct a systematic review of experimental studies investigating which MCI population and tasks are used to evaluate spatial memory and how allocentric and egocentric deficits are impaired in MCI after navigation.

METHODS

PRISMA and PICO guidelines were applied to carry out the systematic search. Down and Black checklist was used to assess methodological quality.

RESULTS

Our results showed that amnestic MCI and AD pathology are the most investigated typologies; both egocentric and allocentric memory are impaired in MCI individuals, and MCI due to AD biomarkers has specific encoding and retrieval impairments; secondly, spatial navigation is principally investigated with the hidden goal task (virtual and real-world version), and among studies involving virtual reality, the privileged setting consists of non-immersive technology; thirdly, despite subtle differences, real-world and virtual versions showed good overlap for the assessment of MCI spatial memory.

CONCLUSION

Considering that MCI is a subclinical entity with potential risk for conversion to dementia, investigating spatial memory deficits with navigation tasks might be crucial to make accurate diagnosis and rehabilitation.

How ageing shapes body and space representations: A comparison study between healthy young and older adults

To efficiently interact with the external world, the brain needs to represent the size of the involved body parts - body representations (BR) - and the space around the body in which the interactions with the environment take place - peripersonal space representation (PPS). BR and PPS are both highly flexible, being updated by the continuous flow of sensorimotor signals between the brain and the body, as observed for example after tool-use or immobilization. The progressive decline of sensorimotor abilities typically described in ageing could thus influence BR and PPS representations in the older adults. To explore this hypothesis, we compared BR and PPS in healthy young and older participants. By focusing on the upper limb, we adapted tasks previously used to evaluate BR and PPS plasticity, i.e., the body-landmarks localization task and audio-tactile interaction task, together with a new task targeting explicit BR (avatar adjustment task, AAT). Results show significantly higher distortions in the older rather than young participants in the perceived metric characteristic of the upper limbs. We found significant modifications in the implicit BR of the global shape (length and width) of both upper limbs, together with an underestimation in the arm length. Similar effects were also observed in the AAT task. Finally, both young and older adults showed equivalent multisensory facilitation in the space close to the hand, suggesting an intact PPS representation. Together, these findings demonstrated significant alterations of implicit and explicit BR in the older participants, probably associated with a less efficient contribution of bodily information typically subjected to age-related decline, whereas the comparable PPS representation in both groups could be supported by preserved multisensory abilities in older participants. These results provide novel empirical insight on how multiple representations of the body in space, subserving actions and perception, are shaped by the normal course of life.

Postural Control While Walking Interferes With Spatial Learning in Older Adults Navigating in a Real Environment

Cognitive demands for postural control increase with aging and cognitive-motor interference (CMI) exists for a number of walking situations, especially with visuo-spatial cognitive tasks. Such interference also influences spatial learning abilities among older adults; however, this is rarely considered in research on aging in spatial navigation. We posited that visually and physically exploring an unknown environment may be subject to CMI for older adults. We investigated potential indicators of postural control interfering with spatial learning. Given known associations between age-related alterations in gait and brain structure, we also examined potential neuroanatomical correlates of this interference. Fourteen young and 14 older adults had to find an invisible goal in an unfamiliar, real, ecological environment. We measured walking speed, trajectory efficiency (direct route over taken route) and goal fixations (proportion of visual fixations toward the goal area). We calculated the change in walking speed between the first and last trials and adaptation indices for all three variables to quantify their modulation across learning trials. All participants were screened with a battery of visuo-cognitive tests. Eighteen of our participants (10 young, 8 older) also underwent a magnetic resonance imaging (MRI) examination. Older adults reduced their walking speed considerably on the first, compared to the last trial. The adaptation index of walking speed correlated positively with those of trajectory efficiency and goal fixations, indicating a reduction in resource sharing between walking and encoding the environment. The change in walking speed correlated negatively with gray matter volume in superior parietal and occipital regions and the precuneus. We interpret older adults’ change in walking speed as indicative of CMI, similar to dual task costs. This is supported by the correlations between the adaptation indices and between the change in walking speed and gray matter volume in brain regions that are important for navigation, given that they are involved in visual attention, sensory integration and encoding of space. These findings under ecological conditions in a natural spatial learning task question what constitutes dual tasking in older adults and they can lead future research to reconsider the actual cognitive burden of postural control in aging navigation research.

Online proprioception feeds plasticity of arm representation following tool-use in healthy aging

Following tool-use, the kinematics of free-hand movements are altered. This modified kinematic pattern has been taken as a behavioral hallmark of the modification induced by tool-use on the effector representation. Proprioceptive inputs appear central in updating the estimated effector state. Here we questioned whether online proprioceptive modality that is accessed in real time, or offline, memory-based, proprioception is responsible for this update. Since normal aging affects offline proprioception only, we examined a group of 60 year-old adults for proprioceptive acuity and movement's kinematics when grasping an object before and after tool-use. As a control, participants performed the same movements with a weight-equivalent to the tool-weight-attached to their wrist. Despite hampered offline proprioceptive acuity, 60 year-old participants exhibited the typical kinematic signature of tool incorporation: Namely, the latency of transport components peaks was longer and their amplitude reduced after tool-use. Instead, we observed no kinematic modifications in the control condition. In addition, online proprioception acuity correlated with tool incorporation, as indexed by the amount of kinematics changes observed after tool-use. Altogether, these findings point to the prominent role played by online proprioception in updating the body estimate for the motor control of tools.

Usability Issues of Clinical and Research Applications of Virtual Reality in Older People: A Systematic Review

Aging is a condition that may be characterized by a decline in physical, sensory, and mental capacities, while increased morbidity and multimorbidity may be associated with disability. A wide range of clinical conditions (e.g., frailty, mild cognitive impairment, metabolic syndrome) and age-related diseases (e.g., Alzheimer's and Parkinson's disease, cancer, sarcopenia, cardiovascular and respiratory diseases) affect older people. Virtual reality (VR) is a novel and promising tool for assessment and rehabilitation in older people. Usability is a crucial factor that must be considered when designing virtual systems for medicine. We conducted a systematic review with Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines concerning the usability of VR clinical systems in aging and provided suggestions to structure usability piloting. Findings show that different populations of older people have been recruited to mainly assess usability of non-immersive VR, with particular attention paid to motor/physical rehabilitation. Mixed approach (qualitative and quantitative tools together) is the preferred methodology; technology acceptance models are the most applied theoretical frameworks, however senior adapted models are the best within this context. Despite minor interaction issues and bugs, virtual systems are rated as usable and feasible. We encourage usability and user experience pilot studies to ameliorate interaction and improve acceptance and use of VR clinical applications in older people with the aid of suggestions (VR-USOP) provided by our analysis.

Applications, indications, and effects of passive hydrotherapy WATSU (WaterShiatsu)-A systematic review and meta-analysis

Background

WATSU (portmanteau word: water and shiatsu) is a form of passive hydrotherapy in chest-deep thermoneutral water (35°C = 95°F = 308.15 K). It combines elements of myofascial stretching, joint mobilization, massage, and shiatsu and is reported to be used to address physical and mental issues. The objective of this systematic review (PROSPERO Registration No. CRD42016029347) and the meta-analyses was to assess the applications, indications, and the effects of WATSU to form a basis for further studies.

Methods

A search for “WATSU OR watershiatsu OR (water AND shiatsu)” was conducted without any restrictions in 32 databases. Peer reviewed original articles addressing WATSU as a stand-alone hydrotherapy were assessed for risk of bias. Quantitative data of effects on pain, physical function, and mental issues were processed in random model meta-analyses with subgroup analyses by study design. Effect sizes were expressed as Hedges's g (± 95% confidence intervals).

Results

Of 1,906 unique citations, 27 articles regardless of study design were assessed for risk of bias. WATSU has been applied to individuals of all ages. Indications covered acute (e.g. pregnancy related low back pain) and chronic conditions (e.g. cerebral palsy) with beneficial effects of WATSU regarding e.g. relaxation or sleep quality. Meta-analyses suggest beneficial effect sizes of WATSU on pain (overall Hedges’s g = -0.71, 95% CI = -0.91 to -0.51), physical function (overall Hedges’s g = -0.76, 95% CI = -1.08 to -0.44), and mental issues (overall Hedges’s g = -0.68, 95% CI = -1.02 to -0.35).

Conclusion

Various applications, indications and beneficial effects of WATSU were identified. The grade of this evidence is estimated to be low to moderate at the best. To strengthen the findings of this study, high-quality RCTs are needed.

Neurorehabilitation of Spatial Memory Using Virtual Environments: A Systematic Review

In recent years, virtual reality (VR) technologies have become widely used in clinical settings because they offer impressive opportunities for neurorehabilitation of different cognitive deficits. Specifically, virtual environments (VEs) have ideal characteristics for navigational training aimed at rehabilitating spatial memory. A systematic search, following PRISMA guidelines, was carried out to explore the current scenario in neurorehabilitation of spatial memory using virtual reality. The literature on this topic was queried, 5048 papers were screened, and 16 studies were included, covering patients presenting different neuropsychological diseases. Our findings highlight the potential of the navigational task in virtual environments (VEs) for enhancing navigation and orientation abilities in patients with spatial memory disorders. The results are promising and suggest that VR training can facilitate neurorehabilitation, promoting brain plasticity processes. An overview of how VR-based training has been implemented is crucial for using these tools in clinical settings. Hence, in the current manuscript, we have critically debated the structure and the length of training protocols, as well as a different type of exploration through VR devices with different degrees of immersion. Furthermore, we analyzed and highlighted the crucial role played by the selection of the assessment tools.

Preserved multisensory body representations in advanced age

The internal representation of the body emerges via the integration of multisensory body cues. Sensory signal transfer and the ability to integrate multisensory information deteriorate significantly with increasing age. However, there is little empirical evidence on age-related changes in body representations based on multisensory integration. Here, we used a standard paradigm for evaluating body representations based on multisensory integration, the rubber hand illusion, and compared the amount of proprioceptive drift and changes in perceived body ownership triggered by the integration of visual, tactile, and proprioceptive cues between younger and older adults. To account for potential age-related differences in the temporal stability of the illusion, proprioceptive drift was measured at five different time points. Our results show that older adults used synchronous visuo-tactile cues similarly to younger adults to update both the position of their own hand, and their feeling of ownership over the artificial hand. Independent of visuo-tactile synchrony, older adults perceived their hand as closer to their body than younger adults did, and showed a less stable representation of this in-depth hand position. This proprioceptive bias towards the body did not correlate with the strength of the illusion. Our results indicate that the integration of visual and tactile cues is largely preserved in advanced age when used to update limb position, whereas proprioception worsens with age. This may be linked to two different pathways that underlie changes in body representations over the life span.

The potential of virtual reality for spatial navigation research across the adult lifespan

Older adults often experience serious problems in spatial navigation, and alterations in underlying brain structures are among the first indicators for a progression to neurodegenerative diseases. Studies investigating the neural mechanisms of spatial navigation and its changes across the adult lifespan are increasingly using virtual reality (VR) paradigms. VR offers major benefits in terms of ecological validity, experimental control and options to track behavioral responses. However, navigation in the real world differs from navigation in VR in several aspects. In addition, the importance of body-based or visual cues for navigation varies between animal species. Incongruences between sensory and motor input in VR might consequently affect their performance to a different degree. After discussing the specifics of using VR in spatial navigation research across species, we outline several challenges when investigating age-related deficits in spatial navigation with the help of VR. In addition, we discuss ways to reduce their impact, together with the possibilities VR offers for improving navigational abilities in older adults.

The dynamics of the interrelation of perception and action across the life span

Successful social interaction relies on the interaction partners' perception, anticipation and understanding of their respective actions. The perception of a particular action and the capability to produce this action share a common representational ground. So far, no study has explored the interrelation between action perception and production across the life span using the same tasks and the same measurement techniques. This study was designed to fill this gap. Participants between 3 and 80 years (N = 214) observed two multistep actions of different familiarities and then reproduced the according actions. Using eye tracking, we measured participants' action perception via their prediction of action goals during observation. To capture subtler perceptual processes, we additionally analysed the dynamics and recurrent patterns within participants' gaze behaviour. Action production was assessed via the accuracy of the participants' reproduction of the observed actions. No age-related differences were found for the perception of the familiar action, where participants of all ages could rely on previous experience. In the unfamiliar action, where participants had less experience, action goals were predicted more frequently with increasing age. The recurrence in participants' gaze behaviour was related to both, age and action production: gaze behaviour was more recurrent (i.e. less flexible) in very young and very old participants, and lower levels of recurrence (i.e. greater flexibility) were related to higher scores in action production across participants. Incorporating a life-span perspective, this study illustrates the dynamic nature of developmental differences in the associations of action production with action perception.

Dance Training Shapes Action Perception and Its Neural Implementation within the Young and Older Adult Brain

How we perceive others in action is shaped by our prior experience. Many factors influence brain responses when observing others in action, including training in a particular physical skill, such as sport or dance, and also general development and aging processes. Here, we investigate how learning a complex motor skill shapes neural and behavioural responses among a dance-naïve sample of 20 young and 19 older adults. Across four days, participants physically rehearsed one set of dance sequences, observed a second set, and a third set remained untrained. Functional MRI was obtained prior to and immediately following training. Participants' behavioural performance on motor and visual tasks improved across the training period, with younger adults showing steeper performance gains than older adults. At the brain level, both age groups demonstrated decreased sensorimotor cortical engagement after physical training, with younger adults showing more pronounced decreases in inferior parietal activity compared to older adults. Neural decoding results demonstrate that among both age groups, visual and motor regions contain experience-specific representations of new motor learning. By combining behavioural measures of performance with univariate and multivariate measures of brain activity, we can start to build a more complete picture of age-related changes in experience-dependent plasticity.

Laterality of Poststroke Cortical Motor Activity during Action Observation Is Related to Hemispheric Dominance

Background

Increased activity in the lesioned hemisphere has been related to improved poststroke motor recovery. However, the role of the dominant hemisphere—and its relationship to activity in the lesioned hemisphere—has not been widely explored.

Objective

Here, we examined whether the dominant hemisphere drives the lateralization of brain activity after stroke and whether this changes based on if the lesioned hemisphere is the dominant hemisphere or not.

Methods

We used fMRI to compare cortical motor activity in the action observation network (AON), motor-related regions that are active both during the observation and execution of an action, in 36 left hemisphere dominant individuals. Twelve individuals had nondominant, right hemisphere stroke, twelve had dominant, left-hemisphere stroke, and twelve were healthy age-matched controls. We previously found that individuals with left dominant stroke show greater ipsilesional activity during action observation. Here, we examined if individuals with nondominant, right hemisphere stroke also showed greater lateralized activity in the ipsilesional, right hemisphere or in the dominant, left hemisphere and compared these results with those of individuals with dominant, left hemisphere stroke.

Results

We found that individuals with right hemisphere stroke showed greater activity in the dominant, left hemisphere, rather than the ipsilesional, right hemisphere. This left-lateralized pattern matched that of individuals with left, dominant hemisphere stroke, and both stroke groups differed from the age-matched control group.

Conclusions

These findings suggest that action observation is lateralized to the dominant, rather than ipsilesional, hemisphere, which may reflect an interaction between the lesioned hemisphere and the dominant hemisphere in driving lateralization of brain activity after stroke. Hemispheric dominance and laterality should be carefully considered when characterizing poststroke neural activity.