The future of cognitive neurorehabilitation

Capitalizing on Neuroplasticity Across Development to Redirect Pathways from Juvenile Justice Involvement

Adolescence is an exquisitely sensitive period of development during which pathways branch toward success in school and prosocial pursuits or, conversely, toward behavior problems and involvement in high-risk activities and systems, such as juvenile justice (JJ). Adverse childhood experiences (ACEs) such as poverty, family dysfunction, and child maltreatment, have been strongly and repeatedly associated with JJ involvement. A significant body of research from neuroscience has established that ACEs can alter facets of neurodevelopment that undergird self-regulation throughout childhood and adolescence, thereby increasing susceptibility to behaviors that attract attention of the JJ system. Because the ability to intervene prior to system-entrenchment is crucial to disrupting an adverse developmental pathway, we look toward neuroscience to offer insights into how to do so more effectively. In this chapter, evidence is summarized that informs an understanding of how neurodevelopmental pathways may lead to JJ involvement. Because neurodevelopment is malleable in response to both detrimental and positive experiences, there is potential for well-targeted interventions to normalize brain and cognitive development, especially during sensitive periods of maturation. This discussion is followed by a proposed research agenda to determine how to exploit these critical windows of opportunity to divert youth from persistent antisocial behavior and JJ involvement. Lastly, a review of neuroscience findings regarding the ability of intervention to strengthen brain systems that modulate self-regulation is presented. This research has direct practical significance with potential to be translated into meaningful policy change.

Higher Trait Psychopathy Is Associated with Increased Risky Decision-Making and Less Coincident Insula and Striatal Activity

Higher trait levels of psychopathy have been associated with both a tendency to maintain disadvantageous decision-making strategies and aberrant cortico-limbic neural activity. To explore the neural mechanisms associated with the psychopathy-related propensity to continue selecting risky choices, a non-forensic sample of participants completed a self-report psychopathy questionnaire and two runs of a risky decision-making task during H₂¹⁵O positron emission tomography (PET) scanning. In this secondary data analysis study, we leveraged data previously collected to examine the impact of previous drug use on risky decision-making to explore the relations between self-reported psychopathy and behavioral and brain metrics during performance of the Cambridge Decision-Making Task (CDMT), in which volunteers chose between small/likely or large/unlikely potential reward outcomes. Behaviorally, we observed that psychopathy scores were differentially correlated with the percent of risky decisions made in run 1 vs. run 2 of the task. Specifically, higher levels of psychopathy, above and beyond that attributable to drug use or sex, were associated with greater tendencies to make risky selections only in the second half (run 2) of the task. In parallel, psychopathy scores negatively correlated with regional cerebral blood flow (rCBF) in the right insula and right ventral striatum during run 2 of the CDMT. These exploratory outcomes suggest that greater levels of psychopathy may be associated with an inability to translate experience with negative outcomes into behavioral adaptations possibly due to decreased neural efficiency in regions related to somatic and/or reward feedback processes.

[Functional neuroimaging of the brain structures associated with language in healthy individuals and patients with post-stroke aphasia]

The introduction of non-invasive functional neuroimaging techniques such as functional magnetic resonance imaging (fMRI), in the practice of scientific and clinical research can increase our knowledge about the organization of cognitive processes, including language, in normal and reorganization of these cognitive functions in post-stroke aphasia. The article discusses the results of fMRI studies of functional organization of the cortex of a healthy adult's brain in the processing of various voice information as well as the main types of speech reorganization after post-stroke aphasia in different stroke periods. The concepts of 'effective' and 'ineffective' brain plasticity in post-stroke aphasia were considered. It was concluded that there was an urgent need for further comprehensive studies, including neuropsychological testing and several complementary methods of functional neuroimaging, to develop a phased treatment plan and neurorehabilitation of patients with post-stroke aphasia.

Evidence for reading improvement following tDCS treatment in children and adolescents with Dyslexia

PURPOSE

There is evidence that non-invasive brain stimulation transitorily modulates reading by facilitating the neural pathways underactive in individuals with dyslexia. The study aimed at investigating whether multiple sessions of transcranial direct current stimulation (tDCS) would enhance reading abilities of children and adolescents with dyslexia and whether the effect is long-lasting.

METHODS

Eighteen children and adolescents with dyslexia received three 20-minute sessions a week for 6 weeks (18 sessions) of left anodal/right cathodal tDCS set at 1 mA over parieto-temporal regions combined with a cognitive training. The participants were randomly assigned to the active or the sham treatment; reading tasks (text, high and low frequency words, non-words) were used as outcome measures and collected before treatment, after treatment and one month after the end of treatment. The tolerability of tDCS was evaluated.

RESULTS

The active group showed reduced low frequency word reading errors and non-word reading times. These positive effects were stable even one month after the end of treatment. None reported adverse effects.

CONCLUSIONS

The study shows preliminary evidence of tDCS feasibility and efficacy in improving non-words and low frequency words reading of children and adolescents with dyslexia and it opens new rehabilitative perspectives for the remediation of dyslexia.

A systematic review of the effects of low-frequency repetitive transcranial magnetic stimulation on cognition

rTMS is increasingly used for a variety of neuropsychiatric conditions. There are data to support 'fast' rTMS (≥10 Hz) having some positive effects on cognitive functioning, but a dearth of research looking at any such effects of 'slow' rTMS. This question is important as cognitive dysfunction accompanies many neuropsychiatric conditions and neuromodulation that potentially enhances or hinders such functioning has important clinical consequences. To determine cognitive effects of slow (≤1 Hz) rTMS, a systematic review of randomized control trials assayed cognition in neurological, psychiatric, and healthy volunteer ≤1 Hz rTMS paradigms. Both active (fast rTMS) and placebo comparators were included. 497 Records were initially obtained; 20 met inclusion criteria for evaluation. Four major categories emerged: mood disorders; psychotic disorders; cerebrovascular accidents; and 'other' (PTSD, OCD, epilepsy, anxiety, and tinnitus). Cognitive effects were measured across several domains: attention, executive functioning, learning, and psychomotor speed. Variability of study paradigms and reporting precluded meta-analytical analysis. No statistically significant improvement or deterioration was consistently found in any cognitive domain or illness category. These data support the overall safety of rTMS in not adversely affecting cognitive functioning. There are some data indicating that rTMS might have cognitive enhancing potential, but these are too limited at this time to make any firm conclusions, and the literature is marked by considerable heterogeneity in study parameters that hinder interpretation. Greater consensus is required in future studies in cognitive markers, and particularly in reporting of protocols. Future work should evaluate the effects of rTMS on cognitive training.

The full translational spectrum of prevention science: facilitating the transfer of knowledge to practices and policies that prevent behavioral health problems

A broad-span, six-stage translational prevention model is presented, extending from the basic sciences-taking a multi-level systems approach, including the neurobiological sciences-through to globalization. The application of a very wide perspective of translation research from basic scientific discovery to international policy change promises to elicit sustainable, population-level reductions in behavioral health disorders. To illustrate the conceptualization and actualization of a program of translational prevention research, we walk through each stage of research to practice and policy using an exemplar, callous-unemotional (CU) traits. Basic science has identified neurobiological, psychophysiological, behavioral, contextual, and experiential differences in this subgroup, and yet, these findings have not been applied to the development of more targeted intervention. As a result, there are currently no programs considered especially effective for CU traits, likely because they do not specifically target underlying mechanisms. To prevent/reduce the prevalence of conduct disorder, it is critical that we transfer existing knowledge to subsequent translational stages, including intervention development, implementation, and scaling. And eventually, once resulting programs have been rigorously evaluated, replicated, and adapted across cultural, ethnic, and gender groups, there is potential to institutionalize them as well as call attention to the special needs of this population. In this paper, we begin to consider what resources and changes in research perspectives are needed to move along this translational spectrum.

A perfect match: noninvasive brain stimulation and psychotherapy

One out of four patients with a psychiatric disorder does not tolerate or sufficiently respond to standard treatments, leading to impaired quality of life, significant morbidity and mortality, as well as high socioeconomic costs. There is increasing evidence that-apart from psychopharmacologic and psychotherapeutic interventions-targeted modulation of neural networks by brain stimulation techniques might serve as a third treatment modality. In the whole spectrum of treatment modalities, combined approaches are often used for difficult-to-treat patients. They may be superior strategies compared to monotherapy and could possible also include brain stimulation interventions. However, systematic research is lacking for the latter issue. Particularly, noninvasive brain stimulation (NIBS), e.g., transcranial direct current stimulation (tDCS) can be easily combined with psychotherapy approaches. Here, we introduce NIBS techniques for priming and augmenting psychotherapy, review preliminary data and propose a future research strategy. Interestingly, this strategy parallels the promising development in neurology and neurorehabilitation where tDCS is currently combined with functional training tasks to enhance motor or cognitive performance.

Is two better than one? Limb activation treatment combined with contralesional arm vibration to ameliorate signs of left neglect

In the present study, we evaluated the effects of the Limb Activation Treatment (LAT) alone and in combination with the Contralateral Arm Vibration (CAV) on left neglect (LN) rehabilitation. We conceived them as techniques that both prompt the activation of the lesioned right hemisphere because of the activation (with the LAT as an active technique) and the stimulation (with the CAV as a passive technique) of the left hemibody. To test the effect of the simultaneous use of these two techniques (i.e., LAT and CAV) on visuo-spatial aspects of LN, we described the case of an LN patient (GR), who showed high intra-individual variability (IIV) in performance. Given the high IIV of GR, we used an ABAB repeated-measures design to better define the effectiveness of the combined application of LAT and CAV, as a function of time. The results showed an improvement of GR's performance on the Bells test following the combined application of LAT and CAV, with respect to the application of LAT alone. We did not find, however, significant effects of treatment on two other LN tests (i.e., Line bisection and Picture scanning). We propose that the combined application of LAT and CAV can be beneficial for some aspects of LN.

Non-invasive brain stimulation in neglect rehabilitation: an update

Here, we review the effects of non-invasive brain stimulation such as transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) in the rehabilitation of neglect. We found 12 studies including 172 patients (10 TMS studies and 2 tDCS studies) fulfilling our search criteria. Activity of daily living measures such as the Barthel Index or, more specifically for neglect, the Catherine Bergego Scale were the outcome measure in three studies. Five studies were randomized controlled trials with a follow-up time after intervention of up to 6 weeks. One TMS study fulfilled criteria for Class I and one for Class III evidence. The studies are heterogeneous concerning their methodology, outcome measures, and stimulation parameters making firm comparisons and conclusions difficult. Overall, there are however promising results for theta-burst stimulation, suggesting that TMS is a powerful add-on therapy in the rehabilitation of neglect patients.