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Bender Pape TL, Livengood SL, Kletzel SL, Blabas B, Guernon A, Bhaumik DK, Bhaumik R, Mallinson T, Weaver JA, Higgins JP, Wang X, Herrold AA, Rosenow JM, Parrish T. Neural Connectivity Changes Facilitated by Familiar Auditory Sensory Training in Disordered Consciousness: A TBI Pilot Study. Front Neurol 2020; 11:1027. [PMID: 33132997 PMCID: PMC7578344 DOI: 10.3389/fneur.2020.01027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 08/06/2020] [Indexed: 12/19/2022] Open
Abstract
For people with disordered consciousness (DoC) after traumatic brain injury (TBI), relationships between treatment-induced changes in neural connectivity and neurobehavioral recovery have not been explored. To begin building a body of evidence regarding the unique contributions of treatments to changes in neural network connectivity relative to neurobehavioral recovery, we conducted a pilot study to identify relationships meriting additional examination in future research. To address this objective, we examined previously unpublished neural connectivity data derived from a randomized clinical trial (RCT). We leveraged these data because treatment efficacy, in the RCT, was based on a comparison of a placebo control with a specific intervention, the familiar auditory sensory training (FAST) intervention, consisting of autobiographical auditory-linguistic stimuli. We selected a subgroup of RCT participants with high-quality imaging data (FAST n = 4 and placebo n = 4) to examine treatment-related changes in brain network connectivity and how and if these changes relate to neurobehavioral recovery. To discover promising relationships among the FAST intervention, changes in neural connectivity, and neurobehavioral recovery, we examined 26 brain regions and 19 white matter tracts associated with default mode, salience, attention, and language networks, as well as three neurobehavioral measures. Of the relationships discovered, the systematic filtering process yielded evidence supporting further investigation of the relationship among the FAST intervention, connectivity of the left inferior longitudinal fasciculus, and auditory-language skills. Evidence also suggests that future mechanistic research should focus on examining the possibility that the FAST supports connectivity changes by facilitating redistribution of brain resources. For a patient population with limited treatment options, the reported findings suggest that a simple, yet targeted, passive sensory stimulation treatment may have altered functional and structural connectivity. If replicated in future research, then these findings provide the foundation for characterizing the unique contributions of the FAST intervention and could inform development of new treatment strategies. For persons with severely damaged brain networks, this report represents a first step toward advancing understanding of the unique contributions of treatments to changing brain network connectivity and how these changes relate to neurobehavioral recovery for persons with DoC after TBI. Clinical Trial Registry: NCT00557076, The Efficacy of Familiar Voice Stimulation During Coma Recovery (http://www.clinicaltrials.gov).
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Affiliation(s)
- Theresa L Bender Pape
- The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sherri L Livengood
- The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sandra L Kletzel
- The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States
| | - Brett Blabas
- The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States
| | - Ann Guernon
- The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States.,Marianjoy Rehabilitation Hospital Part of Northwestern Medicine, Wheaton, IL, United States
| | - Dulal K Bhaumik
- Division of Epidemiology and Biostatistics, Department of Psychiatry, Biostatistical Research Center, University of Illinois at Chicago, Chicago, IL, United States.,Research Service, Cooperative Studies Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, United States
| | - Runa Bhaumik
- Division of Epidemiology and Biostatistics, Department of Psychiatry, Biostatistical Research Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Trudy Mallinson
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
| | - Jennifer A Weaver
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
| | - James P Higgins
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Xue Wang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Amy A Herrold
- The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States.,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Northwestern Memorial Hospital, Chicago, IL, United States
| | - Todd Parrish
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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[Functional brain imaging]. Radiologe 2016; 56:148-58. [PMID: 26767522 DOI: 10.1007/s00117-015-0072-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
METHOD Functional magnetic resonance imaging (fMRI) is a non-invasive method that has become one of the major tools for understanding human brain function and in recent years has also been developed for clinical applications. PERFORMANCE Changes in hemodynamic signals correspond to changes in neuronal activity with good spatial and temporal resolution in fMRI. Using high-field MR systems and increasingly dedicated statistics and postprocessing, activated brain areas can be detected and superimposed on anatomical images. Currently, fMRI data are often combined in multimodal imaging, e. g. with diffusion tensor imaging (DTI) sequences. This method is helping to further understand the physiology of cognitive brain processes and is also being used in a number of clinical applications. In addition to the blood oxygenation level-dependent (BOLD) signals, this article deals with the construction of fMRI investigations, selection of paradigms and evaluation in the clinical routine. Clinically, this method is mainly used in the planning of brain surgery, analyzing the location of brain tumors in relation to eloquent brain areas and the lateralization of language processing. PRACTICAL RECOMMENDATIONS As the BOLD signal is dependent on the strength of the magnetic field as well as other limitations, an overview of recent developments is given. Increases of magnetic field strength (7 T), available head coils and advances in MRI analytical methods have led to constant improvement in fMRI signals and experimental design. Especially the depiction of eloquent brain regions can be done easily and quickly and has become an essential part of presurgical planning.
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Qin P, Wu X, Huang Z, Duncan NW, Tang W, Wolff A, Hu J, Gao L, Jin Y, Wu X, Zhang J, Lu L, Wu C, Qu X, Mao Y, Weng X, Zhang J, Northoff G. How are different neural networks related to consciousness? Ann Neurol 2015; 78:594-605. [PMID: 26290126 DOI: 10.1002/ana.24479] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 07/09/2015] [Accepted: 07/09/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to investigate the roles of different resting-state networks in predicting both the actual level of consciousness and its recovery in brain injury patients. METHODS We investigated resting-state functional connectivity within different networks in patients with varying levels of consciousness: unresponsive wakefulness syndrome (UWS; n = 56), minimally conscious state (MCS; n = 29), and patients with brain lesions but full consciousness (BL; n = 48). Considering the actual level of consciousness, we compared the strength of network connectivity among the patient groups. We then checked the presence of connections between specific regions in individual patients and calculated the frequency of this in the different patient groups. Considering the recovery of consciousness, we split the UWS group into 2 subgroups according to recovery: those who emerged from UWS (UWS-E) and those who remained in UWS (UWS-R). The above analyses were repeated on these 2 subgroups. RESULTS Functional connectivity strength in salience network (SN), especially connectivity between the supragenual anterior cingulate cortex (SACC) and left anterior insula (LAI), was reduced in the unconscious state (UWS) compared to the conscious state (MCS and BL). Moreover, at the individual level, SACC-LAI connectivity was more present in MCS than in UWS. Default-mode network (DMN) connectivity strength, especially between the posterior cingulate cortex (PCC) and left lateral parietal cortex (LLPC), was reduced in UWS-R compared with UWS-E. Furthermore, PCC-LLPC connectivity was more present in UWS-E than in UWS-R. INTERPRETATION Our findings show that SN (SACC-LAI) connectivity correlates with behavioral signs of consciousness, whereas DMN (PCC-LLPC) connectivity instead predicts recovery of consciousness.
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Affiliation(s)
- Pengmin Qin
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.,Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada.,Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Xuehai Wu
- Neurosurgical Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Zirui Huang
- Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Niall W Duncan
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.,Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada.,Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China
| | - Weijun Tang
- Radiologic Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Annemarie Wolff
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jin Hu
- Neurosurgical Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Gao
- Neurosurgical Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Jin
- Neurosurgical Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Xing Wu
- Neurosurgical Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Jianfeng Zhang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China
| | - Lu Lu
- Radiologic Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Chunping Wu
- Radiologic Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoying Qu
- Radiologic Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Mao
- Neurosurgical Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Xuchu Weng
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China
| | - Jun Zhang
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Georg Northoff
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.,Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada.,Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China.,National Chengchi University Research Center for Mind, Brain, and Learning, Taipei, Taiwan
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Perrin F, Castro M, Tillmann B, Luauté J. Promoting the use of personally relevant stimuli for investigating patients with disorders of consciousness. Front Psychol 2015; 6:1102. [PMID: 26284020 PMCID: PMC4519656 DOI: 10.3389/fpsyg.2015.01102] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/17/2015] [Indexed: 11/21/2022] Open
Abstract
Sensory stimuli are used to evaluate and to restore cognitive functions and consciousness in patients with a disorder of consciousness (DOC) following a severe brain injury. Although sophisticated protocols can help assessing higher order cognitive functions and awareness, one major drawback is their lack of sensitivity. The aim of the present review is to show that stimulus selection is crucial for an accurate evaluation of the state of patients with disorders of consciousness as it determines the levels of processing that the patient can have with stimulation from his/her environment. The probability to observe a behavioral response or a cerebral response is increased when her/his personal history and/or her/his personal preferences are taken into account. We show that personally relevant stimuli (i.e., with emotional, autobiographical, or self-related characteristics) are associated with clearer signs of perception than are irrelevant stimuli in patients with DOC. Among personally relevant stimuli, music appears to be a promising clinical tool as it boosts perception and cognition in patients with DOC and could also serve as a prognostic tool. We suggest that the effect of music on cerebral processes in patients might reflect the music's capacity to act both on the external and internal neural networks supporting consciousness.
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Affiliation(s)
- Fabien Perrin
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028)Lyon, France
| | - Maïté Castro
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028)Lyon, France
| | - Barbara Tillmann
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028)Lyon, France
| | - Jacques Luauté
- Henry Gabrielle Hospital, Hospices Civils de LyonLyon, France
- Neurological Hospital, Hospices Civils de LyonLyon, France
- IMPACT, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028)Lyon, France
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Qin P, Wu X, Duncan NW, Bao W, Tang W, Zhang Z, Hu J, Jin Y, Wu X, Gao L, Lu L, Guan Y, Lane T, Huang Z, Bodien YG, Giacino JT, Mao Y, Northoff G. GABAA receptor deficits predict recovery in patients with disorders of consciousness: A preliminary multimodal [(11) C]Flumazenil PET and fMRI study. Hum Brain Mapp 2015; 36:3867-77. [PMID: 26147065 DOI: 10.1002/hbm.22883] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 06/05/2015] [Accepted: 06/12/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Disorders of consciousness (DoC)-that is, unresponsive wakefulness syndrome/vegetative state and minimally conscious state-are debilitating conditions for which no reliable markers of consciousness recovery have yet been identified. Evidence points to the GABAergic system being altered in DoC, making it a potential target as such a marker. EXPERIMENTAL DESIGN In our preliminary study, we used [(11) C]Flumazenil positron emission tomography to establish global GABAA receptor binding potential values and the local-to-global (LTG) ratio of these for specific regions. These values were then compared between DoC patients and healthy controls. In addition, they were correlated with behavioral improvements for the patients between the time of scanning and 3 months later. Functional magnetic resonance imaging resting-state functional connectivity was also calculated and the same comparisons made. PRINCIPAL OBSERVATIONS lobal GABAA receptor binding was reduced in DoC, as was the LTG ratio in specifically the supragenual anterior cingulate. Both of these measures correlated with behavioral improvement after 3 months. In contrast to these measures of GABAA receptor binding, functional connectivity did not correlate with behavioral improvement. CONCLUSIONS Our preliminary findings point toward GABAA receptor binding being a marker of consciousness recovery in DoC.
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Affiliation(s)
- Pengmin Qin
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.,Institute of Mental Health Research, University of Ottawa, Ottawa, Canada.,Brain and Consciousness Research Centre, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Xuehai Wu
- Neurosurgery Department, Huashan Hospital, Fudan University, Shanghai, China
| | - Niall W Duncan
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.,Institute of Mental Health Research, University of Ottawa, Ottawa, Canada.,Brain and Consciousness Research Centre, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Centre for Cognition and Brain Disorders (CCBD), Hangzhou Normal University, Hangzhou, China
| | - Weiqi Bao
- PET/CT Centre, Huashan Hospital, Fudan University, Shanghai, China
| | - Weijun Tang
- Radiologic Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Zhengwei Zhang
- PET/CT Centre, Huashan Hospital, Fudan University, Shanghai, China
| | - Jin Hu
- Neurosurgery Department, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Jin
- Neurosurgery Department, Huashan Hospital, Fudan University, Shanghai, China
| | - Xing Wu
- Neurosurgery Department, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Gao
- Neurosurgery Department, Huashan Hospital, Fudan University, Shanghai, China
| | - Lu Lu
- Antai Hospital, Shanghai, China
| | - Yihui Guan
- PET/CT Centre, Huashan Hospital, Fudan University, Shanghai, China
| | - Timothy Lane
- Institute of Mental Health Research, University of Ottawa, Ottawa, Canada.,Brain and Consciousness Research Centre, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Zirui Huang
- Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | - Yelena G Bodien
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | | | - Ying Mao
- Neurosurgery Department, Huashan Hospital, Fudan University, Shanghai, China
| | - Georg Northoff
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.,Institute of Mental Health Research, University of Ottawa, Ottawa, Canada.,Brain and Consciousness Research Centre, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Centre for Cognition and Brain Disorders (CCBD), Hangzhou Normal University, Hangzhou, China.,Research Centre for Mind, Brain and Learning, National Chengchi University, Taipei, Taiwan
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Crone JS, Soddu A, Höller Y, Vanhaudenhuyse A, Schurz M, Bergmann J, Schmid E, Trinka E, Laureys S, Kronbichler M. Altered network properties of the fronto-parietal network and the thalamus in impaired consciousness. NEUROIMAGE-CLINICAL 2013; 4:240-8. [PMID: 24455474 PMCID: PMC3895618 DOI: 10.1016/j.nicl.2013.12.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/22/2013] [Accepted: 12/17/2013] [Indexed: 12/19/2022]
Abstract
Recovery of consciousness has been associated with connectivity in the frontal cortex and parietal regions modulated by the thalamus. To examine this model and to relate alterations to deficits in cognitive functioning and conscious processing, we investigated topological network properties in patients with chronic disorders of consciousness recovered from coma. Resting state fMRI data of 34 patients with unresponsive wakefulness syndrome and 25 in minimally conscious state were compared to 28 healthy controls. We investigated global and local network characteristics. Additionally, behavioral measures were correlated with the local metrics of 28 regions within the fronto-parietal network and the thalamus. In chronic disorders of consciousness, modularity at the global level was reduced suggesting a disturbance in the optimal balance between segregation and integration. Moreover, network properties were altered in several regions which are associated with conscious processing (particularly, in medial parietal, and frontal regions, as well as in the thalamus). Between minimally conscious and unconscious patients the local efficiency of medial parietal regions differed. Alterations in the thalamus were particularly evident in non-conscious patients. Most of the regions affected in patients with impaired consciousness belong to the so-called ‘rich club’ of highly interconnected central nodes. Disturbances in their topological characteristics have severe impact on information integration and are reflected in deficits in cognitive functioning probably leading to a total breakdown of consciousness. We investigated network properties in patients with a disorder of consciousness. Patients showed reduced global modularity. Alterations in regions of the rich club were related to impaired consciousness. These alterations have severe impact on information integration and segregation. Disturbances in overall integration may lead to breakdown of consciousness.
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Affiliation(s)
- Julia Sophia Crone
- Neuroscience Institute & Centre for Neurocognitive Research, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria ; Centre for Neurocognitive Research & Department of Psychology, University of Salzburg, Salzburg, Austria ; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Andrea Soddu
- Coma Science Group, Cyclotron Research Centre, University of Liège, Belgium ; Brain and Mind Institute, Physics & Astronomy Department, Western University, London, Ontario, Canada
| | - Yvonne Höller
- Centre for Neurocognitive Research & Department of Psychology, University of Salzburg, Salzburg, Austria ; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | | | - Matthias Schurz
- Centre for Neurocognitive Research & Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Jürgen Bergmann
- Neuroscience Institute & Centre for Neurocognitive Research, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Elisabeth Schmid
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Centre, University of Liège, Belgium ; Neurology Department, CHU Sart Tilman Hospital, University of Liège, Belgium
| | - Martin Kronbichler
- Neuroscience Institute & Centre for Neurocognitive Research, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria ; Centre for Neurocognitive Research & Department of Psychology, University of Salzburg, Salzburg, Austria
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