Reinforcer pathology,probabilistic choice,and medication adherence in patients with multiple sclerosis

The reinforcer pathology model posits that core behavioral economic mechanisms, including delay discounting and behavioral economic demand, underlie adverse health decisions and related clinical disorders. Extensions beyond substance use disorder and obesity, however, are limited. Using a reinforcer pathology framework, this study evaluates medical adherence decisions in patients with multiple sclerosis. Participants completed behavioral economic measures, including delay discounting, probability discounting, and a medication purchase task. A medical decision-making task was also used to evaluate how sensitivity to mild side effect risk and efficacy contributed to the likelihood of taking a hypothetical disease-modifying therapy. Less steep delay discounting and more intense (greater) medication demand were independently associated with greater adherence to the medication decision-making procedure. More generally, the pattern of interrelations between the medication-specific and general behavioral economic metrics was consistent with and contributes to the reinforcer pathology model. Additional research is warranted to expand these models to different populations and health behaviors, including those of a positive health orientation (i.e., medication adherence).     

Collective Trauma,Implicit Memories,the Body,and Active Imagination in Jungian Analysis1

This presentation attempts to show the healing potential underlying the inclusion of the patient's body in the analytic process, while honouring and revisiting the understanding of the psyche-body connection described by Jung in his early work. In addition, the author offers reflections on the impact of collective trauma whose aftermath, among others, has been the disappearance of thousands of people, consequently breaking the family genealogy, leaving hundreds of children stripped of their roots and true identity. Referencing clinical material, the author describes how the process of translation and integration—from the sensory-perceptual to the conceptual-symbolic—can be halted on account of collective trauma occurring at an early stage in development. Moreover, it is shown how the potential of the archetype or image schema, linked to the somatic-affective early experiences encoded as implicit memories, can be recovered, when Embodied Active Imagination is included in the analytic work. The patient's bodily gestures and somatic experience may bridge the gap between the preverbal-implicit knowledge and the emergence of emotions and images that allow for the creation of a new symbolic narrative.     

Memory for movement: Interaction of location and distance cues and imagery ability

The present experiments examined the role of imagery ability in recall of either the terminal location or the distance of a preselected horizontal linear movement following changes in the recall starting position. Subjects were selected on the basis of their scores on a shortened version of the Betts Questionnaire upon Mental Imagery (Betts Q.M.I., Sheehan 1967). Both high and low imagers were assigned to one of four groups, HIL, LIL, HID, LID, the last letter indicating the movement cue (terminal location or distance moved) to be recalled. Recall of the appropriate movement cue from one of four new recall starting positions occurred after either a 5-sec or 30-sec unfilled retention interval. Analysis of constant error indicated all groups were unable to recall the specified movement cue independent of the other source of information, even when subjects were given explicit instructions to utilise an imagery strategy. The data corroborate our earlier findings that memory for self paced movements is based on an interaction of location and distance cues derived from the criterion movement.     

The effect of unilateral hand contractions on psychophysiological activity during motor performance: Evidence of verbal-analytical engagement

ObjectivesConscious engagement in movement control can influence motor performance. In most cases, the left hemisphere of the brain plays an important role in verbal-analytical processing and reasoning, so changes in the balance of hemispheric activation may influence conscious engagement in movement. Evidence suggests that unilateral hand contractions influence hemispheric activation, but no study has investigated whether there is an associated effect of hand contractions on verbal-analytical processing during motor performance. This study utilized psychophysiological (and behavioural) measures to examine whether pre-performance unilateral hand contraction protocols change verbal-analytical engagement during motor performance.DesignA repeated measures crossover design was employed.MethodsTwenty-eight participants completed three hand contraction protocols in a randomised order: left-, right- and no-hand contractions. Electroencephalography (EEG) measures of hemispheric asymmetry were computed during hand contractions. A golf putting task was conducted after each protocol. EEG connectivity between sites overlying the left verbal-analytical temporal region (T7) and the motor planning region (Fz) was computed for the 3 sec prior to movement initiation. Additionally, electrocardiography (ECG) and electromyography (EMG) signals were analysed 6 sec prior to movement initiation until 6 sec after. Golf putting performance (distance from the target) and putter swing kinematics were measured.ResultsContralateral hemisphere activity was revealed for the left-hand and right-hand contraction conditions. During motor planning, the left-hand contraction protocol led to significantly lower T7-Fz connectivity, and the right-hand contraction protocol led to significantly higher T7-Fz connectivity than the other conditions. EMG, ECG and kinematic measures did not differ as a function of condition. Importantly, T7-Fz connectivity mediated the relationship between hand squeezing and motor performance (distance from the target).ConclusionThe EEG results suggest that pre-performance unilateral hand contractions influence the extent of verbal-analytical engagement during motor planning, which in turn influences motor performance. However, the hand contractions did not influence cardiac activity, muscle activity or kinematics.     

Efficacy of a 7-week dance (RCT) PE curriculum with different teaching pedagogies and levels of cognitive challenge to improve working memory capacity and motor competence in 8–10 years old children

ObjectivesThis study examined how learning a dance choreography with different teaching pedagogies and different cognitive challenge influenced the development of working memory capacity and motor competence in primary school children.DesignRandomised-controlled trial.MethodsEighty primary school children (8.8 ± 0.7 years old; 61% females) were recruited and randomly assigned to two experimental groups – a high-cognitive and a low-cognitive group – and a control group. The two experimental groups practiced dance for 7 weeks, twice a week, learning a choreography, while the control group participated in the school standard PE curriculum. In the high-cognitive group, the dance teachers limited visual demonstrations and encouraged children to memorise and recall movement sequences to increase the cognitive challenge.ResultsWhile the pre-to post-test improvements did not statistically differ between experimental groups, the analysis showed that the high-cognitive group statistically improved their working memory capacity (p < 0.01; d = 0.51), while the low-cognitive (p = 0.04; d = 0.48) and control groups did not (p = 0.32; d = 0.17). All three groups improved their motor competence from pre-to post-test, and there was a significant group*time effect (p < 0.01, η_p² = 0.13) with the high-cognitive group showing larger improvement than the control.ConclusionsThe results of this study provide initial support that dance practice coupled with a high cognitive challenge could improve working memory capacity and motor competence in children; however, the difference between groups was not statistically significant, and future research is necessary to examine the generalization of this finding.     

Impairment in the control of coupled cyclic movements of ipsilateral hand and foot after total callosotomy

Integrity of both cerebral hemispheres is required to control in-phase or anti-phase coupling of ipsilateral hand and foot oscillations, as shown by the impairment of these tasks when performed on the healthy side of hemiplegic patients. On this basis, coupling of hand–foot movements was analysed in a right-handed subject (ME) who underwent a total resection of the corpus callosum. Oscillations of the prone hand and foot, paced by a metronome at different frequencies, as well as EMG activity in extensor carpi radialis (ECR) and tibialis anterior (TA) muscles were analysed by measuring the average phase difference between the hand and foot movements and EMG cycles.

ME performed in-phase movements (right-hand extension coupled to right-foot dorsal flexion) at frequencies up to 3 Hz, though the hand cycle progressively lagged the foot cycle as the frequency increased. At 3 Hz the hand lag reached −142° (as compared to about 25° in healthy subjects). The lag increased even further after application of an inertial load to the hand, reaching 180° at 1.8 Hz (about 50° in healthy subjects). ME's hand lag is caused by the lack of any anticipatory reaction in hand movers. In contrast to healthy subjects, which activate the ECR earlier than the TA when the frequency increases, ME activated the ECR later than TA at all frequencies higher than 0.9 Hz.

Anti-phase movements (hand extension coupled to foot plantar flexion) were performed only upto 1 Hz in unloaded conditions. At 0.6 Hz, movements were in tight phase-opposition (3°), but at 1 Hz, the hand lag reached −34° because of a delayed ECR activation. After hand loading ME was unable to couple movements in anti-phase. In contrast, normal subjects maintain a tight anti-phase coupling up to 2.0 Hz, both with an unloaded or loaded hand. Similar deficits were observed by ME when performing in-phase and anti-phase coupling on the left side, as well as when he was blindfolded.

In normal subjects, an anticipated muscular activation of hand movers compensates for hand loading. Since this compensation must depend on monitoring the hand delay induced by loading, the absence in ME of such compensatory reaction suggests that callosal division had apparently compromised the mechanisms sustaining feedback compensation for differences in the biomechanical limb properties. They also confirm and reinforce the idea that elaboration of the afferent message, aiming at controlling the phase of the movement association, needs the co-operation of both cerebral hemispheres.     

A simulation study of the degrees of freedom of movement in reaching and grasping

The question of independently controlled components in the act of reaching and grasping has attracted interest experimentally and theoretically. Data from 35 studies were recently found consistent with simulated kinematic finger and thumb trajectories optimised for minimum jerk. The present study closely reproduces those trajectories using a discrete-time model based on minimum acceleration. That model was further used to generate two-dimensional trajectories for finger and thumb to reach and grasp an elliptical object with varying position and/or orientation. Orthogonalisation of these four trajectories revealed one degree of freedom when direction of reach was constant and two degrees of freedom when direction of reach varied, irrespective of object distance and orientation. These simulations indicate that reach and grasp movements contain redundancy that is removable by formation of task-dependent synergies. As skilled movement can be planned and executed in a low dimension workspace, control of these independent components lessens central workload.     

Family Unification with Reactive Attachment Disorder Children: A Brief Treatment

This is a case study of a family with a child (age eight) with reactive attachment disorder and the subsequent individual and family therapy. Treatment of choice for the child was Eye Movement Desensitization and Reprocessing (EMDR) and supportive educational counseling for the parents and family. Qualitative evaluation of the process demonstrated that the parents observed an instant change in the child's attitude. The child reported that she felt better about family, school, and truthfulness, and stated about the therapy: It opened a window for me. A 12-month evaluation demonstrated continued positive effects.     

A Pathological View of Disease

This paper is a response to Christopher Boorse's recent defense of hisBiostatistical Theory (BST) of health and disease. Boorse maintains that hisconcept of theoretical health and disease reflects the ``consideredusage of pathologists.' I argue that pathologists do not use ``disease' inthe purely theoretical way that is required by the BST. Pathology does notdraw a sharp distinction between theoretical and practical aspects ofmedicine. Pathology does not even need a theoretical concept of disease. Itsfocus is not theoretical, but practical; pathology's goal is to contribute tothe healing of patients. Pathology, even experimental pathology, is notvalue-free. Not only ``disease' but also such terms as ``nerve' and ``organ'are laden with conceptual values.