Phantom limb pain following amputation is highly prevalent as it affects up to 80% of amputees. Many amputees suffer from phantom limb pain for many years and experience major limitations in daily routines and quality of life. Conventional pharmacological interventions often have negative side-effects and evidence regarding their long-term efficacy is low. Central malplasticity such as the invasion of areas neighbouring the cortical representation of the amputated limb contributes to the occurrence and maintenance of phantom limb pain. In this context, alternative, non-pharmacological interventions such as mirror therapy that are thought to target these central mechanisms have gained increasing attention in the treatment of phantom limb pain. However, a standardized evidence-based treatment protocol for mirror therapy in patients with phantom limb pain is lacking, and evidence for its effectiveness is still low. Furthermore, given the chronic nature of phantom limb pain and suggested central malplasticity, published studies proposed that patients should self-deliver mirror therapy over several weeks to months to achieve sustainable effects. To achieve this training intensity, patients need to perform self-delivered exercises on a regular basis, which could be facilitated though the use of information and communication technology such as telerehabilitation. However, little is known about potential benefits of using telerehabilitation in patients with phantom limb pain, and controlled clinical trials investigating effects are lacking. The present thesis presents the findings from the ‘PAtient Centered Telerehabilitation’ (PACT) project, which was conducted in three consecutive phases: 1) creating a theoretical foundation; 2) modelling the intervention; and 3) evaluating the intervention in clinical practice. The objectives formulated for the three phases of the PACT project were: 1) to conduct a systematic review of the literature regarding important clinical aspects of mirror therapy. It focused on the evidence of applying mirror therapy in patients with stroke, complex regional pain syndrome and phantom limb pain. 2) to design and develop a clinical framework and a user-centred telerehabilitation for mirror therapy in patients with phantom limb pain following lower limb amputation. 3) to evaluate the effects of the clinical framework for mirror therapy and the additional effects of the teletreatment in patients with phantom limb pain. It also investigated whether the interventions were delivered by patients and therapists as intended.
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Recognition of action, goals and intentions has been shown to be mediated by a multimodal mirror-neuron system, not only in monkeys, but also in humans. A fronto-parietal network of brain areas has been identified where these neurons are located. We should expect musical actions, goals and intentions to be mediated by this system as well. In this fMRI study, we present audio recordings of music composed in two-part harmony to 10 professional, improvising keyboard performers. The first task (Motor Imagery) was to imagine playing the piece, the second task (Judgment) to listen attentively while assessing the performance . Half of the pieces were familiar, the other half unfamiliar. A group of musically unskilled subjects participated as controls. As hypothesized, a fronto-parietal network of cerebral areas was activated, not only during Motor Imagery, but also during Judgement, including activity in left, ventral PMC. In a behavioral test, the ability of these performers to recognize musical actions, goals and intentions was corroborated. Performers listened to various excerpts, played them by ear, harmonized them and transposed them, demonstrating that they not only could replicate, but also manipulate them in a musically plausible manner, suggesting that the cerebral activations observed could indeed be ascribed to recognition of musical action, goals and intentions.
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Mirror neurons in the cerebral cortex have been shown to fire not onlyduring performance but also during visual and auditory observation ofactivity. This phenomenon is commonly called cerebral resonance behavior.This would mean that cortical motor regions would not only beactivated while singing, but also while listening to music. The sameshould hold true for playing a music instrument. Although most individualsare able to sing along when they hear a melody, even highlyskilled instrumentalists, however, are frequently unable to play by ear.They are score-dependent—i.e. they are only able to play a piece of musicwhen they have access to the notes—while musicians who are able to playby ear and improvise are non score-dependent; they are able to playwithout notes. Our hypothesis is that score-dependent instrumentalistswill exhibit less cerebral resonance behavior than non score-dependentmusicians while listening to music. Using fMRI to measure BOLD response,subjects listen to two-part harmony presented with headphones.The following experimental conditions are distinguished: (1) well-knownvs. unknown music (2) motor imagery vs. attentive listening. A voxelbasedanalysis of differences between the condition-related cerebral activationsis performed using Statistical Parametric Mapping.
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Mirror neurons in the cerebral cortex have been shown to fire not onlyduring performance but also during visual and auditory observation ofactivity. This phenomenon is commonly called cerebral resonance behavior.This would mean that cortical motor regions would not only beactivated while singing, but also while listening to music. The sameshould hold true for playing a music instrument. Although most individualsare able to sing along when they hear a melody, even highlyskilled instrumentalists, however, are frequently unable to play by ear.They are score-dependent—i.e. they are only able to play a piece of musicwhen they have access to the notes—while musicians who are able to playby ear and improvise are non score-dependent; they are able to playwithout notes. Our hypothesis is that score-dependent instrumentalistswill exhibit less cerebral resonance behavior than non score-dependentmusicians while listening to music. Using fMRI to measure BOLD response,subjects listen to two-part harmony presented with headphones.The following experimental conditions are distinguished: (1) well-knownvs. unknown music (2) motor imagery vs. attentive listening. A voxelbasedanalysis of differences between the condition-related cerebral activationsis performed using Statistical Parametric Mapping.
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Purpose – Older people with dementia (OPD) have specific housing and technology-related needs, for which various design principles exist. A model for designing environments and its constituting items for people with dementia that has a firm foundation in neurology may help guide designers in making design choices. The paper aims to discuss these issues. Design/methodology/approach – A general design model is presented consisting of three principles for OPD, namely designing for ageing people; designing for a favourable state and designing for beautiful moments. The neurosciences as a whole give shape to an eminent framework explaining the behaviour of OPD. One of the objectives of this paper is to translate the design principles into design specifications and to show that these specifications can be translated in a design. Findings – Philosophical concepts are introduced which are required to understand design for OPD. Four case studies from Dutch nursing homes are presented that show how the theory of modal aspects of the philosopher Dooyeweerd can be used to map design specifications in a systematic way. Research limitations/implications – These examples of design solutions illustrate the applicability of the model developed in this article. It emphasises the importance of the environment for supporting the daily life of OPD. Originality/value – There is a need for a design model for OPD. The environment and technology should initiate positive behaviours and meaningful experiences. In this paper, a general model for the designing of environments for OPD was developed that has a firm foundation in neurology and behavioural sciences. This model consists of six distinct steps and each step can be investigated empirically. In other words, this model may lay the foundation for an evidence-based design. Original article at Emerald: https://doi.org/10.1108/JET-11-2017-0043 For this paper Joost van Hoof received the Highly Recommended Award from Emerald Publishing Ltd. in October 2019: https://www.emeraldgrouppublishing.com/authors/literati/awards.htm?year=2019
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Many health education programs use progress tests to evaluate students’ progress in learning and to identify possible gaps in the curricula. The tests are typically longitudinal and feedback-oriented. Although many benefits of the progress test have been described in the literature, we argue that the acclaimed facilitation of deeper learning and better retention of knowledge appear questionable. We therefore propose an innovative way of presenting both the test itself and the study process for the test: a real-time-strategy game with in-game challenges, both individual and in teams.
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Although empathy is an essential aspect of co-design, the design community lacks a systematic overview of the key dimensions and elements that foster empathy in design. This paper introduces an empathic formation compass, based on a comparison of existing relevant frameworks. Empathic formation is defined here as the formative process of becoming an empathic design professional who knows which attitude, skills and knowledge are applicable in a co-design process. The empathic formation compass provides designers with a vocabulary that helps them understand what kind of key dimensions and elements influence empathic formation in co-design and how that informs designers’ role and design decisions. In addition, the empathic formation compass aims to support reflection and to evaluate co-design projects beyond the mere reliance on methods. In this way, empathic design can be made into a conscious activity in which designers regulate and include their own feelings and experiences (first-person perspective), and decrease empathic bias. We identify four important intersecting dimensions that empathy is comprised of in design and describe their dynamic relations. The first two opposing dimensions are denoted by empathy and differentiate between cognitive design processes and affective design experiences, and between self-and other orientation. The other two dimensions are defined by design research and differentiate between an expert and a participatory mindset, and research-and design-led techniques. The empathic formation compass strengthens and enriches our earlier work on mixed perspectives with these specific dimensions and describes the factors that foster empathy in design from a more contextual position. We expect the empathic formation compass—combined with the mixed perspectives framework—to enhance future research by bringing about a deeper understanding of designers’ empathic and collaborative design practice.
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Motor learning is particularly challenging in neurological rehabilitation: patients who suffer from neurological diseases experience both physical limitations and difficulties of cognition and communication that affect and/or complicate the motor learning process. Therapists (e.g.,, physiotherapists and occupational therapists) who work in neurorehabilitation are therefore continuously searching for the best way to facilitate patients during these intensive learning processes. To support therapists in the application of motor learning, a framework was developed, integrating knowledge from the literature and the opinions and experiences of international experts. This article presents the framework, illustrated by cases from daily practice. The framework may assist therapists working in neurorehabilitation in making choices, implementing motor learning in routine practice, and supporting communication of knowledge and experiences about motor learning with colleagues and students. The article discusses the framework and offers suggestions and conditions given for its use in daily practice.
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Functional Magnetic Resonance Imaging (fMRI) was used to study the cerebral underpinning of resonance behavior in professional keyboard musicians (n=12). The activation paradigm implied that subjects listened to two-part polyphonic music, while either critically appraising the performance or imagining they were performing themselves. Two-voice audition and bimanual motor imagery circumvented a hemisphere bias associated with a main melody.Both tasks activated ventral premotor and auditory cortices, bilaterally, and the anterior parietal cortex right-dominantly, compared to 12 musically unskilled controls. Although left ventral premotor activation was increased during imagery (compared to judgment), bilateral dorsal premotor and right posterior-superior parietal activations were quite unique to motor imagery, suggesting that musicians not only recruited their manual motor repertoire but alsoperformed a spatial transformation from the vertical perceived pitch axis to the horizontal keyboard. Imagery-specific activations in controls comprised left dorsal parietal-premotor and supplementary motor cortices. Although these activations were less strong compared to musicians, this overlapping distribution indicated the recruitment of a general 'mirror-neuron'circuitry. These two levels of sensori-motor transformations point towards common principles by which the brain organizes audition-driven music performance and visually guided task performance.
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Functional Magnetic Resonance Imaging (fMRI) was used to study the activation of cerebral motor networks during auditory perception of music in professional keyboard musicians (n=12). The activation paradigm implied that subjects listened to two-part polyphonic music, while either critically appraising the performance or imagining they were performing themselves. Two-part polyphonic audition and bimanual motor imagery circumvented a hemisphere bias associated with the convention of playing the melody with the right hand. Both tasks activated ventral premotor and auditory cortices, bilaterally, and the right anterior parietal cortex, when contrasted to 12 musically unskilled controls. Although left ventral premotor activation was increased during imagery (compared to judgment), bilateral dorsal premotor and right posterior-superior parietal activations were quite unique to motor imagery. The latter suggests that musicians not only recruited their manual motor repertoire but also performed a spatial transformation from the vertically perceived pitch axis (high and low sound) to the horizontal axis of the keyboard. Imagery-specific activations in controls were seen in left dorsal parietal-premotor and supplementary motor cortices. Although these activations were less strong compared to musicians, this overlapping distribution indicated the recruitment of a general 'mirror-neuron' circuitry. These two levels of sensori-motor transformations point towards common principles by which the brain organizes audition-driven music performance and visually guided task performance.
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