Concussion can increase the risk of visually induced motion sickness.

Concussion can lead to various symptoms such as balance problems, memory impairments, dizziness, and/or headaches. It has been previously suggested that during self-motion relevant tasks, individuals with concussion may rely heavily on visual information to compensate for potentially less reliable vestibular inputs and/or problems with multisensory integration. As such, concussed individuals may also be more sensitive to other visually-driven sensations such as visually induced motion sickness (VIMS). To investigate whether concussed individuals are at elevated risk of experiencing VIMS, we exposed participants with concussion (n = 16) and healthy controls (n = 15) to a virtual scene depicting visual self-motion down a grocery store aisle at different speeds. Participants with concussion were further separated into symptomatic and asymptomatic groups. VIMS was measured with the SSQ before and after stimulus exposure, and visual dependence, self-reported dizziness, and somatization were recorded at baseline. Results showed that concussed participants who were symptomatic demonstrated significantly higher SSQ scores after stimulus presentation compared to healthy controls and those who were asymptomatic. Visual dependence was positively correlated with the level of VIMS in healthy controls and participants with concussion. Our results suggest that the presence of concussion symptoms at time of testing significantly increased the risk and severity of VIMS. This finding is of relevance with regards to the use of visual display devices such as Virtual Reality applications in the assessment and rehabilitation of individuals with concussion.

Evaluating the impact of a national geriatric mental health ECHO educational program on healthcare providers' practice.

Project Extension for Community Healthcare Outcomes (ECHO) enables healthcare providers to share knowledge and best practices via telementoring. The ECHO model builds provider capacity and improves care for patients with a variety of health conditions. This study describes a Canada-wide National ECHO pilot project in the area of geriatric mental health and reports on the program's impact on providers' care practices. A mixed-methods approach was used to analyze surveys completed by participating healthcare providers. Program evaluation measured satisfaction, achievement of learning objectives, awareness of issues related to geriatric mental health, and comfort and self-efficacy working with older adults. The program led to a statistically significant increase in participants' awareness of issues related to support for older adults with mental illness and comfort and self-efficacy in managing these patients in their own practice. The National ECHO pilot project was successful in building healthcare providers' capacity to care for older adults with mental health issues and positively impacting their practice. These findings support using the ECHO model to provide ongoing geriatric mental health education for clinicians from across Canada and beyond.

Virtual reality hope machines in a curative imaginary: recommendations for neurorehabilitation research from a critical disability studies perspective.

PURPOSE: This paper provides recommendations for neurorehabilitative research informed by insights from critical disability studies (CDS) and a research study that tested an augmented neurorehabilitative technology prototype. METHODS: The methodology combines critical reflection, feminist science studies and CDS to analyze how neurorehabilitation and disability studies conceptualize notions of disability and cure. It offers recommendations for reconciling the conflicting ideologies of cure that operate within neurorehabilitative research. RESULTS: The prototype acted as a kind of virtual reality hope machine that tapped into different emotions and language games regarding disability and cure. The result is five recommendations about the ways that a CDS perspective might inform neurorehabilitation research: (I) ensure clarity in recruitment materials to account for dominant social views on disability and the possibility of cure; (II) build "strong objectivity" into research methods through attention to social context and multiple meanings of terms; (III) engage in critical reflection about research processes and findings; (IV) incorporate principles of crip technoscience; and (V) include CDS perspectives in neurorehabilitation education. CONCLUSIONS: Bridging a conversation between neurorehabilitative research and CDS can address the discrepancies between ideologies of cure, and situate rehabilitation within the wider concerns of social determinants of health and disability justice.Implications for rehabilitationBridging connections between rehabilitation studies and critical disability studies can generate productive insights that open up conversations with disabled people and a commitment to disability justice.Disability and cure are social constructs and may have different meanings for patients and rehabilitation professionals.Clinicians should be mindful of the conflicting ideological constructs and socio-political dimensions of disability and cure that are operating below the surface in the rehabilitation profession and in interactions between clinicians and patients.As technology continues to transform clinical rehabilitation care through virtual reality and other innovative paradigms, rehabilitation clinicians should recognize the potential for these technologies to become "hope machines," generating patient expectations that are idealized constructions of hoped-for outcomes of returning to a previous state or level of functionality rather than predictive expectations of likely results.

Sabotage Detection Using DL Models on EEG Data From a Cognitive-Motor Integration Task.

Objective clinical tools, including cognitive-motor integration (CMI) tasks, have the potential to improve concussion rehabilitation by helping to determine whether or not a concussion has occurred. In order to be useful, however, an individual must put forth their best effort. In this study, we have proposed a novel method to detect the difference in cortical activity between best effort (no-sabotage) and willful under-performance (sabotage) using a deep learning (DL) approach on the electroencephalogram (EEG) signals. The EEG signals from a wearable four-channel headband were acquired during a CMI task. Each participant completed sabotage and no-sabotage conditions in random order. A multi-channel convolutional neural network with long short term memory (CNN-LSTM) model with self-attention has been used to perform the time-series classification into sabotage and no-sabotage, by transforming the time-series into two-dimensional (2D) image-based scalogram representations. This approach allows the inspection of frequency-based, and temporal features of EEG, and the use of a multi-channel model facilitates in capturing correlation and causality between different EEG channels. By treating the 2D scalogram as an image, we show that the trained CNN-LSTM classifier based on automated visual analysis can achieve high levels of discrimination and an overall accuracy of 98.71% in case of intra-subject classification, as well as low false-positive rates. The average intra-subject accuracy obtained was 92.8%, and the average inter-subject accuracy was 86.15%. These results indicate that our proposed model performed well on the data of all subjects. We also compare the scalogram-based results with the results that we obtained by using raw time-series, showing that scalogram-based gave better performance. Our method can be applied in clinical applications such as baseline testing, assessing the current state of injury and recovery tracking and industrial applications like monitoring performance deterioration in workplaces.

Long-term effects of concussion on relevancy-based modulation of somatosensory-evoked potentials.

OBJECTIVE: The purpose of this investigation was to better understand the effects of concussions on the ability to selectively up or down-regulate incoming somatosensory information based on relevance. METHODS: Median nerve somatosensory-evoked potentials (SEPs) were elicited from electrical stimulation and recorded from scalp electrodes while participants completed tasks that altered the relevance of specific somatosensory information being conveyed along the stimulated nerve. RESULTS: Within the control group, SEP amplitudes for task-relevant somatosensory information were significantly greater than for non-relevant somatosensory information at the earliest cortical processing potentials (N20-P27). Alternatively, the concussion history group showed similar SEP amplitudes for all conditions at early processing potentials, however a pattern similar to controls emerged later in the processing stream (P100) where both movement-related gating and facilitation of task-relevant information were present. CONCLUSIONS: Previously concussed participants demonstrated impairments in the ability to up-regulate relevant somatosensory information at early processing stages. These effects appear to be chronic, as this pattern was observed on average several years after participants' most recent concussion. SIGNIFICANCE: Given the role of the prefrontal cortex in relevancy-based facilitation during movement-related gating, these findings lend support to the notion that this brain area may be particularly vulnerable to concussive forces.

The Effects of Mild Traumatic Brain Injury on Cognitive-Motor Integration for Skilled Performance.

Adults exposed to blast and blunt impact often experience mild traumatic brain injury, affecting neural functions related to sensory, cognitive, and motor function. In this perspective article, we will review the effects of impact and blast exposure on functional performance that requires the integration of these sensory, cognitive, and motor control systems. We describe cognitive-motor integration and how it relates to successfully navigating skilled activities crucial for work, duty, sport, and even daily life. We review our research on the behavioral effects of traumatic impact and blast exposure on cognitive-motor integration in both younger and older adults, and the neural networks that are involved in these types of skills. Overall, we have observed impairments in rule-based skilled performance as a function of both physical impact and blast exposure. The extent of these impairments depended on the age at injury and the sex of the individual. It appears, however, that cognitive-motor integration deficits can be mitigated by the level of skill expertise of the affected individual, suggesting that such experience imparts resiliency in the brain networks that underly the control of complex visuomotor performance. Finally, we discuss the next steps needed to comprehensively understand the impact of trauma and blast exposure on functional movement control.

A History of Concussion Affects Relevancy-Based Modulation of Cortical Responses to Tactile Stimuli.

Modulating cortical excitability based on a stimulus' relevance to the task at hand is a component of sensory gating, and serves to protect higher cortical centers from being overwhelmed with irrelevant information (McIlroy et al., 2003; Kumar et al., 2005; Wasaka et al., 2005). This study examined relevancy-based modulation of cortical excitability, and corresponding behavioral responses, in the face of distracting stimuli in participants with and without a history of concussion (mean age 22 ± 3 SD years; most recent concussion 39.1 ± 30 SD months). Participants were required to make a scaled motor response to the amplitudes of visual and tactile stimuli presented individually or concurrently. Task relevance was manipulated, and stimuli were occasionally presented with irrelevant distractors. Electroencephalography (EEG) and task accuracy data were collected from participants with and without a history of concussion. The somatosensory-evoked N70 event-related potential (ERP) was significantly modulated by task relevance in the control group but not in those with a history of concussion, and there was a significantly greater cost to task accuracy in the concussion history group when relevant stimuli were presented with an irrelevant distractor. This study demonstrated that relevancy-based modulation of electrophysiological responses and behavioral correlates of sensory gating differ in people with and without a history of concussion, even after patients were symptom-free and considered recovered from their injuries.

The contribution of the prefrontal cortex to relevancy-based gating of visual and tactile stimuli.

Patients with lesions of the prefrontal cortex (PFC) show increased distractibility and impairments in inhibiting cortical responses to irrelevant stimuli. This study was designed to test the role of the PFC in the early modality-specific modulation of event-related potentials (ERPs) generated during a sensory selection task. The task required participants to make a scaled motor response to the amplitudes of visual and tactile stimuli presented individually or concurrently. Task relevance was manipulated and continuous theta burst stimulation (cTBS) was used to transiently inhibit PFC activity to test the contribution of the PFC to modulation of sensory gating. Electroencephalography (EEG) was collected from participants both before and after cTBS was applied. The somatosensory-evoked N70 ERP was shown to be modulated by task relevance before but not after cTBS was applied to the PFC, and downregulating PFC activity through the use of cTBS abolished any relevancy differences in N70 amplitude. In conclusion, this study demonstrated that early modality-specific changes in cortical somatosensory processing are modulated by attention, and that this effect is subserved by prefrontal cortical activity.

Simultaneity and Temporal Order Judgments Are Coded Differently and Change With Age: An Event-Related Potential Study.

Multisensory integration is required for a number of daily living tasks where the inability to accurately identify simultaneity and temporality of multisensory events results in errors in judgment leading to poor decision-making and dangerous behavior. Previously, our lab discovered that older adults exhibited impaired timing of audiovisual events, particularly when making temporal order judgments (TOJs). Simultaneity judgments (SJs), however, were preserved across the lifespan. Here, we investigate the difference between the TOJ and SJ tasks in younger and older adults to assess neural processing differences between these two tasks and across the lifespan. Event-related potentials (ERPs) were studied to determine between-task and between-age differences. Results revealed task specific differences in perceiving simultaneity and temporal order, suggesting that each task may be subserved via different neural mechanisms. Here, auditory N1 and visual P1 ERP amplitudes confirmed that unisensory processing of audiovisual stimuli did not differ between the two tasks within both younger and older groups, indicating that performance differences between tasks arise either from multisensory integration or higher-level decision-making. Compared to younger adults, older adults showed a sustained higher auditory N1 ERP amplitude response across SOAs, suggestive of broader response properties from an extended temporal binding window. Our work provides compelling evidence that different neural mechanisms subserve the SJ and TOJ tasks and that simultaneity and temporal order perception are coded differently and change with age.

Gating at early cortical processing stages is associated with changes in behavioural performance on a sensory conflict task.

While there is evidence to show early enhancement of modality-specific somatosensory cortical event-related potentials (ERP) when two stimuli are task-relevant, less is understood about the cortical and behavioural correlates of early modality-specific sensory gating. This study sought to understand how attentional gating affects cortical processing of visual and tactile stimuli at early stages of modality-specific representation. Specifically, alterations in early somatosensory and visual processing based on attentional relevance were examined, along with the effect of an unattended sensory stimulus on cortical processing and behavioural performance. Electroencephalography (EEG) was collected from healthy participants as they performed a sensory selection task. This task required participants to make a scaled motor response to the amplitudes of visual and tactile stimuli presented individually or concurrently. Results showed that the somatosensory N70 ERP was significantly attenuated when tactile stimuli were unattended. When visual stimuli were unattended, modulation of visual potentials occurred later, at the visual P2 potential. Since unattended tactile stimuli were gated at early cortical processing stages, when they were used as distractors, no changes in cortical responses to target stimuli were observed. Additionally, there was no decrease in task accuracy when grading attended stimuli in the presence of a tactile distractor. However, since early gating was not observed in the visual modality, a visual stimulus used as an unattended distractor resulted in smaller-amplitude cortical responses to attended tactile stimuli and less accurate task performance when grading attended stimuli. In conclusion, this study suggests that early gating of unattended stimuli supports modality-specific cortical processing of target stimuli and maintains behavioural task performance.

Early modality-specific somatosensory cortical regions are modulated by attended visual stimuli: interaction of vision, touch and behavioral intent.

Bimodal interactions between relevant visual and tactile inputs can facilitate attentional modulation at early stages in somatosensory cortices to achieve goal-oriented behaviors. However, the specific contribution of each sensory system during attentional processing and, importantly, how these interact with the required behavioral motor goals remains unclear. Here we used electroencephalography and event-related potentials (ERPs) to test the hypothesis that activity from modality-specific somatosensory cortical regions would be enhanced with task-relevant bimodal (visual-tactile) stimuli and that the degree of modulation would depend on the difficulty of the associated sensory-motor task demands. Tactile stimuli were discrete vibrations to the index finger and visual stimuli were horizontal bars on a computer screen, both with random amplitudes. Streams of unimodal (tactile) and crossmodal (visual and tactile) stimuli were randomly presented and participants were instructed to attend to one type of stimulus (unimodal or crossmodal) and responses involved either an indication of the presence of an attended stimulus (detect), or the integration and summation of two stimulus amplitudes using a pressure-sensitive ball (grade). Force-amplitude associations were learned in a training session, and no feedback was provided during the task. ERPs were time-locked to tactile stimuli and extracted for early modality-specific components (P50, P100, N140). The P50 was enhanced with bimodal (visual-tactile) stimuli that were attended to. This was maximal when the motor requirements involved integration of the two stimuli in the grade task and when the visual stimulus occurred before (100 ms) the tactile stimulus. These results suggest that visual information relevant for movement modulates somatosensory processing as early as the primary somatosensory cortex (S1) and that the motor behavioral context influences this likely through interaction of top-down attentional and motor preparatory systems with more bottom-up crossmodal influences.