Massage therapy in palliative care populations: a narrative review of literature from 2012 to 2022.

BACKGROUND AND OBJECTIVE: Patients living with serious illness are often eligible for palliative care and experience physical symptoms including pain or dyspnea and psychological distress that negatively impacts health-related quality of life and other outcomes. Such patients often benefit from massage therapy to reduce symptom burden and improve quality of life when such treatment is available. At present, no synthesis or review exists exploring massage therapy specifically provided with palliative care patient populations. This review is needed because those with serious illness are a growing and important vulnerable population. Massage therapy is used frequently and in many healthcare delivery contexts, but the body of research has not led to its systematic integration or broad acceptance. METHODS: PubMed search for clinical research focused on massage therapy for palliative care-eligible populations from 2012 and 2022. Search terms included keywords: massage, massage therapy, serious illness, advanced illness, and palliative care. KEY CONTENT AND FINDINGS: Thirteen unique articles were identified through the PubMed database search and from a manual review of references. Study designs of included articles were one pilot, one quasi-experimental single-arm study, one mixed-methods study, two qualitative (both with hospital-based palliative care populations), seven randomized controlled trials, and one retrospective cohort analysis in a major Veterans Health Administration health care facility. CONCLUSIONS: Variability was found in study design, scope, sample size, and outcomes for related articles published in the last ten years. Few eligible interventions reflected real-world massage therapy delivery suggesting more clinical research is needed to examine massage provided by massage therapists trained to work with palliative care populations. Gaps in the current body of existing evidence supports the need for this review and recommendations for the direction of future related research.

Massage Therapy for Hospitalized Patients Receiving Palliative Care: A Randomized Clinical Trial.

CONTEXT: Massage therapy is increasingly used in palliative settings to improve quality of life (QoL) and symptom burden; however, the optimal massage "dosage" remains unclear. OBJECTIVES: To compare three massage dosing strategies among inpatients receiving palliative care consultation. METHODS: At an urban academic hospital, we conducted a three-armed randomized trial examining three different doses of therapist-applied massage to test change in overall QoL and symptoms among hospitalized adult patients receiving palliative care consultation for any indication (Arm I: 10-min massage daily × 3 days; Arm II: 20-min massage daily × 3 days; Arm III: single 20-min massage). Primary outcome measure was single-item McGill QoL question. Secondary outcomes measured pain/symptoms, rating of peacefulness, and satisfaction with intervention. Data were collected at baseline, pre- and post-treatment, and one-day postlast treatment (follow-up). Repeated measure analysis of variance and paired t-test were used to determine significant differences. RESULTS: Total n = 387 patients were 55.7 (±15.49) years old, mostly women (61.2%) and African-American (65.6%). All three arms demonstrated within-group improvement at follow-up for McGill QoL (all P < 0.05). No significant between-group differences were found. Finally, repeated measure analyses demonstrated time to predict immediate improvement in distress (P ≤ 0.003) and pain (P ≤ 0.02) for all study arms; however, only improvement in distress sustained at follow-up measurement in arms with three consecutive daily massages of 10 or 20 minutes. CONCLUSION: Massage therapy in complex patients with advanced illness was beneficial beyond dosage. Findings support session length (10 or 20 minutes) was predictive of short-term improvements while treatment frequency (once or three consecutive days) predicted sustained improvement at follow-up.

Ecological factors shape quantitative decision-making in coyotes.

Much research has focused on the development and evolution of cognition in the realm of numerical knowledge in human and nonhuman animals but often fails to take into account ecological realities that, over time, may influence and constrain cognitive abilities in real-life decision-making. Cognitive abilities such as enumerating and timing are central to many psychological and ecological models of behavior, yet our knowledge of how these are affected by environmental fluctuations remains incomplete. Our research bridges the gap between basic cognitive research and ecological decision-making. We used coyotes (Canis latrans) as a model animal system to study decision-making about smaller, more proximal food rewards and larger, more distant food rewards; we tested animals across their four reproductive cycle phases to examine effects of ecological factors such as breeding status and environmental risk on quantitative performance. Results show that coyotes, similar to other species, spatially discount food rewards while foraging. The degree to which coyotes were sensitive to the risk of obtaining the larger food reward, however, depended on the season in which they completed the foraging task, the presence of unfamiliar humans (i.e., risk), and the presence of conspecifics. Importantly, our results support that seasonal variations drive many differences in nonhuman animal behavior and cognition (e.g., hibernation, breeding, food resource availability). Further, it may be useful in the future to extend this work to humans because seasons may influence human cognition as well, and this remains unexplored in the realms of enumeration, timing, and spatial thinking.

The evolution of quantitative sensitivity.

The ability to represent approximate quantities appears to be phylogenetically widespread, but the selective pressures and proximate mechanisms favouring this ability remain unknown. We analysed quantity discrimination data from 672 subjects across 33 bird and mammal species, using a novel Bayesian model that combined phylogenetic regression with a model of number psychophysics and random effect components. This allowed us to combine data from 49 studies and calculate the Weber fraction (a measure of quantity representation precision) for each species. We then examined which cognitive, socioecological and biological factors were related to variance in Weber fraction. We found contributions of phylogeny to quantity discrimination performance across taxa. Of the neural, socioecological and general cognitive factors we tested, cortical neuron density and domain-general cognition were the strongest predictors of Weber fraction, controlling for phylogeny. Our study is a new demonstration of evolutionary constraints on cognition, as well as of a relation between species-specific neuron density and a particular cognitive ability. This article is part of the theme issue 'Systems neuroscience through the lens of evolutionary theory'.

"I Didn't Know Massages Could Do That:" A qualitative analysis of the perception of hospitalized patients receiving massage therapy from specially trained massage therapists.

OBJECTIVE: This study examined the perception and experience of hospitalized palliative care eligible patients receiving massage therapy from specially trained massaged therapist. DESIGN: Twenty hospitalized palliative care eligible patients received three differing doses of massage therapy from specially trained massage therapists. Patients were interviewed about their experience and perception related to the massage. Open-ended data were collected and analyzed using a grounded theory approach. SETTING: 912-bed tertiary hospital center in Washington, DC. RESULTS: Participants generally perceived the hospital-based massage experience positively. Participants noted how the massage experience provoked reflection on the overall hospital experience in two ways: first, as a reference point to the inpatient environment itself, and second, in terms of how massage reduces this distress and creates a sense of peace, at least temporarily. CONCLUSION: The data collected in these semi-structured interviews showed that massage therapy can uniquely ameliorate some of the most pervasive challenges to quality of life for hospitalized patients affected by chronic and serious illness.

Children's neural activity during number line estimations assessed by functional near-infrared spectroscopy (fNIRS).

Number line estimation (NLE) is an educational task in which children estimate the location of a value (e.g., 25) on a blank line that represents a numerical range (e.g., 0-100). NLE performance is a strong predictor of success in mathematics, and error patterns on this task help provide a glimpse into how children may represent number internally. However, a missing and fundamental element of this puzzle is the identification of neural correlates of NLE in children. That is, understanding possible neural signatures related to NLE performance will provide valuable insight into the cognitive processes that underlie children's development of NLE ability. Using functional near-infrared spectroscopy (fNIRS), we provide the first investigation of concurrent behavioral and cortical signatures of NLE performance in children. Specifically, our results highlight significant fronto-parietal changes in cortical activation in response to increases in NLE scale (e.g., 0-100 vs. 0-100,000). Furthermore, our results demonstrate that NLE performance feedback (auditory, visual, or audiovisual), as well as children's grade (2nd vs. 3rd) influence cortical responding during an NLE task.

Promoting Healthy Decision-Making via Natural Environment Exposure: Initial Evidence and Future Directions.

Research within psychology and other disciplines has shown that exposure to natural environments holds extensive physiological and psychological benefits. Adding to the health and cognitive benefits of natural environments, evidence suggests that exposure to nature also promotes healthy human decision-making. Unhealthy decision-making (e.g., smoking, non-medical prescription opioid misuse) and disorders associated with lack of impulse control [e.g., tobacco use, opioid use disorder (OUD)], contribute to millions of preventable deaths annually (i.e., 6 million people die each year of tobacco-related illness worldwide, deaths from opioids from 2002 to 2017 have more than quadrupled in the United States alone). Impulsive and unhealthy decision-making also contributes to many pressing environmental issues such as climate change. We recently demonstrated a causal link between visual exposure to nature (e.g., forests) and improved self-control (i.e., decreased impulsivity) in a laboratory setting, as well as the extent to which nearby nature and green space exposure improves self-control and health decisions in daily life outside of the experimental laboratory. Determining the benefits of nearby nature for self-controlled decision-making holds theoretical and applied implications for the design of our surrounding environments. In this article, we synergize the overarching results of recent research endeavors in three domains including the effects of nature exposure on (1) general health-related decision-making, (2) health and decision-making relevant for application to addiction related processes (e.g., OUD), and (3) environmentally relevant decision-making. We also discuss key future directions and conclusions.

Natural Categorization: Electrophysiological Responses to Viewing Natural Versus Built Environments.

Environments are unique in terms of structural composition and evoked human experience. Previous studies suggest that natural compared to built environments may increase positive emotions. Humans in natural environments also demonstrate greater performance on attention-based tasks. Few studies have investigated cortical mechanisms underlying these phenomena or probed these differences from a neural perspective. Using a temporally sensitive electrophysiological approach, we employ an event-related, implicit passive viewing task to demonstrate that in humans, a greater late positive potential (LPP) occurs with exposure to built than natural environments, resulting in a faster return of activation to pre-stimulus baseline levels when viewing natural environments. Our research thus provides new evidence suggesting natural environments are perceived differently from built environments, converging with previous behavioral findings and theoretical assumptions from environmental psychology.

Cognitive Load Affects Numerical and Temporal Judgments in Distinct Ways.

Prominent theories suggest that time and number are processed by a single neural locus or a common magnitude system (e.g., Meck and Church, 1983; Walsh, 2003). However, a growing body of literature has identified numerous inconsistencies between temporal and numerical processing, casting doubt on the presence of such a singular system. Findings of distinct temporal and numerical biases in the presence of emotional content (Baker et al., 2013; Young and Cordes, 2013) are particularly relevant to this debate. Specifically, emotional stimuli lead to temporal overestimation, yet identical stimuli result in numerical underestimation. In the current study, we tested adults' temporal and numerical processing under cognitive load, a task that compromises attention. Under the premise of a common magnitude system, one would predict cognitive load to have an identical impact on temporal and numerical judgments. Inconsistent with the common magnitude account, results revealed baseline performance on the temporal and numerical task was not correlated and importantly, cognitive load resulted in distinct and opposing quantity biases: numerical underestimation and marginal temporal overestimation. Together, our data call into question the common magnitude account, while also providing support for the role of attentional processes involved in numerical underestimation.

Feasibility of testing a coaching training intervention for CNAs in nursing homes.

The study aim was to describe the feasibility of conducting a coaching training intervention on use of level of assistance strategies for Certified Nursing Assistants (CNAs) in nursing homes. CNAs received either traditional or coaching training. Feasibility of coaching training was evaluated by determining: acceptability, through use of a Post-Intervention Evaluation Form; fidelity, by adherence to protocol; recruitment and retention, by ease of obtaining the sample and retention rates; and ability to randomize within each home without contamination. CNAs' mean satisfaction score of the coach training was high (4.5 out of 5). Eighteen of 22 comments on the evaluation form were positive. At least six dyads were recruited within the 60-day benchmark in each home. CNA and resident retention rates were 89.47% and 85%, respectively. Eighty-nine percent of intervention group CNAs shared study information, demonstrating contamination. The coaching training intervention is feasible. Findings revealed areas to improve the intervention.

Using an Interactive Video Simulator to Improve Certified Nursing Assistants' Dressing Assistance and Nursing Home Residents' Dressing Performance: A Pilot Study.

This pilot study examined the initial effects and estimated effect size of a computer-based simulation education program on certified nursing assistants' level of assistance when dressing nursing home residents with dementia and on residents' dressing performance. Nine dyads, assigned to either the experimental or control group, completed the study. Both groups received a traditional 1-hour education module delivered by a research assistant. The experimental group was then instructed to undertake an additional 2-hour intervention using a video simulator that enabled nursing assistants to practice level of assistance skills. The appropriateness of dressing assistance from nursing assistants and residents' dressing performance was measured before and 6 weeks after the intervention. The results showed that the two groups did not significantly differ in either appropriate levels of dressing assistance (P = .42) or residents' dressing performance (P = .38). A lack of effort by some assistants to properly assist residents and low statistical power may explain the lack of significance. The effect sizes of the experimental intervention on appropriate levels of dressing assistance and resident dressing performance were 0.69 and 0.89, respectively. Incorporating a strategy to improve motivation should be considered in future studies.

Pilot Testing a Coaching Intervention to Improve Certified Nursing Assistants' Dressing of Nursing Home Residents.

The purpose of the current study was to identify initial effects of a coaching training intervention using Level of Assistance (LoA) strategies compared with traditional lecture techniques on the appropriateness of LoA use by certified nursing assistants (CNAs) and independence of dressing of nursing home residents with dementia. Seventeen CNA-resident dyads participated in this pilot randomized controlled trial (RCT). Control and experimental group CNAs received a 25-minute traditional lecture. Experimental group CNAs also underwent three coaching sessions over 4 weeks. There were significant between-group differences in the percentage of dyads who had improved scores for appropriateness of LoA use and dressing independence from pretest to posttest (experimental: n = 9, 100%; control: n = 8, 50%; p = 0.029). However, there were no statistically significant median differences between groups in appropriateness of LoA use by CNAs and resident dressing independence scores. There were significant within-group median improvements in appropriateness of LoA use (p = 0.004) and independence of dressing scores (p = 0.004) between pretest and posttest in the experimental group, but not in the control group. This initial pilot RCT supports coach training as a method to improve appropriate use of LoA strategies by CNAs and independence of resident dressing. [Res Gerontol Nurs. 2017; 10(6):267-276.].

The Value of Clean Air: Comparing Discounting of Delayed Air Quality and Money Across Magnitudes.

The detrimental health effects of exposure to air pollution are well established. Fostering behavioral change concerning air quality may be challenging because the detrimental health effects of exposure to air pollution are delayed. Delay discounting, a measure of impulsive choice, encapsulates this process of choosing between the immediate conveniences of behaviors that increase pollution and the delayed consequences of prolonged exposure to poor air quality. In Experiment 1, participants completed a series of delay-discounting tasks for air quality and money. We found that participants discounted delayed air quality more than money. In Experiment 2, we investigated whether the common finding that large amounts of money are discounted less steeply than small amounts of money generalized to larger and smaller improvements in air quality. Participants discounted larger improvements in air quality less steeply than smaller improvements, indicating that the discounting of air quality shares a similar process as the discounting of money. Our results indicate that the discounting of delayed money is strongly related to the discounting of delayed air quality and that similar mechanisms may be involved in the discounting of these qualitatively different outcomes. These data are also the first to demonstrate the malleability of delay discounting of air quality, and provide important public health implications for decreasing delay discounting of air quality.

Utilizing Electroencephalography Measurements for Comparison of Task-Specific Neural Efficiencies: Spatial Intelligence Tasks.

Spatial intelligence is often linked to success in engineering education and engineering professions. The use of electroencephalography enables comparative calculation of individuals' neural efficiency as they perform successive tasks requiring spatial ability to derive solutions. Neural efficiency here is defined as having less beta activation, and therefore expending fewer neural resources, to perform a task in comparison to other groups or other tasks. For inter-task comparisons of tasks with similar durations, these measurements may enable a comparison of task type difficulty. For intra-participant and inter-participant comparisons, these measurements provide potential insight into the participant's level of spatial ability and different engineering problem solving tasks. Performance on the selected tasks can be analyzed and correlated with beta activities. This work presents a detailed research protocol studying the neural efficiency of students engaged in the solving of typical spatial ability and Statics problems. Students completed problems specific to the Mental Cutting Test (MCT), Purdue Spatial Visualization test of Rotations (PSVT:R), and Statics. While engaged in solving these problems, participants' brain waves were measured with EEG allowing data to be collected regarding alpha and beta brain wave activation and use. The work looks to correlate functional performance on pure spatial tasks with spatially intensive engineering tasks to identify the pathways to successful performance in engineering and the resulting improvements in engineering education that may follow.

Making Time for Nature: Visual Exposure to Natural Environments Lengthens Subjective Time Perception and Reduces Impulsivity.

Impulsivity in delay discounting is associated with maladaptive behaviors such as overeating and drug and alcohol abuse. Researchers have recently noted that delay discounting, even when measured by a brief laboratory task, may be the best predictor of human health related behaviors (e.g., exercise) currently available. Identifying techniques to decrease impulsivity in delay discounting, therefore, could help improve decision-making on a global scale. Visual exposure to natural environments is one recent approach shown to decrease impulsive decision-making in a delay discounting task, although the mechanism driving this result is currently unknown. The present experiment was thus designed to evaluate not only whether visual exposure to natural (mountains, lakes) relative to built (buildings, cities) environments resulted in less impulsivity, but also whether this exposure influenced time perception. Participants were randomly assigned to either a natural environment condition or a built environment condition. Participants viewed photographs of either natural scenes or built scenes before and during a delay discounting task in which they made choices about receiving immediate or delayed hypothetical monetary outcomes. Participants also completed an interval bisection task in which natural or built stimuli were judged as relatively longer or shorter presentation durations. Following the delay discounting and interval bisection tasks, additional measures of time perception were administered, including how many minutes participants thought had passed during the session and a scale measurement of whether time "flew" or "dragged" during the session. Participants exposed to natural as opposed to built scenes were less impulsive and also reported longer subjective session times, although no differences across groups were revealed with the interval bisection task. These results are the first to suggest that decreased impulsivity from exposure to natural as opposed to built environments may be related to lengthened time perception.

Summary of factors contributing to falls in older adults and nursing implications.

Falls are a common cause of serious injury and injury-related death in the older adult population, and may be associated with multiple risks such as age, history of falls, impaired mobility, balance and gait problems, and medications. Sensory and environmental factors as well as the fear of falling may also increase the risk of falls. The purpose of this article is to review current best practice on screening fall risks and fear of falling, fall prevention strategies, and fall prevention resources to assist gerontological nurses in reducing falls by their older adult clients.

The nature of impulsivity: visual exposure to natural environments decreases impulsive decision-making in a delay discounting task.

The benefits of visual exposure to natural environments for human well-being in areas of stress reduction, mood improvement, and attention restoration are well documented, but the effects of natural environments on impulsive decision-making remain unknown. Impulsive decision-making in delay discounting offers generality, predictive validity, and insight into decision-making related to unhealthy behaviors. The present experiment evaluated differences in such decision-making in humans experiencing visual exposure to one of the following conditions: natural (e.g., mountains), built (e.g., buildings), or control (e.g., triangles) using a delay discounting task that required participants to choose between immediate and delayed hypothetical monetary outcomes. Participants viewed the images before and during the delay discounting task. Participants were less impulsive in the condition providing visual exposure to natural scenes compared to built and geometric scenes. Results suggest that exposure to natural environments results in decreased impulsive decision-making relative to built environments.

The evolution of self-control.

Cognition presents evolutionary research with one of its greatest challenges. Cognitive evolution has been explained at the proximate level by shifts in absolute and relative brain volume and at the ultimate level by differences in social and dietary complexity. However, no study has integrated the experimental and phylogenetic approach at the scale required to rigorously test these explanations. Instead, previous research has largely relied on various measures of brain size as proxies for cognitive abilities. We experimentally evaluated these major evolutionary explanations by quantitatively comparing the cognitive performance of 567 individuals representing 36 species on two problem-solving tasks measuring self-control. Phylogenetic analysis revealed that absolute brain volume best predicted performance across species and accounted for considerably more variance than brain volume controlling for body mass. This result corroborates recent advances in evolutionary neurobiology and illustrates the cognitive consequences of cortical reorganization through increases in brain volume. Within primates, dietary breadth but not social group size was a strong predictor of species differences in self-control. Our results implicate robust evolutionary relationships between dietary breadth, absolute brain volume, and self-control. These findings provide a significant first step toward quantifying the primate cognitive phenome and explaining the process of cognitive evolution.

Multiple visual quantitative cues enhance discrimination of dynamic stimuli during infancy.

Infants possess basic capabilities to assess various quantitative properties such as number, size, and time. Preverbal discriminations are approximate, however, and are similarly limited across these dimensions. Here, we present the first evidence that multiple sources of quantitative unisensory information about dynamic stimuli-namely, simultaneous visual cues to changes in both number and surface area-may accelerate 6-month-olds' quantitative competence. Using a habituation-dishabituation paradigm, results from Experiment 1 demonstrate that, when provided with such visual cues to multiple quantitative properties that occur in the same direction, infants make more precise discriminations than has been shown when they receive information about either cue alone. Moreover, Experiment 2 demonstrates that infants' discrimination also benefits from simultaneous visual cues to quantitative changes that occur in opposite directions. Finally, Experiment 3 demonstrates that these findings are not driven by infants' ability to discriminate a 2:3 ratio change in surface area of a dynamic stimulus alone. Thus, we hypothesize that enhanced quantitative discrimination occurs because simultaneous visual quantitative changes may be more salient than single-source information, which could better recruit attention and result in more precise learning and remembering.

The impact of emotion on numerosity estimation.

Both time and numerosity can be represented continuously as analog properties whose discrimination conforms to Weber's Law, suggesting that the two properties may be represented similarly. Recent research suggests that the representation of time is influenced by the presence of emotional stimuli. If time and numerosity share a common cognitive representation, it follows that a similar relationship may exist between emotional stimuli and the representation of numerosity. Here, we provide evidence that emotional stimuli significantly affect humans' estimation of visual numerosity. During a numerical bisection task, enumeration of emotional stimuli (angry faces) was more accurate compared to enumeration of neutrally valenced stimuli (neutral faces), demonstrating that emotional stimuli affect humans' visual representation of numerosity as previously demonstrated for time. These results inform and broaden our understanding of the effect of negative emotional stimuli on psychophysical discriminations of quantity.