Michelangelo Effect in Cognitive Rehabilitation: Using Art in a Digital Visuospatial Memory Task.

The Michelangelo effect is a phenomenon that shows a reduction in perceived effort and an improvement in performance among both healthy subjects and patients when completing a motor task related to artistic stimuli, compared to performing the same task with non-artistic stimuli. It could contribute to the efficacy of art therapy in neurorehabilitation. In this study, the possible occurrence of this effect was tested in a cognitive task by asking 15 healthy subjects and 17 patients with a history of stroke to solve a digital version of the classical memory card game. Three different types of images were used in a randomized order: French cards, artistic portraits, and photos of famous people (to compensate for the possible effects of face recognition). Healthy subjects were involved to test the usability and the load demand of the developed system, reporting no statistically significant differences among the three sessions (p > 0.05). Conversely, patients had a better performance in terms of time (p = 0.014) and the number of attempts (p = 0.007) needed to complete the task in the presence of artistic stimuli, accompanied by a reduction in the perceived effort (p = 0.033). Furthermore, artistic stimuli, with respect to the other two types of images, seemed more associated with visuospatial control than linguistic functions.

Predicting Male Infertility Using Artificial Neural Networks: A Review of the Literature.

Male infertility is a relevant public health problem, but there is no systematic review of the different machine learning (ML) models and their accuracy so far. The present review aims to comprehensively investigate the use of ML algorithms in predicting male infertility, thus reporting the accuracy of the used models in the prediction of male infertility as a primary outcome. Particular attention will be paid to the use of artificial neural networks (ANNs). A comprehensive literature search was conducted in PubMed, Scopus, and Science Direct between 15 July and 23 October 2023, conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a quality assessment of the included studies using the recommended tools suggested for the type of study design adopted. We also made a screening of the Risk of Bias (RoB) associated with the included studies. Thus, 43 relevant publications were included in this review, for a total of 40 different ML models detected. The studies included reported a good quality, even if RoB was not always good for all the types of studies. The included studies reported a median accuracy of 88% in predicting male infertility using ML models. We found only seven studies using ANN models for male infertility prediction, reporting a median accuracy of 84%.

Michelangelo Effect in Virtual Sculpturing: Prospective for Motor Neurorehabilitation in the Metaverse.

We investigated the Michelangelo effect, i.e. the facilitatory effect of a virtual art therapy in motor rehabilitation (Iosa et al. 2021), with a novel virtual reality paradigm in which users are engaged in motor exercises with 3D sculptures. In particular, thirty young adults were immersed in a virtual environment where they could sculpt, by using the real hands, some famous sculptures in the history of art, such as the David of Michelangelo, the Venus of Milo and the statue of Laocoon and His Sons, and their control stimuli, i.e. statues in very low resolution or cubes. We recorded the kinematics (length, the time to complete each trial, mean normalized jerk) and questionnaire answers (objective and subjective beauty, User Satisfaction Evaluation Questionnaire and Nasa Task Load Index). In general, we found that the perception of subjective and objective beauty was higher when sculpting the statues than control stimuli, the judgment of usability of the system was high. The perceived fatigue was not higher when sculpting the statues despite the longer time spent in completing the task that with respect to the control stimuli. Moreover, we found that the interaction with the experimental statues affected the fluidity and symmetry of hands movements. Finally, we discuss this evidence regarding the art therapy and neuroaesthetics principles for motor rehabilitation in the Metaverse with VR, including the possible role of virtual embodiment (illusory feeling to have a virtual body) for boosting the efficacy of the clinical applications.

Negative emotions enhance memory-guided attention in a visual search task by increasing frontoparietal, insular, and parahippocampal cortical activity.

Previous literature demonstrated that long-term memory representations guide spatial attention during visual search in real-world pictures. However, it is currently unknown whether memory-guided visual search is affected by the emotional content of the picture. During functional magnetic resonance imaging (fMRI), participants were asked to encode the position of high-contrast targets embedded in emotional (negative or positive) or neutral pictures. At retrieval, they performed a visual search for targets presented at the same location as during encoding, but at a much lower contrast. Behaviorally, participants detected more accurately targets presented in negative pictures compared to those in positive or neutral pictures. They were also faster in detecting targets presented at encoding in emotional (negative or positive) pictures than in neutral pictures, or targets not presented during encoding (i.e., memory-guided attention effect). At the neural level, we found increased activation in a large circuit of regions involving the dorsal and ventral frontoparietal cortex, insular and parahippocampal cortex, selectively during the detection of targets presented in negative pictures during encoding. We propose that these regions might form an integrated neural circuit recruited to select and process previously encoded target locations (i.e., memory-guided attention sustained by the frontoparietal cortex) embedded in emotional contexts (i.e., emotional contexts recollection supported by the parahippocampal cortex and emotional monitoring supported by the insular cortex). Ultimately, these findings reveal that negative emotions can enhance memory-guided visual search performance by increasing neural activity in a large-scale brain circuit, contributing to disentangle the complex relationship between emotion, attention, and memory.

Robot- and Technology-Boosting Neuroplasticity-Dependent Motor-Cognitive Functional Recovery: Looking towards the Future of Neurorehabilitation.

The sequelae of neurological disorders are the leading causes of disability in all industrialized countries [...].

Computer-assisted cognitive rehabilitation in neurological patients: state-of-art and future perspectives.

Background and aim: Advances in computing technology enabled researchers and clinicians to exploit technological devices for cognitive training and rehabilitation interventions. This expert review aims to describe the available software and device used for cognitive training or rehabilitation interventions of patients with neurological disorders. Methods: A scoping review was carried out to analyze commercial devices/software for computerized cognitive training (CCT) in terms of feasibility and efficacy in both clinical and home settings. Several cognitive domains responding to the different patients' needs are covered. Results: This review showed that cognitive training for patients with neurological diseases is largely covered by several devices that are widely used and validated in the hospital setting but with few translations to remote/home applications. It has been demonstrated that technology and software-based devices are potential and valuable tools to administer remotely cognitive rehabilitation with accessible costs. Conclusion: According to our results, CCT entails the possibility to continue cognitive training also in different settings, such as home, which is a significant breakthrough for the improvement of community care. Other possible areas of use should be the increase in the amount of cognitive therapy in the free time during the hospital stay.

GABAergic miR-34a regulates Dorsal Raphè inhibitory transmission in response to aversive, but not rewarding, stimuli.

The brain employs distinct circuitries to encode positive and negative valence stimuli, and dysfunctions of these neuronal circuits have a key role in the etiopathogenesis of many psychiatric disorders. The Dorsal Raphè Nucleus (DRN) is involved in various behaviors and drives the emotional response to rewarding and aversive experiences. Whether specific subpopulations of neurons within the DRN encode these behaviors with different valence is still unknown. Notably, microRNA expression in the mammalian brain is characterized by tissue and neuronal specificity, suggesting that it might play a role in cell and circuit functionality. However, this specificity has not been fully exploited. Here, we demonstrate that microRNA-34a (miR-34a) is selectively expressed in a subpopulation of GABAergic neurons of the ventrolateral DRN. Moreover, we report that acute exposure to both aversive (restraint stress) and rewarding (chocolate) stimuli reduces GABA release in the DRN, an effect prevented by the inactivation of DRN miR-34a or its genetic deletion in GABAergic neurons in aversive but not rewarding conditions. Finally, miR-34a inhibition selectively reduced passive coping with severe stressors. These data support a role of miR-34a in regulating GABAergic neurotransmitter activity and behavior in a context-dependent manner and suggest that microRNAs could represent a functional signature of specific neuronal subpopulations with valence-specific activity in the brain.

Are neuroaesthetic principles applied in art therapy protocols for neurorehabilitation? A systematic mini-review.

Art is an instrument created by humans as an alternative way of expression. For this reason, it has found its use in clinical contexts to improve mood, increase participation in therapy, or improve communication for patients with different pathologies. In this systematic mini-review, the Preferred Reporting Item for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were adopted. Internet-based bibliographic searches were conducted via major electronic databases (Web of Science and PubMed). We analyzed the quantitative studies in which art figures as a neurorehabilitation treatment to identify whether standard art therapy protocols exist and whether these are based on the principles of neuroaesthetics. Our review identified 8 quantitative and 18 qualitative studies. Although art therapy has been used for more than 20 years as a clinical tool, there are no standard protocols to refer to when planning interventions. Although the effectiveness of using arts as therapy has been reported in many qualitative or feasibility studies, there is still a lack of quantitative studies in which the outcomes of art therapy are directly based on the principles of neuroaesthetics.

Virtual Art Therapy: Application of Michelangelo Effect to Neurorehabilitation of Patients with Stroke.

In neurorehabilitation, some studies reported the effective use of art therapy for reducing psychological disorders and for enhancing physical functions and cognitive abilities. Neuroaesthetical studies showed that seeing an art masterpiece can spontaneously elicit a widespread brain arousal, also involving motor networks. To combine contemplative and performative benefits of art therapy protocols, we have developed an immersive virtual reality system, giving subjects the illusion that they are able to paint a copy of famous artistic paintings. We previously observed that during this virtual task, subjects perceived less fatigue and performed more accurate movements than when they were asked to color the virtual canvas. We named this upshot the Michelangelo effect. The aim of this study was to test the rehabilitative efficacy of our system. Ten patients with stroke in the subacute phase were enrolled and trained for one month with virtual art therapy (VAT) and physiotherapy. Their data were compared with those of ten patients matched for pathology, age and clinical parameters, trained only with conventional therapy for the same amount of time. The VAT group showed a significantly higher improvements in the Barthel Index score, a measure of independency in activities of daily living (66 ± 33% vs. 31 ± 28%, p = 0.021), and in pinching strength (66 ± 39% vs. 18 ± 33%, p = 0.008), with respect to the group treated with conventional rehabilitation.

Application of an Artificial Neural Network to Identify the Factors Influencing Neurorehabilitation Outcomes of Patients with Ischemic Stroke Treated with Thrombolysis.

The administration of thrombolysis usually reduces the risk of death and the consequences of stroke in the acute phase. However, having received thrombolysis administration is not a prognostic factor for neurorehabilitation outcome in the subacute phase of stroke. It is conceivably due to the complex intertwining of many clinical factors. An artificial neural network (ANN) analysis could be helpful in identifying the prognostic factors of neurorehabilitation outcomes and assigning a weight to each of the factors considered. This study hypothesizes that the prognostic factors could be different between patients who received and those who did not receive thrombolytic treatment, even if thrombolysis is not a prognostic factor per se. In a sample of 862 patients with ischemic stroke, the tested ANN identified some common factors (such as disability at admission, age, unilateral spatial neglect), some factors with higher weight in patients who received thrombolysis (hypertension, epilepsy, aphasia, obesity), and some other factors with higher weight in the other patients (dysphagia, malnutrition, total arterial circulatory infarction). Despite the fact that thrombolysis is not an independent prognostic factor for neurorehabilitation, it seems to modify the relative importance of other clinical factors in predicting which patients will better respond to neurorehabilitation.

The validity and reliability of the Test of Memory Strategies among Italian healthy adults.

Background: Previous literature has shown that executive functions (EF) are related to performance in memory (M) tasks. Nevertheless, there is a shortage of psychometric tests that examine these two constructs simultaneously. The Test of Memory Strategies (TMS; previously validated in Spain and Portugal) could be a useful verbal learning task that evaluates these two constructs at once. In this study, we aimed to evaluate the psychometric properties of the TMS in an Italian adult sample. Method: One hundred twenty-one healthy volunteers (74 F, Mean age = 45.9 years old, SD = 20.4) who underwent a neuropsychological examination participated in this study. We conducted a Confirmatory factor analysis (CFA) to evaluate the structural validity of the TMS. We conducted a latent variable analysis to examine convergent and discriminant validity of the TMS sub-scale scores reflecting executive functions and memory. We also examined the TMS reliability in terms of internal consistency through the McDonald's omega. Results: The CFA confirmed the expectation that the TMS-1 and TMS-2 subtests reflect a factor and that the TMS-3, TMS-4, and TMS-5 subtests reflect a different factor. This result is in line with the prediction that TMS-1 and TMS-2 require the use of executive functions and memory simultaneously, and therefore we called this factor executive functions (EF); whereas the TMS-3, TMS-4, and TMS-5 subtests require less involvement of executive functions, thus reflecting a construct that we named memory (M). The TMS subtests for EF and M showed convergent validity with the test scores using a traditional neuropsychological battery, assessing memory and executive functions separately. Finally, the reliability of the subtests was good. Conclusions: These preliminary findings suggest that TMS is a valid and reliable scale to simultaneously assess M and EF while among Italian healthy adults.

Inside the Michelangelo effect: The role of art and aesthetic attractiveness on perceived fatigue and hand kinematics in virtual painting.

It has recently been discovered that during a virtual reality task of painting, if the subjects have the illusion of recreating an artistic masterpiece, they improve their performances and perceive less fatigue compared to simply coloring a virtual canvas. This phenomenon has been called the Michelangelo effect. However, it was unclear if this effect was related to the aesthetic experience of beauty or if it was specific to artistic stimuli. To clarify this point, 26 healthy subjects performed the virtual task of erasing a blank sheet on the canvas, revealing an image that could be a painting or a photo, classified as beautiful or not. Beautiful paintings were famous artistic portraits, non-beautiful paintings were rough reproductions of them. Photos of popular people were matched with paintings according to their similarity for somatic traits, posture, and clothes. Beautiful and non-beautiful photos were classified according to whether the pictured person was famous or not for their beauty. For each stimulus the objective beauty, subjective beauty, and effort to complete the task perceived by the subject were self-assessed on a numerical rating scale, recorded and analyzed. Furthermore, the hand kinematic trajectory was instrumentally recorded and its spatiotemporal parameters were computed. Less fatigue was perceived for the paintings than for the photos (p = .020), but not for beautiful versus non-beautiful stimuli (p = .325). Only in the artistic stimuli, subjective beauty was found to be negatively correlated with perceived fatigue (p = .030) and performed errors (p = .005). The kinematic parameters were found to be affected by the interactions between the gender of the participant and that of the person in the photo. These results supported the idea that the Michelangelo effect was stronger when subjects interacted with artefacts, modulated by the perceived beauty of the artistic stimulus.

Theory of mind: A clue for the interpretation of functional movement disorders.

OBJECTIVES: Functional movement disorders (FMD) refer to a heterogeneous group of manifestations incongruent with known neurological diseases. Functional neuroimaging studies in FMD indicate the overlap between cerebral regions in which abnormal activation occurs and those considered crucial for theory of mind (ToM), the ability to attribute mental states. The aim of this study was to explore whether FMD might be related to ToM disorders to the extent that they reduce the ability to make inferences about the mental states underlying motor behaviour during social interaction. MATERIALS & METHODS: Eighteen subjects with FMD and 28 matched healthy controls (HC) were given a ToM battery. The severity of FMD was rated by the Simplified-FMD Rating Scale (S-FMDRS). Dissociative symptoms were evaluated by the Dissociative Experiences Scale (DES-II). RESULTS: FMD scored worse than the HC in most ToM tasks: second-order False Beliefs (p = .005), Faux-Pas Recognition Test (p < .001) and Reading the Mind in the Eyes Test (p = .020); control questions elicited normal scores. The DES-II indicated dissociative-borderline psychopathology and negatively correlated with accuracy on the second-order False Belief (Spearman's rho = -.444; p = .032); the positive correlation between DES-II and severity of motor symptoms (S-FMDRS) approached significance (Spearman's rho test = .392; p = .054). ToM disorders were not correlated with S-FMDRS, due to the typical variability in FMD over time with regard to the severity of symptoms and the district of body involved. CONCLUSIONS: Our results are consistent with the hypothesis that FMD are related to ToM deficits, and future studies are needed to define the specific nature of this relationship.

Artificial Neural Network Detects Hip Muscle Forces as Determinant for Harmonic Walking in People after Stroke.

Many recent studies have highlighted that the harmony of physiological walking is based on a specific proportion between the durations of the phases of the gait cycle. When this proportion is close to the so-called golden ratio (about 1.618), the gait cycle assumes an autosimilar fractal structure. In stroke patients this harmony is altered, but it is unclear which factor is associated with the ratios between gait phases because these relationships are probably not linear. We used an artificial neural network to determine the weights associable to each factor for determining the ratio between gait phases and hence the harmony of walking. As expected, the gait ratio obtained as the ratio between stride duration and stance duration was found to be associated with walking speed and stride length, but also with hip muscle forces. These muscles could be important for exploiting the recovery of energy typical of the pendular mechanism of walking. Our study also highlighted that the results of an artificial neural network should be associated with a reliability analysis, being a non-deterministic approach. A good level of reliability was found for the findings of our study.

It is not always positive: emotional bias in young and older adults.

Healthy ageing has been associated with a bias toward positive information and greater psychological well-being. However, to what extent this positivity bias also applies to prioritizing positive information under emotional competition is unclear. Old and young adults performed a word-face interference task, in which they responded to the valence of positive and negative target-words while ignoring happy or angry distractor-faces that could be affectively congruent or incongruent. A control condition with scrambled neutral distractor-faces was also used. Findings showed small facilitation effects with faster responses when targets and distractors were affectively congruent and large interference effects with slower responses when targets and distractors were affectively incongruent compared to the control condition. Importantly, whereas for younger adults there was a similar pattern of interference from happy and angry distractor-faces, for older adults there was greater interference from angry distractor-faces. The present findings are discussed in the context of emotional bias literature.

The golden ratio as an ecological affordance leading to aesthetic attractiveness.

The golden ratio (GR) is an irrational number (close to 1.618) that repeatedly occurs in nature as well as in masterpieces of art. The GR has been considered a proportion perfectly representing beauty since ancient times, and it was investigated in several scientific fields, but with conflicting results. This study aims at investigating if this proportion is associated with a judgment of beauty independently of the type of the stimulus, and the factors that may affect this aesthetic preference. In Experiment 1, an online psychophysical questionnaire was administered to 256 volunteers asked to choose among three possible proportions between the parts of the same stimulus (GR, 1.5, and 1.8). In Experiment 2, we recorded eye movements in 15 participants who had to express an aesthetic judgment on the same stimuli of Experiment 1. The results revealed a slight overall preference for GR (53%, p < .001), with higher preferences for stimuli representing humans, anthropomorphic sculptures, and paintings, regardless of the cultural level. In Experiment 2, a shorter dwell time was significantly associated with a better aesthetic judgment (p = .005), suggesting the possibility that GR could be associated with easier visual processing, and it could be hence considered as a visual affordance.

Psychometric evaluation of an Italian custom 4-item short form of the PROMIS anxiety item bank in immune-mediated inflammatory diseases: an item response theory analysis.

BACKGROUND: There has recently been growing interest in the roles of inflammation in contributing to the development of anxiety in people with immune-mediated inflammatory diseases (IMID). Patient-reported outcome measures can facilitate the assessment of physical and psychological functioning. The National Institutes of Health (NIH)'s Patient-Reported Outcomes Measurement Information System (PROMIS®) is a set of Patient-Reported Outcomes (PROs) that cover physical appearance, mental health, and social health. The PROMIS has been built through an Item Response Theory approach (IRT), a model-based measurement in which trait level estimates depend on both persons' responses and on the properties of the items that were administered. The aim of this study is to test the psychometric properties of an Italian custom four-item Short Form of the PROMIS Anxiety item bank in a cohort of outpatients with IMIDs. METHODS: We selected four items from the Italian standard Short Form Anxiety 8a and administered them to consecutive outpatients affected by Inflammatory Bowel disease (n = 246), rheumatological (n = 100) and dermatological (n = 43) diseases, and healthy volunteers (n = 280). Data was analyzed through an Item Response Theory (IRT) analysis in order to evaluate the psychometric properties of the Italian adaptation of the PROMIS anxiety short form. RESULTS: Taken together, Confirmatory Factor Analysis and Exploratory Factor analysis suggest that the unidimensionality assumption of the instrument holds. The instrument has excellent reliability from a Classical Theory of Test (CTT) standpoint (Cronbach's α = 0.93, McDonald's ω = 0.92). The 2PL Graded Response Model (GRM) model provided showed a better goodness of fit as compared to the 1PL GRM model, and local independence assumption appears to be met overall. We did not find signs of differential item functioning (DIF) for age and gender, but evidence for uniform (but not non-uniform) DIF was found in three out of four items for the patient vs. control group. Analysis of the test reliability curve suggested that the instrument is most reliable for higher levels of the latent trait of anxiety. The groups of patients exhibited higher levels of anxiety as compared to the control group (ps < 0.001, Bonferroni-corrected). The groups of patients were not different between themselves (p = 1, Bonferroni-corrected). T-scores based on estimated latent trait and raw scores were highly correlated (Pearson's r = 0.98) and led to similar results. DISCUSSION: The Italian custom four-item short form from the PROMIS anxiety form 8a shows acceptable psychometric properties both from a CTT and an IRT standpoint. The Test Reliability Curve shows that this instrument is mostly informative for people with higher levels of anxiety, making it particularly suitable for clinical populations such as IMID patients.

User-centered practices in the eyes of informal caregivers of in-patients with severe acquired brain injury: needs, caring experience, and satisfaction.

OBJECTIVE: This study examines the perceived needs, experience, and satisfaction of informal caregivers (ICGs) in in-hospital settings, related to their involvement in the design and delivery of services together with hospital staff, namely co-production. DESIGN: To obtain a picture of current ICG-staff relationship, a multicenter observational study was carried out. Participants were 75 ICGs recruited in five dedicated in-patient neurorehabilitation wards. Participants answered a self-report questionnaire tapping perceived information/communication needs, emotional/social needs, and their satisfaction; family-centered practices implemented by the staff (namely involving practices and cooperative communication); and ICGs' satisfaction with the service. RESULTS: Need satisfaction related positively to staff practices aimed at involving IGCs in treatment and training, but not in decision-making. Involving practices concerning treatment also related positively to ICGs' information/communication needs. In addition, the more the staff involved ICGs in decision-making and promoted cooperative communication regarding treatment, the more ICGs felt that their collaboration in the healthcare process was valuable. Finally, all involvement practices and cooperative communication were positively related to ICGs' overall satisfaction with the service. CONCLUSION: The results of the study help to identify gaps in meeting ICGs' needs and to promote strategies to implement family participation toward co-production in in-hospital settings.

Prognostic Factors in Neurorehabilitation of Stroke: A Comparison among Regression, Neural Network, and Cluster Analyses.

There is a large body of literature reporting the prognostic factors for a positive outcome of neurorehabilitation performed in the subacute phase of stroke. Despite the recent development of algorithms based on neural networks or cluster analysis for the identification of these prognostic factors, the literature lacks a rigorous comparison among classical regression, neural network, and cluster analysis. Moreover, the three methods have rarely been tested on a sample independent from that in which prognostic factors have been identified. This study aims at providing this comparison on a wide sample of data (1522 patients) and testing the results on an independent sample (1000 patients) using 30 variables. The accuracy was similar among regression, neural network, and cluster analyses on the analyzed sample (76.6%, 74%, and 76.1%, respectively), but on the test sample, the accuracy of neural network decreased (70.1%). The three models agreed in identifying older age, severe impairment, unilateral spatial neglect, and total anterior circulation infarcts as important prognostic factors. The binary regression analysis also provided solid results in the test sample, especially in terms of specificity (81.8%). Cluster analysis also showed a high sensitivity in the test sample (82.6%) and allowed a meaningful easy-to-use classification tree to be obtained.

Effects of cognitive workload on heart and locomotor rhythms coupling.

Different physiological signals could be coupled under specific conditions, in some cases related to pathologies or reductions in system complexity. Cardiac-locomotor synchronization (CLS) has been one of the most investigating coupling. The influence of a cognitive task on walking was investigated in dual-task experiments, but how different cognitive tasks may influence CLS has poorly been investigated. Twenty healthy subjects performed a dual-task walking (coupled with verbal fluency vs calculation) on a treadmill at three different speeds (comfortable speed CS; fast-speed: CS + 2 km/h; slow-speed: CS-2 km/h) while cardiac and walking rhythms were recorded using surface electrodes and a triaxial accelerometer, respectively. According to previous studies, we found a cognitive-motor interference for which cognitive performance was affected by motor exercise, but not vice-versa. We found a CLS at the baseline condition, at fast speed in both cognitive tasks, while at comfortable speed only for the verbal fluency task. In conclusion, the cardiac and locomotor rhythms were not coupled at slow speed and at comfortable speed during subtraction task. Cognitive performances generally increased at faster speed, when cardiac locomotor coupling was stronger.