Six-month follow-up of a mindfulness yoga program, MiYoga, on attention, executive function, behaviour and physical outcomes in cerebral palsy.

PURPOSE: A randomised controlled trial (RCT) of a mindfulness-based yoga program, MiYoga, for cerebral palsy (CP) demonstrated improved attention in children and decreased mindfulness in parents post-intervention. This paper evaluates the retention of treatment effects at 6-months follow-up. METHODS: 42 children with CP and their parents participated in a RCT with two groups MiYoga (n = 21) and Waitlist control group (n = 21). Waitlist control participants were offered MiYoga following the post-intervention assessment. 23 out of 42 child-parent dyads from both groups completed follow-up assessment 6-months after completing MiYoga. This paper evaluates and reports data from both groups collapsed (n = 23; MiYoga n = 11; and waitlist control n = 12; 47.8% male; mean age = 9:10 ± 2.4 years) to assess retention from post-MiYoga to follow-up and pre-MiYoga to follow-up. The primary outcome was attention, measured by Conner's Continuous Performance Test II (CCPT). Secondary outcomes included child executive function, physical function, behaviour, quality of life, child and parent mindfulness, personal wellbeing, psychological wellbeing and parent-child relationship. RESULTS: Paired t-tests showed no significant changes between post-MiYoga to follow-up and pre-MiYoga to follow-up for variables that showed an intervention effect immediately after MiYoga, namely, children's attention variables and parent's mindfulness. Paired t-tests showed that children's executive function and physical function and parent's wellbeing improved significantly from pre-MiYoga to 6-months follow-up which may potentially reflect sleeper or delayed effects of MiYoga. CONCLUSION: This study identified possible delayed or sleeper effects in children's executive function and physical function and parent's well-being.Implications for rehabilitation6-month follow-up evidence for retention of effects of MiYoga on children's attention was inconsistent; therefore, booster sessions or continued practice of MiYoga as a lifestyle option are needed to maintain an effect on attention.Because MiYoga can be practised during daily activities, it may provide additional support for children with CP, complementing standard rehabilitation options.By embedding mindfulness in children and parents' daily activities, MiYoga, could provide families with accessible and time-efficient means of learning and practicing mindfulness.

Attachment styles modulate neural markers of threat and imagery when engaging in self-criticism.

Attachment styles hold important downstream consequences for mental health through their contribution to the emergence of self-criticism. To date, no work has extended our understanding of the influence of attachment styles on self-criticism at a neurobiological level. Herein we investigate the relationship between self-reported attachment styles and neural markers of self-criticism using fMRI. A correlation network analysis revealed lingual gyrus activation during self-criticism, a marker of visual mental imagery, correlated with amygdala activity (threat response). It also identified that secure attachment positively correlated with lingual gyrus activation, whilst avoidant attachment was negatively correlated with lingual gyrus activation. Further, at greater levels of amygdala response, more securely attached individuals showed greater lingual gyrus activation, and more avoidantly attached individuals showed less lingual gyrus activation. Our data provide the first evidence that attachment mechanisms may modulate threat responses and mental imagery when engaging in self-criticism, which have important clinical and broader social implications.

Effect of mindfulness yoga programme MiYoga on attention, behaviour, and physical outcomes in cerebral palsy: a randomized controlled trial.

AIM: To investigate the efficacy of an embodied mindfulness-based movement programme (MiYoga), targeting attention in children with cerebral palsy (CP). METHOD: Total number of participants 42, with 24 boys (57.1%) and 18 girls (42.9%); mean age 9y 1mo, SD 3y; Gross Motor Function Classification System levels I=22, II=12, III=8) and their parents were randomized to either MiYoga (n=21) or waitlist comparison (n=21) groups. The primary outcome was attention postintervention measured by the Conners' Continuous Performance Test, Second Edition (CCPT). Secondary outcomes included parent and child mindfulness, child quality of life, parental well-being, child executive function, child behaviour, child physical measures, and the parent-child relationship. RESULTS: Children in the MiYoga group demonstrated significantly better attention postintervention than the waitlist comparison group, with lower inattention scores on the hit reaction time standard error (F1,33 =4.59, p=0.04, partial eta-squared [ηp2]=0.13) variable and fewer perseveration errors (F1,33 =4.60, p=0.04, ηp2=0.13) on the CCPT. Intention-to-treat analysis also revealed that sustained attention in the MiYoga group was significantly better than in the waitlist comparison group postintervention (F1,37 =5.97, p=0.02, ηp2=0.14). Parents in the MiYoga group demonstrated significantly decreased mindfulness (Mindfulness Attention Awareness Scale; F1,33 =10.130, p=0.003, ηp2=0.246). INTERPRETATION: MiYoga offers a lifestyle intervention that improves attention in children with CP. MiYoga can be considered as an additional option to standard rehabilitation to enhance attention for children with CP. WHAT THIS PAPER ADDS: MiYoga, an embodied mindfulness-based movement programme, can enhance attention (more attentive and consistent performance) in children with cerebral palsy. MiYoga had no significant effect on physical functioning.

MiYoga: a randomised controlled trial of a mindfulness movement programme based on hatha yoga principles for children with cerebral palsy: a study protocol.

INTRODUCTION: Cerebral palsy (CP) is the most common childhood physical disability, with life-long impacts for 1.77 in 1000 children. Although CP is primarily a physical disability, children with CP have an increased risk of experiencing cognitive difficulties, particularly attention and executive function deficits. Impairment in cognitive abilities can lead to subsequent impairment in independent functioning, education, employment and interpersonal relationships. This paper reports the protocol of a randomised controlled trial of a novel family-centred lifestyle intervention based on mindfulness and hatha yoga principles (MiYoga). MiYoga aims to enhance child and parent outcomes for children with CP. METHODS AND ANALYSIS: The aim is to recruit 36 child-parent dyads (children aged 6-16 years; bilateral or unilateral CP; Gross Motor Function Classification System I-III), who will be randomly assigned to two groups: MiYoga andwaitlistt control. The MiYoga programme will be facilitated in a group format for 8 weeks. Assessments will be administered at baseline, prior to MiYoga, following completion of MiYoga, and at 6-month follow-up (retention). The primary outcome will be the child's sustained attentional ability as measured by the Conner's Continuous Performance Test II. Other outcomes of interest for children with CP consists of attentional control, physical functioning, behavioural and well-being. For parents, the outcomes of interest are mindfulness, psychological flexibility and well-being. Data will be analysed using general linear models, specifically analysis of covariance and analysis of variance. ETHICS AND DISSEMINATION: Full ethical approval for this study has been obtained by the Children's Health Queensland Hospital and Health Service Research Ethics Committee (HREC/12/QRCH/120) and The University of Queensland (2012000993). If MiYoga is proven effective, its dissemination would assist children with CP and complement their ongoing therapy by improving the ability of the child to pay attention at school and in therapy, and alleviating environmentalstressorss for both the child and his/her parents. TRIAL REGISTRATION NUMBER: ACTRN12613000729729; Pre-results.http://www.ANZCTR.org.au/ACTRN12613000729729.aspx DATE OF TRIAL REGISTRATION: Prospectively registered on 2 July 2013-present (ongoing). FINDINGS TO DATE: Recruitment is complete. Data are still being collected at present. We aim to complete data collection by February 2017.

Mitii™ ABI: study protocol of a randomised controlled trial of a web-based multi-modal training program for children and adolescents with an Acquired Brain Injury (ABI).

BACKGROUND: Acquired brain injury (ABI) refers to multiple disabilities arising from damage to the brain acquired after birth. Children with an ABI may experience physical, cognitive, social and emotional-behavioural impairments which can impact their ability to participate in activities of daily living (ADL). Recent developments in technology have led to the emergence of internet-delivered therapy programs. "Move it to improve it" (Mitii™) is a web-based multi-modal therapy that comprises upper limb (UL) and cognitive training within the context of meaningful physical activity. The proposed study aims to compare the efficacy of Mitii™ to usual care to improve ADL motor and processing skills, gross motor capacity, UL and executive functioning in a randomised waitlist controlled trial. METHODS/DESIGN: Sixty independently ambulant children (30 in each group) at least 12 months post ABI will be recruited to participate in this trial. Children will be matched in pairs at baseline and randomly allocated to receive either 20 weeks of Mitii™ training (30 min per day, six days a week, with a potential total dose of 60 h) immediately, or be waitlisted for 20 weeks. Outcomes will be assessed at baseline, immediately post-intervention and at 20 weeks post-intervention. The primary outcomes will be the Assessment of Motor and Process Skills and 30 s repetition maximum of functional strength exercises (sit-to-stand, step-ups and half kneel to stand). Measures of body structure and functions, activity, participation and quality of life will assess the efficacy of Mitii™ across all domains of the International Classification of Functioning, Disability and Health framework. A subset of children will undertake three tesla (3T) magnetic resonance imaging scans to evaluate functional neurovascular changes, structural imaging, diffusion imaging and resting state functional connectivity before and after intervention. DISCUSSION: Mitii™ provides an alternative approach to deliver intensive therapy for children with an ABI in the convenience of the home environment. If Mitii™ is found to be effective, it may offer an accessible and inexpensive intervention option to increase therapy dose. TRIAL REGISTRATION: ANZCTR12613000403730.

Implicit agency in observed actions: evidence for N1 suppression of tones caused by self-made and observed actions.

Every day we make attributions about how our actions and the actions of others cause consequences in the world around us. It is unknown whether we use the same implicit process in attributing causality when observing others' actions as we do when making our own. The aim of this research was to investigate the neural processes involved in the implicit sense of agency we form between actions and effects, for both our own actions and when watching others' actions. Using an interval estimation paradigm to elicit intentional binding in self-made and observed actions, we measured the EEG responses indicative of anticipatory processes before an action and the ERPs in response to the sensory consequence. We replicated our previous findings that we form a sense of implicit agency over our own and others' actions. Crucially, EEG results showed that tones caused by either self-made or observed actions both resulted in suppression of the N1 component of the sensory ERP, with no difference in suppression between consequences caused by observed actions compared with self-made actions. Furthermore, this N1 suppression was greatest for tones caused by observed goal-directed actions rather than non-action or non-goal-related visual events. This suggests that top-down processes act upon the neural responses to sensory events caused by goal-directed actions in the same way for events caused by the self or those made by other agents.

Neural activity in readiness for incidental and explicitly timed actions.

Voluntary, self-initiated actions are preceded by slowly increasing neural activity in pre-motor regions of the brain, beginning up to 2s before the onset of muscle movement. This activity is commonly seen in the scalp-recorded readiness potential, and is an index of movement preparation involving both motor programming and non-motor or cognitive processes such as attention. The specific contribution of cognitive processes, thought to occur during the earliest stage of planning, remains somewhat unclear. We suggest that attention to the timing of movement is a key voluntary process contributing to early-stage cortical activity. As a novel approach to examining this, we recorded EEG throughout a time reproduction task in which participants replicated the interval between two tones with two button-press actions. The first action, i.e. the beginning of the reproduced interval, was somewhat incidental to the task of time reproduction and required minimal attention to the time of initiation, while the second action required explicit attention to the time of initiation. Pre-movement neural activity preceding the first, relatively unattended movement was greatly reduced in amplitude and almost absent in the early stage, in contrast with readiness potentials typically seen prior to voluntary movement. Neural activity preceding explicitly timed movements was significantly larger, with effects emerging in the early component of pre-movement activity over frontal and right frontal scalp regions. We propose that attention to movement timing, i.e. the process of orienting attention in time towards the moment of movement initiation, is a key component of voluntary action preparation that is reflected in the early-stage neural activity we typically see prior to voluntary movement.

A longitudinal diffusion tensor imaging study in symptomatic Huntington's disease.

OBJECTIVE: The striatum and its projections are thought to be the earliest sites of Huntington's disease (HD) pathology. This study aimed to investigate progression of striatal pathology in symptomatic HD using diffusion tensor imaging. METHOD: Diffusion weighted images were acquired in 18 HD patients and in 17 healthy controls twice, 1 year apart. Mean diffusivity (MD) was calculated in the caudate, putamen, thalamus and corpus callosum, and compared between groups. In addition, caudate width was measured using T1 high resolution images and correlated with caudate MD. Correlation analyses were also performed in HD between caudate/putamen MD and clinical measures. RESULTS: MD was significantly higher in the caudate and putamen bilaterally for patients compared with controls at both time points although there were no significant MD differences in the thalamus or corpus callosum. For both groups, MD did not change significantly in any region from baseline to year 1. There was a significant negative correlation between caudate width and MD in patients at baseline but no correlation between these parameters in controls. There was also a significant negative correlation between Mini-Mental State Examination scores and caudate MD and putamen MD at both time points in HD. CONCLUSIONS: It appears that microstructural changes influence cognitive status in HD. Although MD was significantly higher in HD compared with controls at both time points, there were no longitudinal changes in either group. This finding does not rule out the possibility that MD could be a sensitive biomarker for detecting early change in preclinical HD.

Structural development of the basal ganglia in attention deficit hyperactivity disorder: a diffusion tensor imaging study.

One of the most consistently reported brain regions of structural and functional difference in attention deficit hyperactivity disorder (ADHD) is the basal ganglia, particularly the caudate nucleus. Examining the structural organization of the basal ganglia in ADHD is important because it is the center of wider fronto-striatal networks, reported to be dysfunctional in ADHD. Fifteen right-handed 8- to 18-year-old males with ADHD-combined type and 15 right-handed, age- and performance IQ-matched healthy males underwent diffusion tensor imaging. Caudate, putamen and thalamus were manually identified as regions of interest (ROIs) and tested for differences in fractional anisotropy and mean diffusivity. Measures of fractional anisotropy (FA) showed the expected increase with age within the whole-brain volume and within putamen and thalamus ROIs for both ADHD and control groups. In the caudate nucleus, however, developmental changes in FA with age were significantly different between ADHD and control groups. This study shows that the developmental trajectory of micro-structural organization within the caudate nucleus is different in children with ADHD compared with controls over ages 8-18 years. We suggest that the difference in developmental trajectories arises predominantly during mid-late adolescence and may reflect a developmental delay that begins to normalise over this critical late adolescent age.