Enhancing upper-limb neurorehabilitation in chronic stroke survivors using combined action observation and motor imagery therapy.

Introduction: For people who have had a stroke, recovering upper-limb function is a barrier to independence. When movement is difficult, mental practice can be used to complement physical therapy. In this within-participants study we investigated the effects of combined action observation and motor imagery (AO + MI) therapy on upper-limb recovery in chronic stroke survivors. Methods: A Graeco-Latin Square design was used to counterbalance four mental practice conditions (AO + MI, AO, MI, Control) across four cup-stacking tasks of increasing complexity. Once a week, for five consecutive weeks, participants (n = 10) performed 16 mental practice trials under each condition. Each trial displayed a 1st person perspective of a cup-stacking task performed by an experienced model. For AO, participants watched each video and responded to an occasional color cue. For MI, participants imagined the effort and sensation of performing the action; cued by a series of still-images. For combined AO + MI, participants observed a video of the action while they simultaneously imagined performing the same action in real-time. At three time points (baseline; post-test; two-week retention test) participants physically executed the three mentally practiced cup-stacking tasks, plus a fourth unpractised sequence (Control), as quickly and accurately as possible. Results: Mean movement execution times were significantly reduced overall in the post-test and the retention test compared to baseline. At retention, movement execution times were significantly shorter for combined AO + MI compared to both MI and the Control. Individual participants reported clinically important changes in quality of life (Stroke Impact Scale) and positive qualitative experiences of AO + MI (social validation). Discussion: These results indicate that when physical practice is unsuitable, combined AO + MI therapy could offer an effective adjunct for neurorehabilitation in chronic stroke survivors.

A neural signature for combined action observation and motor imagery? An fNIRS study into prefrontal activation, automatic imitation, and self-other perceptions.

INTRODUCTION: Research indicates that both observed and imagined actions can be represented in the brain as two parallel sensorimotor representations. One proposal is that higher order cognitive processes would align these two hypothetical action simulations. METHODS: We investigated this hypothesis using an automatic imitation paradigm, with functional near-infrared spectroscopy recordings over the prefrontal cortex during different motor simulation states. On each trial, participants (n = 14) observed a picture of a rhythmical action (instructed action) followed by a distractor movie showing the same or different action. Participants then executed the instructed action. Distractor actions were manipulated to be fast or slow, and instructions were manipulated during distractor presentation: action observation (AO), combined action observation and motor imagery (AO+MI) and observe to imitate (intentional imitation). A pure motor imagery (MI) condition was also included. RESULTS: Kinematic analyses showed that although distractor speed effects were significant under all instructions (shorter mean cycle times in execution for fast compared to slow trials), this imitation bias was significantly stronger for combined AO+MI than both AO and MI, and stronger for intentional imitation than the other three automatic imitation conditions. In the left prefrontal cortex, cerebral oxygenation was significantly greater for combined AO+MI than all other instructions. Participants reported that their representation of the self overlapped with the observed model significantly more during AO+MI than AO. CONCLUSION: Left prefrontal activation may therefore be a neural signature of AO+MI, supporting attentional switching between concurrent representations of self (MI, top-down) and other (AO, bottom-up) to increase imitation and perceived closeness.

A systematic review of research investigating the physiological and psychological effects of combining Ginkgo biloba and Panax ginseng into a single treatment in humans: Implications for research design and analysis.

BACKGROUND AND PURPOSE: The traditional herbal supplements Panax ginseng and Ginkgo biloba are self-medicated by members of the general public and prescribed by healthcare professionals in some EU countries for numerous health complaints. Clinical evidence is mixed and mechanisms of action are not fully understood. There is clinical interest into the synergistic effects of combining both herbs. METHODS: We systematically review the literature investigating the effects of combination treatments on physiological and psychological outcomes in humans. We identified all studies meeting inclusion criteria: (a) written in English; (b) peer-reviewed; (c) conducted in humans; (d) including either a proprietary Panax ginseng/Ginkgo biloba treatment or a study preparation containing both; (e) placebo-controlled; (f) utilizing standardized extracts. We critically discuss each trial; calculate standardized effect sizes where possible and provide recommendations for research design and analysis. RESULTS: Eight studies were identified and all investigated a proprietary combination treatment, Gincosan® . Studies are of high quality and robust; however, practice effects, choice of statistical model, and reliance upon null-hypothesis significance testing hinder generalized estimates of effect. The most consistent results are benefits to aspects of the circulatory/cardiovascular system in patient populations and "secondary memory" performance in patient and healthy populations. Two studies demonstrate synergy in healthy populations following a single dose; however, synergy in patient populations and following repeated dosing has not yet been directly tested. CONCLUSIONS: A Panax ginseng and Ginkgo biloba combination treatment can improve aspects of physiological and cognitive function in humans; however, evidence for synergy requires further investigation and future research should directly investigate synergy following repeated dosing.

A randomised crossover trial comparing Thai and Swedish massage for fatigue and depleted energy.

BACKGROUND: The aim of this study was to compare the efficacy and social constructions of Thai massage (TM) and Swedish massage (SM) for patients experiencing fatigue or depleted energy. METHOD: Twenty participants were randomised to receive three once-weekly TM treatments and three once-weekly SM treatments, with crossover after three massages. Symptom checklists were administered at three time points and included Activation-Deactivation Adjective Check List and VAS Scale. Qualitative data were collected through semi-structured interviews and participants' diary entries. RESULTS: Both massage types enhanced physical, emotional and mental wellbeing through improved sleep, relaxation, relief of stress and relief of muscular tension. TM alone showed specific energising and psychological stimulation results, along with carry-over effect and longer lasting benefits. Ninety-five percent of participants found relief from their initial reason presenting symptoms. CONCLUSION: TM or SM can relieve symptoms of fatigue or low energy by releasing stress, promoting relaxation, relieving muscular aches and pains and improving energy. SM results in a larger effect in relaxation and improved sleep whereas TM results in a larger effect in energising, rejuvenating and mentally stimulating effects.

The Happy Antics programme: Holistic exercise for people with dementia.

BACKGROUND: Holistic exercise for people with dementia could have psychological and physical benefits, but there is a lack of research on the experience of this type of exercise. Therefore, the objective of this study was to determine the feasibility and acceptance of holistic exercise among people with dementia. METHOD: A holistic exercise programme for people with dementia was designed and implemented. Semi-structured interviews were undertaken to explore participants' experience of holistic exercise, transcribed verbatim and analyzed. RESULTS: Seven themes were generated from the data. They were enjoyment, relaxation, keeping active, social interaction, pain relief, learning something new and intention to continue, respectively. CONCLUSION: The results of the current small-scale study provide evidence for the feasibility and acceptance of holistic exercise for people with dementia. In addition, participants appeared to benefit in terms of psychological and physical wellbeing.