Enhancing gait cadence through rhythm-modulated music: A study on healthy adults.

BACKGROUND AND OBJECTIVE: Gait disorders stemming from brain lesions or chemical imbalances, pose significant challenges for patients. Proposed treatments encompass medication, deep brain stimulation, physiotherapy, and visual stimulation. Music, with its harmonious structures, serves as a continuous reference, synchronizing muscle activities through neural connections between hearing and motor functions, can show promise in gait disorder management. This study explores the influence of heightened music rhythm on young healthy participants' gait cadence in three conditions: FeedForward (independent rhythm), FeedBack (cadence-synced rhythm), and Adaptive (cadence-controlled musical experience). The objective is to increase gait cadence through rhythm modulation during walking. METHOD: The study involved 18 young healthy participants (13 males and 5 females) who did not have any gait or hearing disorders. Each participant completed the gait task in the three aforementioned conditions. Each condition was comprised of three sessions: 1) Baseline, where participants walked while listening to the original music; 2) Intervention, changing the music rhythm to affect the gait cadence; and 3) Realign, replaying the original music and measuring the durability of the effect of the Intervention session. The measurement tool was a pair of footwear equipped with push-button switches that transmited the foot-to-ground contact to the LabVIEW® software, all designed by the research team. Repeated measures of ANOVA was employed to evaluate the impact of the sessions and conditions. RESULTS: In all three conditions, there was a significant effect of music on increasing gait cadence during Intervention and Realign sessions (p < 0.001). Additionally, the immediate impact of music on gait cadence in the Adaptive condition was superior to the other conditions. CONCLUSION: The study findings indicate that increasing the rhythm of music during walking has a significant impact on gait cadence among young healthy participants. This effect remained significant even after realigning the music to normal. It could be harnessed to support the rehabilitation of individuals with movement disorders characterized by a decrease in movement speed, such as Parkinson's disease. Moreover, the results indicate that the Adaptive method showed promising outcomes, suggesting its potential for further exploration as an effective means to control gait cadence.

Preserving the placebo effect after disclosure: A new perspective on non-deceptive placebos.

The present study explores whether a particular style of placebo disclosure could serve as a tool to foster a renewed trust in one's own inherent resources and elicit a meaningful placebo effect. In a motor performance task, two placebo groups received inert transcutaneous electrical nerve stimulation (TENS) in each of four sessions along with information on its force-enhancing properties. Before the final session, one of the placebo groups was informed about the placebo, which was portrayed as a means to unleash an inherent potential. Along with force, we systematically monitored task-specific self-efficacy to test whether this variable would be differentially modulated in the two placebo groups. Compared to two control groups, placebo groups showed higher force and self-efficacy in the last session. No differences in self-efficacy were observed in the placebo groups even after revealing the placebo procedure, suggesting that the disclosure was effective in 'safeguarding' individuals' self-efficacy. These findings may have important implications, paving the way for the use of placebos that not only are ethically permissible but also support individuals' self-efficacy.

Designing and Developing a Vision-Based System to Investigate the Emotional Effects of News on Short Sleep at Noon: An Experimental Case Study.

Background: Sleep is a critical factor in maintaining good health, and its impact on various diseases has been recognized by scientists. Understanding sleep patterns and quality is crucial for investigating sleep-related disorders and their potential links to health conditions. The development of non-intrusive and contactless methods for analyzing sleep data is essential for accurate diagnosis and treatment. Methods: A novel system called the sleep visual analyzer (VSleep) was designed to analyze sleep movements and generate reports based on changes in body position angles. The system utilized camera data without requiring any physical contact with the body. A Python graphical user interface (GUI) section was developed to analyze body movements during sleep and present the data in an Excel format. To evaluate the effectiveness of the VSleep system, a case study was conducted. The participants' movements during daytime naps were recorded. The study also examined the impact of different types of news (positive, neutral, and negative) on sleep patterns. Results: The system successfully detected and recorded various angles formed by participants' bodies, providing detailed information about their sleep patterns. The results revealed distinct effects based on the news category, highlighting the potential impact of external factors on sleep quality and behaviors. Conclusions: The sleep visual analyzer (VSleep) demonstrated its efficacy in analyzing sleep-related data without the need for accessories. The VSleep system holds great potential for diagnosing and investigating sleep-related disorders. The proposed system is affordable, easy to use, portable, and a mobile application can be developed to perform the experiment and prepare the results.

General tau theory as a model to evaluate audiovisual interplay in interceptive actions.

When interacting with the environment, sensory information is essential to guide movements. Picking up the appropriate sensory information (both visual and auditory) about the progression of an event is required to reach the right place at the right time. In this study, we aimed to see if general tau theory could explain the audiovisual guidance of movement in interceptive action (an interception task). The specific contributions of auditory and visual sensory information were tested by timing synchronous and asynchronous audiovisual interplays in successful interceptive trials. The performance was computed by using the tau-coupling model for information-movement guidance. Our findings revealed that while the auditory contribution to movement guidance did change across conditions, the visual contribution remained constant. In addition, when comparing the auditory and visual contributions, the results revealed a significant decrease in the auditory compared to the visual contribution in just one of the asynchronous conditions where the visual target was presented after the sound. This may be because more attention was drawn to the visual information, resulting in a decrease in the auditory guidance of movement. To summarize, our findings reveal how tau-coupling can be used to disentangle the relative contributions of the visual and auditory sensory modalities in movement planning.

Placebo effect on gait: a way to reduce the dual-task cost in older adults.

The ability to perform two tasks simultaneously is essential for daily activities. In older adults, this ability is markedly reduced, as evidenced by the dual-task cost on gait. Preliminary evidences indicate that the dual-task cost can be influenced by different types of manipulations. Here, we explored the effectiveness of a new approach to reduce the dual-task cost, based on the placebo effect, a psychobiological phenomenon whereby a positive outcome follows the administration of an inert device thought to be effective. Thirty-five healthy older adults were asked to walk on a sensorized carpet (single-task condition) and to walk while counting backward (dual-task condition) in two sessions (pre-test and post-test). A placebo group, randomly selected, underwent sham transcranial direct current stimulation over the supraorbital areas between sessions, along with information about its positive effects on concentration and attention. A control group did not receive any intervention between sessions. The dual-task cost was significantly reduced in the placebo group at the post-test session compared to the pre-test for several gait parameters (Cohen's d > 1.43). At the post-test session, the dual-task cost was also lower in the placebo group than in the control group (d > 0.73). Cognitive (number of subtractions and number of errors) and subjective (perceived mental fatigability) variables remained stable across sessions. The reduced dual-task cost in the placebo group could indicate the ability to re-establish the allocation of attentional resources between tasks. These findings could contribute to the development of cognitive strategies that leverage positive expectations to boost motor control in older adults.

The placebo effect shortens movement time in goal-directed movements.

The placebo effect is a powerful psychobiological phenomenon whereby a positive outcome follows the administration of an inert treatment thought to be effective. Growing evidence shows that the placebo effect extends beyond the healing context, affecting also motor performance. Here we explored the placebo effect on the control of goal-directed movement, a fundamental function in many daily activities. Twenty-four healthy volunteers performed upper-limb movements toward a target at different indexes of difficulty in two conditions: in the placebo condition, an electrical device (inert) was applied to the right forearm together with verbal information about its positive effects in improving movement precision; in the control condition, the same device was applied along with verbal information about its neutral effects on performance. Interestingly, we found shorter movement time in the placebo compared to the control condition. Moreover, subjective perception of fatigability was reduced in the placebo compared to the control condition. These findings indicate that the placebo effect can improve the execution of goal-directed movements, thus adding new evidence to the placebo effect in the motor domain. This study could inspire future applications to improve upper-limb movements or in clinical settings for patients with motor deficits.

The Role of Expectation and Beliefs on the Effects of Non-Invasive Brain Stimulation.

Non-invasive brain stimulation (NIBS) techniques are used in clinical and cognitive neuroscience to induce a mild magnetic or electric field in the brain to modulate behavior and cortical activation. Despite the great body of literature demonstrating promising results, unexpected or even paradoxical outcomes are sometimes observed. This might be due either to technical and methodological issues (e.g., stimulation parameters, stimulated brain area), or to participants' expectations and beliefs before and during the stimulation sessions. In this narrative review, we present some studies showing that placebo and nocebo effects, associated with positive and negative expectations, respectively, could be present in NIBS trials, both in experimental and in clinical settings. The lack of systematic evaluation of subjective expectations and beliefs before and after stimulation could represent a caveat that overshadows the potential contribution of placebo and nocebo effects in the outcome of NIBS trials.

Changes in Corticospinal Circuits During Premovement Facilitation in Physiological Conditions.

Changes in corticospinal excitability have been well documented in the preparatory period before movement, however, their mechanisms and physiological role have not been entirely elucidated. We aimed to investigate the functional changes of excitatory corticospinal circuits during a reaction time (RT) motor task (thumb abduction) in healthy subjects (HS). 26 HS received single pulse transcranial magnetic stimulation (TMS) over the primary motor cortex (M1). After a visual go signal, we calculated RT and delivered TMS at three intervals (50, 100, and 150 ms) within RT and before movement onset, recording motor evoked potentials (MEP) from the abductor pollicis brevis (APB) and the task-irrelevant abductor digiti minimi (ADM). We found that TMS increased MEPAPB amplitude when delivered at 150, 100, and 50 ms before movement onset, demonstrating the occurrence of premovement facilitation (PMF). MEP increase was greater at the shorter interval (MEP50) and restricted to APB (no significant effects were detected recording from ADM). We also reported time-dependent changes of the RT and a TMS side-dependent effect on MEP amplitude (greater on the dominant side). In conclusion, we here report changes of RT and side-dependent, selective and facilitatory effects on the MEPAPB amplitude when TMS is delivered before movement onset (PMF), supporting the role of excitatory corticospinal mechanisms at the basis of the selective PMF of the target muscle during the RT protocol.

The effect of motor and cognitive placebos on the serial reaction time task.

Motor learning is a key component of human motor functions. Repeated practice is essential to gain proficiency over time but may induce fatigue. The aim of this study was to determine whether motor performance and motor learning (as assessed with the serial reaction time task, SRTT) and perceived fatigability (as assessed with subjective scales) are improved after two types of placebo interventions (motor and cognitive). A total of 90 healthy volunteers performed the SRTT with the right hand in three sessions (baseline, training and final). Before the training and the final session, one group underwent a motor-related placebo intervention in which inert electrical stimulation (TENS) was applied over the hand and accompanied by verbal suggestion that it improves movement execution (placebo-TENS). The other group underwent a cognitive-related placebo intervention in which sham transcranial direct current stimulation (tDCS) was delivered to the supraorbital area and accompanied by verbal suggestion that it increases attention (placebo-tDCS). A control group performed the same task without receiving treatment. Overall better performance on the SRTT (not ascribed to sequence-specific learning) was noted for the placebo-TENS group, which also reported less perceived fatigability at the physical level. The same was observed in a subgroup tested 24 hr later. The placebo-tDCS group reported less perceived fatigability, both at the mental and physical level. These findings indicate that motor- and cognitive-related placebo effects differently shape motor performance and perceived fatigability on a repeated motor task.

Hypnosis-induced modulation of corticospinal excitability during motor imagery.

Hypnosis can be considered an altered state of consciousness in which individuals produce movements under suggestion without apparent voluntary control. Despite its application in contexts implying motor control, evidence for the neurophysiological mechanisms underlying hypnosis is scarce. Inter-individual differences in hypnotic susceptibility suggest that sensorimotor strategies may manifest in a hypnotic state. We tested by means of transcranial magnetic stimulation applied over the primary motor cortex whether motor system activation during a motor imagery task differs in the awake and in the hypnotic state. To capture individual differences, 30 healthy volunteers were classified as high or low hypnotizable (Highs and Lows) according to ad-hoc validated scales measuring hypnotic susceptibility and personality questionnaires. Corticospinal activation during motor imagery in the hypnotic state was greater in the Highs than the Lows. Intrinsic motivation in task performance and level of persuasion modulated corticospinal activation in the Highs. Corticospinal system activation under hypnosis may have practical implications that merit research in areas where hypnosis can be applied to improve motor performance, such as loss of motor abilities and sports.

Cathodal Cerebellar tDCS Combined with Visual Feedback Improves Balance Control.

Balance control is essential to maintain a stable body position and to prevent falls. The aim of this study was to determine whether balance control could be improved by using cerebellar transcranial direct current stimulation (tDCS) and visual feedback in a combined approach. A total of 90 healthy volunteers were randomly assigned to six groups defined by the delivery of tDCS (cathodal or anodal or sham) and the provision or not of visual feedback on balance during the acquisition phase. tDCS was delivered over the cerebellar hemisphere ipsilateral to the dominant leg for 20 min at 2 mA during a unipedal stance task. Body sway (i.e., ankle angle and hip position) was measured as an overall maximal unit in anteroposterior and mediolateral direction, together with participant rating of perception of stability, before (baseline), during (acquisition), and after (final) the intervention. We found a reduction in body sway during the acquisition session when visual feedback alone was provided. When the visual feedback was removed (final session), however, body sway increased above baseline. Differently, the reduction in overall maximal body sway was maintained during the final session when the delivery of cathodal tDCS and visual feedback was combined. These findings suggest that cathodal tDCS may support the short-term maintenance of the positive effects of visual feedback on balance and provide the basis for a new approach to optimize balance control, with potential translational implications for the elderly and patients with impaired posture control.

When words hurt: Verbal suggestion prevails over conditioning in inducing the motor nocebo effect.

Perception and behavior are strongly influenced by the verbal information conveyed by other individuals (e.g., verbal suggestion) and by learning (e.g., conditioning). This influence is well represented by the placebo and nocebo effects, in which positive verbal suggestion associated with positive conditioning induces beneficial outcomes (placebo effect), while the opposite is true for the negative counterpart (nocebo effect). It is still unclear whether verbal suggestion and conditioning exert distinctive roles in influencing perception, behavior and motor system activity when they occur in opposite directions. To this purpose, fifty-three healthy volunteers were assigned to four groups characterized by either congruent or incongruent verbal suggestion and conditioning. Participants were asked to perform a force motor task by pressing a piston as strongly as possible. Transcranial magnetic stimulation over the primary motor cortex was used to record motor evoked potentials (MEP) and cortical silent period (CSP) from the muscle involved in the task. We found that negative verbal suggestion counteracted positive conditioning and induced sense of weakness, effort, and force decrements. MEP amplitude was stable, whereas the CSP duration shortened in all the groups throughout the procedure, indicating the involvement of cortical inhibitory circuits, independently of the type of verbal suggestion or conditioning. Our findings highlight a prevalent role of verbal suggestion over conditioning in determining a worsening (nocebo effect) but not an improvement (placebo effect) of motor performance. These results suggest that words associated with treatments should be chosen carefully to avoid negative outcomes, especially in sports and clinical settings.

Positive verbal suggestion optimizes postural control.

Balance is a very important function that allows maintaining a stable stance needed for many daily life activities and for preventing falls. We investigated whether balance control could be improved by a placebo procedure consisting of verbal suggestion. Thirty healthy volunteers were randomized in two groups (placebo and control) and asked to perform a single-leg stance task in which they had to stand as steadily as possible on the dominant leg. The task was repeated in three sessions (T0, T1, T2). At T1 and T2 an inert treatment was applied on the leg, by informing the placebo group that it was effective in improving balance. The control group was overtly told that treatment was inert. An accelerometer applied on participants' leg allowed to measure body sways in different directions. Subjective parameters, like perception of stability, were also collected. Results showed that the placebo group had less body sways than the control group at T2, both in the three-dimensional space and in the anterior-posterior direction. Furthermore, the placebo group perceived to be more stable than the control group. This study represents the first evidence that placebo effect optimizes posture, with a potential translational impact in patients with postural and gait disturbances.

Rehabilitation of the Parkinson's tremor by using robust adaptive sliding mode controller: a simulation study.

One of the efficient methods in controlling the Parkinson's tremor is Deep Brain Stimulation (DBS) therapy. The stimulation of Basal Ganglia (BG) by DBS brings no feedback though the existence of feedback reduces the additional stimulatory signal delivered to the brain. So this study offers a new adaptive architecture of a closed-loop control system in which two areas of BG are stimulated simultaneously to decrease the following three indicators: hand tremor, the level of a delivered stimulation signal in the disease condition, and the level of a delivered stimulation signal in health condition to the disease condition. One area (STN: subthalamic nucleus) is stimulated with an adaptive sliding mode controller and the other area (GPi: Globus Pallidus internal) with partial state feedback controller. The simulation results of stimulating two areas of BG showed satisfactory performance.

The role of the dorsolateral prefrontal cortex in the motor placebo effect.

The neural correlates of the placebo effect in the motor domain are still unknown. The aim of this study was to tackle the role of a frontal cortical region, the dorsolateral prefrontal cortex (dlPFC). To this end, we stimulated the cortical site corresponding to the left dlPFC with transcranial direct current stimulation (tDCS) during a placebo procedure and measured any change in the motor placebo effect in all the participants and more specifically in placebo-responders. Three different experiments were conducted in which healthy volunteers performed a force motor task with the index finger. The placebo treatment consisted of transcutaneous electrical nerve stimulation (TENS). In Experiment 1 (expectation alone), participants were only verbally suggested about the positive effects of TENS. In Experiment 2 (expectation and conditioning), participants were verbally suggested about TENS and conditioned with a surreptitious increase in a visual feedback of force. In Experiment 3 (control procedure), participants were told that TENS was inefficient. Each participant was tested in three different days with anodal, cathodal and sham tDCS over the dlPFC. Results showed that in Experiment 1 and 2 force increased after the procedure, independently of tDCS. By focusing on placebo-responders, we found that in Experiment 1 force remained stable after active tDCS, whereas it increased after inactive tDCS. These findings bring new evidence on the neural underpinnings of the motor placebo effect, by showing that independently of the polarity, active tDCS over the left dlPFC may undermine the expectation-induced enhancement of force in placebo-responders.

The placebo effect in the motor domain is differently modulated by the external and internal focus of attention.

Among the cognitive strategies that can facilitate motor performance in sport and physical practice, a prominent role is played by the direction of the focus of attention and the placebo effect. Consistent evidence converges in indicating that these two cognitive functions can influence the motor outcome, although no study up-to-now tried to study them together in the motor domain. In this explorative study, we combine for the first time these approaches, by applying a placebo procedure to increase force and by manipulating the focus of attention with explicit verbal instructions. Sixty healthy volunteers were asked to perform abduction movements with the index finger as strongly as possible against a piston and attention could be directed either toward the movements of the finger (internal focus, IF) or toward the movements of the piston (external focus, EF). Participants were randomized in 4 groups: two groups underwent a placebo procedure (Placebo-IF and Placebo-EF), in which an inert treatment was applied on the finger with verbal information on its positive effects on force; two groups underwent a control procedure (Control-IF and Control-EF), in which the same treatment was applied with overt information about its inefficacy. The placebo groups were conditioned about the effects of the treatment with a surreptitious amplification of a visual feedback signalling the level of force. During the whole procedure, we recorded actual force, subjective variables and electromyography from the hand muscles. The Placebo-IF group had higher force levels after the procedure than before, whereas the Placebo-EF group had a decrease of force. Electromyography showed that the Placebo-IF group increased the muscle units recruitment without changing the firing rate. These findings show for the first time that the placebo effect in motor performance can be influenced by the subject's attentional focus, being enhanced with the internal focus of attention.

The somatosensory temporal discrimination threshold changes after a placebo procedure.

In a recent study, we showed that tactile perception can be enhanced by applying a placebo manipulation consisting of verbal suggestion and conditioning (Fiorio et al., Neuroscience 217:96-104, 2012). Whether this change in perception is related to a better tactile functioning is still unknown. Aim of this study is to investigate whether placebo-induced enhancement of tactile perception results in better somatosensory temporal discrimination threshold (STDT), as a proxy of tactile acuity. To this purpose, a group of subjects (experimental group) was verbally influenced and conditioned about the effect of an inert cream in enhancing tactile perception, while a control group was informed about the real nature of the cream. In both groups, we measured STDT before and after cream application, by means of pairs of electrical stimuli delivered on the index fingertip and separated by ascending inter-stimulus intervals. STDT was defined as the shortest time interval at which the two stimuli were perceived as separated. Results revealed an increase in subjective perception of stimulus intensity and a reduction of STDT only in the experimental group. This study proves that a placebo procedure, consisting of verbal suggestion and a short conditioning, can reduce the temporal discrimination threshold.

Design of robust adaptive controller and feedback error learning for rehabilitation in Parkinson's disease: a simulation study.

Deep brain stimulation (DBS) is an efficient therapy to control movement disorders of Parkinson's tremor. Stimulation of one area of basal ganglia (BG) by DBS with no feedback is the prevalent opinion. Reduction of additional stimulatory signal delivered to the brain is the advantage of using feedback. This results in reduction of side effects caused by the excessive stimulation intensity. In fact, the stimulatory intensity of controllers is decreased proportional to reduction of hand tremor. The objective of this study is to design a new controller structure to decrease three indicators: (i) the hand tremor; (ii) the level of delivered stimulation in disease condition; and (iii) the ratio of the level of delivered stimulation in health condition to disease condition. For this purpose, the authors offer a new closed-loop control structure to stimulate two areas of BG simultaneously. One area (STN: subthalamic nucleus) is stimulated by an adaptive controller with feedback error learning. The other area (GPi: globus pallidus internal) is stimulated by a partial state feedback (PSF) controller. Considering the three indicators, the results show that, stimulating two areas simultaneously leads to better performance compared with stimulating one area only. It is shown that both PSF and adaptive controllers are robust regarding system parameter uncertainties. In addition, a method is proposed to update the parameters of the BG model in real time. As a result, the parameters of the controllers can be updated based on the new parameters of the BG model.

Designing a robust backstepping controller for rehabilitation in Parkinson's disease: a simulation study.

In this study, a model of basal ganglia (BG) is applied to develop a deep brain stimulation controller to reduce Parkinson's tremor. Conventionally, one area in BG is stimulated, with no feedback, to control Parkinson's tremor. In this study, a new architecture is proposed to develop feedback controller as well as to stimulate two areas of BG simultaneously. To this end, two controllers are designed and implemented in globus pallidus internal (GPi) and subthalamic nucleus (STN) in the brain. A proportional controller and a backstepping controller are designed and implemented in GPi and STN, respectively. The proposed controllers deliver suitable stimulatory control signals to GPi and STN based on hand tremor amplitude (as the feedback). When tremor reduces, these controllers decrease the stimulatory energy intensity proportionally. Therefore, additional stimulatory signal is not delivered to the brain. Subsequently, the side effects from the excessive stimulation intensity become much less. Comparing with one area stimulation, the results show that stimulating two areas of BG results in reduction of the level of the stimulation intensity. It is observed that these two controllers are both robust in terms of changing the system parameters.

Changes in perception of treatment efficacy are associated to the magnitude of the nocebo effect and to personality traits.

The nocebo effect in motor performance consists in a reduction of force and increase of fatigue following the application of an inert treatment that the recipient believes to be effective. This effect is variable across individuals and it is usually stronger if conditioning -exposure to the active effect of the treatment- precedes a test session, in which the treatment is inert. In the current explorative study we used a conditioning procedure to investigate whether subjective perception of treatment effectiveness changes between the conditioning and the test session and whether this change is related to dispositional traits and to the nocebo-induced reduction of force. Results showed that 56.1% of participants perceived the treatment as more effective in the test than in the conditioning session, had a more pronounced reduction of force, felt more effort and sense of weakness and were characterized by lower levels of optimism and higher anxiety traits compared to the other 43.9% of participants, who conversely perceived the treatment as less effective in the test session than in the conditioning. These findings highlight for the first time a link between changes in perception of treatment effectiveness, personality traits and the magnitude of the nocebo response in motor performance.