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1.
J Pain Res ; 17: 1519-1529, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38686102

RESUMEN

Purpose: Alterations in spatial attention have been reported in people with chronic pain and may be relevant to understanding its cortical mechanisms and developing novel treatments. There is conflicting evidence as to whether people with Complex Regional Pain Syndrome (CRPS) have reduced visuospatial attention to their affected limb and/or its surrounding space, with some evidence that these deficits may be greater in personal (bodily) space. We aimed to test the competing hypotheses of whether the visuospatial attentional bias is specific to the personal space of the affected limb or generalizes to the personal space of other parts of the affected side of the body. Patients and Methods: Using visual Temporal Order Judgement tasks, we measured spatial attention in the personal space of the hands and feet of patients with upper (n=14) or lower (n=14) limb CRPS and pain-free controls (n=17). Participants judged the order of two light flashes presented at different temporal offsets on each of their hands or feet. Slower processing of the flash on one side relative to the other reflects reduced attention to that side of space. Results: Controls prioritized stimuli on the non-dominant (left) relative to dominant side, consistent with the well-documented normal leftward bias of attention (ie "pseudoneglect"). Regardless of the location (upper or lower limb) of the pain or visual stimuli, people with CRPS showed no such asymmetry, representing reduced attention to the affected side (compared to the greater attention of controls to their non-dominant side). More severe CRPS symptoms were associated with a greater tendency to deprioritize stimuli on the affected side. Conclusion: Our findings suggest that relative visuospatial bias in CRPS is generalized to the personal space of the affected side of the body, rather than being specific to the personal space of the CRPS-affected limb.

2.
Proc Natl Acad Sci U S A ; 121(12): e2302239121, 2024 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-38470927

RESUMEN

Humans coordinate their eye, head, and body movements to gather information from a dynamic environment while maximizing reward and minimizing biomechanical and energetic costs. However, such natural behavior is not possible in traditional experiments employing head/body restraints and artificial, static stimuli. Therefore, it is unclear to what extent mechanisms of fixation selection discovered in lab studies, such as inhibition-of-return (IOR), influence everyday behavior. To address this gap, participants performed nine real-world tasks, including driving, visually searching for an item, and building a Lego set, while wearing a mobile eye tracker (169 recordings; 26.6 h). Surprisingly, in all tasks, participants most often returned to what they just viewed and saccade latencies were shorter preceding return than forward saccades, i.e., consistent with facilitation, rather than inhibition, of return. We hypothesize that conservation of eye and head motor effort ("laziness") contributes. Correspondingly, we observed center biases in fixation position and duration relative to the head's orientation. A model that generates scanpaths by randomly sampling these distributions reproduced all return phenomena we observed, including distinct 3-fixation sequences for forward versus return saccades. After controlling for orbital eccentricity, one task (building a Lego set) showed evidence for IOR. This, along with small discrepancies between model and data, indicates that the brain balances minimization of motor costs with maximization of rewards (e.g., accomplished by IOR and other mechanisms) and that the optimal balance varies according to task demands. Supporting this account, the orbital range of motion used in each task traded off lawfully with fixation duration.


Asunto(s)
Encéfalo , Movimientos Sacádicos , Humanos , Inhibición Psicológica , Fijación Ocular
3.
IEEE Trans Vis Comput Graph ; 30(5): 2257-2268, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38457326

RESUMEN

Eye tracking is routinely being incorporated into virtual reality (VR) systems. Prior research has shown that eye tracking data, if exposed, can be used for re-identification attacks [14]. The state of our knowledge about currently existing privacy mechanisms is limited to privacy-utility trade-off curves based on data-centric metrics of utility, such as prediction error, and black-box threat models. We propose that for interactive VR applications, it is essential to consider user-centric notions of utility and a variety of threat models. We develop a methodology to evaluate real-time privacy mechanisms for interactive VR applications that incorporate subjective user experience and task performance metrics. We evaluate selected privacy mechanisms using this methodology and find that re-identification accuracy can be decreased to as low as 14% while maintaining a high usability score and reasonable task performance. Finally, we elucidate three threat scenarios (black-box, black-box with exemplars, and white-box) and assess how well the different privacy mechanisms hold up to these adversarial scenarios. This work advances the state of the art in VR privacy by providing a methodology for end-to-end assessment of the risk of re-identification attacks and potential mitigating solutions. f.

4.
J Neurosci Methods ; 406: 110116, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38548122

RESUMEN

BACKGROUND: Little research exists on extending ex-vivo systems to large animal nerves, and to the best of our knowledge, there has yet to be a study comparing these against in-vivo data. This paper details the first ex-vivo system for large animal peripheral nerves to be compared with in-vivo results. NEW METHOD: Detailed ex-vivo and in-vivo closed-loop neuromodulation experiments were conducted on pig ulnar nerves. Temperatures from 20 °C to 37 °C were evaluated for the ex-vivo system. The data were analysed in the time and velocity domains, and a regression analysis established how evoked compound action potential amplitude and modal conduction velocity (CV) varied with temperature and time after explantation. MAIN RESULTS: Pig ulnar nerves were sustained ex-vivo up to 5 h post-explantation. CV distributions of ex-vivo and in-vivo data were compared, showing closer correspondence at 37 °C. Regression analysis results also demonstrated that modal CV and time since explantation were negatively correlated, whereas modal CV and temperature were positively correlated. COMPARISON WITH EXISTING METHODS: Previous ex-vivo systems were primarily aimed at small animal nerves, and we are not aware of an ex-vivo system to be directly compared with in-vivo data. This new approach provides a route to understand how ex-vivo systems for large animal nerves can be developed and compared with in-vivo data. CONCLUSION: The proposed ex-vivo system results were compared with those seen in-vivo, providing new insights into large animal nerve activity post-explantation. Such a system is crucial for complementing in-vivo experiments, maximising collected experimental data, and accelerating neural interface development.


Asunto(s)
Conducción Nerviosa , Nervio Cubital , Animales , Porcinos , Nervio Cubital/fisiología , Conducción Nerviosa/fisiología , Potenciales de Acción/fisiología , Temperatura , Estimulación Eléctrica/métodos
5.
Exp Brain Res ; 242(2): 463-475, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38170233

RESUMEN

Virtual reality (VR) technology has been widely adopted for several professional and recreational applications. Despite rapid innovation in hardware and software, one of the long prevailing issues for end users of VR is the experience of VR sickness. Females experience stronger VR sickness compared to males, and previous research has linked susceptibility to VR sickness to the menstrual cycle (Munafo et al., Exp Brain Res 235(3):889-901). Here we investigated the female versus male experience in VR sickness while playing an immersive VR game, comparing days of the menstrual cycle when hormones peak: day 15 (ovulation-peak estrogen) and day 22 (mid-luteal phase-peak progesterone). We found that immersion duration was greater in the second session than the first, and discomfort was lessened, suggesting a powerful adaptation with repeated exposure. Due to the estrogen levels changing along with the exposure, there was no clear independent impact of that; note, though, that there was a significant difference between self-report and physiological measures implying that GSR is potentially an unreliable measure of motion sickness. Although prior work found a delay over 2 days between session would not allow adaptation and habituation to reduce VR sickness susceptibility, we found that a week delay has potential success.


Asunto(s)
Mareo por Movimiento , Realidad Virtual , Humanos , Masculino , Femenino , Caracteres Sexuales , Interfaz Usuario-Computador , Estrógenos
6.
J Surg Res ; 295: 666-672, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38113610

RESUMEN

INTRODUCTION: Cancer operations are increasingly utilizing specialized equipment and technology. Related costs are often not known to the responsible surgeon. We seek to evaluate cost aspects of care episodes attributable to the surgeon's management decisions. METHODS: Financial cost data in a tertiary academic cancer center were queried over 3 y. Consecutive patients undergoing gastrointestinal operations followed by inpatient admission of two or more days were included, excluding patients with 40+ d admissions. Analysis of variance, Kruskal-Wallis, and multiple regression statistics were utilized. RESULTS: The study population included 1540 patients: 54% men and 46% women, with a median age of 64 y (range 15-95). Eight surgeons conducted major (82%) and minor (18%) operations, with a minimally invasive surgical approach in 60.4%. Procedures included colorectal (37%), pancreatic (19%), esophagogastric (18%), hepatobiliary (18%), and small bowel resections (8%). Total direct costs differed between surgeons with an analysis of variance coefficient range between -$3265 and +$6163 (P < 0.001). Surgeons' cost differences were observed for central medical supply, operating room (OR) supply, total OR, inpatient room, laboratory, pharmacy, supportive care (P < 0.001), and radiology costs (P < 0.02). OR supply cost was the dominant consistent domain with significant differences between surgeons in all case subcategories. When controlled for case category and minimally invasive surgical approach, multiple regression showed the most significant variations between surgeons in ORs, medical supply, and nutrition costs (P < 0.001), followed by laboratory costs (P < 0.01). Top OR supply costs were staplers and energy devices. CONCLUSIONS: Even in a highly subspecialized surgical environment, surgeons' variable utilization of ORs and medical supplies is strongly linked to variations in care-related costs. Specific queries into supply items should reduce costs and optimize value generated.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Neoplasias , Cirujanos , Masculino , Humanos , Femenino , Estudios Retrospectivos , Costos y Análisis de Costo , Hospitalización
7.
Artículo en Inglés | MEDLINE | ID: mdl-38083166

RESUMEN

Neural interfaces that electrically stimulate the peripheral nervous system have been shown to successfully improve symptom management for several conditions, such as epilepsy and depression. A crucial part for closing the loop and improving the efficacy of implantable neuromodulation devices is the efficient extraction of meaningful information from nerve recordings, which can have a low Signal-to-Noise ratio (SNR) and non-stationary noise. In recent years, machine learning (ML) models have shown outstanding performance in regression and classification problems, but it is often unclear how to translate and assess these for novel tasks in biomedical engineering. This paper aims to adapt existing ML algorithms to carry out unsupervised denoising of neural recordings instead. This is achieved by applying bandpass filtering and two novel ML algorithms to in-vivo spontaneous, low-SNR vagus nerve recordings. The performance of each approach is compared using the task of extracting respiratory afferent activity and validated using cross-correlation, MSE, and accuracy in terms of extracting the true respiratory rate. A variational autoencoder (VAE) model in particular produces results that show better correlation with respiratory activity compared to bandpass filtering, highlighting that these models have the potential to preserve relevant features in complex neural recordings.


Asunto(s)
Algoritmos , Epilepsia , Humanos , Aprendizaje Automático , Relación Señal-Ruido , Nervio Vago
8.
Sci Data ; 10(1): 386, 2023 06 15.
Artículo en Inglés | MEDLINE | ID: mdl-37322034

RESUMEN

Electroencephalography (EEG) is a widely-used neuroimaging technique in Brain Computer Interfaces (BCIs) due to its non-invasive nature, accessibility and high temporal resolution. A range of input representations has been explored for BCIs. The same semantic meaning can be conveyed in different representations, such as visual (orthographic and pictorial) and auditory (spoken words). These stimuli representations can be either imagined or perceived by the BCI user. In particular, there is a scarcity of existing open source EEG datasets for imagined visual content, and to our knowledge there are no open source EEG datasets for semantics captured through multiple sensory modalities for both perceived and imagined content. Here we present an open source multisensory imagination and perception dataset, with twelve participants, acquired with a 124 EEG channel system. The aim is for the dataset to be open for purposes such as BCI related decoding and for better understanding the neural mechanisms behind perception, imagination and across the sensory modalities when the semantic category is held constant.


Asunto(s)
Interfaces Cerebro-Computador , Humanos , Electroencefalografía/métodos , Imaginación , Percepción , Semántica
9.
Front Psychol ; 14: 1043088, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37034962

RESUMEN

We sought to understand how the perception of personal space is influenced by different levels of social density, spatial density, and type of window-view in South Korean and United Kingdom workplaces. We employed virtual reality to simulate shared and single occupancy offices. We obtained personal space estimations using a virtual disc around the participant which could be extended and retracted, inside the simulation, to indicate perceived amount of personal space, and compared this measure to questionnaire-based estimations. We found that in both cultures participants experienced greater perceived personal space (1) when in a sparse rather than dense office and (2) having a view of the city outside the office. However, British, but not Korean, participants had significantly higher personal space estimations in single occupancy offices than in shared offices. These results suggest subtle cross-cultural differences in workplace experience, that could only be investigated using virtual reality.

10.
Artículo en Inglés | MEDLINE | ID: mdl-37027619

RESUMEN

In this study, we establish a much-needed baseline for evaluating eye tracking interactions using an eye tracking enabled Meta Quest 2 VR headset with 30 participants. Each participant went through 1098 targets using multiple conditions representative of AR/VR targeting and selecting tasks, including both traditional standards and those more aligned with AR/VR interactions today. We use circular white world-locked targets, and an eye tracking system with sub-1-degree mean accuracy errors running at approximately 90Hz. In a targeting and button press selection task, we, by design, compare completely unadjusted, cursor-less, eye tracking with controller and head tracking, which both had cursors. Across all inputs, we presented targets in a configuration similar to the ISO 9241-9 reciprocal selection task and another format with targets more evenly distributed near the center. Targets were laid out either flat on a plane or tangent to a sphere and rotated toward the user. Even though we intended this to be a baseline study, we see unmodified eye tracking, without any form of a cursor, or feedback, outperformed the head by 27.9% and performed comparably to the controller (5.63% decrease) in throughput. Eye tracking had improved subjective ratings relative to head in Ease of Use, Adoption, and Fatigue (66.4%, 89.8%, and 116.1% improvements, respectively) and had similar ratings relative to the controller (reduction by 4.2%, 8.9%, and 5.2% respectively). Eye tracking had a higher miss percentage than controller and head (17.3% vs 4.7% vs 7.2% respectively). Collectively, the results of this baseline study serve as a strong indicator that eye tracking, with even minor sensible interaction design modifications, has tremendous potential in reshaping interactions in next-generation AR/VR head mounted displays.

11.
Prog Brain Res ; 275: 165-215, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36841568

RESUMEN

This chapter utilizes genomic concepts and evolutionary perspectives to further understand the possible links between typical brain aging and neurodegenerative diseases, focusing on the two most prevalent of these: Alzheimer's disease and Parkinson's disease. Aging is the major risk factor for these neurodegenerative diseases. Researching the evolutionary and molecular underpinnings of aging helps to reveal elements of the typical aging process that leave individuals more vulnerable to neurodegenerative pathologies. Very little is known about the prevalence and susceptibility of neurodegenerative diseases in nonhuman species, as only a few individuals have been observed with these neuropathologies. However, several studies have investigated the evolution of lifespan, which is closely connected with brain size in mammals, and insights can be drawn from these to enrich our understanding of neurodegeneration. This chapter explores the relationship between the typical aging process and the events in neurodegeneration. First, we examined how age-related processes can increase susceptibility to neurodegenerative diseases. Second, we assessed to what extent neurodegeneration is an accelerated form of aging. We found that while at the phenotypic level both neurodegenerative diseases and the typical aging process share some characteristics, at the molecular level they show some distinctions in their profiles, such as variation in genes and gene expression. Furthermore, neurodegeneration of the brain is associated with an earlier onset of cellular, molecular, and structural age-related changes. In conclusion, a more integrative view of the aging process, both from a molecular and an evolutionary perspective, may increase our understanding of neurodegenerative diseases.


Asunto(s)
Enfermedad de Alzheimer , Enfermedades Neurodegenerativas , Humanos , Animales , Enfermedades Neurodegenerativas/patología , Envejecimiento/metabolismo , Enfermedad de Alzheimer/metabolismo , Encéfalo/metabolismo , Genómica , Mamíferos
12.
J Exp Psychol Hum Percept Perform ; 48(9): 926-942, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-35862072

RESUMEN

The tongue is an incredibly complex sensory organ, yet little is known about its tactile capacities compared to the hands. In particular, the tongue receives almost no visual input during development and so may be calibrated differently compared to other tactile senses for spatial tasks. Using a cueing task, via an electro-tactile display, we examined how a tactile cue (to the tongue) or an auditory cue can affect the orientation of attention to electro-tactile targets presented to one of four regions on the tongue. We observed that response accuracy was generally low for the same modality condition, especially at the back of the tongue. This implies that spatial localization ability is diminished either because the tongue is less calibrated by the visual modality or because of its position and orientation inside the body. However, when cues were provided cross-modally, target identification at the back of the tongue seemed to improve. Our findings suggest that, while the brain relies on a general mechanism for spatial (and tactile) attention, the surface of the tongue may not have clear access to these representations of space when solely provided via electro-tactile feedback but can be directed by other sensory modalities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Asunto(s)
Señales (Psicología) , Tacto , Mano , Humanos , Tiempo de Reacción , Lengua
13.
Neurosci Biobehav Rev ; 139: 104735, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35705110

RESUMEN

Harris (1999) proposed that pain can arise in the absence of tissue damage because changes in the cortical representation of the painful body part lead to incongruences between motor intention and sensory feedback. This idea, subsequently termed the sensorimotor theory of pain, has formed the basis for novel treatments for pathological pain. Here we review the evidence that people with pathological pain have changes to processes contributing to sensorimotor function: motor function, sensory feedback, cognitive representations of the body and its surrounding space, multisensory processing, and sensorimotor integration. Changes to sensorimotor processing are most evident in the form of motor deficits, sensory changes, and body representations distortions, and for Complex Regional Pain Syndrome (CRPS), fibromyalgia, and low back pain. Many sensorimotor changes are related to cortical processing, pain, and other clinical characteristics. However, there is very limited evidence that changes in sensorimotor processing actually lead to pain. We therefore propose that the theory is more appropriate for understanding why pain persists rather than how it arises.


Asunto(s)
Síndromes de Dolor Regional Complejo , Fibromialgia , Dolor , Imagen Corporal , Retroalimentación Sensorial , Humanos , Dolor/patología
14.
Cogn Affect Behav Neurosci ; 22(5): 904-951, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-35589909

RESUMEN

This integrative review rearticulates the notion of human aesthetics by critically appraising the conventional definitions, offerring a new, more comprehensive definition, and identifying the fundamental components associated with it. It intends to advance holistic understanding of the notion by differentiating aesthetic perception from basic perceptual recognition, and by characterizing these concepts from the perspective of information processing in both visual and nonvisual modalities. To this end, we analyze the dissociative nature of information processing in the brain, introducing a novel local-global integrative model that differentiates aesthetic processing from basic perceptual processing. This model builds on the current state of the art in visual aesthetics as well as newer propositions about nonvisual aesthetics. This model comprises two analytic channels: aesthetics-only channel and perception-to-aesthetics channel. The aesthetics-only channel primarily involves restricted local processing for quality or richness (e.g., attractiveness, beauty/prettiness, elegance, sublimeness, catchiness, hedonic value) analysis, whereas the perception-to-aesthetics channel involves global/extended local processing for basic feature analysis, followed by restricted local processing for quality or richness analysis. We contend that aesthetic processing operates independently of basic perceptual processing, but not independently of cognitive processing. We further conjecture that there might be a common faculty, labeled as aesthetic cognition faculty, in the human brain for all sensory aesthetics albeit other parts of the brain can also be activated because of basic sensory processing prior to aesthetic processing, particularly during the operation of the second channel. This generalized model can account not only for simple and pure aesthetic experiences but for partial and complex aesthetic experiences as well.


Asunto(s)
Belleza , Cognición , Encéfalo , Estética , Humanos , Percepción
15.
Neurosci Biobehav Rev ; 134: 104550, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-35074313

RESUMEN

Research on the origin of vision and vision loss in naturally "blind" animal species can reveal the tasks that vision fulfills and the brain's role in visual experience. Models that incorporate evolutionary history, natural variation in visual ability, and experimental manipulations can help disentangle visual ability at a superficial level from behaviors linked to vision but not solely reliant upon it, and could assist the translation of ophthalmological research in animal models to human treatments. To unravel the similarities between blind individuals and blind species, we review concepts of "blindness" and its behavioral correlates across a range of species. We explore the ancestral emergence of vision in vertebrates, and the loss of vision in blind species with reference to an evolution-based classification scheme. We applied phylogenetic comparative methods to a mammalian tree to explore the evolution of visual acuity using ancestral state estimations. Future research into the natural history of vision loss could help elucidate the function of vision and inspire innovations in how to address vision loss in humans.


Asunto(s)
Historia Natural , Trastornos de la Visión , Animales , Ceguera , Humanos , Mamíferos , Filogenia , Vertebrados
16.
Atten Percept Psychophys ; 84(2): 509-518, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34862589

RESUMEN

The material-weight illusion (MWI) demonstrates how our past experience with material and weight can create expectations that influence the perceived heaviness of an object. Here we used mixed-reality to place touch and vision in conflict, to investigate whether the modality through which materials are presented to a lifter could influence the top-down perceptual processes driving the MWI. University students lifted equally-weighted polystyrene, cork and granite cubes whilst viewing computer-generated images of the cubes in virtual reality (VR). This allowed the visual and tactile material cues to be altered, whilst all other object properties were kept constant. Representation of the objects' material in VR was manipulated to create four sensory conditions: visual-tactile matched, visual-tactile mismatched, visual differences only and tactile differences only. A robust MWI was induced across all sensory conditions, whereby the polystyrene object felt heavier than the granite object. The strength of the MWI differed across conditions, with tactile material cues having a stronger influence on perceived heaviness than visual material cues. We discuss how these results suggest a mechanism whereby multisensory integration directly impacts how top-down processes shape perception.


Asunto(s)
Ilusiones , Realidad Virtual , Percepción del Peso , Señales (Psicología) , Humanos , Tacto , Percepción Visual
17.
PLoS One ; 16(12): e0261614, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34929004

RESUMEN

There is evidence to suggest that people with Complex Regional Pain Syndrome (CRPS) can have altered body representations and spatial cognition. One way of studying these cognitive functions is through manual straight ahead (MSA) pointing, in which participants are required to point straight ahead of their perceived body midline without visual feedback of the hand. We therefore compared endpoint errors from MSA pointing between people with CRPS (n = 17) and matched controls (n = 18), and examined the effect of the arm used (Side of Body; affected/non-dominant, non-affected/dominant). For all participants, pointing errors were biased towards the hand being used. We found moderate evidence of no difference between Groups on endpoint errors, and moderate evidence of no interaction with Side of Body. The differences in variability between Groups were non-significant/inconclusive. Correlational analyses showed no evidence of a relationship between MSA endpoint errors and clinical parameters (e.g. CRPS severity, duration, pain) or questionnaire measures (e.g. body representation, "neglect-like symptoms", upper limb disability). This study is consistent with earlier findings of no difference between people with CRPS and controls on MSA endpoint errors, and is the first to provide statistical evidence of similar performance of these two groups. Our results do not support a relationship between clinical or self-reported measures (e.g. "neglect-like symptoms") and any directional biases in MSA. Our findings may have implications for understanding neurocognitive changes in CRPS.


Asunto(s)
Síndromes de Dolor Regional Complejo/fisiopatología , Navegación Espacial/fisiología , Brazo , Estudios de Casos y Controles , Cognición/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Desempeño Psicomotor/fisiología
18.
Neuropsychologia ; 163: 108079, 2021 12 10.
Artículo en Inglés | MEDLINE | ID: mdl-34740614

RESUMEN

People with Complex Regional Pain Syndrome (CRPS) following limb injury can show neuropsychological symptoms in the absence of observable brain pathologies. These can include sensory changes, distorted body representation, and inattention to their affected limb and its surrounding space, resembling post-stroke hemispatial neglect. The precise nature and mechanisms of these neuropsychological symptoms are unclear, however insights could be gained by testing for dissociations and associations that have been observed in stroke patients. Drawing from clinical and experimental methods for investigating spatial attention bias and related symptoms in stroke patients, we conducted a detailed investigation of neuropsychological symptoms in a woman with CRPS of her left arm who initially presented to us with pronounced inattention to her affected side. The patient showed visual and tactile neglect and extinction on her affected side on confrontation tests, but no attention deficits on "bedside" tests of neglect. On sensitive computer-based measures, attention biases were found in the patient's body and near space (in Temporal Order Judgements), but not far or imagined space (on the Greyscales task and Mental Number Line Bisection). Unique to the current literature, the patient showed a reversal in her Temporal Order Judgement bias across time, from inattention (first and second session) to hyperattention (third session) to her affected side. In contrast, pain and self-reported body representation distortion were similar across the three sessions. The patient had reduced central and peripheral visual acuity, however these deficits were near symmetrical and therefore could not explain her performance on the visual attention tasks. Given that spatial attention bias has been linked to imbalance in relative activation of the two cerebral hemispheres, we administered a Global-Local processing task to test for hemispheric asymmetry. This revealed no difference in global compared to local interference refuting any hemispheric imbalance. Instead, the patient showed impaired performance (compared to controls) on incongruent trials regardless of trial type, consistent with executive impairment. We conclude that spatial attention bias in CRPS can generalize across different sensory modalities and extend beyond the affected limb to the external space around it, independent of any low-level sensory disturbances. This bias is not necessarily directed away from the affected side or stable over time. People with CRPS can also demonstrate more generalized neuropsychological changes in sensory and executive functions. Our observations refute several existing theories about the mechanisms of attention bias in CRPS, and their relationship to pain, and have potential implications for treatment.


Asunto(s)
Síndromes de Dolor Regional Complejo , Trastornos de la Percepción , Sesgo , Síndromes de Dolor Regional Complejo/complicaciones , Síndromes de Dolor Regional Complejo/diagnóstico por imagen , Síndromes de Dolor Regional Complejo/psicología , Femenino , Lateralidad Funcional , Humanos , Dolor , Dimensión del Dolor/métodos , Trastornos de la Percepción/etiología , Trastornos de la Percepción/psicología
19.
Cortex ; 140: 157-178, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33989901

RESUMEN

It has been suggested that sensorimotor conflict contributes to the maintenance of some pathological pain conditions, implying that there are problems with the adaptation processes that normally resolve such conflict. We tested whether sensorimotor adaptation is impaired in people with Complex Regional Pain Syndrome (CRPS) by characterising their adaption to lateral prismatic shifts in vision. People with unilateral upper-limb CRPS Type I (n = 17), and pain-free individuals (n = 18; matched for age, sex, and handedness) completed prism adaptation with their affected/non-dominant and non-affected/dominant arms. We examined 1) the rate at which participants compensated for the optical shift during prism exposure (i.e., strategic recalibration), 2) endpoint errors made directly after prism adaptation (sensorimotor realignment) and the retention of these errors, and 3) kinematic markers associated with strategic control. Direct comparisons between people with CRPS and controls revealed no evidence of any differences in strategic recalibration, including no evidence for differences in a kinematic marker associated with trial-by-trial changes in movement plans during prism exposure. All participants made significant endpoint errors after prism adaptation exposure, indicative of sensorimotor realignment. Overall, the magnitude of this realignment did not differ between people with CRPS and pain-free controls. However, when endpoint errors were considered separately for each hand, people with CRPS made greater errors (indicating more rather than less realignment) when using their affected hand than their non-affected hand. No such difference was seen in controls. Taken together, these findings provide no evidence of impaired strategic control or sensorimotor realignment in people with CRPS. In contrast, they provide some indication that there could be a greater propensity for sensorimotor realignment in the CRPS-affected arm, consistent with more flexible representations of the body and peripersonal space. Our study challenges an implicit assumption of the theory that sensorimotor conflict might underlie some pathological pain conditions.


Asunto(s)
Adaptación Fisiológica , Síndromes de Dolor Regional Complejo , Mano , Humanos , Movimiento , Dolor
20.
Perception ; 50(5): 399-417, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33789541

RESUMEN

Discomfort provoked by normally innocuous visual stimuli has been reported by people with chronic pain. Visual discomfort may be higher in pain conditions in which central sensitization is implicated, such as Complex Regional Pain Syndrome (CRPS) and fibromyalgia. In an online study, we validated the Leiden Visual Sensitivity Scale (L-VISS) and Visual Discomfort Scale (VDS) in people with CRPS (n = 57), fibromyalgia (n = 75), and general chronic pain (n = 53); investigated whether these groups and pain-free controls (n = 125) differed in visual discomfort; and evaluated the effect of age. The L-VISS and VDS had good internal consistency. Both scales were positively related with experimentally induced visual distortions for mid-spatial frequency striped patterns, suggesting good construct validity. The scales were positively related with each other, and dissociated between the pain and pain-free groups in similar ways, suggesting good construct validity. There was no relationship between age and L-VISS scores and a small negative relationship between age and VDS scores. Visual discomfort was highest in the fibromyalgia group, followed by the CRPS group. This research confirms the utility of the L-VISS and VDS for measuring visual sensitivity in chronic pain and adds to evidence that central sensitization is an important mechanism of visual discomfort.


Asunto(s)
Dolor Crónico , Síndromes de Dolor Regional Complejo , Fibromialgia , Humanos
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