What good emotional care for miscarriage looks like: A mixed-methods investigation in an Australian private hospital setting.

BACKGROUND: Miscarriage is a common medical occurrence which can be associated with significant psychological distress. Patients and partners are frequently disappointed by aspects of their care, especially with regard to emotional support. Although most published studies investigated the experiences of patients and partners in emergency departments (EDs) of public hospitals, miscarriage is also frequently diagnosed in non-emergency settings, such as during sonography or antenatal appointments, and approximately 25% of Australian women receive maternity care in private hospitals. AIM: Because the experience of miscarriage is known to be setting-dependent, it is important to understand how patients and partners experience care outside the ED. Here, we addressed this gap by investigating the experiences of patients and partners who attended a private maternity hospital for miscarriage using a mixed-methods approach. MATERIALS AND METHODS: Eighteen patients and six partners who had recently experienced a miscarriage were recruited at a private maternity hospital to take part in both semi-structured interviews and online surveys. RESULTS: Overall, patients and partners were highly satisfied with the emotional care they received. Thematic analysis of semi-structured interviews allowed us to identify a total of ten themes that contributed to satisfaction with emotional care. CONCLUSIONS: We provide the first specific insights into the experiences of women and partners who received care for miscarriage in an Australian private hospital setting, and the first example of a healthcare setting that achieves high satisfaction with emotional care around miscarriage. The ten themes we identify provide a framework for improving satisfaction with care also in other settings.

Toward Optimal Emotional Care During the Experience of Miscarriage: An Integrative Review of the Perspectives of Women, Partners, and Health Care Providers.

INTRODUCTION: Miscarriage is frequently associated with significant emotional impact, causing psychological distress, trauma, and grief. Unfortunately, women and partners frequently report dissatisfaction with care around miscarriage, and health care providers report feeling ill-prepared and underequipped to provide emotional support. This integrative review synthesizes the individual perspectives of the woman experiencing the miscarriage, the partner, and the different health care provider roles involved in the care to better understand what future research is necessary to improve the experiences of bereaved parents and their health care providers. METHODS: Electronic databases were searched for studies that covered emotional care around miscarriage from the perspective of women, partners, or health care providers. The review included studies published in English between 2015 and 2022, using either quantitative or qualitative methods. Thematic analysis was carried out, and conclusions from these articles were integrated into themes and subthemes. RESULTS: A total of 60 studies met the inclusion criteria. Two main themes were identified for women: (1) a need for more information and (2) a need for acknowledgment of their loss. Two main themes were likewise identified for partners: (1) a need for more information and (2) a need for recognition. Three main themes were identified for health care providers: (1) a need for additional training, (2) components of quality care, and (3) perceived barriers to providing care. DISCUSSION: There is broad overlap in the needs identified by bereaved parents and their health care providers, as well as general agreement regarding the barriers to providing effective care. Five areas of future research priority were identified to understand how best to meet these needs: empirical evaluation of strategies to meet identified needs, investigation of setting-specific needs, integrated consideration of all relevant roles, investigation of the care needs of diverse groups, and an investigation of the predictors of emotional impact.

The rubber hand illusion in children: What are we measuring?

The rubber hand illusion (RHI) is a much-studied bodily illusion that has been used in a wide number of populations to investigate the plasticity of the mental body representation. In adult participants, the wide adoption of the illusion has led to a proliferation of experimental variations of the illusion, and with that, considerable apparent inconsistencies in both empirical results and conceptual interpretations. In turn, this makes it challenging to integrate empirical findings and to identify what those findings together can tell us about the representation of the body in the brain. More recently, scientists have started applying the illusion to populations of children, in order to better understand how body representations develop in both typically developing children and in clinical populations. With this field now starting to expand, we believe it is both urgent and important to prevent unintended methodological variability from hindering the consistency of the paediatric literature as it has the adult literature. With this aim in mind, we review the 12 currently available paediatric RHI studies, and summarise their key methodological choices and conceptual definitions. We highlight a number of important discrepancies, particularly where seemingly equivalent analysis choices might significantly affect the interpretation of results, and make recommendations for future studies. We hope this will allow this important and emerging field to benefit from the synergy that results from multiple studies using convergent and consistent empirical methods.

Talking to Teens about Pain: A Modified Delphi Study of Adolescent Pain Science Education.

Background: Persistent pain is a prevalent condition that negatively influences physical, emotional, social and family functioning in adolescents. Pain science education is a promising therapy for adults, yet to be thoroughly investigated for persistent pain in adolescents. There is a need to develop suitable curricula for adolescent pain science education. Methods: An interdisciplinary meeting of 12 clinicians and researchers was held during March 2018 in Adelaide, South Australia. An a priori objective of the meeting was to identify and gain consensus on key learning objectives for adolescent pain science education using a modified-Delphi process. Results and Conclusion: Consensus was reached via a modified Delphi process for seven learning objectives to form the foundation of a curriculum: 1) Pain is a protector; 2) The pain system can become overprotective; 3) Pain is a brain output; 4) Pain is not an accurate marker of tissue state; 5) There are many potential contributors to anyone's pain; 6) We are all bioplastic and; 7) Pain education is treatment. Recommendations are made for promising areas for future research in adolescent pain science education.

Contexte: La douleur persistante est une pathologie répandue qui influence négativement le fonctionnement physique, émotionnel, social et familial chez les adolescents. L'éducation à la science de la douleur est une thérapie prometteuse pour les adultes, mais doit encore faire l'objet d'études plus approfondies en ce qui concerne la douleur persistante chez les adolescents. Il est nécessaire d'élaborer des programmes d'études appropriés pour l'éducation aux sciences de la douleur chez les adolescents.Méthodes: Une réunion interdisciplinaire de 12 cliniciens et chercheurs s'est tenue en mars 2018 à Adélaïde, en Australie du Sud. L'un des objectifs de la réunion fixé a priori était de déterminer par consensus les principaux objectifs d'apprentissage de l'éducation à la science de la douleur chez les adolescents à l'aide d'un processus Delphi modifié.Résultats et conclusion: Un processus Delphi modifié a permis d'atteindre un consensus sur les sept objectifs d'apprentissage qui devraient constituer la base d'un programme d'études : 1) La douleur est un protecteur ; 2) Le système de la douleur peut devenir surprotecteur ; 3) La douleur est un produit du cerveau; 4) La douleur n'est pas un marqueur précis de l'état des tissus ; 5) Il y a beaucoup de acteurs contributifs potentiels à la douleur de chaque personne; 6) Nous sommes biologiquement plastiques et; 7) L'éducation à la douleur est un traitement. Des recommandations sont formulées en ce qui concerne les domaines les plus prometteurs sur lesquels devraient porter les futures études en matière d'éducation des adolescents à la science de la douleur.

Self-touch modulates the somatosensory evoked P100.

It has recently been shown that contact between one's own limbs (self-touch) reduces the perceived intensity of pain, over and above the well-known modulation of pain by simultaneous colocalized tactile input Kammers et al. (Curr Biol 20:1819-1822, 2010). Here, we investigate how self-touch modulates somatosensory evoked potentials (SEPs) evoked by afferent somatosensory input. We show that the P100 SEP component, which has previously been implicated in the conscious perception of a tactile stimulus, is enhanced during self-touch, as compared to when one is touching nothing, an inanimate object, or another person. A follow-up experiment showed that there was no effect of self-touch on SEPs when the body parts in contact were not symmetric. Altogether, our findings suggest the interpretation that the secondary somatosensory cortex might underlie the specific analgesic effect of self-touch.

Feeling numb: temperature, but not thermal pain, modulates feeling of body ownership.

There is an important link between pain, regulation of body temperature, and body ownership. For example, an altered feeling of body ownership - due to either chronic pain or "rubber-hand illusions" (RHI) - is associated with reduced temperature of the affected limb. However, the causal relationships within this triad are not well understood. We therefore investigated whether external manipulation of body temperature can influence body ownership. We used a thermode to make the right hand of healthy participants either painfully cold, cool, neutral, warm or painfully hot. Next, we induced the RHI and investigated its effects on the perceived position of the hand, on the subjective feeling of body ownership, and on physical changes in hand temperature. We replicate previous reports that inducing the RHI produces a decrease in limb temperature. Importantly, we demonstrate for the first time a causal effect in the opposite direction. Cooling down the participant's hand increased the strength of the RHI, while warming the hand externally decreased the strength of the RHI. Finally, we show that the painful extremes of these temperatures do not modulate the RHI. Hence, while thermosensation is an important driver of body ownership, pain seems to bypass the multisensory mechanisms of embodiment.

Visual distortion of body size modulates pain perception.

Pain is a complex subjective experience that is shaped by numerous contextual factors. For example, simply viewing the body reduces the reported intensity of acute physical pain. In this study, we investigated whether this visually induced analgesia is modulated by the visual size of the stimulated body part. We measured contact heat-pain thresholds while participants viewed either their own hand or a neutral object in three size conditions: reduced, actual size, or enlarged. Vision of the body was analgesic, increasing heat-pain thresholds by an average of 3.2 °C. We further found that visual enlargement of the viewed hand enhanced analgesia, whereas visual reduction of the hand decreased analgesia. These results demonstrate that pain perception depends on multisensory representations of the body and that visual distortions of body size modulate sensory components of pain.

Cooling the thermal grill illusion through self-touch.

Acute peripheral pain is reduced by multisensory interactions at the spinal level [1]. Central pain is reduced by reorganization of cortical body representations [2, 3]. We show here that acute pain can also be reduced by multisensory integration through self-touch, which provides proprioceptive, thermal, and tactile input forming a coherent body representation [4, 5]. We combined self-touch with the thermal grill illusion (TGI) [6]. In the traditional TGI, participants press their fingers on two warm objects surrounding one cool object. The warm surround unmasks pain pathways, which paradoxically causes the cool object to feel painfully hot. Here, we warmed the index and ring fingers of each hand while cooling the middle fingers. Immediately after, these three fingers of the right hand were touched against the same three fingers on the left hand. This self-touch caused a dramatic 64% reduction in perceived heat. We show that this paradoxical release from paradoxical heat cannot be explained by low-level touch-temperature interactions alone. To reduce pain, we often clutch a painful hand with the other hand. We show here that self-touch not only gates pain signals reaching the brain [7-9] but also, via multisensory integration, increases coherence of cognitive body representations to which pain afferents project [10].

How many motoric body representations can we grasp?

At present there is a debate on the number of body representations in the brain. The most commonly used dichotomy is based on the body image, thought to underlie perception and proven to be susceptible to bodily illusions, versus the body schema, hypothesized to guide actions and so far proven to be robust against bodily illusions. In this rubber hand illusion study we investigated the susceptibility of the body schema by manipulating the amount of stimulation on the rubber hand and the participant's hand, adjusting the postural configuration of the hand, and investigating a grasping rather than a pointing response. Observed results showed for the first time altered grasping responses as a consequence of the grip aperture of the rubber hand. This illusion-sensitive motor response challenges one of the foundations on which the dichotomy is based, and addresses the importance of illusion induction versus type of response when investigating body representations.

The weight of representing the body: addressing the potentially indefinite number of body representations in healthy individuals.

There is little consensus about the characteristics and number of body representations in the brain. In the present paper, we examine the main problems that are encountered when trying to dissociate multiple body representations in healthy individuals with the use of bodily illusions. Traditionally, task-dependent bodily illusion effects have been taken as evidence for dissociable underlying body representations. Although this reasoning holds well when the dissociation is made between different types of tasks that are closely linked to different body representations, it becomes problematic when found within the same response task (i.e., within the same type of representation). Hence, this experimental approach to investigating body representations runs the risk of identifying as many different body representations as there are significantly different experimental outputs. Here, we discuss and illustrate a different approach to this pluralism by shifting the focus towards investigating task-dependency of illusion outputs in combination with the type of multisensory input. Finally, we present two examples of behavioural bodily illusion experiments and apply Bayesian model selection to illustrate how this different approach of dissociating and classifying multiple body representations can be applied.

Being in the dark about your hand: resolution of visuo-proprioceptive conflict by disowning visible limbs.

Conflict between sensory modalities can be resolved by one modality overwriting another. For example, movement of a limb that is visible in a stationary visual afterimage results in selective fading of that limb in the afterimage. We investigated the interaction of these two sensory modalities by inducing a mismatch between visual and proprioceptive hand location. Whereas this discrepancy did not affect the initial appearance of the hand in the afterimage, it did prevent subsequent motion with the hand from affecting the hand's appearance. Location mismatch disconnected the visual and proprioceptive experiences of the hand, "protecting" the visual afterimage from interaction with proprioception. Investigation of subjective higher order bodily experiences showed a strong negative correlation between afterimage disruption and the subjective feeling of ownership, suggesting that the brain can resolve multimodal location mismatch by 'disowning' a visible limb, and that the interaction between proprioception and vision is mediated by higher order bodily experiences.

Self awareness and the body image.

What mental representations give us the sense of our body as a unique object in the world? We investigated this issue in the context of the rubber hand illusion (RHI), an illusion of body image in which a prosthetic hand brushed synchronously, but not asynchronously, with one's own hand is perceived as actually being one's hand. We conducted a large-scale study of the RHI, and used psychometric analysis to reveal the structure of the subjective experience of embodiment [Longo et al. (2008). What is embodiment? A psychometric approach. Cognition,107, 978-998]. Here, we use this dataset to investigate the relation between incorporation of a rubber hand into the body image and the perceived similarity between the participant's hand and the rubber hand. Objective similarity (as measured by skin luminance, hand shape, and third-person similarity ratings) did not appear to influence participants' experience of the RHI. Conversely, incorporation of the rubber hand into the body image did affect the similarity that participants perceived between their own hand and the rubber hand. Participants who had experienced the RHI perceived their hand and the rubber hand as significantly more similar than participants who had not experienced the illusion. That is, embodiment leads to perceived similarity, but perceived similarity does not lead to embodiment. Furthermore, similarity ratings following the illusion were selectively correlated with some components of embodiment, but not with others. These results suggest an important role of a mental body image in the perception of the relation between the self and others.

Specificity and coherence of body representations.

Bodily illusions differently affect body representations underlying perception and action. We investigated whether this task dependence reflects two distinct dimensions of embodiment: the sense of agency and the sense of the body as a coherent whole. In experiment 1 the sense of agency was manipulated by comparing active versus passive movements during the induction phase in a video rubber hand illusion (vRHI) setup. After induction, proprioceptive biases were measured both by perceptual judgments of hand position, as well as by measuring end-point accuracy of subjects' active pointing movements to an external object with the affected hand. The results showed, first, that the vRHI is largely perceptual: passive perceptual localisation judgments were altered, but end-point accuracy of active pointing responses with the affected hand to an external object was unaffected. Second, within the perceptual judgments, there was a novel congruence effect, such that perceptual biases were larger following passive induction of vRHI than following active induction. There was a trend for the converse effect for pointing responses, with larger pointing bias following active induction. In experiment 2, we used the traditional RHI to investigate the coherence of body representation by synchronous stimulation of either matching or mismatching fingers on the rubber hand and the participant's own hand. Stimulation of matching fingers induced a local proprioceptive bias for only the stimulated finger, but did not affect the perceived shape of the hand as a whole. In contrast, stimulation of spatially mismatching fingers eliminated the RHI entirely. The present results show that (i) the sense of agency during illusion induction has specific effects, depending on whether we represent our body for perception or to guide action, and (ii) representations of specific body parts can be altered without affecting perception of the spatial configuration of the body as a whole.

Is this hand for real? Attenuation of the rubber hand illusion by transcranial magnetic stimulation over the inferior parietal lobule.

In the rubber hand illusion (RHI), participants incorporate a rubber hand into a mental representation of one's body. This deceptive feeling of ownership is accompanied by recalibration of the perceived position of the participant's real hand toward the rubber hand. Neuroimaging data suggest involvement of the posterior parietal lobule during induction of the RHI, when recalibration of the real hand toward the rubber hand takes place. Here, we used off-line low-frequency repetitive transcranial magnetic stimulation (rTMS) in a double-blind, sham-controlled within-subjects design to investigate the role of the inferior posterior parietal lobule (IPL) in establishing the RHI directly. Results showed that rTMS over the IPL attenuated the strength of the RHI for immediate perceptual body judgments only. In contrast, delayed perceptual responses were unaffected. Furthermore, ballistic action responses as well as subjective self-reports of feeling of ownership over the rubber hand remained unaffected by rTMS over the IPL. These findings are in line with previous research showing that the RHI can be broken down into dissociable bodily sensations. The illusion does not merely affect the embodiment of the rubber hand but also influences the experience and localization of one's own hand in an independent manner. Finally, the present findings concur with a multicomponent model of somatosensory body representations, wherein the IPL plays a pivotal role in subserving perceptual body judgments, but not actions or higher-order affective bodily judgments.

What is embodiment? A psychometric approach.

What is it like to have a body? The present study takes a psychometric approach to this question. We collected structured introspective reports of the rubber hand illusion, to systematically investigate the structure of bodily self-consciousness. Participants observed a rubber hand that was stroked either synchronously or asynchronously with their own hand and then made proprioceptive judgments of the location of their own hand and used Likert scales to rate their agreement or disagreement with 27 statements relating to their subjective experience of the illusion. Principal components analysis of this data revealed four major components of the experience across conditions, which we interpret as: embodiment of rubber hand, loss of own hand, movement, and affect. In the asynchronous condition, an additional fifth component, deafference, was found. Secondary analysis of the embodiment of runner hand component revealed three subcomponents in both conditions: ownership, location, and agency. The ownership and location components were independent significant predictors of proprioceptive biases induced by the illusion. These results suggest that psychometric tools may provide a rich method for studying the structure of conscious experience, and point the way towards an empirically rigorous phenomenology.

A case of illusory own-body perceptions after transcranial magnetic stimulation of the cerebellum.

Illusory own-body perceptions are 'body in space' misinterpretations of the brain and belong to the class of out-of-body experiences wherein the angular gyrus seems importantly implicated. In the present study additional cerebellum involvement in illusory own-body perceptions was investigated in a healthy young female right-handed volunteer. Transcranial magnetic stimulation (TMS) was applied over the cerebellum. Placebo cerebellum TMS and occipital TMS served as control conditions. Illusory own-body perceptions accompanied by electric brain activity over the somatosensory cortex were only observed after cerebellum TMS. The data provide the first evidence that the cerebellum might be involved in a neuronal network underlying illusory own-body perceptions.

Perception of emotional facial expressions at different intensities in early-symptomatic Huntington's disease.

BACKGROUND: While there is abundant evidence that patients with Huntington's disease (HD) have an impairment in the recognition of the emotional facial expression of disgust, previous studies have only examined emotion perception using full-blown facial expressions. OBJECTIVE: The current study examines the perception of facial emotional expressions in HD at different levels of intensity to investigate whether more subtle deficits can be detected, possible also in other emotions. METHOD: We compared early symptomatic HD patients with healthy matched controls on emotion perception, presenting short video clips of a neutral face changing into one of the six basic emotions (happiness, anger, fear, surprise, disgust and sadness) with increasing intensity. Overall face perception ability as well as depressive symptoms were taken into account. RESULTS: A specific impairment in recognizing the emotions disgust and anger was found, which was present even at low emotion intensities. CONCLUSION: These results extend previous findings and support the use of more sensitive emotion perception paradigms, which enable the detection of subtle neurobehavioral deficits even in the pre- and early symptomatic stages of the disease.