Terminal Lucidity in a Pediatric Oncology Clinic.

ABSTRACT: The sporadic occurrence of unusually enhanced mental clarity before death has been documented over time and cultures, and reported in patients with and without neurodegenerative diseases, psychiatric disorders, and other neurocognitive deficits, as well as those with nonterminal and terminal conditions. Using a purposive sampling method via existing professional networks, clinical presentations of terminal lucidity in pediatric populations, as witnessed by pediatric oncologists and medical personnel, were solicited. We document clinical presentations suggestive of terminal lucidity in children, which were compiled by their attending physician at two large tertiary pediatric hospitals. Unanticipated and unexplained changes in mental clarity, verbal communication, and/or physical capability in the days and hours before the death of the pediatric patients were observed. Each patient's medical condition should not have allowed for such changes. The phenomenon known as terminal lucidity provides a conceptual framework for these deviations, although more systematic documentation and clinical research is required before definitive conclusions can be drawn.

Worldviews and environmental ethics: Contributions of brain processing networks.

Research suggests that worldviews define our relationship to the environment, including our responsibility to the environment and our planet. This paper examines two specific worldviews and their potential environmental impact: the materialist worldview, considered to be the dominant worldview of Western society, and the so-called post-materialist worldview. We believe that changing the worldview of both individuals and society is key to changing environmental ethics, specifically attitudes, beliefs, and actions towards the environment. Recent neuroscience research suggests that brain filters and networks contribute to concealing an expanded nonlocal awareness. This creates self-referential thinking and contributes to the limited conceptual framework characteristic of a materialist worldview. We discuss the underlying concepts of both materialist and post-materialist worldviews including their impact on environmental ethics, then explore the various types of neural filters and processing networks that contribute to a materialist worldview, and finally explore methods for modifying neural filters and changing worldviews.

Reflections on extraordinary knowing: Insight into the nature of the mind.

Scientists have spent considerable time and effort studying and mapping the geography of the brain, with the expectation that this understanding will lead to insights related to the nature of the mind. This article discusses evidence that, while the mind utilizes sensory information processed by the brain, awareness is not limited to these structures. Research studies give evidence supporting the mind's ability to expand awareness to include perception of objects and events not available to the five senses. This awareness also extends to moments in the future, including the mind's ability to access information seconds or even days in advance of the occurrence. A major brain filter that limits this capacity for expanded awareness is the Default Mode Network (DMN). We summarize research showing that when the DMN activity is reduced, e.g., through meditation, ingestion of neuromodulatory drugs, or NDEs, filtering within the brain is reduced, there is a concomitant development of new connectivity, and these neural changes are correlated with access to expanded awareness.

Spiritual awakening and transformation in scientists and academics.

The purpose of this study was to document both quantitatively and qualitatively the characteristics of spiritual awakenings and their transformational effects in scientists and academics who reported having experienced this phenomenon; it also aimed to explore barriers these individuals perceived to sharing their experiences with others within society. METHODS: An interview questionnaire was used to collect detailed descriptions of both the physical and metaphysical experiences of 54 scientists and academics having had a spiritually transformative experience (STE) (e.g., spontaneous energetic awakenings, awakenings occurring through near-death experiences (NDEs), and through spiritual practices). RESULTS AND CONCLUSIONS: Participants reported the STE as a mystical experience involving feelings of expansion (including conscious awareness leaving the body), energy rising up the spine, a sense of being enveloped in light, love or part of a unified energetic field. Principle triggers for these experiences included concentrating on spiritual matters, the presence of a spiritually developed person, and intense meditation or prayer. Transformational changes in participants included increased sensory sensitivity, creativity, and changes in beliefs, including a desire to serve others, a sense of unity with all, and the immortality of the spirit. Effects on career ranged from incorporating their new worldview and spiritual insights into the way they interacted with others within their current career, to radically changing their career to focus on questions related to the fundamental nature of consciousness or to serve others from this new perspective. Among barriers to sharing experiences, participants noted their concern that they would be misunderstood or ridiculed by others.

Perceptual phenomena associated with spontaneous experiences of after-death communication: Analysis of visual, tactile, auditory and olfactory sensations.

The purpose of this study was to create a detailed characterization of the nature of the sensory perceptions associated with after-death communication. A primary aim was to determine if perceptions of after-death communication (ADC) support one or more of three hypotheses: (1) they are the result of hallucinations or day-to-day thoughts about the deceased; (2) they are subjective phenomena reflecting the extrasensory perception of remote events; or (3) they constitute objective phenomena, perceived more solidly, as if within the physical world. Methods: The study included a quantitative analysis and qualitative first-person narrative description of part of the data set from a detailed questionnaire study (991 viable cases) investigating the phenomenology of spontaneous ADCs. Results and Conclusions: A majority of respondents reported that ADCs were distinctly different from simple thoughts about the deceased. Specifically, relative distribution of ADCs across the senses was 46% visual, 44% auditory, 48% touch, and 28% olfactory, with 34% sensing the presence of the deceased without input from the five senses. ADCs often were perceived as external and having properties of the material world (e.g., solidity, tactile qualities). Even the more nebulous 'sense of presence' cases were perceived as having a distinct location in space and as being identifiable as a specific deceased presence despite the lack of sensory cues. These elements are more compatible with hypotheses 2 and 3 than hypothesis 1.

Behavioral and ERP Correlates of Long-Term Physical and Mental Training on a Demanding Switch Task.

Physical and mental training are associated with positive effects on executive functions throughout the lifespan. However, evidence of the benefits of combined physical and mental regimes over a sedentary lifestyle remain sparse. The goal of this study was to investigate potential mechanisms, from a source-resolved event-related-potential perspective, that could explain how practicing long-term physical and mental exercise can benefit neural processing during the execution of an attention switching task. Fifty-three healthy community volunteers who self-reported long-term practice of Tai Chi (n = 10), meditation + exercise (n = 16), simple aerobics (n = 15), or a sedentary lifestyle (n = 12), aged 47.8 ± 14.6 (SD) were included in this analysis. All participants undertook high-density electroencephalography recording during a switch paradigm. Our results indicate that people who practice physical and mental exercise perform better in a task-switching paradigm. Our analysis revealed an additive effect of the combined practice of physical and mental exercise over physical exercise only. In addition, we confirmed the participation of frontal, parietal and cingulate areas as generators of event-related-potential components (N2-like and P3-like) commonly associated to the performance of switch tasks. Particularly, the N2-like component of the parietal and frontal domains showed significantly greater amplitudes in the exercise and mental training groups compared with aerobics and sedentary groups. Furthermore, we showed better performance associated with greater N2-like amplitudes. Our multivariate analysis revealed that activity type was the most relevant factor to explain the difference between groups, with an important influence of age, and body mass index, and with small effects of educational years, cardiovascular capacity, and sex. These results suggest that chronic combined physical and mental training may confer significant benefits to executive function in normally aging adults, probably through more efficient early attentional processing. Future experimental studies are needed to confirm our results and understand the mechanisms on parieto-frontal networks that contribute to the cognitive improvement associated with practicing combined mental and aerobic exercise, while carefully controlling confounding factors, such as age and body mass index.

Investigation of the phenomenology, physiology and impact of spiritually transformative experiences - kundalini awakening.

There is a paucity of research examining the phenomenology and energetic effects of spiritually transformative experiences with an energetic component, often referred to as kundalini awakenings (KAs). This limits our ability to understand and support individuals who have these often unexpected and powerful experiences. This study aimed to explore not only the nature of these experiences but also their subsequent behavioral and physiological transformative effects. Methods: An interview questionnaire was used to collect detailed descriptions of both the physical and metaphysical experiences of persons having a spiritually transformative experience (STE) (e.g., spontaneous energetic awakenings, awakenings occurring through near-death experiences, and through spiritual practices). Results: Subjects reported that the entire energetic awakening experience was mystical, involving feelings of expansion (including conscious awareness leaving the body), and a sense of being enveloped in light or love. Of 18 descriptors of experiences of energy, 85% of participants reported unusual flows of energy through or around the body. Principle triggers for these experiences included concentrating on spiritual matters, the presence of a spiritually developed person, and intense meditation or prayer. Transformational changes in participants included, e.g., increased sensory sensitivity, creativity, and changes in beliefs, including a desire to serve others, a sense of unity with all, and the immortality of the spirit. Most participants reported a lack of understanding of the STE phenomenon by healthcare professionals, resulting in their inability to address the needs of experiencers when they came to clinicians for help.

Verified account of near-death experience in a physician who survived cardiac arrest.

Research exploring the nature of near-death experiences (NDEs) is extensive. There are a variety of hypothesized mechanisms proposed to explain the origin of the experiences, including hallucinations due to physiological changes in a dying brain. However, there is growing evidence that these theories cannot explain a number of the characteristics of NDEs. In this article we present a detailed and extensively verified case study of a physician, Bettina Peyton, who experienced an NDE during the birth of her third child when she was 32 years old. The data provide additional evidence that supports the hypotheses 1) that during NDEs individuals have sensory perceptual experiences that are not possible according to the materialist framework in which consciousness is solely produced by the activity of neurons in the brain, and 2) that NDEs lead to a fundamental change in their understanding of the nature of consciousness, and in the place of the sacred in their lives.

The Seated Postural & Reaching Control Test in Cerebral Palsy: A Validation Study.

Aim: Children with moderate-severe cerebral palsy (CP) show postural control deficits that affect their daily activities, like reaching. The Seated Postural and Reaching Control test (SP&R-co) was developed to address the need for clinical measures that objectively identify dimensions of postural imbalance and corresponding reaching limitations in children with CP.Methods: SP&R-co documentation was designed for test validity and rater training. Rater and internal consistency were examined using Cronbach's α. Reference SP&R-co score sheets of children and rater's scores were used for absolute item-by-item, average inter-rater, and intra-rater reliability. Motor classification systems and performance tests were used for construct and concurrent validity.Results: The SP&R-co scoring showed acceptable-good consistency (α = 0.76-0.84). Interrelatedness of SP&R-co items was good-excellent (α = 0.82-0.97). The raters demonstrated fair, good, and excellent item-by-item reliability (ICC = 0.41-0.92). Inter-rater and intra-rater reliability of SP&R-co dimensions were good-excellent (ICC = 0.68-0.86 and ICC = 0.64-0.95, respectively). Construct and concurrent validity showed moderate-excellent correlations (r = 0.49-0.88).Conclusions: Results provide evidence that the SP&R-co is a reliable and valid test for therapists to objectively examine and quantify seated postural and reaching control in children with CP.

The Impact of Segmental Trunk Support on Posture and Reaching While Sitting in Healthy Adults.

The authors investigated postural and arm control in seated reaches while providing trunk support at midribs and pelvic levels in adults. Kinematics and electromyography of the arm and ipsiliateral and contralateral paraspinal muscles were examined before and during reaching. Kinematics remained constant across conditions, but changes were observed in neuromuscular control. With midribs support, the ipsilateral cervical muscle showed either increased anticipatory activity or earlier compensatory muscle responses, suggesting its major role in head stabilization. The baseline activity of bilateral lumbar muscles was enhanced with midribs support, whereas with pelvic support, the activation frequency of paraspinal muscles increased during reaching. The results suggest that segmental trunk support in healthy adults modulates ipsilateral or contralateral paraspinal activity while overall kinematic outputs remain invariant.

The functional effect of segmental trunk and head control training in moderate-to-severe cerebral palsy: A randomized controlled trial.

PURPOSE: To determine whether segmental training is more effective in improving gross motor function in children and young people with moderate-to-severe cerebral palsy than conventional physiotherapy. METHODS: Twenty-eight participants were randomized to a segmental training or control group. Outcomes were Gross Motor Function Measure (GMFM), Pediatric Evaluation of Disability Inventory (PEDI), Segmental Assessment of Trunk Control (SATCo), and postural sway at baseline, at primary endpoint (6 months), and at follow-up (12 months). RESULTS: There were no significant differences in either GMFM, PEDI, or SATCo scores at primary endpoint or follow-up. There were significant reductions in anterior-posterior head angular sway and trunk sway in the segmental training group at primary endpoint but not at follow-up. CONCLUSION: Segmental training was not superior to usual care in improving GMFM. Improvements in head and trunk sway were greater in the segmental training group at primary endpoint but not at follow-up.

Effect of Biomechanical Constraints on Neural Control of Head Stability in Children With Moderate to Severe Cerebral Palsy.

BACKGROUND: External support has been viewed as an important biomechanical constraint for children with deficits in postural control. Nonlinear analysis of head stability may be helpful to confirm benefits of interaction between external trunk support and level of trunk control. OBJECTIVE: The purpose of this study was to compare the effect of biomechanical constraints (trunk support) on neural control of head stability during development of trunk control. DESIGN: This was a quasi-experimental repeated-measures study. METHODS: Data from 15 children (4-16 years of age) with moderate (Gross Motor Function Classification System [GMFCS] IV; n=8 [4 boys, 4 girls]) or severe (GMFCS V; n=7 [4 boys, 3 girls]) cerebral palsy (CP) were compared with previous longitudinal data from infants with typical development (TD) (3-9 months of age). Kinematic data were used to document head sway with external support at 4 levels (axillae, midrib, waist, and hip). Complexity, predictability, and active degrees of freedom for both anterior-posterior and medial-lateral directions were assessed. RESULTS: Irrespective of level of support, CP groups had lower complexity, increased predictability, and greater degrees of freedom. The effect of support differed based on the child's segmental level of control. The GMFCS V and youngest TD groups demonstrated better head control, with increased complexity and decreased predictability, with higher levels of support. The GMFCS IV group had the opposite effect, showing decreased predictability and increased complexity and degrees of freedom with lower levels of support. LIMITATIONS: Infants with typical development and children with CP were compared based on similar segmental levels of trunk control; however, it is acknowledged that the groups differed for age, cognitive level, and motor experience. CONCLUSIONS: The effect of external support varied depending on the child's level of control and diagnostic status. Children with GMFCS V and young infants with TD had better outcomes with external support, but external support was not enough to completely correct for the influence of CP. Children with GMFCS IV performed worse, with increased predictability and decreased complexity, when support was at the axillae or midribs, suggesting that too much support can interfere with postural sway quality.

Vestibular control of standing balance is enhanced with increased cognitive load.

When cognitive load is elevated during a motor task, cortical inhibition and reaction time are increased; yet, standing balance control is often unchanged. This disconnect is likely explained by compensatory mechanisms within the balance system such as increased sensitivity of the vestibulomotor pathway. This study aimed to determine the effects of increased cognitive load on the vestibular control of standing balance. Participants stood blindfolded on a force plate with their head facing left and arms relaxed at their sides for two trials while exposed to continuous electrical vestibular stimulation (EVS). Participants either stood quietly or executed a cognitive task (double-digit arithmetic). Surface electromyography (EMG) and anterior-posterior ground-body forces (APF) were measured in order to evaluate vestibular-evoked balance responses in the frequency (coherence and gain) and time (cumulant density) domains. Total distance traveled for anterior-posterior center of pressure (COP) was assessed as a metric of balance variability. Despite similar distances traveled for COP, EVS-medial gastrocnemius (MG) EMG and EVS-APF coherence and EVS-TA EMG and EVS-MG EMG gain were elevated for multiple frequencies when standing with increased cognitive load. For the time domain, medium-latency peak amplitudes increased by 13-54% for EVS-APF and EVS-EMG relationships with the cognitive task compared to without. Peak short-latency amplitudes were unchanged. These results indicate that reliance on vestibular control of balance is enhanced when cognitive load is elevated. This augmented neural strategy may act to supplement divided cortical processing resources within the balance system and compensate for the acute neuromuscular modifications associated with increased cognitive demand.

Electrocortical Sources Related to Whole-Body Surface Translations during a Single- and Dual-Task Paradigm.

Appropriate reactive motor responses are essential in maintaining upright balance. However, little is known regarding the potential location of cortical sources that are related to the onset of a perturbation during single- and dual-task paradigms. The purpose of this study was to estimate the location of cortical sources in response to a whole-body surface translation and whether diverted attention decreases the N1 event-related potential (ERP) amplitude related to a postural perturbation. This study utilized high-resolution electroencephalography in conjunction with measure projection analysis from ERPs time-locked to backwards surface translation onsets to determine which cortical sources were related to whole-body postural perturbations. Subjects (n = 15) either reacted to whole-body surface translations with (dual task) or without (single task) performing a visual working memory task. For the single task, four domains were identified that were mainly localized within the frontal and parietal lobes and included sources from the prefrontal, premotor, primary and supplementary motor, somatosensory and anterior cingulate cortex. Five domains were estimated for the dual task and also included sources within the frontal and parietal lobes, but the sources also shifted to other locations that included areas within the temporal and occipital lobes. Additionally, mean absolute N1 ERP amplitudes representing the activity from similar locations in both tasks were greater for the single than dual task. The present localization results highlight the importance of frontal, parietal and anterior cingulate cortical areas in reactive postural control and suggest a re-allocation or shift of cortical sources related to reactive balance control in the presence of a secondary task. Thus, this study provides novel insight into the underlying neurophysiology and contribution of cortical sources in relation to the neural control of reactive balance.

Effect of Segmental Trunk Support on Posture and Reaching in Children With Cerebral Palsy.

PURPOSE: To test the effects of segmental trunk support on seated postural and reaching control in children with cerebral palsy. METHODS: Seventeen children (age range 2-15 y, Gross Motor Function Classification System levels III-V) were classified with the Segmental Assessment of Trunk Control into mild (complete trunk control/lower lumbar deficits), moderate (thoracic/upper lumbar deficits), and severe (cervical/upper thoracic deficits). Postural and arm kinematics were measured while reaching with trunk support at axillae, mid-ribs, or pelvis. RESULTS: Children in the mild group did not display changes in posture or reaching across conditions. The moderately involved group showed decrements in postural and reaching performance with pelvic compared with higher supports (P < .01). Children in the severe group were unable to maintain posture with pelvic support and showed postural deficiencies with mid-ribs compared with axillae support (P < .01). CONCLUSIONS: Children with cerebral palsy and trunk dysfunction demonstrate improved motor performance when the external assistance matches their intrinsic level of trunk control.

Corrigendum: The development of trunk control and its relation to reaching in infancy: a longitudinal study.

[This corrects the article on p. 94 in vol. 9, PMID: 25759646.].

The development of trunk control and its relation to reaching in infancy: a longitudinal study.

The development of reaching is crucially dependent on the progressive control of the trunk, yet their interrelation has not been addressed in detail. Previous studies on seated reaching evaluated infants during fully supported or unsupported conditions; however, trunk control is progressively developed, starting from the cervical/thoracic followed by the lumbar/pelvic regions for the acquisition of independent sitting. Providing external trunk support at different levels to test the effects of controlling the upper and lower regions of the trunk on reaching provides insight into the mechanisms by which trunk control impacts reaching in infants. Ten healthy infants were recruited at 2.5 months of age and tested longitudinally, until 8 months. During the reaching test, infants were placed in an upright seated position and an adjustable support device provided trunk fixation at pelvic and thoracic levels. Kinematic and electromyographic data were collected. Results showed that prior to independent sitting, postural instability was higher when infants were provided with pelvic compared to thoracic support. Associated reaches were more circuitous, less smooth and less efficient. In response to the instability, there was increased postural muscle activity and arm muscle co-activation. Differences between levels of support were not observed once infants acquired independent sitting. These results suggest that trunk control is acquired in a segmental sequence across the development of upright sitting, and it is tightly correlated with reaching performance.

Measuring postural sway in sitting: a new segmental approach.

Global measures of trunk sway are traditionally used even though the trunk comprises a multiple number of segments. The authors' aim was to measure the seated sway of typically developing children using a multisegment approach. Twenty typically developing children divided into 2 groups, older and younger than 10 years old, participated in this study. The children sat unsupported for 30 s while their posture and sway were quantified using stereophotogrammetry. The tendency in both age groups was to sit with a backward tilted pelvis and a kyphotic trunk. The sitting position was most varied in the younger group. Marker sway amplitude and velocity in sitting were age dependent, with reduced sway amplitude and velocity with increased age for all segments. Anteroposterior intersegmental angular sway was not age dependent. The difference in marker sway in the anteroposterior direction for the younger group appeared to result from an equally stable trunk supported on a less stable pelvis. Mediolateral marker sway and intersegmental angular sway showed a clearer age dependency. Trunk postural control does not appear to differ between children older and younger than 10 years old, but sagittal plane pelvic stability can explain the increased sway reported in younger children.