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Visuo-tactile cross-modal associations in cortical somatosensory cells.

Recent studies show that cells in the somatosensory cortex are involved in the short-term retention of tactile information. In addition, some somatosensory cells appear to retain visual information that has been associated with the touch of an object. The presence of such cells suggests that nontactile stimuli associated with touch have access to cortical neuron networks engaged in the haptic sense. Thus, we inferred that somatosensory cells would respond to behaviorally associated visual and tactile stimuli. To test this assumption, single units were recorded from the anterior parietal cortex (Brodmann's areas 3a, 3b, 1, and 2) of monkeys performing a visuo-haptic delay task, which required the memorization of a visual cue for a tactile choice. Most cells responding to that cue responded also to the corresponding object presented for tactile choice. Significant correlations were observed in some cells between their differential reactions to tactile objects and their differential reactions to the associated visual cues. Some cells were recorded in both the cross-modal task and a haptic unimodal task, where the animal had to retain a tactile cue for a tactile choice. In most of these cells, correlations were observed between stimulus-related firing in corresponding cue periods of the two tasks. These findings suggest that cells in somatosensory cortex are the components of neuronal networks representing tactile information. Associated visual stimuli may activate such networks through visuo-haptic associations established by behavioral training.

Animals↗

Upper limb exteroceptive somatosensory and proprioceptive sensory afferent modulation of hemispatial neglect.

In many paradigms of stimulation techniques aimed at reducing hemispatial neglect, somatosensory and proprioceptive stimulation are often interchanged, although the anatomical and functional pathways transmitting these signals are clearly different. Therefore, we have investigated the effects of one somatosensory stimulation technique, the cyclic pressure application (CPA), and have compared them with the effects of left transcutaneous electrical stimulation (TENS) on the expression of left hemispatial neglect in 13 stroke patients, as assessed by two visuospatial exploration tasks: the Star Cancellation task and Schenkenberg's Line Bisection task. In a first experiment, four treatment conditions were given: TENS, CPA, TENS + CPA, as well as a placebo condition. For each patient, the intensity of the TENS was determined, based on his/her conscious somatosensory threshold for the electrical impulses. In order to determine whether unconscious proprioceptive afferent information instead of exteroceptive somatosensory stimulation is a sufficient condition to improve hemispatial neglect, we carried out a second experiment, only with patients suffering from complete somatosensory loss. The effects of the different treatments were investigated, using the same sequence as for Experiment 1, but, this time, the applied intensity of TENS was manipulated over two conditions : (1) one in which the intensity of TENS stimulation was below the motor (proprioceptive) threshold and (2) one in which the intensity was determined following the degree of proprioceptive stimulation demonstrated by the point at which a visible muscle contraction during the stimulation could be elicited. The results demonstrated that proprioceptive-based TENS stimulation is a sufficient condition to reduce hemispatial neglect, even when a severe somatosensory loss was present.

Aged↗

The use of hypnosis in a deaf patient with multiple personality disorder: a case report.

We present the first report of multiple personality disorder (MPD) in a prelingually deaf patient and the first description of alter personalities as the source of auditory hallucinations in a nonpsychotic deaf person. This young woman's history and clinical symptoms of MPD did not differ from those of hearing patients. A hypnotic trance was induced by instructing the patient in muscle relaxation, modeling relaxation with exhalation, and having the patient focus her gaze on the hypnotist repeatedly fingerspelling R-E-L-A-X. Hypnosis facilitated automatic handwriting, allowed the first meeting with an alter personality, and speeded the diagnostic process. Fingerspelling has not previously been reported in hypnosis of the deaf. It is a practical means of induction for a therapist who lacks fluent signing skills. It provides a narrow fix of gaze and avoids induction by physical stimulation, a process that some abused patients find upsetting.

Adult↗

Responses to innocuous, but not noxious, somatosensory stimulation by neurons in the ferret superior colliculus.

The intermediate and deep layers of the superior colliculus (SC) are known for their role in initiating orienting behaviors. To direct these orienting functions, the SC of some animals (e.g., primates, carnivores) is dominated by inputs from the distance senses (vision, audition). In contrast, the rodent SC relies more heavily on non-visual inputs, such as touch and nociception, possibly as an adaptive response to the proximity of dangers encountered during their somatosensory-dominant search behaviors. The ferret (a carnivore) seems to employ strategies of both groups: above ground they use visual/auditory cues, but during subterranean hunting ferrets must rely on non-visual signals to direct orienting. Therefore, the present experiments sought to determine whether the sensory inputs to the ferret SC reveal adaptations common to functioning in both environments. The results showed that the ferret SC is dominated (63%; 181/286) by visual/auditory inputs (like the cat), rather than by somatosensory inputs (as found in rodents). Furthermore, tactile responses were driven primarily from hair-receptors (like cats), not from the vibrissae (as in rodents). Additionally, while a majority of collicular neurons in rodents respond to brief noxious stimulation, no such neurons were encountered in the ferret SC. A small proportion (4%; 13/286) of the ferret SC neurons were responsive to long-duration (>5 s) noxious stimulation, but further tests could not establish these responses as nociceptive. Collectively, these data indicate that the ferret SC is best adapted for the animal's visuallacoustically guided activities and most closely resembles the SC of its phylogenetic relative, the cat.

Acoustic Stimulation↗

Attention-related, cross-modality modulation of somatosensory neurons in primate ventrobasal (VB) thalamus.

Attention-related modulation (AM) of the somatosensory responses of single neurons has been demonstrated in the cerebral cortex and medullary dorsal horn, but not in the ventrobasal thalamus. The somatically evoked activity was recorded of single units in the ventral posterior lateral thalamus (VPL) of awake monkeys while they detected the termination of task-relevant somatic or visual stimuli. Eighteen of 56 somatically responsive VPL neurons are reported that were recorded for enough time for a complete analysis of their responses during both the visual and somatic attention tasks. All neurons were spontaneously active and responded either to innocuous cutaneous (13/18) or deep (5/18) stimuli. Seven neurons (7/18, 38.8%) showed AM of somatosensory responsiveness. Two cells (2/7, 28.6%) showed AM only during the visual task, two others (2/7, 28.6%) only during the somatosensory task, and three cells (3/7, 42.8%) showed AM during both tasks. All five cells showing AM during the somatosensory task had enhanced responses to the task-relevant somatic stimulus. In contrast, the somatosensory responses of all five cells showing AM during the visual task were reduced. It is concluded that selective attention is associated with a modality specific modulation of the somatosensory responses of a sub-population of neurons within the primate VPL nucleus.

Animals↗

Rehabilitative management of post-stroke visuospatial inattention.

PURPOSE: Visuospatial inattention or sensory neglect is a common impairment following cerebrovascular accident and is thought to negatively impact on functional recovery and long-term outcome. This review examines various rehabilitative interventions available for the management of visuospatial inattention and the literature that supports their efficacy. METHOD: Medical literature review. RESULTS: Therapies geared toward improved visual scanning and 'retraining' of patients to attend to the neglected field are the mainstay of current therapy. While some studies support their efficacy, others have reported limited benefit. Newer approaches that may be efficacious include eye patching techniques, use of video feedback during therapy, training in visual imagery, and pharmacologic therapy with dopamine agonists. Protocols using vestibular, somatosensory and optokinetic stimulation have each been shown to produce transient improvements in neglect. However, therapeutic applications for these techniques have not been studied. CONCLUSIONS: A number of approaches toward the rehabilitation of post-stroke neglect are described in the literature. Further research is needed to better define which techniques may prove most beneficial.

Aged↗

Radial artery remodeling in response to shear stress increase within arteriovenous fistula for hemodialysis access.

It is known that changes in blood flow induce vascular remodeling and that shear stress, the tractive force acting on the vessel wall due to blood flowing, influences endothelial cell function. The aim of the present study was to investigate the relation between changes in pulsatile shear forces and arterial remodeling in response to chronic elevation in blood flow within the radial artery. The authors studied vessel diameter, flow rate, and shear stress in the radial artery of uremic patients before and after surgical creation of a native arteriovenous fistula for hemodialysis access. For this purpose, the authors used echo-color-Doppler ultrasound to perform diameter and blood velocity measurements. Time-function blood flow rate and wall shear stress were calculated based on arterial diameter, center-line velocity wave-form, and blood viscosity, using a numerical method developed according to Womersley's theory for unsteady flow in tubes. The results confirmed that the radial artery diameter increases in response to a chronic increase in blood flow in uremic patients. Moreover, it seems that the radial artery dilates in such a way as to maintain the peak wall shear stress constant, suggesting that endothelial cells sense the maximum rather than the time-averaged wall shear stress. This finding may lead to further understanding of the mechanisms responsible for endothelial response to physical stimulation by flowing blood.

Adult↗

Botulinum toxin type-A and plaster cast treatment in children with upper brachial plexus palsy.

BACKGROUND AND PURPOSE: Electrical stimulation, physical therapy and occupational therapy remain the main treatment for children with upper brachial plexus palsy (UBPP), when surgery has been excluded. A pilot study was undertaken to investigate whether botulinum toxin type A (BoNT-A) and plaster casting, as adjunct to the physical therapy, decreased muscle contracture and improved the position and function of the impaired arm. METHOD: Twenty-two children (mean age 5.6 +/- 3.4 years) with mild UBPP who previously underwent serial cast treatment, unsuccessfully, were enrolled. Neurological impairment and functional status were quantified using Medical Research Council (MRC) and Mallet scales and the Nine-Hole Peg Test (NHPT). Elbow extension was measured using a goniometer. Biceps brachii, brachialis, pronator teres and pectoralis major muscles were injected with 22 units kg(-1) BoNT-A (Dysport, Ipsen). After injection, the treated arm was fixed with a plaster cast and progressively lengthened over 14 days. The cast was maintained for 30 days. Assessments of elbow extension, MRC, Mallet Scale and NHPT were made at baseline, 3, 6 and 12 months. RESULTS: After BoNT-A injection, children had significant improvement of active elbow extension (15.5 degrees +/- 17.1 at 12 months after injection, compared with 42.0 degrees +/- 10.4 at baseline; p < 0.001). NPHT scores improved significantly over the 12 months (51.1 +/- 21.8 seconds compared with 56.7 +/- 19.3 seconds at baseline, p < 0.01). MRC and Mallet scale scores of the paretic muscles were unchanged. CONCLUSION: The children showed a reduction in muscular contracture and improvements of the arm position and elbow extension. The data support the use of BoNT-A and plaster casting as an adjunct to physical therapy, in the treatment of children with mild UBPP.

Adolescent↗

Relationship between bisacodyl-induced urolithiasis and rat urinary bladder tumorigenesis.

Dietary supplementation with bisacodyl at concentrations ranging from 1 to 0.3% was found to induce both calculi and epithelial proliferative lesions, including a transitional-cell carcinoma, in the urinary bladder of F344/DuCrj rats. In order to clarify the relationship between the bisacodyl-associated urinary bladder calculi and the development of proliferative lesions in the urinary bladder, male and female rats were administered bisacodyl-diets at concentrations of 0.3, 0.1, and 0.03% for 32 wk. Both sexes of animals treated with bisacodyl suffered from diarrhea throughout the experimental period. Epithelial proliferative lesions and calculus formation were observed only in the urinary bladder of male rats given the 0.3% bisacodyl diet. Proliferative lesions and increases of bromouracil deoxyriboside (BUdR) labeling indices were found only in the urinary bladder epithelium of rats with calculi, the severity of the former correlating with the calculus weight and being most marked in the dome areas, which are susceptible to physical stimulation. These findings indicate a close relationship between the development of proliferative lesions and the existence of calculi in the urinary bladder, and suggest that bisacodyl-induced proliferative lesions are not caused directly by bisacodyl per se but are secondary to calculus formation.

Administration, Oral↗

Mach band type lateral inhibition in different sense organs.

Experiments were done on the skin with shearing forces, vibrations, and heat stimuli and on the tongue with taste stimuli to show that the well known Mach bands are not exclusively a visual phenomenon. On the contrary, it is not difficult to produce areas of a decreased sensation magnitude corresponding to the dark Mach bands in vision. It is shown on a geometrical model of nervous interaction that the appearance of Mach bands for certain patterns of stimulus distribution is correlated with nervous inhibition surrounding the area of sensation. This corroborates the earlier finding that surrounding every area transmitting sensation there is an area simultaneously transmitting inhibition.

Acoustic Stimulation↗

Quantification of intensity variations in functional MR images using rotated principal components.

In functional MRI (fMRI), the changes in cerebral haemodynamics related to stimulated neural brain activity are measured using standard clinical MR equipment. Small intensity variations in fMRI data have to be detected and distinguished from non-neural effects by careful image analysis. Based on multivariate statistics we describe an algorithm involving oblique rotation of the most significant principal components for an estimation of the temporal and spatial distribution of the stimulated neural activity over the whole image matrix. This algorithm takes advantage of strong local signal variations. A mathematical phantom was designed to generate simulated data for the evaluation of the method. In simulation experiments, the potential of the method to quantify small intensity changes, especially when processing data sets containing multiple sources of signal variations, was demonstrated. In vivo fMRI data collected in both visual and motor stimulation experiments were analysed, showing a proper location of the activated cortical regions within well known neural centres and an accurate extraction of the activation time profile. The suggested method yields accurate absolute quantification of in vivo brain activity without the need of extensive prior knowledge and user interaction.

Algorithms↗

Ketamine anesthesia at high altitude.

There is a clinical need for a safe and effective anesthetic technique in high altitude and remote areas. This report presents a series of 11 consecutive cases documenting the use of ketamine anesthesia in a remote hospital at an altitude of 3,900 m, by primary-care physicians without specialist training in anesthesia. The method of administration is fully described. At a low dose of 2.0 mg/kg, ketamine produces a dissociative anesthesia that does not depress the hypoxic drive, or interfere with the pharyngeal or laryngeal reflexes. Although supplemental oxygen is useful in the recovery phase for less acclimatized individuals, it is usually not required as reductions in oxygen saturation can be raised by physical stimulation that encourages the patient to breathe faster and deeper. The common side effect of emergent nightmares was avoided using midazolam as premedication and a quiet recovery area. This study offers the first available evidence that ketamine with midazolam offers a safe and effective means of anaesthesia at very high altitude, without the need for specialist equipment or training, by careful clinicians experienced in basic airway management.

Acclimatization↗

Effects of L-NAME and 7-NI on NOS catalytic activity and behavioral outcome after traumatic brain injury in the rat.

Traumatic brain injury (TBI) produces transient increases in constitutive nitric oxide synthase (cNOS) activity and prolonged behavioral abnormalities. This study investigated the effects of nitro-L-arginine-methyl ester (L-NAME) and 3-bromo-7-nitroindazole (7-NI) treatment on cNOS catalytic activity and sensorimotor behavioral outcome after TBI. Rats underwent moderate (1.8-2.2 atm) parasagittal fluid percussion brain injury (FPI). At 5 min after FPI, cNOS activity was significantly increased within the damaged cerebral cortex of vehicle-treated rats compared to the noninjured contralateral cortex (206.7 +/- 150.5 % of contralateral, p < 0.01). Pretreatment with L-NAME and 7-NI significantly reduced injury-induced cNOS activation (47.7 +/- 42.6 %, p < 0.05, and 96.16 +/- 12.76, p < 0.05, respectively). Pretreatment with L-NAME and 7-NI also inhibited cNOS activity within the contralateral noninjured cerebral cortex compared to vehicle-treated rats (L-NAME 43.7 +/- 12.47%, p < 0.05; 7-NI 36.8 +/- 7.47%, p < 0.05). Furthermore, pretreatment with 7-NI, but not L-NAME, significantly reduced forelimb placing sensorimotor deficits (3.14 +/- 1.07, p < 0.05) at 1 day after TBI compared to vehicle-treated rats (5.38 +/- 0.42). These data indicate that inhibition of injury-induced elevations in neuronal NOS activity has a beneficial effect on neurological outcome after parasagittal FPI brain injury.

Animals↗

Visual peripersonal space centred on the face in humans.

A convergent series of studies in monkeys and man suggests that the computation of visual space is performed in several brain regions for different behavioural purposes. Among these multiple spatial areas, the ventral intraparietal cortex, the putamen and the ventral aspect of the premotor cortex (area 6) contain a system for representing visual space near the face (peripersonal space). In these cerebral areas some neurons are bimodal: they have tactile receptive fields on the face, and they can also be driven by visual stimuli located near the tactile field. The spatial correspondence between the visual and tactile receptive fields provides a map of near visual space coded in body-part-centred co-ordinates. In the present study we demonstrate for the first time the existence of a visual peripersonal space centred on the face in humans. In patients with right hemispheric lesions, visual stimuli delivered in the space near the ipsilesional side of the face extinguished tactile stimuli on the contralesional side (cross-modal visuotactile extinction) to the same extent as did an ipsilesional tactile stimulation (unimodal tactile extinction). Furthermore, a visual stimulus presented in the proximity of the contralesional side of the face improved the detection of a left tactile stimulus: i.e. under bilateral tactile presentation patients were more accurate to report the presence of a left tactile stimulus when a simultaneous visual stimulus was presented near the left side of the face. However, when visual stimuli were delivered far from the face, visuotactile extinction and visuotactile facilitation effects were dramatically reduced. These findings are consistent with the hypothesis of a representation of visual peripersonal space coded in bodypart-centred co-ordinates, and they provide a striking demonstration of the modularity of human visual space.

Adult↗

Left tactile extinction following visual stimulation of a rubber hand.

In close analogy with neurophysiological findings in monkeys, neuropsychological studies have shown that the human brain constructs visual maps of space surrounding different body parts. In right-brain-damaged patients with tactile extinction, the existence of a visual peripersonal space centred on the hand has been demonstrated by showing that cross-modal visual-tactile extinction is segregated mainly in the space near the hand. That is, tactile stimuli on the contralesional hand are extinguished more consistently by visual stimuli presented near the ipsilesional hand than those presented far from it. Here, we report the first evidence in humans that this hand-centred visual peripersonal space can be coded in relation to a seen rubber replica of the hand, as if it were a real hand. In patients with left tactile extinction, a visual stimulus presented near a seen right rubber hand induced strong cross-modal visual-tactile extinction, similar to that obtained by presenting the same visual stimulus near the patient's right hand. Critically, this specific cross-modal effect was evident when subjects saw the rubber hand as having a plausible posture relative to their own body (i.e. when it was aligned with the subject's right shoulder). In contrast, cross-modal extinction was strongly reduced when the seen rubber hand was arranged in an implausible posture (i. e. misaligned with respect to the subject's right shoulder). We suggest that this phenomenon is due to the dominance of vision over proprioception: the system coding peripersonal space can be 'deceived' by the vision of a fake hand, provided that its appearance looks plausible with respect to the subject's body.

Aged↗

Orienting of attention and Parkinson's disease: tactile inhibition of return and response inhibition.

There is growing evidence for cognitive impairments in Parkinson's disease (PD), including in the orienting of attention and inhibition of return (IOR). IOR refers to the slowing of a response to a target stimulus presented in the same location as a previous stimulus. While some researchers have reported normal levels of visual IOR in PD patients using cue-target tasks, others have reported significant reductions in IOR in this patient group. However, the inhibitory effects observed in cue-target tasks may reflect non-ocular response inhibition associated with withholding a response from the cue stimulus, rather than attentional or oculomotor processes. Many researchers working with normal participants have circumvented this confound by using a target-target task, in which a response is made to all peripheral stimuli. Here, we compared IOR measured in cue-target and target-target tasks, using tactile rather than visual stimuli. Both the PD and the control groups exhibited significant inhibitory effects in the cue-target task, but only the control group exhibited significant IOR in the target-target task. Our results demonstrate a reduction, or elimination, of IOR in PD and this change may have been underestimated in previous studies, in which methodologically flawed cue-target tasks were used. This reduction in IOR may reflect impaired inhibitory processes or hyper-reflexive orienting in parkinsonian patients.

Aged↗

An exploration of the role of the superior temporal gyrus in visual search and spatial perception using TMS.

This study sought to investigate the recent claim by H.-O. Karnath and his colleagues that the crucial locus of neurological damage in neglect patients lies in the right superior temporal gyrus (STG), and not in the right posterior parietal cortex (PPC) as conventionally thought. Using transcranial magnetic stimulation (TMS), we first tested the involvement of the right STG in a task commonly used in the diagnosis of neglect, the landmark task. No evidence was found for a critical involvement of the right STG in the processing of this task, though evidence was found for the involvement of the right PPC. In contrast, however, when we examined the effects of TMS on exploratory search, a double dissociation between right STG and right PPC was found. When the processing of conjunction items was required, involvement of the right PPC (and not STG) was found in accordance with our previous research. When a difficult exploratory search through feature items was required, however, the right STG (not PPC) was found to be involved. A hitherto unknown role for right STG in visual search tasks was thus uncovered. These data suggest that conclusions about the area of brain damage resulting in neglect-like symptoms are highly dependent on the task used to diagnose them, with lesions in right PPC leading to deficits on the landmark task and conjunction visual search, and lesions in right STG resulting in deficits in feature based serial exploratory search tasks.

Adult↗

Directing attention to locations and to sensory modalities: multiple levels of selective processing revealed with PET.

We used positron emission tomography (PET) to investigate the neural correlates of selective attention in humans. We examined the effects of attending to one side of space versus another (spatial selection) and to one sensory modality versus another (intermodal selection) during bilateral, bimodal stimulation of vision and touch. Attention toward one side resulted in greater activity in several contralateral areas. In somatosensory cortex, these spatial attentional modulations were found only when touch was relevant. In the intraparietal sulcus, spatial attentional effects were multimodal, independent of the modality attended. In occipital areas, spatial modulations were also found during both visual and tactile attention, indicating that tactile attention can affect activity in visual cortex; but occipital areas also showed more activity overall during visual attention. This suggests that while spatial attention can exert multimodal influences on visual areas, these still maintain their specificity for the visual modality. Additionally, irrespective of the attended side, attending to vision activated posterior parietal and superior premotor cortices, while attending to touch activated the parietal operculi. We conclude that attentional selection operates at multiple levels, with attention to locations and attention to modalities showing distinct effects. These jointly contribute to boost processing of stimuli at the attended location in the relevant modality.

Adult↗