scholarly journals Investigating Therapies for Freezing of Gait Targeting the Cognitive, Limbic, and Sensorimotor Domains

2021 ◽  
pp. 154596832199233
Author(s):  
Rebecca Chow ◽  
Bryan P. Tripp ◽  
Daniel Rzondzinski ◽  
Quincy J Almeida
Keyword(s):  
Behavioral Therapy ◽  
Freezing Of Gait ◽  
Cognitive Intervention ◽  
Motor Symptom ◽  
Poor Understanding ◽  
Proprioceptive Training ◽  
Cognitive Challenge ◽  
Underlying Mechanisms ◽  
Single Blind ◽  
Viable Treatment

Background Freezing of gait (FOG) is arguably the most disabling motor symptom experienced with Parkinson’s disease (PD), but treatments are extremely limited due to our poor understanding of the underlying mechanisms. Three cortical domains are postulated in recent research (ie, the cognitive, limbic, and sensorimotor domains), thus, treatments targeting these mechanisms of FOG may potentially be effective. Cognitive training, cognitive behavioral therapy (CBT, a well-known anxiety intervention), and proprioceptive training may address the cognitive, limbic, and sensorimotor domains, respectively. Objective To investigate whether these 3 treatments could improve functional outcomes of FOG. Methods In a single-blind, randomized crossover design, 15 individuals with PD and FOG were randomized into different, counterbalanced orders of receiving the interventions. Each consisted of eight 1-hour sessions, twice weekly for 4 weeks. FOG severity was assessed as the primary outcome using a novel gait paradigm that was aimed at evoking FOG when the cognitive, limbic, or sensorimotor domains were independently challenged. Results FOG severity significantly improved after the cognitive intervention, with strong trends toward improvement specifically in the baseline and cognitive-challenge assessment conditions. CBT, as the anxiety intervention, resulted in significantly worse FOG severity. In contrast, proprioceptive training significantly improved FOG severity, with consistent trends across all conditions. Conclusions The cognitive and proprioceptive treatments appeared to improve different aspects of FOG. Thus, either of these interventions could potentially be a viable treatment for FOG. However, although the results were statistically significant, they could be sensitive to the relatively small number of participants in the study. Considering the significant results together with nonsignificant trends in both FOG and gait measures, and given equal time for each intervention, proprioceptive training produced the most consistent indications of benefits in this study. (clinicaltrials.gov NCT03065127).

PROPRIOCEPTIVE TRAINING AS AN ADJUNCT IN OSTEOARTHRITIS OF KNEE

2013 ◽  
Vol 16 (01) ◽  
pp. 1350002 ◽  
Author(s):  
Suraj Kumar ◽  
Ashish Kumar ◽  
Ratnesh Kumar
Keyword(s):  
Pain Intensity ◽  
Functional Disability ◽  
Womac Score ◽  
Position Sense ◽  
Joint Position Sense ◽  
Knee Oa ◽  
Post Test ◽  
Proprioceptive Training ◽  
Conventional Physiotherapy ◽  
Single Blind

Osteoarthritis (OA) is steadily becoming the most common cause of disability with advancing age. So, this study was aimed to prevent and rehabilitate the patient with such disability. Proprioception along with other deficits have been established with threat to the concerned joint. Hence, objective of the study was set to show the efficacy of proprioceptive training with conventional physiotherapy versus conventional physiotherapy. A Pre test- Post test single blind experimental study was designed with 44 patients having knee OA and randomly divided in two groups. Outcome measures were pain intensity on NRS, functional disability on Reduced WOMAC and joint position sense (JPS) error on Electronic Goniometer. Results between group comparisons showed significant improvement in pain intensity (p < 0.05), WOMAC score (p < 0.05) and JPS error (p < 0.05). However both the groups improved significantly but there was more significant improvement in group with proprioception intervention. Hence, it can be concluded that proprioceptive training should be included along with conventional physiotherapy in knee OA rehabilitation.

scholarly journals Enhancing In Vivo Exposure in the Treatment of Panic Disorder and Agoraphobia Using Location-Based Technologies: A Case Study

2019 ◽  
Vol 19 (2) ◽  
pp. 145-159 ◽  
Author(s):  
Ignacio Miralles ◽  
Carlos Granell ◽  
Azucena García-Palacios ◽  
Diana Castilla ◽  
Alberto González-Pérez ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Emotional Disorders ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Future Research ◽  
Unified Protocol ◽  
High Satisfaction ◽  
Patient Reported ◽  
Underlying Mechanisms

Panic disorder (PD) is quite prevalent and often appears along with agoraphobia (PD/A). The treatment of choice is cognitive behavioral therapy (CBT). Transdiagnostic intervention, an emotion-focused, cognitive behavioral intervention that has led to the Unified Protocol (UP), emphasizes the common underlying mechanisms that contribute to the development and maintenance of emotional disorders such as PD/A. A core feature of this treatment approach is in vivo exposure (IVE) to feared situations, which aims to prevent avoidance behaviors and encourages the patient to confront feared situations gradually. It is a difficult component for patients, especially when implementing the exposure on their own. Different feedback formats can be used to increase adequate IVE and reduce overt or subtle avoidance. The use of smartphones is a very useful option to initiate and sustain exposure behavior. The purpose of this study is to describe the use of location-based technologies (LBTs) during the IVE component of the UP treatment of a 47-year-old patient with PD/A. The acceptability and usability of the system were assessed. The Symptoms platform was employed during the exposure module, using LBT with a smartphone app. The patient reported positive expectations, high satisfaction scores, and an overall satisfactory experience. Enhancing key therapeutic components during treatment through the development of media-based tools is a very promising future research aim, and the possibility of using advanced smartphone features should be explored.

scholarly journals Abnormal Olfaction in Parkinson’s Disease Is Related to Faster Disease Progression

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Sara Cavaco ◽  
Alexandra Gonçalves ◽  
Alexandre Mendes ◽  
Nuno Vila-Chã ◽  
Inês Moreira ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Disease Progression ◽  
Rating Scale ◽  
Freezing Of Gait ◽  
Motor Symptom ◽  
Identification Test ◽  
Disease Rating ◽  
Abnormal Performance ◽  
Smell Identification

Introduction. A possible association between olfactory dysfunction and Parkinson’s disease (PD) severity has been a topic of contention for the past 40 years. Conflicting reports may be partially explained by procedural differences in olfactory assessment and motor symptom evaluation.Methods. One hundred and sixty-six nondemented PD patients performed the Brief-Smell Identification Test and test scores below the estimated 20th percentile as a function of sex, age, and education (i.e., 80% specificity) were considered demographically abnormal. Patients underwent motor examination after 12 h without antiparkinsonian medication.Results. Eighty-two percent of PD patients had abnormal olfaction. Abnormal performance on the Brief-Smell Identification Test was associated with higher disease severity (i.e., Hoehn and Yahr, Unified Parkinson’s Disease Rating Scale-III, Freezing of Gait questionnaire, and levodopa equivalent dose), even when disease duration was taken into account.Conclusions. Abnormal olfaction in PD is associated with increased severity and faster disease progression.

scholarly journals Effects of depression on prefrontal-striatal goal-directed and habitual control

2018 ◽  
Author(s):  
Suyeon Heo ◽  
Sang Wan Lee
Keyword(s):  
Behavioral Therapy ◽  
Control Model ◽  
Clinical Applications ◽  
Model Free ◽  
Reward Prediction ◽  
Frontopolar Cortex ◽  
Poor Understanding ◽  
Therapy Design ◽  
The Impact ◽  
Different Levels

ABSTRACTDepression is characterized by deficits in the reinforcement learning (RL) process. Although many computational and neural studies have extended our knowledge of the impact of depression on RL, most focus on habitual control (model-free RL), yielding a relatively poor understanding of goal-directed control (model-based RL) and arbitration control to find a balance between the two. We investigate the effects of depression on goal-directed and habitual control in the prefrontal–striatal circuitry. We find that depression is associated with attenuated state and reward prediction error representation in the insula and caudate, a disruption of arbitration control in the predominantly inferior lateral prefrontal cortex and frontopolar cortex, and suboptimal value–action conversion. These findings fully characterize how depression influences different levels of RL, challenging previous conflicting views that depression simply influences either habitual or goal-directed control. Our study creates possibilities for various clinical applications, such as early diagnosis and behavioral therapy design.

scholarly journals Which Cognitive Behavioral Therapy Formats Work for Depression in Dementia Family Caregivers ?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 656-656
Author(s):  
Yue Sun ◽  
Zhi-wen Wang
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Cognitive Intervention ◽  
Biomedical Literature ◽  
Cognitive Behavioral ◽  
Cochrane Central Register ◽  
China National Knowledge Infrastructure ◽  
Self Help ◽  
Delivery Formats

Abstract Cognitive behavioral therapy (CBT) has been shown to be effective to delay cognitive decline for family dementia caregivers (DCs). However, whether cognitive intervention could effectively reduce depression through internet, group, telephone, individual, unguided self-help and combined formats remains unclear. Pubmed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials, Web of science, China National Knowledge Infrastructure database, Chinese Biomedical Literature database and Wan Fang database were systematically searched. A total of 34 studies were included in our analysis based on a series of rigorous screenings, which comprised 3577 DCs. We conducted a network meta-analysis (NMA) to evaluate the relative effects and rank probability of different CBT delivery formats. A series of analyses and assessments, such as the pairwise meta-analysis and the risk of bias, were performed concurrently. Compared with controls, internet, telephone, and individual showed the largest improvement on depressive symptoms, whereas the unguided self-help delivery format was less effective. Internet delivery formats had the highest probability among the five CBT delivery formats. Our study indicated that the internet might be the best delivery formats for reducing the depression of family DCs. The findings from our study may be useful for policy makers and service commissioners when they make choices among different CBT delivery formats.

scholarly journals Isolating therapeutic procedures to investigate mechanisms of change in cognitive behavioral therapy for depression

2018 ◽  
Vol 9 (4) ◽  
pp. 204380871880089 ◽  
Author(s):  
Sanne J. E. Bruijniks ◽  
Marit Sijbrandij ◽  
Caroline Schlinkert ◽  
Marcus J. H. Huibers
Keyword(s):  
Cognitive Therapy ◽  
Skill Acquisition ◽  
Social Stress ◽  
Behavioral Therapy ◽  
Stress Test ◽  
Mechanisms Of Change ◽  
Therapeutic Procedures ◽  
Underlying Mechanisms ◽  
Underlying Processes ◽  
Healthy Participants

Background: Isolating a therapeutic procedure might be a powerful way to enhance our understanding of how cognitive behavior therapy (CBT) works. The present study explored new methods to isolate cognitive procedures and to study their direct impact on hypothesized underlying processes and CBT outcome. Method: The effects of a cognitive therapy skill acquisition procedure ( n = 36) were compared to no procedure ( n = 36) on cognitive therapy skills, dysfunctional thinking, distress, and mood in response to induced distress following a social stress test in healthy participants. Results: Participants reported more cognitive therapy skills after the procedure that focused on the acquisition of cognitive therapy skills compared to no procedure, but there were no differences in dysfunctional thinking, distress, and mood between the groups. Conclusions: By demonstrating an experimental approach to investigate mechanisms of change, including the pitfalls that come along with it, the present experiment provides a blueprint for other researchers interested in the underlying mechanisms of change in CBT for depression.

scholarly journals Simulating the computational mechanisms of cognitive and behavioral psychotherapeutic interventions: insights from active inference

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryan Smith ◽  
Michael Moutoussis ◽  
Edda Bilek
Keyword(s):  
Behavior Change ◽  
Avoidance Behavior ◽  
Behavioral Interventions ◽  
Behavioral Therapy ◽  
Cognitive Restructuring ◽  
Strong Interactions ◽  
Active Inference ◽  
Cognitive Interventions ◽  
Underlying Mechanisms ◽  
The Individual

AbstractCognitive-behavioral therapy (CBT) leverages interactions between thoughts, feelings, and behaviors. To deepen understanding of these interactions, we present a computational (active inference) model of CBT that allows formal simulations of interactions between cognitive interventions (i.e., cognitive restructuring) and behavioral interventions (i.e., exposure) in producing adaptive behavior change (i.e., reducing maladaptive avoidance behavior). Using spider phobia as a concrete example of maladaptive avoidance more generally, we show simulations indicating that when conscious beliefs about safety/danger have strong interactions with affective/behavioral outcomes, behavioral change during exposure therapy is mediated by changes in these beliefs, preventing generalization. In contrast, when these interactions are weakened, and cognitive restructuring only induces belief uncertainty (as opposed to strong safety beliefs), behavior change leads to generalized learning (i.e., “over-writing” the implicit beliefs about action-outcome mappings that directly produce avoidance). The individual is therefore equipped to face any new context, safe or dangerous, remaining in a content state without the need for avoidance behavior—increasing resilience from a CBT perspective. These results show how the same changes in behavior during CBT can be due to distinct underlying mechanisms; they predict lower rates of relapse when cognitive interventions focus on inducing uncertainty and on reducing the effects of automatic negative thoughts on behavior.

scholarly journals Effects of cognitive behavioral therapy in patients with fibromyalgia: a single blind, randomized controlled study

2021 ◽  
Vol 11 (1) ◽  
pp. 41
Author(s):  
Arun Mozhi ◽  
Narkeesh Arumugam
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Para Determinar ◽  
Single Blind

INTRODUÇÃO: A fibromialgia (FM) é uma dor musculoesquelética de longa duração, que continua a ser uma entidade clínica problemática a nível mundial, o manejo desta condição é um desafio para os profissionais de saúde. Numerosas opções de tratamento individual estão disponíveis para melhorar os sintomas da fibromialgia, mas ainda falta um tratamento individualizado. Assim, neste estudo testamos tanto os efeitos individuais das técnicas fisioterapêuticas, quanto a combinação das técnicas de terapia cognitiva-comportamental e as técnicas de fisioterapia, se trariam alguma alteração nos sintomas da fibromialgia. OBJECTIVO: Para determinar o efeito combinado de terapia cognitiva-comportamental associada as técnicas de fisioterapia no manejo dos sintomas de fibromialgia. MÉTODOS: Este estudo experimental recrutados 60 participantes com diagnóstico de FM, com idade compreendidas entre 18-50 anos, de Dehradun, Índia. Foram divididos aleatoriamente em dois grupos: Fisioterapia integrada apenas, fisioterapia integrada e terapia cognitiva-comportamental por 12 semanas. Escala analógica visual, questionário de impacto da fibromialgia revisado, Índice de Depressão Beck, inquéritos de saúde-36 versão resumida, algômetro de pressão de dor, transtorno de ansiedade geral -7. Foram registados na linha de base, quatro semanas, oito semanas e doze semanas. RESULTADOS: Após três meses, uma melhora significativa (p <0,05) foi observada em todas as medidas de resultados da fisioterapia integrada e do grupo de terapia cognitiva-comportamental. CONCLUSÃO: A terapia cognitiva comportamental combinada com o tratamento de fisioterapia teve um efeito na redução da depressão, na deficiência e a melhoria na qualidade de vida na fibromialgia.

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