For stroke victims, at-home strength and balance exercises provided by a physical therapist work just as well in regaining walking ability as participating in the actual task of walking through the use of a treadmill and partial body weight support, according to a study published in the New England Journal of Medicine.

Furthermore, patients continued to make improvements during therapy up to one year after a stroke, longer than typically expected.

“For individuals who have suffered a stroke, the findings of this trial offer good news for improving walking within the first year post-stroke through intense physical therapy interventions,” said Andrea Behrman, Ph.D., co-principal investigator and an associate professor in the department of physical therapy at the University of Florida College of Public Health and Health Professions.

“For therapists and physicians, the study informs us of the merit of two rehabilitation strategies for improving walking — one via practice of walking and the other via strengthening and balance training — and who will benefit and when to deliver the intervention.”

The trial, called the Locomotor Experience Applied Post-Stroke (LEAPS), included more than 400 patients who were randomly assigned to either a home-based therapy group or a treadmill training group two or six months after their stroke.

The home-based therapy group was supervised by a physical therapist and focused on flexibility, range of motion, strength and balance.  Those in the walking group practiced walking using a treadmill that provided partial body-weight support, also known as locomotor training, in a clinic setting.

At the one-year mark, 52 percent of all the study participants had made significant improvements in their walking ability. Both the exercise program and the walking training patients had similar improvements in walking speed, motor recovery, balance, social participation and quality of life.

However, the at-home exercise program may save on health-care costs and promote treatment follow-through: Only 3 percent of patients in the home-based therapy dropped out of the study compared to 13 percent who discontinued the locomotor training.

“We were pleased to see that stroke patients who had a home physical therapy exercise program improved just as well as those who did the locomotor training. The home physical therapy program is more convenient and pragmatic. Usual care should incorporate more intensive exercise programs that are easily accessible to patients to improve walking, function and quality of life,” said Pamela W. Duncan, Ph.D., the study’s principal investigator and a professor at Duke University School of Medicine.

Furthermore, patients in the group who began the therapy six months after their stroke also improved their walking. Researchers say this finding challenges the widely held belief that patients can only make gains in their rehabilitation within the first few months of a stroke.

“More than 4 million stroke survivors experience difficulty walking. Rigorously comparing available physical therapy treatments is essential to determine which is best,’’ said Dr. Walter Koroshetz, deputy director of the National Institute of Neurological Disorders and Stroke.

“The results of this study show that the more expensive, high-tech therapy was not superior to intensive home strength and balance training, but both were better than lower intensity physical therapy.”

The National Institute of Neurological Disorders and Stroke provided primary funding for the study.

Source:  University of Florida

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For decades public health researchers have known that individuals living in the American South displayed an increased risk of stroke and other forms of cardiovascular disease.

A new study finds that individuals living in this region also have a greater incidence of cognitive decline compared to other regions of the country.

The region is generally considered to be an 11-state cluster including Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia. Researchers believe shared risk factors are to blame for the increased chance of cardiovascular events and cognitive decline.

Risk factors have been hypothesized to include increased rates of hypertension, low socioeconomic status, high fat diet, cultural lifestyle, quality of health care facilities, smoking, and infections.

In 1965, the “Stroke Belt” first appeared in medical literature to describe the southeastern region of the U.S. where stroke mortality rates were 50 percent higher than the remaining U.S. regions.

In the new study, called The Reasons for Geographic and Racial Differences in Stroke (REGARDS), Principal Investigator George Howard, Dr.PH., recruited over 30,000 U.S. adults aged 45 or older from 2003 through 2007 and is following them for stroke and cognitive decline.

REGARDS participants included 56 percent from the Stroke Belt states and 44 percent  from the remaining states in the continental U.S., including the District of Columbia, which researchers collectively termed “non-Belt” states.

For their report on cognitive decline, the investigators included 23,913 REGARDS participants, made up only of African-Americans (38 percent) and European-Americans (62 percent) who reported no history of stroke at baseline and had normal cognitive status at the first assessment.

“Our study is the first to document higher incidence of cognitive impairment in the Stroke Belt compared to remaining U.S. regions,” said researcher Virginia Wadley, Ph.D.

Researchers assessed brain function using the Six-item Screener (SIS)—a test of global cognitive function that includes item recall and temporal orientation. SIS scores range from 0 to 6 with a score of 4 or less representing cognitive impairment.

Results indicate that 8.1 percent of participants showed cognitive impairment at their most recent assessment, over a mean of 4.1 years following the initial assessment. Stroke Belt residents had a greater likelihood of cognitive impairment than non-Belt residents.

Risk of cognitive impairment was 18 percent higher in residents of the Stroke Belt than in those living in non-Belt states after adjusting for the influences of age, sex, race, and education level. The research team suggests that future studies should examine the impact of migration patterns, urban versus rural residence, socioeconomic factors, and educational quality on cognitive decline.

“Investigating regional patterns that contribute to modifiable risk factors affecting cognitive decline will allow for prevention and intervention efforts that are geographically concentrated,” Wadley said.

“Information obtained from the REGARDS study can be used to develop services for older Americans at both local and national levels to improve outcomes for those most vulnerable to diminished cognitive function.”

Source: Wiley-Blackwell

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A new study to be published in an upcoming issue of Psychological Science shows how culture can influence how people respond to mortality.

In particular, investigators found European-Americans confronted with thoughts of death are likely to try to protect their sense of self, while Asian-Americans are more likely to reach out to others.

Psychologists label the topic of thinking about death as “mortality salience;” much of the research has been performed on people of European descent. In their studies, scientists have learned that “mortality salience” appears to cause people to think in dramatic ways.

For example, “Men become more wary of sexy women and they like wholesome women more. People like to stereotype more. You see all these strange and bizarre occurrences when people think about the fact that they aren’t going to live forever,” said researcher Christine Ma-Kellams, a doctoral student at the University of California Santa Barbara.

Researchers say another interesting observation is that people try to protect their sense of self, by putting down people who aren’t like them or distancing themselves from innocent victims.

But, as a cultural psychologist, Ma wondered if this reaction might be different in other cultures. In particular, she wanted to look at people of Asian backgrounds, whose sense of self is generally more linked to people around them.

Ma-Kellams recruited both European-Americans and Asian-Americans for the study. Each person was told to either write down thoughts that come to mind when thinking about their own death – or to write down their thoughts about dental pain. (Those people were the control group.)

Then they were asked to decide what bail should be set for a prostitute and given a survey on their attitudes toward prostitution. As other research has found, European-American people who had thought about death were much harsher towards the prostitute than those in the control group.

But Asian-Americans who thought about death were much kinder toward the prostitute – even though they started out more conservative.

In a second experiment, participants were presented with a less extreme case, a story about a university employee who’d been injured in an accident through no fault of his own. The same result was found; European-Americans were more likely to blame him if they’d contemplated their own mortality, while Asian-Americans were less likely to blame him.

This aligns with research that finds that European-Americans and Asian-Americans think about the self very differently.

“For European-Americans, everyone wants to save themselves after thinking about death because loss of self is the worst possible consequence,” Ma-Kellams said.

“Asians don’t necessarily see themselves in that individualistic kind of way. Self is very much tied up with the people around you.” In this case, that means that when they’re threatened with their own mortality, Asian-Americans apparently reach out to other people.

Source: Association for Psychological Science

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Although most people find pleasure in eating and even have a difficult time refraining from foods they love, individuals suffering from anorexia nervosa often say that eating makes them feel more anxious. Instead, refusing to eat — something called food refusal – is what brings more pleasure.

New research, published online in the journal International Journal of Eating Disorders, helps explain why these symptoms occur in anorexia.  

For the study, scientists administered a one-time dose of the drug amphetamine which releases dopamine in the brain; positron emission tomography (PET) was then used to visualize the subsequent dopamine activity.

In healthy subjects without an eating disorder, the amphetamine-induced release of dopamine was associated with feelings of extreme pleasure in the brain’s “reward center.” However, in people with anorexia, amphetamine made them feel anxious and activated the part of the brain that worries about consequences.

“This is the first study to demonstrate a biological reason why individuals with anorexia nervosa have a paradoxical response to food,” said Walter Kaye, M.D., professor of psychiatry and director of the Eating Disorder Treatment and Research Program at the University of California-San Diego School of Medicine.

“It’s possible that when people with anorexia nervosa eat, the related release of the neurotransmitter dopamine makes them anxious, rather than experiencing a normal feeling of reward. It is understandable why it is so difficult to get people with anorexia to eat and gain weight, because food generates intensely uncomfortable feelings of anxiety.”

Significantly, the study included individuals who had recovered from anorexia for at least a year, suggesting that the feeling provoked was possibly due to pre-existing traits, rather than a response to being extremely underweight.

Currently, there are few treatments proven to reduce core symptoms in anorexia, including eating-induced anxiety. Finding ways to help anorexic individuals eat and gain weight is necessary for treatment, even when food is still accompanied by severe anxiety.

The study was supported in part by the National Institute of Mental Health and the Prince Foundation.

Source:  University of California

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Brain imaging has provided a new appreciation of “simple” line drawings as researchers discover the brain’s amazing ability to recreate detailed scenes from just a few lines.

Researchers found that viewing a “beach” scene depicted in a line drawing activated nearly the same patterns of brain activity in study participants as did viewing an actual color photograph of a beach.

The same was true when people viewed line drawings and photographs of other natural scenes including city streets, forests, highways, mountains and offices.

Remarkably, even when researchers removed up to 75 percent of the pixels in a line drawing, people still did better than chance at determining what the lines represented — as long as the remaining lines showed the broad contours of the scene.

“Our results suggest that our brains can recreate whole detailed scenes from just a few lines,” said Dirk Bernhardt-Walther, Ph.D., lead author of the study and assistant professor of psychology at Ohio State University.

“The representations in our brain for categorizing these scenes seem to be a bit more abstract than some may have thought — we don’t need features such as texture and color to tell a beach from a street scene,” he said.

Research findings are published in the online early edition of the Proceedings of the National Academy of Sciences.

For the study, 10 participants viewed color photographs and line drawings of six categories of scenes — beaches, city streets, forests, highways, mountains and offices — while their brains were scanned using functional magnetic resonance imaging (fMRI).

The fMRI images showed the researchers what was going on in several areas of the participants’ brains when they viewed the photos and line drawings. The most significant results occurred in the parahippocampal place area (PPA), an area of the brain that scientists know plays an important role in the encoding and recognition of scenes (rather than faces or objects).

Using the data from when participants viewed the color photos, the researchers trained a software-based decoder to tell what type of scene the participants viewed – a beach, mountain, etc., – based on the patterns of brain activity in the PPA shown in the fMRI.

The decoder was far from perfect, but it did better than chance at predicting what scene a person was viewing in a particular fMRI image.

Most importantly, the decoder could do just as well at predicting which scene a person viewed when it was focused on line drawings as it was on photographs. In fact, the decoder did slightly better – although not significantly so – at predicting line drawings compared to photographs in the primary visual cortex.

“We expected that line drawings would be good enough to allow some decoding, but it was surprising that there was no benefit to photographs – the decoder was no better when it was used on photos than it was on line drawings,” Bernhardt-Walther said.

Findings showed that when the decoder was trained on photographs, it still did equally well at predicting which scenes people were viewing in line drawings, and vice versa.

“That suggests the brain uses the same information to decode which scene it is viewing when it is presented with line drawings or photos,” he said.

In addition, results showed that when the decoder did make errors, it made similar errors in both photographs and line drawings. For example, if the decoder thought people were looking at a photo of a mountain when they were really looking at a photo of a forest, it would make the same mistake when it was analyzing line drawings.

“The patterns of error match incredibly well, so that’s an additional piece of evidence that the representations for photos and line drawings are very similar in the brain,” Bernhardt-Walther said.

But what is it about line drawings that allow people to recognize what they represent? As part of the study, the researchers removed some of the lines in the line drawings and asked participants if they could still tell what scene was depicted. In some cases, they removed up to 75 percent of the pixels in the drawing.

If the researchers left the long contours in the drawings, which represented global structure – such as sky, water or sand – participants could still correctly predict what kind of scene was depicted about 60 percent of the time.

However, when researchers took out these long contours and left only short ones –representing details like leaves, windows in buildings or individual ridges in a mountainside – the accuracy of participants went way down.

These findings cast doubt on some models of human visual perception which argue that people need specific information that is found in photographs – such as color, shading and texture – to classify a scene.

“Of course, we use the rich sources of information found in a photograph when it is available, but the brain is an opportunist — it uses what is available,” Bernhardt-Walther said. “We can get a lot of information from a line drawing.”

The results also suggest why line drawings have played such an important role in human history, both as an art form and a way of presenting information simply.

“Imagine the astonishment of early man when he discovered he could draw shapes on a rock wall and it resembled the actual animal he had just killed. Line drawings have been with us since prehistoric times,” Bernhardt-Walther said.

Source: Ohio State University

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