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Neural Separability. Deep brain stimulation. DBS application. Parkinson’s disease Clinical depression (Nucleus accumbens) Tourette syndrome Other application Post-traumatic coma Obsessive-compulsive disorder Phantom limb pain. Parkinson’s disease (Symptoms). Freezing
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DBS application • Parkinson’s disease • Clinical depression (Nucleus accumbens) • Tourette syndrome • Other application • Post-traumatic coma • Obsessive-compulsive disorder • Phantom limb pain
Parkinson’s disease (Symptoms) • Freezing • Postural instability • Increased muscle tone (Rigidity) • Slowness in the execution of movment (Bradykinesia) • Involuntary and unwanted movements • Resting tremor • Dystonia Levels of motor control
Deep Brain Stimulation area for Parkinson’s disease • Subthalamic Nucleus (STN) • Freezing • Postural instability • Rigidity • Bradykinesia • Tremor • Globus Pallidus Internal (GPi) • Rigidity • Bradykinesia • Tremor • Dystonia
Transcranial Magnetic Stimulation • Electrical flow in brain induced by magnetic field formed by the electrical flow of external coil • Increase or decrease the excitability of Neural pathways • Slow rTMS (1 Hz) increase inhibition • Fast rTMS (> 5 hz) increases excitability
Clinical uses of TMS • Diagnostic purpose • Interruption of ongoing neural activity to assess functional localization • Visual cortex • SMA • Motor Cortex • Cortical Physiology • Brain Plasticity: Verifying structural change • Therapeutic purpose • Parkinson’s Disease • Writer’s Cramp (dystonia) • Epilepsy • Stroke Recovery • Various psychiatric disorders
TMS (Good & Bad) • Strength • Can be conducted with “normal” subjects thus removing the possible confound of additional lesions • Can be performed acutely without involvement of neural plasticity or re-organization • TMS can be repeated with same subject thus introducing possibility for appropriate controls • Multiple subjects can be subjected to identical lesions thus increasing statistical power • Can target different brain regions with same subject to more precisely describe behavioral disruptions • Can execute the TMS with many different tasks to look at specificity issues • Weakness • Hard to control deep brain area • Hearing the loud click made by the TMS pulse • Some discomfort or pain reported
TMS: Cerebellum pft = paced finger tapping Theoret et al., (2001). Neuroscience Letters, 306: 29-32.
Behavioral Findings LC = lateral cerebellum; MC medial Cerebellum; MT= site of motor threshold; Sham = reorientation of TMS Theoret et al., (2001). Neuroscience Letters, 306: 29-32.
TMS on M1 effects early stage of motor learning Hoterman et al., (2009). EJN
TMS on M1 effects early stage of motor learning Hoterman et al., (2009). EJN
Speech Disorders • Apraxia of speech (Plan) • Aphasia (Language) • Dysarthria • Stuttering (Flow) • Cluttering (Communication) • Articulation Disorder
Apraxia of Speech • Overview of Apraxia • Ideational apraxia • unable to perform due to loss of idea • Ideomotor apraxia • unable to perform due to control problem • AOS, Verbal apraxia
Apraxia of Speech • Definitions • An ariticulatory disorder resulting from impairment, as a result of brain damage, of the capacity to program the positioning of speech musculature and the sequencing of muscle movements for the volitional production of phonemes • Can occur without significant weakness or neuromuscular slowness, and in the absence of disturbances of thought or language
Aphasia • Language problem • Broca's aphasia • Damage in frontal lobe • Speak short sentence hardly & repeatedly • Wernicke's aphasia • Damage temporal lobe • speak no meaning long sentences • Anomic Aphasia (Anomia) • Impaired recall of words or names • Circumlocutions (speaking in a roundabout way) • Caused by damage to various parts of parietal or temporal lobe of the brain
Others • Dysarthria • Neurological Speech Disorder • Caused by disorder in the nervous system • ALS, Parkinson's disease, and cerebral palsy • Compare to AOS • Muscle weakness • Sensory loss • Comprehension deficit • Stuttering • Cluttering • Rapid speaking rate • Erratic rhythm • Words or group of words unrelated to the sentence
Speech problem in PD • Speech disorders in parkinson patients(Kerschan, 1998) • Functional impairment of articulation, phonation, prosody, respiration • Therapy seem useful only if no cognitive impairment • Speech motor programming in hypokinetic and ataxic dysarthria(Spencer, 2005) • Unable to maintain a programmed response or to rapidly switch between responses • Ataxic dysarthria are separable from motor execution impairments
Speech problem in AD • Empty speech in Alzheimer's disease(Nicholas, 1985) • Produce more empty phrases and conjunctions • Naming deficits • Compare to Wernicke's aphasia • produce more verbal, literal paraphrase • Anomic aphasia • share characteristics • Alzheimer's disease and Parkinson's disease: comparison of speech and language alterations(Cummings, 1988) • PD shows no evidence of intellectual impairment • AZ has greater language disturbances • Dementia of PD and AZ are distinguishable
Speech Problem in Aging • Processing speed and timing in aging adults: psychoacoustics, speech perception, and comprehension(Pickora, 2003) • auditory temporal processing differences > cognitive performance • increases quantity, reduces density of informational content and cohesive reference of narratives • increases the units of irrelevant content • Aging affects hemispheric asymmetry on a competing speech task(Greenwald, 2001)
Levels of Motor Contol & Speech problem • Higher • Programming (AOS) • Middle • Speech Perception (Wernicke’s) • Speech Generation (Broca’s) • Lower • Fluency, Flow • Strength and coordination of the speech muscles (Dysarthria) • Swallowing
Brain • Generalization • Obscureness • Plasticity • Taxi driver in London • Musician’s brain • Limitation • Learning new function limited by critical period