Nieuwe techniek in multisensorische stimulatie: kansen voor functieherstel in revalidatie?

Transcription

1 Nieuwe techniek in multisensorische stimulatie: kansen voor functieherstel in revalidatie? Prof. Dr. Raymond van Ee Sensorische NeuroWetenschappen Visuele Waarneming

2 Nieuwe techniek in multisensorische stimulatie: kansen voor functieherstel in revalidatie? Boodschap: Functie naast compensatie Want stroke is attentie probleem Wat is stroke? Anatomie Wat is attentie? Hoe te beïnvloeden?

3 Task: complete lines to crosses Psycholoog (emotie) Logopedist Fysiotherapeut Neuroloog (neglect) ~55% one-sided visual neglect /year in US; in Ned Kunnen neuronen weer betrokken worden bij visuele waarneming? Er is hoop: 84% afgenomen visueel neglect

4 US: 1 stroke every 40 seconds = new patients / year Ned: ~30% under the age of 65 = / year Ned: ~70% of stroke survivors cannot return to previous job ~50% are unable to return to any type of work

5 Right Eye Left Eye Stroke Left Visual Detection

6 Right Eye Left Eye Frontal Cortex, ruling attention Limbic system (validation/ Emotion) Stroke Parietal Cortex Left Visual Detection Visual cortex Not all neurons are dead attention

7 Visual Cortex 7

8 Brainard et al

9 Only little information makes it to the frontal cognitive brain Attention

10 Bombarded by signals and thoughts Attention: information selection Very selective and restrictive we perceive only small part of incoming information efficient for small brain

11 A B C

12 How observant are you?

13 Oxygen in blood

14 To study attention fixed stimulation but changing brain activity use 3D depth illusions

15 Necker Cube bi-stability A constant stimulus gives rise to two 3D interpretations Front Front

16 Gijs Brouwer, J NeuroSci (2005)

17 One interpretation Mind reading Other interpretation Gijs Brouwer, van Ee et al, J NeuroSci (2005)

18 Frequency Power 6 Hz 10 Hz Time Kamphuisen, van Ee, et al, 2008

19 Necker Cube bi-stability A constant stimulus gives rise to two 3D interpretations Front Front Voluntary attentional control is there but it is not overwhelming

20 Model for how the brain controls attention Frontal Cortex, ruling attention Limbic system (Validation/ Emotion) Parietal Cortex Gain Factor Other cortices Visual cortex Auditory cortex

21 Vision: brightness Audition: loudness Peaks at same moment = same period = same frequency = rhythmically synchronous

22 Looming Rotating

23 Looming Rotating

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25 Multisensory Synergy in Attention Frontal Cortex, ruling attention Limbic system (validation/ Emotion) Other cortices Multisensory synergy 1+1>2 Visual cortex Parietal Cortex Auditory cortex Increased Attentional Gain facilitates enhanced performance: 1. Quicker 2. Stronger in competition Van Ee et al., J NeuroSci (2009)

26 Ear Ringing (Tinnitus) Ear-ringing sufferers would benefit from attentional control illusion of hearing a sound Their mind keeps paying attention to ear-ringing and does not unwind Unmet need for non-pharmacological methods to fall asleep Big group of patients

27 Tinnitus Demonstration The illusion of hearing a sound Physical Cause Inhibition Problem Illusion

28 Attention Model of Tinnitus Frontal Cortex, ruling attention Limbic system (validation/ Emotion) Gain factor g tinnitus Parietal Cortex Other cortices Visual cortex Auditory cortex Mission: Find overruling attentional signal to reduce gain g tinnitus

29 Solution for Tinnitus Frontal Cortex, ruling attention Gain factor g multisens Limbic system (validation/ Emotion) Multisensory synergy 1+1>2 Other sensory signal Parietal Cortex PHANTOM tinnitus Auditory signal Gain factor g tinnitus Optimal Multisensory Combination? Sound & Vestibular (balance)

30 Audio-Vestibular Pillow Okke Ouweltjes Murtaza Bulut Frank Vossen Estrella Mena Ronald Aarts Raymond van Ee Sound PC 10 sec period Inflatable Rocking Pillow Questionnaires, breathing rate Air Pump Conditions (presented in random order) Duration 10 min Baseline; Audio only (sound of sea-waves); Rocking pillow only; Rhythmic synchrony of sound and rocking.

31 Looming in Vision and Audition How to apply?

32 Right Eye Left Eye Frontal Cortex, ruling attention Limbic system (validation/ Emotion) Stroke Parietal Cortex Other cortices Left Visual Detection Visual cortex Auditory cortex Mission: Find overruling attentional signal to re-open gate to consciousness

33 Frontal Cortex, ruling attention Visual cortex Limbic system (validation/ Emotion) Parietal Cortex Multisensory synergy 1+1>2 Auditory cortex Mission: Find overruling attentional signal to re-open gate to Consciousness Vision, Audition

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36 Samenvattend Hoe vaak komt stroke en visual neglect voor? Wat is stroke? Anatomie Wat is attentie? Hoe te beïnvloeden? Boodschap: Functie naast compensatie Want stroke is attentional probleem Een neurowetenschappelijke Kijk-Verder Multisensorische aanpak voor stroke revalidatie