Sleepy brains neglect half the world

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alertness, attentional deficits, bodily sensations, damage, drowsiness, frontal lobes, hemispatial neglect, parietal lobes, right hemisphere, sights, sleep, sounds, space, spatial awareness, stroke, visual field, visual neglect

Sleepy brains neglect half the world

Damage to certain parts of the brain can lead to a bizarre syndrome called hemispatial neglect, in which one loses awareness of one side of their body and the space around it. In extreme cases, a patient with hemispatial neglect might eat food from only one side of their plate, dress on only one side of their body, or shave or apply make-up to half of their face, apparently because they cannot pay attention to anything on that the other side.

Research published last week now suggests that something like this happens to all of us when we drift off to sleep each night. The work could help researchers to understand the causes of hemispatial neglect, and why it affects one side far more often than the other. It also begins to reveal the profound changes in conscious experience that take place while we fall asleep, and the brain changes that accompany them.

Hemispatial neglect is a debilitating condition that occurs often in people who suffer a stroke, where damage to the left hemisphere of the brain results in neglect of the right half of space, and vice versa. It can occur as a result of damage to certain parts of the frontal lobes, which are involved in alertness and attention, and the parietal lobes, which process information about the body and its surrounding space.

In clinical tests, patients with hemispatial neglect are typically unaware of all kinds of stimuli in one half of space – they fail to acknowledge objects placed in the affected half of their visual field, for example and cannot state the location of touch sensations on the affected side of their body. Some may stop using the limbs on the affected side, or even deny that the limbs belong to them. Patients with neglect can usually see perfectly well, but information from the affected side just does not reach their conscious awareness.

In 2005, researchers at the MRC Cognition and Brain Sciences Unit in Cambridge reported that reduced alertness dramatically alters spatial awareness in healthy people by shifting attention to the right so that they neglect visual stimuli to the left. To investigate further, they recruited 26 more healthy participants and tested their spatial awareness while they fell asleep.

To do so, they took the participants one by one into a dark room and told them to sit back in a comfortable reclining chair and relax. They recorded the participants’ brain wave patterns using electrodes attached to the scalp, and measured their reaction times, to determine exactly when they started getting drowsy, then played sounds to either their left or right, and asked them to indicate which side each one came from by pressing one of two buttons.

Again, the researchers saw that reduced alertness caused a rightward shift in spatial attention. During the few moments of drowsiness just before falling asleep, the participants consistently mislocated sounds played to their left, and said that they had been played to the right.

“This is an exciting development,” says Masud Husain, a clinical neurologist at the University of Oxford who studies neglect in stroke patients. “It suggests that while falling asleep the healthy brain behaves in a similar way to stroke patients who have difficulty keeping alert.”

The findings further suggest that the attentional deficits associated with hemispatial neglect apply to sounds as well as to sights and bodily sensations, and also provide clues about why, in the vast majority of cases, neglect only persists after damage to the right hemisphere of the brain. “Both groups appear to have particular difficulty attending to information to their left, consistent with the view that frontal and parietal regions of the right hemisphere play a key role in maintaining alertness.”

The study also provides clues about the brain mechanisms underlying neglect. “People don’t necessarily miss items on the left as they become more drowsy, but instead respond as if they had come from the right,” says Husain, “as if their perception of space becomes skewed to the right as their alertness declines.”

“The implication is that right hemisphere brain mechanisms that are crucial to representing space around our bodies also interact with processes that keep us vigilant and alert,” he adds. “The results are intriguing but need to be confirmed, perhaps with a more precise method than pressing buttons.”

Reference: Bareham, C. A., et al. (2014). Losing the left side of the world: Rightward shift in human spatial attention with sleep onset.Scientific Reports 4, doi: 10.1038/srep05092

Stroke survivors and their families left to deal with the emotional impact alone, says report

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anxiety, carers, confidence, Depression, family, relationships, stress, stroke, support

Stroke survivors and their families left to deal with the emotional impact alone, says report

Stroke survivors and their families feel abandoned by health and social services after being left to deal with the emotional impact of stroke alone, a report reveals today.

The report, ‘Feeling Overwhelmed’, published by the Stroke Association, marks the beginning of Stroke Month and details the emotional strain of strokes on survivors and families after they have left the hospital.

More than half of survivors experienced depression and two thirds anxiety, in addition to lack of confidence and fear of recurrent stroke, the association says.

A high percentage of stroke carers are also reported to have experienced depression, stress, anxiety and frustration. Relationships are proven to suffer, with almost three in ten couples separating or considering it following stroke.

Of more than 2,700 people surveyed at the end of last year, 79 per cent claimed to have received no information or advice on how to cope with the emotional consequences of strokes.

Claire Whitehouse, 23, from Bournemouth, suffered a stroke when she was 19. Following her release from hospital, Claire suffered from depression and anxiety which also led to anorexia. She said:  “I wish someone, when I was in hospital, gave me a big leaflet with everyone I’d need to contact and said This is what you’re going to experience and this is the group you need to go to’. We need some information to tell us what’s going on.

“I can push myself to become physically able, but emotionally it’s much harder.”

In response to the findings, the Stroke Association is calling for psychological and emotional support to be as integral to recovery as the physical rehabilitation. It wants information and support to be accessible to everyone, survivors and carers, who have been affected by the illness.

The man whose brain ignores one half of his world

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hemispatial neglect, stroke, visual neglect

The man whose brain ignores one half of his world

Alan Burgess doesn’t need a rhyme to remember the 5th of November. He’ll never forget the day he had his stroke. It left him with a syndrome known as hemispatial neglect and a strange new perspective.

I asked him how he explains this to other people. “I say it’s two different worlds,” says Burgess. “My old world finished on 5 November 2007 and the new world started the same day.”

His stroke damaged the parietal lobe on the right side of his brain, the part that deals with the higher processing of attention. The damage causes him to ignore people, sounds, and objects on his left.

“Hemispatial neglect typically occurs after a stroke,” says Dr Paresh Malhotra, senior lecturer in neurology at Imperial College London. “It is not blindness in one eye, and it’s not damage to the primary sensory cortex, it’s a process of ignoring, for want of a better word, one side of space.”

Burgess, 64, originally trained as a tool design draughtsman and, before his stroke, he was working as a driver. His visual neglect makes driving impossible, and he was forced into early retirement. He had never painted before his stroke, but it became an important outlet for him afterwards.

Look at his artwork, though, and it is not only the vivid colours that grab your attention. He hands me a sketch of a pig that has half its head missing, and then produces two robins copied from a Christmas card – the robin on the right is full of rich detail, but the one on the left remains unfinished.

“Vision is most strikingly affected because we are visual creatures, but hearing, touch, representation and sense of self are also affected,” says Dr Malhotra.

People with hemispatial neglect are often unaware of their condition. Friends or relatives might suggest they look to their neglected side but that instruction misunderstands the problem they have with navigating the space around them. Burgess, and people like him, are not aware that something is missing, so why would they seek it out?

Patients might bump into things on their neglected side, shave or apply makeup only on one side of their face, or leave half of the food on their plate.

Alan often has to stop and think to make sense of the world around him. Walking down a street, he hugs the right side of the pavement, brushing up against walls and hedges. He won’t notice any potential dangers coming from the left, so he cannot go out on his own.

“I can’t describe how the world looks to neglect patients,” says Dr Malhotra. “Part of the reason it’s so difficult is because we don’t really appreciate how the world looks to ourselves. We think it’s just a nice screen and you can see everything, but that’s something that your brain is computing and telling you you’re seeing.

“In fact you’re attending to specific things at specific times. Your eyes are darting all over the place, but you have a sensation of a static world.”

After his stroke, Burgess was assessed by Dr Malhotra, who tested the severity of his condition by asking him to mark the centre of a 25cm line on a piece of paper. During his first meetings, Burgess marked approximately 2cm from the right edge – he simply did not attend to the left side of the line. Nowadays, after regular practice, his mark is more accurate, approximately 10cm from the right.

“It’s in the middle of my line, not the middle of your line,” Burgess told Dr Malhotra during one consultation.

Dr Malhotra says that people with visual neglect do realise something is wrong when it is pointed out to them over and over and over again. “So in a way I think for them it’s slightly abstract that they know there’s some problem on the left hand side, and they use strategies to try and overcome the problem, without really being able to appreciate it in its fullness.”

His most recent work has looked at how patients might reduce this bias to the right. Previous research suggests that people with normal vision perform better at visual attention tasks when they are rewarded for good performanceand Dr Malhotra and his team have found the same thing in neglect patients.

In the experiment, he asked patients to circle images of coins and buttons on a piece of paper covered with lots of other similar symbols. On their first visit, patients performed equally badly with coins or buttons. When they returned for a second test, they were told they would get a pound for each coin they circled.

Their performance subsequently improved on the coins test, but not on the buttons test – where they were told there was no reward – suggesting that motivation could be used in the rehabilitation of stroke patients.

Burgess is going from strength to strength in his rehabilitation. As I shook his hand to leave I remarked on his muscular grip. This somehow ended up with our having an arm wrestle. He is 37 years older than me, and yet he won hands down.

‘They thought I had sunstroke – but it was a clot on my brain’

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blood clot, diagnosis, fatigue, stroke, young people

‘They thought I had sunstroke – but it was a clot on my brain’

I was 18 and had just finished my A-levels when I had a stroke. Not that I had any idea that was what it was. Even when I was diagnosed weeks later, I looked at the consultant blankly. Aren’t strokes something that happen to old people?

I was on holiday in Spain with friends when it happened. Six of us went out there to celebrate the end of our exams. On our first full day, I’d never felt better. We headed straight to the beach and after months of hard work, I finally felt relaxed.

The next evening, when I was getting ready in the bathroom to go out, I coughed and had a bizarre sensation where I felt I could no longer stand. I was completely aware of what was happening and knew full well I was about to fall to the floor, but it was out of my control. I felt very confused. “OK,” I thought as I lay on the tiled floor. “This is weird. I can’t get up or find my balance.”

My friends were downstairs waiting for me and somehow I managed to crawl down the landing and down the stairs and told them I couldn’t walk. By now, I felt very sick and had an overwhelming urge to sleep. They carried me into one of the downstairs beds.

When I woke up a few hours later and crawled into the living room to see them, I noticed the right side of my body – my face, arm, waist and leg – felt weak. Then I was violently sick and the room spun round.

My friends nursed me as I slept on the sofa, waking sporadically to be sick. They called my dad, too, who told them to give me plenty of fluids. But each time I woke up, the weakness on my right side was worse and by now, I found I couldn’t really talk. I knew exactly what I wanted to say, but I couldn’t get it out. I was disoriented and frightened and felt very far from home.

My friends decided I must have had sunstroke but four days later, when I still had no appetite and couldn’t walk or talk, they were really worried. My dad asked his friend from whom we’d rented the villa to go and see me. He took one look at me and said, “You need to get to hospital.”

As soon as I arrived, they sent my friends away, gave me a CT scan and started hooking me up to things they weren’t explaining. Most of them couldn’t speak English and those who could had a small vocabulary. Eventually, one of them told me I was going to intensive care because they’d found lesions on my brain. What on earth did that mean? Could it be a brain tumour? It was terrifying.

My dad flew out the next morning. It was so good to see his face. He and my mum are separated and she didn’t have a passport, which was awful for her. But a few days later, she managed to get an emergency one and when she walked in, we both wept.

I had various tests and scans, but there were still no answers. One consultant mumbled to the doctors something about it perhaps being the beginning stages of multiple sclerosis, but he wasn’t sure. I tried to focus on the “wasn’t sure” bit.

A week later, I was told that I’d exhausted all their tests and they had come to no firm conclusions. They sent me home, saying I’d probably be better off in familiar surroundings.

I was driven straight from the airport to the GP, who gave me an urgent referral to hospital, where I had an MRI scan. Within half an hour, I was told I’d had a stroke. “What’s that?” I asked through my slurred speech. My mum started crying, so I knew it couldn’t be good.

I’d had a blood clot that had managed to lodge itself in the brain, the consultant explained. He didn’t know why I had it, though further investigations showed it was a result of a hole in my heart that I didn’t even know about and possibly a contraceptive pill that I’d been taking for nine months, which I should apparently have been warned can cause blood clots. Other contributing factors I was informed of included the stress of A-levels and the fact that I’d flown.

All I really wanted to know was whether I was going to get better, to speak properly and to feel the right side of my body again. By now, I couldn’t even hold things in my hand. To my huge relief, the doctor said he was almost sure I’d get everything back.

For the next three weeks, I stayed on a stroke ward, where the person closest to my age was 39 and where most were around double that age. A few passed away while I was there and sometimes I’d have moments of worrying it would be my turn next. But most of the time, I remained hopeful.

By the time I was discharged, my weakness and speech did seem to be improving. But I was told I’d need to be booked in for surgery because they’d discovered that my body was susceptible to blood clots and there was a 50 per cent chance I’d have another stroke within a few years. The three-month wait was hard. I was 18 and all my friends were going out and socialising.

But then the operation day came. I was told they’d carry out quite a complicated procedure to prevent future blood clotting and it all sounded so clever that I expected to wake up feeling brilliant. In fact, I was extremely tired and had a lot of migraines for weeks. But there was one positive – they said that what I thought was asthma was actually my deoxygenated blood mixing with my oxygenated blood as a result of the hole in the heart. It meant that when I exercised, it felt like I didn’t have enough air, but they had now solved this problem.

Three months later, I felt a lot better and took a part-time job as a personal shopper in Tesco to bring some money in. As time went on, I decided I’d like to help others who have had strokes or – for whatever reason – can’t be as independent as they’d like, and I got a full-time job as a care assistant. I’d go round to clients’ homes taking them out and doing personal care at home and I loved it. I know what it’s like to be in a position of utter frustration, depending on other people. More recently, I’ve got a job in the NHS as a clinical-management officer. I help to run clinics for certain conditions, including strokes. My next plan is to go to university – which I’d had to put on hold – to train to become a speech and language therapist.

It took a good two years before I was free of stroke symptoms and the exhaustion of it all. I still have some fatigue, migraines and short-term memory problems and I’ve been told that if ever I have children, I’ll need to be closely monitored by a cardiac team. But apart from that, I feel great, am going running as much as I used to and have no visible signs of what I went through. Sometimes it feels a bit like a dream that it ever happened at all.

Interview by Kate Hilpern

Facts about stroke

* A stroke happens when the blood supply to the brain is cut off by either a clot or a bleed, starving the brain of oxygen and causing brain cells to become damaged or die.

* Around 1,000 people under the age of 30 have a stroke every year in the UK and it affects at least 400 children annually.

* Diagnosis of stroke in younger people is often delayed as people generally don’t suspect strokes to happen among this age group – but prompt treatment can significantly improve outcomes.

* Causes of stroke in younger people often differ to those in older people. These include heart conditions such as atrial fibrillation or an undetected hole in the heart. However, risk factors normally associated with older people such as high blood pressure or diabetes can also cause stroke in young people.

* The expectations for recovery after a stroke are slightly better the younger you are.

* Regardless of age, all strokes can be diagnosed using the FAST model:

Facial weakness – has the person’s face drooped, usually down one side?

Arm weakness – is the person able to lift both arms above their head?

Speech problems – does the person’s speech sound slurred?

Time to call 999 – if one or more of these symptoms are present call 999 immediately.

For more information go to stroke.org.uk

How would it feel if you couldn’t recognise your own family?

Tags

'face blindness', Alzheimer's, autism, brain impairment, brain injury, Children, dementia, face processing, facial perception, Memory, new national centre to study, parents, prosopagnosia, stroke, treatment

How would it feel if you couldn’t recognise your own family?

Imagine waking up and not knowing who’s sharing your bed. Imagine collecting a child from school – but picking up the wrong one. Or being a mother and not being recognised by your own child. These are all the problems faced by around a million people in the UK today. Among the famous sufferers are Duncan Bannatyne of Dragons’ Den, playwright Tom Stoppard and Jane Goodall.

It’s called face blindness – or prosopagnosia. It affects more people than Alzheimer’s and autism and, just like dyslexia before it, it’s a hidden handicap that gets people in trouble every day.

But a new national centre to study the condition has been established and pressure is building up on the NHS to recognise the condition and to get the public to understand it and sympathise with the sufferers. There’s also pressure for children to be tested because, after an experiment in Australia there may be hope of treatment. There, in Sydney, an eight-year-old boy identified only as “AL” was put through a long series of tests using grey scale photographs to retrain his brain. For the first time psychologists here are hoping there might finally be a solution. In a letter to the British Medical Journal Dr David Fine, himself a sufferer, revealed the torment of his early life. He wrote that the condition “has shaped my life”. He added: “I often fail to recognise my children or even my wife.” The doctor, from Southampton, is calling for a simple children’s test “so that the next generation of sufferers grows up in a society that understands and recognises our disability”.

Leading researcher Dr Sarah Bate, of Bournemouth University, also wants to develop a way of training sufferers with the condition. She’s just got funding to start a new national centre to study prosopagnosia and she’s already been contacted by 700 individuals offering to be tested. A number of parents who think their children might be sufferers have been in touch and now a joint project with the University of St Andrews is under way – the first attempt to improve these children’s skills at face processing.

Bate has found that part of the problem is the British tradition of wearing school uniforms. She says: “We had one boy of five and the only friend he could make – simply because her face was different – was a Chinese girl.”

In the United States, where they don’t use school uniforms, there was no such problem. And some children, she found, couldn’t even recognise their own parents. One teacher with the condition only coped by the use of seating plans. But when the pupils played up by swapping seats he got depressed and got a post at the Open University corresponding by email.

Dr Bate says: “We’re wondering whether, if we could test children at, say, seven, there might be a chance that some training could help. It’s going to be an uphill battle but we do need those tests – just as they have them for dyslexia.”

A classic case is former IT teacher Jo Livingston, 67, from Bexley. She suffers from the condition and, having retired, is now touring schools and giving talks to make people aware of the problem. Even now, she only recognises her husband “because he has a beard and talks a lot”. They met in their 20s as members of a climbing club.

She says: “When you’re climbing you always wear the same clothes and if someone wears a red anorak they’ll be in a red anorak next week. So I married the one in the red anorak because that was the one I was looking for. Now I do the talks so that people can know about it – so they can have that ‘that’s me’ moment.”

Livingston has found instances where a woman could only be sure it was her baby in hospital if it was the one with a cuddly toy in the cot. Another woman said she was at a festival, looking for someone she’d planned to meet and only later found she’d been chatting to Ronan Keating. And a Hollywood engineer couldn’t even recognise Brad Pitt when they shared a lift.

“Television’s very difficult because characters change clothes and hairstyles and sometimes the plot hinges on that,” Livingston says. “You see two young blond women and you think they’re the same person until they appear on screen together and then you mentally have to rewrite the entire plot. It’s quite exhausting.”

Another sufferer is social worker Nerina Parr, 44, from Brighton. She says: “It’s the new dyslexia… nobody could explain what it was and half the time they didn’t have any sympathy with it anyway. It’s always getting me into trouble. For instance, my partner changed the picture of us on my bedside and I got really jealous and demanded to know who this new person was… then there’s the nightmare of walking into work meetings and not knowing who the people are – even though you work with them.”

Anna Cady, a 60-year-old artist from Winchester, thought at one stage that she had Alzheimer’s or dementia. “So when I found out what it was it was a tremendous relief. Then again, I did some tests on the internet and ended up sobbing my eyes out because I couldn’t even tell when they changed the faces. The awful thing is that you dread going outside because you might offend someone by not recognising them. When someone says ‘hello, Anna’ your heart sinks because you just hope you aren’t going to offend someone.”

If you think you have face blindness and would like to be part of the research you can register at prosopagnosiaresearch.org

Face blindness: Causes and cures

Prosopagnosia or face blindness can be caused by stroke or brain injury, but some people are born with it or develop it despite having no other signs of brain impairment. Recent research suggests it may sometimes be genetic.

It is thought to be caused by abnormality of or damage to a part of the brain that controls memory and facial perception.

In extreme cases, those with the condition are unable to recognise their own faces or tell the difference between a face and an object.

Treatment focuses on teaching coping strategies and the use of a variety of prompts and cues to recognise people by other means. But research is under way and it is hoped an effective prevention or cure may be found.

Elderly patients win right to sue if medical treatment is denied because of age

Tags

abuse, age, discrimination, elderly, stroke

Elderly patients win right to sue if medical treatment is denied because of age

Elderly patients are to receive legal protection against being denied medical treatment simply because of their advanced years, ministers will announce today.

A ban against age discrimination in public services, such as health and social care, is to come into force in October. It will outlaw doctors, care home staff and hospital managers from deciding on levels of care on any grounds other than medical need.

Patients or relatives who believe they have been discriminated against because of their age or are being regarded as a lower priority than younger people with the same condition will able to sue health managers.

Nurses and carers will also face a legal obligation to treat older people with respect and dignity.

The moves follow years of reports of treatment being rationed by age – for instance with younger patients placed nearer the front of the queue for heart surgery – and accounts of elderly patients receiving sub-standard care.

Age discrimination in the workplace is already illegal and ministers have been deliberating for more than a year on whether the ban should be extended to the provision of services. As the timetable slipped, fears grew among campaigners for the elderly that the Government might be having second thoughts.

Ministers have dropped plans to outlaw companies and banks from charging older customers higher prices for products such as travel insurance, but are to implement the bulk of their initial proposals.

Doctors and hospital chiefs are formally advised only to allocate treatment on the basis of medical need and not age.

But studies suggest they are not always abiding by the instruction. Three years ago a think-tank concluded that older people had “differential access to services” – they were less likely than younger people to be referred to intensive care after a serious accident and waited longer in casualty departments. It also found they were not receiving equivalent treatment for conditions such as strokes and heart disease.

Paul Burstow, the Care Minister, will say today: “We know that older people are not always treated with the dignity and respect they deserve because of ageist attitudes – this will not be tolerated. Our population is ageing as more of us live longer. The challenge for the NHS is to look beyond a person’s date of birth and meet the needs of older people as individuals.”

Michelle Mitchell, of Age UK, said: “Discrimination based on your date of birth is as indefensible in 21st-century Britain as prejudice on the basis of race, gender, disability or sexual orientation.

“We hope the new law which will apply to the NHS, social care and other services will prevent older people being denied proper treatment because of their age. It sends a clear message to service providers that discrimination law will in future also protect older people.”

More:

Theresa May announces blanket ban on age discrimination of patients

GPs devise new treatment to beat depression. It’s called gardening

Tags

anxiety, Depression; Gardening, Exercise, stroke

http://www.independent.co.uk/life-style/health-and-families/health-news/gps-devise-new-treatment-to-beat-depression-its-called-gardening-7584583.html

Doctors are to swap pills for the potting shed under plans to prescribe gardening on the NHS as a way to help patients beat depression.

Time spent planting, pruning and propagating can be more powerful than a dose of expensive drugs, according to Sir Richard Thompson, president of the Royal College of Physicians.

He claims the Government’s health reforms will give GPs more choice in how to treat patients, and allow them the freedom to embrace the physical and mental health benefits of horticulture.

“Drug therapy can be really expensive, but gardening costs little and anyone can do it,” said Sir Richard, who is a patron of Thrive, a national charity that provides gardening therapy.

The idea is the latest in a long line of offbeat ideas aimed at improving the nation’s health, from dance lessons that can combat obesity to sending depressed people on camping trips. Under the coalition’s health reforms, clinical groups led by GPs will commission services and Sir Richard, who spoke out in favour of the changes, believes patients could benefit more from gardening classes than extra medication.

“I have, for some time, thought doctors should prescribe a course of gardening for people who come to them with depression or stroke,” Sir Richard said. “The new commissioning structures about to be introduced might allow more innovative treatment approaches to be put in place, including the opportunity to try gardening rather than prescribe expensive drugs.”

Too often, appointments are rushed and doctors are unable to spend time talking to their patients. “There are definite benefits to longer consultations – I would much rather a doctor had time to listen to patients and, instead of prescribing anti-depressants, prescribe a course of gardening.”

Half an hour spent working in the garden can burn off some 200 calories, according to a study published last year. Sir Richard added: “I always wonder why people go to the gym when there is a ‘green gym’ outdoors for us all – and, what’s more, it’s free. Gardening burns off calories; makes joints supple and is fantastic exercise. It is a physical activity that has been shown to be helpful in the treatment of anxiety, depression and dementia.”

Ian Rickman, who suffered a stroke at the age of 40 which left him paralysed down one side, has since been helped by Thrive.

He said: “At first, I burst into tears a lot. I couldn’t see a way I would ever be able to live my life again, to walk out into a garden, let alone work in a garden. Therapy through gardening is a powerful tool – it helped me come to terms with my stroke, and it helped me learn how to live again.”

The idea of gardening as a therapy is gaining high-profile backing from other quarters. The TV presenter Alan Titchmarsh has hailed horticulture for being “great as a therapy” that can “make a real difference to disabled people’s lives”. And the Health minister Paul Burstow added: “There is plenty of evidence to show the benefits of exercise on people’s health and well-being. I’m sure gardening brings those benefits.”

Just the job: How you can enjoy the health benefits of gardening this weekend:

Seedy business Sow vegetable seeds such as carrots, turnips, radishes, rocket and lettuce outside, and try some herbs in pots or trays.

First cut Take advantage of the warm weather to fire up the mower for the first time. It will help create a denser carpet for the summer.

Dead ends Finish pruning any roses, and remove dead leaves and old stalks from perennials. Cut back ivy.

Carry the can Consider buying a water butt: it may be a long dry year.

Water works Clear ponds and reinstall pumps and lights.

Heatwave Enjoy the sun!

Sniffing device allows paralysed woman to communicate

Tags

Locked-In Syndrome, paralysis, stroke

2010:

http://www.guardian.co.uk/science/2010/jul/26/sniffing-device-paralysed-woman-communicate?INTCMP=ILCNETTXT3487

A 51-year-old woman who was left paralysed and unable to communicate following a massive stroke has written for the first time in seven years, scientists say.

The Israeli patient, who was diagnosed with “locked-in syndrome”, typed an emotional email to her six children using a revolutionary device that is controlled by sniffing.

The woman was so badly brain-damaged by the stroke that she cannot move any of her limbs or even blink in response to simple questions. She wrote the letter within a few days of being taught how to use the device.

The technology, developed by scientists at the Weizmann Institute in Rehovot,Israel, is now being used by other severely disabled people to surf the internet and even control a wheelchair. One, a 63-year-old quadriplegic woman who can barely speak, wrote her first letter in 10 years with the device and has started using it to send emails.

“The most moving thing has been witnessing this technology give people a means of communication when they haven’t had it,” said Noam Sobel, a neurobiologist at the institute, who helped develop the technology.

The device works by detecting slight changes in pressure that are produced when a person opens or closes their soft palate, the tissue at the roof of the mouth that controls air flow through the nose. Many patients with serious disabilities are still able to move their palate voluntarily, and so can use the device, said Sobel.

When the sensor is connected to a computer, a person wearing the device can use sniffs alone to select letters on the screen and build up words, phrases and sentences.

One patient, a 42-year-old man who was diagnosed with locked-in syndrome after a car crash 18 years ago, used the sniff-controlled device to say he preferred it to a previous disability aid that performed a similar function by tracking his eye movement, writing that it was “more comfortable and more easy to use”.

The speed at which patients can write with the new device varies between around 20 seconds and a minute for a single letter of the alphabet. The 1997 book, The Diving Bell and the Butterfly, was written by Jean-Dominique Bauby at a rate of roughly one word every two minutes. Bauby, who became locked-in after suffering a stroke, selected letters by blinking his left eye.

In another test of the device, a 30-year-old man who was paralysed from the neck down in a car accident six years ago, used the device to steer a motorised wheelchair along a winding path 30 metres long. After one trial attempt, the patient completed the course as fast as healthy volunteers.

Sobel said he was anxious what locked-in patients might write after being unable to move or communicate for so long, but he said none wrote about wanting to end their own lives. “I was afraid that the minute we could communicate, all that might come out,” he said. “What’s important is giving the person the ability to express themselves.”

The findings are published in the latest issue of the Proceedings of the National Academy of Sciences.

How joggers can help the housebound

Tags

elderly, Exercise, Housebound, stroke

http://www.guardian.co.uk/lifeandstyle/2012/mar/04/good-gym-exercise-community-work

Every Thursday evening, whatever the weather, Harriet Cawley runs two-and-a-half miles from Shoreditch, east London, to the home of her coach, Michael Mulcahy. Cawley regularly undertakes half-marathons but this is no ordinary training session. Mulcahy is a house-bound widower who enjoys receiving a London Evening Standard from Cawley and having a chat for half-an-hour. After which, Cawley runs home again.

Cawley is a member of the Good Gym, a not-for-profit organisation that encourages people to combine their exercise regime with a spot of social care, matching busy workers with elderly “coaches”, who receive a daily paper or other modest delivery and, in turn, provide an incentive for their weekly visitors to keep on running. Set up two-and-a-half years ago, the Good Gym is this year expanding across all Olympic boroughs, part-funded by the Olympic Park Legacy Company.

The Good Gym was the brainchild of Ivo Gormley, 29, who discovered that combining a weekly run with a visit to a housebound friend of the family was just the motivation he needed to keep him exercising; it helped that his elderly friend was a former boxer who could offer training tips. As Gormley did his prescribed situps, he thought about how best to link up a series of very modern disconnects: how few people have the time or energy to volunteer and yet use gyms to burn off excess energy; and how little dialogue there is between working people and the elderly, particularly in densely populated urban communities.

“Gyms are this ridiculous invention,” says Gormley. “People have got too much energy and go to these weird places where they get purged of it by machines. I thought we could channel the energy from people’s exercise into something more productive.”

Through working with the NHS, charities and local community centres, including The Sundial Centre in Bethnal Green and Toynbee Hall, the Good Gym matches runners with an individual coach – a housebound elderly person who would like a regular visitor. They are encouraged to take a newspaper or a modest gift to the value of £1.

There are also monthly group runs around east London, to perform useful activities along the way. So far Good Gym members have distributed flyers for a local hospice, tidied up community gardens and hauled compost on to a school roof. Two runners are now being sought for a somewhat unusual task: taking donkeys from Stepney City Farm for a trot. (The donkeys need the exercise to keep their hooves down; donkey handling training will be provided.)

Cawley, 38, a costume stylist, heard about the Good Gym through Twitter. “It seemed such a brilliant idea,” she says. It took four months for her to be checked by the Criminal Records Bureau (the Good Gym now uses a company to speed up this process and claims it takes just a couple of weeks), then she was assigned Mulcahy to run to, based on the distance she requested.

Having a break in her running works well from a training point of view: she does a speed run to Mulcahy’s house, rests there, then a does a more gentle, warm-down jog on the way home. Cawley is from Stockport and has no grandparents in London, so enjoys chatting to her elderly coach – “someone I would never have met,” she says. While the Good Gym advises runners to stay for about 10 minutes, Cawley sometimes chats to Mulcahy for an hour. Although he has family, and regular visits from professional carers, Cawley thinks he enjoys a visit from someone who does not worry like relatives and is not there out of professional duty. She didn’t really know what he made of “this random person turning up and chatting to him” until she told him she was going away on holiday. “He said: ‘I’ll really miss you.'”

Terry Duncan, 67, a retired printer from Stepney, uses an electric wheelchair after a stroke. He is regularly visited by Sally, another Good Gym member. “It’s lovely. I look forward to her coming,” he says. He played football when he was younger, but is not sure how much use he is as a coach. “I don’t coach her,” he says. What about a mid-run cup of tea? “She normally has a glass of water. She’s a bit hot and sweaty but sits down and has a chat. We’ve become good friends.”

Duncan has recommended the Good Gym to several immobile neighbours, but says they are “a bit dubious about strangers coming into their house”. Despite these fears, the Good Gym is expanding, with interest in Edinburgh and a Good Gym run in Chicago. Most significant this year will be its Olympics expansion. As organisers hope the Games will leave a more enduring legacy in east London, Gormley wants his enterprise to become a social norm for the young professionals moving into the new housing around the Olympic Park. “It’s an amazing opportunity to shape the culture of a new area,” he says. “And link it to the existing community.”

The stroke patient for whom strangers look normal whilst family look strange

Tags

facial recognition, prosopometamorphopsia, stroke

http://bps-research-digest.blogspot.com/2012/02/stroke-patient-for-whom-strangers-look.html

Neuropsychologists in The Netherlands and the UK have documented the curious case of a 62-year-old stroke patient whose brain damage affected her perception of familiar faces whilst leaving her perception of unfamiliar faces intact

The woman, referred to as J.S., struggled to recognise family, fared slightly better with celebrities, whilst having no problems correctly categorising as unfamiliar the faces of complete strangers. When the woman’s daughters came to visit her in hospital, she had no trouble recognising the daughter she hadn’t seen for eight years, but struggled to identify her other daughter who visited daily.

Joost Heutink and his team confirmed this pattern of deficits by comparing J.S.’s performance against three age-matched women in a series of face recognition tasks. As well as having impaired recognition of her family (and to a lesser extent celebrities), J.S. also reported that the appearance of her family members was distorted. For example, she said her grandchildren looked grossly overweight and that they were a deep tanned colour. J.S. also had a general problem recognising emotional facial expressions.

Further details came from recordings of J.S.’s skin conductance (a measure of physiological arousal) when she looked at various faces. This showed that she experienced more arousal after looking at family members’ faces as opposed to strangers and celebrities. This is normal, although the peak and latency of this arousal was delayed relative to the control participants.

So what explains J.S.’s pattern of deficits? Those familiar with neuropsychology may be reminded of Capgras Syndrome, in which the patient claims that one or more close relations have been replaced by an imposter. But J.S. does not have this syndrome. People with Capgras say that the imposter is a perfect likeness to the real relation. By contrast, J.S. does not think her relations are imposters, she just struggles to identify them and thinks their appearance has been distorted.

J.S.’s condition also bears some resemblance to prosopagnosia – a specific deficit affecting face recognition. Again, this doesn’t really match J.S.’s neuropsychological profile. After all, her recognition of strangers’ faces as unfamiliar was near perfect. Moreover, the brain region that’s normally damaged in proposopagnosia – the fusiform face area – was unaffected in J.S.’s brain.

Joost Heutink and his colleauges think part of the answer may lie with a rare condition known as prosopometamorphopsia – in which other people’s faces are perceived as being warped or distorted. The researchers suggest J.S. may have a form of this condition that interacts in some way with the emotional meaning of faces. So, if a face affects her emotionally (as happens with family), she perceives their face as distorted, which also has the side-effect of affecting her conscious recognition. This account fits with the distribution of brain damage in J.S.’s brain. In particular she suffered damage to the posterior superior temporal sulcus, which it’s been suggested is involved in merging information about face identity with emotional context and meaning.

This account also helps explain two exceptions to J.S.’s relatively superior performance in recognising celebrity faces vs. family members. When it came to images of Hitler and Bin Laden (characters likely to trigger an emotional response), she believed they actually depicted imposters, and poor ones at that.

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Heutink, J., Brouwer, W., Kums, E., Young, A., and Bouma, A. (2012). When family looks strange and strangers look normal: A case of impaired face perception and recognition after stroke. Neurocase, 18 (1), 39-49 DOI:10.1080/13554794.2010.547510

Post written by Christian Jarrett for the BPS Research Digest.