Bases para un dise��o metodol��gico de estimulaci��n binaural como terapia ac��stica en neurolog��a

La medicina y la ingenier��a del siglo XXI han dado como fruto numerosos avances para la sociedad aunque en la mayor��a de los casos los tratamientos suelen ser costosos e invasivos. La educaci��n que recibe la sociedad sobre la salud es escasa, ya que s��lo vamos al m��dico cuando realmente estamos enfermos. Este trabajo presenta nuestra apuesta por las terapias complementarias, para el desarrollo de una metodolog��a terap��utica no invasiva y con un costo muy bajo. La finalidad de esta Tesis, que se enmarca en un equipo multidisciplinar, fruto de la estrecha colaboraci��n en el que participan psicopedagogos, ingenieros y m��dicos, es perfilar una metodolog��a que luego pueda ser aplicable a patolog��as neurol��gicas. Aqu��, dejamos sentadas las bases. Faltar��n nuevos investigadores que contin��en este camino para tener una base de datos lo suficientemente extensa de registros de sujetos que hayan sido sometidos a terapia binaural, para poder sacar unas conclusiones s��lidas. La aportaci��n de esta Tesis deja cubierta la aplicaci��n, selecci��n, procesado de se��al y desarrollo de algoritmos, test cognitivos indicados para el caso espec��fico que nos ocupa, c��lculo de incertidumbre del sistema utilizado para la aplicaci��n del est��mulo y desarrollo de un test psicoac��stico espec��fico. EL empleo del sonido en medicina como es la musicoterapia o sonoterapia ha experimentado una gran difusi��n en los ��ltimos a��os, m��s de 100.000 nuevas citas bibliogr��ficas han aparecido con respecto al a��o anterior. Sin embargo, son escas��simas las que hacen referencia a las caracter��sticas f��sico ac��sticas del sonido empleado, tan s��lo hemos encontrado una par de ellas que correlacionan las caracter��sticas f��sicas del sonido con el tipo de respuesta terap��utica. No encontramos citas bibliogr��ficas espec��ficas que planteen un modelo experimental cient��fico capaz de reproducir las mismas respuestas ante los mismos par��metros y est��mulos. En esta Tesis proponemos el uso de estimulaci��n sonora binaural, que consiste en la utilizaci��n de dos tonos puros id��nticos pero ligeramente diferentes en frecuencia que se presentan de manera separada cada uno en un o��do, como consecuencia, la persona que recibe la estimulaci��n percibe un tercer tono, llamado tono binaural, formado por la diferencia de frecuencia de ambos variando su amplitud. Existen estudios que sugieren que dichas frecuencias binaurales pueden modificar los patrones el��ctricos de la actividad cerebral y los niveles de arousal, conoci��ndose en la literatura bajo el nombre de ���entrainment���. Tras la revisi��n bibliogr��fica del estado del arte, podemos concluir que es necesario el desarrollo de estudios doble ciego bien dise��ados, con el objetivo de establecer una base s��lida sobre los efectos de este tipo de estimulaci��n, ya que la mayor��a de los beneficios documentados se refieren a muestras muy peque��as y con poco rigor cient��fico, siendo los resultados positivos obtenidos debidos al efecto placebo. La tecnolog��a binaural es barata siendo cualquier avance en esta direcci��n de inter��s p��blico. El objetivo concreto de la investigaci��n es estudiar el potencial de las ondas binaurales en un ��rea en particular: tareas que requieren atenci��n y concentraci��n. Se busca obtener cualquier cambio en las ondas cerebrales que se puedan correlar con la mejoras. A la vista de los resultados de estas investigaciones se intentar�� aplicar esta metodolog��a en neuropatolog��as que presenten alguna deficiencia en el ��rea de atenci��n como es el Trastorno de espectro Autista. En esta Tesis presentamos los resultados de dos estudios independientes, el primero para sentar las bases del m��todo (tiempos, dise��o de estimulaciones, procesado) en una muestra de 78 adultos sanos, el segundo a partir de los resultados obtenidos en el primero, afinando la metodolog��a y para un grupo de 20 ni��os entre 8 y 12 a��os, los resultados del segundo estudio sirven para justificar su aplicaci��n en ni��os con TEA que presenten d��ficit de atenci��n. ABSTRACT Medicine and engineering in the 21st century have resulted in advances for society but in most cases the treatments are often costly and invasive. The health education society receive is scarce, since only go to the doctor when we are really sick. With this work I present my commitment to complementary therapies, my little grain of sand in the development of a noninvasive therapeutic approach and very low cost, well and can be used in a preventive manner resulting in a society with less sick. The purpose of this thesis is to outline a methodology that can then be applied to neurological diseases, here we lay the groundwork. New researchers are needed to continue this path for a sufficiently extensive records database of subjects who have undergone binaural therapy, and so to draw firm conclusions. The contribution of this thesis includes: the application, selection, signal processing and algorithm development, indicated cognitive tests for the specific case at hand, calculation of system uncertainty of the system and development of a specific psychoacoustic test. The use of sound in medicine, such as music therapy or sound therapy has experienced a great diffusion in recent years, more than 100,000 new citations have appeared over the previous year but very few are those referring to acoustic physical characteristics of sound employee, we have only found a couple of them that physical sound characteristics are correlated with the therapeutic response. We found no specific citations posing a scientific experimental model capable of reproducing the same answers to the same parameters and stimuli. In this thesis we propose the use of binaural sound stimulation which involves the use of two identical but slightly different in frequency pure tones presented separately each in one ear, as a result the subject perceives a third tone, called binaural tone, formed by the difference in frequency with amplitude variations Studies suggest that these binaural frequencies can modify the electrical patterns of brain activity and arousal levels, being known in the literature under the name of ���entrainment���. After the literature review of the state of the art, we conclude, it is necessary to develop well-designed double-blind studies, in order to establish a solid foundation on the effects of such stimulation, since most of the documented benefits relate to very small samples and unscientific may be obtained positive results due to the placebo effect. The binaural technology is cheap being any progress in this direction in the public interest. The specific objective of the research is to study the potential of binaural waves in a particular area: tasks requiring attention and concentration also we want to get any change in brain waves that can correlate with improvements. In view of the results of this research we seek to apply this methodology in neuropathology presenting any deficiency in the area of attention such as Autism Spectrum Disorder. In this thesis we present the results of two independent studies, the first to lay the foundation of the method (times, stimulation design, processing) in a sample of 78 healthy adults, the second from the results obtained in the first, refine the methodology for a group of 20 children between 8 and 12 years, the results of the second study used to justify its use in children with ASD that present attention deficit.

Using quantitative descriptive analysis and temporal dominance of sensations analysis as complementary methods for profiling commercial blackcurrant squashes

Quantitative descriptive analysis (QDA) is used to describe the nature and the intensity of sensory properties from a single evaluation of a product, whereas temporal dominance of sensation (TDS) is primarily used to identify dominant sensory properties over time. Previous studies with TDS have focused on model systems, but this is the first study to use a sequential approach, i.e. QDA then TDS in measuring sensory properties of a commercial product category, using the same set of trained assessors (n = 11). The main objectives of this study were to: (1) investigate the benefits of using a sequential approach of QDA and TDS and (2) to explore the impact of the sample composition on taste and flavour perceptions in blackcurrant squashes. The present study has proposed an alternative way of determining the choice of attributes for TDS measurement based on data obtained from previous QDA studies, where available. Both methods indicated that the flavour profile was primarily influenced by the level of dilution and complexity of sample composition combined with blackcurrant juice content. In addition, artificial sweeteners were found to modify the quality of sweetness and could also contribute to bitter notes. Using QDA and TDS in tandem was shown to be more beneficial than each just on its own enabling a more complete sensory profile of the products.

A graphical tool for designing interactive video cognitive rehabilitation therapies

Acquired Brain Injury (ABI) has become one of the most common causes of neurological disability in developed countries. Cognitive disorders result in a loss of independence and therefore patients? quality of life. Cognitive rehabilitation aims to promote patients? skills to achieve their highest degree of personal autonomy. New technologies such as interactive video, whereby real situations of daily living are reproduced within a controlled virtual environment, enable the design of personalized therapies with a high level of generalization and a great ecological validity. This paper presents a graphical tool that allows neuropsychologists to design, modify, and configure interactive video therapeutic activities, through the combination of graphic and natural language. The tool has been validated creating several Activities of Daily Living and a preliminary usability evaluation has been performed showing a good clinical acceptance in the definition of complex interactive video therapies for cognitive rehabilitation.

Running away from side effects: physical exercise as a complementary intervention for breast cancer patients

The number of breast cancer survivors increases every year, thanks to the development of new treatments and screening techniques. However, patients present with numerous side effects that may affect their quality of life. Exercise has been demostrated to reduce some of these side effects, but in spite of this, few breast cancer patientes know and follow the exercise recommendations needed to remain healthy. In this review, we describe the differente breast cancer treatments and the related side effects and implications of exercise in relation to these. We propose that exercise could be and integrative complementary intervention to improve physiological, physical and psychological factors that affect survival and quality of life of these patients. For that reason, the main objective of this review is to provide a general overview of exercise benefits in breast cancer patients and recommendations of how to design exercise interventions in patients with different side effects.

Magnetic resonance imaging based signal intensity mapping predicts appropriate therapies after prophylactic ventricular tachycardia substrate ablation in patients with previous myocardial infarction and secondary prevention implantable cardioverter-defibrillator implantation

The aim of this study was to determine the capability of ceMRI based signal intensity (SI) mapping to predict appropriate ICD therapies after PVTSA.

Modelling ecological cognitive rehabilitation therapies for building virtual environments in brain injury

Brain Injury (BI) has become one of the most common causes of neurological disability in developed countries. Cognitive disorders result in a loss of independence and patients? quality of life. Cognitive rehabilitation aims to promote patients? skills to achieve their highest degree of personal autonomy. New technologies such as virtual reality or interactive video allow developing rehabilitation therapies based on reproducible Activities of Daily Living (ADLs), increasing the ecological validity of the therapy. However, the lack of frameworks to formalize and represent the definition of this kind of therapies can be a barrier for widespread use of interactive virtual environments in clinical routine.