Bases para un diseño metodológico de estimulación binaural como terapia acústica en neurología

La medicina y la ingeniería del siglo XXI han dado como fruto numerosos avances para la sociedad aunque en la mayoría de los casos los tratamientos suelen ser costosos e invasivos. La educación que recibe la sociedad sobre la salud es escasa, ya que sólo vamos al médico cuando realmente estamos enfermos. Este trabajo presenta nuestra apuesta por las terapias complementarias, para el desarrollo de una metodología terapéutica no invasiva y con un costo muy bajo. La finalidad de esta Tesis, que se enmarca en un equipo multidisciplinar, fruto de la estrecha colaboración en el que participan psicopedagogos, ingenieros y médicos, es perfilar una metodología que luego pueda ser aplicable a patologías neurológicas. Aquí, dejamos sentadas las bases. Faltarán nuevos investigadores que continúen 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 sólidas. La aportación de esta Tesis deja cubierta la aplicación, selección, procesado de señal y desarrollo de algoritmos, test cognitivos indicados para el caso específico que nos ocupa, cálculo de incertidumbre del sistema utilizado para la aplicación del estímulo y desarrollo de un test psicoacústico específico. EL empleo del sonido en medicina como es la musicoterapia o sonoterapia ha experimentado una gran difusión en los últimos años, más de 100.000 nuevas citas bibliográficas han aparecido con respecto al año anterior. Sin embargo, son escasísimas las que hacen referencia a las características físico acústicas del sonido empleado, tan sólo hemos encontrado una par de ellas que correlacionan las características físicas del sonido con el tipo de respuesta terapéutica. No encontramos citas bibliográficas específicas que planteen un modelo experimental científico capaz de reproducir las mismas respuestas ante los mismos parámetros y estímulos. En esta Tesis proponemos el uso de estimulación sonora binaural, que consiste en la utilización de dos tonos puros idénticos pero ligeramente diferentes en frecuencia que se presentan de manera separada cada uno en un oído, como consecuencia, la persona que recibe la estimulación 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 eléctricos de la actividad cerebral y los niveles de arousal, conociéndose en la literatura bajo el nombre de “entrainment”. Tras la revisión bibliográfica del estado del arte, podemos concluir que es necesario el desarrollo de estudios doble ciego bien diseñados, con el objetivo de establecer una base sólida sobre los efectos de este tipo de estimulación, ya que la mayoría de los beneficios documentados se refieren a muestras muy pequeñas y con poco rigor científico, siendo los resultados positivos obtenidos debidos al efecto placebo. La tecnología binaural es barata siendo cualquier avance en esta dirección de interés público. El objetivo concreto de la investigación es estudiar el potencial de las ondas binaurales en un área en particular: tareas que requieren atención y concentración. 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 intentará aplicar esta metodología en neuropatologías que presenten alguna deficiencia en el área de atención como es el Trastorno de espectro Autista. En esta Tesis presentamos los resultados de dos estudios independientes, el primero para sentar las bases del método (tiempos, diseño de estimulaciones, procesado) en una muestra de 78 adultos sanos, el segundo a partir de los resultados obtenidos en el primero, afinando la metodología y para un grupo de 20 niños entre 8 y 12 años, los resultados del segundo estudio sirven para justificar su aplicación en niños con TEA que presenten déficit de atención. 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.

Violence is Rare in Autism : When It Does Occur, Is It Sometimes Extreme?

Peer reviewed

Asperger's Disorder in College Students: Application of Acceptance and Commitment Therapy

College students with Asperger's Disorder (AD) are likely to face significant challenges as they encounter the unpredictable and socially demanding environment of their university setting. Acceptance and Commitment Therapy (ACT) can be a valuable approach to addressing many of these struggles. This paper will explore the application of ACT to problems that are commonly associated with individuals diagnosed with AD. Utilizing ACT and the Hexaflex Model as a guide for working with AD students can assist in establishing a greater understanding and acceptance of their unique internal experience, as well as their interaction with the external world. ACT can offer these students the ability to be more present in the moment, to recognize efforts to avoid negative experiences, and to move in directions in life that are personally meaningful.

Attitudes of the autism community to early autism research

Investigation into the earliest signs of autism in infants has become a significant sub-field of autism research. This work invokes specific ethical concerns such as use of 'at-risk' language, communicating study findings to parents and the future perspective of enrolled infants when they reach adulthood. This study aimed to ground this research field in an understanding of the perspectives of members of the autism community. Following focus groups to identify topics, an online survey was distributed to autistic adults, parents of children with autism and practitioners in health and education settings across 11 European countries. Survey respondents (n = 2317) were positively disposed towards early autism research, and there was significant overlap in their priorities for the field and preferred language to describe infant research participants. However, there were also differences including overall less favourable endorsement of early autism research by autistic adults relative to other groups and a dislike of the phrase 'at-risk' to describe infant participants, in all groups except healthcare practitioners. The findings overall indicate that the autism community in Europe is supportive of early autism research. Researchers should endeavour to maintain this by continuing to take community perspectives into account.

Pre-attentive auditory sensory processing in autistic spectrum disorder:are electromagnetic measurements telling us a coherent story?

Sensory processing is a crucial underpinning of the development of social cognition, a function which is compromised in variable degree in patients with pervasive developmental disorders (PDD). In this manuscript, we review some of the most recent and relevant contributions, which have looked at auditory sensory processing derangement in PDD. The variability in the clinical characteristics of the samples studied so far, in terms of severity of the associated cognitive deficits and associated limited compliance, underlying aetiology and demographic features makes a univocal interpretation arduous. We hypothesise that, in patients with severe mental deficits, the presence of impaired auditory sensory memory as expressed by the mismatch negativity could be a non-specific indicator of more diffuse cortical deficits rather than causally related to the clinical symptomatology. More consistent findings seem to emerge from studies on less severely impaired patients, in whom increased pitch perception has been interpreted as an indicator of increased local processing, probably as compensatory mechanism for the lack of global processing (central coherence). This latter hypothesis seems extremely attractive and future trials in larger cohorts of patients, possibly standardising the characteristics of the stimuli are a much-needed development. Finally, specificity of the role of the auditory derangement as opposed to other sensory channels needs to be assessed more systematically using multimodal stimuli in the same patient group. (c) 2006 Elsevier B.V. All rights reserved.

Case study: auditory brain responses in a minimally verbal child with autism and cerebral palsy

An estimated 30% of individuals with autism spectrum disorders (ASD) remain minimally verbal into late childhood, but research on cognition and brain function in ASD focuses almost exclusively on those with good or only moderately impaired language. Here we present a case study investigating auditory processing of GM, a nonverbal child with ASD and cerebral palsy. At the age of 8 years, GM was tested using magnetoencephalography (MEG) whilst passively listening to speech sounds and complex tones. Where typically developing children and verbal autistic children all demonstrated similar brain responses to speech and nonspeech sounds, GM produced much stronger responses to nonspeech than speech, particularly in the 65–165 ms (M50/M100) time window post-stimulus onset. GM was retested aged 10 years using electroencephalography (EEG) whilst passively listening to pure tone stimuli. Consistent with her MEG response to complex tones, GM showed an unusually early and strong response to pure tones in her EEG responses. The consistency of the MEG and EEG data in this single case study demonstrate both the potential and the feasibility of these methods in the study of minimally verbal children with ASD. Further research is required to determine whether GM's atypical auditory responses are characteristic of other minimally verbal children with ASD or of other individuals with cerebral palsy.

The relationship between spoken language and speech and nonspeech processing in children with autism:a magnetic event-related field study

It has been proposed that language impairments in children with Autism Spectrum Disorders (ASD) stem from atypical neural processing of speech and/or nonspeech sounds. However, the strength of this proposal is compromised by the unreliable outcomes of previous studies of speech and nonspeech processing in ASD. The aim of this study was to determine whether there was an association between poor spoken language and atypical event-related field (ERF) responses to speech and nonspeech sounds in children with ASD (n = 14) and controls (n = 18). Data from this developmental population (ages 6-14) were analysed using a novel combination of methods to maximize the reliability of our findings while taking into consideration the heterogeneity of the ASD population. The results showed that poor spoken language scores were associated with atypical left hemisphere brain responses (200 to 400 ms) to both speech and nonspeech in the ASD group. These data support the idea that some children with ASD may have an immature auditory cortex that affects their ability to process both speech and nonspeech sounds. Their poor speech processing may impair their ability to process the speech of other people, and hence reduce their ability to learn the phonology, syntax, and semantics of their native language.

Singing About Expected Behaviors for Group Instruction

The proposed study will be displayed on a poster board that contains the research methods and results due to the use of music intervention with students with ASD.

Investigating the developmental and behavioral consequences of maternal immune activation on affected offspring

Maternal infection during pregnancy increases the risk of several neuropsychiatric disorders later in life, many of which have a component of dopaminergic (DA) dysfunction, including schizophrenia, autism spectrum disorders (ASD), and attention deficit hyperactivity disorder (ADHD). The majority of DA neurons are found in the adult midbrain; as such the midbrain is a key region of interest regarding these disorders. The literature is conflicting regarding the behavioral alterations following maternal immune activation (MIA) exposure, and the cellular and molecular consequences of MIA on the developing midbrain remain to be fully elucidated. Thus, this thesis aimed to establish the consequences of acute and mild MIA on offspring dopamine-related behaviors, as well as the associated cellular and molecular disturbances of MIA on offspring midbrains. We utilized a rat model of MIA using low dose (50μg/kg, I.P.) of LPS administered at different gestational ages. Our first study indicated that MIA at later gestational ages significantly increased pro-inflammatory IL-1β expression, and reduced HSD11B2 expression in the placenta, which is an important regulator of fetal development. In utero LPS exposure at later gestational ages also impaired the growth of neurons from affected offspring. This study identified key gestational stages during which MIA resulted in differential effects. We utilized these time points in subsequent studies, the next of which investigated neurobehavioral outcomes following MIA. Our results from that study showed that motor differences occurred in juvenile offspring following MIA at E16 only, and these differences were compensated for in adolescence. Then, there was a decline in motor behavior capabilities in adulthood, again only for animals exposed to MIA on E16 (and not E12). Furthermore, our results also demonstrated adolescent and adult offspring that were exposed to MIA at E12 had diminished responses to amphetamine in reward seeking behaviors. In our final study, we aimed to investigate the molecular and cellular changes following MIA which might explain these behavioral alterations. This final study showed a differential inflammatory response in fetal midbrains depending on gestational age of exposure as well as differential developmental alterations. For example, LPS exposure at E16 resulted in decreased VM neurosphere size after 7DIV and this was associated with an increased susceptibility to neurotoxic effects of pro-inflammatory cytokines for VM neurospheres and VM DA neurons treated in culture. In utero LPS exposure at E16 also reduced DA neuron count of fetal VM, measured by TH staining. However, there were no differences in DA neuron number in juvenile, adolescent, or adult offspring. Similarly, LPS exposure did not alter cell number or morphology of glial cells in the midbrains of affected offspring. In conclusion, this thesis indicated later rat pregnancy (E16) as vulnerable time for MIA to affect the development of the nigrostriatal pathway and subsequent behavioral outcomes, possibly implicating a role for MIA in increased risk for disorders associated with motor behavior, like PD. These effects may be mediated through alterations in the placenta and altered inflammatory mediators in the offspring brain. This thesis has also shown that MIA in earlier rat pregnancy (E12) results in altered mesocorticolimbic function, and in particular MIA on E12 resulted in a differential response to amphetamine in affected offspring, which may implicate a role for MIA in increasing the risk for disorders associated with this pathway, including drug tolerance and addiction.

Staff training in autism: The one-eyed wo/man….

Having well-trained staff is key to ensuring good quality autism services, especially since people affected with autism generally tend to have higher support needs than other populations in terms of daily living as well as their mental and physical health. Poorly-trained staff can have detrimental effects on service provision and staff morale and can lead to staff burn-out as well as increased service user anxiety and stress. This paper reports on a survey with health, social care, and education staff who work within the statutory autism services sector in the UK that explored their knowledge and training with regards to autism. Interview data obtained from staff and service users offer qualitative illustrations of survey findings. Overall, the findings expose an acute lack of autism specific training that has detrimental impacts. At best this training was based on brief and very basic awareness raising rather than on in-depth understanding of issues related to autism or skills for evidence-based practice. Service users were concerned with the effects that lack of staff training had on the services they received. The paper concludes with a discussion of policy routes to achieving quality staff training based on international best practice. The focus is on improving the quality of life and mental health for services users and staff as well as making potentially significant cost-savings for governments.

Barnbok om AST – Autismspektrumtillstånd : Processen bakom skapandet av en informativ barnbok

Idag finns det mycket litteratur om Autismspektrumtillstånd att läsa, men det mesta är riktat till dem som redan har diagnosen eller föräldrar och bekanta. Det finns även många med AST som själva har skrivit böcker om sin diagnos. Det som saknas är en bok för barn utan AST men som möter barn med AST i vardagen och därför valde vi att skapa en bok om AST för barn. Detta för att barn utan kunskap kanske inte vet hur de ska bemöta sina klasskompisar med diagnosen. På ett lärorikt sätt ska barn utan AST kunna läsa och uppleva boken för att få en ökad förståelse om vad det innebär att ha AST. En bakgrundsstudie genomfördes för att få en ökad förståelse för AST och hur man skriver en barnbok. En webbenkätundersökning genomfördes för att ta reda på människors generella uppfattning och kunskaper om AST. Därefter skapade vi en barnbok för målgruppen 7–9 år med all den bakgrundskunskap vi fick fram. Vi testade vår slutprodukt med klass 3A och 3B på Hälsinggårdsskolan i Falun. De fick själva läsa boken och svara på en enkät med frågor om vad de tyckte om boken och om de hade lärt sig något nytt. Testet av vår bokprototyp visade att målgruppen uppskattade bokprototypen och att de elever som deltog lärde sig något om AST.

Fetal Alcohol Spectrum Disorder Primary Prevention through FASD Diagnosis: Identification of High-Risk Birth Mothers through the Diagnosis of their Children. Follow-up Study

Thesis (Master's)--University of Washington, 2016-08

Supporting people with Autism Spectrum Disorders in leisure time: impact of an University Volunteer Program, and related factors

La participación social tiene efectos positivos en salud mental y física, y puede tomarse como un indicador de calidad de vida. Sin embargo, la participación de personas con discapacidad en su comunidad es aún escasa, especialmente para las personas con autismo. En este trabajo evaluamos el grado de satisfacción con un programa de voluntariado universitario dirigido a personas con autismo para apoyar actividades de ocio y tiempo libre (APUNTATE). Un total de 159 familias de usuarios y 230 voluntarios cumplimentaron un cuestionario de satisfacción que identificó las áreas en las que el programa tenía más impacto. Los resultados mostraron una alta satisfacción general tanto en usuarios como en voluntarios, aunque algunas características personales de los usuarios generaron leves diferencias. Los aspectos más valorados fueron la organización del programa, la formación y tutorización continua que se ofrecía a los voluntarios. Otra característica del programa, ampliamente valorada, fue la capacidad de éste de adaptar los apoyos a las necesidades individuales de usuarios y voluntarios. Este trabajo pone de manifiesto que la universidad pública puede implementar con éxito programas de apoyos para promover la participación social. Estos programas pueden favorecen el desarrollo personal, favorecer el cambio de actitudes hacia las personas con discapacidad y mejorar las perspectivas de empleo de los estudiantes.