Music in the recovering brain

Listening to music involves a widely distributed bilateral network of brain regions that controls many auditory perceptual, cognitive, emotional, and motor functions. Exposure to music can also temporarily improve mood, reduce stress, and enhance cognitive performance as well as promote neural plasticity. However, very little is currently known about the relationship between music perception and auditory and cognitive processes or about the potential therapeutic effects of listening to music after neural damage. This thesis explores the interplay of auditory, cognitive, and emotional factors related to music processing after a middle cerebral artery (MCA) stroke. In the acute recovery phase, 60 MCA stroke patients were randomly assigned to a music listening group, an audio book listening group, or a control group. All patients underwent neuropsychological assessments, magnetoencephalography (MEG) measurements, and magnetic resonance imaging (MRI) scans repeatedly during a six-month post-stroke period. The results revealed that amusia, a deficit of music perception, is a common and persistent deficit after a stroke, especially if the stroke affects the frontal and temporal brain areas in the right hemisphere. Amusia is clearly associated with deficits in both auditory encoding, as indicated by the magnetic mismatch negativity (MMNm) response, and domain-general cognitive processes, such as attention, working memory, and executive functions. Furthermore, both music and audio book listening increased the MMNm, whereas only music listening improved the recovery of verbal memory and focused attention as well as prevented a depressed and confused mood during the first post-stroke months. These findings indicate a close link between musical, auditory, and cognitive processes in the brain. Importantly, they also encourage the use of listening to music as a rehabilitative leisure activity after a stroke and suggest that the auditory environment can induce long-term plastic changes in the recovering brain.

Narratives of Travel and the Travelling Concept of Narrative: Genre Blending and the Art of Transformation

In this article I shall argue that understandings of what constitutes narrative, how it functions, and the contexts in which it applies have broadened in line with cultural, social and intellectual trends which have seen a blurring, if not the dissolution, of boundaries between ‘fact’ and ‘fiction’; ‘literary’ and ‘non-literary’ narrative spaces; history and story; concepts of time and space, text and image, teller and tale, representation and reality.To illustrate some of the ways in which the concept of narrative has travelled across disciplinary and generic boundaries, I shall look at The Art of Travel (de Botton 2003), with a view to demonstrating how the blending of genres works to produce a narrative that is at once personal and philosophical; visual and verbal; didactic and poetic. I shall show that such a text constitutes a site of interrogation of concepts of narrative, even as it depends on the reader’s ability to narrativize experience.

Cognitive Functioning in Alcohol and Other Substance Use Disorders in Young Adulthood : A Genetic Epidemiological Study

Alcohol and other substance use disorders (SUDs) result in great costs and suffering for individuals and families and constitute a notable public health burden. A multitude of factors, ranging from biological to societal, are associated with elevated risk of SUDs, but at the level of individuals, one of the best predictors is a family history of SUDs. Genetically informative twin and family studies have consistently indicated this familial risk to be mainly genetic. In addition, behavioral and temperamental factors such as early initiation of substance use and aggressiveness are associated with the development of SUDs. These familial, behavioral and temperamental risk factors often co-occur, but their relative importance is not well known. People with SUDs have also been found to differ from healthy controls in various domains of cognitive functioning, with poorer verbal ability being among the most consistent findings. However, representative population-based samples have rarely been used in neuropsychological studies of SUDs. In addition, both SUDs and cognitive abilities are influenced by genetic factors, but whether the co-variation of these traits might be partly explained by overlapping genetic influences has not been studied. Problematic substance use also often co-occurs with low educational level, but it is not known whether these outcomes share part of their underlying genetic influences. In addition, educational level may moderate the genetic etiology of alcohol problems, but gene-environment interactions between these phenomena have also not been widely studied. The incidence of SUDs peaks in young adulthood rendering epidemiological studies in this age group informative. This thesis investigated cognitive functioning and other correlates of SUDs in young adulthood in two representative population-based samples of young Finnish adults, one of which consisted of monozygotic and dizygotic twin pairs enabling genetically informative analyses. Using data from the population-based Mental Health in Early Adulthood in Finland (MEAF) study (n=605), the lifetime prevalence of DSM-IV any substance dependence or abuse among persons aged 21—35 years was found to be approximately 14%, with a majority of the diagnoses being alcohol use disorders. Several correlates representing the domains of behavioral and affective factors, parental factors, early initiation of substance use, and educational factors were individually associated with SUDs. The associations between behavioral and affective factors (attention or behavior problems at school, aggression, anxiousness) and SUDs were found to be largely independent of factors from other domains, whereas daily smoking and low education were still associated with SUDs after adjustment for behavioral and affective factors. Using a wide array of neuropsychological tests in the MEAF sample and in a subsample (n=602) of the population-based FinnTwin16 (FT16) study, consistent evidence of poorer verbal cognitive ability related to SUDs was found. In addition, participants with SUDs performed worse than those without disorders in a task assessing psychomotor processing speed in the MEAF sample, whereas no evidence of more specific cognitive deficits was found in either sample. Biometrical structural equation models of the twin data suggested that both alcohol problems and verbal ability had moderate heritabilities (0.54—0.72), and that their covariation could be explained by correlated genetic influences (genetic correlations -0.20 to -0.31). The relationship between educational level and alcohol problems, studied in the full epidemiological FT16 sample (n=4,858), was found to reflect both genetic correlation and gene-environment interaction. The co-occurrence of low education and alcohol problems was influenced by overlapping genetic factors. In addition, higher educational level was associated with increased relative importance of genetic influences on alcohol problems, whereas environmental influences played a more important role in young adults with lower education. In conclusion, SUDs, especially alcohol abuse and dependence, are common among young Finnish adults. Behavioral and affective factors are robustly related to SUDs independently of many other factors, and compared to healthy peers, young adults who have had SUDs during their life exhibit significantly poorer verbal cognitive ability, and possibly less efficient psychomotor processing. Genetic differences between individuals explain a notable proportion of individual differences in risk of alcohol dependence, verbal ability, and educational level, and the co-occurrence of alcohol problems with poorer verbal cognition and low education is influenced by shared genetic backgrounds. Finally, various environmental factors related to educational level in young adulthood moderate the relative importance of genetic factors influencing the risk of alcohol problems, possibly reflecting differences in social control mechanisms related to educational level.

Cognitive functioning and its heritability in bipolar I disorder

Bipolar I disorder is a severe psychiatric disorder characterized by episodic mood alterations that can be manic, depressive or mixed. Bipolar disorder seems to be highly genetic, but the etiology of this complex disorder has remained elusive. In recent years, studies have found that euthymic patients with bipolar disorder may have impairments particularly in executive functioning, verbal learning and memory. These impairments may be present also among some of the relatives of these patients, who may be vulnerable to the disorder. Using neuropsychological variables as endophenotypes, i.e. intermediate phenotypes between genes and the phenotypes, has been suggested to aid search for the etiological background of the disorder, but evidence is sparse on whether these variables fulfill the criteria for endophenotypes. The present thesis is part of the Genetic Epidemiology and Molecular Genetics of Severe Mental Disorders in Finland project. The specific aim was to investigate whether neuropsychological test variables would indicate genetic liability to the disorder and could therefore be regarded as endophenotypes. Thus, cognitive functions and their heritability were studied in bipolar I disorder patients and in their unaffected first-degree relatives from a population-based sample of families, comparing them to a population-based control group. In order to add homogeneity to the subgroups of bipolar disorder patients and their relatives, cognitive functions and their heritability were further studied in a group of families affected by bipolar I disorder only (bipolar families) and another group of families affected by both bipolar I disorder and schizophrenia or schizoaffective disorders (mixed families). Finally, the effect of processing speed on other cognitive functions was investigated. The study showed that especially executive functioning and processing speed fulfilled the endophenotype criteria. Impairments in these functions were found in bipolar patients and in their relatives irrespective of other severe psychopathology in the family. These functions were highly heritable in these families. Study also showed that generalized impairment in verbal memory may associate more with bipolar disorder than to vulnerability to other psychotic disorders, and be more related to fully developed disease; impairments in verbal learning and memory were found only in patients, and they were not found to be highly heritable. Finally, the most potential endophenotype, i.e. processing speed, seemed to contribute to a range of other cognitive dysfunctions seen in bipolar disorder patients. Processing speed, in particular, has also been shown to be a valid endophenotype in subsequent association analyses in psychiatric genetics in Finland and internationally. Information concerning cognitive impairments and their association with the psychosocial consequences of bipolar disorder is important in planning treatment. It is also important to understand and acknowledge that patients may have cognitive impairments that affect their everyday life. Psychosocial interventions and neuropsychological rehabilitation may supplement other conventional treatments for bipolar patients.

Functional limitations and quality of life in schizophrenia and other psychotic disorders

There is substantial evidence of the decreased functional capacity, especially everyday functioning, of people with psychotic disorder in clinical settings, but little research about it in the general population. The aim of the present study was to provide information on the magnitude of functional capacity problems in persons with psychotic disorder compared with the general population. It estimated the prevalence and severity of limitations in vision, mobility, everyday functioning and quality of life of persons with psychotic disorder in the Finnish population and determined the factors affecting them. This study is based on the Health 2000 Survey, which is a nationally representative survey of 8028 Finns aged 30 and older. The psychotic diagnoses of the participants were assessed in the Psychoses of Finland survey, a substudy of Health 2000. The everyday functioning of people with schizophrenia is studied widely, but one important factor, mobility has been neglected. Persons with schizophrenia and other non-affective psychotic disorders, but not affective psychoses had a significantly increased risk of having both self-reported and test-based mobility limitations as well as weak handgrip strength. Schizophrenia was associated independently with mobility limitations even after controlling for lifestyle-related factors and chronic medical conditions. Another significant factor associated with problems in everyday functioning in participants with schizophrenia was reduced visual acuity. Their vision was examined significantly less often during the five years before the visual acuity measurement than the general population. In general, persons with schizophrenia and other non-affective psychotic disorder had significantly more limitations in everyday functioning, deficits in verbal fluency and in memory than the general population. More severe negative symptoms, depression, older age, verbal memory deficits, worse expressive speech and reduced distance vision were associated with limitations in everyday functioning. Of all the psychotic disorders, schizoaffective disorder was associated with the largest losses of quality of life, and bipolar I disorder with equal or smaller losses than schizophrenia. However, the subjective loss of qualify of life associated with psychotic disorders may be smaller than objective disability, which warrants attention. Depressive symptoms were the most important determinant of poor quality of life in all psychotic disorders. In conclusion, subjects with psychotic disorders need regular somatic health monitoring. Also, health care workers should evaluate the overall quality of life and depression of subjects with psychotic disorders in order to provide them with the basic necessities of life.

Monikasvoinen TAVA-partisiippi : Tutkimus suomen TAVA-partisiipin käyttökonteksteista ja verbiliittojen kieliopillistumisesta

The multifaceted passive present participle in Finnish This study investigates the uses of the passive present participle in Finnish. The participle occurs in a variety of syntactic environments and exhibits a rich polysemy. Former descriptions have treated it as a mainly modal element, but it has several non-modal uses as well. The present study provides an overview of its uses and meanings, with the main focus on the factors which trigger the modal reading. In addition, the study contains two case studies on modal periphrastic constructions consisting of the verb 'to be' and the present passive participle, the Obligation construction, e.g., on men-tä-vä [is go-pass-ptc], and the Possiblity construction, e.g., on pelaste-tta-v-i-ssa [is save-pass-ptc-pl-ine]. The study is based on empirical data of 9000 sentences obtained from i) large collections of transcribed material from Finnish dialects, ii) a corpus of modern Finnish newspaper texts, iii) corpora of Old Finnish texts. Both in colloquial and standard Finnish the reading of the participle is highly dependent of the context and determined by such factors as the overall syntactic environment and other co-occurring elements. One of the main findings here is that the Finnish passive present participle is not modal per se. The contextual modal reading arises whenever the state of affairs is conceptualized from the viewpoint of the implied subject of the participle, and the meaning of possibility or obligation depends mostly on whether the situation is pleasant or undesirable. In sections examining the grammaticalization of the Possibility and Obligation constructions, the perspective is diachronic. Both constructions have derived from copula constructions with the passive present participle as a predicate (adjective or adverb). These sections show how a linguistic change can be investigated on the basis of the patterns of usage in the empirical data. The Possibility construction is currently going through a restructuration to a passive verbal complex. The source of this construction is reflected in its present-day use by the fact that it heavily biased towards a small set of verbs. The Obligation construction has grammaticalized to a construction comparable to a compound tense. Patterns of use of the construction show that grammaticalization originates in specific syntactic constructions with an implication of practical necessity. Furthermore, it is shown that the Obligation construction has grammaticalized in different directions in standard and colloquial Finnish. Differing from the study on most typical phenomena investigated in the literature on grammaticalization of modality, the present study opens new perspectives and methods for discussion on these questions.

Murteellisuus, maalaisuus ja miellyttävyys helsinkiläisten kuulemana : Monimenetelmäinen tutkimus lukiolaisten kieliasenteista

Tutkielmassa tarkastellaan helsinkiläislukiolaisten asennoitumista suomen murteisiin ja pääkaupunkiseudun puhekieleen. Teoreettisena viitekehyksenä toimivat sosiaalipsykologinen kieliasennetutkimus ja kansanlingvistiikka. Keskeisin tutkimusmenetelmä tutkielmassa on kuuntelutesti, jonka avulla selvitettiin, miten helsinkiläisnuoret arvioivat kuulemiaan erimurteisia ääninäytteitä ja minne he paikantavat ne. Pääaineistona on 221:n ja lisäaineistona 19 helsinkiläislukiolaisen lomakevastaukset. Lomakkeen avulla vastaajilta kerättiin tietoa ääninäytteisiin liitetyistä assosiaatioista muun muassa asenneskaalojen ja lisäaineistossa avoimien kysymysten avulla. Laajemman aineiston analysoinnissa on hyödynnetty tilastollisia menetelmiä SPSS-ohjelman avulla. Kuuntelutesti koostui yhdeksästä tutkimusta varten äänitetystä puhenäytteestä. Verbal guise -tekniikan mukaisesti kunkin näytteen puhuja puhuu omaa murrettaan, poikkeuksena yksi puhuja, joka tuotti kuuntelutehtävää varten kaksi erimurteista ääninäytettä (matched guise). Kokonaisuutena miellyttävimmäksi arvioitiin helsinkiläisnaisen ja kiiminkiläismiehen ääninäytteet. Lukiolaiset arvioivat siis myönteisimmin ääripäitä: oman asuinalueensa puhetapaa ja murteellista puhetapaa. Kuitenkin toinen Helsinkiin paikannettu puhuja, espoolaisnainen, arvioitiin toiseksi epämiellyttävimmäksi: samalla lailla arvioitiin myös uusimaalaisena pidetyn turkulaismiehen näyte. Nämä epämiellyttävän kuuloisiksi arvioidut puhuivat vastaajien mielestä epäselvästi, mikä vaikutti tilastollisesti merkitsevästi heidän evaluointeihinsa. Matched guise -ääniparista vastaajat pitivät lounaisvälimurteista versiota peräpohjalaisversiota miellyttävämpänä. Tasoittunutta murretta puhuneet sijoitettiin pääasiassa Etelä-Suomeen ja leimallista murretta puhuneet Savoon ja Pohjanmaalle. Kuvaillessaan sanallisesti ääninäytteitä vastaajat kiinnittivät huomiota siihen, kuinka hyvin puhuja suoriutui tehtävästä (kuvasta kertominen), millainen oli hänen tunnetilansa ja kuinka murteellinen hän oli. Murteellisiksi kuvattuja puhujia pidettiin myös maalaisimpina. Helsinkiin paikannettuja puhujia pidettiin murteettomina. Sekä suoraan kysymällä että epäsuorasti kuuntelutestillä tutkien lukiolaisten murreasenteista saadaan samansuuntainen kuva: suurin osa vastaajista suhtautuu melko myönteisesti murteisiin. Sen sijaan suhde pääkaupunkiseutulaiseen puheeseen on ristiriitainen, sillä kuuntelutestin perusteella vastaajat eivät automaattisesti suosi helsinkiläisiksi tunnistamiaan ja puolet heistä pitää slangia leuhkan kuuloisena. Tutkielma antaa tietoa siitä, miten helsinkiläislukiolaiset suhtautuvat kuulemiinsa erilaisiin puhetapoihin. Tämä kuva poikkeaa osin aiempien tutkimusten kuvaamista stereotyyppisistä murreasenteista. Metodisesti tutkimus avartaa käsitystä siitä, miten olennainen merkitys kuulijoille esitetyn äänimateriaalin luonteella on tuloksiin. Murreaineksen ohella asenteisiin vaikuttavat puheen sisällölliset seikat, sekä se, miten selvästi tai epäselvästi puhujan koetaan puhuvan. Menetelmään liittyvistä ongelmista huolimatta kuuntelutehtävän avulla on mahdollista saada tietoa sekä avoimista että alitajuisemmista asenteista eri kielimuotoja kohtaan.

Effect of GPS on understanding relationship between mobile map and environment : A field experiment

Objectives: GPS technology enables the visualisation of a map reader s location on a mobile map. Earlier research on the cognitive aspects of map reading identified that searching for map-environment points is an essential element for the process of determining one s location on a mobile map. Map-environment points refer to objects that are visualized on the map and are recognizable in the environment. However, because the GPS usually adds only one point to the map that has a relation to the environment, it does not provide a sufficient amount of information for self-location. The aim of the present thesis was to assess the effect of GPS on the cognitive processes involved in determining one s location on a map. Methods: The effect of GPS on self-location was studied in a field experiment. The subjects were shown a target on a mobile map, and they were asked to point in the direction of the target. In order for the map reader to be able to deduce the direction of the target, he/she has to locate himself/herself on the map. During the pointing tasks, the subjects were asked to think aloud. The data from the experiment were used to analyze the effect of the GPS on the time needed to perform the task. The subjects verbal data was used to assess the effect of the GPS on the number of landmark concepts mentioned during a task (landmark concepts are words referring to objects that can be recognized both on the map and in the environment). Results and conclusions: The results from the experiment indicate that the GPS reduces the time needed to locate oneself on a map. The analysis of the verbal data revealed that the GPS reduces the number of landmark concepts in the protocols. The findings suggest that the GPS guides the subject s search for the map-environment points and narrows the area on the map that must be searched for self-location.

Yhteisestä toiminnasta yhteiseen kieleen : keskustelunanalyyttinen tutkimus toisen kielen oppimisesta kielikylpypäiväkodin arkitilanteissa

This dissertation examines how Finnish-speaking children learn Swedish in an immersion kindergarten where the method of Canadian immersion is used. Within the framework of conversation analysis, this study explores how second language learning is situated in interaction and evidenced in the participants´ verbal and non-verbal behavior. The database consists of 40 hours of videotaped data collected in naturally occurring situations in a group of 15 four-year-old children during the first two years of their immersion. Due to the immersion method, all the children share the same L1, in this case Finnish, and the teachers understand Finnish. However, they speak only Swedish to the children in all situations and Swedish is learned in interaction without formal teaching. The aim of the study is to discover how the children´s second language competence gradually increases when they participate in interaction with the Swedish-speaking teachers. The study also sheds light on the methodological question of how second language learning can be analyzed with the method of conversation analysis. The focus is on showing how the second language is learned in interaction, especially on how learning is achieved collaboratively. In this study, the emerging second language competence is explored by investigating how the children show understanding of the teachers´ non-verbal and verbal actions during the first and the second semester of the immersion. The children´s use of Swedish is analyzed by investigating how they recycle lexical items and later even syntactic structures from the teachers´ Swedish turns. The results show that the teachers´ actions are largely understood by the children even at the beginning of the immersion. The analyzes of the children´s responsive turns reveal that they interpret the teachers´ turns on the basis of non-verbal cues at first. Especially at the beginning of the immersion, the participants orient to the progress of interaction and not to problems in understanding. Even in situations where the next actions show that the children do not understand what is said, they tend to display understanding rather than non-understanding. This behavior changes, however, when the children´s competence in their second language increases. At the second semester, the children both show understanding of the teachers´ verbal turns and also display their non-understanding by initiating repair when they do not understand. Understanding of the teachers´ verbal turns, including their syntactic structure, is manifested in the ways the children tie their turns to the teachers´ turns. Recycling, on the other hand, proves to be the way by which the children start to speak the second language. In this study, the children´s common L1 is evidenced to be an important resource in interaction. It allows the children to participate in their individual ways and to share their experiences both with each other and with the teachers. It also enables them to co-construct conversations that lead to collaborative learning. Moreover, the uninhibited use of L1 proves to be an important analytic tool that makes the immersion data especially fruitful for conversation analytic research on second language learning, since the children´s interpretations of the second language are in evidence even when they do not speak the second language.

Pain measurement and management in elderly patients : Clinical studies in long term hospital care and after cardiac surgery

The proportion of patients over 75 years of age, receiving all different types of healthcare, is constantly increasing. The elderly undergo surgery and anaesthetic procedures more often than middle-aged patients. Poor pain management in the elderly is still an issue. Although the elderly consumes the greatest proportion of prescribed medicines in Western Europe, most clinical pharmacological studies have been performed in healthy volunteers or middle-aged patients. The aim of this study was to investigate pain measurement and management in cognitively impaired patients in long term hospital care and in cognitively normal elderly patients after cardiac surgery. This thesis incorporated 366 patients, including 86 home-dwelling or hospitalized elderly with chronic pain and 280 patients undergoing cardiac surgery with acute pain. The mean age of patients was 77 (SD ± 8) years and approximately 8400 pain measurements were performed with four pain scales: Verbal Rating Scale (VRS), the Visual Analogue Scale (VAS), the Red Wedge Scale (RWS), and the Facial Pain Scale (FPS). Cognitive function, depression, functional ability in daily life, postoperative sedation and postoperative confusion were assessed with MMSE, GDS, Barthel Index, RASS, and CAM-ICU, respectively. The effects and plasma concentrations of fentanyl and oxycodone were measured in elderly (≥ 75 years) and middle-aged patients (≤ 60 years) and the opioid-sparing effect of pregabalin was studied after cardiac surgery. The VRS pain scores after movement correlated with the Barthel Index. The VRS was most successful in the groups of demented patients (MMSE 17-23, 11-16 and ≤ 10) and in elderly patients on the first day after cardiac surgery. The elderly had a higher plasma concentration of fentanyl at the end of surgery than younger patients. The plasma concentrations of oxycodone were comparable between the groups. Pain intensity on the VRS was lower and the sedation scores were higher in the elderly. Total oxycodone consumption during five postoperative days was reduced by 48% and the CAM-ICU scores were higher on the first postoperative day in the pregabalin group. The incidence of postoperative pain during movement was lower in the pregabalin group three months after surgery. This investigation demonstrates that chronic pain did not seem to impair daily activities in home-dwelling Finnish elderly. The VRS appeared to be applicable for elderly patients with clear cognitive dysfunction (MMSE ≤17) and it was the most feasible pain scale for the early postoperative period after cardiac surgery. After cardiac surgery, plasma concentrations of fentanyl in elderly were elevated, although oxycodone concentrations were at similar level compared to middle-aged patients. The elderly had less pain and were more sedated after doses of oxycodone. Therefore, particular attention must be given to individual dosing of the opioids in elderly surgical patients, who often need a smaller amount for adequate analgesia than middle-aged patients. The administration of pregabalin reduced postoperative oxycodone consumption after cardiac surgery. Pregabalin-treated patients had less confusion, and additionally to less postoperative pain on the first postoperative day and during movement at three months post-surgery. Pregabalin might be a new alternative as analgesic for acute postoperative and chronic pain management in the elderly. Its clinical role and safety remains to be verified in large-scale randomized and controlled studies. In the future, many clinical trials in the older category of patients will be needed to facilitate improvements in health care methods.