Body representation and sensorimotor function as agents for brain reorganization and behavior change: from chronic pain to immobility and dementia
Final Report Abstract
This project assumed that maladaptive reorganization of sensorimotor maps of the brain is associated with perceptual and behavioral changes such as chronic pain, impaired muscle function after injury, and cognitive or physical impairment in dementia and frailty. We developed mechanistic neuroplasticity-based sensorimotor treatments and assessed the associated neural mechanisms. For the treatment of chronic back pain we tested if an avatarbased movement model in virtual reality could reduce fear of movement, avoidance behavior and pain in an implicit manner. In the first study we developed the movements and the avatars needed for the testing in patients and found that a personalized avatar led to better modelling than an abstract or general avatar. In the patients we found that personalized virtual movement models are better in instigating intuitive observational modelling, increasing pain tolerance, and reducing pain avoidance compared to video training. Thus virtual reality applications may enhance exposure and exercise treatments in chronic back pain. For the treatment of early signs of dementia and of frailty in older persons we developed a neuroplasticity-based sensorimotor intervention, which trained visual, auditory, tactile and sensorimotor discrimination at home in a tablet-based mode. This intervention was compared to a standard cognitive training in the cognitively impaired persons or a relaxation training in the frail participants. The sensorimotor training stabilized episodic memory function comparable to the cognitive intervention. However, the sensorimotor training had specific brain-related effects relevant to Alzheimer’s diease: it significantly reduced dysfunctional hippocampal activity in a mnemonic discrimination task and sharpened the cortical somatosensory map. Both changes were significantly related, suggesting that the sensory changes were instrumental for the memory-associated changes. In the frail persons, the sensorimotor training reduced frailty more than the control training and also had positive effects on chronic pain, but did not yield differential brain changes. In healthy persons we showed that addition of tactile feedback enhances the pain-reducing effects of virtual reality and sensorimotor training likewise reduces pain perception. In the immobilization- and sports-related subproject we first showed that psychological factors explain a large proportion of the variance in the amount of injury and in performance levels of professional soccer players. We then tested if an augmented reality based training with movement of of uninjured limb displayed as if the the injured limb would be moving (virtual mirror training) would maintain motor function and brain activation related to the injured limb. We first tested this in helathy subjects with an artificially immobilized limb. We found that the volume of muscle tissue and muscle integrity as well as activation in the central sensory and motor maps were significantly better maintained in the virtual mirror trained group compared to controls. A pilot training in persons with sports injury (torn knee ligament) showed that muscular function also seems to be better maintained in this condition. These studies indicate that interventions that target sensorimotor mechanisms are effective in reversing negative behavioral and perceptual symptoms and they give insights into relevant brain mechanisms. https://wissenschaftspodcasts.de/podcasts/kannste-vergessen/staffel-2-folge-5-dem-schmerz-auf-die-pelle-ruecken_7533897/ Herta Flor: Psychotherapie und Hirnforschung; https://www.youtube.com/watch?v=kpQnMO-_GGg #40 Prof. Dr. Herta Flor - Veränderungen des zentralen Nervensystems bei chronischen Schmerzen – PhysioBibPodcast – Podcast – Podtail; https://theolab.hypotheses.org/518
Publications
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Lost in Translation: Psychologische Mechanismen und Psychotherapie. Verhaltenstherapie, 25(2), 111-117.
Flor, Herta
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Recovery–stress balance and injury risk in professional football players: a prospective study. Journal of Sports Sciences, 33(20), 2140-2148.
Laux, Philipp; Krumm, Bertram; Diers, Martin & Flor, Herta
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Tablet-based sensorimotor home-training system for amnestic mild cognitive impairments in the elderly: design of a randomised clinical trial. BMJ Open, 9(8),e028632.
Bekrater-Bodmann, Robin; Löffler, Annette; Silvoni, Stefano; Frölich, Lutz; Hausner, Lucrezia; Desch, Simon; Kleinböhl, Dieter & Flor, Herta
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Exploring Virtual Doppelgangers as Movement Models to Enhance Voluntary Imitation. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 29(2021), 2173-2182.
Kammler-Sucker, Kornelius I.; Loffler, Annette; Kleinbohl, Dieter & Flor, Herta
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Making sense of phantom limb pain. Journal of Neurology, Neurosurgery & Psychiatry, 93(8), 833-843.
Schone, Hunter R; Baker, Chris I; Katz, Joel; Nikolajsen, Lone; Limakatso, Katleho; Flor, Herta & Makin, Tamar R
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Pleasant touch perception in borderline personality disorder and its relationship with disturbed body representation. Borderline Personality Disorder and Emotion Dysregulation, 9(1).
Löffler, Annette; Kleindienst, Nikolaus; Neukel, Corinne; Bekrater-Bodmann, Robin & Flor, Herta
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Sensory and motor correlates of frailty: dissociation between frailty phenotype and frailty index. BMC Geriatrics, 22(1).
Beier, Florian; Löffler, Martin; Nees, Frauke; Hausner, Lucrezia; Frölich, Lutz & Flor, Herta
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Adaptive Framework for Long-term Sensory Home Training: a Proof of Principle Study. (2023, 2, 7). Wallstein Verlag.
Silvoni, Stefano; Desch, Simon; Beier, Florian; Bekrater-Bodmann, Robin; Löffler, Annette; Kleinböhl, Dieter; Tamascelli, Stefano & Flor, Herta
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Adding tactile feedback increases avatar ownership and makes virtual reality more effective at reducing pain in a randomized crossover study. Scientific Reports, 13(1).
Hoffman, Hunter G.; Fontenot, Miles R.; Garcia-Palacios, Azucena; Greenleaf, Walter J.; Alhalabi, Wadee; Curatolo, Michele & Flor, Herta
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Effects of an app-based sensorimotor training in promoting neuroplasticity and neuropsychological functioning in frailty: a randomized controlled trial. (2023, 6, 29). Wallstein Verlag.
Beier, Florian; Löffler, Martin; Nees, Frauke; Bekrater-Bodmann, Robin; Silvoni, Stefano; Desch, Simon; Löffler, Annette; Hausner, Lucrezia; Frölich, Lutz & Flor, Herta
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Effects of personalized movement models in virtual reality on pain expectancy and motor behavior in patients with chronic back pain: a feasibility study. Virtual Reality, 27(4), 3581-3598.
Kammler-Sücker, Kornelius Immanuel; Löffler, Annette & Flor, Herta
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Effects of sensorimotor training on memory and brain plasticity in persons with amnestic mild cognitive impairment. (2023, 6, 29). Wallstein Verlag.
Silvoni, Stefano; Löffler, Annette; Hausner, Lucrezia; Bekrater-Bodmann, Robin; Berron, David; Beier, Florian; Zidda, Francesca; Finnern, Marina; Beyer, Nicole; Desch, Simon; Kleinböhl, Dieter; Düzel, Emrah; Frölich, Lutz & Flor, Herta
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Evidence for dopaminergic involvement in endogenous modulation of pain relief. eLife, 12(2023, 2, 1).
Desch, Simon; Schweinhardt, Petra; Seymour, Ben; Flor, Herta & Becker, Susanne
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Extensive Sensorimotor Training Predetermines Central Pain Changes During the Development of Prolonged Muscle Pain. The Journal of Pain, 24(6), 1039-1055.
Zamorano, Anna M.; Kleber, Boris; Arguissain, Federico; Boudreau, Shellie; Vuust, Peter; Flor, Herta & Graven-Nielsen, Thomas
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Tactile sensitivity is reduced in mild cognitive impairment. (2023, 6, 29). Wallstein Verlag.
Löffler, Annette; Beier, Florian; Bekrater-Bodmann, Robin; Hausner, Lucrezia; Desch, Simon; Silvoni, Stefano; Kleinböhl, Dieter; Löffler, Martin; Nees, Frauke; Frölich, Lutz & Flor, Herta
