Traumatic Brain Injury: Survivor to Survivor “Let’s Make It Better With Art”
Maureen Del Giacco, Ph.D., LCAT
2015
Copyright
Š Published by Maureen C. Del Giacco, Ph.D., LCAT 27 Lisha Kill Road Colonie, New York 12205 All rights reserved by Maureen C. Del Giacco, Ph.D., LCAT no replications may be made without approval. 08/10/2015
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Dedication
Special Thanks This book is being written because of my love, my service to God and because I am grateful for all of the miracles in my life. For my wife Pamela, without your love and support my life would not have reached the wonders that it has in the past several years.
Thank you to all the clients involved in testing the methods used in this book. They are too many to mention their names here. Thank you all for your trust. To my students, graduates and the private foundations who funded this program in its early development stages. Thank you. To the New York State Education Department Office of VESID for it’s support and guidance. Thank you. To my first art teacher, Lori Lawrence who showed me it is not only wise to strive for accomplishments, but, that you can realize your dreams for the rest of your life. Thank you. To those friends and colleagues I did not mention here, I am most grateful to you all. You all are brave, considerate and kind individuals who offered me support and guidance at critical times. I Thank you all. ii
Forward
Movie: How to use this iBook Below is a movie with simple visual instructions of how to use this iBook. Please note there is no sound with this movie.
As a professional Creative Arts Therapist and a survivor of a mild traumatic brain injury of 25 years I have realized the wide lack of cognitive home exercises for people with memory deficits. This ibook is an attempt to provide some cognitive stimulation that will prove to be helpful for; Care-givers, survivors, significant others and those who otherwise would not have access to daily stimulation Daily stimulation is important to help keep pathways open.
The daily exercises are designed to help with short-term memory, focusing and attention. They are in no way meant to take the place of formal therapeutic interventions. I have placed art exercises here for daily work. The exercises should be done when rested and slowly. Go at your own pace and enjoy the other interactive and multi-media exercises they provide good foundational work to help regenerate awareness and cognitive shifting skills.
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All of the exercises are developmentally designed. Therefore, the exercises are best suited for a natural progressive continuum. One should begin at one’s level of function and move forward from there. Initially, it is best to find a comfort zone and rest as you progress. The exercises are not designed to substitute for a trained therapist. They are designed to help in your recovery process as home exercises until and/or while working with a skilled professional. Therapists who work with the Del Giacco Neuro Arts Therapy Cognitive Rehabilitation Program are those Certified in the Del Giacco Neuro Art Therapy Method’s. Our therapist’s are listed on our web site: http://www.delgiacconeuroarttherapy.com Other professional’s who work with developmental and cognitive deficits are: Art Therapist’s, Cognitive Rehabilitation Specialist’s, Special Education Teacher’s, Occupational Therapist’s, Psychologist’s, Speech Pathologist’s and Psychotherapists. Ask if they are trained in Cognitive Rehabilitation. Remember, not all professionals are trained in an art based cognitive rehabilitation program. That does not mean that the more formal cognitive rehabilitation programs do not work, it means the two are very different.
functions over time. The exercises should be done developmentally and slowly. If the exercises are too hard I suggest you stop them and try another self help strategy. Initially, the Del Giacco Neuro Art Therapy exercises were developed for persons with a traumatic brain injury. However, they have also proven helpful to some persons with ADD, ADHD, Stroke, early Alzheimer’s Disease, Brain tumors and a host of other cognitive conditions related to neurological factors such as many types of dementia. The exercises are for self help exercises, but, may also be used by parents, therapists and those interested in assisting persons with cognitive and neurological based deficits. Maureen C. Del Giacco, Ph.D., LCAT
Foundational exercises (Chapter-1) are designed to help with sensory stimulation that may led to improved cognitive iv
A Brief History
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A UDIO 1.1
My acute (mild) traumatic brain injury occurred on June 12, 1990. I don’t know why they call it mild, because there was nothing mild about it, I can assure you.
My acute (mild) traumatic brain injury occurred on June 12, 1990. I don’t know why they call it mild, because there was nothing mild about it, I can assure you.
Over the years, I have worked with many populations with neurological-based cognitive problems, and they all have benefited in some way from the exercises I developed for them.
As with many other people who survive a serious brain injury, it takes a long time to heal and recovery is a very hard and stressful process.
Of course, there will always be an exception to every rule. Some who may not benefit are those that do not want to work and rest. Sounds odd, but, there are those who will not want to challenge their disability. I believe fear is the major factor here. There may also be those who are just too sensitive to stimuli, and are simply not able to tolerate the exercises. In those cases, I suggest not using the exercises without a therapist present. In fact, therapists have their own special knowledge and expertise they can provide you with. When you have the opportunity to do so, give them a chance to teach and assist you.
However, let’s not focus on me in this book. I would rather focus on what came out of my recovery process and how it has helped people, as that is how this therapy developed. Initially, others with brain injuries asked me, and the professionals that were working with me, to answer the question: “How are you getting better?” Those types of questions started me on a quest that lasted over 25 years. Since the first questions were asked, I have completed my education, created a distancelearning program for professionals, and certified them in my program by right of Trade Mark. Additionally, I have written an extensive amount about the theory of the Del Giacco Neuro Art Therapy that I developed. Now, I am creating an iBook, and I am designing it to serve those who use it as an independent tool. Its purpose is to help those who need assistance but have no way of obtaining it. The exercises herein are not the end of what you will need, but rather, another tool offered to support and guide you in your road to recovery.
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Interactive Tool: Click on the text to learn more.
Drawing
Del Giacco Neuro Art Therapy
Visual Arts
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Self Monitoring
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A UDIO 2.1
Neuro-Distress is believed to occur from too much sensory stimuli. In many cases the brain can learn to tolerate more stimuli. Tolerance to increasing stimuli must be done developmentally.
Why do you need to monitor? Because of the Neuro-Distress factor. Persons with a brain injury and other neurologically based problems may become overwhelmed from sensory stimuli and many go into a state coined “Neuro-Distress.” I coined it Neuro-Distress, because no one seemed to know what I was experiencing during my early stages of injury, or even why I was so sensitive to light, sound and emotional challenges. I discovered later that it was the Neuro-Distress factor all along; thus, I have taken the time to identify it and manage it for my clients. It works wonders when people can understand and manage what is happening to them. Neuro-Distress can occur suddenly, even when a person is not tired from normal activity, and it can be a scary experience for the person with a brain injury.
Therefore, as you proceed with the exercises in this book, it is important that you pay attention to how you are feeling and stop working if you are feeling overwhelmed. The following exercises are stimuli, and may make you fatigued. That is why REST is important before, during, and after performing them. You be the judge of what you need. Nevertheless, the more consistently you work with the exercises, the more tolerance you may develop over time. This does not mean you will become cured of your damaged nervous system (brain injury); rather, it means you are building more pathways, leading to an easier recovery once they grow nice and strong. Remember: you will always have to monitor and see how you are doing, so you can rest. Again, less is more here.
With proper monitoring and understanding, you can manage your symptoms and be in control of your brain injury. Understanding also lends to a better quality of life for those around you.
If you find you are experiencing Neuro-Distress, all you need to do is close your eyes for 15 seconds and rest. If you find you are not recharged, take more time off and walk away until you feel better enough to try again.
However, there are exceptions to every rule, and that is where asking questions and paying more attention to how you are responding to stimuli can benefit you. There are different types and degrees of brain injury, so not everyone will experience the same symptoms, nor will they need the same responses recommended in this iBook. If you do need them, they are here. If you don’t, that is wonderful; do the exercises and progress at your own pace. However, even a noninjured brain needs to be paced, rested and recharged.
For those that may need to monitor themselves with these exercises, here are the Neuro-Distress symptoms and how to respond to them.
A good rule of thumb for progress here is “less is more” as you recover from a brain injury. In other words, the more you can pace yourself, the more progress you will be able to tolerate. The more you over-stimulate, the more you can set yourself back, then progress will not be as smooth as you would like. 9
What can cause Neuro Distress (ND)? What can cause Neuro-Distress (ND)? • Bright Lights • Sounds - Sudden and Prolonged • Cognitive Work - Thinking • Emotional Situations • Physical Activity What are the symptoms of Neuro-Distress (ND)? • Fatigue • Glassy Eyes • Balance Problems • Speech Problems • Irritation-Behavioral Problems • Thinking Problems ( Appears to SHUT DOWN) • Racing Heart • Nausea • Headache • Fear
that processes all sensory stimuli. Therefore, his or her reaction to stimuli should be monitored carefully. As an example about how unknown the ND factor is, I once had a discussion with a clinical neuropsychologist’s cognitive rehabilitation specialist. “I have been working with people with brain injury for over a decade and I have never seen this problem nor have the client’s complained about it,” the specialist said to me. My answer was this: “Many people with brain injuries may not even be aware that they are experiencing ND. Or they may feel embarrassed, or even uncomfortable, telling you that they are afraid or do not understand what is happening to them.” I continued, “I did notice that the lights were very dim in your office and that you all spoke in a low tone to your clients. Perhaps, you realized that the clients needed that type atmosphere because they were not well. Maybe without placing a name on the “not feeling well,” you simply responded to their need intuitively. Both my colleagues and myself have witnessed ND over the years, and realized that ND is both an undocumented and misunderstood part of a brain injury. Hopefully this information will shed some light on the ND factor.
How to manage your symptoms of ND AWARENESS, REST, PROPER DIET, & PROPER SLEEP. It is important to note that each person’s response to stimuli will be different. While some will not exhibit these symptoms, or have varying degrees of symptoms, many people will have ND and it is important to be mindful of how to assist those that do. Often, many people get confused with fatigue and ND. ND is a more serious condition that can escalate if not managed properly. Remember, when working with someone with a traumatic brain injury, that brain injury is damage to the central nervous system: the system 10
Brain Grows Using Art
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A UDIO 3.1
The human brain grows from the process of plasticity. Art helps to provide the stimulus needed to grow new brain pathways.
Knowledge Learning that your brain can grow is an important part of recovery. The video to the right demonstrates this fact more than any clinical study can. A picture is worth a thousand words. At the age of 2 a young Chinese boy had a high fever leaving him with only half of his brain. As you watch the video, you will see that the right side of his brain is completely gone. You will see that the left side has grown in order to accommodate the right side’s loss. This fellow in his 20’s, when the PBS special was created, actually has two fields of vision left and right. This is not supposed to be possible. You may watch a longer version of this film on my website. http://www.delgiacconeuroarttherapy.com
Plasticity Is the growth of new pathway’s. To grow new pathways, we must somehow expose ourselves to hard work, much like how we did when we were children. As children, we learned to first work with shapes, color and visual movement. When you watch the longer version of the video on my website, you will learn that fellow is also an artist. This is also not supposed to be possible. In her book Drawing on the Right side of the Brain, Edwards spends a great deal of time documenting the creation of art happens on the right side of the brain.
While it may be true that the normal brain may develop in this way, we can learn from this film that the brain will try its best to accommodate loss and regrow itself in ways not before understood. As in the case of the Chinese man using only the left- side of his brain.
Movie: Brain can grow
Plasticity is very apparent in this clip of a young man’s brain. Source: “Our Brain The Universe Within: Perception”, Series 1994, For Discovery Productions, Cathryn Garland, NHK/NHK Creative, INC.
All it needs is proper stimuli. That is what this iBook will attempt to provide. The brain processes all stimulation we are exposed to. We as human beings are made up of electromagnetic energy. The working hypothesis of the Del Giacco Neuro Art Therapy process is that the electro-magnetic energy in our brain becomes disrupted when we have a brain injury, stroke, tumor or any other form of insult or change to our brain’s normal pattern’s of functioning. This is the way we work from an
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information-processing model that is based on sensory processing.
ously noted, good sensory processing is required for good cognitive functions.
Without good, stable and reliable sensory functions, we may be susceptible to seizures, or not have proper access to our thoughts; when that happens, we shut down in an effort to protect ourselves (Neuro-Distress). Once the brain has recharged, it tries to function the best it can again. Sensory stimuli, helps brain pathways to grow, and once they are developed over time, thought patterns become longer and functional. In the next chapter, I discuss how we will use that logic throughout the exercises to obtain the best results for cognitive regeneration.
Art as Cognitive Rehabilitation In the PBS video noted earlier, the subject became an artist. I believe the hypothesis I practice directs us to, the Bottom’s-up model of information processing. This is where shape, colors and visual movement are processed in our brain: the components we use in the arts. These then become the building blocks of good sensory processing for our thoughts. As previ13
Bottoms-up then Top-Down
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A UDIO 4.1
Our drawing exercises are Bottom’s-up based for stimuli which occurs when using the arts. Thinking, reasoning and planning are related to Top-down thinking.
Bottom’s-Up then Top-Down ( Visual Spatial Exercises) First and foremost, understanding is the key to success. We are using a time proven process. Let’s begin with asking: What does Bottom’s-Up (the Limbic System) mean, and why is it important? Bottom’s up is the lower part of the brain where all sensory information begins to formulate. It is akin to a coffee pot and its filter. Without a filter, coffee can become messy and would not taste very good. Sensory information, therefore, must be filtered correctly in order for the individual to have good thinking abilities. After we send the Bottom’s-up part of sensory information to the gym - with the exercises that you will do here - then we need a place for the sensory work to go. This is where TopDown comes into play. The cortex, or top part of the brain, uses the information sent from the bottom of the brain to form better focusing pathways that will help us to do better cognitively.
The diagram below shows Bottom’s-Up processes (Violet color) sensory information and then connects to Top-Down (Green color) or cortex - our thinking brain. That’s how the exercises are designed.
2.TOP-DOWN: THINKING BRAIN
1.BOTTOM’SUP:
Second Top-Down works
FIRST BOTTOMS -UP
SENSORY PROCESSING
To learn more about the information processing model and Bottom’s-up vs.Top-down procedures go to our glossary in this iBook. That is why the exercises will be visual spatial, cognitive and then visual spatial again for cool down.
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You will have many types of exercises to preform, but, they will all help you to rebuild the bottom’s-up and Topdown mechanic’s that are related to good thinking. Bottom’s-up Exercises or Visual Spatial Exercises • Matching Shapes and Text • White Board Exercises • Drawing/Copying Designs • Coloring • Copying a Drawing • Puzzles • Mix and Match Shapes • Quizzes
Top-down Exercises or Concentration Exercises • Problem Solving • Word Match • Analysis • Reasoning • Comparing • Sequencing • Memory-Long Term • Memory-Short Term As you continue to the next chapter to begin level-1 of the exercises please complete the quiz on the chapter’s cover page.
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Visual-Spatial Exercises Bottom’s-up & Top down
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Quiz-1 A UDIO 5.1
To take the Quiz click on the question mark above.
Match
Memory
Level-1
Match shapes, words & numbers.
Match 1
Match 1.2
Match 1.3
Match 1.4
Memory 1.5
Memory 1.6
Level-1
Level-1
Level-1
Level-1
Shapes & Words
Shapes & Words.
Match 2
Match 2.1
Match 2.2
Match 2.3
Match 2.4
Match 2.5
Level-1
Level-1
Level-1
Level-1
Shapes & Words
Shapes & Words
Match 3
Match 3.1
Match 3.2
Match 3.4
Match 3.5
Match 3.6
Level-1
Level-1
Level-1
Level-1
Shapes & Words
Shapes & Words
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Shapes, Words & Numbers Level-2
Memory 1.7
Memory 1.8
Memory 1.9
Memory 1.10
Memory 1.11
Memory 1.12
Shapes & Words
Shapes & Words
Shapes & Words
Shapes & Numbers
Shapes & Numbers
Shapes & Numbers
Memory 2.6
Memory 2.7
Memory 2.8
Shapes & Words
Shapes & Words
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Match 3.7
Match 3.8
Memory 3.9
Shapes & Words
Shapes & Words
Shapes & Words
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Chapter 5 - Section 2
The Drawing Exercises The drawing exercises are important to do. They will help you to become more aware for our day and help you to focus. To use the exercises simply copy a drawing on a sheet of paper the best you can and then color it in. The idea is to have fun and not judge yourself. Using a drawing is about growing brain pathways. So try to have fun and know that every effort you put forth is valuable and with be cumulative in the end.
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Gallery The Therapeutic Drawing Series Coloring and Drawing Exercises
Tap on drawing to enlarge. Scroll to left to see another drawing. 1 of 22
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Coloring Color and/or Trace the Picture Coloring Exercises: All the tools are located on the bottom of the screen. To exit click on the Done button located on the upper left corner of the screen. An audio explanation is provided to help you along.
Hint: To color with more detail you may use a iPad pen. Click to open paint tool
Color 1
Color 2
Click to Color Click on me to try it out.
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Color 3
Color 4
Color 5
Color 6
Visit this web site for adult and child coloring book pages to download. They are free. http://azcoloring.com/search?q=adult . 25
Color 7
Color 8
Color 9
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Draw and Color
Draw & Color Draw 1
Draw 2
Draw 5
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Draw 3
Draw 4
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Read & Draw Autumn
Read the poem, then draw a tree in autumn.
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Jigsaw Puzzles Click-Listen
Puzzle 1.4 The brief audio to the left will provide directions on how to use the puzzle exercise. Puzzle pieces do not rotate. Circular arrows in the right hand corner will reset the puzzle picture. To see the ghost image as you work the puzzle click on the “?� located on the top right side of screen.
Level-1
Puzzle 1
Puzzle 1.2
Puzzle 1.3
Puzzle 1-8
Level-1
Level-1
Level-1
Level-1
Puzzle 1.5
Puzzle 1.6
Puzzle 1.7
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Word Search
Word Search -1
Hang-man
Word Search -2
Word Search - 3
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Word Search -4
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Attention Exercises Bottom’s-up & Top down
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A UDIO 6.1
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Using sounds and shapes with cognitive exercises may help you to grow new pathways. Also, check in with a simple quiz to remind yourself to take it easy.
Attention Math Quiz
Click to begin
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Memory Exercises
Reading Scroll below to read full text. About Lions Lions are one of the largest cats in the world. They live in southern and eastern parts of Africa. Lions are only social cats which live in groups called "prides". Each pride is composed of one or two males and large number of females. Larger prides can consist of around 40 members. Life in a group increases the chance for successful hunt and provides protection of cubs. Lions are carnivores and they hunt mostly antelopes, zebras and wildebeests. Al-
Lion Quiz Question 1 of 4 Although lions are larger and stronger, lionesses are in charge for the hunt.
A. True B. False
Check Answer
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Drawing
Check-in
G ALLERY 6.1 Select then draw a picture.
How are you doing? Question 1 of 3 When I an tired I get a headache and my eyes look glassy. I should sit back and close my eyes for 15
A. True B. False
Check Answer
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Web Resource Web Exercises Here is a simple technique to help with memory problems. When you are working on memory problems it is helpful to say what you are seeing out loud. This technique will help you to hang on the information longer then if you relayed solely on your visual senses. You will need a connection to the Internet with Apple computer to access these free memory exercises. Here is a direct link to the web site. http://www.softschools.com/games/memory_games/
Please note: In order to use the exercises from the Web Site above you will need a Flash Player. iPad does not come with a Flash Player for the Safari Browser. However, You may try to use the Phonton Web Browser from https://itunes.apple.com/us/app/photon-flash-player-for-ipad/id430200224?mt =8 there is a fee to download the Phonton Web Brower. The exercises from the web site abovehave rich resources for you. It may prove beneficial for you to access it’s exercises.
For example during the memory exercises when you are presented with 2 shapes you may do fine. however, as the number increases it may be harder to recall what just flashed before you. That is the time to use the speaking aloud technique to help with your memory. It I were to see four images for 2 seconds of a tree, a book, a car and a book again. I would say out loud, 2 books, a tree and a car. Then asdown they ask you more. to select what you Scroll to read
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Concentration
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Art Exercises are for focusing. First, select a drawing and then copy it on a piece of paper.
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Bibliography Lorem ipsum dolor rutur amet. Integer id dui sed odio imperd feugiat et nec ipsum. Ut rutrum massa non ligula facilisis in ullamcorper purus
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Art-Based Cognitive Rehabilitation Our Art Based Cognitive Rehabilitation is based on The Del Giacco Neuro Art Therapy (DAT) program. It is an arts-based therapy, and a multi-sensory and a developmental program that uses the Therapeutic Drawing Series. We use the Therapeutic Drawing Series in a developmental process according to each client's level of tolerance and ability. This type of progression is believed to assist in rehabilitating the brain while simultaneously improving attention, awareness and memory. The DAT program is designed to work within the primary areas of the brain that initially process shape, emotion and working memory: the amygdala and hippocampus. The DAT program is designed to strengthen the lower sensory processing mechanisms of attention, and to build a strong foundation for the encoding and decoding mechanisms in the Limbic System.
Source: Del Giacco Neuro Art Therapy Web Sites: http://www.delgiacconeuroarttherapy.com : Free memory exercises. http://www.neuroarttherapy.com : Professional and Semi-Professional Distance Learning CEU and Certification.
Related Glossary Terms Creative Arts Therapist
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Bottom-up Verses Top-down The classical view of information processing is that of a Bottom’s-up process in a feedforward hierarchy. However, psychological, anatomical and physiological evidence suggests that Top-Down defects play a crucial role in the processing of inputs stimuli. Not much is known about neural mechanisms underlying these effects. Here we investigate a physiologically inspired model of two reciprocally connected cortical areas. Each area receives Bottom’s-Up as well as Top-Down information. This information interactions by a mechanism that exploits recent findings of somato-dendritic interactions. (1). This results in a burst of signals robust in the context of noise in Bottom’sUp signals. (2). Investigating the influence of additional Top-Down information, priming-like effects on the processing of Bottom-Up input can be demonstrated. (3). In accordance with recent physiological findings, inter-areal coupling in low-frequency ranges is characteristically enhanced by Top-Down mechanisms. The proposed scheme combines a qualitative influence of Top-Down directed signals on the temporal dynamics of the neural activity with a limited effect on the mean firing rate of the targeted neurons . As it gives an account of the system properties on the cellular level, it is possible to derive several experimentally testable predictions. Source:http://www.ncbi.nm.nih.-gov/pubmed/10798600# J Comput Neurosci. 2000 Mar-Apr;8 (2): 161-73, “ integrating top-down and bottom-up sensory processing by somato-dendritic interactions.” Siegel M1, Kording KP, Konig P, 1 Institute of Neuroinformatics, ETH/ University Zürich.
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Cerebral Cortex According to the National Institute of Neurological Disorders and Stroke (2014) The Cerebral Cortex “Coating the surface of the cerebrum and the cerebellum is a vital layer of tissue with the thickness of a stack of two or three dimes. It is called the cortex, from the Latin word for bark. Most of the actual information processing in the brain takes place in the cerebral cortex. When people talk about "gray matter" in the brain, they are talking about this thin rind. The cortex is gray because nerves in this area lack the insulation that makes most other parts of the brain appear to be white. The folds in the brain add to its surface area and therefore increase the amount of gray matter and the quantity of information that can be processed.�
Source: http://www.ninds.nih.gov/disorders/brain_basics/know_your_brain.htm
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Closed Head Injury Closed Head Injury When a person receives an impact to the head from an outside force, but the skull does not fracture or displace this condition is termed a "closed head injury". Again, separate terminology is added to describe the brain injury. For example, a person may have a closed head injury with a severe traumatic brain injury. • With a closed head injury, when the brain swells, the brain has no space to expand. This can cause an increase in intracranial pressure, which is the pressure within the skull. • If the brain swells and has no place to expand, this can cause brain tissues to compress, causing further injury. • As the brain swells, it may expand through any available opening in the skull, including the eye sockets. When the brain expands through the eye sockets, it can compress and impair the functions of the eye nerves. For instance, if an eye nerve, Cranial Nerve III, is compressed, a person's pupil (i.e.the dark center part of the eye) will appear dilated (big). This is one reason why medical personnel may monitor a person's pupil size and intracranial pressure.
Source:http://www.biausa.org/about-brain-injury.htm
Related Glossary Terms Neuro-Distress
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Concussion Concussion • A concussion can be caused by direct blows to the head, gunshot wounds, violent shaking of the head, or force from a whiplash type injury. • Both closed and open head injuries can produce a concussion. A concussion is the most common type of traumatic brain injury. • A concussion is caused when the brain receives trauma from an impact or a sudden momentum or movement change. The blood vessels in the brain may stretch and cranial nerves may be damaged. • A person may or may not experience a brief loss of consciousness (not exceeding 20 minutes). A person may remain conscious, but feel “dazed” or “punch drunk.” • A concussion may or may not show up on a diagnostic imaging test, such as a CAT Scan. • Skull fracture, brain bleeding, or swelling may or may not be present. Therefore, a concussion is sometimes defined by exclusion, and is considered a complex neurobehavioral syndrome. • A concussion can cause diffuse axonal type injury, resulting in permanent or temporary damage. • It may take anywhere few months to a few years for a concussion to heal.
Source:http://www.biausa.org/about-brain-injury.htm
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Coup-contrecoup Injury • Coup-contrecoup injury describes contusions that are both at the site of the impact and on the complete opposite side of the brain. • This occurs when the force impacting the head is not only great enough to cause a contusion at the site of impact, but also is able to move the brain and cause it to slam into the opposite side of the skull, which causes the additional contusion.
Source:http://www.biausa.org/about-brain-injury.htm
Related Glossary Terms Neuro-Distress
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Creative Arts Therapist While guiding patients to create and reflect on art and the artistic process, creative arts therapists help people increase awareness of self and others, cope with the symptoms of stress, illness and trauma, and enhance cognitive abilities. They help their patients improve self-esteem, develop more effective communications skills and relationships, gain insight into patterns of behavior, and create new options for coping with problems. Source: Office of NY State Professions: www.op.nysed.gov ADDITIONAL RESOURCES: http://www.brainyart.com: More information on Creative Arts Therapy http://www.delgiacconeuroarttherapy.com: Free memory exercises. http://www.neuroarttherapy.com: Professional and Semi-Professional Distance Learning CEU and Certification.
Related Glossary Terms Art-Based Cognitive Rehabilitation
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Del Giacco Neuro Art Therapy Program The Del Giacco Neuro Art Therapy (DAT) program is an art-based therapy and a multisensory developmental program that uses 3 applications; Cognitive Range of Motion Exercises, The Therapeutic Drawing Series and Computer Exercises. We use the 3 applications in a developmental process according to each client's level of tolerance and ability. This type of progression is believed to assist in rehabilitating the brain while improving attention, awareness and memory. Del Giacco Neuro Art Therapy is designed to work within the primary areas of the brain that initially process shapes, emotions and working memory: the amygdala and hippocampus. Once the Bottom’s-Up sensory areas have improved, then the cerebral cortex (Top-Down information processing) is exercised to stimulate the hierarchy of information processing. The overall design of the DAT program strengthens the lower sensory processing mechanisms of attention, and to builds a strong foundation for the encoding and decoding mechanisms originating in the Limbic System.
Source: http:www.delgiacconeuroarttherapy.com
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Diffuse Axonal Injury • A diffuse axonal injury can be caused by shaking or strongly rotating of the head, as with Shaken Baby Syndrome, or by rotational forces, such as a car accident. • Injury occurs because the unmoving brain lags behind the movement of the skull, causing brain structures to tear. •There is an extensive tearing of nerve tissue throughout the brain. This can cause brain chemicals to be released, causing additional injury. • The tearing of the nerve tissue disrupts the brain’s regular communication and chemical processes. • This disturbance in the brain can produce temporary or permanent widespread brain damage, coma, or death. • A person with a diffuse axonal injury could present a variety of functional impairments depending on where the shearing (tears) occurred in the brain.
Source:http://www.biausa.org/about-brain-injury.htm
Related Glossary Terms Neuro-Distress, Shaking Baby Syndrome
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Mild Traumatic Brain Injury (mTBI) mTBI is an occurrence of injury to the head resulting from blunt trauma or an acceleration or deceleration forces with one or more of the following conditions attributable to the head injury during the surveillance period: • Any period of observed or self-reported transient confusion, disorientation, or impaired consciousness; • Any period of observed or self-reported dysfunction of memory (amnesia) around the time of injury; • Observed signs of other neurological or neuropsychological dysfunction, such as— ◦ Seizures acutely following head injury; ◦ Among infants and very young children: irritability, lethargy, or vomiting following head injury; ◦ Symptoms among older children and adults such as headache, dizziness, irritability, fatigue, or poor concentration, when identified shortly after injury, can be used to support the diagnosis of mild TBI, but cannot be used to make a diagnosis in the absence of of consciousness or altered consciousness. Further research may provide additional guidance in this area. • Any period of observed or self-reported loss of consciousness lasting 30 minutes or less. The definition focuses on the actual injury or symptoms, rather than possible consequences. For many people, there are challenges in getting an accurate diagnosis and treatment, especially when there is no documented or observed loss of consciousness. There does not need to be a loss of consciousness for a brain injury to occur.
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Neuro-Distress According to Dr. John Sowa, Ph.D., Dr. Jan Tucci, Ph.D., and Dr. Maureen Del Giacco, Ph.D., LCAT (2000), The Therapist Training Manual (for Del Giacco Neuro Art Therapy) Neuro-Distress occurs when a person with a neurological impairment goes past their level of fatigue. Persons with neurological damage and/or impairment have varying levels of fatigue will occur. Neuro-Distress is the brain’s way of saying “I cannot proceed any further.” The injury and/or impairment do not have the capacity to handle what is being asked of it. At this point, you may see that the person has glassy eyes, headaches, becomes irritable, dizzy, short of breath and a host of other anatomical symptoms. Symptoms, will vary from person to person, but, will escalate if the person is unable to rest. Rest is recommended. Often, if the person closes his or her eyes for 15 seconds it may help the brain to recharge, and the person can proceed. In other extreme cases, more rest may be required. Each will have to judge, as he or she moves along, how much rest is required.
Related Glossary Terms Closed Head Injury, Coup-contrecoup Injury, Diffuse Axonal Injury, Post Concussive Syndrome, Traumatic Brain Injury
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Neurogenesis Hippocampal Neurogenesis
What is Neurogenesis?
What is Neurogenesis? By Dr Ananya Mandal, MD The term neurogenesis is made up of the words “neuro” meaning “relating to nerves” and “genesis” meaning the formation of something. The term therefore refers to the growth and development of neurons. This process is most active while a baby is developing in the womb and is responsible for the production of the brain’s neurons. The development of new neurons continues during adulthood in two regions of the brain. Neurogenesis takes place in the subventricular zone (SVZ) that forms the lining of the lateral ventricles and the subgranular zone that forms part of the dentate gyrus of the hippocampus area. The SVZ is the site where neuroblasts are formed, which migrate via the rostral migratory stream to the olfactory bulb. Many of these neuroblasts die shortly after they are generated. However, some go on to be functional in the tissue of the brain. Previously, neuroanatomists such as Santiago Ramon Cajal, believed the nervous system was a fixed system that was not capable of regeneration but in 1962, the first evidence of adult neurogenesis was demonstrated by Joseph Altman who also identified the rostral migratory stream in 1969. These findings were largely ignored by the scientific community until the 1980s when research reignited interested in the topic by showing that neurogenesis occurs in rats and birds. In the early 1990s, adult neurogenesis was also demonstrated in non-human primates and humans. The actual function of adult neurogenesis has not yet been clearly determined. Some evidence suggests that the process is key to functions such as learning and memory. Studies have shown that new neurons increase memory capacity, reduce the overlap between different memories and also add information regarding time to memories. Other studies have shown that the learning process itself is also linked to the survival of neurons. Another important discovery is the role of the neurosteroid allopregnanolone in aiding neurogenesis in the brain. Levels of allopregnanolone start to decline in the elderly and in patients with Alzheimer’s disease. Reviewed by Sally Robertson, BSc Sources 1. www.culturacientifica.org/.../neurogenesis_humans.pdf 2. http://www.jneurosci.org/content/22/3/612.full.pdf 3. http://web.mit.edu/7.72/restricted/readings/Gotz_review.pdf 4. perso.ens-lyon.fr/annececile.boulay/UE%20biblio/pdf/7.4.Sahay07.pdf 5. www.societyns.org/runn/2009/pdfs/bednarsept2109neurogenesis1998.pdf Further Reading Last Updated: Oct 8, 2014
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Plasticity According to Neuroscientist, 2004 The adult cerebral cortex possesses the remarkable ability to change its neuronal connectivity through experience, a phenomenon termed “synaptic plasticity.� Synaptic plasticity constitutes a cellular mechanism that is thought to underlie information storage and memory formation in the brain, and represents a use-dependent long-lasting increase or decrease in synaptic strength. Recent findings have shown that the adult visual cortex undergoes dynamic synaptic plasticity driven by active visual experience, suggesting the possibility that it may be involved in information processing and memory formation. The visual cortex provides a crucial sensory input to the hippocampus, and is a key component in the creation of spatial memories. An understanding of how visual cortical neurons respond with synaptic plasticity to visual experience, and whether these responses influence the induction of hippocampal plasticity, is fundamental to our understanding of the neuronal mechanisms and functional consequences of visuospatial information processing. In this review, we summarize recent findings with regard to the expression of dynamic synaptic plasticity in the visual cortex, and how this plasticity may influence information processing in the hippocampus. Source: NEUROSCIENTIST 14(6):584-597, 2008. DOI: 10.1177/1073858408315655
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Post Concussive Syndrome Abstract Individuals sustaining mild traumatic brain injuries often report a constellation of physical, cognitive, and emotional and behavioral symptoms referred to as post-concussion symptoms (PCS). The most commonly reported post concussion symptoms are headache, dizziness, decreased concentration, memory problems, irritability, fatigue, visual disturbances, sensitivity to noise, judgment problems, depression, and anxiety. Although these PCS are often resolved within one month, in some individuals PCS can persist from months to years following injury, and may even be permanent and cause disability. When this cluster of PCS is persistent in nature, it is often called the post concussion syndrome or persistent PCS. Both physiological and psychological etiologies have been suggested as causes for persistent post concussion symptoms and this has led to much controversy and debate in the literature. Most investigators now believe that a variety of pre-morbid, injury-related, and post-morbid neuropathological and psychological factors contribute to the development and continuation of these symptoms in those sustaining mild traumatic brain injury (MTBI). Source: http://www.ncbi.nlm.nih.gov/pubmed/15276952 Int Rev Psychiatry. 2003 Nov;15(4):310-6, Post concussion syndrome, Ryan LM1, Warden DL
Related Glossary Terms Neuro-Distress
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Shaking Baby Syndrome • Shaken Baby Syndrome is a violent, criminal act that causes traumatic brain injury. Shaken Baby Syndrome occurs when the perpetrator aggressively shakes a baby or young child. The forceful whiplash-like motion causes the brain to be injured. • Blood vessels between the brain and skull rupture and bleed. • The accumulation of blood causes brain tissue to compress, while the injury causes the brain to swell. This further damages the brain cells. • Shaken Baby Syndrome can cause seizures, lifelong disability, coma, and death. • Irritability, changes in eating patterns, tiredness, difficulty breathing, dilated pupils, seizures, and vomiting are signs of Shaken Baby Syndrome. A baby experiencing such symptoms needs immediate emergency medical attention.
Source:http://www.dontshake.org
Related Glossary Terms Diffuse Axonal Injury
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Traumatic Brain Injury What is traumatic brain injury? According to The National Institute of Neurological and Stroke Disorders (2014) “Traumatic brain injury (TBI), a form of acquired brain injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI include headaches, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking. A person with a moderate or severe TBI may exhibit these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.” Source: http://www.ninds.nih.gov/disorders/tbi/tbi.htm Office of Communications and Public Liaison National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda, MD 20892
Related Glossary Terms Neuro-Distress
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