functional neurology, rehabilitation, and ergonomics

FUNCTIONAL NEUROLOGY, REHABILITATION, AND ERGONOMICS Volume 5, Number 4, 2015

TABLE OF CONTENTS Editorial - Academic Repression in the Cause of Peace? Gerry Leisman

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Infant and Childhood Frontal Lobe Development: Asymmetry and the Regulation of Temperament and Affect Gerry Leisman and Robert Melillo

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IAFNR News and Events

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Literature Calling

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New York

Journal of

Functional Neurology, Rehabilitation, and Ergonomics The Official Journal of the International Association of Functional Neurology and Rehabilitation The aim of this interdisciplinary journal is to provide a forum for the fields of Biomedical and Rehabilitation Engineering, Neuropsychology, Clinical Neurology, Human Factors and Ergonomics, and vocational assessment and training to present critical ideas, theories, proof-ofconcept for technology solutions, and data-based evaluative research to facilitate return to work or more effective functional development in children and adults. Functional Neurology, Rehabilitation, and Ergonomics is published quarterly by Nova Science Publishers, Inc. 400 Oser Avenue, Suite 1600 Hauppauge, New York 11788, USA E-mail: [email protected] Web: www.novapublishers.com ISSN: 2156-941X Institutional Subscription Rates per Volume Print: $350

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Editor-In-Chief Gerry Leisman Nazareth, Israel Co-Editor-In-Chief Robert Melillo Rockville Centre, NY USA Assistant Editor - Production Janet Groschel Gilbert, AZ USA

Randy Beck Perth, Australia

Editorial Board Members Newton Howard Cambridge, MA, USA

Eti Ben-Simon Tel-Aviv, Israel

Megan L. Hudson West Springfield, MA, USA

Paul Berger-Gross Bayside, NY USA

Efraim Jaul Jerusalem, Israel

John A. Brabyn San Francisco, CA, USA

Datis Kharrazian Carlspoor, CA, USA

Orit Braun-Benjamin Karmiel, Israel

Samuel Landsberger Los Angeles, CA, USA

Lynn M. Carlson W. Springfield, MA, USA

Seung Won Lee Seoul, Korea

Emmanuel Donchin Tampa, FL USA

Joy MacDermid Hamilton, Ontario, CA

Andrew L. Egel College Park, MD, USA

Calixto Machado Havana, Cuba

Khosrow Eghtesadi W. Palm Beach, FL, USA

Joav Merrick Jerusalem, Israel

Mario Estévez-Báez Havana, Cuba

Raed Mualem Nazareth, Israel

Paul Noone Hampton East Victoria, Australia Jackie Oldham Manchester, UK Chandler Phillips Dayton, OH, USA Rafael Rodríguez-Rojas Havana, Cuba Anthony L. Rosner Boston, MA, USA Fredric Schiffer Boston, MA, USA Peter Scire Peachtree City, GA, USA Suryakumar Shah Scottsdale, AZ, USA Joseph Weisberg Great Neck, NY, USA Leslie Weiser Boston, MA, USA

Funct Neurol Rehabil Ergon 2015;5(4):435-442

ISSN: 2156-941X © Nova Science Publishers, Inc.

Editorial - Academic Repression in the Cause of Peace? Gerry Leisman Editor-in-Chief FNRE The National Institute for Brain and Rehabilitation Sciences, Nazareth, Israel Universidad de Ciencias Médicas de la Habana, Facultad Manuel Fajardo, Cuba

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[email protected]

The 21st century has begun as a time of war, violence, and terrorism on a global scale as social, political, and environmental problems continue to mount to crisis levels. In response to policies of various governments and world bodies, intense forms of resistance are mounting against the great endorsers of these policies whatever they may be. These resistance movements range from nonviolent anti-war and social justice protests to animal liberation and environmental protests, to movements to boycott academics that are members of Israeli universities. Included in these ranks of resistors are professors who are developing analysis and theoretical works about and in support of the resistance and some who are using academia to advance their own political objectives by suppressing the academic freedom of others. There is no doubt that academic freedom is a complex concept that cannot be analyzed from one perspective or within a unified context. Although there is a consensus among academicians about the definition of this concept as being the freedom to undertake teaching and research in a free and unrestricted manner and the ability to publish research findings without fear of political and social consequences. The interpretation of this concept has been different in various social and political contexts. This is largely dependent on or linked to the general freedoms prevailing in national political systems. In democratic systems of government, academic freedom is usually guaranteed even if the state is totally financing the academic system. This has recently been compromised with the academic boycott in the UK of Israeli academics. Academic freedom, a principle clearly established in British Universities has been restricted and infringed upon, by attempting to create conformity by academicians and researchers with one political philosophy or orientation. In any context where academic freedom is restricted or limited, the ability of academicians and researchers to produce

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and use knowledge for the welfare of society is impeded. The United Nations’ UNESCO convened a conference on academic freedom in 2005 [1] in which apologists for academic boycotts of Israeli academics were represented but no detractors. This was supported by an organization that in 1948 generated the Universal Declaration of Human Rights in which the right the unfettered access to knowledge was guaranteed without concern for geographic borders. The United Nations, by its development of the Declaration, supports academic freedom, and by its inclusion of such a position as the support of an academic boycott by British faculty, supports the violation of its own principles of academic freedom. “In view of the fact that people of conscience in the international community of scholars and intellectuals have historically shouldered the moral responsibility to fight injustice, as exemplified in their struggle to abolish apartheid in South Africa through diverse forms of boycott, PACBI calls upon them to boycott Israel’s academic and cultural institutions in the spirit of international solidarity, moral consistency and resistance to oppression.” (Palestinian Campaign for the Academic and Cultural Boycott of Israel [2])

The United Nations Declaration of Human Rights has been supported by many including Pope John Paul II who in a speech to the United Nations on 5 October 1995 called the UDHR “one of the highest expressions of the human conscience of our time” [3]. Eleanor Roosevelt agreed in 1948 [4], so too did Marcello Spatafora in a speech made on behalf of the European Union on 10 December 2003: “Over the past 55 years, humanity has made extraordinary progress in the promotion and protection of human rights thanks to the creative force generated by the Universal Declaration of Human Rights, undoubtedly one of the most influential documents in history. It is a remarkable document, full of idealism but also of determination to learn lessons from the past and not to repeat the same mistakes. Most importantly, it placed human rights at the center of the framework of principles and obligations shaping relations within the international community” [5]. Critical of the Universal Declaration of Human rights have been representatives of predominately

Muslim countries like Sudan, Pakistan, Saudi Arabia, and Iran, to name but a few who frequently criticize the UDHR for its perceived failure to take into account the cultural and religious context of nonWestern countries. In 1981, the Iranian representative to the United Nations, Said Rajaie-Khorassani [6], articulated the position of his country regarding the UDHR, by saying that it was “a secular understanding of the Judeo-Christian tradition”, which could not be implemented by Muslims without trespassing the Islamic law. Rudolph Peters, Professor of Islamic Law at the Free University of Amsterdam has said that, “Muslim nations are committed to different international human rights conventions that have been drafted and are implemented under the aegis of the United Nations. The legitimacy of modern human rights discourse is often challenged by Muslims with the argument that human rights are a Western invention based on a Western discourse that does not take into account the cultural specificity of the Muslim world or non-Western cultures in general….” [7]. Peters is likely correct in his assertion and we witness attempts at communication where the operational definitions and basic assumptions between “east” and “west” are different. From just this superficial foray into something as patently obvious to a western eye as the UDHR, we seem to have a language barrier large enough to prevent any advance on any level of human interaction between Eastern and Western thought that a boycott will certainly not solve. Only the effective communication and expression of ideas with understood operational definitions can be an effective starting point unless the motivation is to stifle discourse. In 2002, British academics called for a moratorium on all cultural and research links with Israeli academic institutions and specifically questioned the special status afforded to Israeli academia by the European Union [8]. Similar boycott campaigns have been launched in France, Belgium and Australia, in addition to on-going divestment campaigns in universities in the United States. Most recently, in 2005, a decision was taken (although later rescinded) by the British Association of University Teachers (AUT) [1, 2] to boycott two Israeli universities Haifa University and Bar Ilan

Editorial Universities. Some have argued in this regard that academic freedom is a super value placed above all other freedoms. Others have argued that a boycott may help to generate academic freedom. Ben-Dor [9] sees a boycott of Israeli institutions as “a means to transcend the publicly-sanctioned limits of debate. A second argument against boycott is that it isolates and punishes the very section of Israeli society most likely to support the Palestinian cause. This argument is based on the assumption that in general, academics and intellectuals tend to be the most sympathetic to the struggle of the oppressed. This argument of course is fallacious in that it indicates that the proponents of one cause should not be silenced while the other should. The issue is silencing of one voice. This is not the function of the academy. Ilan Pappe formerly of Haifa University and now in the UK, who has been severely attacked for his own dissenting views, has stated that out of 9,000 academics in Israel, only 100-150 of them actively voices their opposition to the occupation” [10]. Here there is an assumption that because this individual’s view have been attacked and that there is, as he claims, a small dissenting voice to the perceived orthodoxy, therefore an academic boycott of Israel’s academics and institutions should be supported. We have entered a neo-McCarthyist period rooted in witch-hunts against academics and critics of the ruling elites. What the McCarthy's era did not have was an articulated plan to convert the institutions of higher learning to the dominant ideology. This blaze of repression is targeting anyone in alliance with the repressed as well. A case in point: is exemplified by Ward Churchill [11] who made news with his controversial article about the “technocrats” or “Little Eichmans” who worked in the Twin Towers in New York and were killed September 11, 2001. His scheduled lecture at Hamilton College on 3 February 2005 was cancelled because he had indicated that the World Trade Centers were legitimate military targets. The university has become a battlefield between academic freedom and academic repression. Academic repression is becoming more and more familiar to non-conventional and critical intellectuals. College administrations have been putting their campuses on intellectual lockdown post September 11, 2001. There is an intellectual war and this war is

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not new. The governing elite in the academy have attempted to silence controversy since day one, during Socrates time, and as recently in the U.S. as the blacklisting communist professors during the Red Scare in the 1940s and 50s. One of the most famous cases in U.S. history of academic repression occurred in 1969 when UCLA philosophy professor Angela Davis, a well-known international scholar against oppression in all forms, was fired from her teaching position because she was a communist. Ironically enough, Former Governor of California Ronald Reagan once vowed that Davis would in no way ever work for the University of California educational system again; today she is an honored tenured faculty and chair of the History of Consciousness Department at University of California Santa Cruz. Furthermore, in a memorandum written to all faculty of UC, Governor Ronald Regan wrote in June 19, 1970 [12]: “This memorandum is to inform everyone that, through extensive court cases and rebuttals, Angela Davis, Professor of Philosophy, will no longer be a part of the UCLA staff. As head of the Board of Regents, I, nor the board will not tolerate any Communist activities at any state institution. Communists are an endangerment to this wonderful system of government that we all share and are proud of. Please keep in mind that in 1949 it was reaffirmed that any member of the Communist Party is barred from teaching at this institution. Cordially, Ronald Reagan, Governor

In 1970, as if things were not bad enough for Davis, she was framed and placed on the FBI's Top Most Wanted List for charges of kidnapping three San Quentin prisoners and supplying the gun that killed four people during the incident, which drove her underground until her arrest. She was acquitted in 1972. It has been documented that in the 1970s and 80s University of California employees had to sign a statement saying that they are not a member of a group that seeks to overthrow the U.S. government. But, even in 1915, Scott Nearing, a socialist professor of economics, was fired from the University of Pennsylvania during the beginning of World War I. Nearing was an activist and academic who wrote against the war, including a pamphlet, Great Madness, which noted the commercialization of war

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and another, The Menace of Militarism, which discussed the war as a profitable investment. Along with his strong position against war, he also aided in the establishing in the U.S. of the “back-to-the-land movement,” as a part of which he started the organic Kokopelli Farm in California. He was also very publicly opposed to the use of child labor in coal mines. A mine owner on the board of trustees of the University of Pennsylvania influenced the president of the university to fire Nearing [13, 14]. Today, academic repression is not only coming from offices of the administration, but from the voices in the university student body and alumni as well. Faculty members are being targeted for the actions of studying, supporting, sympathizing, or merely being a scholar of dissent to policies of various kinds. Furthermore, we can look at the case of Middle Eastern Professor Joseph Massad of the Department of Middle East and Asian Languages and Cultures at Columbia University, who spoke, organized events, taught, and advocated against Zionism. Massad, one of the University's most controversial professors, teaches courses on the Arab-Israeli conflict, Islam, and modern intellectual thought. He also speaks around the country, is the assistant editor of the Journal of Palestine Studies, and was listed among “Columbia's Worst Faculty” by the Columbia Conservative Alumni Association [15]. This case is only one of many that demonstrate that conservatives on and off college campuses are demanding that critical thinking and education for liberation marginalized, if not in full done away with. What they do want is to chase liberal and social justice teaching out of every corner of this country, from politics to teaching. Radical leftists are seeking the same on the other side of the spectrum and the result would be the sterilization of the academic enterprise. Each group is in pursuit of hijacking platforms of discourse. The supporters of academic boycotts are not sympathizers with a cause but rather supporters of that cause. Supporters are individuals that actively and publicly support actions and organizations, not merely understand or relate to them as academics do. Support, for example, could be in the way of speaking, writing, or engaging in activities that promote and advocate for a group or actions. An individual that transports individuals, provides

financial aid to active members, or is involved in a given campaign or action, is not a supporter anymore, but a member of that group as are the boycott supporters in the UK. One individual that is clearly a supporter and not a member of a militant group is Dr. Steve Best, professor at University of Texas, El Paso who co-edited, Terrorists or Freedom Fighters? Reflections on the Liberation of Animals [16], who began his public support of a militant underground transnational group, the Animal Liberation Front. The Federal Bureau of Investigation (FBI) in the United States has labelled the Animal Liberation Front as a terrorist threat. Therefore, one can clearly argue that Steve Best is a public supporter of terrorists. As a result, Best has been banned from England, appeared in the Higher Education Chronicle, and has been asked to step down from his chairpersonship of the philosophy department at University of Texas, El Paso, with pressure by his peers in the department, external interests, and law enforcement. Critics can say he is helping terrorists. Best, however, is an academic and is therefore a voice promoting the ability of students to be critical and have hope for a more ethical and kind world. No voice can be silenced in an environment promoting scholarship and the free flow of ideas. There is plenty of that outside of the academy. A Boycott of academics represses critical thought. Noam Chomsky noted the importance of using the academic legitimacy “... to expose the lies of governments, to analyze actions according to their causes and motives and often hidden intentions. In the Western world at least, they have the power that comes from political liberty, from access to information, and freedom of expression” [17]. If those who desire to create rigid closed orthodox notions of their political take on reality in the form of academic repression and boycott as a surrogate for the free exchange of ideas and dialogue, then there may be a vehicle for intelligent and informed nonviolent conflict resolution. Teaching rather than repressive pedagogy may result, research and scholarship rather than political manifestos may be created. Higher education has now become one of the battlegrounds for the global information war, all are fighting for the control of public opinion, via blogs, books, articles, classrooms, magazines, newspapers, videos, and websites. Academic-activists are experts at this game, and in many ways are

Editorial winning, but the result is mass academic repression. Academic repression has not hit the radar as it should, most likely because the journals and authors which expose repression are the ones being silenced, therefore leaving no one to write for them except for activists. Ironically enough, many activists have a preconceived notion that academics are detached and neutral in the fight for peace and justice. Academicactivists aid in research, theoretical justification, and serve as expert witnesses for street-line activists. The attack against Middle Eastern studies and the attempts at the boycotting of Israeli academics has opened the door to a whole new level of assault on academic freedom, teacher authority, and critical pedagogy. These attacks are much more widespread and, for reasons to be expanded upon, more dangerous than the McCarthyite campaign in the United States several decades ago. Trading upon the ongoing “corporatization” of the university, its increasing reliance on non-government financial resources, and its vulnerability to outside criticism, a number of advocacy groups, from both the right and the left are now targeting higher education, alleging it is not only a breeding ground for cultivating anti-Israel and anticapital sentiments and creating also a hot-bed of politicized and discriminatory pedagogical encounters. Invoking academic freedom is crucial for maintaining the university in the democratic public sphere, but it is equally essential to defend critical pedagogy and the free exchange of ideas as a condition of civic responsibility and teaching as a deliberate act of intervening in the world as part of the goal of encouraging students to think about justice and to question “the ostensibly unquestionable premises of our way of life- all aspects of it. While most defenders of the university as a democratic public sphere rightly argue that both the right-wing and left-wing’s assault on the academy levels a serious threat to academic freedom, they have largely ignored the crucial issue that the very nature of pedagogy as a political, moral, and critical practice is at stake, particularly the role it plays in presupposing a view of the world that is more just, democratic, and free from human suffering. Robert Ivie has argued rightly that academic freedom in its basic form, “means unfettered scholarly inquiry, a scholar's fundamental right of research, publication, and instruction free of institutional

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constraint” [18]. But it is pedagogy, including cooperative research and the public dissemination of ideas by academics that begs both a more spirited defense and analysis so that it can be protected against the challenges to critical engagement, dialogue, research, and debate. Pedagogy at its best is about neither training nor political indoctrination; instead, it is about a political and moral practice that provides the knowledge, skills, and social relations that enable students and academics to expand the possibilities of what it means to be critical citizens while using their knowledge and skills to deepen and extend their participation in a substantive and inclusive international democracy. Rather than assume the mantle of a false impartiality, academics should recognize that research, education, and teaching involve the crucial act of intervening in the world and the recognition that human life is conditioned, not determined. The responsibility of academics amounts to more than becoming the instrument of official power or an apologist for the existing order. Academics should attempt to understand how power works through the production, distribution, and consumption of knowledge within particular institutional contexts and should seek to constitute students and other academics as social agents. Academics should also invest in both the practice of self-criticism about the values that inform teaching and research and a critical selfconsciousness regarding what it means to equip students with analytical skills to be self-reflective about the knowledge and values they confront. This is not accomplished by the repression of ideas. What makes critical academics so dangerous to Christian evangelicals, neo-conservatives, left-wing socialists and right-wing nationalists anywhere is that central to its very definition is the task of educating students to become critical agents who actively question and negotiate the relationships between theory and practice, critical analysis and common sense, and learning and social change. Academia opens a space where students should be able to come to terms with their own power as critical agents; it provides a sphere where the unconditional freedom to question and assert is central to the purpose of the university, if not democracy itself and as a political and moral practice, academics should “make evident the multiplicity and complexity of history,” [19] as a

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narrative to enter into critical dialogue with rather than accept unquestioningly suffering. Similarly, academics should cultivate in students as well as in other academics, a healthy skepticism about power “a willingness to temper any reverence for authority with a sense of critical awareness” [19]. As a performance practice, academics should provide the conditions for students and other academics to be able to reflectively frame their own relationship to the ongoing project of an unfinished democracy. It is precisely this relationship between democracy and academia that is so threatening to so many. Academia represents a commitment to the future, and it remains the task of educators to make sure that the future points the way to a more socially just world, a world in which the discourses of critique and possibility in conjunction with the values of reason, freedom, and equality function to alter, as part of a broader democratic project, the grounds upon which life is lived. This is hardly a prescription for political indoctrination, but it is a project that gives education its most valued purpose and meaning, which in part is “to encourage human agency, not mold it in the manner of Pygmalion.” It is also a position that threatens right and leftwing private advocacy groups, extremists on all sides of the political spectrum because they recognize that such a intellectual commitment goes to the very heart of what it means to address real inequalities of power at the social level and to conceive of education as a project for democracy and critical citizenship while at the same time foregrounding a series of important and often ignored questions such as: “Why do we [as educators] do what we do the way we do it?” Whose interests does higher education serve? How might it be possible to understand and engage the diverse contexts in which education takes place? In spite of the view that equates indoctrination with any suggestion of politics, academia is not simply concerned with offering students new ways to think critically and act with authority as agents in the classroom; it is also concerned with providing students and researches with the skills and knowledge necessary for them to expand their capacities both to question deep-seated assumptions and myths that legitimate the most archaic and dis-empowering social practices that structure every aspect of society and to

take responsibility for intervening in the world they inhabit. Education is not neutral, but that does not mean it is merely a form of indoctrination. On the contrary, as a practice that attempts to expand the capacities necessary for human agency and hence the possibilities for democracy itself, the university must nourish those pedagogical practices that promote “a concern with keeping the forever unexhausted and unfulfilled human potential open, fighting back all attempts to foreclose and pre-empt the further unraveling of human possibilities, prodding human society to go on questioning itself and preventing that questioning from ever stalling or being declared finished” In other words, academia forges both critique and agency through a language of skepticism and possibility, and a culture of openness, debate, and engagement, all elements that are now at risk in the latest and most dangerous attack on higher education in the form of academic boycotts. The attack on the academy through academic boycotts is, in part, an attempt to deskill teachers and dismantle openness replacing it with intellectual arrogance, the tyranny of orthodoxy of thought and resulting in intellectual dishonesty. Teachers and researchers can make a claim to being fair, but not to being either neutral or impartial. Teacher authority can never be neutral, nor can it be assessed in terms that are narrowly ideological. It is always broadly political and interventionist in terms of the knowledge-effects it produces, the classroom experiences it organizes, and the future it presupposes in the countless ways in which it addresses the world. The authority of the academic, at its best, means taking a stand without standing still. It suggests that as educators we make a sincere effort to be selfreflective about the value-laden nature of our authority while taking on the fundamental task of educating students to take responsibility for the direction of society. Rather than shrink from our political responsibility as educators, we should embrace one of academia’s most fundamental goals: to teach students to believe that democracy is desirable and possible. Connecting education to the possibility of a better world is not a prescription for indoctrination; rather it marks the distinction between the academic as a technician and the academic as a self-reflective educator who is more than the

Editorial instrument of a safely approved and officially sanctioned worldview. It is impossible to separate what we do in the classroom from the economic and political conditions that shape our work, and that means that pedagogy has to be understood as a form of academic labor in which questions of time, autonomy, freedom, and power become as central to the classroom as what is taught. As a referent for engaging fundamental questions about democracy, pedagogy gestures to important questions about the political, institutional, and structural conditions that allow teachers to produce curricula, collaborate with colleagues, engage in research, and connect their work to broader public issues. Academia is not about balance, a merely methodological consideration; on the contrary, as Cornelius Castoriadis reminds us, if education is not to become “the political equivalent of a religious ritual,” [20] it must do everything possible to provide students with the knowledge and skills they need to learn how to deliberate, make judgments, and exercise choice, particularly as the latter is brought to bear on critical activities that offer the possibility of democratic change. Democracy cannot work if citizens are not autonomous, self-judging, and independent - qualities that are indispensable for students if they are going to make vital judgments and choices about participating in and shaping decisions that affect everyday life, institutional reform, and governmental policy. Hence, academia becomes the cornerstone of democracy in that it provides the very foundation for students to learn not merely how to be governed, but also how to be capable of governing. Academia cannot close off debate by preventing all voices from being heard and it cannot succumb to the tyranny and orthodoxy of the few. The proponents of academic boycotts, have made the classroom an unworldly counterpart to the gated community, a space for conformity in which the meaning of education is largely reduced to respecting their ideological “comfort zones” and to perpetuating governmental and social practices, however corrupt and antidemocratic. This is not academia - it is a flight from self and society. Its outcome is not a student or a researcher who feels a responsibility to others and who feels that his or her presence in the world matters, but one who feels the presence of difference as an unbearable burden to be contained or expelled.

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Edward Said has captured the importance of academics as engaged intellectuals, for making education worldly, and for pedagogy a moral and political practice, He wrote: “So in the end it is the intellectual as a representative figure that matters--someone who visibly represents a standpoint of some kind, and someone who makes articulate representations to his or her public despite all sorts of barriers. My argument is that intellectuals are individuals with a vocation for the art of representing. And that vocation is important to the extent that it is publicly recognizable and involves both commitment and risk, boldness and vulnerability. The intellectual is neither a pacifier nor a consensusbuilder, but someone whose whole being is staked on a critical sense, a sense of being unwilling to accept easy formulas, or readymade clichés, or the smooth, ever-soaccommodating confirmations of what the powerful or conventional have to say, and what they do. Not just passively unwilling, but actively willing to say so in public” [21].

The current assault on the academy is first and foremost an attack not only on the conditions that make critical pedagogy possible. Pedagogy and the transnational open discussion of ideas must be understood as central to any discourse about academic freedom, but, more importantly, it must be understood as the most crucial referent we have for understanding politics and defending the university as one of the very few remaining democratic public spheres in the world today.

References [1]

[2]

Barghouti R, Murray H. The struggle for academic freedom in the Palestinian occupied territories. In: Bubtana A.R. (Ed.), Proceedings Academic Freedom: Problems and Challenges in Arab and African Countries. Paris: United Nations Educational, Scientific and Cultural Organization, 2005. Taraki L. Palestinian campaign for the academic and cultural boycott of Israel, presented at the SOAS conference on resisting Israeli apartheid: Strategies and principles, SOAS, London,

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December, 2004. (http://unesdoc.unesco.org/ images/0014/001494/149491e.pdf)(Downloade d 18 October 2015) [3] John Paul II. Address to the United Nations. http://www.vatican.va/holy_father/john_paul_ii/ speeches/1995/october/documents/hf_jpii_spe_05101995_address-to-uno_en.html#top, 1995. (Downloaded 18 October 2015) [4] Roosevelt E. U.N. Address on Adopting the Universal Declaration of Human Rights. [5] www.americanrhetoric.com/speeches/PDFFiles/ Eleanor%20Roosevelt%20-%20U.N.%20Add ress.pdf, 1949 (downloaded 18 October 2015). [6] Spatafora, M. http://www.europa-eu-un.org/ articles/en/article_3126_en.htm, 2003. (Downloaded 18 October 2015). [7] Kalanges K. Taking God Seriously: Why religion is essential to the defence of religious human rights. Fides at Libertas. 2011:37-58. [8] Peters R. Crime and punishment in Islamic law”, New York, NY: Cambridge Univ. Press, 2005. [9] The Guardian. Open Letter: More pressure for Mideast peace. April 6, 2002. [10] Ben-Dor O. The ethical and legal challenges facing Palestine. (http://www.counterpunch.org /2005/12/15/the-ethical-and-legal-challengesfacing-palestine/) (Downloaded 18 October 2015). [11] Pappe I. The meaning and objectives of the academic boycott. (Presented at the SOAS conference on Resisting Israeli Apartheid: Strategies and Principles) SOAS, London, December 2004. (https://cuncap.files.wordpress .com/2009/06/pappe-2004-meaning-andobjectives-of-the-academic-boycott.pdf) (Downloaded 18 October 2015).

[12] Churchill W, Wall JV. The COINTELPRO papers: Documents from the FBI's secret wars against dissent in the United States. Cambridge, MA: South End Press, 2002. [13] Davis A. Angela Davis: An Autobiography. New York: Random House, 1974. [14] Schultz B, Schultz R. It did happen here: Recollections of political repression in America. Los Angeles: University of California Press, 1989. [15] Schultz, B, Schultz, R. The price of dissent: Testimonies to political repression in America. Los Angeles: University of California Press, 2001. [16] Massad JA. The persistence of the Palestinian question: Essays on zionism and the Palestinians. London: Routledge, 2006. [17] Best S, Nocella AJ. II. Terrorists or freedom fighters? Reflections on the liberation of animals. New York: Lantern Books, 2004. [18] Chomsky N. The responsibility of intellectuals. In Peck J. (Ed.). The Chomsky Reader. New York, NY: Pantheon, 1987. [19] Ivie R. “A Presumption of Academic Freedom,” Review of Education, Pedagogy, and Cultural Studies 2005;27(1): 53-85. [20] Said E. Representations of the Intellectual. New York: Pantheon, 1994. [21] Castoriadis C. Democracy as procedure and democracy as regime. Constellations 1997;4:1-5. [22] Said E. Reflections on exile and other essays. Cambridge, MA: Harvard Univ. Press, 2001.



Infant and Childhood Frontal Lobe Development: Asymmetry and the Regulation of Temperament and Affect Gerry Leisman1,2,3,4 and Robert Melillo1,2,3 1

The National Institute for Brain and Rehabilitation Sciences, Nazareth, Israel 2 The Institute for Brain and Rehabilitation Sciences, Gilbert, Arizona, USA 3 Biomechanics Laboratory, O.R.T.-Braude College of Engineering, Karmiel, Israel 4 Universidad de Ciencias Médicas de la Habana, Facultad Manuel Fajardo

Abstract The rapidity of growth of the entire brain, the frontal lobes and their connectivities, as well as lateralization evident in infancy that we know so little about can foretell so much about the cognitive and social-emotional capacities of the infant and developing child. This paper outlines what happens to the frontal lobes at the outset of prenatal and postnatal life, as well as during early childhood. Specifically, the authors examine how early frontal brain development and its asymmetries and connectivities might affect temperament and social interaction, or vice versa. Keywords: Frontal lobes; connectivity; development; lateralization; temperament; affect

Introduction

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[email protected]

At conception a zygote is roughly 1 x 10-7 of an inch in diameter [1] and yet during the course of nine months of gestation the neonate reaches approximately 30 percent of his or her adult brain weight and approximately 85 percent by the age of two. The frontal lobes, as we all know painfully from our adolescent children, continue to develop through the remainder of the teenage years and early 20s depending upon sex and individual differences [2]. Anatomic studies show that increases in absolute brain weight occur almost entirely before birth and in the first two years of life. Over 90 percent of human brain growth is completed by the age of 6 years [3, 4] (see Table I). As indicated in Figure 1, while the brain and nervous system mature at an incredibly fast rate, Figure 2 indicates that certain areas take significantly longer to do so, especially the frontal and prefrontal

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areas, making the infant and child more vulnerable to environmental manipulation and experience. This is a good thing as long frontal lobe development that begins prenatally and that continues into early adulthood is altered by a wide range of positive and negative experiences that include: the development of short-term memory, associative learning, strategy formation, social/emotional behavior, response inhibition and behavioral spontaneity. Experiences that alter frontal lobe development will alter these functions too. A lot of what is guided by what we can call temperament, perhaps the basis of personality, has an effect on social interactions and it is based in part on cerebral asymmetry and lateralization.

Table 1. Average brain weights of males and females developmentally [5] Age Newborn 1 Year 2 years 3 years 10-12 years 19-21 years 56-60 years 81-85 years

Brain WeightMale (in grams) 380 970 1,120 1,270 1,440 1,450 1,370 1,310

Brain Weight Female (grams) 360 940 1,040 1,090 1,260 1,310 1,250 1,170

Figure 1. Development of brain from conception through the first nine postnatal months. Frontal lobes do not fully develop until the early 20s on average.

Infant and Childhood Frontal Lobe Development

Figure 2. Some brain areas are slow to mature and thus vulnerable to change by experience which is especially true of lighter areas.

The rapidity of growth of the entire brain, the frontal lobes and their connectivities, as well as lateralization evident in infancy that we know so little about can foretell so much about the cognitive and social-emotional capacities of the infant and developing child. It is what happens to the frontal lobes at the outset of prenatal and postnatal life as well as during early childhood that is the subject of this discussion. We are here examining how early frontal brain development and its asymmetries and connectivities might affect temperament and social interaction, or vice versa.

Individual Differences in Temperament While the old nature-nurture debate is today a non-starter, much from the earlier arguments has a singular value in understanding the nature and purpose of the development of the frontal lobes and brain asymmetry in infancy. It had for the longest time been thought by many that the infant was a tabula rasa. Systematic studies of the nature of the child's specific pattern of individuality and the presence of and contribution to the psychological development of the infant and child have been given much attention over the past decades, during which environmental approaches to the study of behavioral development has predominated, exemplified by early intervention programs, and even behavior modification programs for autistics as examples.

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While these standards have served to identify the many aspects of parental attitude and practice, sibling and family relationships, social values, expectations, and cultural norms which appear to contribute significantly to a child's normal or deviant behavioral development, they do not address a principal component of infant development, namely, the infant as he himself is. Earlier in the 20th century Gesell [6] and Shirley [7], reported significant individual differences in the behavioral characteristics of infants. However, over the succeeding years, scattered stands of theory were presented insufficient to provide the basis for systematic and comprehensive understanding of behavioral individuality and psychological development. A number of factors were responsible for this neglect. Important among these was the disrepute of the previously influential constitutionalist views, which had ascribed personality structures and the elaborate psychopathological syndromes to heredity and constitution only. The alternatively held views in the past noted that purely environment explains most of child development. Unfortunately, the fact remains that a purely environmental approach does not adequately explain the great variability in responses of infants and children to similar childcare practices. Nor does it explain the absence of a one to one relationship between parental functioning in the presence of psychological abnormality in the child. Perhaps individual organismic behavioral differences important for development might exist in infants. Constitutionalist views had, of course, erred in discounting environmental influences. Was it not possible that the environmentalist positions might also be mistaken in ignoring significant organismic characteristics of the child? The nature of the interactions of infant with his or her environment in the context of both the infant’s specific characteristics of individuality and significant effects in his frontal lobe development in the context of cognition and emotionality speaks to the need for a fundamental understanding of the how differences in dynamic interactions between the brain and nervous systems of infants and children can create individual differences in the reactivity of these infants’ to their environment and how the dynamic interplay between brain regions and their connectivities influences brain and nervous system development.

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For infants’ individuality to be seriously incorporated into the body of developmental theory, more substantial information on the nature of individual differences is required. The pertinent initial characteristics of individuality in infancy have to be identified along with the continuities and discontinuities over time and their relevance to various features of child psychological development determined. Such analyses require long-term longitudinal study of data on the behavioral characteristics of substantial sample of children analyzed from infancy onward. This in fact happened with the New York longitudinal study initiated in 1956 but with little follow up beyond its initial release. Observations of a number of normal and deviant children over periods of years revealed that the aspect of initial difference most likely to have pertinent for later development was behavioral style or temperament. Temperament has been referred to as the “behavioral style” of a child and contains no inferences as to the genetic, somatalogic, endocrine or environmental etiologies. It was originally a phenomenological term used to describe the characteristics about, energy expenditure, focus, mood and rhythmicity that fire the behaviors of an individual child independently of their contents. Temperament refers only to the how, not the why, of behavior and implies neither immutability nor permanence [8]. In the original New York longitudinal study of infants’ individual differences, the authors [9] (found through inductive content analyses of the infant behavior protocols that it was possible to characterize the individual behavior style of each child the study in terms of nine categories of reactivity. These qualities were defined when the child was only two months of age were also identified at all subsequent age periods, in infancy and in childhood. Nine categories of reactivity in which temperamental attributes were subsumed were: 1. Activity level: motor components present in a given child's functioning and the diurnal proportion of active and interactive periods. Protocol data on the child's motility when he is being bathed, fed dressed, and handled, as well as information concerning his sleep-

2.

3.

4.

5.

6.

7.

8.

9.

wake cycle and is reaching, crawling, walking, and his play patterns. Rhythmicity (biological regularity): the predictability and rhythmicity and/or the unpredictability and arhythmicity in time of any function, analyzed in relation to the child's sleep-wake cycle, his hunger or feeding patterns and his elimination schedule. Approach-withdrawal (positive-negative initial responses): the nature of the child's initial response to a new or altered in numerous, being new food, a new toy, or a new person. Adaptability: the nature of the child's responses to new or altered situations with respect to the ease with which they are modified in the desired direction, irrespective of the initial response. Intensity of reaction: the energy level or vigor of a child's response, independent of direction. (Either a negative or a positive response could be mild or intense.) Responses to stimuli, to pre-elimination tension, to hunger, to repletion, to new foods, to attempts at control, to restraint, to dressing and to diapering. Threshold of responsiveness: the intensity level of stimulation necessary to evoke a discernible response without regard to the specific form that the response may take or the sensory modality affected. The behaviors used are responses to a) sensory stimuli b) environmental objects, and c) social contacts. Quality of mood: the amount of pleased, joyful, and friendly versus the amount of displeased, crying, and unfriendly behavior. (Does the infant show more smiling and laughing for more fussing and crying behavior? Distractibility: the ease with which a child can be diverted from an ongoing activity by extraneous peripheral stimulus. Attention span and persistence: attention span is the length of time to nuclear activity is pursued by the end persistence refers to the continuation of an activity by the infant in the face of the obstacles to the maintenance of the activity direction. (cf. [10]).

Infant and Childhood Frontal Lobe Development In attempting to understand the systems physiology basis of temperament thusly described, it has been postulated for a significant period of time already [11] that patterns of electroencephalographic activity might be correlated with various types of temperament. Although there has been a long history in seeking indications of biochemical individuality that might offer clues to initial sources of individuality in infants, [12] gene x environment interactions have been noted involving child temperament and maternal social support. Investigators have found heightened behavioral inhibition in children homozygous or heterozygous for the serotonin transporter (5HTTLPR) gene short allele whose mothers reported low social support. Fox and colleagues had proposed how with plasticity for affective neuro-circuitry, genetic dispositions could be described that allow for interaction with environmental circumstances. Children with persistently fearful temperament (and the 5HTTLPR short allele) would be are more likely to experience care-giving environments in which threat is highlighted. This in turn will exacerbate an attention bias that alters critical affective neuro-circuitry to threat and enhances and would maintain anxious behavior in the child. In contradistinction to the descriptions above, temperament in the context of frontal lobe development refers to individual differences in motor and emotional reactivity and selfregulation according to Rothbart and Bates [13]. The temperamental variable related to the development of executive attention is termed effortful control, representing the infant’s ability to inhibit a dominant response in order to perform a sub-dominant response. The construct of effortful control is extremely important in understanding the influence of temperament on behavior. Most of the more behaviorally based definitions of temperament have focused on temperament’s more reactive aspects related to positive and negative affect, reward, punishment, and arousal to stimulation. Brain-based systems of effortful control are understood in the context of immediate cues and avoidance. The program of effortful control is critical to socialization. Kochanska [14] has indicated that conscience is related to temperamental individual differences in effortful control. Although the literature on temperament had originally believed that

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temperament systems would be in place very early in development and change little over time [15,16] we have since learned that temperament systems follow a developmental course. Children’s reactive tendencies to experience and their emotional expressivity and response to events in their environment can be observed very early in life. Children’s self-regulatory executive attention develops relatively late and coincidently with the development of their frontal and prefrontal cortices throughout the early school years. Self-regulation, a direct manifestation of temperament, involves complex questions about the nature of volition and its relation to one’s genetic endowment and social experiences. Much of the work on self-regulation has been purely behavioral. The lack of appropriate methods to study the physiology of the developing human brain has led to understandable hesitation in thinking about these processes at the neuro systems level. Kandel [17] however, has argued persuasively that new concepts in the neurosciences make it possible to relate higherlevel cognitive concepts to underlying brain systems. Control of distress is a major task for the infant and the caregiver in the early months of life and of course the tasks involved in distress control in turn require external or self-regulatory processes. In the first few months, caregivers help control distress mainly by holding and rocking. Increasingly in the early months, visual orienting is also used. Caregivers then attempt to involve the child in activities that will occupy their attention and reduce their distress. These interactions between infant and caregiver may train the infant in the control of distress and lead to the development of the mid-frontal area as a control system for negative emotion. Later when similar cognitive challenges arise, a system for regulating remote brain areas may already be prepared. Evidence exists for a physiological basis of individual differences in the self-regulation of distress and its resultant system of emotional control (inhibition) in human infants. Differences among infants in negative and positive emotionality are often assumed to reflect differences in temperament that are expected to have a constitutional basis [18, 19]. According to Rothbart [20], the constitutional basis of temperament should be reflected in endocrine processes that may, in turn, be related to genetic differences among individuals [21, 22].

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Studies using vagal tone, a measure of parasympathetic input to the heart, have shown that by the end of the first year of life, high vagal tone is associated with greater emotional expressivity (both positive and negative), while low vagal tone is associated with inhibition of approach to strange objects and people [23] have also shown that a variety of measurements of sympathetic tone are associated with behavioral inhibition among preschoolers. Higher cortisol concentrations have also been reported for behaviorally inhibited children compared to uninhibited children [25]. In a series of studies with nine-month olds, Gunnar and Associates [26] found that infants who are more distressed had higher cortisol concentrations following separation. Evidence consistent with this notion has been presented in several studies. Significant heritability components of temperament have also been reported in the Louisville twin study [27, 28]. In a detailed and fascinating study by Gunnar and Nelson [29], event-related potentials (ERPs) were recorded from year-old infants with sets of familiar faces presented frequently and sets of novel faces presented infrequently. The normative response of infants in this sample was a late positive slow wave to the infrequent familiar faces, and a return to baseline for the frequent familiar and infrequent novel faces. A factor score based on data from frontal and central leads that reflected this normative pattern was significantly associated with infant emotional behavior and cortisol level. Infants scoring higher on the normative ERP factor and distressed during

separation, as reported by their parents, smiled and laughed more and had lower cortisol concentrations during ERP testing. These data were interpreted as reflecting the coordination of adaptive responding among different physiological and behavioral systems and reflective of individual differences in infant responsivity. These data are reflected in Table II and clearly indicate that there are relationships between ERP's and emotional stimuli in year-old infants.

Frontal Lobes, Temperament and Affect Regulation A number of neuropsychological studies have linked the frontal lobes to affect expression and regulation [30, 31]. Anatomically, the frontal lobe has extensive connections with various limbic structures directly implicated in control of emotion. Findings in both normal [32] and brain-damaged adults [33] indicate that left and right frontal regions are differentially specialized for specific emotions. The data suggests that the left frontal region is specialized for the expression of emotions associated with approach, such as joy and interest, whereas the right frontal region is specialized for emotions associated with withdrawal such as disgust or distress [34]. Several early EEG studies of infants [35, 36] suggest that these functional brain asymmetries are present at least very early in life and possibly even at birth if not before.

Table 2. Correlations between event-related potentials and separation distress, IBQ temperament, and cortisol ERP Summary Factor

Event-Related Potentials FF

.73** -.23 Separation distress (df = 17) * .49 .02 IBQ: Positive Affect (df = 21) .31 .18 IBQ: Difficultness (df = 21) .01 -.26 IBQ: Fearfulness (df = 21) -.57* .29 ERP cortisol (df = 17) -.07 .11 Pre-SEP cortisol (df = 16) -.31 .12 Post-SEP cortisol (df = 15) Note: FF = Frequent Familiar, IF = Infrequent Familiar, and IN = Infrequent Novel. * p < .05. ** p < .01.

IF

IN

.72** .54* .31 -.03 -.50* .13 -.33

.34 .06 .40* -.02 -.01 -.45* .13

Infant and Childhood Frontal Lobe Development Davidson and Fox [37] noted that individual difference in resting infant EEG asymmetries were highly predictive of that infant’s emotional response to stress. They showed that infants with greater right rather than left frontal EEG activity during a resting state were significantly more likely to cry when later separated from their mothers compared with infants who exhibited significantly greater left frontal activity. The few revealing studies of EEG in infancy assist us in understanding the nature and purpose of frontal activation asymmetries in infancy, and whether extremes in these patterns of hemispheric asymmetry relate to temperamental differences in infants and/or risk for psychopathology. Some investigators have reported that the pattern of the resting frontal EEG reflects individual differences in the predisposition of the infant to experience positive or negative affect and is associated with individual differences in affective style in healthy infants, children, and adults, as well as in some clinical populations [38, 39]. We can see in the patterns of resting frontal EEG of neonates and infants significant individual differences of asymmetry that tend to remain in a stable fashion across the development of the child and adolescent. These EEG patterns also tend to correlate with temperament and can predict developmental outcome (Henderson et al., 2001). Davidson and Fox [37] examined whether certain features of infant temperament might be related to individual differences in the asymmetry of resting frontal activation. EEG was recorded from the left and right frontal and parietal scalp regions of 13 normal 10-month-old infants. Infant behavior was then observed during a brief period of maternal separation. Those infants, who cried in response to maternal separation showed greater right frontal activation during the preceding baseline period, as exemplified in Figure 3 below, compared with infants who did not cry. Frontal activation asymmetry may be a stateindependent marker of individual differences in threshold of reactivity to stressful events and vulnerability to particular emotions. Davidson [38] had reported that left frontal EEG asymmetry at rest is associated with individual differences of the neonate and infant to regulate affect and behavior. Fox and colleagues have indicated that

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infants displaying elevated left frontal EEG asymmetry at rest have been reported to have “easy” temperaments, manifested by reports of these infants being easily soothed and calmed.

Figure 3. Mean log 6-8-Hz power for the resting baseline period in the left and right frontal and parietal regions for criers (N = 6) and non-criers (N = 7). (Decreases in 6-8-Hz power are indicative of increases in activation. Error bars indicate standard errors of the mean.) [From [37]].

In contrast, Davidson and Fox [37] noted that negative affect and a lowered ability by the infant to regulate his or her affect and behavior is highly associated with lower right frontal EEG asymmetry at rest. Infants, when crying had demonstrated elevated right frontal activity during the baseline conditions preceding crying. This is highly associated with what we have reported elsewhere in asymmetric activation patterns in ADHD and autistic spectrum children [2,40, 41]. Fox reports that the infants who exhibited this pattern of right frontal EEG asymmetry in resting state-at rest have been characterized as having ‘‘negative reactive’’ temperaments [42]. These infants are easily distressed, are difficult to soothe, certainly do not generally self-soothe, and have problems switching and focusing attention. Since the demand for higher level integrative behavior placed upon the infant in the investigation of his reflexes by standard clinical methods and his muscle tonus are normally quite minimal, such indicators are frequently insensitive to even marked

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neurological deficiencies. Although the examination of neuroelectrical activity is promising with respect to identifying individual infants with immature or defective neuro-integration or organization, the examination is limited by our imperfect understanding of the relationship between such neuroelectrical activity and behavior at the present time. In children with inadequately developing frontal lobe function, hyperactivity, depression, poor sustained attention, language difficulties, and impulsive or impetuous behavior are common. We normally see this in later childhood as abnormal but we are in fact describing the typical behavior of the neonate likely because of the status of his or her frontal lobes. Motor activity in the infant will grow his or her motor skills but coincidentally if not causally increasing the growth of the frontal lobes. We also have to consider that since the cerebellum and thalamus may both be important to the anatomical and functional development of the frontal cortex, that if a child does not have normal or proper motor development, we would expect that the higher frontal lobe functions of cognition and behavior would be delayed in their development. Likewise, helping an infant to develop his or her motor skills should also help develop their non-motor skills. So from this we see that we have inadequate measuring tools, to examine the nature and function of the frontal lobes in infancy along with numerous confounding variables that impede our understanding of the relationship between motor function and cognition, asymmetry and lateralization and how all impact on the cognitive and affective development of the infant and child.

Development of Neurological Systems Articulating with the Frontal Lobes and Associated Structures in the Development of Temperament The Frontal and Prefrontal Cortices Major developmental events in the first year include the cortical inhibition of the brainstem, the improvement in recognition and working memory,

and the appearance of separation anxiety. From around the age of 3 months, the neonatal palmar grasp reflex begins to disappear. This event is related in time to the differentiation of the pyramidal neurons in the supplementary motor cortex [43]. Stimuli are transmitted by the cortico-bulbar tract to the interneurons in the brainstem. These inhibit the motor neurons by means of the neurotransmitter GABA, leading to an inhibition of the reflex action of the muscles of the hand. At this age, the cortico-bulbar tract shows intensive myelination, accelerating nerve conduction speed. In the brainstem, synaptic contacts of interneurons to motor neurons are intensified, and GABA synthesis is increased. These processes increase the cortical inhibition of brainstem reflex activity. If brainstem mechanisms controlling respiration are immature or compromised, then the increased cortical inhibition could place infants at risk for sudden infant death syndrome, which can occur around that age [44]. Conversely, persisting primitive brainstem reflex activity may be associated with a lack of cortical inhibition. The frontal lobe (Figure 4) plays a major role in motor activities like planning and in the execution of movements. The primary motor area proximal to the precentral gyrus is known as the motor strip (Brodmann’s area 4). This is located just anterior to the central sulcus. The primary motor area is also referred to as motor area 1 or MI. Anterior to this area are two additional primary motor areas (Brodmann’s 4, 5, and 6). This supplementary motor cortex lies anterior to the motor strip and extends around to the hemisphere’s medial surface. The premotor cortex lies anterior to the supplementary motor cortex and on the lateral surface of the hemispheres. These motor areas contain motor neurons whose axons extend to the spinal cord and brainstem and synapse on motor neurons in the spinal cord. The motor neurons are located in layer 5, the output layer of the motor cortex. This layer contains large pyramidal cells; they are the largest neurons in the cerebral cortex. The most anterior region of the frontal lobe, the prefrontal cortex is responsible for higher aspects of motor control and planning and in the execution of behavior, tasks requiring integration of information over time. The prefrontal cortex has two main areas, the dorsolateral prefrontal cortex, which is found on the lateral surface of the frontal lobe anterior to the

Infant and Childhood Frontal Lobe Development premotor regions, and the orbitofrontal cortex. The orbitofrontal cortex is located on the frontal lobe’s anterior-ventral surface and is more medial. The orbitofrontal cortex includes limbic lobe structures and is connected to them. The frontal lobe is the largest lobe in humans (Figure 4) and the prefrontal cortex constitutes approximately 50 percent of the size of the frontal lobes. The prefrontal cortex is included in a neuronal system that includes the basal ganglia, the thalamus, and the cerebellum. Most of the higher and more complex motor, cognitive, and emotional behavioral functions are thought to be found primarily in the frontal lobes. This area of the neocortex has expanded

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evolutionarily more than any other in the human brain. The frontal lobes comprise one-third of the neocortex and the prefrontal cortex constitutes 50 percent of the frontal lobes. The prefrontal cortex is unique to humans; the reference to highbrow, for example, is a reference to the structural changes of one forehead that humans underwent to provide more space for our prefrontal cortices. It is thought that most of the unique qualities that humans possess are found or connected in some way with the expansion of the prefrontal cortex. This brain region is also important because the frontal lobes include areas of motor control as well.

Figure 4. Cytoarchitecture of the cortex with reference to the frontal lobes according to Broadmann. Areas 1, 2 and 3 Primary Somatosensory Cortex, Area 4 - Primary Motor Cortex, Area 5 - Somatosensory Association Cortex, Area 6 - PreMotor and Supplementary Motor Cortex (Secondary Motor Cortex), Area 7 - Somatosensory Association Cortex, Area 8 Includes Frontal eye fields, Area 9 - Dorsolateral prefrontal cortex, Area 10 – Fronto-polar area (most rostral part of superior and middle frontal gyri), Area 11 – Orbitofrontal area (orbital and rectus gyri, plus part of the rostral part of the superior frontal gyrus) Area 12 – Orbitofrontal area (used to be part of BA11, refers to the area between the superior frontal gyrus and the inferior rostral sulcus), Area 13 and Area 14* - Insular cortex, Area 15* - Anterior Temporal Lobe, Area 17 Primary Visual Cortex (V1), Area 18 - Visual Association Cortex (V2), Area 19 – (V3), Area 20 - Inferior Temporal gyrus Area 21 - Middle Temporal gyrus, Area 22 - Superior Temporal Gyrus, of which the rostral part participates to Wernicke's area, Area 23 - Ventral Posterior cingulate cortex, Area 24 - Ventral Anterior cingulate cortex, Area 25 – Sub-genual cortex, Area 26 – Ecto-splenial area, Area 28 - Posterior Entorhinal Cortex, Area 29 – Retro-splenial cingular cortex, Area 30 - Part of cingular cortex, Area 31 - Dorsal Posterior cingular cortex, Area 32 - Dorsal anterior cingulate cortex, Area 34 - Anterior Entorhinal Cortex (on the Para-hippocampal gyrus), Area 35 – Peri-rhinal cortex (on the Para-hippocampal gyrus), Area 36 – Para-hippocampal cortex (on the Para-hippocampal gyrus), Area 37 - Fusiform gyrus, Area 38 – Temporo-polar area (most rostral part of the superior and middle temporal gyri, Area 39 - Angular gyrus, part of Wernicke's area, Area 40 – Supramarginal gyrus part of Wernicke's area, Areas 41 and 42 - Primary and Auditory Association Cortex, Area 43 – Sub-central area (between insula and post/pre-central gyrus), Area 44 - pars opercularis, part of Broca's area, Area 45 - pars triangularis Broca's area, Area 46 - Dorsolateral prefrontal cortex, Area 47 - Inferior prefrontal gyrus, Area 48 – Retro-subicular area (a small part of the medial surface of the temporal lobe), Area 52 – Para-insular area (at the junction of the temporal lobe and the insula).

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Figure 5. Compared to other parts of the brain, frontal lobe development is on a delayed timetable. As frontal lobes mature throughout childhood and adolescence, the ability to think through, inhibit, and plan actions as well as executive functions of governing emotions, judgment, planning, organization, problem solving, impulse inhibition, abstraction, analysis/synthesis, self-awareness and self-concept, and identity gradually develops.

Proceeding anteriorly in the frontal lobes from the motor strip to the supplementary motor areas and the premotor cortices, we see the control of motor activity becoming more sophisticated (Figure 5). We also see that as the brain expanded and evolved anteriorly, the frontal lobes became more concerned with the cognitive control, timing, and duration of movement whereas the motor strip was an evolutionary advance giving humans greater gross voluntary motor control. The newer areas of the frontal lobe provide more precision and direction to the movement. Eventually we see that the prefrontal cortex has little to do with the movement per se, but has become largely concerned with the control of direction of the movement and the behavior that drives that movement. It is well established that humans need normal frontal lobes to accomplish goals, make decisions, express creatively and navigate through complex social situations [45]. The frontal lobes regulate goal directed behavior, a hierarchy of reflexive movements, cross-temporal contingencies, approach and avoidance behavior, response inhibition, and perseveration. As we will see, all of the activities that the prefrontal cortex controls revolve around improvement of goal directed behavior. We hypothesize that the development of the human prefrontal cortices was a natural expansion of the evolutionarily earlier developed areas of the frontal lobe and that goal directed movements and behavior provided for an expansion of those areas. The same regions of the human central nervous

system that were already employed for better control, coordination, and timing of movements, expanded in parallel with the frontal cortex. The lateral portions of the cerebellum, for example, are more involved with the cognitive coordination and control of motor activity than with the control of the actual movement of muscles. The ventral lateral thalamus, linking the lateral cerebellum to the prefrontal cortex, is witness to the fact that these two areas evolved together. There must have developed a partnership between the cerebellum and the prefrontal cortex. The initial focus of the frontal lobes was the control of motor activity as it was for the cerebellum, but as the movements became more goal-directed, greater cognitive control over movement was necessitated. The prefrontal cortex was required in higher organisms and in humans not just for more speed, precision, and coordination, but also for the provision of a control mechanism for memory of previous motor actions, projection of future movements, facilitation and inhibition of movement and the reaction or inhibition of reaction to stimuli; to know when to move toward prey or away from a predator. All of these involve higher cognitive control that all link to the emotion controlling limbic system which provides motivation, emotion in general and aggression/temperament in particular, and autonomic regulation, the subject of this paper. The links of frontal and prefrontal regions of the cortex to the limbic system had as its main function the provision of a mechanism to either allow the organism to catch the prey, to run from a predator, or


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to seek a mate. The frontal lobes then in coordination with the cerebellum and basal ganglia have expanded beyond their control of movements and have evolved to control the behaviors that guide goal directed movement and most of our basic actions, but driven in large measure by emotionality and its regulation, based upon approach and avoidance behavior.

behaviors are merely evolutionary expansions of goal directed movements, and that all of the activities of the frontal lobe are variations and refinements of the same function. Achieving a goal is provided by the stimulation of the limbic system and therefore of emotionality. Therefore temperament and frontal lobe development are associated.

Frontal Lobes in Infancy

The Maturation of Prefrontal Cortex in Human and Nonhuman Primates

Many developmentalists agree with Denkla [46] when she stated that, “the difference between the child and the adult resides in the unfolding of executive functions.” Luria [30] and Rothbart and Bates, [13] both concurred that the development of a frontal lobe and the resultant higher level social attention system as well as well as the development of more volitional attentional mechanisms and individual differences in executive function have important implications for the early development of behavioral and emotional control. Infants and their developing frontal lobes demonstrate exaggerated approach and avoidance behavior. Exaggerated approach activities can be as simple as their grasp reflex, or complex like using whatever implements are within view. Avoidance behavior can be simple or complex such as extension of finger to touch, spatial neglect of an area of space in a way characteristic of the behaviors described by Piaget and other Developmental Psychologists, and certainly reminiscent of post-stroke adults. Also controlled by the frontal lobes are movements over time and, therefore perseveration, a characteristic of the dysfunctioning adult, is appropriate to the developing neonate and infant over the first year of life, and is the result of the status of the frontal lobes. We can see the repeated sounds or facial expressions made by an adult that causes the infant to laugh again and again in a perseverative fashion. It had been previously thought that the functions of the prefrontal cortex and its role in cognitive or emotional activities were separate from other motor areas of the frontal lobe [30]. Therefore, motor functions of the frontal lobe did not necessarily relate to non-motor function of the frontal lobe. However, it can be alternatively viewed that goal directed

Like other primates, humans are born with an immature brain. After birth, the cerebral cortex experiences a massive proliferation of synapses (synaptogenesis), followed by an extended pruning period (synaptic elimination). In the Rhesus Macaque—an old-world monkey whose brain development has been studied extensively—these developmental processes occur at the same rate in all cortical areas [47]. In contrast, analyses of human cortex across the life span (using autopsy tissue samples) reveal a different pattern. In humans, synaptogenesis reaches its peak in visual and auditory cortex within a few months after birth, but the increase in the number of synaptic junctions occurs much more slowly in the PFC [48] (Figure 6). In the evolution of the human brain, there has thus been a shift from concurrent to heterochronous cortical development. The synaptic density of the human PFC does not “catch up” with the auditory cortex until the fourth year of life. Heterochronicity in human cortical development is also observed in measurements of dendritic arborization (the development of treelike terminal branching of nerve fibers), regional metabolism (the extent of anabolic and catabolic processes within a brain region), and myelination; for example, positron emission tomography (PET) data indicate a lag of up to eight months in glucose metabolism in human PFC as compared to occipital, temporal, and parietal cortices [49]. As a result of this long period of prefrontal development, human children exhibit impaired behavioral and cognitive control—akin to adult patients with neurological PFC damage, and they do so for a long time.

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Figure 6. Brain Cells develop connections over the first two years of the infant’s life. These connectivities are formed, altered, and actively sculpted over the first twenty years of life.

Changes in both working memory capacity and the ability to produce behaviors that conflict with prepotent responses—two canonical frontal lobe functions—are linked to the maturation of the PFC [50]. Furthermore, the extended immaturity of the PFC may carry the cost of a longer period of vulnerability than that which occurs in more rapidly developing cortical systems. Prefrontal sensitivity to environmental factors has been described in children with phenylketonuria (PKU) (Diamond, 1996) and may contribute to specific cognitive deficits associated with poverty (Farah et al., 2006). The accumulation of evidence for the prolonged period of prefrontal immaturity—and the behavioral consequences thereof—has spurred the scientific community to develop programs to facilitate the development of cognitive control abilities. While these efforts might be instrumental in vulnerable populations, some caution might be warranted in a more widespread effort to hasten PFC development, as we had earlier indicated. Late prefrontal development seemingly has some negative consequences for childhood behavior. Yet despite this, there are many examples of learning tasks (e.g., language acquisition) at which children do better than adults. We propose that these differences may reflect the costs and benefits of hypofrontality that arise from the inherent tradeoffs between learning and performance. That is, a system optimized for

performance may not be optimal for learning, and vice versa. In the domain of emotion, crucial early experiences must occur for behavioral development to proceed on a normal track and for the brain systems underlying these behaviors to develop normally. This is achieved by neural plasticity. Some of neuronal systems remain open only so long to environmental inputs and if such input fails to occur, or if the input is abnormal, the window of opportunity closes and development goes astray – the concept of critical period. Greenough and colleagues have taken that concept and referred to part of this process as experience-expectant [51] by which they mean a process by which synapses form after some minimal experience and is common to all members of the species thereby saving the genome from the trouble of orchestrating and regulating all aspects of development. It is for this reason that the frontal lobes and asymmetry speak very well to the issue of the dynamics of change in early infant development. In general, Greenough has proposed that the structural substrate of expectation is the a pattern of temporary overproduction of synapses distributed within a relatively wide area during early development, followed by a subsequent retraction of synapses that had not formed connections at all or that had formed abnormal connections. The nature of

Infant and Childhood Frontal Lobe Development neuronal connectivity is illustrated in Figure 7 below. The expected experience produces patterns of neuronal activity, targeting those synapses that will be selected for preservation. The assumption is that synaptic contacts are initially transient and require some type of confirmation for their continued survival. If such confirmation is not obtained, synapses will be retracted according to a developmental schedule or due to competition from confirmed synaptic connectivities [52]. Experience-expectant neurogenesis stands in marked contrast to the other type of plasticity that Greenough then calls experience-dependent. This is the process that optimizes the individual’s adaptation to specific and possibly unique features of the environment e.g., learning. Thus, for any given instance, diverse information will be obtained and stored for use at a later time, giving rise to individual differences in a variety of cognitive domains, including temperament and emotionality. The fundamental difference between experience-expectant and experience-dependent development is that the former applies in a similar fashion to all members of the species, whereas the latter applies to individual members, seen in normal emotional development in infancy. The massive overproduction of synapses by the brain early in life followed postnatally by selective elimination of these exuberant connections has as its likely purpose the preparation of the nervous system for experience by the proliferation of connections on a sensory system-wide basis. Experience-related neuronal activity can then select functionally appropriate subsets of the abundant synaptic connections (represented in Figure 7). This period of excessive synaptogenesis is also correlated with a burst of brain metabolism and, at least in the monkey, with the onset of social interactions [53]. Infancy is a critical period of development, in which rapidly growing structures are more sensitive to damage [2, 54]. For example, disturbances such as disease, metabolic disturbances, malnutrition, sensory impairment, and trauma produce both structural and functional impairment in the development of the cerebral cortex if they occur during periods of synaptogenesis [55]. These same global conditions, when occurring in the older child or adult, do not

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seem to produce the same degree of impairment in both structure and function. In addition, many children with brain insults, including those who sustain traumatic brain injury, are susceptible to both immediate and long-term neurobehavioral impairments [56]. In some cases, there is little evidence that sequelae resolve with age. In contrast, the infant brain also demonstrates greater ability to recover from some types of injury than seen later in development. The best examples of neuronal system reorganization to environmental inputs come from studies of adult animals in enriched environments [54] and infants deprived of sensory input [57]. The slow development of the frontal lobe allows the infant the slow journey through circuit developments necessary for response inhibition, socialization, and emotional control. To thrive as social animals, we need to master a myriad of cultural and linguistic conventions. We need to be able to do and say and understand the right thing in the right context, and we must agree with one another on what these right things are. This is a formidable task. We suggest that in convention learning, the ability to think unconventionally (i.e., flexibly) is a disadvantage. The consequences of conventional versus flexible thinking have been computationally demonstrated for the acquisition of irregular plurals (e.g., mice), a set of linguistic conventions adults find particularly difficult to master. The trajectory of learning of these exceptions is non-monotonic in children, marked by a brief period in which over-regularization errors (e.g., “mouses”) replace previously correct plural forms. An associative learning model that simply practices and reinforces the most frequent forms it “hears” easily simulates this U-shaped pattern [58]. Our account explains the developmental trajectories and sensitive periods in language acquisition in terms of the gradual development of the PFC (and its associated control mechanisms) rather than a change to some putative language-specific device. Consider the case of Simon, a deaf child who learned ASL from parents who were late learners of ASL; by age 7, Simon had acquired an orderly morphological-rule system that far surpassed the imperfect input, from his parents, from whom he learned ASL [59].

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From the perspective we propose here, adults' ability to control their responses allows them to mix and match correct and incorrect signs for the same things at different times, such that staying true to their probabilistic understanding leads them to produce noisy patterns of input. Absent these control abilities,

young children will practice (and hence learn) only the most frequent of any alternate patterns they hear [58]. This allows children to learn conventions from the output of parents who, because of their ability to monitor and control their responses might never master them themselves.

Figure 7. Cerebral metabolic rate as a function of age. Elevated CMRGlc during 3-10 yrs. corresponds to era of exuberant connectivity needed for energy needs of neuronal processes which is greater by a factor of 2 in childhood as compared to adults. PET shows relative glucose metabolic rate. We see the complexity of dendritic structures of cortical neurons consistent with expansion of synaptic connectivities and increases in capillary density in frontal cortex.

The Development of Cortical-Limbic Interactions in Affective Development We can now explore in more detail the cortical and limbic interactions that are involved (represented in Figure 8). The most basic division of cortico-limbic structures is not left/right, but rather dorsal/ventral. It is thought that evolution of the neocortex from paralimbic cortices occurred by two paths of network differentiation: the first, the dorsal archi-cortical network, concentrated on the hippocampus; the second, the ventral paleo-cortical network, focused on

the olfactory cortex with important interconnections with the amygdala [60]. Studies have been conducted to explore the cognitive and perceptual differences between these two systems. These studies suggest that the dorsal pathways are specialized for spatial memory and that the ventral pathways are specialized for object memory [61]. It is also thought that the functional differences between these two networks are significant in the motivational realm as they are in the cognitive realm. It is also thought that there has not been an equal distribution of dorsal and ventral networks within the left and right hemisphere. It is thought that the left

Infant and Childhood Frontal Lobe Development hemisphere has specialized to express the so-called “cybernetic” characteristics of the dorsal cortical network. It is further thought that asymmetries of dorsal and ventral expansion lead to hemispheric asymmetries in the limbic control of cognition [62]. Some of the research has shown that lesions in the dominant (right-handers) or the left hemisphere typically result in what has been termed “catastrophic reaction,” for example, tears, despair, and anger. Damage to the right hemisphere, which in most people is the minor hemisphere, is accompanied by indifference reactions such as unawareness, euphoria, or lack of concern [64,65]. Therefore, the left and right hemispheres, based on this early research, were thought to result in opposite emotional tone with the left normally being more oriented towards a positive mood, whereas the right was oriented towards a more negative mood. Other studies have confirmed that pathologic crying occurs with left hemispheric lesions [66, 67]. It has been reported by Sackheim and associates [68] that changes in affect following unilateral injury is due to disinhibition of contralateral cortical regions and not because of release of ipsilateral subcortical areas. A significant finding has been the relation between arousal and hemisphericity.

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Right hemisphere lesioned patients have been described as “hypo-aroused” [69] and show reduced cortical and autonomic responsivity, in skin conductance or heart rate, especially when exposed to emotionally charged stimuli [70]. Anterior and posterior cortical regions appear to express different levels of control over the vertical hierarchy of subcortical centers [71,72]. It is further thought that the right hemisphere global conceptual skills may be critical to combining external and internal environmental information to achieve the integration of emotional experience [73]. In other words, it is thought that the right hemisphere is able to access internal feelings that monitor and individuals internal state [74]. It appears that the right hemisphere has greater interconnectivities between areas of the right hemisphere than the left hemisphere [75, 76]. This suggests that the specialized psychological abilities are due to its more diffuse interconnections, which provide it with a more dynamic and holistic integration across different sensory modalities (Semmes, 1968).

Figure 8. The cortico-limbic system consists of several brain regions that include the rostral anterior cingulate cortex, hippocampal formation, and baso-lateral amygdala. The anterior cingulate cortex has a central role in processing emotional experiences at the conscious level and selective attentional responses. Emotionally related learning is mediated through the interactions of the basolateral amygdala and hippocampal formation and motivational responses are processed through the dorsolateral prefrontal cortex (from [63]).

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EEG studies appear to confirm this belief, showing in both children [77] and adults [78] with greater coherence among right hemisphere regions than left [75, 79]. Dense interconnections between regions are characteristic of the paralimbic cortex. In fact, the greatest density of interregional connections is achieved by the paralimbic cortex [60]. If connection density reflects the level of functional integration, it is thought that the brain’s functional integration would be more likely to occur in the denser paralimbic areas than in higher “association” areas [80]. It is also thought that greater connection density in the right hemisphere would indicate that its representation would be formed with greater interaction with paralimbic influences. It is fairly well documented that subcortical structures like the basal ganglia are associated with the development of affective disorder. A possibility is that lateralized cerebral changes may result from the release or disinhibition of ipsilateral subcortical centers that may have a vertical hierarchy of emotional control [31]. Poeck [66] and Rinn [67] in their research noted involvement of subcortical structures mainly the basal ganglia and the internal capsule in practically all the cases they studied of patients who suffered from pathologic emotional outbursts in the absence of brainstem lesions. Subcortical centers may be able to affect emotional expressions independent of the cerebrum; an example of this may be seen in anencephalic newborns that show normal facial expression of emotion [68]. It has been postulated that with lesions that exclude the frontal convexity, both dorso-lateral and dorso-medial prefrontal cortices are associated with slowness, indifference, apathy, and lack of initiative. On the other hand, lesions of the orbitofrontal cortex appear to lead to disinhibition, lack of social constraint, hyperactivity, grandiose thinking, and euphoria [81, 82]. Others have shown a relationship between secondary mania being associated with orbitofrontal and basal-temporal lesions, especially in the right hemisphere. In addition, mania is more frequent in right subcortical lesions of the thalamus and basal ganglia as opposed to left [72, 83]. There are five functional parallel cortico-striatalthalamic loops; two of them are purely motor [84]. The three non-motor loops have different levels of

limbic connections. It is thought that each loop represents a functional unit, which includes as the primary target, the prefrontal region. One of these non-motor loops, a dorso-lateral prefrontal network is thought to support temporary storage in working memory of spatial locations [85, 86]. There is also a lateral orbitofrontal circuit, projecting from the orbitofrontal cortex and connecting to different parts of the caudate and globus pallidus, which project to the thalamus and back to the orbitofrontal cortex. This circuit is thought to be involved in the control of inhibitory responses during learning and recognition tasks requiring frequent shifts of set developing during infancy. This may explain perseveration or repetitive compulsive behavior seen with damage to the orbitofrontal cortex and the perseveration seen in infancy. Another circuit, the anterior cingulate circuit, includes the ventral striatum, nucleus accumbens, and medio-dorsal nucleus of the thalamus. The hippocampus and entorhinal cortex is thought to send inputs in this circuit, which integrates information from the paralimbic association cortex.

Ontogeny of Human Lateralization and Its Significance in Cognitive and Affective Development When Does Lateralization Occur Developmentally? To understand fully the function of the adult human brain we need to examine not only its phylogenetic, but also its embryologic and childhood development. There are specific lateralized functions that have ontogenetic significance. Neuroanatomic asymmetries have been noted in infants [87-90] that seem similar to those seen in adults [88, 91, 92]. Asymmetries in normal children’s brains have been studied and provide even greater support for early lateralization of language. In regard to non-verbal function, it has been shown that left lateralized lesions result in more mathematical difficulties than do rightsided lesions [93] as well as temperamental problems, involving mood and rhythmicity all being noted after right and not left hemispherectomy [94]. These

Infant and Childhood Frontal Lobe Development findings all argue for early lateralization of hemispheric specialization of mood and temperament. Numerous findings in infants strongly suggest that the human brain is functionally asymmetric long before language and other higher cognitive skills have developed. It has been proposed that these asymmetries are not indicative of the lateralized neural processors that manifest later in development, but instead indicate precursors of these lateralized processors, especially given the immaturity of the newborns cerebrum [95]. These precursors are thought to be at the level of the basal ganglia and thalamus, structures that are now known to share in the complementary specialization that is familiar in the case of cerebral hemispheres. The concept of precursors, which is an important explanation for early behavior [96], allows us to appreciate that lateralization of behavior or the lateralization of certain early developing components of a behavior may preclude the expression of the behavior itself. Therefore, development of the cortical areas that direct behaviors is dependent on the proper development of subcortical structures. If these precursory structures do not develop appropriately, then the subsequent cortical areas would resultantly not develop appropriately. In addition, the behavior for which these inadequately developed cortical areas are responsible will likewise not develop adequately. The asymmetries that are seen at the neonatal level are to some degree regarded as precursory to a more mature form of hemispheric specialization for perpetual, motor, and cognitive functions [96]. As lateralized precursors develop and the degree of asymmetry increases [97] these precursors evolve to become the controllers of increasingly mature behaviors. The Planum temporale asymmetry is already present in the fetal brain [87, 88]. Increased size of right anterior and left posterior brain is also seen in the fetus [98]. Therefore, we see that precursors of adult asymmetries are present at a very early stage of development. There is adaptive significance of asymmetric lateralization of the brain. Corballis [99] indicates that bilateral symmetry is itself an evolutionary adaptation and that, “for bilateral symmetry to have emerged in so precise and comprehensive a fashion there must

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have been adaptive advantages associated with symmetry sufficiently strong to overcome a natural predisposition to asymmetry.” One advantage may have come from the neural network characteristic of the forebrain and from the hemispheric representation of contralateral turning. The activation of each vertebrate half-brain, occasions contralateral turning [100]. The processing of information relative to a target is best accomplished in the hemisphere opposite its location because that is where processing and orienting functions are congruent. Processing information ipsilateral to the target would incur crosstalk interference between hemispheres [101]. It is thought that mental operations not targeted to specific points in space (e.g. language, emotions, problem solving) do not need to be bilaterally represented and therefore the relaxation of the need for bisymmetry may be a sufficient condition for lateralization to evolve [102]. Specialization can also occur in orientations other than along a lateral left-right plane. There is also evidence for a dorsal-ventral specialization of the brain. It has been postulated that there may be a phylogenetic shift from dorsal-ventral to right-left complimentarity in a hominid ancestor [103]. Directional responses to spatially distributed stimuli are among the earliest organized patterns of behavior to emerge in ontogeny. It has been known for a longtime that the early emergence of such patterns is evidenced by their appearance in the embryo, fetus and neonate of such diverse vertebrate forms as salamanders [104], rats [105] and man [106]. In view of their prevalence and early appearance, directionalized behaviors appear to represent sensitive indicators of neurointegrative organization. It is known that in normal infants between 24 and 72 hours of age, the head response to laterally applied somesthetic stimulation of the perioral region is not equivalently manifested when the stimulus is applied to the infant’s left side compared to when it is applied to his right [107] (Figure 9). Although the response typically elicited on stimulation of either side is, in turn, in the direction of stimulation [108], ipsilateral responses seem to be more readily elicited by stimulation of the infant’s right than by stimulation of his left side.

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Figure 9. Preponderant responses of infants responding to right v. left visual stimulation as a function of Apgar score [107].

In summary, we can see that structural and functional asymmetries are seen in non-human vertebrates. Therefore, we cannot say that brain lateralization is an exclusively human characteristic. It appears that natural selection favors bisymmetry in motile organisms. Only when selection pressures are relaxed do asymmetries appear in species. Human brain asymmetries exist much earlier in development than previously thought. The fact that asymmetries appear so early implies that a subcortical mechanism is the foundation of infantile lateralization. The more commonly recognized cortical asymmetries might therefore be an expression of the corresponding subcortical asymmetries.

Frontal Lobes, Asymmetries, Emotionality and Temperament in Infancy: Approach-Withdrawal Behavior as a Basis for Temperament How Adult Models of Asymmetry Inform Emotional Development in the Infant and Child Brain It is clear that in complex organisms, and especially in humans, the cerebral cortex plays an important role in aspects of emotional behavior and experience [109], especially anterior or frontal cortical regions, which have extensive anatomic

reciprocity with both subcortical centers and with posterior control circuits, all extremely important in emotional behavior. The frontal lobes or anterior cortical zones are the brain areas, which have shown the most dramatic growth in relative size over the course of phylogeny in comparison to other brain regions [2, 10, 30]. Asymmetries of frontal lobe function have been implicated in different forms of emotional behavior. Some of the first observations of asymmetries and their role in emotional behavior were with patients with unilateral cortical lesions [110]. Most of these reports seemed to show that injury to the left hemisphere was more likely to result in what has been called catastrophic-depressive reaction. This was originally seen with similar injury to the right hemisphere [111]. More recent studies show that damage specifically to the left frontal lobe results in depression. In addition, the closer the injury is to the frontal pole, the more severe the depression. However, patients with right frontal lobe injury are more likely to develop mania [71]. It has been stated that a fundamental asymmetry in the control of functions related to emotion should not be surprising based on speculation in regard to the evolutionary advantage of cerebral asymmetry [2]. Most researchers agree that approach and withdrawal are fundamental motivational behaviors, which are found at all levels of phylogeny. It has been postulated that the frontal lobes or anterior regions of the left and right hemispheres are specialized for

Infant and Childhood Frontal Lobe Development approach and withdrawal behavior respectively [112115]. This is thought partly because the left frontal region has been noted as an important center for intention, self-regulation, and planning [30]. This area is thought to be the region that produces behaviors that have been described as the “will.” Also, during development, the child will approach and reach out to objects that it is drawn to using the right hand more than the left, which would involve the left frontal motor areas more than the right [116]. Right-handed reaching and positive behavior or affect are thought together to be an expression of a brain circuit controlling approach behavior, and the left frontal region is thought to act as a “convergence zone” for this current circuit [117, 118]. It has also been noted that injury to the left frontal region results in a deficit in approach behavior. Adult patients with damage in this area of the brain are reported to present with apathetic behavior, experience a loss of interest and pleasure in objects and people, and have difficulty initiating voluntary action. Therefore, it is thought that hypoactivation in this brain region would be expected to be associated with a lowered threshold for sadness and depression [119]. On the other hand, it is thought that the right anterior region is specialized for withdrawal behavior. Some of the most informative studies have been those on normal human subjects that involve measurement of regional hemispheric activation based on electrophysiologic measurement. These studies show that activation of withdrawal-related emotional states (e.g. fear and disgust) occur when the right frontal and anterior temporal regions are specifically stimulated; also, baseline tonic activation on these same areas show greater likelihood of response with increased withdrawal-related negative behavior to emotional stimuli. In addition, individuals with chronically increased baseline activation of these areas are reported to have greater negative disposition in general [119]. Morris and associates studied a patient with right temporal lobectomy exposed to positive and negative emotional stimuli [120]. Surgical ablation included the right temporal lobe including the anterior part and the complete right amygdala. The investigators recorded skin conductance responses to stimuli. They found that skin response to positive stimuli was

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normal whereas skin conductive response to negative stimuli was markedly decreased. Interestingly, PET studies have reported increased activation of a resting baseline activity in a right hemisphere subcortical area which projects to the amygdala in panic prone patients [121]. These results are thought to suggest anterior cortical and subcortical right hemisphere regions for specializing in the control of withdrawalrelated negative affect [119]. Therefore, it can be stated that activation of the left anterior region of the cerebral cortex is associated with approach-related emotions. Decreased activation in this same area is associated with approach-related deficit behaviors, such as sadness, apathy, and depression. Conversely, activation in the right anterior region is associated with withdrawal-related emotions such as fear and disgust, and withdrawal-related psychopathology like anxiety or mania. However, it is important to understand that the areas of the hemisphere that perceive emotional information are thought to be different from those that experience the actual emotion [105]. Research appears to suggest that the right posterior cortical region is specialized for the perception of emotional information not depending on the type of emotion. Volitional self-regulatory behavior is a significant part of the notion of temperament consistent with the view of most theorists on the topic. Ziaie [122] performed a longitudinal study (at 3, 6.5, 10 and 13.5 months) in which the development of behaviors that serve to regulate distress were observed. The study was part of a larger longitudinal study of temperament, in which infants were presented with auditory, visual and tactile stimuli varying in novelty, intensity and complexity, and their reactions videotaped. Because these episodes were designed to evoke emotional reactions, they proved to elicit a number of self-regulatory strategies as well. Behaviors that had been identified as self-regulatory in the literature were grouped together into larger functional categories of forms of self-regulation [123]. The larger categories included Active Avoidance (including specific behaviors of Arch Back, Arm Retraction, Leave Chair, Lean Away, Push Back and Withdraw Hand), Orientation Toward Mother (Look Toward Mother, Lean Toward Mother and Leave Chair Toward Mother), Disengagement of Attention

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(Gaze Aversion, Look Down, Look Away, Turn Head and Look Toward Experimenter), Approach (Lean Forward, Reach, Point-Reach, and Inhibited Reach), Attack (Bang Toy, Pounding and Push Toy Away), Body Self-Stimulation (Arm Movement, Banging, Body Movement, Kicking and Repeated Hand Movement), Tactile Self-Soothing including HandMouth Activity (Hand-Mouth, Mouthing), Touch EarHead, Clasp Hands, and Respiration (Heavy Breathing, Sigh and Yawn). They related self-regulatory behaviors to infant temperament by investigating relationships between 13.5-month self-regulation and infant emotionality as reported by the mother and observed in the laboratory. They found that by 13 months, the negative emotions of dear and distress to limitations were differentially related to patterns of self-regulation, with fear related to less active forms of coping, and distress to limitations to active attack. Associated with approach-withdrawal developments is its relation to the development of attentional disengagement and temperament. The marked development occurs between two and six months of infants' orienting of attention in space and approach-withdrawal undergoes marked development between two and six months of life, with changes related to infants' preferences for novel locations [124], their ability to disengage gaze from an external stimulus [125] and their ability to anticipate the location of upcoming visual events [126]. The development of infants' ability to disengage attention from one location so as to be able to move it to another and their ability to anticipate the location of future events is particularly important for the early self-regulation of emotion. Johnson and colleagues studied both contingency learning and disengagement in infant stimulation [125]. Using a disengagement measure, these investigators found that four-month-old infants disengaged more readily than the younger infants. The four-month-olds disengaged on an average close to 90% of the trials, in comparison with 36% and 46% disengagement for two- and three-month olds. In our measure of contingency learning, only the four-month olds showed a significant preference for the predicted side above chance (61% vs. 56% for the other two ages). Thus, a developmental shift appears to be

occurring between three and four months on both of these capacities. In examining whether infants’ ability to disengage was found to be related to their susceptibility to the negative emotions and to their soothability, mothers filled out an Infant Behavior Questionnaire, a caregiver-report measure of infant temperament that assesses the child's tendency to express the negative affects of fear and distress to limitations (frustration) as well as their soothability [127]. They found that the four-month-old infants who were better able to disengage tended to be less susceptible to negative affect (fear and distress to limitations) and more soothable as described by their mothers. The development of these attentional abilities is in turn related to brain development [128]. Evidence from neuroanatomy indicates that only the deeper layers of primary visual cortex are supportive of organized activity in the newborn. During the first weeks of life, development of middle level lamina comes to support an inhibitory pathway to the superior colliculus. For a period of several weeks, this control system may inhibit disengagement when the infant is engaged at a visual location. It is likely that this development is also responsible for the phenomenon of “obligatory attention” observed in young infants, where infants may look at a single location for extended periods, sometimes appearing to try to move their gaze but not being able to, and become distressed after a period of intent looking [129]. By 4 months, development of both the parietal cortex [130] and/or frontal eye field connections [128] allows for more flexible disengagement of attention and greater self-regulation for the infant. These early developments in attentional control are of interest to those who study social-emotional development because early changes in social interaction are related to these changing patterns of self-regulation. When caregiver and infant are observed interacting with one another in the vis a vis position (face-to-face), periods of extended visual orienting of the infant toward the mother seen at 6 and 13 weeks are followed by decreased orienting toward her by 6.5 months [131]. In other studies, a shift of infant visual orienting to foci other than the mother has been observed by

Infant and Childhood Frontal Lobe Development about 4 months of age [131, 132]. This change in infant orienting is often associated with the mother turning the infant away from the vis a vis position so that the child can more easily look around. What we know then is that in self-regulation infants at three months infants already demonstrate ability to stimulate or soothe themselves, but engage in few approach behaviors. In comparison to threemonth-old infants, six-month-old infants are more active stimulus seekers. They demonstrate greater use of organized patterns of motor behavior such as reaching, which showing further increases to thirteen months of age. In comparison with their behavior at six months, ten-month-olds appear generally inhibited, showing less active self-stimulating behavior and more self-soothing. Increases in inhibitory capacity, self-soothing, and social communication thus appear to be hallmarks of development of self-regulation at ten months. Thirteen-month-old infants, in comparison to tenmonth-old infants, are more active at seeking stimulation, showed less self-soothing, more approach, fewer avoidance behaviors, and more selfstimulating behaviors than ten-month-old infants. In their attentional regulation, they further increased their visual regard toward human beings as opposed to inanimate aspects of the environment. They also showed greater gestural communication in pointing and an increased ability to move objects away from themselves rather than moving themselves away from the objects. In general, a change from more palliative methods of self-regulation (e.g., clasping, mouthing) to more active coping, and a decrease over time in near receptor activity is seen. Overall, there were no changes in frequency of attentional disengagement from stimuli after six months, but older infants were more likely to redirect their attention toward their mothers. Major changes in disengagement occur between three and four months. The summary of the literature indicates that 3 to 13 months is a period of rapid development in self-regulatory behaviors, with little individual stability in their use other than in oral self-soothing, and with disengagement of attention continuing to be related to lower susceptibility to distress and consistent with the development of inhibitory systems.

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Child Brain Asymmetry in Affective Behavior In attempting to integrate our understanding of asymmetry frontal lobe development in temperament development and emotionality in infancy and childhood we had noted previously that Davidson and Fox [37] reported that measures of cerebral asymmetry in prefrontal regions predicts negative emotionality during infancy. Specifically, infants with moral rights/left as measured under baseline conditions are more likely to fuss and cry during maternal separation than our infants with more or less lateralized activity. Davis [123] further reported that Kagan’s measures of behavioral inhibition in preschool children were correlated with greater right lateralization. These data on children are similar to reports of adults showing that right frontal cerebral asymmetry is associated with predispositions to negative emotional response Davidson [112, 114]. Results of baseline asymmetry and affective style in adults have proven to be the same as in children. It has been noted that among ten-month-old infants, there can be extreme differences in response to maternal separation. Some infants become distressed right away and cry as soon as their mother leaves. Other infants show a much different pattern of response and show almost no negative emotions when separated from their mothers. In a study of ten-month-old infants separated into groups based on whether they cried or not after being separated from their mother for approximately 60 seconds [36], it was found that about half the group cried and half did not. Baseline measures of frontal and parietal activation from both hemispheres were taken 30 minutes prior to separating the infants from their mothers. It was found that there was a large difference in frontal asymmetry that could predict which infants would cry and which would not. The infants that cried had greater right-sided and less leftsided frontal activation during the baseline period as compared to those who did not cry. There did not appear to be the same asymmetry in the parietal lobes. This is thought to be the first study that demonstrated that in infant’s individual differences in frontal asymmetry can predict emotional reactivity. In addition, this relationship is the same as seen with adults.

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Another study examining behavior and frontal asymmetry in children specifically examined behavioral inhibition [24]. Behavioral inhibition is a young child’s tendency to withdraw or freeze in novel or unfamiliar situations. In these new or unfamiliar situations, behaviorally inhibited children will stay close to their mothers without playing or interacting with other children. Three hundred and eighty six children aged 31 months were tested in a peer play session. Brain electrical activity was taken at rest and in response to several tasks. Results showed that inhibited children show right frontal activation whereas uninhibited children show left frontal activation. The question raised after examining the results was whether the behavioral inhibition is due to a decreased left-sided approach behavior, or due to increased right-sided withdrawal activity. Further information confirmed that in these children, the reason for inhibited behavior appeared to be due to a decrease in left frontal activation rather than due to an increase in right frontal activation. The pattern of decreased left frontal activation found in inhibited children was practically the same that has been reported in depressed adults. It would be expected with these children, that they should be more likely to experience sadness and depression-like reactions to emotionally stressful situations. However, it has been speculated that although only a small percentage of the vulnerable children would be expected to actually develop an affective disorder, more of them would be expected to have sub-clinical characteristics like dysthymic mood, shyness, and decreased dispositional affect [119]. It is possible that children with the opposite finding of decreased right-sided withdrawal behavior would show the same results. Nevertheless, it would be expected that these uninhibited children would display impulsive behavior and show an overreaction to reward. We see that these asymmetries can be acute or chronic over time and can predict the affective behavior or threshold to appropriate stressors.

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IAFNR News and Events Functional Neurology Related Conferences 2016 National Institute for Brain & Rehabilitation Sciences Sponsored Events

Conferences Vienna Neuro & Orthopaedic MRI Workshop February 26, 2016 - March 1, 2016 Location: Vienna, Austria Contact: Paul Bohart; Phone: [(513.924.5048)]; Email: [email protected] Weblink: http://proscanshopping.com/viennaneuroandorthopaedicmriworkshop.aspx

6th France-Israel Conference in Neuroscience: The Power of Mathematics in Contemporary Neuroscience July 11 - 15, 2016 Location: Marseille, France Organizer: Centre International de Rencontres Mathématiques (CIRM) Weblink: http://www.cirmmath.fr/spip.php?rubrique2&EX=liste_rencontre&annee=2016&lang=en

Society for Neuroscience 2016 Annual Meeting November 12 - 16, 2016 Location: San Diego, USA Weblink: http://www.sfn.org/annual-meeting/past-and-future-annual-meetings Abstract: Neuroscience 2016 is the premier venue for neuroscientists to present emerging science, learn from experts, forge collaborations with peers, explore new tools and technologies, and advance careers. Join more than 30,000 colleagues from more than 80 countries at the world’s largest marketplace of ideas and tools for global neuroscience.

Memory Mechanisms in Health and Disease December 5 - 8, 2016 Location: Tampa, Florida, USA Contact: Evie Hartley; Email: [email protected] Weblink: http://www.zingconferences.com/conferences/memory-mechanisms-in-health-and-disease/ Abstract: We are proud to announce the 1st Zing Memory Mechanisms in Health and Disease Conference which shall be taking place in December 2016. This conference will present cutting-edge, multi-disciplinary research on mechanisms of learning and memory in health and disease. Particular

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emphasis will be given to address the questions of how is memory stored at the molecular and neuronal circuit level? How is memory storage affected in dementia and autism? What are the molecular and neuronal circuits of retrieval-induced memory modulation? How of retrieval-induced memory modulation impaired in post-traumatic stress disorder?

MOVEMENT – 2017 Functional Neurology Brain, Body, Cognition July 9 – 11, 2017 Location: Oxford University, Oxford, UK Weblink: www.movementis.com In conjunction with Spaulding Hospital of Harvard University School of Medicine, the M.I.N.D. Institute M.I.T., the Hebrew University of Jerusalem School of Medicine, and The National Institute for Brain and Rehabilitation Sciences, Nazareth, Israel

Dear colleagues, We have the pleasure of inviting you to attend the world conference on Movement, sponsored, in part, by the Harvard University School of Medicine’s Spaulding Rehabilitation Hospital, the M.I.N.D. Institute at M.I.T., the Hebrew University of Jerusalem, the Wingate Institute for Sports and Exercise Science, the National Institute for Brain and Rehabilitation Sciences, Nazareth, Israel, the Institute for Neurology and Neurosurgery, Havana, the University of the Medical Sciences facultad ‘Manuel Fajardo’ Havana, the School of Public Health of the University of Havana, and Bielefeld University in Germany. The purpose of the conference is to share knowledge of all those whose interests lie in the nature of human movement. The conference will address issues related to gait, motion, kinesiology, disorders of movement, movement rehabilitation, motion, and balance, movement and cognition, human factors and ergonomics, as well as optimized movement in elite athletes, developmental issues of movement and coordination. Workshops on dance, dance therapy, and physiotherapy of movement impairment will also be provided.

IAFNR News and Events Abstract Topic Areas Brain, Body, Cognition 

Kinesiology Bipedalism as a signature of humanity Factors influencing the kinds and amounts of motor performance Identification of critical components of physical activity Heredity and motor performance Motor behavior

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Sport and Exercise Psychology and Physiology

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Physical Education of Movement

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Coaching of Movement Effectiveness

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Anatomical and Physiological Fundamentals of Human Motion Neurophysiology Cardiac and autonomic effects of movement

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Therapeutic Exercise

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The Musculoskeletal System The skeletal framework and its movements The neuromuscular basis of movement Upper extremity movement – Reach and Grasp (elbow, forearm, wrist, and hand) Brain and biomechanical control Lower extremity movement (knee, ankle, and foot) Brain and biomechanical control

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Biomechanics of Movement Biomechanical measurement of movement Conditions of linear motion Conditions of rotary motion Center of gravity and stability

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Motor Skills: Principles and Applications Kinesiology of fitness and exercise Moving objects: pushing and pulling Moving objects: throwing, striking, and kicking Locomotion: solid surface Locomotion: The aquatic environment Locomotion: When suspended and free of support Impact Instrumentation for motion analysis

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Developmental Aspects of Movement Primitive reflexes and normal and abnormal motor development Motion and developmental disabilities Functional movement development across the life span

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Movement Disorders Age related Posture and balance Locomotion

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IAFNR News and Events Prehension Functional aspects of the basal ganglia Electrophysiology of movement disorders Movement disorders: structural and functional imaging Genetic techniques, impact, and diagnostic issues in movement disorders Parkinsonism: differential diagnosis Parkinsonism: management Multiple system atrophy (MSA) Progressive supranuclear palsy and cortico-basal degeneration Primary dementia syndromes and Parkinsonism Essential tremor and other tremors Dystonias Huntington's disease and look-alikes Non-Degenerative choreas Wilson's disease Tic disorders and stereotypies Myoclonus Paroxysmal movement disorders Hereditary and acquired cerebellar ataxias Drug-induced movement disorders Systemic disease and movement disorders Psychogenic movement disorders

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Motor Control Sensory contributions to motor control Closed-loop control systems Vision-motor Audition-motor Proprioception and motor control Feed-forward influences on motor control Vestibular-motor Central Contributions to Motor Control Open-loop processes Central control mechanisms Central control of rapid movements Motor program issues Generalized motor programs

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Speed and Accuracy in Movement Fitts’ Law: the Logarithmic speed–Accuracy trade-off Linear speed–accuracy trade-off The temporal speed–accuracy trade-off Central contributions to the speed–accuracy trade-off Correction models of the speed–accuracy trade-off

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Coordination

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Individual Differences and Capabilities in Movement

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Motor Learning

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Augmented Feedback

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Gait

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Rehabilitation of Motor Dysfunction

IAFNR News and Events 

Movement and Cognition

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Physics of Movement

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Physics of Dance

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Physics of Sports

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Technology and Movement Sciences

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Optimizing Human Motor Performance

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Workshops Physiotherapy Restorative and Functional Neurology Kinesiology and Physical Education Dance Therapy Dancer’s Workshop Technology Workshops for Rehabilitationists Cognitive Movement Therapy

ABSTRACT SUBMISSION INSTRUCTIONS You can participate in the conference as a delegate, although we encourage you to submit an abstract. Please, read carefully the following instructions before submitting your abstract. Only abstracts submitted in English will be accepted. Full papers of accepted abstracts will, pending additional review, be published in a special issue of the journal Functional Neurology, Rehabilitation and Ergonomics. Details will follow after acceptance of the submitted conference abstracts. ● Submit your abstract in Microsoft Word format. ● Authors names should be provided in the format Alvarez, RS. Do not add Dr, Prof, Mr., Mrs., etc. ● The title should have a maximum of 150 characters, typed in capitals. ● Affiliation should be included in line a. If authors’ affiliations are different, you should indicate them filling b, c, and d lines. ● The presenting author’s email address must be included. ● The abstract should have a maximum of 350 words. Any longer and the abstracts will not be accepted. ● Indicate whether the abstract is intended for oral or poster presentation or either. ● The abstract should be structured using the following headings: Objective, Methods, Results, Conclusions, and Keywords (no more than four keywords). ● The abstract should be as informative as possible, including statistical evaluation. ● Statements such as "results will be discussed" or "data will be presented" are not acceptable. ● Standard abbreviations such as: PVS, MCS, EEG, MEEG, MRI, etc., may be used. Others should be described in full when first mentioned, followed by the abbreviation in parenthesis. ● Tables may be included, but not photographs, figures, or references. ● You will be notified via e-mail to confirm that your abstract has been received. ● If you do not receive a confirmation within two weeks, please contact the Symposium Secretariat. ● The Scientific Committee will review all abstracts. ● Some very high quality abstracts offered for oral presentation might be included in satellite symposium or courses. ● Deadline for submission of abstracts: Apr. 15, 2016 ● Notification of Accepted Abstracts: Jul. 15, 2016

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● Full papers submitted for review: Oct. 15, 2016 ● Abstracts and full papers are to be submitted directly to the head of the conference’s scientific committee: [email protected]

FULL PAPER SUBMISSION INSRTRUCTIONS Available in early 2016

Recent Conference Presentations 1. Leisman, G. Optimization Methodology and Functional Connectivities Inform the Cognitive Modifiability in the Rehabilitation of Developmental Language Difficulties [Invited Plenary Paper presented at the Conference on Cognitive Modifiability, Jerusalem, Israel 3-5 June 2013]. (http://www.brainconvention.org/en/index.php?page_id=48) 2. Leisman, G. If It Is Localization then There Is No Development, Education, & Rehabilitation: It’s the Networks Silly. [Invited Plenary Paper presented at the 4th Conference of the International Association for Functional Neurology, and Rehabilitation, 10-13 October, 2013 Phoenix, Arizona]. 3. Leisman, G., Machado, C., Melillo, R. The Development of Fetal And Neonatal Consciousness [Invited Plenary Address, VI International Conference on Brain Death and Disorders of Consciousness, 3-6 December, 2013](http://www.komascience-cuba.com/) 4. Leisman, G. & Mualem, R. Brains, Bilinguals, and Functional Connectivities: Neural Networks Play Out in the Classroom. [Invited Speaker Oxford Education Research Symposium at St. Edmund Hall, Oxford University. 25-26 March 2014](http://www.oxford-education-research-symposium.com/) 5. Leisman, G. Functional Connectivities and Re-connectivities Reflect Cognitive Modifiability in Neurorehabilitation. [Invited paper presented at the Second Annual Conference in Rehabilitation Medicine, Balitmore, MD USA 1-16 July 2014]. (http://dx.doi.org/10.4172/2329-9096.S1.006) 6. Leisman, G. Optimization Models for Quantifying Visual Search Scanpath Efficiency: Measuring Treatment Recovery in Traumatic Brain Injury. [Invited paper presented at the Second Annual Conference in Rehabilitation Medicine, Baltimore MD, USA 1-16 July 2014]. (http://dx.doi.org/10.4172/2329-9096.S1.006) 7. Leisman, G., Gilchriest. J., Rodriguez-Rojas, R., Estevez, M., Machado, C., Kaspi, M., Melillo, R. A Method for Quantifying Visual Search Scanpath Efficiency in Elucidating Cognitive Status Post Traumatic Brain Injury. [Paper presented IEEE-Israel, Eilat, Israel 2-5 December, 2014]. 8. Leisman, G., Rodríguez Rojas, R., Batista, K., Carballo, M., Morales, J.M., Iturria, Y., Machado, C. Measurement of Axonal Fiber Connectivity in Consciousness Evaluation. [Paper presented IEEE-Israel, Eilat, Israel 2-5 December, 2014]. 9. Leisman, G. The Coincident Decline of Movement and Cognitive Ability: Movement Sciences in the Aid of Public Health Policy Intervention. [Paper presented at the 4th International Conference on Pediatric Disease, Disability and Human Development, 20-23 January, 2015, Jerusalem Israel] 10. Mualem, R., Leisman, G., Mograbie, S.K., Boshnak S. Brain-Based Learning During Preschool: An Underused Window of Opportunity. [Paper presented at the 4th International Conference on Pediatric Disease, Disability and Human Development, 20-23 January, 2015, Jerusalem Israel] 11. Leisman, G. Machado, C. Thinking, Walking, Talking: The Development of Integratory Brain Function [Paper presented as part of a Symposium on Movement and Thought at the International Convention of Psychological Sciences, Amsterdam, The Netherlands, 12-14 March, 2015] 12. Leisman, G. and Braun-Benjamin, O. Symposium on Movement and Thought at the International Convention of Psychological Sciences, Amsterdam, The Netherlands, 12- 14 March, 2015] 13. Koch, P. Leisman, G. Cortical Activity Waves are the Physical Carriers of Memory and


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Thought. [Paper presented at the 7th Annual IEEE Engineering in Medicine and Biology Society Meeting on Neuroengineering. Montpellier, France, 22-24 April 2015]. Leisman, G. Government Policy Implications of a Cognitive Neuroscience on the Effects of Movement on Functional Connectivity [Plenary presentation, 7th International Symposium on Brain Death and Disorders of Consciousness, 8-11 December 2015, Havana, Cuba] Leisman, G. Leisman, G. Public Health Policy Implications of a Cognitive Neuropsychology of Language and Movement in Neurorehabilitation of Integrative Brain Function. [Paper presented 11th World Congress of Brain Injury, 2-5 March, 2016 The Hague, The Netherlands] Leisman, G. Functional Connectivities in the Understanding of the Restoration of Integrative Brain Function [Paper presented 9th World Congress for Neurorehabilitation, Philadelphia, PA, USA, 10-13 May, 2016] Leisman, G. Lifespan Developmental Issues in Functional Connectivities [Paper presented 10th FENS Forum for Neuroscience, 2-6 July Copenhagen, Denmark].

Recent Books and Chapters 1. Leisman, G. Optimization Methodology and Functional Connectivities Inform the Cognitive Modifiability in the Rehabilitation of Developmental Language Difficulties. Cognitive Modifiability. Bologna, Italia: Medimond s.r.l. 2013 (http://www.medimond.com/ebook/ Q602.pdf) 2. Estevez, M., Machado, C., Leisman, G., Melillo, R., Machado, A., Hernandez-Cruz, A., Arias, A., Rodriguez-Rojas, R., Carballo, M. EEGConn: A Software Tool for Offline qEEG Analysis, Including Spectral Univariate and Bivariate Processes and Linear and Non-Linear Indices of Brian Connectivity in Autistic Spectrum Disorder. Chronic Disease and Disability in Childhood. Haupague, NY: Nova Science Publishers, 2013, p. 65. 3. Jammalieh, J., Mualem, R., Leisman, G. Clinical Effects of Physiological Rhythms in Premature Infants. Chronic Disease and Disability in Childhood. Haupague, NY: Nova Science Publishers, 2013, p. 109. 4. Leisman, G. Advances in Cognitive Neuroscience and Optimization Can Inform The Rehabilitation Process in Developmental Language Difficulties. Chronic Disease and Disability in Childhood. Haupague, NY: Nova Science Publishers, 2013, p. 123. 5. Leisman, G. Functional Connectivities in the Postnatal Development of Consciousness. Chronic Disease and Disability in Childhood. Haupague, NY: Nova Science Publishers, 2013, p. 124. 6. Machado, C., Estevez, M., Leisman, G., Melillo, R., Machado, A., Hernanandez-Cruz, A., Arias, A., Rodriguez-Rojas, R., Carballo, M. Exploration of Resting Brain Connectivity Using Linear Coherence Measures in the Autistic Spectrum Disorder. Chronic Disease and Disability in Childhood. Haupague, NY: Nova Science Publishers, 2013, p. 149. 7. Machado, C. Estevez., M., Melillo, R., Leisman, G., Carrick, R., Machado, A., Hernandez-Cruz, A., Arias, A., Rodriguez-Rojas, R., Carballo, M., Quantitative Resting EEG in the Autistic Spectrum Disorder. Chronic Disease and Disability in Childhood. Haupague, NY: Nova Science Publishers, 2013, p. 150. 8. Melillo, R. and Leisman, G. Functional Brain Imbalance and Autistic Spectrum Disorder. Olfman, S (Ed.) The Science and Pseudoscience of Children's Mental Illness: Cutting Edge Research and Practice. Childhood in America Book Series. Santa Barbara, CA: Praeger, 2015, pp. 6591. (http://www.abc-clio.com/Praeger/product.aspx?pc=A4219C) 9. Leisman, G., Rodriguez-Rojas, R. Batista, K, Carballo, M Morales, J. M., Iturria, Y., Machado, C. Measurement of Axonal Fiber Connectivity in Consciousness Evaluation. Proceedings of the 2014 IEEE 28th Convention of Electrical and Electronics Engineers in Israel, IEEE: Minneapolis, MN, 2014. IEEE Cat. No: CFP14417-CDR; ISBN: 978-1-47995987-7; DOI: 10.13140/2.1.4845.7289 (https://www.researchgate.net/publication/269404631_ Measurement_of_Axonal_Fiber_Connectivity_in_Consciousness_Evaluation) 10. Koch, P and Leisman, G. Cortical Activity Waves are the Physical Carriers of Memory and Thought. Neural Computation. IEEE/EMBS, Minneapolis MN, 2015. (http://emb.

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IAFNR News and Events citengine.com/event/ner-2015/author?authorID=12426) (https://www.researchgate.net/profile/Ger ry_Leisman/publications) Leisman, G., Melillo, R., Machado, C. Intentionality and “Free-Will” from a Neurodevelopmental Perspective. In: Santrock, J. (Ed.) To be used in connection with: A Topical Approach to Lifespan Development Plymouth, MA; McGraw-Hill Education, 2015 (ISBN-13: 9780078035500). Rodríguez-Rojas, R., Machado, C., Batista, K., Carballo M., Leisman, G. (2015). Neuroimages in Autism. In: Robinson-Agramonte, M. Translational Approaches to Autism Spectrum Disorder. New York, NY: Springer, pp. 95-117. (ISBN: 978-3-319-16320-8) (http://www.springer.com /gp/book/9783319163208#aboutBook) (http://link.springer.com/chapter/10.1007/978-3-319-1632 1-5_6) Leisman, G. Cognitive Rehabilitation in Developmental Disabilities. In: S. Misciagna (Ed.). Handbook of Cognitive Rehabilitation. Secaucus, NJ: Austin Press, 2015 [In Press]. (http://austinpublishinggroup.org/ebooks/handbook-cognitive-rehabilitation-volume-1/index.php) Leisman, G. and Moustafa, A. (Eds.) Thinking about Action: Integration of Functional Connections in Movement and Cognition. Frontiers in Public Health; Child Health and Human Development. Zurich. Switzerland, Frontiers, 2015. [In Press] (http://www.frontiersin. org/Child_Health_and_Human_Development/researchtopics/Thinking_about_Action_Integrat_1/ 3369) Leisman, G. and Moustafa, A. (Eds.) Thinking about Action: Integration of Functional Connections in Movement and Cognition. Frontiers in Public Health; Child Health and Human Development. Zurich. Switzerland, Frontiers, 2016. [In Press] (http://www. frontiersin.org/Child_Health_and_Human_Development/researchtopics/Thinking_about_Action_ Integrat_1/3369) Vojdani, A. Nova Series in Functional Neurology. Vol. 1. Neuroimmunity and the Brain-Gut Connection. Leisman, G. and Merrick, J. (Series Eds.). Hauppauge, NY: Nova Science Publishers. 2016 [In Press]. (https://www.novapublishers.com/catalog/product _info.php ?products_id=56306&osCsid=42666102c643021c47b41e653e7fb66f) Leisman, G. Neuroimmunity. In: A. Vojdani. Neuroimmunity and the Brain-Gut Connection. Leisman, G. and Merrick, J. (Eds.). Hauppauge, NY: Nova Science Publishers. 2016 [In Press]. (https://www.novapublishers.com/catalog/product_info.php?products _id=56306&osCsid=42666102c643021c47b41e653e7fb66f) Leisman, G. The coincident decline of movement and cognitive ability. Movement sciences in the aid of public policy intervention. In: J. Merrick (Ed.). Disability, Chronic Disease and Human Development. Hauppauge, NY: Nova Science Publishers. 2015, pp. 97-98. (https://www. novapublishers.com/catalog/product_info.php?products_id=55227&osCsid=6de28dbcde62a15b8 12faba057064716) Mualem, R., Leisman, G., Mograbie, S.K., and Boshnak, S. Brain-based learning during preschool: An underused window of opportunity. In: J. Merrick (Ed.). Disability, Chronic Disease and Human Development. Hauppauge, NY: Nova Science Publishers. 2015, pp. 56-57. (https://www.novapublishers.com/catalog/product_info.php?products_id=55227&osCsid=6de28d bcde62a15b812faba057064716) Leisman, G., and Merrick J. (Ed.) Considering Consciousness Clinically. Nova Series in Functional Neurology. Vol. 3. Leisman, G. and Merrick, J. (Series Eds.) Hauppauge, NY: Nova Science Publishers. 2016 [In Press]. (https://www.novapublishers.com/catalog/ product_info. php?products_id=56691) Leisman, G., Machado, C., and Merrick, J. Considering Consciousness Clinically. In: Leisman, G., and Merrick J. (Eds.) Considering Consciousness Clinically. Nova Series in Functional Neurology. Vol. 3. Hauppauge, NY: Nova Science Publishers. 2016 [In Press]. (https://www.novapublishers.com/catalog/product_info.php?products_id=56691) Leisman, G., and Koch, P. Networks of conscious experience: Computational neuroscience in understanding life, death and consciousness. In: Leisman, G., and Merrick J. (Eds.) Considering Consciousness Clinically. Nova Series in Functional Neurology. Vol. 3. Hauppauge, NY: Nova


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Science Publishers. 2016 [In Press]. (https://www. novapublishers.com/catalog/product_info. php?products_id=56691) Rodriguez-Rojas, R. Batista, K., Iturria, Y., Machado, C., Leisman, G., Chinchilla, M., DeFina, P., Carballo, M., and Morales, J.M. Disrupted axonal fiber connectivity as a marker of impaired consciousness states. In: Leisman, G., and Merrick J. (Eds.) Considering Consciousness Clinically. Nova Series in Functional Neurology. Vol. 3. Hauppauge, NY: Nova Science Publishers. 2016 [In Press]. (https://www.novapublishers.com/catalog /product_info.php?products _id=56691) Machado, C., Estévez, M., Rodríguez-Rojas R., Carballo, M., Pérez-Nellar, J., Gutiérrez, J., Fleitas, M., and Leisman, G., Vegetative state and the outer world. In: Leisman, G., and Merrick J. (Eds.) Considering Consciousness Clinically. Nova Series in Functional Neurology. Vol. 3. Hauppauge, NY: Nova Science Publishers. 2016 [In Press]. (https://www.novapublishers.com/ catalog/product_info.php?products_id=56691) Perez-Nellar, J., Machado, C., Scherle C., Rodríguez, R., Carballo, M., Leisman, G., and Melillo, R. Persistant vegetative state: Ventricular CSF pulsation artifact. In: Leisman, G., and Merrick J. (Eds.) Considering Consciousness Clinically. Nova Series in Functional Neurology. Vol. 3. Hauppauge, NY: Nova Science Publishers. 2016 [In Press]. (https://www.novapublishers.com/ catalog/product_info.php?products_id=56691) Perez-Nellar, J., Machado, C., Scherle C., Rodríguez, R., Carballo, M., Leisman, G., and Melillo, R. Persistent vegetative state: Ventricular CSF pulsation artifact. In: Leisman, G., and Merrick J. (Eds.) Considering Consciousness Clinically. Nova Series in Functional Neurology. Vol. 3. Hauppauge, NY: Nova Science Publishers. 2016 [In Press]. (https://www.novapublishers.com/ catalog/product_info.php?products_id=56691) Leisman, G. Neuroplasticity in Learning and Rehabilitation. Nova Series in Functional Neurology. Vol. 2. Leisman, G. and Merrick, J. (Series Eds.) Hauppauge, NY: Nova Science Publishers. 2016 [In Press]. (https://www.novapublishers.com/catalog/product_ info.php?products _id=56789) Leisman, G. Plasticity and Functional Connectivities in Rehabilitation. In: Leisman, G. and Merrick, J. (Series Eds.) Neuroplasticity in Learning and Rehabilitation. Nova Series in Functional Neurology. Vol. 2. Hauppauge, NY: Nova Science Publishers. 2016 [In Press]. (https://www.novapublishers.com/catalog/product_info.php?products_id=56789) Leisman, G. and Merrick, J. Neuroplasticity in Learning and Rehabilitation In: Leisman, G. and Merrick, J. (Eds.) Neuroplasticity in Learning and Rehabilitation. Nova Series in Functional Neurology. Vol. 2. Hauppauge, NY: Nova Science Publishers. 2016 [In Press]. (https://www.novapublishers.com/catalog/product_info.php?products_id=56789) Leisman, G. Neuroeducational networks. In: Leisman, G. and Merrick, J. (Eds.) Neuroplasticity in Learning and Rehabilitation. Nova Series in Functional Neurology. Vol. 2. Hauppauge, NY: Nova Science Publishers. 2016 [In Press]. (https://www. novapublishers.com/catalog/product_ info.php?products_id=56789) Leisman, G. Auditory, visual, spatial aesthetic and artistic training facilitates brain plasticity. In: Leisman, G. and Merrick, J. (Eds.) Neuroplasticity in Learning and Rehabilitation. Nova Series in Functional Neurology. Vol. 2. Hauppauge, NY: Nova Science Publishers. 2016 [In Press]. (https://www.novapublishers.com/catalog/product_info .php?products_ id=56789)

Published Papers in Indexed Peer-reviewed Journals 1. Oggero, E., Carrick, F.R., Pagnacco, G. Frequency content of standard posturographic measures biomed 2013. Biomedical Science Instrumentation. 2013;49, 48-53. (http://www.ncbi.nlm.nih. gov/pubmed/23686180) 2. Koch, P. and Leisman G. Computational Model of Attention Brain Function Functional Neurology, Rehabilitation and Ergonomics. 2012;2(4):353-363. (https://www.novapublishers .com/catalog/product_info.php?products_id=41117&osCsid=1578167af1850a70f1ac579581504a 7e1)

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3. Leisman, G. and Melillo, R. The Basal Ganglia: Motor and Cognitive Relationships in a Clinical Neurobehavioral Context Reviews in the Neurosciences. 2013;24(1):9-25. doi: 10.1515/ revneuro-2012-0067. (http://www.ncbi.nlm.nih.gov/pubmed/23241666) 4. Leisman, G., Machado, C., Mualem, R. The merging the neurosciences principles with educational practice in the treatment of ADHD: Function specific treatment for rehabilitation. Frontiers of Public Health: Frontiers of Child Health and Human Development. 2013, 1:22. doi: 10.3389/fpubh.2013.00022 (http://www.frontiersin.org/Journal/Abstract.aspx?ART_DOI= 10.3389/fpubh.2013.00022&name=Child_Health_and_Human_Development) (http://www.ncbi. nlm.nih.gov/pubmed/24350191) 5. Machado C, Estévez M, Rodríguez R, Pérez-Nellar J, Chinchilla M, Defina P, Leisman G, Carrick FR, Melillo R, Schiavi A, Gutiérrez J, Carballo M, Machado A, Olivares A, Pérez-Cruz N. Zolpidem Arousing Effect in Persistent Vegetative State Patients: Autonomic, EEG and Behavioral Assessment. Current Pharmaceutical Design. 2013 Sep 10. [Epub ahead of print] (http://www.ncbi.nlm.nih.gov/pubmed/24025063) 6. Machado, C., Estevez, M., Leisman, G., Melillo, R., Rodriguez, R., Hermandez, A. Perez-Nellar, J., Naranjo, R., and Chinchilla, M. EEG Coherence Assessment of Autistic Children in Three Different Experimental Conditions. Journal of Autism and Developmental Disorders. DOI 10.1007/s10803-013-1909-5. (http://link.springer.com/article/10.1007/ s10803-013-1909-5#page1) (http://www.ncbi.nlm.nih.gov/pubmed/24048514) 7. Howard N. and Leisman G. DIME (Diplomatic, information, military and economic power) effects modeling system: Dual use in brain small-world connectography and rehabilitation. Functional Neurology, Rehabilitation, and Ergonomics, 2013; 3(2-3): 257-274. (https://www.novapublishers.com/catalog/product_info.php?products_id=45010) 8. Rodriguez-Rojas, R., Batista K., Iturria, Y. Machado, C. Chinchilla, M. Carballo, M. Morales JM., De Fina P., and Leisman G. Disrupted axonal fiber connectivity as a marker of impaired consciousness states. Functional Neurology, Rehabilitation and Ergonomics, 2013; 3(23):319-328. (https://www.novapublishers.com/catalog/product_info.php?products _id=45010) 9. Leisman, G. If It Is Localization Then There is No Development, Education, and Rehabilitation: Neuroeducation Needs to be about Building Networks. Functional Neurology, Rehabilitation, and Ergonomics. 2013:3(2-3):329-340. (https://www.novapublishers.com/catalog/product_info .php?products_id=45010) 10. Estevez, M., Machado, C., Leisman, G., Melillo, R., Machado, A., Hernandez-Cruz, A., Arias, A., Rodriguez-Rojas, R., Carballo, M. EEGConn: A Software Tool for Offline qEEG Analysis, Including Spectral Univariate and Bivariate Processes and Linear and Non-Linear Indices of Brian Connectivity in Autistic Spectrum Disorder. International Journal of Child Health and Human Development. 2013; 6(4): 427. (https://www.novapublishers. com/catalog/product_info .php?products_id=43824) 11. Jammalieh, J., Mualem, R., Leisman, G. Clinical Effects of Physiological Rhythms in Premature Infants. International Journal of Child Health and Human Development. 2013; 6(4): 470. (https://www.novapublishers.com/catalog/product_info.php?products_ id=43824) 12. Leisman, G. Advances in Cognitive Neuroscience and Optimization Can Inform The Rehabilitation Process in Developmental Language Difficulties. International Journal of Child Health and Human Development. 2013; 6(4): 484. (https://www.novapublishers.com/catalog /product_info.php?products_id=43824) 13. Leisman, G. Functional Connectivities in the Postnatal Development of Consciousness. International Journal of Child Health and Human Development. 2013; 6(4): 485. (https://www.novapublishers.com/catalog/product_info.php?products_id=43824) 14. Leisman, G., Melillo, R., Machado, C. Rodriguez-Rojas, R., Batista, K., Carballa, M., Mualem, R. Functional Disconnectivities in Individuals with Autistic Spectrum Disorders. International Journal of Child Health and Human Development. 2013; 6(4): 486. (https://www. novapublishers.com/catalog/product_info.php?products_id=43824) 15. Machado, C., Estevez, M., Leisman, G., Melillo, R., Machado, A., Hernanandez-Cruz, A., Arias, A., Rodriguez-Rojas, R., Carballo, M. Exploration of Resting Brain Connectivity Using Linear


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Coherence Measures in the Autistic Spectrum Disorder. International Journal of Child Health and Human Development. 2013; 6(4):510. (https://www. novapublishers.com/catalog/product_ info.php?products_id=43824) Rodriguez-Rojas, R., Machado, C., Alvarez, L., Carballo, M., Estevez, M., Perez-Nellar, J., Pavon, N., Chinchilla, M., Carrick, F.R., DeFina, P. Zolpidem induces paradoxical metabolic and vascular changes in a patient with PVS. Brain Injury. 2013;27(11),1320-1329. (http://www.ncbi.nlm.nih.gov/pubmed/23924270) Machado, C. Estevez, M., Melillo, R., Leisman, G., Carrick, R., Machado, A., Hernandez-Cruz, A., Arias, A., Rodriguez-Rojas, R., Carballo, M., Quantitative Resting EEG in the Autistic Spectrum Disorder. International Journal of Child Health and Human Development. 2013; 6(4):511. (https://www.novapublishers.com/catalog/product_info.php? products_id=43824) Rodriguez-Rojas, R., Batista, K., Carballo, M., Iturria, Y., Sanabria, G., Machado, C., Leisman, G., Estevez, M., Melillo, R. Anatomical and Topological Connectivity Reveal Different Attributes of Disrupted Small-World Networks in Autistic Children. International Journal of Child Health and Human Development. 2013; 6(4):551. (https://www. novapublishers.com /catalog/product_info.php?products_id=43824) Leisman, G., Braun-Benjamin, O., Melillo, R. Cognitive-Motor Interactions of the Basal Ganglia in Development. Frontiers in Systems Neuroscience. 2014, 8:16. doi: 10.3389/ fnsys.2014.00016. [Cross-referenced in Frontiers in Computational Neuroscience]. (http://www.frontiersin.org/Journal/10.3389/fnsys.2014.00016/abstract) (http://www.frontiersin .org/computational_neuroscience/researchtopics/Basal_Ganglia_XI_-_Proceedings /1118) Pagnacco, G., Wright, C.H., Oggero, E., Bundle, M.W., Carrick, F.R. On "Comparison of a laboratory grade force platform with a Nintendo Wii Balance Board on measurement of postural control in single-leg stance balance tasks" by Huurnink, A., et al. [J. Biomech 46(7) (2013) 1392]: Are the conclusions stated by the authors justified? J Biomech. 2014 7;47(3):759-670. Epub 2013 Dec 4. (http://www.ncbi.nlm.nih.gov/pubmed/24359674) Leisman, G. Functional Connectivities and Re-connectivities Reflect Cognitive Modifiability in Neurorehabilitation. International Journal of Rehabilitation. 2014, 2:4, 54-55. (http://dx.doi. org/ 10.4172/2329-9096.S1.006) Leisman, G. Optimization Models for Quantifying Visual Search Scanpath Efficiency: Measuring Treatment Recovery in Traumatic Brain Injury. International Journal of Rehabilitation. 2014, 2:4, 43-45. (http://dx.doi.org/10.4172/2329-9096.S1.006) Machado, C., Estevez, M., Leisman, G., Melillo, R., Rodriguez, R., Hernandez, A. Perez-Nellar, J., Naranjo, R., and Chinchilla, M. EEG Coherence Assessment of Autistic Children in Three Different Experimental Conditions. Journal of Autism and Developmental Disorders. 2015, 45:406-424 DOI 10.1007/s10803-013-1909-5. (http://link.springer.com/ article/10.1007/s10803013-1909-5#page-1) (http://www.ncbi.nlm.nih.gov/pubmed/24048 514) Leisman, G. and Melillo, R. (2015) The Plasticity of Brain Networks as a Basis for a Science of Nervous System Rehabilitation. International Journal of Neurorehabilitation. 2:2, 155. doi:10.4172/2376-0281.1000155 Mualem, R., Leisman, G., Mograbie, K.K., and Boshnak, S. Brain-Based Learning During Preschool: An Underused Window Of Opportunity. International Journal of Child Health and Disability. 2015 [In press] Leisman, G. The Coincident Decline of Movement and Cognitive Ability: Movement Sciences In the Aid of Public Health Policy Intervention. International Journal of Child Health and Disability. 2015 [In press] Estévez, M., Machado C., Leisman, G., Hernández-Cruz, A., Estévez-Hernández, T., AriasMorales, A. Machado, A., Montes-Brown, J. Spectral Analysis of Heart Rate Variability. International Journal of Disability and Human Development. 2015 [In Press]. Leisman, G. Thinking, Walking, Talking: The Development of Integratory Brain Function. Frontiers in Public Health: Child Health and Human Development, 2015 [In Press]. Estévez-Báez, M., Machado, C., Leisman, G. Brown-Martínez, M., Jas-García, J.D., MachadoGarcía, A . , Montes- Brown, J., Carricarte-Naranjo, C. A Procedure to Correct the Effect of

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IAFNR News and Events Heart Rate on Heart Rate Variability Indices: Description and Assessment. International Journal of Disability and Human Development. 2015 [In Press] Machado C., Rodríguez, R., Estévez, M., Leisman, G., Chinchilla, M., Melillo, R. Electrophysiologic and fMRI Anatomic and Functional Connectivity Relationships in Autistic Children During Three Different Experimental Conditions. Brain Connectivity. 2015. doi:10.1089/brain.2014.0335 (http://www.ncbi.nlm.nih.gov/pubmed/26050707) (http://online. liebertpub.com/doi/abs/10.1089/brain.2014.0335?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3 Acrossref.org&rfr_dat=cr_pub%3Dpubmed) Leisman, G., Moustafa, A. Thinking about action: Integration of Functional Connections in Movement and Cognition. Frontiers in Pediatrics. 2015. (http://journal.frontiersin.org/ researchtopic/3369/thinking-about-action-integration-of-functional-connections-in-movementand-cognition) Estévez, M., Machado C., Leisman, G., Hernández-Cruz, A., Estévez-Hernández, T., AriasMorales, A. Machado, A., Montes-Brown, J. Spectral Analysis of Heart Rate Variability. International Journal of Disability and Human Development. DOI: 10.1515/ijdhd-2014-0025, April 2015 (http://www.degruyter.com/view/j/ijdhd.ahead-of-print/ijdhd-2014-0025/ijdhd-20140025.xml?format=INT) Leisman, G., Mualem, R., Mougrabi, S.K. The Neurological Development of the Child with Educational Enrichment in Mind. Psicología Educativa. 2015. doi: 10.1016 / j.pse.2015.08.006 (http://www.sciencedirect.com/science/article/pii/S1135755X15000226) Leisman, G., Dorta-Contreras, A.J., Machado, C. International Cooperation with Cuban Science: Research on Connectivities Brings Advances in Functional Brain Science at the Highest Levels. Functional Neurology, Rehabilitation and Ergonomics, 2015, 5(3), [In Press] Mualem, R., Leisman, G., Mograbie, K.K., and Boshnak, S. Brain-Based Learning During Preschool: An Underused Window Of Opportunity. International Journal of Child Health and Disability. 2015 [In press] Leisman, G. The Coincident Decline of Movement and Cognitive Ability: Movement Sciences In the Aid of Public Health Policy Intervention. International Journal of Child Health and Disability. 2015 [In press] Leisman, G. Thinking, Walking, Talking: The Development of Integratory Brain Function. Frontiers in Public Health: Child Health and Human Development, 2015 [In Press]. Estévez-Báez, M., Machado, C., Leisman, G. Brown-Martínez, M., Jas-García, J.D., MachadoGarcía, A . , Montes- Brown, J., Carricarte-Naranjo, C. A Procedure to Correct the Effect of Heart Rate on Heart Rate Variability Indices: Description and Assessment. International Journal of Disability and Human Development. 2015 [In Press] Rosner, A.L., Leisman, G. Gilchriest, J. Charles E., Keschner, M.G. Minond, M. Reliability and Validity of Therapy Localization as Determined from Multiple Examiners and Instrumentation. Functional Neurology, Rehabilitation and Ergonomics, 2015, 5(3) [In Press] Leisman, G., Dorta-Contreras, A.J., Machado, C. International Cooperation with Cuban Science: Research on Connectivities Brings Advances in Functional Brain Science at the Highest Levels. Funct. Neurol. Rehab. Ergon. 2015, 5:3 [In Press]. Leisman, G., Melillo, R. Hirsh, O., Mualem, R. (Autistic Spectrum Disorder as a Functional Disconnection Syndrome) Harefuah, (Hebrew) [submitted] Jammalieh, J. Mualem, R, Leisman, G. Clinical Effects of the Development of Physiological Rhythms. Journal of Pediatrics and Neonatology, 2014 [submitted] Leisman, G., Moustafa, A. Shafir, T. Thinking, Walking, Talking: The Development of Integratory Brain Function. Frontiers in Pediatrics, 2015 [Submitted].



Literature Calling A Survey of Recent Publications of Interest to Functional Neurology

Common Meds and Brain Injury Ilene Schneider August 11, 2015 LAB ROOTS Drugs that are used to treat common conditions such as bladder problems, depression and insomnia could delay recovery time for brain injury patients. These medications with anticholinergic properties are prescribed to as many as 50 percent of older people, according to research by University of East Anglia (UEA) and University of Aberdeen scientists, published in Brain Injury and reported in Dr.ug Discovery & Development (http://www.dddmag.com/news/2015/08/common-medicationscould-delay-brain-injury-recovery?et_cid=4731052&et_rid=45505806&location=top). Anticholinergics block the action of the neurotransmitter acetylcholine in the brain, according to Healthline. Used to treat diseases like asthma, incontinence, gastrointestinal cramps, and muscular spasms, they are also prescribed for depression and sleep disorders. Anticholinergics help to block involuntary movements of the muscles associated with these diseases and balance the production of dopamine and acetylcholine in the body. They can also be used to treat certain types of toxic poisoning, and are sometimes used as an aid to anesthesia These medications are frequently used on neuro-rehabilitation units to manage symptoms from urinary incontinence to pain. While anticholinergics are known to have side effects such as temporary cognitive impairment, dizziness and confusion, their effects on people with pre-existing brain and spinal injuries have not been investigated before. Conducted by the University of East Anglia, the study of 52 patients with acquired brain or spinal injury at a neuro-rehabilitation unit demonstrated that “the average length of stay was longer in patients with a higher level of anticholinergic drugs in their system, known as the anticholinergic drug burden, or ACB.” Professor Phyo Myint, chair of old age medicine at the University of Aberdeen has conducted a number of previous studies examining the effect of medications with anti-cholinergic properties. He analyzed the results with Dr. Chris Fox, professor of clinical psychiatry at the Norwich Medical School at UEA. The researchers indicated that the change in ACB correlated directly to the length of hospital stay. “A higher ACB score on discharge, compared with on admission, was associated with a longer stay in hospital and a lower ACB on discharge saw on average a shorter stay,” the article said. While the researchers said that cause-and-effect relationship cannot be implied, Dr. Fox, lead author on the paper, believes that “The findings suggest there may be a statistically significant relationship between ACB score and length of stay in a neuro-rehabilitation unit following traumatic brain or spinal cord injury.”

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According to Dr. Fox, “This pilot study demonstrates the need for larger studies to confirm the results and need for further investigation into what long-term effects these common medications are having on the recovery of these patients. While medications with ACB are often needed to treat common complications of brain or spinal cord injuries, cognitive impairment due to the medication may adversely affect a patient’s ability to engage in the rehabilitation process, potentially increasing their length of stay in hospital.”

Brain Connectivity Study Reveals Striking Differences between Men and Women October 13, 2013 LAB ROOTS A new brain connectivity study from Penn Medicine published in the Proceedings of National Academy of Sciences found striking differences in the neural wiring of men and women that's lending credence to some commonly-held beliefs about their behavior. In one of the largest studies looking at the “connectomes” of the sexes, Ragini Verma, PhD, an associate professor in the department of Radiology at the Perelman School of Medicine at the University of Pennsylvania, and colleagues found greater neural connectivity from front to back and within one hemisphere in males, suggesting their brains are structured to facilitate connectivity between perception and coordinated action. In contrast, in females, the wiring goes between the left and right hemispheres, suggesting that they facilitate communication between the analytical and intuition. “These maps show us a stark difference--and complementarity--in the architecture of the human brain that helps provide a potential neural basis as to why men excel at certain tasks, and women at others,” said Verma. For instance, on average, men are more likely better at learning and performing a single task at hand, like cycling or navigating directions, whereas women have superior memory and social cognition skills, making them more equipped for multitasking and creating solutions that work for a group. They have a mentalistic approach, so to speak. Past studies have shown sex differences in the brain, but the neural wiring connecting regions across the whole brain that have been tied to such cognitive skills has never been fully shown in a large population. In the study, Verma and colleagues, including co-authors Ruben C. Gur, PhD, a professor of psychology in the department of Psychiatry, and Raquel E. Gur, MD, PhD, professor of Psychiatry, Neurology and Radiology, investigated the gender-specific differences in brain connectivity during the course of development in 949 individuals (521 females and 428 males) aged 8 to 22 years using diffusion tensor imaging (DTI). DTI is water-based imaging technique that can trace and highlight the fiber pathways connecting the different regions of the brain, laying the foundation for a structural connectome or network of the whole brain. This sample of youths was studied as part of the Philadelphia Neurodevelopmental Cohort, a National Institute of Mental Health-funded collaboration between the University of Pennsylvania Brain Behavior Laboratory and the Center for Applied Genomics at the Children's Hospital of Philadelphia. Proceedings of National Academy of Sciences vol. 111 no. 2, 823–82.

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Mental Problems? Blame Your Microbiome Robert Woodard March 5, 2015 LAB ROOTS The microbiome and its role in our health and well-being has been receiving a lot of publicity recently. According to an article titled Mental Health May Depend on Creatures in the Gut by Charles Schmidt in the February 17 issue of Mind & Brain, mental health may also depend on the microbiome. And if that’s the case, the microbiome may yield a new class of psychobiotics for the treatment of anxiety, depression, and other mood disorders. It turns out that this will come as no surprise to many people. As the article points out, the idea that our gut governs our mental state has been around for over a century. As far back as the 19thcentury, some scientists believed that accumulating wastes in the colon triggered a state of “autointoxication,” which was linked to depression, anxiety, and psychosis. The cause of this was infections caused by poisons emanating in the gut, and patients were treated with colonic purges and even bowel surgeries. Research on the human microbiome today promises to bring the gut-brain connection into clearer focus. This connection appears to be bidirectional, with the brain acting on the gastrointestinal and immune functions that help shape the gut’s microbes, some of which make neuroactive compounds, including neurotransmitters and metabolites that act on the brain. The article gives a number of examples of scientists who are looking into the gut-brain connection. One of them is Sven Pettersson, a microbiologist at the Karolinska Institute in Stockholm, who has shown that gut microbes help to control leakage through both the intestinal lining and the blood-brain barrier, which ordinarily protects the brain from potentially harmful agents. Another researcher, John Cryan, a neuroscientist at University College Cork in Ireland, maintains that microbes may have their own reasons for communicating with the brain. They need us to be social, so that they can spread between us and survive. Cryan's research shows that when bred in sterile conditions, germ-free mice lacking in intestinal microbes have difficulty recognizing other mice. Other studies have shown that disruptions of the microbiome induced mice behavior that mimics human anxiety, depression and even autism. Scientific American. 2015 Volume 312, Issue 3.

Parkinson’s May Spread from Gut to Brain via Vagus Nerve Megan Brooks August 06, 2015 Medscape Neurology A large Danish epidemiologic study supports the theory that Parkinson's disease (PD) may begin in the gastrointestinal tract and spread through the vagus nerve to the brain. Researchers found that patients who have had the entire vagus nerve severed were less apt to develop PD. “Their risk was halved after 20 years,” Elisabeth Svensson, PhD, from the Department of Clinical Epidemiology, Aarhus University in Denmark, said in a statement. “However, patients who had only had a small part of the vagus nerve severed were not protected. This also fits the hypothesis that the disease process is strongly dependent on a fully or partially intact vagus nerve to be able to reach and affect the brain,”

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Dr. Svensson noted.This study is an “important piece of the puzzle” in terms of the causes of PD, she told Medscape Medical News. The study was published online July 17 in Annals of Neurology. In the past, vagotomy was commonly performed for peptic ulcer, the researchers note in their paper. The two most common procedures were full truncal vagotomy, in which both vagal trunks were severed, and superselective vagotomy, in which only the nerves supplying the fundus and body of the stomach were resected. Using prospectively collected Danish registry data, the researchers investigated the risk for PD in 5339 patients who had truncal and 5870 who had superselective vagotomy, in relation to 66,711 and 60,500 matched population controls, respectively. A direct comparison of the two vagotomy groups showed that patients who had truncal vagotomy had a lower risk for PD than did those having the superselective procedure, after adjustment for age and sex (adjusted hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.56-1.27). After a follow-up period of over 20 years after the date of surgery, the age- and sex-adjusted HR was 0.58 (95% CI, 0.28-1.20), the researchers report. The risk for PD was also lower after truncal vagotomy when compared with the general population. The overall adjusted HR was 0.84 (95% CI, 0.63-1.14). After more than 20 years’ followup, the adjusted HR was 0.53 (95% CI, 0.28-0.99). The risk for PD in patients who had superselective vagotomy was similar to that in population controls overall (HR, 1.09; 95% CI, 0.84-1.43) and after 20 years (HR, 1.16; 95% CI, 0.80-1.70). These findings, say the researchers, “suggest that having an intact vagus nerve increases the risk of developing PD. The finding is in accord with a primary pathological process being initiated in the gastrointestinal mucosa, which then uses the vagus as a major entry point into the brain.” They say strengths of the study include the large sample size and nationwide population-based design with long-term follow-up, reducing the potential for selection bias. They note, however, that the statistical precision of their risk estimates was “limited” and they encourage independent verification of their observations.

Eye Movements in Sleep ‘Change Scenes’ of Dreams Viva Sarah Press August 13, 2015 A new Israeli-led study based on rare neuronal data offers the first scientific evidence of the link between rapid eye movement (REM) sleep- the period in which we experience vivid dreams- dream images, and accelerated brain activity. According to the study, when we move our eyes in REM sleep specific brain regions show sudden surges of activity that resemble the pattern that occurs when we see new images when awake. The scientists suggest that these flickering eye movements during REM sleep are responsible for resetting our dream “snapshots” or “changing the scene” in our dreams. “The electrical brain activity during rapid eye movements in sleep were highly similar to those occurring when people were presented with new images,” said by Dr. Yuval Nir of Tel Aviv University’s Sackler Faculty of Medicine, who led the study. “Many neurons — including those in the hippocampus — showed a sudden burst of activity shortly after eye movements in sleep, typically observed when these cells are ‘busy’ processing new images.” “The research findings suggest that rapid eye movements represent the moment the brain encounters a new image in a dream, similar to the brain activity exhibited when one encounters visual images while awake,” said TAU’s Prof. Itzhak Fried, also of UCLA and Tel Aviv Medical Center.

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The research, recently published in Nature Communications, was a collaboration between TAU’s Fried and Nir and Thomas Andrillon of the Laboratoire de Sciences Cognitives et Psycholinguistique in Paris; and Dr. Giulio Tononi and Dr. Chiara Cirelli of the University of Wisconsin-Madison. The recordings were made from 19 patients with electrodes implanted in their brains to monitor epileptic seizures. These electrodes were able to provide the rare data needed to prove the link between eye movements, dream imagery, and brain activity. “We focused on the electrical activities of individual neurons in the medial temporal lobe, a set of brain regions that serve as a bridge between visual recognition and memories,” said Dr. Nir. “Prof. Fried’s prior research had shown that neurons in these regions become active shortly after we view pictures of famous people and places, such as Jennifer Aniston or the Eiffel Tower — even when we close our eyes and imagine these concepts.” In addition to monitoring the patients’ brain activity via intracranial electrodes, the researchers also recorded scalp EEG, muscle tone, and eye movements to identify periods of REM sleep and detect the precise moment of each rapid eye movement. “How and why eye movements occur are important,” said Dr. Nir. “And these moments represent privileged windows of opportunity for the study of brain activity.” Nature Communications 2015, 6, Article number: 7884

The Mediterranean Diet May Help Preserve Structural Connectivity in the Brain in Older Adults: Healthy Diet ‘Promising Target’ to Prevent Cognitive Decline Megan Brooks August 10, 2015 Medscape The MIND diet ― a hybrid of the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet ― may slow cognitive decline in elderly adults, according to researchers from Chicago's Rush University Medical Center who developed the MIND diet. In an observational study, elderly people who rigorously followed the MIND diet were 7.5 years younger cognitively during a period of roughly 5 years than those with the poorest adherence. “Following the MIND diet may be a way to preserve the brain with age and to prevent dementia,” Martha Clare Morris, ScD, a nutritional epidemiologist at Rush University Medical Center, told Medscape Medical News. The study was published online June 15 in the journal Alzheimer’s and Dementia. “MIND” is an acronym for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay. Both the Mediterranean and DASH diets have been found to reduce the risk for hypertension, myocardial infarction, and stroke. “The MIND diet modifies the Mediterranean and DASH diets to highlight the foods and nutrients shown through the scientific literature to be associated with dementia prevention,” Dr. Morris said in a news release. The MIND diet has 15 dietary components, including 10 “brain-healthy” food groups and five unhealthy groups (i.e., red meat, butter and stick margarine, cheese, pastries and sweets, and fried or fast food). Greater adherence to the Mediterranean diet was associated with preserved microstructure in extensive areas of the white matter up to a decade later, the study team found. And this appeared to be related to strong cognitive benefit, equal to up to 10 years of delayed cognitive aging for those with the greatest adherence, they say. “This is to our knowledge the first study investigating the

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associations of the Mediterranean diet to brain structure in humans, focusing not only on grey matter volume but also on white matter architecture (a more novel marker of brain health),” Cecilia Samieri, PhD, from University of Bordeaux, France, told Medscape Medical News. “The findings give mechanistic clues on the link between the Mediterranean diet and lower cognitive aging which have been suggested in previous research,” she said. There exists a strong association between the Med Diet and diffusion tensor imaging patterns, suggesting that higher MeDi adherence was associated with a “general pattern of preserved WM [white matter] microstructure in multiple bundles,” the researchers say. And preserved white matter microstructure with higher adherence to the MedDi “appeared to delay cognitive aging by up to 10 years.” “Our results suggest that the Mediterranean diet helps preserve the connections between neurons, which appear to be damaged with aging, vascular brain diseases and neurodegenerative diseases such as Alzheimer's dementia,” Dr. Samieri told Medscape Medical News. “In addition, the regions which appeared preserved with greater adherence to the Mediterranean diet were extended and were not specific to a particular disease, suggesting that the Mediterranean diet may have the potential to prevent not only stroke (as previously demonstrated with the PREDIMED [Prevención con Dieta Mediterránea] trial) but also multiple age-related brain pathologies,” she added. The added finding that none of the individual components of the Mediterranean diet was strongly associated with imaging results “supports our hypothesis that overall diet quality may be more important to preserve brain structure than any single food,” they write. In an interview with Medscape Medical News, Keith Fargo, PhD, director of scientific programs and outreach at the Alzheimer's Association, said this study suggests that the Mediterranean diet may help preserve structural connectivity in the brain, and the authors suggest this may be mediated by a favorable effect on the vascular system in the brain. These findings and conclusions are “sensible,” Dr. Fargo said. “One study can't tell the whole story, but it is consistent with the idea that the Mediterranean diet may have some beneficial effect for your brain vasculature, which could account for some of the cognitive effects some studies are seeing.” Dr. Fargo said it's important to note that the study was small and diet was assessed only at one time point and brain structure measured 9 years later. “Whether patients maintained the Mediterranean diet over time is unknown,” he said. “This is an observational not an interventional study, which is ultimately needed to determine whether there really is an effect. There may be something else about people that makes them both more likely to eat a Mediterranean diet and more likely to have preserved white matter structure as they age,” Dr. Fargo said. Nonetheless, he said, the findings support a growing literature indicating that diet does matter to brain health. Alzheimer’s & Dementia, 2015, Volume 11, Issue 9, Pages 1023–1031.

Mind-Controlled Technology Could Make Homes Smarter Sensor-embedded clothing could turn things on and off. Wouldn’t it be nice to brew a cup of coffee in the morning just by thinking about it, or shut off the TV with a blink of an eye? So-called mind-controlled technology may help people accomplish these simple tasks by wearing, say, a sleep mask or pajamas embedded with sensors. The technology involves a system of sensors like those used for picking up a person’s brain waves when taking electroencephalograms (EEGs), or a recording of electrical activity along the scalp. Recently, EEG sensors have been commercialized for gaming whereby a player can control what’s on the screen with the help of a sensor-mounted headset. Such sensors on the head are also being used to help patients with prosthetics control the movement of their artificial limbs.

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IEEE Senior Member Dean Aslam, a professor of electrical and computer engineering at Michigan State University, in East Lansing, is working with a team of neurologists and students to incorporate what he calls biomedical inexpensive micro systems (BIMS) into everyday applications. He has designed sensors that, when sewn into garments, can transmit a signal to a receiver placed in a device the user wants to control. “I started working on mind-controlled technology to get students excited about engineering, and I wound up turning it into a full-fledged research program,” Aslam says. “I now have a workstation that includes a sewing machine for sewing sensors into baseball caps and other garments. We’ve also put together a host of gadgets programmed to be controlled by the mind using the micro system.” He is currently working on commercializing the BIMS technology for use in clothing so that one day people will be able to control smart-home appliances simply by focusing on them. When a person concentrates on one object at a time, the brain’s prefrontal lobe, located just behind the forehead, starts to fire neurons, creating electromagnetic waves in the range of 0.3 to 60 hertz. This radiation is strong enough to induce voltages of 10 to 100 microvolts in EEG sensors placed on the skull. Aslam, who has a background in micro and nano technologies, knew he had to design a sensor that was smaller and lighter than anything already on the market for EEGs. He was able not only to reduce the size of the EEG sensor—normally about 20 millimeters in diameter—but also embed it in fabric. He designed the sensor to be a 110-micrometer-thick copper wire essentially the dimension of sewing thread. The sensor can be sewn into a hat, a headband, or even a shirt collar along with the miniscule BIMS containing an amplifier and transmitter. The signal picked up in the by BIMS is then sent to another BIMS in the device to be controlled that’s equipped with a microcontroller. The controller can be programmed to do a variety of tasks, such as turn on an appliance, change the temperature setting in a room via a thermostat, or lower the volume of a TV set. Although a person could focus attention on anything for the system to work because the brain will generate electromagnetic waves, Aslam says it’s best to concentrate on the task at hand for several seconds until it is completed.” He says a sensor could be made to detect eye movements, such as blinks, to produce the same results. Thus, combinations of attention level and eye blinks can provide a large number of control options for appliances. As the technology advances, Aslam believes controlling devices around us could become automatic. For example, when a person falls asleep wearing sensor-embedded pajamas, sensors could detect the brain waves that dominate when we are in deep sleep—delta waves—and shut off the lights and television on their own.

Melding Mind and Machine: Brain-Machine Interfaces Could Someday Help People with Severe Paralysis Move Their Limbs, Walk, and Use a Computer Michael J. Riezenman June 6, 2008 IEEE Mind control is generally regarded as scary—conjuring up The Manchurian Candidate and other depictions of brainwashing. But recent refinements of brain-machine interfacing (BMI) may redefine the expression to mean something totally different: control by, not of, the mind. It is a field that holds

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out the hope of allowing severely paralyzed people to communicate with the world, move their limbs, and even walk. The basic idea is simple: paralysis is caused by a break in the neural pathway between the cognitive part of the brain, where the intention to make a movement is generated, and the muscles that do the moving. So an artificial system that senses the neural signals generated in the brain, analyzes what the brain is trying to do, and then moves the limbs mechanically can bypass the roadblock in the pathway and restore normal functioning. Such BMI systems are not just for moving limbs; for example, signals from the brain can be harnessed to move the cursor on a computer screen with no actual limb movement. Of course, making that happen is far from simple. But laboratory experiments have proved the viability of the approach, and a number of IEEE members are working to develop solutions to the many practical problems that have prevented the idea from becoming a clinical reality. One problem is signal acquisition, specifically the design of the actual physical interface that taps into the brain’s neural signals. The ideal would be to sense the signals noninvasively, through electrodes placed on the scalp. But signals obtained that way have poor signal-to-noise ratios compared with ones obtained by arrays of microelectrodes inserted directly into the cerebral cortex, the outermost portion of the brain, points out Member Justin C. Sanchez, a professor of pediatrics, neuroscience, and biomedical engineering at the University of Florida, Gainesville, and chair of the Gainesville chapter of the IEEE Engineering in Medicine and Biology Society. Moreover, microelectrodes can pick up signals from individual neurons, while external electrodes reflect the aggregate of many millions of neurons. On the other hand, poking electrodes into the brain is a surgical procedure that risks infection as well as injury. As in many engineering situations, the name of the game is trade-off. Proponents of the noninvasive approach are constantly improving their signal-processing software to better extract every bit of information from the signals they collect. At the same time, those who favor microelectrodes are trying to lessen their impact by improving the electrode-tissue interface. Cyberkinetics Neurotechnology Systems of Foxborough, Mass., has developed a device that inserts an array of microelectrodes quickly. The procedure reduces tissue trauma because of the viscoelastic nature of neural tissue—that is, its ability to recover from mechanical stresses, provided they are of short duration. Another method of accessing the brain’s neural signals falls between those two. Sanchez’s group is experimenting with an electrocorticographic (ECoG) technique that places an array of small electrodes on the cortex, each of which aggregates signals from a large number of neurons—many more than a microelectrode does but significantly fewer than an external electrode. Moreover, since the signals need not pass through the membrane surrounding the brain cortex, the skull, or the scalp before being sensed, ECoG signals suffer much less attenuation than EEG signals and exhibit a higher signal-to-noise ratio. Minimizing power consumption is another major issue with BMI. Any permanently implantable device needs amplifiers, signal-processing circuitry, and a wireless transmitter. Therefore, using as little power as possible to minimize the heating of tissue and to prolong battery life is another important goal. One way is to minimize the bandwidth occupied by the data being sent from the implanted device to the outside world. Pursuing that goal, John G. Harris, a professor of electrical and computer engineering at the University of Florida, came up with a sampling scheme that samples more rapidly when the signal amplitude is large and more slowly when it is small. Since neurological signals are spike trains with a high amplitude only a small part of the time, that saves a lot of bandwidth. The price paid is a complex reconstruction algorithm performed in circuitry outside the body—where power limitations do not apply.

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A team at Stanford University came up with a scheme that combines a variable-precision analogto-digital converter with a spike-sorting subsystem that samples the neurological signal only when a spike is present and varies its resolution from 3 to 8 bits, depending on the quality of the signal. IEEE Student Member Michael D. Linderman, who is part of the Stanford team, says the subsystem can be trained by the signal shapes to identify individual neurons whose signals are picked up by the same electrode. That information is enough for the complex decoding algorithms to analyze and determine what action the person intends to take. BMI researchers are optimistic because, as Linderman and his colleagues explain in “Signal Processing Challenges for Neural Prostheses” [IEEE Signal Processing Magazine, January 2008], “many of the obstacles facing the prosthetics community as it develops a clinically viable implantable prosthetic processor are primarily engineering challenges.” IEEE Signal Processing Magazine, January 2008.

Young People at Clinical High Risk (CHR) for Psychosis Show a Particular Pattern of Neural Disruption in Communication Involving the Thalamus and the Rest of the Brain Megan Brooks Medscape “Critically, the pattern we observed in individuals at risk for psychosis was also observed in a more severe form in people who fully converted to psychosis later,” lead author Alan Anticevic, PhD, of the Department of Psychiatry, Yale University, New Haven, Connecticut, told Medscape Medical News. “The key clinical implication is that this evidence provides a possible method to understand what patterns of brain communication may predict future emergence of psychosis. This may point to neural treatment targets that could be amenable to earlier intervention (prior to full-blown psychosis onset),” he said. The study by Dr. Anticevic, senior author Tyrone Cannon, PhD, who is also from Yale and is principal investigator of the North American Prodrome Longitudinal Study, and colleagues, was published August 12 in JAMA Psychiatry. The researchers generated whole brain thalamic functional connectivity maps for 243 people who experienced early warning symptoms of psychosis (the CHR group, which included 21 patients who converted to full-blown psychosis) and 154 healthy control individuals and followed them for 2 years. They observed a widespread decrease in functional connectivity between the thalamus and prefrontal and cerebellar regions in the CHR group, which was more pronounced in the 21 individuals who developed full-blown psychosis. The CHR group also displayed hyper-connectivity between thalamus and sensory areas of the brain, which again was most evident in those who converted to full-blown psychosis. “This study establishes that thalamo-cortical disconnectivity is present in CHR states before psychosis onset,” the investigators write. The patterns they uncovered are consistent with prior observations by the Yale team (and others) in patients with schizophrenia, they note. In this latest study, the magnitude of thalamic disconnectivity in both hyper-connected and hypo-connected regions correlated significantly with prodromal symptom severity, they point out. This “fascinating result” in which both thalamo-cortical disconnectivity patterns correlated with the baseline levels of psychotic symptoms “opens the theoretical door to future translational interventions targeting abnormal functional brain connectivity on CHR patients,” writes Paolo Fusar Poli, MD, PhD, RCPsych, from the Department of Psychosis Studies, King's College.

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The investigators caution that the relatively small number of patients in the study sample who converted (n = 21) “limits firm conclusions about whether this particular imaging phenotype is a true clinical predictor of conversion.” Dr. Fusar Poli agrees, noting that “nearly 40 years of inconclusive neuroimaging research in psychosis...should caution us against excessive enthusiasm when weighing the clinical effect of the findings by Anticevic et al.” Dr. Fusar Poli says external validation in large samples is needed to ensure that thalamo-cortical disconnectivity can be consistently replicated in other CHR cohorts. Of “highest concern,” he says, is that only 21 (8.6%) of the 243 baseline CHR patients had converted to frank psychosis after 2 years. A similar “low transition” rate (8%) was seen in the largest randomized clinical trial conducted on CHR patients. “It seems alarming that 2 of the largest CHR research studies currently published reported an 8% transition risk at 2 years, which is dangerously too close to the 3% lifetime risk of psychosis observed in the general population. This finding clearly advocates for future studies elucidating the epidemiology of CHR,” Dr. FusarPoli writes. “The near decade will be crucial to definitively tell us whether and to what extent the translational promises of Anticevic et al.’s findings and of neuroimaging methods in early psychosis have been kept,” he concludes. JAMA Psychiatry 2015, 72(9); 882-891. Published online August 12, 2015.

Insulin Resistance Is Associated Lower Brain Glucose Metabolism and Poorer Memory in Late Middle Aged Adults at Risk for Alzheimer's Disease (AD) July 31, 2015 Medscape “While we have known for several years that people with type 2 diabetes areat increased risk for developing AD, the exact mechanisms underlying increased risk are still elusive,” Barbara B. Bendlin, PhD, from University of Wisconsin School of Medicine and Public Health and Wisconsin Alzheimer's Disease Research Center in Madison, told Medscape Medical News. “Our findings suggest that insulin resistance, a central feature of diabetes, could increase risk for AD by altering the way the brain uses glucose, the primary fuel for the brain.” Participants included 150 cognitively normal adults with a mean age of 60.7 years who underwent cognitive testing, fasting blood draw, and fludeoxyglucose F 18–labeled positron emission tomography of the brain at baseline. They are part of the Wisconsin Registry for Alzheimer's Prevention (WRAP), a community sample enriched for AD parental history. Of the 150 participants, 108 (72%) were women, 103 (68.7%) had a parental history of AD, 61 (40.7%) had an APOE†ε4 allele, and 7 (4.7%) had type 2 diabetes. Higher homeostatic model assessment of peripheral insulin resistance was significantly associated with lower global glucose metabolism (P< .01) and regional glucose metabolism (P< .05) “across large portions of the frontal, lateral, parietal, lateral temporal, and medial temporal lobes,” the researchers report. The association was particularly “robust” in the left medial temporal lobe, and lower glucose metabolism in this area correlated significantly with poorer performance on tests of immediate and delayed memory (P < .001 for both), they note. “In addition to finding that people with insulin resistance have lower brain glucose metabolism, we also found that lower glucose uptake in brain regions, important for memory function, was associated with lower memory performance,” Dr. Bendlin told Medscape Medical News. It's important to note, she added, that the participants studied

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are late middle-aged, and the majority do not have diabetes. “Midlife may provide a window of opportunity for altering insulin resistance which may be protective against memory decline,” she said. “We suspect that there are optimal ranges of glucose and insulin levels that are needed for healthy brain function. Especially for individuals who are 'prediabetic', it is likely important to maintain insulin sensitivity (for example, through diet and exercise modification), for overall health, and more specifically for brain health as well,” Dr. Bendlin said.” Although this paper reiterates a known observation (decrease in brain metabolism associated with APOE4†genotype and the link with the metabolic syndrome), it extends this relationship to middle-aged people with increased risks for AD,” Claude Messier, MD, PhD, from the University of Ottawa School of Psychology in Ontario, Canada, who wasn't involved in the study, told Medscape Medical News. “Although it does not prove that there is a causal relationship between type 2 diabetes (or the metabolic syndrome) and AD, it demonstrates convincingly that insulin sensitivity is associated with decreases in metabolic activity in brain regions most sensitive to AD,” he said. It is now “pretty clear,” Dr. Messier added, that being diabetic will “hasten cognitive decline and interact with other disease states (vascular disease and AD) to hasten their progression.” At this point, it's fair to say that if “you can avoid diabetes through lifestyle changes, you are probably reducing your odds of early AD.” Laura D. Baker, PhD, from the University of Washington School of Medicine in Seattle, told Medscape Medical News that these new findings “build on the work of others who have helped shift our scientific focus to midlife health status as a potent predictor of those who are likely to develop AD down the road.” Dr. Baker, who wasn't involved in the study, said it also expands on previous work conducted by her group that uncovered “striking similarity in brain glucometabolic signatures of older insulin resistant adults and patients with early AD. The [new] findings indicate that this similarity extends to middle-aged adults and thus makes the important point that increased AD risk may be linked to glucometabolic dysfunction, regardless of when it occurs in adulthood,” she said. “At a time in history when type 2 diabetes is diagnosed in progressively younger adults, the [new] findings have important implications for age of AD onset — with symptoms that will be increasingly reported by adults in their 50s and even possibly even in their 40s. These and other findings that highlight the importance of middle-age health status for AD risk have important implications for when interventions to prevent or slow the disease must be initiated,” Dr. Baker said. JAMA Neurol. Published online July 27, 2015. doi:10.1001/jamaneurol.2015.0613

Less Exercise Activity Linked to Kids with MS Disease Pauline Anderson August 13, 2015 Children with multiple sclerosis (MS) are less physically active than those with monophasic acquired demyelinating syndrome (monoADS), a disorder that involves a single demyelinating episode, a new study shows. However, youngsters with MS who participated in strenuous physical activity have lower T2 lesion volumes and a lower relapse rate, the findings suggest. “One of the messages from this study is that kids with MS who are highly active seem to have less disease activity, either demonstrated by the relapse rate or by the size of the lesions in their brain,” said study author E. Ann Yeh, MD, associate professor of neurology, Department of Pediatrics, Hospital for Sick Children and the University of Toronto, in Canada.

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However, Dr. Yeh stressed that the cross-sectional design of the study prevents conclusions about causality. “We need to learn more,” she said. “I don't want to overstate our results, as this is an early finding, and although it's hopeful for sure, we need to look further longitudinally with interventional trials.” The study enrolled 110 patients aged 5 to 18 years who had demyelinating disorders. These included 31 patients with MS and 79 with monoADS, who were included as control participants. To evaluate physical activity, researchers used the Godin Leisure Time Exercise Questionnaire. Patients reported the frequency of strenuous (e.g., running), moderate (e.g., fast walking), and mild (e.g., leisurely walking) physical activity for 15 or more minutes during a typical week. From patient responses, researchers calculated metabolic equivalents and categorized these into strenuous, moderate, or mild. They also developed health contribution scores (HSCs) by grading the level of physical activity and categorizing that into active, moderately active, and insufficiently active. Compared with those with monoADS, patients with MS reported participating in less strenuous (median, 0.0 vs. 27.0; P = .0012) and total (median, 40.0 vs. 54.0; P = .0284) physical activity. MS patients also had lower HCSs than those with monoADS (median score, 25.0 vs. 42.0; P = .098). More MS patients were insufficiently active (32.26% vs. 12.66%). There were no differences between the groups in participation in moderate or mild physical activity. Because the study excluded children with a very high Expanded Disability Status Scale score, “disability was not the driving force” behind the results, commented Dr. Yeh. A subgroup analysis of youngsters undergoing MRI showed that MS patients reporting strenuous physical activity had lower T2 lesion volume compared with less active MS patients (P = .022). “It was a very strong association,” Dr. Yeh said. They also had a lower annualized relapse rate (P = .035). How exercise might limit brain lesion load “is an area we have to investigate,” said Dr. Yeh. She added that the MRI results suggest that the link between physical activity and disease involves “more than just a compensatory mechanism.” The analysis seems to suggest that it is not necessarily the amount of physical activity that kids with MS do but how strenuous it is, said Dr. Yeh. “We looked at that in many different ways, and it looks like the strenuous activity is probably more important, but we don't know that” because of the limitations of the study, she said. However, Dr. Yeh pointed to other studies that suggest that “there is something inherently good about physical activity” in MS patients and that the more physically active they are, the less active their disease. The small numbers prevented the researchers from doing a subanalysis based on sex. The ratio of girls to boys in the pediatric MS population mirrors that of the adult population (3 to 1), she noted. They also could not examine whether exercise has more of an impact in younger children compared with older ones. Dr. Yeh noted that all kids are fairly active early on but that many ― at least girls ― tend to drop out of sports and other physical pursuits as they grow older. In the pediatric population, MS affects primarily those in their preteen and teen years, said Dr. Yeh. “So we couldn't see if there was an effect in the very young kids because we just didn't have the population to study that.” Overall, patients did not report a lot of fatigue on the Pediatrics Quality of Life Multidimensional Fatigue Scale, but MS patients did report more general and total fatigue, as well as cognitive fatigue, than monoADS patients. Those with lower fatigue scores were more physically active, and those with more fatigue were less physically active. Here again, “it could go either way,” she said, in that strenuous activity could have lessened fatigue, or fatigue might have prevented kids from participating in strenuous activity. Dr. Yeh and her colleagues are doing longitudinal work to explore this relationship. “We don't have the answer yet, but we think that, based on other work in adult populations, high fitness and high physical activity actually have an effect on fatigue in MS patients.” Researchers also looked at depression scores on the Center for Epidemiology Studies Depression Scale for Children. Although

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the MS patients were more depressed than those with monoADS, “we didn't see a relationship with depression” and physical activity, said Dr. Yeh. She and her colleagues pursued the current study because kids with MS have such high rates of both depression and fatigue. “We wanted to see if there were any lifestyle changes that kids could make that would be simple to do and could help improve outcomes.” But before rolling out an exercise program for kids with MS, it is important to demonstrate “that this is meaningful in a longitudinal way and in a controlled way,” she said, and to then “translate” it into something that children will pursue in their everyday lives, outside of a clinical trial. “A lot of our work revolves around thinking about these issues, about how to make it work; if we can't make it work, it's not useful.” Between 2% and 10% of all MS cases are pediatric, the researchers write. About 1 per 100,000 in the Canadian pediatric population develop an episode of inflammatory demyelination, and about a fifth of those are MS, Dr. Yeh said. Neurology. Published online August 12, 2015. doi: http://dx.doi.org/10.1212/WNL.000000000 0001939.

Brain Imaging with Single Photon Emission Computed Tomography (SPECT) Can Distinguish Posttraumatic Stress Disorder (PTSD) from Traumatic Brain Injury (TBI) with High Sensitivity July 15, 2015 Medscape Medical News “Persons with TBI or PTSD can present with overlapping symptoms, making them challenging to tell apart,” coauthor Cyrus Raji, MD, PhD, from the University of California, Los Angeles (UCLA), told Medscape Medical News. “SPECT imaging can be effectively used in both inpatient and outpatient settings to understand if a patient may have PTSD as opposed to TBI. In our study, SPECT shows that persons with TBI have abnormally decreased blood flow while those with PTSD have abnormally elevated perfusion in certain brain regions.” “Clinically, this information can be applied to stratify patients into appropriate treatment strategies that are very different depending on if a patient has PTSD or TBI,” Dr. Raji said. The researchers conducted a retrospective analysis of more than 20,000 SPECT examinations performed at rest and on task among nonmilitary patients evaluated for psychiatric and/or neurologic conditions at 1 of 9 outpatient clinics from 1995 to 2014. Diagnoses were made by board certified or board eligible psychiatrists on the basis of clinical history, mental status examination, and criteria of the fourth or fifth editions of the Diagnostic and Statistical Manual of Mental Disorders, “consistent with the current standard of care.” They analyzed two groups. Group 1 included 104 patients with TBI, 104 with PTSD, and 73 with both conditions matched for demographic characteristics and comorbidity compared with each other and to 116 healthy individuals. Group 2 consisted of 7505 patients diagnosed with TBI, 1077 with PTSD, and 1017 with both, along with 11,147 individuals who did not have PTSD or TBI but had other psychiatric illnesses, such as depression. “To my understanding this is the largest functional neuroimaging study on TBI or PTSD published. Using both quantitative and qualitative analyses of over 20,000 SPECT images of the brain, we can distinguish TBI from PTSD with 80% to 100% sensitivity,” Dr. Raji told Medscape Medical News. SPECT was able to “separate PTSD and TBI from healthy controls, from each other, and detect their co-occurrence, even in highly comorbid samples,” the researchers report in their

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article. “This modality may offer a clinical option for aiding diagnosis and treatment of these conditions.” Back in April, in the journal Brain Imaging and Behavior, Dr. Raji and his collaborators reported results of a smaller study in about 200 military veterans showing that SPECT can distinguish PTSD and TBI with 94% accuracy in this population. In the current study, compared with patients who have TBI, patients with PTSD showed increases in the limbic regions, cingulum, basal ganglia, insula, thalamus, prefrontal cortex, and temporal lobes, the researchers note. The observations in this study are “pretty robust and in a robust population, which I think is neat,” Jacob Dubroff, MD, PhD, assistant professor of radiology at the Hospital of the University of Pennsylvania in Philadelphia, who wasn't involved in the study, noted in an interview with Medscape MedicalNews. “These two patient populations,” he added, “can cross over a little bit and it looks like we can figure out who is who a little bit better not just from their symptoms but from their brain scans. SPECT is not new and the concept of increased blood flow going to where there is more activity is not new, [but] the study gives insights into some of the brain circuitry, which is always helpful. You really see where there is more blood flow in PTSD patients in the limbic regions, which is the very emotional, primordial part of the mammalian brain, vs TBI where everything seems to be much quieter, there is not as much blood flow,” Dr. Dubroff commented. “The question is what do we do with this information and should more people be getting this test. SPECT has been around for a while, is readily available, and I do think it's underutilized in these patients,” Dr. Dubroff said. “This publication may pave the way for future studies that prospectively apply functional brain imaging in a variety of psychiatric disorders in general and PTSD and TBI in particular,” said Dan Silverman, MD, PhD, chief of neuronuclear medicine at UCLA Medical Center, who was not involved with the study. PLoS One. Published online July 1, 2015. DOI: 10.1371/journal.pone.0129659

Be a part of something fantastic… The 7th Annual Conference and Awards Dinner November 4 – 6, 2016 in Henderson, Nevada SHORTENED CONFERENCE SCHEDULE Arrive Thursday night, Conference Friday, Saturday, and Sunday!  Conference IAFNR Member Price = $600.00 (Entire Conference, Friday event cocktail party and Saturday awards dinner)  Conference Non-Member Price = $700.00 (Entire Conference, Friday event cocktail party and Saturday awards dinner)  Room Package IAFNR Member = $1150.00 (Conference package above, plus hotel for Thursday, Friday & Saturday)  Student Limited Time Offer = $250.00 (Conference Package but for active at time of registration students only)  Extra Dinner Ticket for Companion = $110.00 (Ticket for Friday evening cocktail party and Saturday awards dinner) In order to receive IAFNR Member Discount, Membership must be current through entire 2016 calendar year. Visit www.iafnr.org for more information LIMITED TIME OFFER – Register Now and Take Advantage of Payment Options  Please bill my credit card listed below in equal monthly installments (through 11/01/2016).  Please bill my credit card now for payment in full. Name: ________________________________________ Phone Number: ______________________________ Email Address:

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Please email, fax, or mail your registration IAFNR – 2487 S. Gilbert Rd #106-116, Gilbert, AZ 85296 * Phone (480) 926-1115 * Fax (480) 813-1868 Email: [email protected] For any information on our cancellation policy, please refer to our website. Penalties will be incurred if cancellation occurs with less than 3 months before the event.

Poster Presentation Requirements for 2016 Annual Conference November 4–6, 2016 Henderson, Nevada • Abstracts must be original and must not be or have been published or presented at any other meeting prior to the congress. • Abstracts must be submitted in English. • Abstracts must be received by the announced deadline. Abstracts received after the deadline will not be considered. • The Presenting Author is required to ensure that all co-authors are aware of the content of the abstract before submission. • Presenting Author's contact details must be included (email address, postal address, daytime and evening phone number, author and co-authors' details, and family name(s). Authors' names must be in upper and lower case. • Affiliation details (department, institution, hospital, city, state, country) must be included. • Abstract title must be limited to 20 words in upper case. • Abstract text must be limited to 250 words, including acknowledgements. • Abstracts should clearly state: Background, Aims, Methods, Results, Conclusion • Use only standard abbreviations. Place any special or unusual abbreviations in parentheses after the full word appears the first time. Use generic names of supplements or drugs. Do not use product identifiers. Express numbers as numerals. • Case studies are of real cases and all identity to a patient must be kept confidential. Do not use names or identifying initials.

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Tables, Graphs, and Images: • A maximum of 3 tables of up to 10 rows x 10 columns can be included per abstract. • Each image included in the abstract is worth 30 words. A maximum of 3 images can be included per abstract. • The maximum file size of each graph image is 500 kb. The maximum pixel size of the graph / image is 600(w) x 800 (h) pixels in .jpeg format only. • Disclosure of financial relationships that the author(s) may have with the manufacturer / supplier of any commercial product or services related to the work should be indicated on the abstract form. For example, if you use a certain product or diagnostic instrument in your case study, you must state that you have no conflict of interest or state whatever relationship you might have. • All accepted poster abstracts will be printed in the conference issue of the journal of functional neurology, rehabilitation and ergonomics • All abstracts need to be submitted. • All abstracts must be digitally submitted to Janet Groschel at [email protected]. International Association of Functional Neurology & Rehabilitation 2487 S. Gilbert Rd. #106-116 Gilbert, AZ 85295 USA Phone: (480) 926-1115 Web: www.iafnr.org

Childhood Developmental Learning Disabilities and Behavioral Disorders Certification Course Co-Sponsored through IAFNR and AIC

Italy Program – 7 modules Early Registration is now open Instructor: Robert J. Melillo, MS, DC, PhD(C) DABCN, FACFN, FABCDD Module 1: Physical Exam for the Newborn & Infant: Introduction to childhood neurobehavioral disorders examining the newborn, child and adolescent Module 2: ADHD, OCD, Tourette’s I Module 3: ADHD, OCS, Tourette´s II Module 4: Autism Module 5: Dyslexia and Learning Disabilities Module 6: Nutrition and Immune for Children: Nutritional, Dietary, Immune and Endocrine Considerations in Neurobehavioral Disorders of Childhood Module 7: Behavioral and Attachment Considerations in Neurobehavioral disorders in childhood Registration Information Registration is available at https://www.iafnr.org/content/courses IAFNR Members receive discount and 7 Module Package discount available. For Module Description visit the website listed above Location: http://www.hotelmanin.it/ Hotel Mannin, Milano, Italy The class hours for all modules will be Friday and Saturday 09.00 – 17.00 and Sunday 09.00 – 15.00. In total, 25 class hours per weekend.

AIM AND SCOPE OF THE JOURNAL The aim and scope of this interdisciplinary journal is to provide a forum for the fields of biomedical and rehabilitation engineering, neuropsychology, clinical neurology, human factors and ergonomics, and vocational assessment and training to present critical ideas, theories, proof-of-concept for technology solutions, and data-based evaluative research to facilitate return to work or more effective functional development in children and adults. FNRE accepts review papers, articles of original research, data-based and controlled case studies pertaining to functional neurology, man-machine interactions, rehabilitation sciences, brain-behavior relationships, and in applied cognitive neuroscience that relate to translational research. Engineering proof-of-concept applied to functional neurology as ergonomics are also welcome. FNRE also welcomes commentary on either the review papers or on original research as the journal intends to be an archival source of discussion of new advances in rehabilitation.

Description of the Fields Covered Assessment & Rehabilitation in Neurological Disorders

• Diseases and trauma of the brain • Cognitive, language, motor, sensory (e.g. visual, auditory, pain, vestibular, etc.) and behavioral disorders

• Developmental disabilities • Autism in childhood and adults • Diseases and trauma of the spinal cord • Neuropathy, myopathy, and peripheral nerve lesions • Diseases and trauma impacting on vestibular function Assessment & Rehabilitation in Orthopedic and Musculoskeletal Disorders

• Limb disease, trauma, and amputation • Rheumatic diseases; osteoporosis • Back and neck pain Assessment & Rehabilitation in Other Specific Populations

• Geriatric rehabilitation • Pediatric rehabilitation • Special medical conditions (e.g., heart disease; respiratory disorders; cancer; burns; vegetative state)

Topics of General Interest in P&RM Organization and management of rehabilitation services: rehabilitation in the framework of hospitalization and in the community; quality control in rehabilitation; vocational rehabilitation. Scope of the specialty: educational needs; ethical and medico-legal aspects; role for alternative/complementary medicine practices in P&RM. Functional assessment & outcome measurement at various levels: impairment; disability (activity); handicap (participation); quality-of-life (QOL); WHO-ICF system. Management of commonly encountered disabling conditions: pain; sexual disability; spasticity; postural instability & recurrent falls; wounds; sleep disorders; disability related emotional disorders. Other topics of general interest in P&RM: secondary and tertiary prevention in medical rehabilitation; nursing of disabled persons; sports medicine and sports for the disabled; rehabilitation of terror victims; electrodiagnosis; kinesiology; walking analysis; movement analysis; posturography; orthotic devices; advanced technologies in P&RM; augmentative devices; neuromuscular electrical stimulation; biofeedback; ergonomic considerations in the home and workplace of disabled persons.

Rationale for Why the Journal Is Needed The field of Rehabilitation does not presently exist as a cohesive discipline. Rehabilitation specialists define themselves as neurologists, practitioners of physical medicine and rehabilitation, vocational experts, engineers, psychologists, educators, social workers, physical therapists, occupational therapists and the like. The intrinsic cross-disciplinary nature of the rehabilitation process and the requirement for clinical-driven applied and basic science is not represented in any presently published journal, or for that matter, professional organization. The International Association of Functional Neurology and Rehabilitation and the F. R. Carrick Institute for Clinical Ergonomics, Rehabilitation, and Applied Neuroscience, the host organization and research institution for the journal FNRE, is addressing the foregoing by training interdisciplinary rehabilitation professionals whose dissertations also require patent and product development, the establishment of cross-disciplinary research laboratories and projects, the transfer of technology into community based services such as free medical equipment and services for those in need of getting to or back to work, regional clinical program integration systems, and international academic and research cooperative agreements. It is expected that the proposed journal will strongly reflect the structure and philosophy of science and practice.

Description of the Peer Review Process Papers will be solicited through the organs of fields impacting on rehabilitation science. Peer review will be performed on each paper but will be blind. Periodically, papers linking a particular cogent theme applied to rehabilitation will be compiled within a single issue and published in book form. Papers will be ranked as accepted without revision, accepted but with minor revision, requiring major rework and an additional review, or rejected. We do desire to create dialogue within the rehabilitation community, and reviewer’s comments, when appropriate, will be included with the published paper.

INSTRUCTIONS FOR AUTHORS All manuscripts for the Journal of Functional Neurology, Rehabilitation, and Ergonomics (FNRE) must be submitted to the Editor-in-Chief by e-mail only: [email protected] Type of Manuscripts Accepted FNRE accepts review papers, articles of original research, data-based and controlled case studies pertaining to Functional Neurology, Man-Machine Interaction, Rehabilitation Sciences, brainbehavior relationships, and in applied cognitive neuroscience that relate to translational research. Engineering proof-of-concept applied to functional neurology as ergonomics are also welcome. FNRE also welcomes commentary on either the review papers or on original research as the journal intends to be an archival source of discussion of new advances in rehabilitation. Manuscript Requirements [1] Manuscripts must be written in English and be typewritten with double spacing throughout the entire text and with margins of at least 2.5 cm. An original on 8½"  11" heavy duty white bond paper and two duplicate copies should be provided. An email copy as a file attachment in MS WORD for WINDOWS or a text file must also be submitted by email to the above indicated email address. [2] Each manuscript must have a title (first) page that includes the title, the authors’ full names, the laboratory or origin of the data, a running head, a list of 6-8 key words and the name, address and FAX number of the person to whom correspondence and proofs should be mailed. [3] Full length review articles should be divided into sections in the following order: Synopsis, Body (with relevant sub-headings), Acknowledgements, and References. Short notes should contain no sections. Number pages consecutively. [4] Abbreviations should be defined when first used by placing in parentheses after the full term; e.g., acetylcholin-esterase (AChE). [5] References will follow the "Uniform requirements for manuscripts submitted to biomedical journals" format (also called the Vancouver style, see http://www.icmje.org/index.html) determined by the International Committee of Medical Journal Editors and used for PubMed/Medline journals. Abbreviations of journal names should conform to the Index Medicus.

References (maximum of 25 for articles, 40 for review articles and 5 for case reports) should be cited consecutively (enclosing the number in parenthesis) in the text and listed in the same numerical order at the end of the paper. The Vancouver Style is required (http://www.icmje.org/).The first reference in the text should be (1) and the next (2) and so forth and then listed accordingly at the end of the paper after discussion or after acknowledgements.

Examples: Journal article Damianopoulos EN, Carey RJ. Pavlovian conditioning of CNS drug effects: a critical review and new experimental design. Rev Neurosci 1992; 3: 65-77. Note: no comma in between name an initials, no italics or bold, no capitol letters in title except at the begining of sentence, no period between jorunal name and year, year;vol:page-page without space betwwen and last page number shortened. All authors must be cited. Journal name abbreviated according to the international standard found at PubMed Journal Database. (http://www. ncbi.nlm.nih.gov/sites/entrez ?db=journals) Book Melillo R, Leisman G Neurobehavioral disorders of childhood: An evolutionary approach. New York: Kluwer, 2004. Book chapter Leisman G, Melillo R. Cortical asymmetry and learning efficiency: A direction for the rehabilitation process. In: Randall SV Learning disabilities: New research. Hauppauge, NY: Nova. 2006: 1-24. Research report Shek DTL. A positive youth development program in Hong Kong. Hong Kong: Soc Welfare Pract Res Centre, Univ Hong Kong, 2004. (Chinese) Unpublished thesis Kaplan SJ. Post-hospital home health care: The elderly’s access and utilization. Dissertation. St Louis: MO: Washington Univ, 1995. Internet materials / publication Internet journal: Morse SS. Factors in the emergence of infectious diseases. Emer Infect Dis 2006;5:1. Internet material Morse SS. Factors in the emergence of infectious diseases. Emer Infect Dis 2006. Accessed 2007 Jun 05. URL: http://www.cdc.gov/ncidod/EID/eid.htm [6] Case studies. FNRE will publish limited case-study material as long as the appropriate format is followed including the format for references, figures and tables. The conclusions must be supportable by laboratory-based evidence presented within the case study. The authors of case study material are strongly encouraged to study the following websites that may be useful in increasing the likelihood of the material being published (e.g. http://www.bgfl.org/bgfl/18.cfm?s=18&m=473&p =261.index or http://www.bmhlinguistics. org /joomla2/guidelines-for-writing-case-studies). [7] Copyright responsibility. This is the author’s own responsibility. If any figure(s), illustration(s), table(s) or extended quotation(s) etc. are to be taken from material(s) previously published, the author(s) must secure reproduction permission from the copyright owner. Only original papers will be accepted, and copyright of published papers will be retained by the publisher. [8] Transfer of author copyright. Please include a signed release of copyright to Nova Publishers with your manuscript. Include the title of the article being sub-mitted, as well as the date. Include the signatures of co-authors. [9] Manuscript editing. All accepted manuscripts are subject to manuscript editing. [10] The original manuscript and diagrams will be discarded one month after publication unless there is a written request for the material to be returned to the author.

Functional Neurology, Rehabilitation, and Ergonomics requires all authors and reviewers to declare any conflict of interest that may be inherent in their submissions. Conflict-of-Interest Statement Public trust in the peer review process and the credibility of published articles depend in part on how well conflict of interest is handled during writing, peer review, and editorial decision making. Conflict of interest exists when an author (or the author's institution), reviewer, or editor has financial or personal relationships that inappropriately influence (bias) his or her actions (such relationships are also known as dual commitments, competing interests, or competing loyalties). These relationships vary from those with negligible potential to those with great potential to influence judgment, and not all relationships represent true conflict of interest. The potential for conflict of interest can exist whether or not an individual believes that the relationship affects his or her scientific judgment. Financial relationships (such as employment, consultancies, stock ownership, honoraria, paid expert testimony) are the most easily identifiable conflicts of interest and the most likely to undermine the credibility of the journal, the authors, and of science itself. However, conflicts can occur for other reasons, such as personal relationships, academic competition, and intellectual passion. - International Committee of Medical Journal Editors ("Uniform Requirements for Manuscripts Submitted to Biomedical Journals") - February 2006 Statement of Informed Consent Patients have a right to privacy that should not be infringed without informed consent. Identifying information, including patients' names, initials, or hospital numbers, should not be published in written descriptions, photographs, and pedigrees unless the information is essential for scientific purposes and the patient (or parent or guardian) gives written informed consent for publication. Informed consent for this purpose requires that a patient who is identifiable be shown the manuscript to be published. Authors should identify Individuals who provide writing assistance and disclose the funding source for this assistance. Identifying details should be omitted if they are not essential. Complete anonymity is difficult to achieve, however, and informed consent should be obtained if there is any doubt. For example, masking the eye region in photographs of patients is inadequate protection of anonymity. If identifying characteristics are altered to protect anonymity, such as in genetic pedigrees, authors should provide assurance that alterations do not distort scientific meaning and editors should so note. - International Committee of Medical Journal Editors ("Uniform Requirements for Manuscripts Submitted to Biomedical Journals"_ - February 2006 Statement of Human and Animal Rights When reporting experiments on human subjects, authors should indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). If doubt exists whether the research was conducted in accordance with the Helsinki Declaration, the authors must explain the rationale for their approach, and demonstrate that the institutional review body explicitly approved the doubtful aspects of the study. When reporting experiments on animals, authors should be asked to indicate whether the institutional and national guide for the care and use of laboratory animals was followed. - International Committee of Medical Journal Editors ("Uniform Requirements for Manuscripts Submitted to Biomedical Journals") - February 2006