At the end of the late Middle Ages, there had been changes in indications for surgery, with prophylactic trepanation falling out of favor. The management of wounds and the methods for opening the cranium had become fairl...At the end of the late Middle Ages, there had been changes in indications for surgery, with prophylactic trepanation falling out of favor. The management of wounds and the methods for opening the cranium had become fairly standardized. Narrow non-plunging trepans were the preferred drills, and cranial openings were widened by the use of multiple drill holes connected with chisels of which the lenticular was preferred. Concerns about damaging the dura led Theodoric to delay trepanation until the clinical changes reflected separation of the dura from the cranium, at least in his view. Draining pus remained the main indication for trepanation. In no case was the level of consciousness considered in determining the need to open the cranium.
The larger part of this chapter is concerned with the technique of drilling the cranium with a circular saw called a trepan or trephine. The terminology of the instrument is outlined. Safe use of the instrument includes...The larger part of this chapter is concerned with the technique of drilling the cranium with a circular saw called a trepan or trephine. The terminology of the instrument is outlined. Safe use of the instrument includes probing the groove produced by its use and angling the drill so that it impinges on bone which hitherto has not been sawn through. There is then an account of how larger openings may be made by drilling multiple small holes and connecting them by means of a chisel.
The period described in this chapter reflects activity prior to the establishment of surgical centers in Europe in the twelfth century. It is a kind of prologue to the reintroduction of high-quality surgical practice. Re...The period described in this chapter reflects activity prior to the establishment of surgical centers in Europe in the twelfth century. It is a kind of prologue to the reintroduction of high-quality surgical practice. Religious squabbles within Christianity led to European medicine and surgery, the principles of which were written in Greek, being transported eastwards into the region newly dominated by Islam. There the works were translated into Arabic and during three to four hundred years, the works were not only retained but were enriched by contributions from within Arab culture. This evolution naturally enough came to affect what happened next. However, one thing is clear and was even commented on as early as by Albucasis. The surgeon's respect and distinction within society had depreciated during the sojourn of medical science in the Islamic world, with physicians being regarded as distinctly superior beings. With regard to specific details related to opening the head there was broad consistency between the various authors all of whom seem to have been greatly influenced by Paul of Ægina. Thus, there is no mention of the crown trepan. Opening the skull was performed with the non-perforating trepans making small holes which were connected with chisels or lenticulars. The indication to do this was separation of the dura from the bone. Whether or not the sutures should be avoided when trepanning is not a topic mentioned in these writings. There was also no recommendation for prophylactic trepanation.
The chapter reviews certain topics in outline. It starts with a brief account of the nature of surgery. This is followed by a short account of modern management of cranial trauma including the evolution of notions of ana...The chapter reviews certain topics in outline. It starts with a brief account of the nature of surgery. This is followed by a short account of modern management of cranial trauma including the evolution of notions of anatomy and pathophysiology. It is emphasized that these principles are and must be irrelevant to the management of cranial trauma in the period covered in this book from Hippocrates to the end of the 18th century. Historical errors arising from assuming modern principles applied in historical practice are mentioned. Finally, the risks inherent in accepting images without questioning their authorship and provenance is also mentioned.
There is a well-recognized, yet nuanced, positive relationship between acute physical activity and cognitive function. However, the precise impact of exercise intensity remains ambiguous. We tested learning and memory, w...There is a well-recognized, yet nuanced, positive relationship between acute physical activity and cognitive function. However, the precise impact of exercise intensity remains ambiguous. We tested learning and memory, working memory and processing speed, and motor speed and accuracy across three distinct exercise intensities. A sample of 207 participants (100 female) between 18 and 44 years (mean age: 22.5±3.7years) completed all study procedures. Utilizing a within-subjects, cross-over design, participants completed moderate (35% VO Max), vigorous (70% VO Max), and sedentary (no exercise) conditions. Cognitive and motor assessments, including the Paced Auditory Serial Addition Test (PASAT), Rey Auditory Verbal Learning Test (RAVLT), Typing Speed Test, and Ten Key Data Entry Task, were conducted approximately 60min post-exercise. There were no significant differences in primary cognitive or motor outcome measures across the three exercise intensities, even with the study being strongly powered. There was, however, a small difference on the fastest trial of the PASAT, where vigorous-intensity exercise yielded slightly better performance compared to both sedentary and moderate-intensity exercise. This effect was no longer significant when including VO Max or maximum heart rate as indicators of fitness. There were no interactions on outcome variables by exercise intensity when including biological sex in the models. Thus, a single bout of acute exercise, regardless of its intensity, did not alter cognitive and motor performance when measured approximately 1h post-exercise. Findings highlight the importance of large samples and suggest that the temporal dynamics post-exercise might play a pivotal role in cognitive outcomes.
There is a relationship between acute bouts of aerobic exercise and cognition in adults, yet the exact nature of this relationship remains unclear. The current pilot study aims to investigate how different modes of cycli...There is a relationship between acute bouts of aerobic exercise and cognition in adults, yet the exact nature of this relationship remains unclear. The current pilot study aims to investigate how different modes of cycling (active-assisted cycling vs recumbent cycling) at different moderate-to-vigorous physical activity (MVPA) intensity levels (prescribed 65-70% Heart Rate Max and self-selected 12-13 Rate of Perceived Exertion) modulate neurocognitive, and behavioral markers of cognition in healthy older adults. A sample of 10 adults (aged 50-74years) participated in baseline (no exercise), active-assisted, and recumbent cycling interventions at different intensity levels. The P3 event-related potential (ERP), a neural index of executive functions, was recorded at baseline and following each exercise condition during an auditory odd-ball paradigm. Results revealed that greater amplitudes within the P3 ERP component were associated with post-exercise recumbent bike cycling compared to baseline and active-assisted cycling. Further, post-exercise behavioral cognitive measures (i.e., button press accuracy) were significantly greater than baseline for both active-assisted and recumbent bikes at both intensity levels. These findings suggest that exercise modulated both neurocognitive and behavioral measures of executive functions in older healthy adults, and that exercise modalities and intensity levels differentially modulate neurocognitive measures.
An increasing number of studies have linked engagement in sport or increased physical fitness with improved cognitive performance. Additionally, studies have employed physical activity as an intervention to help with cog...An increasing number of studies have linked engagement in sport or increased physical fitness with improved cognitive performance. Additionally, studies have employed physical activity as an intervention to help with cognition in aging individuals. Despite this, the underlying mechanism (or mechanisms) by which benefits occur remain unclear. We investigated whether improved trainability for individuals engaged in sport or fitness training might underlie such benefits. Specifically, we assessed motor skill performance and learning rates in young adult runners, baseball players, and "control" individuals who did not regularly engage in sport or exercise using an implicit motor sequence learning task. Better initial performance on the task was seen for both the runner group and the baseball group but no benefits were seen for the baseball/runner groups for rates of improvement on the task. This was the case for both non-specific learning (or general motor skill learning-learning not associated with specific sequences of responses) and for sequence-specific learning (or improvement on repeated sequences of responses that participants were not aware of). This pattern may mean that either engagement in sport/physical activity results in improvements that are transferable beyond the context of the sport/training activity or that engagement in sport/exercise may relate to initial differences in the motor competence of an individual. Further work could beneficially investigate learning in more directly cognitive-related tasks and consolidation/improvement of performance over more prolonged time periods. Importantly, assessment of a fitness/sport intervention on performance and learning rates may provide a better context for some of the benefits reported in cross-sectional investigations of the effects of sport/fitness on cognition and aid in determining which differences are due to engaging in exercise and which differences affect the tendency for such engagement.
Physical activity has been viewed as a potential non-pharmacological therapeutic strategy to improve the clinical symptoms and neurocognitive deficits in patients with schizophrenia. However, there are various types of p...Physical activity has been viewed as a potential non-pharmacological therapeutic strategy to improve the clinical symptoms and neurocognitive deficits in patients with schizophrenia. However, there are various types of physical activities, and different exercise prescriptions might produce inconsistent benefits. Thus, this study aimed to conduct a systematic review of exercise interventions for patients with schizophrenia, clarifying the benefits of these interventions on cognitive function and clinical symptoms. This review encompasses six electronic databases, with inclusion criteria including randomized controlled trial designs, participants with schizophrenia, and a comprehensive exercise intervention program. Twenty-seven studies met the inclusion criteria, incorporating data from 1549 patients with schizophrenia. The results highlight that when comparing the exercise intervention group to the non-intervention control group, patients with schizophrenia showed significant improvement in negative symptoms. Structured exercise interventions can help improve the negative symptoms of schizophrenia, filling the gaps where medication falls short. Regarding functional outcomes, exercise interventions aid in enhancing the overall functionality (psychological, social, occupational) of individuals with schizophrenia. The improvement is largely tied to the boost in physical fitness that exercise provides. Based on current findings, exercise interventions assist in enhancing cognitive function in patients with schizophrenia. Notably, significant improvements are observed in higher-order cognitive functions, including processing speed, attention, and working memory. It is recommended to engage in moderate-intensity exercises at least three times a week, with each session lasting a minimum of 30min. Well-structured exercise interventions contribute to enhancing the negative symptoms and cognitive functions in patients with schizophrenia.
Physical exercise confers numerous benefits to brain structure, function and cognition, however, considerable individual variability exists in these effects. Emerging paradigms focused on intraindividual dynamics provide...Physical exercise confers numerous benefits to brain structure, function and cognition, however, considerable individual variability exists in these effects. Emerging paradigms focused on intraindividual dynamics provide novel opportunities to map and leverage individualized neural architectures underlying exercise-cognition relationships. Progress at the intersection of psychometrics, structural and functional neuroimaging, electrophysiology, and genetics can be integrated to elucidate each individual's potential for improvement, as well as the specific abilities that are most likely to benefit from exercise regimens. These personalized profiles can then guide targeted exercise programs tailored to effectively modulate the pathways identified as most promising for that individual. Such mapping-guided exercise interventions tailored to a person's neurocognitive profile allows optimizing cognitive improvements compared to results elicited by generic regimens. While still in its infancy, precision interventions represent an innovative future direction to advance exercise in support of brain health, toward potent, truly personalized cognitive enhancement.
The literature suggesting acute exercise benefits cognitive function has been largely confined to single cognitive domains and measures of reliant on measures of central tendencies. Furthermore, studies suggest cognitive...The literature suggesting acute exercise benefits cognitive function has been largely confined to single cognitive domains and measures of reliant on measures of central tendencies. Furthermore, studies suggest cognitive intra-individual variability (IIV) to reflect cognitive efficiency and provide unique insights into cognitive function, but there is limited knowledge on the effects of acute exercise on IIV. To this end, this study examined the effects of acute exercise on three different cognitive domains, executive function, implicit learning, and hippocampal-dependent memory function using behavioral performance and event-related potentials (ERPs). Furthermore, this study also sought to explore the effects of an acute bout of exercise on IIV using the RIDE algorithm to separate signals into individuals components based on latency variability. Healthy adult participants (N=20; 26.3±4.8years) completed a randomized cross-over trial with seated rest or 30min of high intensity cycling. Before and after each condition, participants completed a cognitive battery consisting of the Eriksen Flanker task, implicit statistical learning task, and a spatial reconstruction task. While exercise did not affect Flanker or spatial reconstruction performance, there were exercise related decreases in accuracy (F=5.47; P=0.040), slowed reaction time (F=5.18; P=0.036), and decreased late parietal positivity (F=4.26; P=0.046). However, upon adjusting for performance and ERP variability, there were exercise related decreases in Flanker reaction time (F=24.00; P<0.001), and reduced N2 amplitudes (F=13.03; P=0.002), and slower P3 latencies (F=3.57; P=0.065) for incongruent trials. These findings suggest that acute exercise may impact cognitive IIV as an adaptation to maintain function following exercise.
Prior research has highlighted the potential impact of aerobic exercise on cognitive functioning, particularly in situations demanding heightened cognitive control. However, the mechanism underlying this cognitive enhanc...Prior research has highlighted the potential impact of aerobic exercise on cognitive functioning, particularly in situations demanding heightened cognitive control. However, the mechanism underlying this cognitive enhancement has remained unknown. To address this issue, this study examined the impact of a 4-week aerobic exercise program on cognitive control processes in young male adults (aerobic exercise group: n=36, aged 21.42±1.13years) in comparison to a control group that received no treatment (n=33, aged 21.82±1.76years). We employed the redundant-target Stroop task to investigate inhibition processes at both perceptual and semantic stages. Utilizing systems factorial technology and the drift diffusion model, we assessed changes in resilience capacity and the underlying cognitive mechanisms. Our primary findings revealed a significant reduction in mean response times (RTs) in the aerobic exercise group, accompanied by a decrease in RT variability when inhibiting semantic processing. Resilience capacity significantly declined in both groups at similar levels. Notably, the aerobic exercise group exhibited an enhanced drift rate during automatic response inhibition and reduced non-decision time in the condition involving the inhibition of perceptual information. This study deepens our understanding of how a 4-week aerobic exercise program enhances cognitive control, affecting distinct cognitive processes, including processing speed, information accumulation during automatic response inhibition, and sensory and motor processes in perceptual conflicts. Our research underscores the potential of aerobic exercise as a means to boost cognitive control among young adults.
Executive functions (EFs) play a pivotal role in daily functioning, academic and vocational achievement, well-being, and the regulation of cognitive processes that impact the quality of life. Physical exercise has been s...Executive functions (EFs) play a pivotal role in daily functioning, academic and vocational achievement, well-being, and the regulation of cognitive processes that impact the quality of life. Physical exercise has been shown to have positive effects on EFs. However, there remains some controversy regarding whether exercise with greater cognitive loads may be more effective for improving EFs. Through this systematic review, we aimed to synthesize available cross-sectional and longitudinal intervention studies concerning the effects of exercise with varying cognitive loads on EFs. The literature search was conducted across three electronic databases, retrieving cross-sectional and longitudinal intervention (randomized controlled trials) studies, using a standardized EF measurement from inception until June 2023. Our search yielded a total of 1570 potentially relevant articles, of which 53 were considered for full-text reading, and 28 were included in the review after full-text reading. The present study utilized Gentile's (2000) taxonomy classification to determine the cognitive load levels in exercises. Overall, findings from the 28 included studies suggested that exercise training interventions are a promising way to promote overall EF. Noteworthy, there is preliminary empirical evidence to suggest that exercises with higher cognitive loads resulted in greater benefits for EF than those with lower cognitive loads.
The aim of the present study was to examine the associations of adiposity and fitness on the preadolescent brain's response to acute exercise. In a sample of 58 children (ages 8-10; 19 females), demographic measures of a...The aim of the present study was to examine the associations of adiposity and fitness on the preadolescent brain's response to acute exercise. In a sample of 58 children (ages 8-10; 19 females), demographic measures of age, sex, IQ, puberty, and socioeconomic status were considered. Children participated in a randomized crossover study, whereby they completed two different interventions; seated rest or treadmill walking, counterbalanced across participants. Associations between adiposity measures (standardized body mass index [BMI-Z], whole body percent fat [%Fat], visceral adipose tissue [VAT]), cardiorespiratory fitness measures (VOmax and Fat-Free VO) were assessed on self-reported measures of mental wellbeing, and cognitive performance (response accuracy, reaction time) and neuroelectric (P3 amplitude and latency) indices of a Go/NoGo task following both exercise and rest interventions. Higher adiposity (whole-body percent fat, BMI-Z) was associated with higher trait anxiety (P's≤0.05) and disordered eating (P's≤0.05) scores. Higher fitness (VOmax) was associated with lower childhood depression scores (P=0.02). Regression analyses yielded specific post-exercise neurocognitive associations with adiposity-related (VAT, BMI-Z), and fitness-related (FF-VO) outcomes, after controlling for post-rest neurocognitive outcomes. VAT was positively associated with post-exercise P3 ERP Latency for the Go task (P≤0.001); BMI-Z was negatively associated with P3 ERP amplitudes for the Go task (P's≤0.005); FF-VO was negatively associated with P3 ERP latency for the Go/NoGo task (P's≤0.05), and positively associated with NoGo task accuracy (P≤0.001). Overall, adiposity and fat-free fitness measures yield sensitive and differential associations with neurocognitive performance after exercise and after rest interventions.
Increasing studies have observed the benefit of acute exercise on core executive functions (EFs). However, the effects of high-order EFs (i.e., metacognition) are poorly investigated. Additionally, the beneficial effect...Increasing studies have observed the benefit of acute exercise on core executive functions (EFs). However, the effects of high-order EFs (i.e., metacognition) are poorly investigated. Additionally, the beneficial effect varies depending on exercise-related variables (e.g., intensity, duration). Exercise volume, represented by exercise intensity and duration, is one approach to examine the relationship between acute exercise and metacognition. Therefore, this study aims to investigate the effects of acute exercise, involving three volume-matched evaluations, on metacognition in late middle-aged adults. It recruited 40 community-dwelling late middle-aged adults (22 females; M=61.05±4.17years). Its counterbalanced and repeated-measure experimental design included a control reading session and three exercise sessions: (1) acute moderate-intensity exercise for 30min, (2) higher-intensity exercise for 16min, and (3) lower-intensity exercise for 40min. After each session, all participants were asked to perform the Tower of London (TOL) task to assess their metacognition related to planning and problem-solving. This study showed that regardless of exercise intensity and duration variation, acute exercise led to higher move-related (i.e., total correct and move scores) and time-related (i.e., total executive and problem-solving times) scores but did not affect total initial time and violation-related scores compared to reading treatment. These findings suggest enhanced performance in metacognition after acute exercise regardless of its intensity and duration variation.
Numerical cognition is an essential skill for survival, which includes the processing of discrete and continuous quantities, involving a mainly right fronto-parietal network. However, the neurocognitive systems underlyin...Numerical cognition is an essential skill for survival, which includes the processing of discrete and continuous quantities, involving a mainly right fronto-parietal network. However, the neurocognitive systems underlying the processing and integration of discrete and continuous quantities are currently under debate. Noninvasive brain stimulation techniques have been used in the study of the neural basis of numerical cognition with a spatial, temporal and functional resolution superior to other neuroimaging techniques. The present randomized sham-controlled single-blinded trial addresses the involvement of the right dorsolateral prefrontal cortex and the right intraparietal sulcus in magnitude processing and integration. Multifocal anodal transcranial direct current stimulation was applied online during the execution of magnitude comparison tasks in three conditions: right prefrontal, right parietal and sham stimulation. The results show that prefrontal stimulation produced a moderated decrease in response times in all magnitude processing and integration tasks compared to sham condition. While parietal stimulation had no significant effect on any of the tasks. The effect found is interpreted as a generalized improvement in processing speed and magnitude integration due to right prefrontal neuromodulation, which may be attributable to domain-general or domain-specific factors.
Numerical skills are part of cognitive and formal education development, and low performance in math has been associated with adverse features such as low income and unemployment. The studies of functional magnetic reson...Numerical skills are part of cognitive and formal education development, and low performance in math has been associated with adverse features such as low income and unemployment. The studies of functional magnetic resonance imaging (fMRI) activation in numerical Stroop interference had been accomplished to evidence neural correlates of numerical, automatic, and controlled processes. The aim of this research was to summarize the results of the neural correlates of a number-size congruity task through meta-analysis of fMRI, behavioral evidence, and connectometry. Our study includes 15 fMRI papers (total number of subjects n=155-302, the total number of foci=81-233). Meta-analyses used an activation likelihood estimation (ALE) logarithm. For connectometry, it was used the diffusion tensor image. We found that, for the attentional control numerical Stroop effect, the activated areas were the dorsolateral prefrontal cortex, the anterior cingulate gyrus, and the intraparietal sulcus. Consistent activation over both paradigms was found in five clusters, two in the frontal and three in the parietal lobe. The matrix of connectivity showed connections between insula and inferior parietal right with 587 fibers, cingulate gyrus, and inferior parietal right with 843 fibers. Both paradigms activate parietal areas but differ in the activation of regions correlated to attentional control. The results of these meta-analyses summarized results from fMRI studies that may contribute to current theories. The results of connectometry could be interpreted regarding the fibers connection between the clusters right inferior parietal with insula and cingulate gyrus that suggests the integration of information.
Eye tracking is one of the techniques used to investigate cognitive mechanisms involved in the school context, such as joint attention and visual perception. Eye tracker has portability, straightforward application, cost...Eye tracking is one of the techniques used to investigate cognitive mechanisms involved in the school context, such as joint attention and visual perception. Eye tracker has portability, straightforward application, cost-effectiveness, and infant-friendly neuroimaging measures of cognitive processes such as attention, engagement, and learning. Furthermore, the ongoing software enhancements coupled with the implementation of artificial intelligence algorithms have improved the precision of collecting eye movement data and simplified the calibration process. These characteristics make it plausible to consider eye-tracking technology a promising tool to assist the teaching-learning process in school routines. However, eye tracking needs to be explored more as an educational instrument for real-time classroom activities and teachers' feedback. This perspective article briefly presents the fundamentals of the eye-tracking technique and four illustrative examples of employing this method in everyday school life. The first application shows how eye tracker information may contribute to teacher assessment of students' computational thinking in coding classes. In the second and third illustrations, we discuss the additional information provided by the eye-tracker to the teacher assessing the student's strategies to solve fraction problems and chart interpretation. The last illustration demonstrates the potential of eye tracking to provide Real-time feedback on learning difficulties/disabilities. Thus, we highlight the potential of the eye tracker as a complementary tool to promote personalized education and discuss future perspectives. In conclusion, we suggest that an eye-tracking system could be helpful by providing real-time student gaze leading to immediate teacher interventions and metacognition strategies.
Current theories postulate that numerical processing depends upon a brain circuit formed by regions and their connections; specialized in the representation and manipulation of the numerical properties of stimuli. It has...Current theories postulate that numerical processing depends upon a brain circuit formed by regions and their connections; specialized in the representation and manipulation of the numerical properties of stimuli. It has been suggested that the damage of these network may cause Developmental Dyscalculia (DD): a persistent neurodevelopmental disorder that significantly interferes with academic performance and daily life activities that require mastery of mathematical notions and operations. However, most of the studies on the brain foundations of DD have focused on regions of interest associated with numerical processing, and have not addressed numerical cognition as a complex network phenomenon. The present study explored DD using a Graph Theory network approach. We studied the association between topological measures of integration and segregation of information processing in the brain proposed by Graph Theory; and individual variability in numerical performance in a group of 11 school-aged children with DD (5 of which presented with comorbidity with Developmental Dyslexia, the specific learning disorder for reading) and 17 typically developing peers. A statistically significant correlation was found between the Weber fraction (a measure of numerical representations' precision) and the Clustering Index (a measure of segregation of information processing) in the whole sample. The DD group showed significantly lower Characteristic Path Length (average shortest path length among all pairs of regions in the brain network) compared to controls. Also, differences in critical regions for the brain network performance (hubs) were found between groups. The presence of limbic hubs characterized the DD brain network while right Temporal and Frontal hubs found in controls were absent in the DD group. Our results suggest that the DD may be associated with alterations in anatomical brain connectivity that hinder the capacity to integrate and segregate numerical information.