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Cognitive E ects on the Neurophysiology and Biomechanics
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c Solomon Gilbert Diamond,All rights reserved,Thesis advisor Author. Robert D Howe Solomon Gilbert Diamond, Cognitive Effects on the Neurophysiology and Biomechanics. of Stroke Recovery, Motor function recovery after stroke typically plateaus after six months Case re. ports suggest that hypnosis has the potential to stimulate further recovery of function. beyond this period A pilot clinical investigation of hypnosis aided recovery of motor. function after stroke is presented Baseline hand motor performance was quantified. for six stroke subjects with a force following task Brain activity during the task. was measured using functional magnetic resonance imaging fMRI After cognitive. training with hypnosis for improved motor performance subjects performed the task. again Reaction times and muscle contraction and relaxation rates improved signif. icantly after hypnosis and changes persisted during follow up testing at two weeks. Hypnosis versus baseline fMRI results show increased activation extent in bilateral. sensorimotor cortex with an ipsilateral shift in laterality No significant differences. were found in motor performance or fMRI results when the unaffected hand performed. the task as a control condition, The autonomic physiology of hypnosis was studied by correlating heart rate vari. ability HRV model parameters with hypnotic depth and motor performance changes. Modeling the low frequency LF and high frequency HF components in HRV as. Abstract iv, a sum of two sinusoids poses a significant signal processing challenge An Improved.
Prony Algorithm IPA is presented for estimating the frequencies of real valued si. nusoids embedded in noise The variance in estimated frequency is exactly analyzed. for the single sinusoid case and a closed form solution is derived for the estimation of. two sinusoid frequencies, Utilizing IPA the effects of hypnosis on HRV were studied Ten normal subjects. used a lever to dynamically rate their hypnotic depth Principle findings were that. heart rate and HF frequency were negatively correlated with self rated hypnotic depth. whereas HF amplitude was positively correlated IPA analysis of HRV data collected. from stroke subjects in the pilot clinical investigation showed persistent HRV effects. immediately after hypnosis Muscle relaxation rate was correlated with lower heart. rate and higher HF amplitude indicating that the autonomic relaxation effect of hyp. nosis may play a role in the observed motor performance changes The neuroimaging. biomechanical and HRV results of this pilot study justify further investigation of neu. rorehabilitation with hypnosis,Title Page i,Abstract iii. Table of Contents v,Acknowledgments viii,Dedication xiii. 1 Introduction 1,1 1 Mind Body Interactions in Stroke Recovery 3. 1 2 The Physiology of Hypnotic Depth and Hypnotic Effects 4. 1 3 Tracking Motor Function Recovery 6,1 4 Overview of Experiments 6.
2 Hypnosis Aided Recovery of Motor Function After Stroke 8. 2 1 Introduction 8,2 2 Methods 11,2 2 1 Subjects 12. 2 2 2 Experimental Design 13,2 2 3 Motor Function Testing 14. 2 2 4 Functional Brain Imaging 17,2 2 5 Analysis of fMRI Data 18. 2 2 6 Comparisons Between Experimental Conditions 22. 2 3 Results 23,2 3 1 Motor Function Results 23,2 3 2 fMRI Results 27. 2 3 3 Case Descriptions 33,2 4 Discussion 41, 2 4 1 Neurophysiological Bases of Observed Results 42.
2 4 2 Relevance to Other Research 43,2 4 3 Limitations and Lessons Learned 45. 2 4 4 Further Questions 47,Contents vi,3 Real Valued Sinusoid Frequency Estimation 49. 3 1 Introduction 49,3 2 Background 56,3 2 1 The Original Prony Method 56. 3 2 2 Geometric Perspective on the Single Sinusoid Model 57. 3 2 3 The Modified Prony Method 61, 3 2 4 Total Least Squares Modified Prony Method 63. 3 3 The Improved Prony Method for Single Sinusoid Frequency Estimation 64. 3 3 1 Expected Value and Bias 66,3 3 2 Variance and the Cramer Rao Lower Bound 68.
3 3 3 Improving Performance for Band Limited Signals 72. 3 4 Generalizing the Improved Prony Algorithm 75,3 4 1 Forming the Difference Equation Matrix 76. 3 4 2 Calculating the Total Least Squares Homogeneous Solution 76. 3 4 3 Solve for the Frequencies with the Chebyshev Polynomials 77. 3 4 4 Closed form Solution for Two Sinusoids 78,3 4 5 Common Extensions 80. 3 5 Numerical Simulations 83, 3 5 1 Expected Value and Variance of the Modified Covariance Matrix 83. 3 5 2 Variance in Estimated Frequency and Its Approximations 85. 3 5 3 Improved Performance with Resolved Aliasing 87. 3 5 4 Comparison with Other Methods 89, 3 5 5 Performance of the Closed Form Two Sinusoid Model 91. 3 6 Discussion 92, 4 The Effects of Hypnosis on Heart Rate Variability 97.
4 1 Introduction 97,4 2 Methods 102,4 2 1 Experimental Conditions 103. 4 2 2 Deriving the Heart Rate Variability Signal 105. 4 2 3 Statistical Analysis of Heart Rate Variability 106. 4 2 4 Correlating HRV Statistics with Hypnotic Depth 108. 4 2 5 Relating HRV Hypnotic Depth to Motor Performance 109. 4 3 Results 110,4 3 1 Normal Subjects 110,4 3 2 Stroke Subjects 113. 4 4 Discussion 118, 4 4 1 Overall Statistical Changes During Hypnosis 118. 4 4 2 Correlations with Self Rated Hypnotic Depth 120. 4 4 3 Correlations with Motor Performance During Therapy 122. Contents vii,5 Conclusion 125,5 1 Mind Body Interactions in Stroke Recovery 125. 5 2 The Physiology of Hypnotic Depth and Hypnotic Effects 127. 5 3 Tracking Motor Function Recovery 130,5 4 A Framework for Further Study 131.
Bibliography 133,Acknowledgments, The kindness of family colleagues and mentors carried me through this Ph D. program After completing my Bachelors degree at the Thayer School of Engineering. at Dartmouth College I had the whimsical desire to learn a little bit about hypnosis. I saw hypnosis as a way to counterbalance the quantitative rigor of engineering and. help keep my mind healthy My father Charles Diamond encouraged me to take this. interest to a higher level and the next thing I knew I was on a plane to California. where I would study hypnosis in an intensive program for the next four weeks and. become a certified Hypnotherapist I attended the Hypnotherapy Training Institute. in Corte Madera just north of San Francisco The program was run by two of the. most inspirational teachers I have ever met Marleen Mulder and Randal Churchill. They guided me through a new world of experiences in healing and the mind that. changed me forever, During the year that followed I turned back to engineering while working at Syn. ergy Innovations Inc in Lebanon New Hampshire with Dr Robert Dean as my. employer mentor and friend Bob began encouraging me to pursue a doctoral degree. in engineering and his encouragement consisted of long hours spent helping me to. formulate a plan of study and locate sources of funding It was in those discussions. that I first attempted to bridge the gap between the quantitative world of engineering. and the subjectivity of hypnosis Bob then traveled with me to M I T and Harvard. University where he interviewed my potential advisors more thoroughly then they. interviewed me as a candidate We were both impressed with Dr Robert Howe who. runs the Harvard BioRobotics Laboratory and Rob was sufficiently impressed with. me to admit me into the Ph D program,Acknowledgments ix. I proposed to Rob the somewhat far fetched idea that hypnosis could be used. to help with the recovery of stroke patients and furthermore that this effect could. be studied using engineering tools and methodology To my complete surprise he. agreed to give me a year to put together a team and secure funding for the project. I wrote the final paper for a functional neuroimaging class with Dr Robert Savoy. as a pre proposal for my research ideas with hypnosis and stroke The guidance I. received in the class was pivotal to formulating the ideas into a coherent research. project Around the same time I discovered that the Charles A Dana Foundation. was requesting proposals for pilot clinical investigations into brain body effects in. cardiovascular disease and stroke The fit with my interests was perfect and the race. was on to gather a research team and submit by the deadline. I was always nervous making cold calls to researchers in the Harvard community I. would explain my proposal to study the effects of hypnosis on stroke recovery within. an engineering framework and then wince while waiting for someone to say are. you completely out of your mind Instead I found time and again that the people. here are exceptionally open minded and willing to advise and direct me through the. tremendous network of researchers at Harvard Dr Robert Savoy agreed to become. a co investigator on the proposal as did Dr Judith Schaechter a Neuroscientist and. Physical Therapist at Massachusetts General Hospital and Dr Casey Kerrigan a. Physiatrist from Spaulding Rehabilitation Hospital With Dr Robert Howe as the. official lead investigator and this team of co investigators we won the grant from. the Dana Foundation This was an incredibly uplifting experience because so many. people invested time and resources to make this high risk project come to life. Acknowledgments x, I soon met Dr Max Shapiro the Director of Education and Research at the New. England Society of Clinical Hypnosis NESCH Max invited me to participate in the. clinical hypnosis seminars offered by the Society and provided invaluable advise on the. use of hypnosis in stroke recovery At one of the NESCH meetings Max introduced. me to Dr Elvira Lang a Radiologist at the Beth Israel Deaconess Medical Center. and a leader in clinical hypnosis research Elvira further advised my research and. greatly helped me understand the physiology of hypnosis by providing me with hours. of physiological data from her clinical experiments on the effects of hypnosis on pain. and anxiety I am grateful to Noami Halsey and Diana Kim Lee for their hard work. in gathering and analyzing this physiological data. One of the only people in the BioRobotics lab that I did not hypnotize for my. preliminary experiments with hypnosis is my advisor because I was afraid that some. ill informed individual would then question his objectivity toward my work Everyone. else willingly devoted hours of their time as my subjects and as a forum for my ideas. as they developed I would especially like to thank Amy Kerdok Dr Anna Galea. Heather Gunter Dr Yoky Matsuoka Paul Novotny Chris Wagner Ryan Beasley. Aaron Dollar and Tomas Debus and Dr Doug Perrin from the lab for always having. time to help and listen when I was searching for direction and purpose I also need to. thank Guy Rachmuth for helping me survive MIT 9 373 and the many other courses. I have deep respect for and gratitude toward the stroke survivors who participated. in my study The MBTA s The Ride van service was notoriously late for pickups. and as a consequence I spent countless hours listening to stories from the lives of my. Acknowledgments xi, subjects It was from these conversations that I began to understand what it means.
in human terms to have a stroke This part of my education went beyond what any. class or textbook could offer and will stay with me throughout my life. I would also like to thank my committee Dr David Boas inspired me to tackle the. mathematics of signal and image processing in ways that I never thought possible I. admired David s thought process in problem solving and research from the beginning. Dr Garrett Stanley taught me by example how to read engineering journal articles. in neuroscience Because of his inherent interest in mathematics he is one of the. few people in the world who actually read Chapter 3 of this dissertation Through. the expert guidance of Dr Stephen Kosslyn my work may one day rise to a level of. excellence in both engineering and cognitive psychology but I still have a long way. to go Thank you to Dr Jack Dennerlein for helping in my attempts to develop a. systems level model for hypnosis I hope that some day I know enough about this. phenomenon to complete the model Of course none of my success would have been. possible without the constant guidance of my thesis advisor Dr Robert Howe Rob. demonstrated an exceptional ability to stay focused and to keep me focused on even. this most nebulous of projects Rob taught me by example about integrity in research. and teaching I could not have asked for a better advisor. There is no separation between personal and professional life for a graduate stu. dent My wife Diane Ihn Ae Gilbert Diamond has been my advisor critic subject. teacher co investigator editor colleague and partner from before the beginning of. this project and throughout its evolution I am forever grateful for your sacrifices that. made this research and my degree possible During the final weeks of writing our. Acknowledgments xii, daughter Sage was born Sage put the fire in my belly to finally finish this project I. would also like to acknowledge Aji who kept my feet warm during those final weeks. of writing Thank you to my mother Mary Jane Diamond for letting me play in the. sandbox even on the coldest winter days To my father Charles Diamond thank you. for teaching me to question every manifestation of life To Diane s parents Dr Robert. and Ihn Jae Gilbert thank you for your steadfast support and kindness I truly stand. here today on the shoulders of giants,Dedicated to my wife Diane. and my daughter Sage,Introduction, Stroke can inflict devastating injury to the human brain and mind Imagine. waking up unable to move your body to one side of an imaginary line from head to. toe right down your middle You are able to think of words but incapable of calling. out Your life physical function and mental capacity all hang in the balance This. is only the beginning of a nightmare scenario Those who survive a stroke are faced. with a recovery process that can be the most challenging physical and mental struggle. of a lifetime, Science does not fully understand the complexity of this injury to the brain nor. all the ways that the brain can heal The benefits of modern medicine to the stroke. survivor are great but limited by our lack of understanding These limitations are. keenly felt when progress in physical therapy stops and yet significant physical im. pairments still remain For most stroke survivors this plateau is reached six months. to a year after the stroke occurred As the benefits of physical therapy lessen so does. the availability of insurance reimbursements for ongoing care leaving most survivors. Chapter 1 Introduction 2,on their own, Despite the recommendations of health care professionals who advise learning.
strategies to cope with remaining physical impairments some stroke survivors vig. orously pursue alternative therapies with the hope of making further fundamental. improvements in motor function One such alternative therapy is hypnosis. Hypnosis in the clinical setting is vastly different from the stage hypnotist shows. that frequent comedy clubs and college campuses Controlled clinical trials have. proven that hypnosis is effective for non pharmacological analgesia 4 60 and for. treating even severe refractory irritable bowel syndrome 44 113 among other med. ical conditions In the case of stroke rehabilitation however while it is known that. psychological factors are important 53 the scientific literature on hypnosis for neu. rorehabilitation consists mainly of case reports, The available case reports show a trend of positive results when hypnosis is incor. porated into standard therapy 2 Spontaneous improvements in motor function have. been observed during hypnosis sessions 15 21 63 and improvements have occurred. after recovery by other means has plateaued 42 59 The common hypnotic method. used is to perform physical movements while vividly remembering a time prior to the. stroke event This is a process known as hypnotic regression 36 58. While the available reports encourage the hypothesis that hypnosis can have a. positive effect on the recovery of motor function after stroke there is insufficient. quantitative evidence to draw any well founded conclusions The motivation for the. present research was to use biomedical engineering tools and knowledge to generate. quantitative evidence of the benefits of hypnosis applied to neurorehabilitation to.


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