Background:Gait impairment is a major long-term consequence of acquired brain injury and remains difficult to treat in the chronic phase. Robot-assisted gait training can deliver high-intensity repetitive practice, but robotic assistance alone may not fully engage central motor processes; motor imagery may complement this limitation. Objective:The primary aim was to evaluate the feasibility of an integrated protocol combining robotic gait training with structured motor imagery in adults with chronic acquired brain injury; a secondary, exploratory, aim was to characterize preliminary clinical signals and kinematic parameters observed in associated with the protocol. Methods:Seven adults completed 12 sessions over 4 weeks (3 sessions/week, about 30 min of active robotic walking per session). Outcomes included gait kinematics at baseline, post-intervention, and 3-month follow-up, plus Berg Balance Scale and 6-Minute Walk Test at baseline and post-intervention. Gait variables were analysed during both single-task and dual-task walking. Results:Clinical outcomes improved from baseline to post-intervention (Berg Balance Scale and 6-Minute Walk Test). For gait outcomes, session effects indicated improvement over time in temporal efficiency and phase organization on the more-affected limb, and task type effects were observed in key spatiotemporal variables, with expected dual-task costs maintained. Conclusions:This preliminary study supports the feasibility of combining robotic gait training with motor imagery in chronic acquired brain injury and provides exploratory, hypothesis-generating signals of concurrent clinical and kinematic change, to be tested in future controlled studies.

It is well known that social interaction enhances learning processes, improving abilities such as attention and memorization. However, it is not clear whether similar advantages may be obtained even in virtual environments. Here, we investigate whether virtual interactions in a video game, similarly to real-life social interactions, may improve individuals' performance in a subsequent implicit learning task. Twenty-one healthy participants were asked to play a cooperative video game for 20 minutes in three different gaming modalities: alone (Single-Player); together with someone without verbal interactions (Multi-Player -); and with someone with verbal interactions (Multi-Player +). After each gaming session, participants were presented with an EEG paradigm directed to measure mismatch negativity (MMN) responses, a well-validated index of implicit learning. MMN responses were significantly larger following Multi-Player +, as compared with Single-Player, and Multi-Player - conditions. No significant difference was found between Single-Player, and Multi-Player - conditions. These results indicate that implicit learning processes are enhanced following communicative virtual interactions. Verbal interaction in a virtual environment seems necessary to elicit social copresence and its positive effects on learning performances. This finding may have important implications for the design of virtual rehabilitation protocols and distance learning programs.

This paper reviews biophysical models of psychotherapeutic change based on synergetics and the free energy principle. These models suggest that introducing sensory surprise into the patient-therapist system can lead to self-organization and the formation of new attractor states, disrupting entrenched patterns of thoughts, emotions, and behaviours. We propose that the therapist can facilitate this process by cultivating epistemic trust and modulating embodied attention to allow surprising affective states to enter shared awareness. Transient increases in free energy enable the update of generative models, expanding the range of experiences available within the patient-therapist phenomenal field. We hypothesize that patterns of disorganization at behavioural and physiological levels, indexed by increased entropy, complexity, and lower determinism, are key markers and predictors of psychotherapeutic gains. Future research should investigate how the therapist's openness to novelty shapes therapeutic outcomes.

Shared attention effects on learning and memory demonstrate that experiences are amplified when we are not alone. Virtual reality poses new challenges to the study of co-presence. Above all, is coattending together with someone else’s avatar in an immersive VR setting comparable with shared experiences at a neural processing level? In the present study we investigate shared attention effects in VR for the first time. We recorded mismatch negativities (MMN) during an auditory roving paradigm, a well-known index of implicit perceptual learning. EEG responses to deviant and standard sounds were registered while subjects were alone (Solo condition) or together (Other condition) with a virtual avatar (Virtual scenario) or physically present confederate (Physical scenario). We found an overall main effect of co-presence on MMN revealed by a point-by-point 2 × 2 ANOVA, thereby replicating previous studies on physical co-presence. Additionally, we found no significant interaction between the scenario (Physical vs. Virtual) and co-presence (Solo vs. Other). Our results indicate that virtual immersive co-presence mimics physical co-presence.

Introduction:Stroke-related deficits often include motor impairments and gait dysfunction, leading to a limitation of social activities and consequently affecting the quality of life of stroke survivors. Neurorehabilitation takes advantage of the contribution of different techniques in order to achieve more benefits for patients. Robotic devices help to improve the outcomes of physical rehabilitation. Moreover, motor imagery seems to play a role in neurological rehabilitation since it leads to the activation of the same brain areas as actual movements. This study investigates the use of a combined physical and cognitive protocol for gait rehabilitation in stroke patients.Methods:Specifically, we tested the efficacy of a 5-week training program using a robotic orthosis (P.I.G.R.O.) in conjunction with motor imagery training. Twelve chronic stroke patients participated in the study. We evaluated balance and gait performance before and after the training. Six of them underwent fMRI examination before and after the training to assess the effects of the protocol on brain plasticity mechanisms in motor and imagery tasks.Results:Our results show that the rehabilitation protocol can effectively improve gait performance and balance and reduce the risk of falls in stroke patients. Furthermore, the fMRI results suggest that rehabilitation is associated with cerebral plastic changes in motor networks.Discussion:The present findings, if confirmed by future research, have the potential to advance the development of new, more effective rehabilitation approaches for stroke patients, improving their quality of life and reducing the burden of stroke-related disability.

Pursuing new knowledge in the entropic environment is pivotal for survival. However, dealing with uncertainty is a costly challenge for the agent surrounded by the stochastic sensory world, giving rise to different epistemic emotions, such as curiosity and anxiety. We recently proposed that aesthetic appreciation may have the role of associating pleasant feedback with the update of predictive representations. According to this idea, aesthetic appreciation and its associated rewarding feeling could drive people to seek new knowledge over anxiety. However, the relationship between aesthetic appreciation, curiosity, and anxiety has been still under-examined in the literature. Here, we explore the relationship between these epistemic emotions in a series of three experiments. In study 1, we examined whether music-induced aesthetic appreciation would influence curiosity in a gambling task. In studies 2a and 2b, we explore the relationship between music-induced aesthetic appreciation and anxiety state. Overall, aesthetic appreciation promoted curiosity-driven behaviour while it was negatively associated with anxiety. These results were consistent with the idea that aesthetic appreciation could act as a ‘valve’, prompting the individual to perceive curiosity (i.e. to consider novelty as a valuable opportunity to acquire new knowledge) rather than anxiety (i.e. to consider novelty as a risk to be avoided). This article is part of the theme issue ‘Art, aesthetics and predictive processing: theoretical and empirical perspectives’.

Telemedicine and e-health services are considered fundamental pillars to ensure the sustainability of the health system in the next future. In fact, the aging of the population, and the consequent growing percentage of people suffering from neurological pathologies and related disabilities, require more and more resources from healthcare facilities in terms of monitoring and rehabilitation services. Solutions based on Information and Communication Technologies can support new patient care and disease management strategies, by deploying telemedicine applications and services. In this context, the paper presents the integrated platform implemented in the "REHOME" project, for the remote monitoring and rehabilitation of cognitive, motor, and sleep disorders caused by neurological diseases. The solution integrates sensors and innovative methodologies to face patients' and clinical needs by ensuring the continuity of care and rehabilitation services from health facilities to domestic scenarios.

Prospect Theory, proposed and developed by Kahneman and Tversky, demonstrated that people do not make rational decisions based on expected utility, but are instead biased by specific cognitive tendencies leading to neglect, under- or over- consider information, depending on the context of presentation. In this vein, the present paper focuses on whether and how individual decision-making attitudes are prone to change in the presence of globally challenging events. We ran three partial replications of the Kahneman and Tversky (1979) paper, focusing on a set of eight prospects, after a terror attack (Paris, November 2015, 134 subjects) and during the Covid-19 pandemic, both during the first lockdown in Italy (Spring 2020, 176 subjects) and after the first reopening (140 subjects). The results confirm patterns of choice characterizing uncertain times, as shown by previous literature. In particular, we note significant increase of risk aversion, both in the gain and in the loss domains, that consistently emerged in the three replications. Given the nature of our sample, and the heterogeneity between the three periods investigated, we suggest that the phenomenon we present can be explained stress-related effects on decision making rather than by other economic effects, such as the income effect.

Can preferred music listening improve following attentional and learning performances? Here we suggest that this may be the case. In Experiment 1, following preferred and non-preferred musical-piece listening, we recorded electrophysiological responses to an auditory roving-paradigm. We computed the mismatch negativity (MMN - the difference between responses to novel and repeated stimulation), as an index of perceptual learning, and we measured the correlation between trial-by-trial EEG responses and the fluctuations in Bayesian Surprise, as a quantification of the neural attunement with stimulus informational value. Furthermore, during music listening, we recorded oscillatory cortical activity. MMN and trial-by-trial correlation with Bayesian surprise were significantly larger after subjectively preferred versus non-preferred music, indicating the enhancement of perceptual learning. The analysis on oscillatory activity during music listening showed a selective alpha power increased in response to preferred music, an effect often related to cognitive enhancements. In Experiment 2, we explored whether this learning improvement was realized at the expense of self-focused attention. Therefore, after preferred versus non-preferred music listening, we collected Heart-Beat Detection (HBD) accuracy, as a measure of the attentional focus toward the self. HBD was significantly lowered following preferred music listening. Overall, our results suggest the presence of a specific neural mechanism that, in response to aesthetically pleasing stimuli, and through the modulation of alpha oscillatory activity, redirects neural resources away from the self and toward the environment. This attentional up-weighting of external stimuli might be fruitfully exploited in a wide area of human learning activities, including education, neurorehabilitation and therapy.

E-learning activities are becoming more and more common. Whilst it is well known that the physical presence of others motivates individuals to engage in perceptual and learning tasks, systematic investigations comparing the effects of physical and virtual co-presence of others on knowledge acquisition are still scarce. Here we investigate the effects of physical and virtual co-presence of others on explicit and implicit learning. In Experiment 1 (discovery sample), retrieval accuracy in a spatial memory task and EEG indexes (mismatch negativity-MMN) of implicit perceptual learning were recorded when participants were alone or in presence of another individual. In Experiment 2 (replicating sample), we added a "virtual" condition, where the same tasks were performed during a video-conference call. In both experiments, MMN was demonstrated to encode for perceptual learning as revealed by the significant correlation with Bayesian Surprise (a consolidated information-theoretic index of Bayesian learning). Furthermore, In Experiments 1 and 2 physical co-presence systematically ameliorated memorization performances and increased MMN indexes related to implicit learning. These positive effects were absent in the virtual condition, thus suggesting that only physical, but not virtual co-presence is effective in potentiating learning dynamics.

Drawing from field theory, Gestalt therapy conceives psychological suffering and psychotherapy as two intentional field phenomena, where unprocessed and chaotic experiences seek the opportunity to emerge and be assimilated through the contact between the patient and the therapist (i.e., the intentionality of contacting). This therapeutic approach is based on the therapist’s aesthetic experience of his/her embodied presence in the flow of the healing process because (1) the perception of beauty can provide the therapist with feedback on the assimilation of unprocessed experiences; (2) the therapist’s attentional focus on intrinsic aesthetic diagnostic criteria can facilitate the modification of rigid psychopathological fields by supporting the openness to novel experiences. The aim of the present manuscript is to review recent evidence from psychophysiology, neuroaesthetic research, and neurocomputational models of cognition, such as the free energy principle (FEP), which support the notion of the therapeutic potential of aesthetic sensibility in Gestalt psychotherapy. Drawing from neuroimaging data, psychophysiology and recent neurocognitive accounts of aesthetic perception, we propose a novel interpretation of the sense of beauty as a self-generated reward motivating us to assimilate an ever-greater spectrum of sensory and affective states in our predictive representation of ourselves and the world and supporting the intentionality of contact. Expecting beauty, in the psychotherapeutic encounter, can help therapists tolerate uncertainty avoiding impulsive behaviours and to stay tuned to the process of change.

Neurocomputational models of cognition have framed aesthetic appreciation within the domain of knowledge acquisition and learning, suggesting that aesthetic appreciation might be considered as a hedonic feedback on successful perceptual learning dynamics. Such hypothesis, however, has never been empirically demonstrated yet. In order to investigate the relationship between aesthetic appreciation and learning, we measured the EEG mismatch negativity (MMN) response to more or less appreciated musical intervals, which is considered as a reliable index of perceptual learning. To this end, we measured the MMN to frequency (Hz) standard and frequency deviant musical intervals (Experiment 1) while participants were asked to judge their beauty. For each single stimulus, we also computed an information-theoretic index of perceptual learning (Bayesian surprise). We found that more appreciated musical intervals were associated with a larger MMN responses, which, in turn, correlated with trial-by-trial fluctuations in Bayesian surprise (Experiment 1). Coherently with previous results, Bayesian surprise was also found to correlate with slower RTs in a detection task of the same stimuli, evidencing that motor behavior is inhibited in presence of surprising sensory states triggering perceptual learning (Experiment 2). Our results provide empirical evidence of the existence of a positive correlation between aesthetic appreciation and EEG indexes of perceptual learning. We argue that the sense of beauty might have evolved to signal the nervous system new sensory knowledge acquisition and motivate the individual to search for informationally profitable stimuli. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Is it true that we learn better what we like? Current neuroaesthetic and neurocomputational models of aesthetic appreciation postulate the existence of a correlation between aesthetic appreciation and learning. However, even though aesthetic appreciation has been associated with attentional enhancements, systematic evidence demonstrating its influence on learning processes is still lacking. Here, in two experiments, we investigated the relationship between aesthetic preferences for consonance versus dissonance and the memorisation of musical intervals and chords. In Experiment 1, 60 participants were first asked to memorise and evaluate arpeggiated triad chords (memorisation phase), then, following a distraction task, chords' memorisation accuracy was measured (recognition phase). Memorisation resulted to be significantly enhanced for subjectively preferred as compared with non-preferred chords. To explore the possible neural mechanisms underlying these results, we performed an EEG study, directed to investigate implicit perceptual learning dynamics (Experiment 2). Through an auditory mismatch detection paradigm, electrophysiological responses to standard/deviant intervals were recorded, while participants were asked to evaluate the beauty of the intervals. We found a significant trial-by-trial correlation between subjective aesthetic judgements and single trial amplitude fluctuations of the ERP attention-related N1 component. Moreover, implicit perceptual learning, expressed by larger mismatch detection responses, was enhanced for more appreciated intervals. Altogether, our results showed the existence of a relationship between aesthetic appreciation and implicit learning dynamics as well as higher-order learning processes, such as memorisation. This finding might suggest possible future applications in different research domains such as teaching and rehabilitation of memory and attentional deficits.

1 During the several Covid-19 pandemic lockdowns, massive and unprecedented use of music as a 2 medium for social communication emerged. Here we propose a theoretical discussion aboutthis 3 specific social function of music. A centuries-old philosophical debate, as well as more recent 4 neurocomputational models of neuroaesthetics, postulates the existence of a tight relation between 5 aesthetic emotions and knowledge acquisition. By presenting neuroscientific evidence on low-level 6 perceptual learning mechanisms, which confirms this relation, we suggest that – at a higher level – 7 the social sharing of music might have helped individuals process novel and disturbing information. 8 More broadly, the pleasant aesthetic emotions elicited by listening to music might contribute both 9 on an individual and social level to embrace dissonant attitudes, emotions and cognitions, thus 10 enhancing our ability to tolerate transient states of uncertainty without reacting impulsively. 11 Accordingly, we speculate that sharing emotions through music might represent a “social vaccine” 12 contrasting the collective difficulty to learn from and adapt to changes in the environment. 13

The development of innovative robotic devices allows the design of exoskeletons for robotic neurorehabilitation training. This paper presents the active exoskeleton called pneumatic interactive gait rehabilitation orthosis (P.I.G.R.O.), developed by the authors. The main innovative characteristic of this prototype is its design for fully unloaded robotic neurorehabilitation training, specific for brain-injured patients. It has six degrees of freedom (DOF) in the sagittal plane, an active ankle joint (removable if it is required); a wide range of anthropometric regulations, both for men and for women; a useful human machine interface (HMI); and an innovative harness system for the patient for the unloaded training. It is realized using light and strong materials, and it is electropneumatically controlled. In particular the authors also studied and defined some innovative input control curves useful for the unloaded training. In this paper, the main characteristics and innovations of P.I.G.R.O. are presented.

According to a millennial-old philosophical debate, aesthetic emotions have been connected to knowledge acquisition. Recent scientific evidence, collected across different disciplinary domains, confirms this link, but also reveals that motor inhibition plays a crucial role in the process. In this review, we discuss multidisciplinary results and propose an original account of aesthetic appreciation (the stopping for knowledge hypothesis) framed within the predictive coding theory. We discuss evidence showing that aesthetic emotions emerge in correspondence with an inhibition of motor behavior (i.e., minimizing action), promoting a simultaneous perceptual processing enhancement, at the level of sensory cortices (i.e., optimizing learning). Accordingly, we suggest that aesthetic appreciation may represent a hedonic feedback over learning progresses, motivating the individual to inhibit motor routines to seek further knowledge acquisition. Furthermore, the neuroimaging and neuropsychological studies we review reveal the presence of a strong association between aesthetic appreciation and the activation of the dopaminergic reward-related circuits. Finally, we propose a number of possible applications of the stopping for knowledge hypothesis in the clinical and education domains.

Lexical competence includes both the ability to relate words to the external world as accessed through (mainly) visual perception (referential competence) and the ability to relate words to other words (inferential competence). We investigated the role of visual imagery in lexical inferential competence by using an auditory version of an inferential naming-to-definition task, in which visual imageability of both definitions and target words was manipulated. A visual imageability-related brain activity (bilateral posterior-parietal lobe and ventrotemporal cortex, including fusiform gyrus) was found during a "pure" inferential performance. The definition effect in high vs. low imageability contrast suggests that a visual-imagery strategy is spontaneously activated during the retrieval of a word from a high imageable definition; such an effect appears to be independent of whether the target word is high or low imageable. This contributes to the understanding of the neural correlates of semantic processing and the differential role of spontaneous visual imagery, depending on the semantic properties of the processed stimuli.

The effect of long-term immobilization on the motor system has been described during motor preparation, imagination or execution, when the movement has to be performed. But, what happens when the movement has to be suppressed? Does long-term limb immobilization modulate physiological responses underlying motor inhibition? Event-related potentials (ERPs) were recorded in healthy participants performing a Go/Nogo task, either with both hands free to respond (T1/T4: before/after the immobilization) or when left-hand movements were prevented by a cast (T2: as soon as the cast was positioned; T3: after one week of immobilization). In the right (control) side, N140, N2, and P3 components showed the expected greater amplitude in Nogo than in Go trials, irrespective of the timepoint. On the contrary, in the left (manipulated) side, each component of the ERP responses to Nogo trials showed specific differences across timepoints, suggesting that the inhibition-related EEG activity is significantly reduced by the presence of the cast and the duration of the immobilization. Furthermore, inhibition-related theta band activity to Nogo stimuli decreased at post-immobilization blocked session (T3-blocked). Altogether these findings can be interpreted as a consequence of the plastic changes induced by the immobilization, as also demonstrated by the cast-related corticospinal excitability modulation (investigated by using TMS) and by the decreased beta band in response to Go and Nogo trials. Thus, only if we are free to move, then inhibitory responses are fully implemented. After one week of immobilization, the amount of inhibition necessary to block the movement is lower and, consequently, inhibitory-related responses are reduced.

In this paper the exoskeleton P.I.G.R.O.(Pneumatic Interactive Gait Rehabilitation Orthosis), developed in the Department of Mechanical and Aerospace Engineering (DIMEAS) Politecnico di Torino with the important co-operation with doctors, is presented.It was preliminary designed for a completely unloaded walking gait cycle in order to treat the first steps of the neurorehabilitation trainings.An initial FEM evaluation of P.I.G.R.O.structure is here presented.It underlines a lot of important aspects and techniques to analyse the structural characteristics of P.I.G.R.O.legs rigid parts using a commercial software but analysing both the actions of the pneumatic actuators and of the patients muscles and/or movements.The results obtained are good and allow to verify the P.I.G.R.O.legs structure and to establish a procedure to study its characteristics also with the presence of the patient.

Anatomo-clinical evidence from motor-awareness disorders after brain-damages suggests that the premotor cortex (PMC) is involved in motor-monitoring of voluntary actions. Indeed, PMC lesions prevent patients from detecting the mismatch between intended, but not executed, movements with the paralyzed limb. This functional magnetic resonance imaging study compared, in healthy subjects, free movements against blocked movements, precluded by a cast. Cast-related corticospinal excitability changes were investigated by using transcranial magnetic stimulation. Immediately after the immobilization, when the cast prevented the execution of left-hand movements, the contralateral right (ventral) vPMC showed both increased hemodynamic activity and increased functional connectivity with the hand area in the right somatosensory cortex, suggesting a vPMC involvement in detecting the mismatch between planned and executed movements. Crucially, after 1 week of immobilization, when the motor system had likely learned that no movement could be executed and, therefore, predictions about motor consequences were changed, vPMC did not show the enhanced activity as if no incongruence has to be detected. This can be interpreted as a consequence of the plastic changes induced by long-lasting immobilization, as also proved by the cast-related corticospinal excitability modulation in our subjects. The present findings highlight the crucial role of vPMC in the anatomo-functional network generating the human motor-awareness.