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1

Integrated self system: a microgenetic approach

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Pąchalska M.

Acta Neuropsychologica

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2019

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vol. 17(4)

349-393

EN

This article is dedicated to my beloved mother, Zofia Kuzak, Honorary Member of the Polish Neuropsychological Society, and my highest moral authority, to honor her 100 th birthday. During the Nazi occu pation, at the age of 23, she was deport ed to Germany and forced into slave labour at a German camp, from which she managed to escape. During this escape she had to sit for three long days high up in a tree, without food and without anything to drink, something made possible by her strong physical condition. After three days, she dared to leave the tree and, in throwing the Nazis pursuing her, she ran away not to the South - to her home in Nowy Sącz, but to the North – to Poznań, where she took refuge in the apartment of other relatives, true Polish patriots. She stayed there for the years 1943–1947, keeping the accounts at the large family grocery store. The experiences from this period influenced the formation of her own self and her identity. Her stories about times of tragedy and her ways of dealing with the darkest moments in her life contributed to the fact that I became interested in the subject of the self and identity. I have prepared two monographs and several articles on this topic. This article presents a new approach to integrated self system, associated not only with the physical organism, but also with the social and cultural world. The foundation of this approach to the self is microgenetic theory, especially its account of consciousness, of the transition from self to image, act and object, the epochal nature of this transition, and its relation to introspection, imagination and agency. The affinities of microgenetic theory to many aspects of the thought process should be evident to readers of this journal, but the theory, which was developed from studies of pathological cases, rests on a wealth of clinical detail. In brief, the micro-temporal transition from archaic to recent formations (distributed systems) in the phyletic history of the forebrain constitutes the absolute mental state, with consciousness the relation of self to image and/or object. The reader will be able also to find here the overlapping of states, the continuity of the core over successive states, and subjective time experience. However, the integrated self system is associated not only with the operation of the biological brain and its complex patterns of neural connections, but also with the activity of the social mind/brain, in terms of bonds created within social groups, as well as the cultural mind/brain creating the world of cultural values, including religious ones. I will sum up with a model of self system changing in time (4D), pulsating according to the states of mind (5D) forming different numbers of “bits” of information, as marked on the x axis, and linked to the duration of memories, marked on the y axis. The self system also depends on gravity (6D), and other hyperspace dimensions hitherto unknown in neuroscience.

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NEUROPSYCHOLOGY OF CREATIVITY: A MICROGENETIC APPROACH

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Pąchalska M.

Acta Neuropsychologica

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2022

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vol. 20(1)

87-114

EN

The neuropsychology of creativity is recently understood as a subdiscipline developing on the borderline of being a: (1) medical neuroscience - using clinical and experimental neuroanatomical, neurophysiological, neurobiological, neurosurgical, neurological, neuropsychiatric methods and approaches and (2) social neuroscience - using social psychology and neuropsychology, social linguistics and neurocultural studies to help disabled people. The subject of research into the neuropsychology of creativity is the relationship between creativity and the functioning of the brain (structures and neuronal connections) and the self using the individual, social and cultural mind and modelling these behaviors in relation to the biological organism and the social and cultural environment itself. Neuropsychological research of creativity is directed mainly to discover the brain mechanisms of creativity, to form the theoretical models, to elaborate the methods of diagnosis and therapy of artists with brain damage. A promising model that allows for a better understanding of the creation process, and therefore one offering better assistance to individuals who have never developed or have lost the ability to create due to brain damage, is the microgenetic approach that will be discussed in this article. To introduce the reader to these issues, a case study of an artist with brain damage is presented. It illustrates the importance of performing a syndrome analysis, supported by the neurophysiological studies (neuroimaging studies of the brain, quantitative electroencephalography (qEEG), event-related potentials (ERPs) and sLorette tomography) with the use of neuromarkers to avoid a false diagnosis. It also shows the possibilities of art therapy in the process of rebuilding the creative abilities lost as a result of brain damage, and thus the rebuilding of one's individual, social and cultural Self. However, something that is also important for artists, selected works, especially the most characteristic and significant ones, are also achieving critical recognition. It even happens that they become a part of the world's cultural heritage, are displayed at various exhibitions and are even bought to be hung in the collections of galleries acrosss the world, like in the case of the artist presented in these paper.

3

Event-related potentials as an index of lost cognitive control and lost self in a TBI patient with duration increasing post-traumatic Delusional Misidentification Syndrome concluded with Cotard Syndrome

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Pąchalska M.

Acta Neuropsychologica

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2019

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vol. 17(4)

487-508

EN

The goal of the study was twofold: 1) to evaluate the QEEG/ ERPs indexes of functional brain impairment in a TBI patient diagnosed with chronic lost cognitive control and lost self caused by post traumatic, and here increasing over time, delusional misidentification syndrome concluded with Cotard syndrome in the blooming stage, with nihilistic delusions concerning the body and existence, and the delusion of being dead, and 2) to explore the mind of a patient whose identity has been disengaged, and who experiences the loss of his self and relations with his immediate surroundings with all the tragic consequences that entails. I herein present a 52-year-old patient, who – after a serious head injury due to a car accident 20 years ago, which re- sulted in focal injuries in the frontal and temporal areas of the right hemisphere – developed Cotard syndrome. After arousal from a 63-day coma and 98 days of post-traumatic amnesia, he manifested: (1) the loss of autobiographical memory, (2) a lost self, (3) forgotten family ties (including his lover). The study revealed that the patient’s cognitive control system is completely destroyed: no cognitive components have been found. Recall from memory has been completely disturbed (a low amplitude of N170). The two hemispheres work inco- herently with the right hemisphere revealing a serious delay in memory recall.

4

VISUAL ART IN APHASIA THERAPY: THE LOST AND FOUND SELF

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Pąchalska M., Góral-Półrola J.

Acta Neuropsychologica

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2020

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vol. 18(2)

149-181

EN

Recently, the relationship between visual art and brain function and disease has raised considerable interest among neurologists, neuroscientists, and artists themselves. Visual art production involves multiple processes including basic motor skills, such as the coordination of movements, visual-spatial processing, emotional output, a socio-cultural context, as well as obviously creativity. Thus, the relationship between artistic output and brain diseases is particularly complex, and brain disorders may lead to an impairment of artistic production in multiple domains. Understanding the nature of aphasia, which leads to significant changes in human life in the physical, psychological, social and professional sphere, makes us aware of the importance of the individual (objective and subjective) and the social (collective and cultural) self system in the process of creation, especially in artists. Observing the works of artists with aphasia, we notice that each of them perceives the surrounding world differently. One wonders what makes them present reality in one way and not in another. It is true that all works of art show reality in thousands of different ways, and only an unoriginal artist will employ someone else's vision - one already used in a work. It should not be forgotten, however, that the work of artists with aphasia often takes on features resulting from the nature of the problems they face and is initially unoriginal, as they have to overcome fundamental technical difficulties and problems of technique. In this article, we present the possibilities for rehabilitation, of strengthening artists with aphasia, in order for them to find the self lost as a result of illness.

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HEALTH-RELATED QUALITY OF LIFE IN A PATIENT FOLLOWING ANEURYSMOTOMY OF RARE MEGA-GIANT ANEURYSM OF THE COMMON CAROTID ARTERY

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Pąchalska M., Trystuła M.

Acta Neuropsychologica

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2020

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vol. 18(4)

411-423

EN

In the subject literature there are only a few articles devoted to the Health-Related Quality of Life (HRQoL) of patients with large ex- tracranial aneurysms of the carotid artery segment. There are no reports on the quality of life of patients with rare Mega-Giant Carotid Artery Aneurysms (MGCAA) manifesting themselves as chronically large and growing neck tumors. The aim of the research was an evaluation of the health related quality of life (HRQL) of a patient following aneurysmotomy of Mega-Giant Carotid Artery Aneurysms (MGCAA). An 82-year-old patient was referred to the Department of Vascular Surgery at the John Paul II Hospital in Krakow, due to the presence of a megagiant, painful tumor covering the entire left side of the neck. A physical examination and angio-CT confirmed the pres- ence of a pulsating tumor, which extended vertically from the level of the angle of the mandible to the clavicle, and horizontally from the trachea to the cervical spine. An aneurysmotomy and recon- struction of LICA with cerebral protection using a shunt catheter was performed. The patient was awakened from anesthesia and extubated shortly after the procedure, without any Central Nervous System neurological defects. The surgery was complicated by left recurrent laryngeal nerve paresis and aphonia without dyspnoea, which was only partially resolved around 3 months after the oper- ation itself. The postoperative period was uncomplicated. Health related Quality of Life (HRQoL) was studied using the 36-Item Short Form Health Survey (SF-36) to study both the clinical symp-toms and how these symptoms would be reduced in a year follow up after the aneurysmotomy. Despite the increasing availability of endovascular options and techniques, open surgical repair of ICA aneurysms, especially Mega- Giant Carotid Artery Aneurysms (MGCAA), using cerebral protection (shunts), remains a basic option, providing an opportunity to avoid major intraoperative and postoperative complications. The aneurysmotomy, despite laryngeal nerve paresis and aphonia without dyspnoea, improves the patient’s health-related quality of life.

6

EVENT-RELATED POTENTIALS STUDIES OF PTSD AFTER INFECTION OF SARS-COV-2 AND NEUROCOVID-19

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Pąchalska M., Nowaczyk N.

Acta Neuropsychologica

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2021

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vol. 19(3)

347-360

EN

Coronavirus disease 19 (COVID-19) hospitalisation is a potentially traumatic experience, especially in severe cases. Furthermore, the unprecedented context of the SARS-CoV-2 pandemic, with the daily media bombardment about COVID-19 mortality, may have amplified its life-threatening perception also in patients with moderate infection. The purpose of our study was twofold: 1) to evaluate QEEG/ERPs shows of PTSD associated with severe infection SARS-CoV-2, and neuroCOVID-19, 2) to construct a neurofeedback protocol based on these indices to support the psychotherapy of the case study described herein. Patient N.C. 49, a frontline healthcare worker in the emergency services (an ambulance driver), became ill with Covid-19 on November 14, 2020. Initially, he lost his sense of smell (anosmia), of taste (ageusia), and had latent blinks (heterophila), headaches, and dizziness. After 10 days of illness, the patient had additionally a dry cough and a shortness of breath and he was hospitalized, sedated and mechanically ventilated for 24 days. After a few months he was diagnosed with PTSD (according to the DSM- 5 criteria) and referred to the Reintegration and Training Center of the Polish Neuropsychological Society for further diagnosis and treatment. It was found that the P3 GO and P3 NOGO waves were indeed less in his case (p < 0.01) when compared to the ERPs results of a health group of individuals of a similar age (n = 100), derived from the normative data bases of the Human Brain Index (HBI) in Switzerland. The ERPs wave pattern in our patient reflects the pattern appearing in patients with PTSD. The patient took part in 20 sessions of individually tailored anodal transcranial direct current stimulation (tDCS), with the excitatory stimulation of the left prefrontal cortex and inhibitory stimulation of the right prefrontal cortex which can reduce anxiety, as was proposed in the subject literature. Also, the neuromarker of PTSD obtained with the use of QEEG/ERPs was helpful in choosing the appropriate tDCS protocol. Neurostimulation with the use of tDCS was administered systematically, every day, 15-20 and 30-40 minutes for each session, for 20 days. He also received individual sessions of psychotherapy every day, 30-40 minutes for each session, for 20 day. After the treatment the patient improved and returned to his previous job as a frontline healthcare worker in the emergency services (an ambulance driver) in the fight against COVID-19. Detection of the PTSD neuromarker enabled the development of a proper tDCS protocol and the conduct of effective brain neurostimulation of a patient with PTSD. The proposed protocol of treatment, in combination with goal-oriented individual psychotherapy, offered to the patient, was effective in the reduction of PTSD. ERPs can be useful in the diagnosis of PTSD as well as in selecting an appropriate therapy protocol for these patients.

7

THE NEUROPSYCHOLOGY OF METAPHORS IN PATIENTS AWAKENED FROM POST-TRAUMATIC COMA

64%

Pąchalska M., Góral-Półrola J.

Acta Neuropsychologica

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2020

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vol. 18(4)

437-464

EN

Metaphor simply is defined as a verbal construct with two referents: one literal, based on the ordinary, concrete meanings of the word or words involved, and the other metaphorical, that is one derived from an implicit analogy between the literal referent and some other phenomenon, usually an abstraction that is implied, but not named. The aim of this paper is a description of the neuropsychology of metaphors in patients awakened from post-traumatic coma. A group of 34 patients awakened from post-traumatic coma and treated at the Reintegrative and Teaching Centre of the Polish Neuropsychological Society, Poland during the period 2017- 2019 participated in this study. This group included 15 women and 17 men, with an average age of 31.2 ± 8.72 years; as a group, the women were somewhat older (32.6 ± 9.79 vs. 31.1 ± 9.18). We recorded the patients’ utterances with the use of video record- ings of open-ended conversations, and made occasional efforts to introduce proverbs, idioms, and other metaphors into their conversation, but this was done on an impromptu basis. The analysis of recordings of 100 randomly selected statements obtained from each patient revealed the presence of 4 types of errors: (1) non-comprehension, i.e. the listener’s inability to comprehend the meaning of the metaphor used by the speaker, as indicated by the lack of an adequate response, an expression of puzzlement, or a question as to the meaning of the metaphor used by the speaker; (2) concretization, which occurs when the listener reacts to the literal meaning of the word, phrase, or sentence, rather than its metaphorical referent; (3) misapplication, when the speaker uses a familiar metaphor in an inappropriate context; (4) the use of incomprehensible or bizarre metaphors by the speaker, so that the intended meaning is difficult or impossible for the listener to ascertain. On many occasions, however, the gist of the metaphor emerged at some later point in the discourse, despite the surface problems. It was found that the TBI patients we studied showed a marked tendency in spontaneous conversation to concretize or misunderstand the metaphors used by others, and to use inappropriate or bizarre metaphors in their own speech. On many occasions, however, the gist of the metaphor emerged at some later point in the discourse, despite the surface problems.

8

FUNCTIONAL NEUROMARKERS OF POST-TRAUMATIC STRESS DISORDER (PTSD) IN A MAJOR ISCHEMIC STROKE SURVIVOR AFTER CAROTID ENDARTERECTOMY (CEA) REVASCULARIZATION

52%

Trystuła M., Góral-Półrola J., Kropotov J. D., Pąchalska M.

Acta Neuropsychologica

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2018

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vol. 16(4)

417-429

EN

The aim of this study was to test the hypothesis of developing Post-Traumatic Stress Disorder (PTSD) in a major right-hemisphere ischemic brain stroke survivor half a year after CEA revascularization, with the use of Event Related Potentials (ERPs). He was in a serious condition and had limited consciousness. Therefore, the doctor informed the patient's wife about the possibility of sudden death. The patient heard this information and remembered it, which was one of the main causes of the development of PTSD. On the basis of previous research amplitudes of P3 ERP, components elicited in the cued GO/NOGO tasks have been chosen as the candidate for PTSD neuromarkers . A 44-year-old patient had a major ischemic brain stroke while sizeable atherosclerotic plaque causing critical stenosis of the internal carotid artery in Angio-CT was dioscovered. The patient was urgently operated on using CEA. After the operation he had the opportunity to see the removed plaque which had been the cause of his stroke. Despite the positive postoperative recovery, half a year later, the patient began to complain of flashbacks, anxiety, trouble in falling and staying asleep, difficulty in concentration, a loss of interest. For the diagnosis of PTSD we used Checklist Specific for a stressor (PCL-S). Additionally we used Checklist according to the Diagnostic Statistical Manual-5 (DSM-5) classification, and the patient met the PTSD criteria. The cognitive profile of the patient was measured with the use of the Wechsler Memory Test – III (WMS-III). Subsequently, the patient participated in the cued GO/NOGO task (Kropotov, 2009) with a recording 19-channel EEG. The P3 GO and NOGO waves in this task were found to be significantly smaller at p<0.01 in comparison to a group of healthy control subjects of the same age (N=23) taken from the Human Brain Institute (HBI) normative database (https://www.hbimed.com/). The pattern of this neuromarker in our patient corresponds to the ERPs pattern found in PTSD patients. The ERPs in a GO/NOGO task can be used in the assessment of the functional brain changes induced by chronic PTSD.

9

DOES GERSTMANN SYNDROME EXIST?

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Pyrtek S., Badziński A., Adamczyk-Sowa M., Pąchalska M.

Acta Neuropsychologica

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2020

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vol. 18(2)

259-284

EN

The aim of the study is to present Gerstmann syndrome, manifested as a neuropsychological deficit resulting from the damage to the parietal lobe of the left hemisphere. Here it is discussed based on the studies conducted mainly since the 1950’s when it attracted considerable interest, as well as and controversy at the same time. The classic symptoms are briefly described, including the clinical tasks useful in any the diagnosis for during the neuropsychological assessment. The paper also presents recent studies and a alternative different proposal for the understanding of this clinical syndrome. Josef Gerstmann described a clinical tetrad in his patients, which was later to be known as Gerstmann syndrome. The symptoms included finger agnosia, agraphia, acalculia and left-right disorientation. He associated the above symptoms with damage to the left angular gyrus, hence the alternative a different name for of the syndrome i.e., the angular gyrus syndrome. The existence of the syndrome was questioned for some time, something which was never approved by Gerstmann. Currently, the occurrence of the syndrome is confirmed by studies. However, the full and pure tetrad of the classic symptoms as observed is not common. The clinical picture of the syndrome often usually remains incomplete and is related to other neuropsychological deficits such as aphasia, which frequently occurs. In modern considerations, the language deficiencies of semantic aphasia are not treated as non- Gerstmann syndrome, disturbing its pure form, but are considered to be a part of Gerstmann syndrome as such.

10

Evaluation of the effectiveness of electroencephalographic training with neurofeedback (EEG-NFB) for a patient with dysexecutive syndrome after neurosurgery of two brain aneurysms detected after COVID-19 disease

52%

Morga R., Mirski A., Buczaj A., Pąchalska M.

Acta Neuropsychologica

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2023

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vol. 21(3)

279-303

EN

The purpose of this study is to evaluate the effectiveness of functional neuromarker- based electroencephalographic training with neurofeedback (EEG-NFB) for a patient with dysexecutive syndrome following neurosurgical operation of two brain aneurysms of the left and right middle cerebral artery (MCA) detected after COVID-19 disease. A right-handed, 56-years-old, not vaccinated, patient, became infected with SARS- CoV-2 and contracted COVID-19 with the manifestation of respiratory symptoms, high fever, dyspnea and low saturation of 79% Sa02. She was hospitalized at the Infectious Disease Unit, where a positive RT PCR test for COVID-19 was confirmed. The acute phase of COVID-19, during which oxygen therapy was administered, lasted two weeks and was complicated by brain fog and transient hypertension (175/100). There were no signs of focal damage to the central nervous system. She was discharged home in a good general and neurological condition. After returning home, the patient was unable to cope with daily functioning, as she said her brain fog continued to persist, manifesting itself as executive dysfunction. Eight weeks after the infection, the patient's neuropsychiatric condition worsened. On CT and MRI examination of the cerebral vessels, she was diagnosed with the presence of two aneurysms located on the left and right middle cerebral arteries (MCA). She was operated on at the Department of Neurosurgery and Neurotraumatology, where a pterional craniotomy and clipping of both brain aneurysms was performed. The Yasargil titanium clip was placed on the aneurysm neck. During the surgery procedures, performed two months apart, there were no signs of a history of subarachnoid haemorrhage and the post-operative period was uneventful, except for a drooping right-eye eyelid (after the second surgery) with a tendency to improve. Each time, the patient was mobilized and walked independently and was discharged home in a good general condition, with no neurological symptoms, except for executive dysfunction. Approximately five months after the SARS-CoV-2 infection (four weeks after the second surgery), her executive dysfunction worsened. Neuropsychological testing using Mindstreams™ Interaction Computer Tests revealed moderate Dysexecutive Syndrome (DES), while neurophysiological testing using qEEGs, ERPs and sLORETA tomography, a functional neuromarker of frontotemporal area dysfunction. The EEG pattern was characterized by excessive, slow (about 6 Hz) activity in frontotemporal areas, which indicated the progressive loss of cognitive control over time. The patient was offered an electroencephalographic training protocol with neurofeedback (EEG-NFB) based on the detected functional neuromarker, which reduced DES. The improvement achieved during therapy was statistically significant [compared to the normative database (Human Brain Index, HBI)]. In effect, the patient's quality of life improved, as she herself pointed out. Her symptoms of brain fog and DES disappeared and she returned to her previous work as a waitress. The Human Brain Index (HBI) methodology can be successfully used in the neurodiagnosis and implementation of individualized electroencephalographic training with neurofeedback (EEG-NFT) for patients with executive dysfunction after contracting longCOVID.

11

Quality of life of a patient with persistent complications after SARS-CoV-2 infection requiring urgent surgical intervention – endarterectomy with emergency angioplasty of an inflamed, bleeding Right Internal Carotid Artery (RICA) using the Trans-Carotid Artery Revascularization (TCAR)

52%

Hydzik A., Opławski M., Trystuła M., Pąchalska M.

Acta Neuropsychologica

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2023

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vol. 21(3)

259-278

EN

SUMMARY The purpose of this study was to determine the quality of life of a patient with persistent complications of SARS-CoV-2 infection requiring urgens surgical intervention – endarterectomy with emergency angioplasty of an inflamed, bleeding Right Internal Carotid Artery (RICA) by direct access via Right Common Carotid Artery (RCCA), known as Transcarotid Artery Revascularization (TCAR). A patient in her 60s was infected with the SARS-CoV-2 virus and contracted COVID-19 in March 2022, as confirmed by RT PCR antigen test. The infection was followed by short- and long-term complications, many of which can be linked to COVID. These include significant weakness persisting for months after the illness, rapid weight loss of 25 kg, sleep disturbances, chronic fatigue, severe dizziness, onset of diabetes, decrease dimmunity with increased periodontal inflammation (including formation of a periapical abscess of a molar tooth) and secondary suppuration of the submandibular lymphnodes, one of which lying jacent to the right internal carotidartery (RICA). This accumulation of symptoms led the patient to seek medical and neuropsychological help. Test ingusing the Beck Depression Inventory (BDI) confirmed depression, with vegetative disorders being the most predominant. Eight months after undergoing COVID-19, the patient suffered a Transient Ischemic Attack (TIA). The accumulation of diseases (diabetes mellitus, stage III hypertension and TIA) had a dramatic impact on the patient's health, including life-threatening conditions.A vascular surgeon consulted the patient advised immediate surgical treatment: carotid endarterectomy. The urgency of the situation was exacerbated by bleeding during the operation from the operated, secondarily inflamed wall of the RICA (lying adjacent to the suppurated submandibular node). This prompted an emergency decision for an endovascular procedure: the implantation of a stent covered with water-proof material (peripheral stent graft). This was made by a direct access via puncture of the common carotid artery (RCCA) below the endarterectomy level (TCAR). The SF-36 questionnaire was chosen to measure health-related quality of life (HRQOL).The SF-36 results are presented in such a way that higher scores correspond to fewer complaints, indicating better health and higher quality of life. Before revascularization, the patient's HRQOL was found to be lower, which was related to the negative impact of long COVID, while after the procedure, the quality of life gradually improved in subsequent surveys. A significant difference was found in physical function, with a mean score of 66.0 (p<0.001) compared to a score of 94.9 (±9.4) for 100 age-matched health subjects. A similar result was found in the physical role (p < 0.001). The patient's overall quality of life score was 331.0 compared to a score of 578.0 (±111.9) for age-matched normal healthy people. Better quality of life in patients with long COVID is an important therapeutic goal that can be achieved through comprehensive, multispecialty treatment for both physical and psychological conditions.

12

NEUROPSYCHOLOGY AND THE NEUROPHYSIOLOGY OF PERCEPTUAL MICROGENESIS

52%

Pąchalska M., Góral-Pólrola J., Mueller A., Kropotov J. D.

Acta Neuropsychologica

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2017

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vol. 15(4)

365-389

EN

Perception is one of the psychological operations that can be analyzed from the point of view of microgenetic theory. Our study tests the basic premise of microgenesis theory – the existence of recurrent stages of visual information processing. The event related potentials in two variants of a cued GO/NOGO task (contrasting images of Animals and Plants in the first variant, and contrasting images of Angry and Happy faces in the second variant) were studied during the first 300 ms following stimulus presentation. The independent component analysis was applied to a large collection of ERPs. The functional independent components associated with visual category discrimination, comparison to working memory, action initiation and conflict detection were separated. Information processing in the ventral visual stream (the temporal independent components) occurs at two sequential stages with positive/negative fluctuations of the cortical potential as indexes of the stages. The first stage represents the comparison of the pure physical features of the visual input with the memory trace. The second stage represents the comparison of more sophisticated semantic/emotional features with the working memory. The two stages are the results of interplay between bottom-up and top-down projections in the visual ventral stream.

13

Self reported individual differences in inner speech (internal monologue and dialogue) in adolescents with Social (Pragmatic) Communication Disorder (SCD)

52%

Siedler A., Gałkowski T., Pąchalska M.

Acta Neuropsychologica

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2019

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vol. 17(1)

39-53

EN

The aim of the study was to assess self-reported individual differences in the use of the inner speech of adolescents with Social (Pragmatic) Communication Disorder (SCD) and in particular to answer the questions: Do adolescent with SCD have inner speech and what is the direction of this speech? Is this a monologue and internal dialogue, i.e., do they speak to themselves (internal monologue) or to other people (internal dialogue)? We tested 22 adolescents with SCD, diagnosed according to the DSM-5 criterion. The average age was 16.48 years, SD = 2.71. The youngest patient was 12 years old and the oldest was 19 years old. The modified version of the Puchalska-Wasyl Scale of Inner Speech was used for the study. The questionnaire was tailored to the capabilities of the persons with SCD and included questions about the occurrence of internal speech and the direction of this speech, that is, internal conversations to yourself (internal monologue) or to other people (internal dialogue). The patients participating in the experiment were informed in detail about the whole procedure and they or their parents, if they were under age, provided written consent for their participation in the experiment (according to the guidelines of the Helsinki Declaration, 2008). Statistical analysis showed that in adolescents with SCD there is a statistically significant relationship in the frequency of the monologue and internal dialogue. Persons who declared a more frequent occurrence of internal dialogue also declared more frequent occurrences of internal monologue, which means that they had the general ability for inner speech. A comparison of the direction of inner speech, that is the internal monologue and internal dialogue has shown that during inner speech they more often use internal dialogue than internal monologue. It was found that in adolescents with SCD, inner speech is present, and it manifests itself in the form of an internal monologue and internal dialogue. However, far more often do they use internal dialogue than internal monologue.

14

EFFECT OF INDIVIDUALLY-TAILORED TDCS AND SYMBOLIC ART THERAPY FOR CHRONIC ASSOCIATIVE PROSOPAGNOSIA AFTER INFECTION BY SARS-COV-2, NEUROCOVID-19 AND ISCHEMIC STROKE

52%

Pąchalska M., Góral-Półrola J., Chojnowska-Ćwiąkała I.

Acta Neuropsychologica

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2021

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vol. 19(3)

329-345

EN

Background The rehabilitation of patients with chronic prosopagnosia that occurs following a stroke is a challenge for modern medicine. Dysfunction to the facial processing areas is permanent and standard rehabilitation brings only limited improvement. Therefore, therapists suggest reinforcing the compensatory strategies used by such patients such as voice, figure, and gait recognition to help with the identification of a particular person, which promotes their social functioning. New neurotechnologies, especially QEEG/ERPs, displays of functional brain impairment in prosopagnosia, may be helpful in developing an appropriate neurotherapy protocol and create the conditions for other forms of rehabilitation in such patients. The purpose of our study was twofold: 1) to evaluate QEEG/ ERPs shows of post-stroke functional impairment associated with prosopagnosia, 2) to construct a neurofeedback protocol based on these indices to sup- port the neuropsychological rehabilitation of the case study described herein. We present the case of a 23-year-old right-handed student of the Graphics Faculty of the Academy of Fine Arts, with chronic associative prosopagnosia after infection with SARS-CoV-2 followed by Covid-19 and a right hemisphere stroke. He was re- ferred in April 2021 for diagnosis and therapy at the Reintegration and Training Cen- ter of the Polish Neuropsychological Society (PTNeur). Six months earlier, in October 2020, the patient had been admitted to the Infectious Disease Hospital. COVID-19 was diagnosed based on coronavirus 2 (SARS-CoV-2) reverse transcrip- tion PCR (RT-PCR) on a nasopharyngeal swab. The neurological examination re- vealed muscle weakness on the left side of the body, slow and aprosodic speech, preserved comprehension, and acute left homonymous hemianopsia, as well as prosopagnosia and mirror symptom. The patient was sedated and mechanically ventilated for six days. The CT-scan showed foci in the posterior part of the superior temporal lobe and hyperintense changes in the blood supply area of the right middle cerebral artery. After 30 days of hospitalization, the patient was discharged from this hospital and referred to an outpatient rehabilitation center for five months. Ther- apy improved his general condition but did not remove the chronic prosopagnosia: a personal tragedy for the patient which prevented him from continuing his studies. He was diagnosed at the PTNeur Reintegration and Training Center within the next few weeks: (1). ophthalmologic examinations revealed no pathology; (2) neuropsy- chological testing confirmed the presence of chronic apperceptive prosopagnosia; (3) examination of event-related potentials (ERPs) revealed a large delay of the N170 wave, particularly on the right side, indicating a slowing of the rate of nerve impulses in early face processing and a cause of prosopagnosia. The patient was referred for rehabilitation: he participated in 20 sessions of individually tailored anodal transcranial direct current stimulation (tDCS) twice a week for ten weeks, and in parallel, for indi- vidualized Prosopagnosia Symbolic Art Therapy provided once a week for ten weeks. By the end of therapy, the patient was not only recognizing but also painting portraits of faces. He returned to college, finished and defended a master’s thesis in Artistic Drawing, in which facial presentation played an important role. Quantitative EEG (QEEG) and event-related potentials (ERPs) neuromarkers helped to understand the mechanism of prosopagnosia and to choose an individualized protocol, thus the appropriate application of tDCS in our patient, which accelerated the recovery of the ability to perform complex tasks and created the conditions for Symbolic Art Therapy. Modern medicine can successfully use such a management protocol in individuals with chronic prosopagnosia.

15

FUNCTIONAL NEUROMARKERS IN PARKINSON’S DISEASE (PD)

52%

Góral-Półrola J., Mirski A., Knapik H., Pąchalska M.

Acta Neuropsychologica

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2021

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vol. 19(2)

147-168

EN

New neurotechnologies which help to study not only the structure but also brain work, especially in milliseconds, allow for a more accurate diagnosis of a given disease entity. The aim of our study was to characterize the functional neuromarkers, including a new neuromarker, that is high rolandic beta, in Parkinson’s disease (PD). A 76-year-old male patient, a university professor, a widower, in an intimate relationship with a beloved partner, was tested in the Reintegration and Training Center of the Polish Society of Neuropsychology. Five years earlier (when he was 71 years old), following long-term stress, he had had a transient ischemic attack (TIA). In the following years he experienced two neurological episodes, and was diagnosed, on the basis of MRI findings and clinical symptoms, with vascular (multi-infarct) Parkinsonism. A sudden deterioration in his functioning, including hand tremors at rest, bradykinesia (motor slowdown), asymmetrical gait difficulties, postural instability, and falls typical for PD, as well as MRI finding (the appearance of ‘a swallow tail ’ on the left side, and the lack on the right of the substantia nigra within the midbrain) was the cause of further differential diagnosis. He was assessed using the HBI methodology (Kropotov 2016; Pąchalska, Kaczmarek, Kropotov 2014). EEG was recorded from 19 scalp sites, in resting state conditions, with eyes open and eyes closed, and during the cued GO/NOGO tasks with animal/plants as GO/NOGO stimuli. The electrodes were applied according to the International 10-20 system. The EEG was recorded referentially to linked ears, allowing for a computational re-referencing of the data (remontaging). Event related potentials (ERPs) were used to assess the functional changes manifested by the patient. To compare our patient with healthy controls we used the normative Human Brain Index (HBI), a database obtained through joint research by Swiss, Norwegian, Polish and Russian neuroscientists (Kropotov 2018). This database included behavioral parameters and ERP measures in 6 different neuropsychological tasks for 1000 healthy subjects. What is striking, no signs of cognitive dysfunction was found; however observed were an asymmetrical frontal lobe alpha (a neuromarker of depression) and excessive Rolandic beta (a neuromarker of Parkinson’s disease). We will discuss the results on the basis of recent subject literature findings, including the personal factors that might influenced the process of the diagnosis and treatment of this patient, ones which should be also taken into account in any differential diagnosis. The obtained results show the importance of using HBI methodology in clinical practice. Physicians involved in the diagnosis and treatment of those with progressive ambulatory impairment and an abnormal white matter (WM) signal on neuroimaging, should when formulating any differential diagnosis consider the use of this approach. ------------------------------------------------------------------------------------------------------------------------------------

16

Comprehensive program of neurotherapy for a visual artist with post- covid-19 syndrome following sars-cov-2 infection and severe course of covid-19 treated in long-term pharmacologically induced coma

52%

Pąchalska M., Grzywniak C., Kobos M.

Acta Neuropsychologica

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2023

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vol. 21(1)

93-107

EN

The purpose of the study was twofold: (1) to present post-COVID-19 syndrome, which involves a variety of ongoing neurological, neuropsychiatric, neurocognitive, emotional and behavioral disorders resulting from SARS-CoV-2 infection followed by a severe course of COVID-19 treated in long term pharmacologically induced coma in a visual artist, which impacted on her artwork; (2) to present QEEG/ERP results and neuropsychological testing results in the evaluation of the effectiveness of a comprehensive neurotherapy program, with individualized EEG-Neurofeedback, and art-therapy in the reduction of post-COVID-19 syndrome in this artist. Ms. G., 42, a visual artist, portraitist, with good health, became ill in May 2022. Allegedly flu symptoms appeared first. After a few days, shortness of breath joined in. The PCR test for SARS-CoV-2 was positive. The patient was hospitalized, referred to the ICU, put on a respirator and treated over 11 days of a pharmacologically induced coma. Two months after leaving hospital the patient developed post-COVID-19 syndrome. She was diagnosed by an interdisciplinary team: a neurologist, neuropsychiatrist and neuropsychologist. A PET scan of her brain revealed extensive changes involving a loss of metabolism in various brain areas. The presence of complex post-COVID, neurological, neuropsychiatric, neurocognitive, emotional and behavioral disorders was found and a neuropsychiatrist suggested a diagnosis of post-COVID schizophrenia. She was refered to the Reintegration and Training Center of the Polish Neuropsychological Society. We tested the working hypothesis as to the presence of schizophrenia and there was no reduction in the difference of ERPs waves under GO/NOGO task conditions. The absence of a neuromarker for schizophrenia allowed us to exclude this diagnosis and to propose a new disease entity, that being post-COVID-19 syndrome. She received a comprehensive two-component program of neurotherapy: (1) program A, consisting in goal-oriented neuropsychological rehabilitation, including art therapy, and (2) program B, based on the most commonly used form of EEG-Neurofeedback: frequency/ power EEG-Neurofeedback, using 2 bipolar surface electrodes, with the protocols written for her specific needs. The comprehensive neurotherapy program lasted 10 weeks, EEG Neurofeedback and art therapy classes were conducted 3 times a week for 45 minutes each. We found that after the completion of the comprehensive neurotherapy program there was a statistically significant reduction in high beta activity compared to the normative HBI database, which is associated with a reduction of anxiety. Also, we observed the improvement of neurocognitive functioning in neuropsychological testing (a significant reduction of anxiety and a noticeable improvement in neurocognitive functions). It should be stressed that the artist was happy that she had regained the ability to create, and even sells her artwork, although her style of painting had changed. Almost all the neurological, psychiatric, neurocognitive, emotional and behavioral disturbances, were reduced in their severity. The artist showed marked improvement and was able to return to painting. The artwork she produced after her illness is in high demand with art collectors. It can be also helpful in the reintegration of the Self System, and the improvement in her quality of life. Human Brain Index (HBI) methodology might be very useful in diagnosing and developing therapies for patients with Post-COVID-19 Syndrome.

17

HEALTH RELATED QUALITY OF LIFE OF THE PATIENT WITH IMMUNOGLOBULIN G4-RELATED CRANIAL HYPERTROPHIC PACHYMENINGITIS (IGG-HP) CAUSING DISTURBANCES OF COGNITIVE CONTROL TREATED WITH NEUROFEEDBACK

52%

Morga R., Radwańska E., Trystuła M., Pąchalska M.

Acta Neuropsychologica

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2021

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vol. 19(3)

373-388

EN

Health related quality of life (HRQoL) is the most desired patient centered outcome of medical care (Leplége et al. 1997). In patients with long term illness, such as Hypertrophic Pachymeningitis (HP) still under diagnosis, therefore no possible to properly cure, it might be the only outcome achievable (Netuveli et al. 2005; Trystuła 2017). The problem becomes even more serious when occurs in young person: starting a family and caring for children becomes hard or even impossible, because of his/her physical and psychical conditions. Most clinicians are aware of the importance for quality of life of this functional limitation, but there are no articles describing this problem in the literature. We aimed to fill this gap in knowledge. 29 year old patient, a car mechanic, married, with 4-year-old son, with the long his- tory of the illnes, and especially persistent, diffuse, non-specific headaches, frequent seizures and cognitive deterioration which have been particularly troublesome recently. He was finalny diagnosed with Hypertrophic Pachymeningitis (HP) associated with Immunoglobulin G4-related (IgG4) with the use of specific diagnostic criteria for HP associated with IgG4-RD (IgG4-HP), which rely on histopathologic analysis (Lindstrom et al. 2010; Lu et al 2014). Computed tomography (CT) of the head showed massive calcifications visible along the cerebellar tentorium on the right side, along the cerebral falx, as well as on dura mater on the cranial vault of both cerebral hemispheres. The patient was diagnosed with common variable immunodeficiency (D 83), thrombocytopenia, chronic EBV hepatitis and epilepsy. IgG4-HP was confirmed by CT, MRI and biopsy (IGg4-RHP antibody was detected). The treatment with steroids, and immunosuppressive therapy (RTX) was introduced (as it was suggested by Levraut et al. (2019). It should be stressed that he had a significantly reduced health-related quality of life (HRQoL), mainly because of long-lasting illness, diverse symptoms, often hospitalization, complex differential diagnosis, and especially biopsy which requires neurosurgical intervention, which affect his physical and mental well-being, especially cognitive control, and not possibility to take care of his family. To help the patient we introduce HBI methodology (Kropotov 2016), that is an evaluation of working brain in milliseconds. Quantitative electroencephalography (qEEG), event-related potentials (ERPs) and low-resolution sLORETA tomography were performed. We did not found any paroxysm of 3 Hz rhythm in Eyes Closed (EO) and in Eyes Open (EO) conditions, however the ERPs deviations from the reference indicate deficit of cognitive control (decrease of P3 NOGO wave in comparison to 100 persons from the normative data base from the Human Brain Index in Chur, Switzerland). Therefore, the patient was offered Transcranial Direct Current Stimulation (atDCS) combined with goal-oriented psychotherapy program. It was found that after 40 days of therapy, cognitive control returned, which was translated into a better quality of life related to the patient's health, measure in the 36-Item Short Form Survey (SF-36). The patient returned to his previous job as a head of car mechanic service. Final diagnosis of IgG4-HP and subsequently, proper farmacotherapy, and introduction of HBI methodology allowing for the selection of an adequate method of neurotherapy, for our patient the transcranial direct current stimulation (atDCS) combined with goal- oriented psychotherapy, was helpful in the improvement of his quality of life.

18

THE LONG-TIME EFFECTS OF GROUP THERAPY INTERVENTION ON MARRIAGE COMMUNICATION BETWEEN FLUENT AND NON-FLUENT APHASIC PATIENTS AND THEIR SPOUSES: WHO BENEFITS THE MOST?

45%

Orłowska E., Rasmus A., Góral-Półrola J., Morga R., Pąchalska M.

Acta Neuropsychologica

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2018

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vol. 16(3)

229-241

EN

Our study aims to assess the long-time effects of group therapy intervention on marriage communication between fluent and non-fluent aphasic patients and their spouses. From the initial cohort of 150 couples four experimental groups have been selected, each comprising 20 subjects: (1) patients with fluent aphasia (FAP) (2) patients with fluent aphasia spouses (FAPS) (3) patients with non-fluent aphasia (NFAP) (4) patients with non-fluent aphasia spouses (NFAPS). All aphasic patients had mild or moderate fluent or nonfluent aphasia, as confirmed by the Cracow Neuropsychological Battery for Aphasia Examination – CNBA (Pąchalska, 1999). To assess the 3 aspects of interactions between spouses: support, engagement and depreciation we use the Communication in Marriage Questionnaire – KKM scores (Kaźmierczak, Plopa, 2008). These patients attended the groups sessions administered according to Pąchalska’s Model of Aphasia Group Therapy (1991a; 1991b) . It was found that after the long-time group intervention the experimental and the control groups of aphasic patients as well as their spouses differ one from another. NFAP as well as FAP therapy patients had higher KKM scores in the support received from their spouses and their spouses engagement in communication and lower scores in depreciation in their spouses’ behavior than did the controls. Also NFAPS evaluated support and engagement expressed by their aphasic partner higher than the control group. However FAPS and the control group KKM scores were quite similar, except for the support expressed by their aphasic partner. Long-time group therapy for patients with aphasia with the presence of caregivers not only improves the communication with significant others but also it is associated with better marital interactions and communication after therapy as reflected in the KKM scores than in the case of the controls, and improves the patient’s and caregivers’ perception of quality of life.

19

Emotional attitudes linked to common objects: practical and clinical implications

45%

Kaczmarek B. L. J., Stencel M., Grzegorczyk M., Marczak I., Pąchalska M.

Acta Neuropsychologica

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2019

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vol. 17(4)

395-405

EN

Studies concerning emotional changes following brain damage neglect the emotional responses that might arise in reaction to the stimuli used in their examination of such patients. Yet those reactions may be quite forceful often provoking feeling of anxiety or panic and dismay. A questionnaire designed to reveal associations and emotional attitudes was presented to 96 extramural students. Four categories of products and the products within those categories were selected. The categories included: sweets; alcohol; transport, and consumer electronics. In addition, 174 participants of various ages and professions produced associations linked to emotionally loaded words. A list of associations and their dominance scores were created. It revealed that transport (4.9) and consumer electronics (5) were given the highest mean scores. Also, the terms car (5.3) and mobile phone (5) aroused the highest levels of emotion. The significance of the emotional attitudes of the participants to objects were determined within particular dimensions that measured likableness, interest, goodness, and attractiveness. The terms beer, chocolate, car and mobile phone were reported to be most acceptable in all four dimensions. The above data suggests that the emotional attitude awakened by a particular object finds its expression in all of the dimensions examined. The studies revealed the significance of primary subconscious affects for creating positive or negative attitudes. This should be taken into account by therapists since objects which evoke a negative affect may trigger a patient’s reluctance to take part in the rehabilitation procedure.

20

HEALTH-RELATED QUALITY OF LIFE OF A PATIENT FOLLOWING NEUROSURGERY ON GLIOBLASTOMA MULTIFORME (GBM)

39%

Morga R., Moskała M., Adamek D., Góral-Półrola J., Herman-Sucharska I., Pąchalska M.

Acta Neuropsychologica

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2018

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vol. 16(3)

307-319

EN

Health-related quality of life (HRQoL) plays a role as a patient-centered meaningful endpoint, assessing the direct clinical benefit for a patient. The inclusion of HRQoL measurements in a glioma patient may provide important data to inform clinicians on treatment decision-making. The aim of the study was to evaluate cognitive decline and HRQoL in the clinical care of a patient following neurosurgery on of glioblastoma multiforme (GBM). A 69-year-old female developed malignant brain glioma in the right temporal-occipital area; this being confirmed by CT and MR study and neuropathological findings. She had complained of headaches, dizziness, nausea, vomiting as well as attention and memory loss, and anxiety, sadness and a slowing down in the performance of daily activities. The symptoms rapidly became worse and she was referred to a neurosurgery department for consultation. She was successfully neurosurgically operated on. She was examined with the use of ne uro psycho logical tests three times: the first examination was conducted before the neurosurgical operation, the second two weeks after, and the third half year after the neurosurgical operation. In the first examination by the standard Polish version of the Mindstreams™ Interactive Computer Tests disturbances for all the tested cognitive functions occurred. The greatest changes were to occur however in the areas of visual-spatial functions. attention, executive functions and memory. In the second test, a return to the norm was achieved for the disturbed cognitive and executive functions. In the third examination (half a year after the neurosurgical operation), the cognitive and executive functions were still not bad, but had slightly decreased. Similar trend was observed in HRQoL. A significant difference in the health profile between the 1 st and 2 nd as well as between 1 st and 3 rd examination was detected for the eight SF-36 domains - HRQoL was improved. While only slight but no significant changes occurred between 2 nd and 3 rd examination. HRQoL was still not bad, but had slightly decreased. The patient after the neurosurgical operation of glioblastoma multiforme (GBM) is capable of carrying out daily activities, but shows some level of reduced complains for functional capacity, pain, general health and vitality, emotional and social functioning for mental health which has led to the impaired HRQoL.

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Comprehensive program of neurotherapy for a visual artist with post- covid-19 syndrome following sars-cov-2 infection and severe course of covid-19 treated in long-term pharmacologically induced coma

HEALTH RELATED QUALITY OF LIFE OF THE PATIENT WITH IMMUNOGLOBULIN G4-RELATED CRANIAL HYPERTROPHIC PACHYMENINGITIS (IGG-HP) CAUSING DISTURBANCES OF COGNITIVE CONTROL TREATED WITH NEUROFEEDBACK

THE LONG-TIME EFFECTS OF GROUP THERAPY INTERVENTION ON MARRIAGE COMMUNICATION BETWEEN FLUENT AND NON-FLUENT APHASIC PATIENTS AND THEIR SPOUSES: WHO BENEFITS THE MOST?

Emotional attitudes linked to common objects: practical and clinical implications

HEALTH-RELATED QUALITY OF LIFE OF A PATIENT FOLLOWING NEUROSURGERY ON GLIOBLASTOMA MULTIFORME (GBM)