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Sleep regularity index as a novel indicator of sleep disturbance in stroke survivors: a secondary data analysis
Abstract Sleep disturbance is common but often overlooked after stroke. Regular sleep is increasingly recognised as important for overall health, yet little is known about how sleep regularity changes after stroke. This study examined differences in the Sleep Regularity Index (SRI) between stroke survivors and healthy controls using actigraphy data from an existing dataset (~ 1 week per participant). Data were analysed for 162 stroke survivors (mean age 61 ± 14 years, 5 ± 5 years post-stroke, 89 males) and 60 controls (mean age 57 ± 17 years, 32 males). Stroke survivors had significantly lower SRI scores than controls (p = 0.001), indicating less regular sleep. In the stroke group, higher SRI correlated with longer total sleep time (p = 0.003) and better self-reported sleep quality (p = 0.001) but not with other sleep metrics. Lower SRI was associated with worse depressive symptoms (p = 0.006) and lower quality of life (p = 0.001) but not with disability (p = 0.886) or time since stroke (p = 0.646). These findings suggest that sleep regularity is disrupted post-stroke and may influence well-being. Future research should explore interventions to improve sleep regularity and related health outcomes in stroke survivors.
A cross-cultural examination of bi-directional mentalising in autistic and non-autistic adults.
BACKGROUND: So-called 'mismatch accounts' propose that, rather than arising from a socio-cognitive deficit present in autistic people, mentalising difficulties are the product of a mismatch in neurotype between interaction partners. Although this idea has grown in popularity over recent years, there is currently only limited empirical evidence to support mismatch theories. Moreover, the social model of disability such theories are grounded in demands a culturally situated view of social interaction, yet research on mentalising and/or autism is largely biased towards Western countries, with little knowledge on how successful mentalising is defined differently, and how tools to assess socio-cognitive ability compare, across cultures. METHODS: Using a widely employed mentalising task-the animations task-, the current study investigated and compared the bi-directional mentalising performance of British and Japanese autistic and non-autistic adults and assessed observer-agent kinematic similarity as a potential dimension along which mismatches may occur between neurotypes. Participants were asked to depict various mental state- and action-based interactions by moving two triangles across a touch-screen device before viewing and interpreting stimuli generated by other participants. RESULTS: In the UK sample, our results replicate a seminal prior study in showing poorer mentalising abilities in non-autistic adults for animations generated by the autistic group. Crucially, the same pattern did not emerge in the Japanese sample, where there were no mentalising differences between the two groups. LIMITATIONS: Limitations of the current study include that efforts to match all samples within and across cultures in terms of IQ, gender, and age were not successful in all comparisons, but control analyses suggest this did not affect our results. Furthermore, any performance differences were found for both the mental state- and action-based conditions, mirroring prior work and raising questions about the domain-specificity of the employed task. CONCLUSIONS: Our results add support for a paradigm shift in the autism literature, moving beyond deficit-based models and towards acknowledging the inherently relational nature of social interaction. We further discuss how our findings suggest limited cultural transferability of common socio-cognitive measures rather than superior mentalising abilities in Japanese autistic adults, underscoring the need for more cross-cultural research and the development of culturally sensitive scientific and diagnostic tools.
Cognitive Therapy for PTSD in Children and Adolescents
Children and adolescents exposed to traumatic events are at high risk of developing post-traumatic stress disorder (PTSD). With the rare exception of young children, their PTSD presentations at the symptom level are similar to those of trauma-exposed adults, as are their patterns of psychiatric comorbidity, particularly for adolescents. Untreated, at least a significant proportion will carry on with symptoms at or above the diagnostic threshold or at sub-threshold levels that are still clinically impairing. The presence of untreated or poorly treated PTSD symptoms leaves the young person at significantly increased risk of developing other psychiatric disorders, a worsening of any pre-existing conditions, and with greater long-term impairments in education, family, and peer functioning. Fortunately, evidence-based treatments exist with the first-line recommendation being trauma-focused cognitive behavioural therapies, with a growing body of evidence for the efficacy of eye movement desensitization and reprocessing therapy (EMDR). This chapter provides an update on the state of the literature with respect to the evidence base for trauma-focused cognitive behavioral therapy (CBT), and in particular, for an explicitly cognitive approach, originally developed for use with adults and successfully adapted for use with children and adolescents across the age range. The chapter describes the theoretical underpinning for this approach, guidance on reliving (a form of exposure to update the trauma memory) and the modification of trauma-related beliefs (two primary targets in treatment), parental involvement in treatment, dealing with comorbidity, and a case example.
What role does touch play in active entertainment? A narrative review of tactile feedback in gaming
This narrative literature review explores the role of tactile stimulation within interactive gaming and storytelling. Focusing on active entertainment experiences—where the audience/player has some control over what happens, unlike passive media such as film. The review traces tactile/haptic feedback from the 18th century electric-shock amusements to contemporary vibrotactile controllers and interactive cinema. The review also highlights touch's potential to enhance interactivity across active entertainments. Key themes include the role of touch in active versus passive forms of entertainment. In the context of active entertainment, audience participation influences the gameplay/plot, while in passive entertainment, the audience simply observes without being able to alter the outcome. The review also contrasts first- and third-person viewer perspectives and the viewpoint specificity of much tactile/haptic stimulation, particularly concerning these perspectives. Additionally, the review discusses the technical challenges associated with much of the wearable haptic technology that has been introduced to date, and consumer preferences and willingness to pay for haptic devices and enhanced haptic (broadly referring to any kind of tactile) experiences. The review concludes by emphasizing the multifaceted roles of haptic feedback in gameplay, narrative enhancement, and emotional engagement. It also suggests directions for future research to expand the potential of touch within multisensory entertainment.
Dissociating Frontal Lobe Lesion Induced Deficits in Rule Value Learning Using Reinforcement Learning Models and a WCST Analog
Distinct frontal regions make dissociable contributions to rule-guided decision-making, including the ability to learn and exploit associations between abstract rules and reward value, maintain those rules in memory, and evaluate choice outcomes. Value-based learning can be quantified using reinforcement learning (RL) models predicting optimal trial-wise choices and estimating learning rates, which can then be related to the intact functioning of specific brain areas by combining a modeling approach with lesion-behavioral data. We applied a three-parameter feedback-dependent RL model to behavioral data obtained from macaques with circumscribed lesions to the principal sulcus (PS), anterior cingulate cortex (ACC), orbitofrontal cortex (OFC), superior dorsolateral prefrontal cortex (sdlPFC), and frontopolar cortex (FPC) performing a Wisconsin card sorting task (WCST) analog. Our modeling-based approach identified distinct lesion effects on component cognitive mechanisms contributing to WCST performance. OFC lesions decreased the rate of rule value updating following both positive and negative feedback. In contrast, we found no deficit in rule value updating following PS lesions, which instead made monkeys less likely to repeat correct choices when rule values were well established, suggesting a crucial role of the PS in the working memory maintenance of rule representations. Finally, ACC lesions produced a specific deficit in learning from negative feedback, as well as impaired the ability to repeat choices following highly surprising reward, supporting a proposed role for ACC in flexibly switching between a trial-and-error mode and a working memory mode in response to increased error likelihood.