Integrating Interventions after Traumatic Brain Injury: A Synergistic Approach to Neurorehabilitation

2013 ◽  
Vol 14 (1) ◽  
pp. 51-62 ◽  
Author(s):  
Kristen Dams-O'Connor ◽  
Wayne A. Gordon
Keyword(s):  
Emotional Regulation ◽  
Day Treatment ◽  
Life Quality ◽  
Executive Dysfunction ◽  
Higher Order ◽  
Integrative Approach ◽  
Top Down ◽  
Bottom Up ◽  
Psychotherapeutic Interventions ◽  
Synergistic Approach

Deficits in attention, processing speed and executive functioning are among the most commonly reported and functionally limiting cognitive impairments among individuals with TBI. Changes in mood can exacerbate cognitive deficits and reduce life quality. Contemporary hierarchical models of cognitive functioning suggest that attention/arousal processes underlie and support higher-order functions. Building on decades of clinical research, a synergistic, integrative approach to neurorehabilitation is described, which combines bottom-up and top-town cognitive interventions in addition to psychotherapeutic interventions for mood. This approach is intended to address directly impairments in both foundational (i.e., attention) and higher-order (i.e., executive functions) processes. Executive dysfunction is addressed in a top-down fashion through the application of a series of problem-solving and emotional regulation modules that teach and integrate strategies that can be generalised across situations with practice. Attention, arousal and information processing are necessary prerequisites of successful higher-order thinking, attention skills, and are addressed in a bottom-up fashion through intensive individualised attention and processing training tasks. Combining top-down and bottom-up approaches within a comprehensive day-treatment programme can effect a synergistic improvement of overall functioning.

scholarly journals Environmental and Social Risks to Biodiversity and Ecosystem Health—A Bottom-Up, Resource-Focused Assessment Framework

Earth ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 440-456
Author(s):  
Roger A. Pielke ◽  
Jimmy Adegoke ◽  
Faisal Hossain ◽  
Dev Niyogi
Keyword(s):  
Ecosystem Function ◽  
Ecosystem Health ◽  
Interactive System ◽  
Integrative Approach ◽  
Individual Species ◽  
Assessment Framework ◽  
Top Down ◽  
Bottom Up ◽  
Social Risks ◽  
Biodiversity And Ecosystem Function

Risks from human intervention in the climate system are raising concerns with respect to individual species and ecosystem health and resiliency. A dominant approach uses global climate models to predict changes in climate in the coming decades and then to downscale this information to assess impacts to plant communities, animal habitats, agricultural and urban ecosystems, and other parts of the Earth’s life system. To achieve robust assessments of the threats to these systems in this top-down, outcome vulnerability approach, however, requires skillful prediction, and representation of changes in regional and local climate processes, which has not yet been satisfactorily achieved. Moreover, threats to biodiversity and ecosystem function, such as from invasive species, are in general, not adequately included in the assessments. We discuss a complementary assessment framework that builds on a bottom-up vulnerability concept that requires the determination of the major human and natural forcings on the environment including extreme events, and the interactions between these forcings. After these forcings and interactions are identified, then the relative risks of each issue can be compared with other risks or forcings in order to adopt optimal mitigation/adaptation strategies. This framework is a more inclusive way of assessing risks, including climate variability and longer-term natural and anthropogenic-driven change, than the outcome vulnerability approach which is mainly based on multi-decadal global and regional climate model predictions. We therefore conclude that the top-down approach alone is outmoded as it is inadequate for robustly assessing risks to biodiversity and ecosystem function. In contrast the bottom-up, integrative approach is feasible and much more in line with the needs of the assessment and conservation community. A key message of our paper is to emphasize the need to consider coupled feedbacks since the Earth is a dynamically interactive system. This should be done not just in the model structure, but also in its application and subsequent analyses. We recognize that the community is moving toward that goal and we urge an accelerated pace.

scholarly journals Embodying Cognition in Cognitive Behavioral Therapy

2017 ◽  
Author(s):  
Tania Pietrzak ◽  
Christina Lohr ◽  
Beverly Jahn ◽  
Gernot Hauke
Keyword(s):  
Emotional Disorders ◽  
Emotional Regulation ◽  
Process Model ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Top Down ◽  
Bottom Up ◽  
Knowledge Processes ◽  
Interpersonal Synchrony ◽  
Cognitive Behavioral Theory

The Embodied Cognitive Behavior Therapy (ECBT) approach for the treatment of emotional disorders in clinical settings is presented. The model integrates cognitive behavioral theory, neuroscience and embodied cognition. ECBT draws from evidence of bidirectional effects between modes of bottom up (sensori-motor simulations giving rise to important basis of knowledge) and top down (abstract mental representations of knowledge) processes in psychotherapy. The paper first describes the dominance of the traditional mentalistic view of cognition and its limitations. Evidence for the embodied model of cognition and emotion is reviewed whilst highlighting its advantages as a complimentary process model to deepen and broaden talking therapies. An overview is given of the switch (e.g., the technique of balancing) between top-down and bottom-up orientation in the ECBT model as well as a clear description of the method for emotional regulation, acceptance of unwanted emotions and emotional mastery. ECBT builds on and extends the unconscious processes of the ‘Interpersonal Synchrony’ (IS) model identified by Koole and Tschacher [1], to enhance the therapeutic alliance for emotional co-regulation. A new idea is proposed that both embraces and extends the IS model: embodiment techniques of imitation and movement synchronization in the Emotional Field of our method be used in a conscious way to speed up the calming effects of co-regulation and the client’s self-regulatory capacity. The paper ends with an outline of the criteria needed to become an embodied therapist. A case study is given highlighting these aspects.

The Origin of Consciousness

2010 ◽  
Vol 18 (3) ◽  
pp. 481-495
Author(s):  
Jonathan Cole
Keyword(s):  
Clinical Medicine ◽  
Neural Correlates ◽  
Higher Order ◽  
Brain Anatomy ◽  
Special Issue ◽  
Top Down ◽  
Bottom Up ◽  
Neural Correlates Of Consciousness ◽  
Definition Of ◽  
External Stimuli

This paper introduces the background to the debate addressed by the papers of this Special Issue of Pragmatics & Cognition. Starting with a definition of consciousness it traces some ways in which the term is applied; from clinical medicine, where it relates somewhat crudely to responsiveness to external stimuli, to more cognitive and philosophical aspects such as higher order consciousness and its content. It then discusses the relation of consciousness to brain anatomy, the neural correlates of consciousness, and its possible evolution. In the meeting which forms the basis for Frith’s core paper, Christof Koch also made important contributions, here précised. A discussion of the origins of consciousness in relation to the top-down and bottom-up models brought to the fore follows suit.

scholarly journals Bottom-Up and Top-Down Paradigms for Psychopathology: A Half-Century Odyssey

2020 ◽  
Vol 16 (1) ◽  
pp. 1-24 ◽  
Author(s):  
Thomas M. Achenbach
Keyword(s):  
Empirical Data ◽  
Higher Order ◽  
Assessment Instruments ◽  
Assessment Data ◽  
Top Down ◽  
Services Research ◽  
Bottom Up ◽  
Conceptual Representations ◽  
And Training ◽  
Internalizing And Externalizing

Bottom-up paradigms prioritize empirical data from which to derive conceptualizations of psychopathology. These paradigms use multivariate statistics to identify syndromes of problems that tend to co-occur plus higher-order groupings such as those designated as internalizing and externalizing. Bottom-up assessment instruments obtain self-ratings and collateral ratings of behavioral, emotional, social, and thought problems and strengths for ages 1½–90+. Ratings of population samples provide norms for syndrome and higher-order scales for each gender, at different ages, rated by different informants, in relation to multicultural norms. The normed assessment instruments operationalize the empirically derived syndromes and higher-order groupings for applications to clinical services, research, and training. Because cross-informant agreement is modest and no single informant provides comprehensive assessment data, software compares ratings by different informants. Top-down paradigms prioritize conceptual representations of the nature and structure of psychopathology, as exemplified by psychodynamic, DSM/ICD, and HiTOP paradigms. Although these paradigms originated with observations, they tend to prioritize conceptual representations over empirical data.

scholarly journals Sub-Optimal Learning of Tactile-Spatial Predictions in Patients with Complex Regional Pain Syndrome

2019 ◽  
Author(s):  
Christopher A. Brown ◽  
Ingrid Scholtes ◽  
Nicholas Shenker ◽  
Michael C. Lee
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Statistical Learning ◽  
Bayesian Model ◽  
Pain Syndrome ◽  
Higher Order ◽  
Spatial Displacement ◽  
Top Down ◽  
Bottom Up ◽  
Spatial Changes ◽  
Statistical Regularities

ABSTRACTIn Complex Regional Pain Syndrome (CRPS), tactile sensory deficits have motivated the therapeutic use of sensory discrimination training. However, the hierarchical organisation of the brain is such that low-level sensory processing can be dynamically influenced by higher-level knowledge, e.g. knowledge learnt from statistical regularities in the environment. It is unknown whether the learning of such statistical regularities is impaired in CRPS. Here, we employed a hierarchical Bayesian model of predictive coding to investigate statistical learning of tactile-spatial predictions in CRPS. Using a sensory change-detection task, we manipulated bottom-up (spatial displacement of a tactile stimulus) and top-down (probabilistic structure of occurrence) factors to estimate hierarchies of prediction and prediction error signals, as well as their respective precisions or reliability. Behavioural responses to spatial changes were influenced by both the magnitude of spatial displacement (bottom-up) and learnt probabilities of change (top-down). The Bayesian model revealed that patients’ predictions (of spatial displacements) were found to be less precise, deviating further from the ideal (statistical optimality) compared to healthy controls. This imprecision was less context-dependent, i.e. more enduring across changes in probabilistic context and less finely-tuned to statistics of the environment. This caused greater precision on prediction errors, resulting in predictions that were driven more by momentary spatial changes and less by the history of spatial changes. These results suggest inefficiencies in higher-order statistical learning in CRPS. This may have implications for therapies based on sensory re-training whose effects may be more short-lived if success depends on higher-order learning.

scholarly journals Biology by Design: From Top to Bottom and Back

2010 ◽  
Vol 2010 ◽  
pp. 1-11 ◽  
Author(s):  
Brian R. Fritz ◽  
Laura E. Timmerman ◽  
Nichole M. Daringer ◽  
Joshua N. Leonard ◽  
Michael C. Jewett
Keyword(s):  
Synthetic Biology ◽  
Conceptual Model ◽  
Biological Systems ◽  
Higher Order ◽  
Trial And Error ◽  
Top Down ◽  
Bottom Up ◽  
Societal Needs ◽  
Technical Discipline ◽  
Higher Order Networks

Synthetic biology is a nascent technical discipline that seeks to enable the design and construction of novel biological systems to meet pressing societal needs. However, engineering biology still requires much trial and error because we lack effective approaches for connecting basic “parts” into higher-order networks that behave as predicted. Developing strategies for improving the performance and sophistication of our designs is informed by two overarching perspectives: “bottom-up” and “top-down” considerations. Using this framework, we describe a conceptual model for developing novel biological systems that function and interact with existing biological components in a predictable fashion. We discuss this model in the context of three topical areas: biochemical transformations, cellular devices and therapeutics, and approaches that expand the chemistry of life. Ten years after the construction of synthetic biology's first devices, the drive to look beyond what does exist to what can exist is ushering in an era of biology by design.

scholarly journals Neuronal Activity in the Rat Pulvinar Correlates with Multiple Higher-Order Cognitive Functions

Vision ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. 15
Author(s):  
Fang-Chi Yang ◽  
Rebecca D. Burwell
Keyword(s):  
Neuronal Activity ◽  
Cognitive Functions ◽  
Target Location ◽  
Stimulus Onset ◽  
Visuospatial Attention ◽  
Higher Order ◽  
Top Down ◽  
Bottom Up ◽  
Thalamic Input ◽  
Selection Behavior

The pulvinar, also called the lateral posterior nucleus of the thalamus in rodents, is one of the higher-order thalamic relays and the main visual extrageniculate thalamic nucleus in rodents and primates. Although primate studies report the pulvinar is engaged under attentional demands, there are open questions about the detailed role of the pulvinar in visuospatial attention. The pulvinar provides the primary thalamic input to the posterior parietal cortex (PPC). Both the pulvinar and the PPC are known to be important for visuospatial attention. Our previous work showed that neuronal activity in the PPC correlated with multiple phases of a visuospatial attention (VSA) task, including onset of the visual stimuli, decision-making, task-relevant locations, and behavioral outcomes. Here, we hypothesized that the pulvinar, as the major thalamic input to the PPC, is involved in visuospatial attention as well as in other cognitive functions related to the processing of visual information. We recorded the neuronal activity of the pulvinar in rats during their performance on the VSA task. The task was designed to engage goal-directed, top–down attention as well as stimulus-driven, bottom–up attention. Rats monitored three possible locations for the brief appearance of a target stimulus. An approach to the correct target location was followed by a liquid reward. For analysis, each trial was divided into behavioral epochs demarcated by stimulus onset, selection behavior, and approach to reward. We found that neurons in the pulvinar signaled stimulus onset and selection behavior consistent with the interpretation that the pulvinar is engaged in both bottom–up and top–down visuospatial attention. Our results also suggested that pulvinar cells responded to allocentric and egocentric task-relevant locations.

Psychology and Culture: Top Down Versus Bottom Up?

PsycCRITIQUES ◽  
2005 ◽  
Vol 50 (19) ◽  
Author(s):  
Michael Cole
Keyword(s):  
Top Down ◽  
Bottom Up
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