Science


Juggling as a cognitive empowerment tool in patients with schizophrenia.

Overview


Since 2008, with “juggling-therapy” project I have been involved in the introduction of juggling in psychiatric rehabilitation paths. Psychiatric rehabilitation alongside social and relational support that provides to the patients, specializes in identifying specific compromised areas and cognitive functions in order to carry out targeted work aimed at recovery and enhancement of those.

Looking for a systematic, quantifiable and verifiable approach to rehabilitation, I have studied the changes that juggling can bring to the brain.
There are many scientific studies carried out on this specific art, since juggling by its characteristics is a skill often used in recent years as a scientific investigation tool for neuroplasticity induced by motor skills learning.
From these studies it is noted that learning juggling exercises develops the V5 area of the brain that is compromised in patients with schizophrenia. This deficit is also linked to a deficit in Theory of Mind, or the ability to interpret intentions and emotions of others.
Hence the idea of proposing a scientific study aimed at demonstrating that the acquisition of juggling exercises, with the consequent increase in gray matter in V5 area, could improve performance in ToM in patients with schizophrenia diagnosis.
Below is a more in-depth analysis of all aspects of this study proposal.

Proposal

The study aims at verifying the possibility of offsetting the deficit in "Theory of Mind" (ToM) in patients with schizophrenia, through a change in gray matter induced by the learning of juggling exercises.

Evidence

The study proposal is based on three main evidences supported by scientific studies:

-Patients with schizophrenia have a deficit in the V5 area.
Lencer, Rebekka, et al. "Reduced neuronal activity in the V5 complex underlies smooth-pursuit deficit in schizophrenia: evidence from an fMRI study." Neuroimage 24.4 (2005): 1256-1259.

- deficits in the Theory of Mind, in patients with schizophrenia are related to dysfunction in motion perception. Specifically, we hypothesize a correlation between ToM deficits and the impairment of the brain areas of motion perception.
Kelemen, Oguz, et al. "Theory of mind and motion perception in schizophrenia." Neuropsychology 19.4 (2005): 494.

-Acquiring juggling skills causes a significant increase of density in the V5 area of the brain and hence its functionality.
Draganski, Bogdan, et al. "Neuroplasticity: changes in grey matter induced by training." Nature 427.6972 (2004): 311-312.
The V5 area is the area that process complex movements perceived by the view. We can find in the literature cases of patients with a lesion in this specific area that have a "static frames view", or perceive space as a series of static images that follow: they see the cars advancing and the water coming down the faucet appears frozen. People who have injured all areas except the V5 area, do not see what surrounds them but may perceive the movement of objects around them.


Target

Demonstrating a correlation between increasing the functionality of the V5 area and improving performance in the ToM would provide us with the opportunity to have a rehabilitation tool, which is the acquisition of juggling practices, that can be systematic, quantifiable and effective. We can intervene to compensate for organic deficits in patients with schizophrenia diagnosis with clinical evidence of an improvement in the pathophysiological situation. It would also give greater value to an artistic therapeutic approach, juggling-therapy, which finds now its benefits quantifiable in expressive and relational aspects.

Action

It is intended to identify two groups of patients (the study group and the control group) diagnosed with schizophrenia matched by age and gender. Then follow the following path:

For the study group:


1. Perform a Magnetic brain Resonance imaging MRI (T1 weighted magnetic resonance imaging MRI)
2.  Perform Test to assess capacity in the ToM.

3.  Participate in a learning process of juggling techniques that leads to acquiring the 3-ball cascade maintained for at least 60 seconds, which leads to a variation in gray matter as demonstrated in “Neuroplasticity: Changes in Gray matter induced by training”. The estimated time is 9 months.

4.  Repeat magnetic resonance imaging

5.  Repeat test to assess capacity in ToM

6.   Analyze and compare data

An implementation of this study could be the introduction of these three additional points

7.   At the end of point 6 interrupt any type of exercise or practice concerning juggling

8.  Repeat Magnetic Resonance and Test Abilities in Tom at 3 Months From Exit Exercise (ie when we can hypothesize a decrease in gray matter in V5 area)

9.   Analysis and comparison of data

This is to follow what is indicated in the study "Neuroplasticity: Changes in Gray Subject Induced by Training" and to further evaluate the correlation between increased functionality in the V5 area and better performance in the ToM, and thus also a decrease in functionality in the " V5 area and worse performance in ToM.


For the control group

Patients diagnosed with schizophrenia

1.  Perform brain magnetic resonance imaging and ToM tests

2.  Repeat Magnetic Resonance and ToM Testing After the Time the Study Group Acquired the Juggling Skills)

3.  Analysis and comparison of data

Tools

"Reading the mind in the eyes test" is a test consisting of thirty-six faces photographs with complex emotional facial expressions. For each photo, participants are asked to choose between four different emotional states they feel is expressing the person in photography.
T1 weighted magnetic resonance imaging MRI: This is the type of magnetic resonance used in Neuroplasticity: Changes in gray matter induced by training, which allows us to evaluate a variation in gray matter.

Expected results

The results expected from this study are that an expansion of V5 area gained through  the acquisition of juggling skills brings schizophrenic patients improved performance in the ToM.

Who is involved?

At this stage I am looking for feedback on this study proposal and I'm looking for institutions available to evaluate the feasibility of this study and start a collaboration to realize this study.

Antonio Caggioni
Psychiatric rehabilitator and juggler.
www.juggling-therapy.com
+39 333 7808103


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