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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Although often termed a "neurological condition," synesthesia is not listed in either the DSM-IV or the ICD since it most often does not interfere with normal daily functioning. Indeed, most synesthetes report that their experiences are neutral or even pleasant. Like perfect pitch, synesthesia is simply a difference in perceptual experience.
The simplest approach is test-retest reliability over long periods of time, using stimuli of color names, color chips, or a computer-screen color picker providing 16.7 million choices. Synesthetes consistently score around 90% on reliability of associations, even with years between tests. In contrast, non-synesthetes score just 30–40%, even with only a few weeks between tests and a warning that they would be retested.
Grapheme-color synesthetes, as a group, share significant preferences for the color of each letter (e.g. A tends to be red; O tends to be white or black; S tends to be yellow etc.) Nonetheless, there is a great variety in types of synesthesia, and within each type, individuals report differing triggers for their sensations and differing intensities of experiences. This variety means that defining synesthesia in an individual is difficult, and the majority of synesthetes are completely unaware that their experiences have a name.
Neurologist Richard Cytowic identifies the following diagnostic criteria for synesthesia in his "first" edition book. However, the criteria are different in the second book:
1. Synesthesia is involuntary and automatic.
2. Synesthetic perceptions are spatially extended, meaning they often have a sense of "location." For example, synesthetes speak of "looking at" or "going to" a particular place to attend to the experience.
3. Synesthetic percepts are consistent and generic (i.e. simple rather than pictorial).
4. Synesthesia is highly memorable.
5. Synesthesia is laden with affect.
Cytowic's early cases mainly included individuals whose synesthesia was frankly projected outside the body (e.g. on a "screen" in front of one's face). Later research showed that such stark externalization occurs in a minority of synesthetes. Refining this concept, Cytowic and Eagleman differentiated between "localizers" and "non-localizers" to distinguish those synesthetes whose perceptions have a definite sense of spatial quality from those whose perceptions do not.
Mirror-touch synesthesia is a rare condition which causes individuals to experience the same sensation (such as touch) that another person feels. For example, if someone with this condition were to observe someone touching their cheek, they would feel the same sensation on their own cheek. Synesthesia, in general, is described as a condition in which a stimulus causes an individual to experience an additional sensation. Synesthesia is usually a developmental condition; however, recent research has shown that mirror touch synesthesia can be acquired after sensory loss following amputation.
Synesthesia is found in at least 4.4% of the population, as a high estimate, which is equivalent to 1 in 23 people. This study had also concluded that one common form of synesthesia—grapheme-color synesthesia (colored letters and numbers) – is found in more than one percent of the population, and this latter prevalence of graphemes-color synesthesia has now been independently verified in a yet larger sample. Earlier estimates of the prevalence of synesthesia were based on "best-guess" estimations only ("e.g." 1 in 250,000) or had limitations in their methodologies because they required synesthetes to refer themselves for study ("e.g." 1 in 2000) and for this reason the authors of those studies had been moderate in their claims. Also, some individuals will not self-classify as synesthetes because they do not realize that their perceptions are different from those of everyone else.
The most common forms of synesthesia are those that trigger colors, and the most prevalent of all is day-color. Also relatively common is grapheme-color synesthesia. We can think of "prevalence" both in terms of how common is synesthesia (or different forms of synesthesia) within the population, or how common are different forms of synesthesia within synesthetes. So within synesthetes, forms of synesthesia that trigger color also appear to be the most common forms of synesthesia with a prevalence rate of 86% within synesthetes. In another study, music-color is also prevalent at 18–41%. Some of the rarest are reported to be auditory-tactile, mirror-touch, and lexical-gustatory.
There is research to suggest that the likelihood of having synesthesia is greater in people with autism.
Three conditions must be met in order to confirm the presence of mirror touch synesthesia. The first condition is that the synaesthetic response, which is defined as the sensation synesthetes feel after observing someone else being touched, should feel like conscious experiences. The second condition is that synesthetic responses are induced by a stimulus that normally does not induce that response. The third condition is that the synesthetic experiences must occur automatically, without conscious thought. In order to examine the prevalence of this condition, a study was conducted at the University College London and University of Sussex. 567 undergraduate participants were recruited and given a questionnaire. From the questionnaire, it was determined that approximately 2.5% of the population experienced mirror-touch synesthesia symptoms. Further studies have shown the prevalence to be 1.6%, meaning that this condition is one of the more common types of synesthesia, along with grapheme-color synesthesia (1.4%) and day-color synesthesia (2.8%). At the moment it is believed that there are two subtypes of the condition. The first type causes a person to feel sensations on the part of their body that mirrors the observed touch. The second type causes a person to feel sensations on the same side of their body as the observed touch.
Studies have attempted to more explicitly define the of synesthetic responses. In most studies, participants are asked to observe someone else being touched and report what kind of synesthetic response they experience. In one particular instance, video clips were used to show different types of observed touch. The of the synesthetic touch is not affected by the location of the observed touch (arm, leg, hand, etc.); however, it is sometimes affected by the spatial orientation of the observed touch. When crossed hands are touched, the hands become uncrossed in the perception of synesthetes. However when the observed hand is upside down, the observed touch does not get rotated. Intensity is also not affected if the observed act consists of someone touching themselves, versus someone touching them. Additionally, the type of object doing the touching has a significant effect on the intensity of the response. If a finger or knife tip is used, a much higher intensity is experienced than if a feather is used. Finally, watching a dummy being touched decreases the intensity of the observed touch significantly. For this reason, it is suspected that in order to experience a synesthetic touch, synesthetes must observe somebody who is capable of feeling sensations.
Mirror touch responses are not limited to feeling touch. Mirror touch synesthetes have a higher ability to feel empathy than non-synesthetes, and can therefore feel the same emotions that someone else may be observed to feel. Additionally, some individuals experience pain when observing someone else in pain, and this is a condition usually developed from birth. Approximately 30% of the normal population experience some form of this condition and around 16% of amputees report synesthetic pain after an amputation. This condition can either be acquired or developed. In the congenital condition, synesthetes experience pain in the same location as the observed pain; however, in the acquired condition, high intensity pain is felt at the same location as the trauma.
When diagnosing allochiria, it is important to consider the sensory and the motor aspects of the problem. In absence of knowledge there are a number of ways in which the various symptoms may be overlooked or misinterpreted and as the condition goes frequently unrecognized. One rare example in medicine that causes a wrong diagnosis of allochiria is due to the unawareness of a few simple facts than to any failure in judgment. It is evident that the details of the sensory symptoms get overlooked when testing a patient's localizing capacity. The observer neglects to inquire expressly as to the side to which the sensation is referred. This is evident when patients with allochiria show no fault in sensorial perception and localization. However, even if the patient mentions the wrong side, it is sometimes being just regarded as a slip of the tongue and matter may not be pursued any further. Looking at the motor aspect of allochiria, the symptoms again are described in a misleading way because the symptoms are less obvious. Unless motor manifestations are carefully analyzed, they may be interpreted as clumsiness or weakness. Moreover, when patients complained of weakness and awkwardness of right side—examinations apparently confirmed that the truth of this statement and defect was marked as acts consciously performed and was present only in relation to such acts. If a patient says that he cannot tell on which side the certain stimulus is applied—existence of allochiria is confirmed, provided that sensibility is intact.
Scintigraphy, plain radiographs, and magnetic resonance imaging (MRI) may all be useful diagnostically. Patchy osteoporosis (post-traumatic osteoporosis), which may be due to disuse of the affected extremity, can be detected through X-ray imagery as early as two weeks after the onset of CRPS. A bone scan of the affected limb may detect these changes even sooner and can almost confirm the disease. Bone densitometry can also be used to detect changes in bone mineral density. It can also be used to monitor the results of treatment since bone densitometry parameters improve with treatment.
Presently, established empirical evidence suggests against thermography's efficacy as a reliable tool for diagnosing CRPS. Although CRPS may, in some cases, lead to measurably altered blood flow throughout an affected region, many other factors can also contribute to an altered thermographic reading, including the patient's smoking habits, use of certain skin lotions, recent physical activity, and prior history of trauma to the region. Also, not all patients diagnosed with CRPS demonstrate such "vasomotor instability" — less often, still, those in the later stages of the disease. Thus, thermography alone cannot be used as conclusive evidence for - or against - a diagnosis of CRPS and must be interpreted in light of the patient's larger medical history and prior diagnostic studies.
In order to minimise the confounding influence of external factors, patients undergoing infrared thermographic testing must conform to special restrictions regarding the use of certain vasoconstrictors (namely, nicotine and caffeine), skin lotions, physical therapy, and other diagnostic procedures in the days prior to testing. Patients may also be required to discontinue certain pain medications and sympathetic blockers. After a patient arrives at a thermographic laboratory, he or she is allowed to reach thermal equilibrium in a 16–20 °C, draft-free, steady-state room wearing a loose fitting cotton hospital gown for approximately twenty minutes. A technician then takes infrared images of both the patient's affected and unaffected limbs, as well as reference images of other parts of the patient's body, including his or her face, upper back, and lower back. After capturing a set of baseline images, some labs further require the patient to undergo cold-water autonomic-functional-stress-testing to evaluate the function of his or her autonomic nervous system's peripheral vasoconstrictor reflex. This is performed by placing a patient's unaffected limb in a cold water bath (approximately 20 °C) for five minutes while collecting images. In a normal, intact, functioning autonomic nervous system, a patient's affected extremity will become colder. Conversely, warming of an affected extremity may indicate a disruption of the body's normal thermoregulatory vasoconstrictor function, which may sometimes indicate underlying CRPS.
There are no standard diagnostic criteria. Misophonia is distinguished from hyperacusis, which is not specific to a given sound and does not involve a similar strong reaction, and from phonophobia, which is a fear of a specific sound, but it may occur with either.
It is not clear whether people with misophonia usually have comorbid conditions, nor whether there is a genetic component.
One approach that has received public interest is the use of a mirror box. The mirror box provides a reflection of the intact hand or limb that allows the patient to "move" the phantom limb, and to unclench it from potentially painful positions.
As of 2011, however, the quality of evidence is low. There is a wide range in the effectiveness of this approach. The potential for a person to benefit from mirror therapy is not predictable and appears to be related to the subjective ability of the patient to internalize the reflection of a complete limb as their own limb. About 40% of people do not benefit from mirror therapy.
Supernumerary phantom limb is a condition where the affected individual believes and receives sensory information from limbs of the body that do not actually exist, and never have existed, in contradistinction to phantom limbs, which appear after an individual has had a limb removed from the body and still receives input from it.
An fMRI study of a subject with a supernumerary phantom left arm was done by Khateb "et al." at the Laboratory of Experimental Neuropsychology at the University of Geneva. When the subject was told to touch her right cheek with the phantom limb, there was increased activity in the motor cortex of her brain in the area roughly corresponding to the left arm. When she announced that she had touched the phantom limb to her cheek, activity was monitored in the area of the somatosensory cortex that corresponded to the right cheek. At times during the experiment, the subject was asked to move the phantom limb to a location that was obstructed or otherwise unfeasible. In these instances, there was similar activation of the motor cortex but no such activity in the somatosensory cortex.
Allochiria represents a psychical affection and the occurrence of any form of allochiria should be regarded as a positive indication of the presence of hysteria. Recognition of the allochiria may throw light upon a number of symptoms that would otherwise be misinterpreted as paresis, aboulia, and defective sensibility. This enables a correct analysis to be made of the precise defects present and serve as a guide toward the original focus of the whole affection and proving an important step in the exact psychological diagnosis that is an essential preliminary to the scientific treatment of hysteria.
The diagnosis of misophonia is not recognized in the DSM-IV or the ICD 10, and it is not classified as a hearing, neurological, or psychiatric disorder. It may be a form of sound–emotion synesthesia, and has parallels with some anxiety disorders. As of 2015 it was not clear if misophonia should be classified as a symptom or as a condition.
Grapheme-color synaesthesia or colored grapheme synesthesia is a form of synesthesia in which an individual's perception of numerals and letters is associated with the experience of colors. Like all forms of synesthesia, Grapheme-color synesthesia is involuntary, consistent, and memorable. Grapheme-color synesthesia is one of the most common forms of synesthesia, and because of the extensive knowledge of the visual system, one of the most studied.
While it is extremely unlikely that any two synesthetes will report the same colors for all letters and numbers, studies of large numbers of synesthetes find that there are some commonalities across letters (e.g., "A" is likely to be red). Early studies argued that grapheme-color synesthesia was not due to associative learning, such as from playing with colored refrigerator magnets. However, one recent study has documented a case of synesthesia in which synesthetic associations could be traced back to colored refrigerator magnets. Despite the existence of this individual case, the majority of synesthetic associations do not seem to be driven by learning of this sort. Rather, it seems that more frequent letters are paired with more frequent colors, and some meaning-based rules, such as ‘b’ being blue, drive most synesthetic associations.
There has been a lot more research as to why and how synesthesia occurs with more recent technology and as synesthesia has become more well known. It has been found that grapheme-color synesthetes have more grey matter in their brain. There is evidence of an increased grey matter volume in the left caudal intra- parietal sulcus (IPS). There was also found to be an increased grey matter volume in the right fusiform gyrus. These results are consistent with another study on the brain functioning of grapheme-color synesthetes. Grapheme-color synesthetes tend to have an increased thickness, volume, and surface area of the fusiform gyrus. Furthermore, the area of the brain where word, letter, and color processing are located, V4a, is where the most significant difference in make-up was found. Though not certain, these differences are thought to be part of the reasoning for the presence of grapheme-color synesthesia.
Individuals with grapheme-color synesthesia rarely claim that their sensations are problematic or unwanted. In some cases, individuals report useful effects, such as aid in memory or spelling of difficult words.
These experiences have led to the development of technologies intended to improve the retention and memory of graphemes by individuals without synesthesia. Computers, for instance, could use "artificial synesthesia" to color words and numbers to improve usability. A somewhat related example of "computer-aided synesthesia" is using letter coloring in a web browser to prevent IDN homograph attacks. (Someone with synesthesia can sometimes distinguish between barely different looking characters in a similar way.)
Experiences - are characterized by the presence of the following three factors:
- disembodiment, an apparent location of the self outside one's body;
- impression of seeing the world from an elevated and distanced visuo-spatial perspective or extracorporeal, but egocentric visuo-spatial perspective;
- impression of seeing one's own body from this perspective (autoscopy).
Laboratory of Cognitive Neuroscience, École Polytechnique Fédérale de Lausanne, Lausanne, and Department of Neurology, University Hospital, Geneva, Switzerland, have reviewed some of the classical precipitating factors of autoscopy. These are sleep, drug abuse, and general anesthesia as well as neurobiology. They have compared them with recent findings on neurological and neurocognitive mechanisms of the autoscopy. The reviewed data suggest that autoscopic experiences are due to functional disintegration of lower-level multisensory processing and abnormal higher-level self-processing at the temporoparietal junction.
Most approaches to treatment over the past two decades have not shown consistent symptom improvement. Treatment approaches have included medication such as antidepressants, spinal cord stimulation, vibration therapy, acupuncture, hypnosis, and biofeedback. Reliable evidence is lacking on whether any treatment is more effective than the others.
Most treatments are not very effective. Ketamine or morphine may be useful around the time of surgery. Morphine may be helpful for longer periods of time. Evidence for gabapentin is mixed. Perineural catheters that provide local anesthetic agents have poor evidence when placed after surgery in an effort to prevent phantom limb pain.
Autoscopy is the experience in which an individual perceives the surrounding environment from a different perspective, from a position outside of his or her own body. Autoscopy comes from the ancient Greek ("self") and ("watcher").
Autoscopy has been of interest to humankind from time immemorial and is abundant in the folklore, mythology, and spiritual narratives of most ancient and modern societies. Cases of autoscopy are commonly encountered in modern psychiatric practice. According to neurological research, autoscopic experiences are hallucinations.
Pharmacological techniques are often continued in conjunction with other treatment options. Doses of pain medications needed often drop substantially when combined with other techniques, but rarely are discontinued completely. Tricyclic antidepressants, such as amitriptyline, and sodium channel blockers, mainly carbamazepine, are often used to relieve chronic pain, and recently have been used in an attempt to reduce phantom pains. Pain relief may also be achieved through use of opioids, ketamine, calcitonin, and lidocaine.
Deep brain stimulation is a surgical technique used to alleviate patients from phantom limb pain. Prior to surgery, patients undergo functional brain imaging techniques such as PET scans and functional MRI to determine an appropriate trajectory of where pain is originating. Surgery is then carried out under local anesthetic, because patient feedback during the operation is needed. In the study conducted by Bittar et al., a radiofrequency electrode with four contact points was placed on the brain. Once the electrode was in place, the contact locations were altered slightly according to where the patient felt the greatest relief from pain. Once the location of maximal relief was determined, the electrode was implanted and secured to the skull. After the primary surgery, a secondary surgery under general anesthesia was conducted. A subcutaneous pulse generator was implanted into a pectoral pocket below the clavicle to stimulate the electrode. It was found that all three patients studied had gained satisfactory pain relief from the deep brain stimulation. Pain had not been completely eliminated, but the intensity had been reduced by over 50% and the burning component had completely vanished.
Anaphia, also known as tactile anesthesia, is a medical symptom in which there is a total or partial absence of the sense of touch.
Anaphia is a common symptom of spinal cord injury and neuropathy.
Somatoparaphrenia is a type of monothematic delusion where one denies ownership of a limb or an entire side of one's body. Even if provided with undeniable proof that the limb belongs to and is attached to their own body, the patient produces elaborate confabulations about whose limb it really is, or how the limb ended up on their body. In some cases, delusions become so elaborate that a limb may be treated and cared for as if it were a separate being.
Somatoparaphrenia differs from a similar disorder, asomatognosia, which is characterized as loss of recognition of half of the body or a limb, possibly due to paralysis or unilateral neglect. For example, asomatognosic patients may mistake their arm for the doctor's. However, they can be shown their limb and this error is temporarily corrected.
Somatoparaphrenia has been reported to occur predominately in the left arm of one's body, and it is often accompanied by left-sided paralysis and anosognosia (denial or lack of awareness) of the paralysis. The link between somatoparaphrenia and paralysis has been documented in many clinical cases and while the question arises as to whether paralysis is necessary for somatoparaphrenia to occur, anosognosia is not, as documented by cases with somatoparaphrenia and paralysis with no anosognosia.
Ordinal-linguistic personification (OLP, or personification for short) is a form of synesthesia in which ordered sequences, such as ordinal numbers, days, months and letters are associated with personalities and/or genders (). Although this form of synesthesia was documented as early as the 1890s (; ) researchers have, until recently, paid little attention to this form (see History of synesthesia research).
CMM has clear severe impacts on a patient’s ability to carry out daily manual tasks. It is recommended that children be placed under more forgiving school environments, allowing more time for written evaluations and limiting handwritten assignments, to ease the burden of the movement disability. Furthermore, because of patients’ inability to perform pure unilateral movements and their difficulty with tasks requiring skilled bimanual coordination, young and new members to the workforce are encouraged to consider professions that do not require complex bimanual movements, repetitive or sustained hand movements, or extensive handwriting, to reduce overuse, pain, and discomfort in upper limbs.
Because of its pronounced and obviously noticeable signs and symptoms, CMM patients can suffer social stigma, however physicians need to make it clear to parents, family, and friends that the disorder bears no relation to intellectual abilities. However, the rarity of this neurologic disease, found in one in a million people, makes its societal and cultural significance quite limited.
Hypoesthesia (or hypesthesia) refer to a reduced sense of touch or sensation, or a partial loss of sensitivity to sensory stimuli. In everyday speech this is sometimes referred to as "numbness".
Hypoesthesia is one of the negative sensory symptoms associated with cutaneous sensory disorder (CSD). In this condition, patients have abnormal disagreeable skin sensations that can be increased (stinging, itching or burning) or decreased (numbness or hypoesthesia). There are no other apparent medical diagnoses to explain these symptoms.
Cutaneous hyperesthesia has been associated with diagnosis of appendicitis in children but this symptom was not supported by the evidence.
Hypoesthesia originating in (and extending centrally from) the feet, fingers, navel, and/or lips is one of the common symptoms of beriberi, which is a set of symptoms caused by thiamine deficiency.
Hypoesthesia is also one of the more common manifestations of decompression sickness (DCS), along with joint pain, rash and generalized fatigue.
Daily oral muscle physical therapy, or the administration of antidepressants have been reported as effective therapy for occlusal dysesthesia patients. Tooth grinding, and the replacement or removal of all dental work should be avoided in patients with occlusal dysesthesia, despite the frequent requests for further surgery often made by these patients.
Antidepressants are also often prescribed for scalp dysesthesia.
Prakash et al. found that many patients suffering from burning mouth syndrome (BMS), one variant of occlusal dysesthesia, also report painful sensations in other parts of the body. Many of the patients suffering from BMS met the classification of restless leg syndrome (RLS). About half of these patients also had a family history of RLS. These results suggest that some BMS symptoms may be caused by the same pathway as RLS in some patients, indicating that dopaminergic drugs regularly used to treat RLS may be effective in treating BMS as well.