Institute for Music and Neurologic Function

Background: Large infarct cores on CT or CTP were an exclusion from most trials of Endovascular thrombectomy (EVT). However, large cores may be seen in occasional patients presenting within the early window (0-3 hours) and may not preclude potential benefit from thrombectomy. We studied clinical outcomes with thrombectomy in patients presenting with large cores measured by CT or CTP within 3 hours of last known well (LKW). Methods: From a multicenter prospective cohort study of imaging selection for EVT (SELECT), patients with a large ischemic core (CBF<30%) > 50cc or ASPECT≤5 presenting within 3 hours from LKW to imaging were identified. All patients received CT and CTP with mismatch determination by RAPID software. A blinded independent core-lab adjudicated all images. Good (90 day mRS 0-2) and safety (sICH and mortality) outcomes were compared between patients who received EVT and those with medical management (MM) only. Results: Of 445 patients enrolled, 54 met criteria for large core and early presentation; 28 had ASPECT≤5 (17 EVT, 11 MM) and 40 had CTP >50 cc (26 EVT, 14 MM) and 14 on both CT and CTP. Median (IQR) age 66 years (60, 75), NIHSS 20 (18, 23), LKW to puncture 162 min (range 69-343). Baseline characteristics were similar between EVT and MM. Patients with large core whether on CT (ASPECT≤5) or CTP (CBF>50cc) had more frequent good outcome with EVT (30% overall, CT 35%, and CTP 27% vs 0% MM, p=0.04, Fig 1) Furthermore, EVT resulted in smaller average final infarcts (77 vs 202 ml, p=0.03), similar mortality (31% vs 29%, p=0.87) and sICH (16% vs 6%,p=0.34). In patients who achieved good outcome with thrombectomy, EVT resulted in smaller infarct growth 31 ml (10-58) vs 111 cc (67-233) in patients who had poor outcome, p=0.01. Outcome rates were similar if large core was defined as >70ml. Conclusion: Patients with large core infarct measured by CT or CTP presenting within 3 hours may benefit from EVT. Time may trump imaging in patients with large core who present early.

Music has been a wonderful tool to investigate the interconnection between brain science, psychology, and human experience. Moderated by Steve Paulson, executive producer and host of To the Best of Our Knowledge, cognitive neuroscientist and musician Jamshed Bharucha, music therapy pioneer Concetta Tomaino, jazz pianist Vijay Iyer, and physician musician Charles Limb discuss the neurological basis of creativity and aesthetic judgment and the capacity of music to elicit specific emotions and to heal the body. The following is an edited transcript of the discussion that occurred December 12, 2012, 7:00-8:15 PM, at the New York Academy of Sciences in New York City.

ABSTRACT: The role of music therapist is to be there for and with client in and outside music. This article describes how music therapist in musical interaction can be there for and with client at same time as he/she is there for him/herself. This is demonstrated through clinical examples that focus on defining, identification and effective work with musical countertransference as a tool of insight and assessment. The clinical settings include private practice, postgraduate training, internship training, and a short and long term rehabilitation facility. My hope is to reach graduate and postgraduate music therapy clinicians and educators. The educational basis for my work is a Master's degree in Music Therapy, a training in Analytical Music Therapy by lhe founder of AMT Mary Priestley, a Master's degree in Music Education, and 20 years of providing Analytical Music Therapy supervision. What is role of music therapist?'The answer is simple: Being there musically and, if needed, verbally for and with client. What could this mean? We will begin with a music example from work in private practice-a piece of music from end of second session with an adult client, Erik, a 29-year-old man, who was depressed, lonely and grieving. He is vocalizing and am accompanying him on piano. am being there for and with him? Make a judgment yourself. Scheiby excerpt #1, music therapist is playing improvised version of J. S. Bach: in B minor on piano. Client is crying during music. Before music asked Erik: How would you like to end session? He answered, I was thinking that perhaps you could play something for me-something lonely, Bach perhaps. chose to play J.S. Bach's Prelude in B Minor from The Well-Tempered Clavier. My initial reason for choosing that piece by Bach was my perception of its color of sadness that could possibly match client's feelings. Equally important was that it could perform a strong holding function that he needed at that point. Soon after music started Erik began crying and crying became more intense. He had been holding back his tears after first improvisation that we had played together in session. was surprised by intensity of his crying, and it affected me in a countertransferential way. As one can hear, there is a certain heaviness in way articulated tones. When played second part of piece and Erik cried again, this time more intensely, played in a faster tempo, as if wanted it to end quickly because intensity of his expression was too much for me. Erik was grieving because his father was dying. His father had left home due to a divorce and moved to another country when Erik was very young. As a result, he also tapped into his sadness about having had so little time with his father as a child. Moreover, he was depressed because his situation at that time was one of loneliness and isolation. He was also recovering from a liver dis ease that had left him feeling depleted. The concept of countertransference was originally identified by Freud (1910): Countertransference can be regarded as a result of client's influence on his {the analyst's} unconscious (p. 145). Analytical music therapist Mary Priestley (1975) defines countertransference as the therapist's identification with unconscious feelings, self-parts (instinctive self, rational self or conscience) or internal objects of client, which, being conscious in therapist, can serve him as a guide to client's hidden life (p. 240). In above example, my countertransference, that manifested itself in music by a heavy articulation and a sudden faster tempo, was elicited by my unconscious identification with client's strong emotional expression. My own father died when was three months old, and 1 had experienced feelings of loss and sadness that were related to missing strong masculine holding at an early age. …

The therapeutic effects of music are being recognized increasingly in the field of rehabilitation medicine. More music therapists are being employed in physical medicine and rehabilitation centres, with the goal of using music therapy services to assist in the physical recovery and health maintenance of clients. In spite of the benefits of physical rehabilitation programs, client participation to their full potential is often not observed. Music encourages participation in exercises and activities. Music can ease the discomfort and difficulty associated with exercise and therapy activities, and help ensure consistent participation. One of the goals of the music therapist is to provide a means for the client to express him/herself in a musical activity. Music therapy and rehabilitation medicine are starting to find a common niche in working together with clients who have various neurological, orthopaedic, and paediatric conditions. Therapeutic application of music in rehabilitation contributes to the quality of life of individuals with disabilities. Combined goals could include improving strength, range of motion, balance, communication, and cognition. Continued efforts in clinical practice and research will build on the information already available to further define possible applications of music therapy in rehabilitation, and its outcome and benefits. Occupational therapists can use the therapeutic medium of music, and the services of the music therapy discipline, in assisting clients to maximize their functional independence in their daily occupational roles.

Abstract. Observations of spawning by uninjured and injured Atlantic salmon, Salmo salar L., indicated that uninjured fish usually spawned in the outlets, or inlets, to pools and on coarse bottom sediments, whereas injured females spawned in different places. Frequently, the spawning sites lay in very shallow water with a slow current and on a bed of sand or fine gravel. Subsequent excavation of the spawning redds revealed that about 28% of the eggs laid by uninjured females were recovered, compared with only about 8% of those laid by injured females. This difference was significant (P < 0·01).