Posts Tagged anxiety
- Anxiety and seizures
- PNES (pseudoseizures)
- Panic attacks and seizures
- Panic attack vs. PNES
- PNES symptoms
- PNES diagnosis
- PNES treatment
- Bottom line
Anxiety is a necessary human emotion designed to alert us to potential dangers and protect us from potential threats. For most people, feelings of anxiety are short-lived, but in some people, anxiety can become a chronic condition that greatly impacts quality of life.
Anxiety can cause a wide range of physical and mental symptoms, one of which may include psychogenic nonepileptic seizures (PNES), also called pseudoseizures.
In this article, we’ll explain what PNES are, how they differ from neurological seizures, and everything you need to know about anxiety and PNES.
A seizure is a brief period of uncontrolled electrical activity in the brain that can provoke a wide variety of changes in the body. Epilepsy is a chronic condition that causes unpredictable, recurrent seizures.
Seizures can be caused by a variety of triggers, including increased stress and anxiety. In fact, according to the British Epilepsy AssociationTrusted Source, stress is one of the most commonly self-reported seizure triggers in people with epilepsy.
Research has also shown that even in people without epilepsy, stress and anxiety can trigger what’s known as psychogenic nonepileptic seizures (PNES), or pseudoseizures. PNES are physiologically different from the neurological seizures found in epilepsy.
Pseudoseizures (PNES) aren’t the same type of neurological seizures that are caused by uncontrolled activity in the brain. Instead, PNES are an extreme response to stress and anxiety and are therefore considered psychiatric in nature.
According to the literatureTrusted Source, PNES are classified as a type of functional neurological disorder (FND), or conversion disorder. Conversion disorders are triggered by emotional stress that causes physical symptoms that can’t be explained by other underlying conditions.
PNES most often occur in people who struggle to manage stress, anxiety, or other traumatic emotions through traditional coping strategies. When these emotions become overwhelming enough, the body may shut down as a defense mechanism. In some people, this can present as a PNES.
Sometimes, anxiety symptoms can manifest as a sudden, intense episode called a panic attack. Panic attack symptoms mimic many of the same symptoms you may feel when you’re anxious. However, you may also notice other intense symptoms, such as:
- difficulty breathing or swallowing
- sharp chest pains
- chills or hot flashes
- tingling or numbness in the extremities
- feelings of panic or dread
- feelings of disconnection from yourself or reality
Panic attacks aren’t a known cause of neurological seizures in people without epilepsy. However, there may be a correlation between panic attacks and PNES in people who experience them.
In one meta-analysisTrusted Source from 2018, researchers investigated the link between panic and hyperventilation and PNES. Eighteen studies were analyzed for a potential relationship between panic attacks, hyperventilation episodes, and PNES.
According to the results, up to 83 percent of individuals who had PNES also reported having accompanying panic attacks. In addition, the researchers found that up to 30 percent of individuals with voluntarily induced hyperventilation also experienced PNES.
While these results seem to suggest that panic attacks and panic attack symptoms may be a trigger for PNES, more research is still needed.ADVERTISEMENTExplore new calming exercises with Calm
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Panic attacks and PNES can both happen as a result of stress and anxiety. However, there are differences between the two experiences that distinguish them from each other.
These episodes feature many, if not all, of the classic symptoms of anxiety. Panic attacks come on suddenly and pass within about 10 minutes. Many people who have panic attacks are still able to retain some level of function during the attack. However, symptoms vary from person to person.
These episodes may not feature any symptoms of panic or anxiety at all. PNES tend to come on gradually and last longer than panic attacks. Many people who have PNES also experience panic symptoms, but some don’t.
In some cases, panic attacks can even be used as a diagnostic tool to help differentiate PNES from neurological seizures. In one studyTrusted Source from 2014, researchers found that panic attack symptoms were more likely to appear in a PNES than in an epileptic seizure.
Although PNES and neurological seizures may appear similar, there are some differences in symptoms between the two conditions. For example, PNES may feature some of the symptoms found in neurological seizures, such as:
- lowered awareness
- loss of body control
- flailing or thrashing
- head arching
- tongue biting
In addition to the symptoms above, PNES may also present with symptoms not traditionally found in neurological seizures, such as:
- side to side head movements
- nonsynchronized body movements
- muscle contractions
- closed or fluttering eyes
- crying during the episode
- avoidance behaviors
- memory recall or avoidance
Another distinguishing factor of PNES is that these symptoms tend to appear more gradually and last longer than in neurological seizures.
If you have been experiencing PNES, your doctor will most likely refer you to an inpatient setting for testing. Video-electroencephalography (vEEG) is the most common diagnostic test for pseudoseizures.
During your inpatient stay, you will be connected to an electroencephalography (EEG) machine and a video monitoring system. The EEG machine tracks electrical activity in the brain, while the video monitoring system records any physical symptoms.
Any seizures or PNES that happen during your stay will be analyzed to determine the correct diagnosis. If you appear to have a seizure, but there’s no unusual brain activity, the most likely diagnosis is PNES.
In some cases, further imaging of the brain with a CT scan or MRI scan may be warranted. Your doctor may also want to perform further testing to eliminate any other underlying conditions, such as deficiency or infection.
They may also order additional psychological testing to narrow down any potential causes or triggers for your PNES.
Since PNES are psychological in nature, treatmentTrusted Source of the underlying anxiety is important. Treatment options for anxiety-induced PNES may include:
- Psychotherapy. Cognitive-behavioral therapy (CBT) is the first line of treatment for anxiety disorders. With CBT, an individual can learn how to better cope with stressful or anxious thoughts, feelings, and behaviors. This may help reduce the frequency of pseudoseizures. In addition, trauma-focused therapy may be helpful for individuals with trauma-based disorders who experience pseudoseizures.
- Medications. Anti-epileptic drugs aren’t useful for pseudoseizures because these seizures aren’t neurological. Instead, selective serotonin reuptake inhibitors (SSRIs) may be prescribed to help reduce the symptoms of anxiety that can cause pseudoseizures. SSRIs have been found to be most effectiveTrusted Source when used in conjunction with psychotherapy.
- Lifestyle. Both psychotherapy and medications can help an individual more easily cope with stress and anxiety. In turn, this can reduce the potential for emotionally triggered pseudoseizures. However, lifestyle changes can also help to reduce the symptoms of anxiety. Focusing on good sleep, a balanced diet, daily exercise, and mindfulness practices can further reduce anxiety and greatly improve quality of life.
Ultimately, you and your doctor will work together to come up with the best treatment approach for your personal situation.
While anxiety is unlikely to trigger neurological seizures in people without epilepsy, it can trigger PNES in individuals with underlying mental health conditions. Since these episodes have a psychiatric origin, treatment of the underlying anxiety can help reduce or eliminate these episodes.
If you’re concerned that you have been having PNES, reach out to your doctor for an appropriate diagnosis and treatment.
Last medically reviewed on March 29, 2021
What Is a Weighted Blanket?
Pros and Cons About the Popular “Pressure Therapy” Device
Weighted blankets, also known as gravity blankets, have been used for years by mental health professionals as a form of pressure therapy. Today, they have gained mainstream popularity with those who believe that the pellet-filled blankets, which weigh anywhere from 5 to 30 pounds, can relieve stress, improve sleep, calm children with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), and aid in the treatment of anxiety disorders.
Although many people report improvements in their health and well-being from these popular blankets, there remains considerable debate as to whether they offer the benefits that proponents claim.
Many adults associate snuggling under a comfy blanket with a sense of security, which harkens back to “security blankets” they may have had as a child. Blankets are often referred to as “comfort objects” by child psychologists—that is, an item used to ease frustration or anxiety at times of stress.1
An older study by psychologist and security object expert Richard Passman, now retired from the University of Wisconsin at Milwaukee, found that approximately 60% of children are attached to a toy, blanket, or pacifier during the first three years of life.2
More recent studies have examined adult attachment to transitional objects, such as blankets and stuffed animals. In one study using a non-clinical community sample of 80 participants, researchers found that people who reported intense attachments to objects were significantly more likely to meet the criteria for borderline personality disorder than those who did not; they also reported more childhood trauma.3
Weighted blankets aim to evoke the same therapeutic effects of a security blanket by intensifying the sensation of being held, stroked, cuddled, or squeezed.
The science behind using a weighted blanket is a well-known and proven relaxation therapy that is frequently used for people with stress and anxiety. Known by various names, it is commonly referred to as deep pressure stimulation (DPS).
DPS, offered by trained practitioners who apply pressure to certain parts of the body, stimulates what is known as the parasympathetic nervous system. The nervous system reacts to stressful situations naturally, by inducing its sympathetic or “alert” state, which can produce anxiety and stress. The parasympathetic system counterbalances this sympathetic activation.
DPS and weighted blankets can stimulate the parasympathetic response. When the parasympathetic nervous system kicks in, it can instill feelings of calm, slowing many of the body’s autonomic functions. There are also psychological calming effects, akin to being cocooned in your favorite duvet on a cold winter night, knowing you are protected from the outside world.4
Weighted blankets may help adults and children with sensory processing disorder feel calmer and more relaxed.5 Persons with this disorder have difficulty processing sensory information such as textures, sounds, smells, tastes, brightness, and movement.
These difficulties can make ordinary situations overwhelming, interfere with daily living, and even isolate individuals and their families. Sensory integration therapy uses activities in ways designed to change how the brain reacts to various stimuli.6
Applying deep pressure has also been shown to be beneficial for children with high levels of anxiety or arousal due to sensory overload. According to research, the application of deep pressure provided by a weighted vest or blanket can produce a calming or relaxing effect in children with certain clinical conditions who have sensory processing issues.5
Although more studies are needed, research has been conducted on the use of weighted blankets to treat the following conditions:
- General anxiety
- Anxiety during certain medical procedures
- Insomnia in children with autism spectrum disorder
- Sleep problems in children with ADHD
Some studies show that the use of weighted blankets may help reduce nighttime levels of cortisol, a stress hormone that can contribute to anxiety.7 Cortisol is best known for being involved in the “fight or flight” response, a reaction that evolved as a means of survival, enabling people to react to what could be a life-threatening situation.
Over time, however, elevated cortisol levels can have a negative impact on a person’s physical and mental health.8 By providing deep pressure, weighted blankets can promote relaxation and help break this cycle. For example, one study examined the use of a 30-pound weighted blanket in a sample of 32 adults; 63% reported lower anxiety after using the blanket.9
Anxiety During Certain Medical Procedures
A 2016 study, believed to be the first one investigating the effect of deep pressure stimulation during wisdom tooth extraction, examined heart rate variability and anxiety in healthy adults using weighted blankets while undergoing the procedure. Researchers found that the weighted blanket group experienced lower anxiety symptoms than the control group.10
A similar follow-up study was performed a few years later on healthy adolescents using a weighted blanket during a molar extraction. Those results also found less anxiety in those using a weighted blanket.11
Since medical procedures tend to cause anxiety symptoms, such as increased heart rate, researchers concluded that weighted blankets may be beneficial in calming those symptoms.12
Most research on weighted blankets and insomnia has focused on their use in children with clinical disorders, such as ASD, as discussed below. However, the majority of these studies do not examine sleep objectively.
A Swedish study published in the Journal of Sleep Medicine & Disorders concluded that the use of weighted blankets had a positive impact on sleep, both objectively and subjectively, where a number of physiological and behavioral measures were improved in a cohort of 31 adults. However, the study was biased in that it was conducted by a blanket manufacturer and had design limitations, such as the lack of a control group.5
A systematic literature review, which evaluated eight studies, concluded that while weighted blankets have the potential to be beneficial in limited settings and populations and may be an appropriate therapeutic tool in reducing anxiety, there is not enough evidence to suggest that they are beneficial in alleviating insomnia.13
Insomnia in Children with ASD
Children with ASD sleep poorly compared with their peers. A study published in Pediatrics involving 67 children with ASD found that the use of a weighted blanket did not help them fall asleep significantly faster, sleep for a longer period of time, or awaken less often.14
Sleep Problems in Children with ADHD
Similarly to children with ASD, many children with ADHD have sleep disturbances, such as trouble falling asleep and waking up several times throughout the night. Unlike children with ASD, however, weighted blankets proved useful in some instances in children with ADHD who had difficulty sleeping.
A study involving 21 children ages 8 to 13 years with ADHD and 21 healthy controls found that the use of a weighted blanket improved the time it took to fall asleep and the number of awakenings.15
A more recent study examined 120 patients who were randomized (1-to-1) to either a weighted metal chain blanket or a light plastic chain blanket for four weeks. Researchers found that weighted chain blankets are an effective and safe intervention for insomnia in patients with ADHD and other psychiatric disorders.16
It is important to note that, despite positive findings in several of these studies, they are limited by their small size, short duration, and/or lack of diverse subjects. Further research on the benefits of weighted blankets is needed in all of these therapeutic areas.
Although there have been studies on the benefits of massage therapy for osteoarthritis and chronic pain, there is currently no evidence that weighted blankets are effective in the treatment of these conditions.
Some manufacturers make unsubstantiated claims about weighted blankets benefiting certain health and psychological conditions, but, ultimately, it’s up to the consumer to do their own research and make an educated decision.
As a general rule, weighted blankets are safe for healthy adults, older children, and teenagers. Weighted blankets, however, should not be used for toddlers under age 2, as they may pose a suffocation risk. Even older children with developmental disabilities or delays may be at risk of suffocation.
There have been at least two reports of deaths in children due to weighted blankets, one in a 7-month-old baby and one in a 9-year-old boy who had autism.17 Parents should consult their pediatrician before using a weighted blanket for children of any age.
People with certain health conditions should also avoid weighted blankets. These include chronic respiratory conditions, such as asthma, chronic obstructive pulmonary disease (COPD), and obstructive sleep apnea.
In addition, a weighted blanket may also be unsuitable for those people who are claustrophobic, as it may cause anxiety rather than ease it.
As a general rule, a weighted blanket should be 10% of an adult person’s body weight, according to most manufacturers’ websites. Other guidelines include:18
- Adults can use medium-to-large weighted blankets ranging from 12 to 30 pounds.
- For a 30- to 70-pound child, a small weighted blanket should weigh from 5 to 8 pounds.
- For a 30- to 130-pound child, a medium-weighted blanket should weigh from 5 to 15 pounds.
Young children should never be left unsupervised with a weighted blanket, particularly those made for an adult.18
A Word From Verywell
While there is no conclusive evidence that weighted blankets are effective for the treatment of any health condition, they are popular with many people due to the comfort they provide.
Some studies have shown positive results in reducing anxiety and helping children with ADHD get a good night’s sleep. If you are a healthy adult, there is little risk of trying one—other than to your wallet, as they start around $100.
Many studies over many years have explored the correlation between an individual’s optimistic or pessimistic outlook and the impact on stress, anxiety, health and well- being. Consistent consensus has been made that optimism is positively correlated with improved psychological health whereas a pessimistic outlook may increase vulnerabilities for poor psychological health.
There are also strong associations between optimism and resilience.
“A resilient person works through challenges by using personal resources, strengths, and other positive capacities of psychological capital like hope, optimism, and self-efficacy.”
“The results indicated that psychological well-being is influenced by personal characteristics such as resilience, and the individual’s optimism regardless of his/her degree of resilience can to some extent provide for psychological well-being.”
Souri and Hasanirad, 2011
I recently explored this with a friend who had a performance review planned with her Manager. Her last performance review (with a different company) left her feeling deflated and unsupported as the poor feedback from her Manager was unexpected, and unwanted. She was expecting the worst from her upcoming review as well, and the only ‘qualifier’ for this pessimistic view was her last performance review. Jill had been working for this company for over a year, and over our coffee catch ups, I recalled events and stories that appeared to indicate a positive work environment and signs that she was a strong performer in the workplace, so I queried her negative outlook.
– “So, what about that quality assurance project you lead, with great outcomes?” “Yeah, that went well, but the team did most of the work.”
– “Who delegated the work?”
– “I did.”
– “So, you collaborated with the team, as their project manager, provided them with direction, agreed to task roles and ultimately guided the team to a successful outcome?”
Jill’s experience with predicting future outcomes in a negative framework, based on experience is not uncommon. To help Jill feel more confident going into her review, we brainstormed all the positive outcomes she contributed to or was personally responsible for. This included achievement of KPI’s, positive reviews from customers, and her contribution to positive team culture. By challenging her low expectations of the review, she was able to develop a plan to go into the meeting feeling confident, positive and adequately prepared if her Manager did happen to raise any issues. This would also help to put any criticisms that may be raised, into context. After all, none of us are perfect, but if the positive outcomes outweigh the ‘room for improvement’ results, we are winning!
Your current way of thinking may be keeping you where you are, but is that where you want to be? Are your current actions moving you closer to your goals or further away from them? If you would like to improve your current situation, it is likely that you need to start by changing your mindset.
Developing a positive mindset, if you are not already manifesting this, will take a conscious effort. Included below are some tips on helping to manifest a positive outlook in your own life:
- You may have heard about practising gratitude. This is a simple and reflective process you can add into your routine at the end of each day, to reflect on something positive that happened during your day. It may be as simple as receiving a friendly smile from a stranger or feeling gratitude for the comfortable roof over your head. Many studies have found that expressing gratitude increases optimism.
- Reframing your thought processes: This can start with challenging your own negative thoughts e.g., ‘My life is not going the way I would like it to’. To challenge this, you might break it down by looking at one aspect of your life – “I have a great social life.” In the words of author Martin Seligman (2019), “The key to learning optimism is learning how to recognise and then dispute unrealistic catastrophic thoughts.”
- There are numerous studies regarding the practice of meditation and how the regular practice of meditation can improve your mindset, improve your memory, help you manage stress more effectively and many other health benefits. Meditation is a form of brain training. There are multiple studies which show that meditation can actually change your brain.
- Try to surround yourself with positive people. When you seek out positive people, you will be around solution-focused thinking and can-do attitudes. Being in such company can influence your own thinking. These types of people are often found in groups which are focused on goal achievements such as business networking groups. You may already know someone who has a ‘glass half full’ attitude. Meeting up with them more frequently will be a start to increasing your network of positive people.
- If you can join a gym or any type of exercise class, such as yoga, you can meet people trying to improve their lives, well-being and fitness through exercise. Any group that focuses on personal development and growth is likely to include positive people. There is significant evidence that exercise is also good for the mind.
My own personal experience with embracing optimism was best reflected in my journey after a severe traumatic brain injury, and waking up from my coma unable to walk, talk, see or have control over any of my bodily functions. Medical opinion was negative about my outlook. Prognosis predictions included life in a vegetative state, an inability to finish school or achieve the goals I had set, little hope of ever being able to participate in meaningful work, and more. My story of using those negative predictions as a powerful motivator to prove those doctors wrong, to lead a full, productive and meaningful life is documented in my new book, Holding on to Hope, Finding the ‘New You’ after a Traumatic Brain Injury.
[Abstract] Moderate Intensity Treadmill Exercise Increases Survival of Newborn Hippocampal Neurons and Improves Neurobehavioral Outcomes after Traumatic Brain Injury
Physician-prescribed rest after traumatic brain injury (TBI) is both commonplace and an increasingly scrutinized approach to TBI treatment. Although this practice remains a standard of patient care for TBI, research of patient outcomes reveals little to no benefit of prescribed rest after TBI, and in some cases prolonged rest has been shown to interfere with patient well-being. In direct contrast to the clinical advice regarding physical activity after TBI, animal models of brain injury consistently indicate that exercise is neuroprotective and promotes recovery. Here, we assessed the effect of low and moderate intensity treadmill exercise on functional outcome and hippocampal neural proliferation after brain injury. Using the controlled cortical impact (CCI) mouse model of TBI, we show that 10 days of moderate intensity treadmill exercise initiated after CCI reduces anxiety-like behavior, improves hippocampus-dependent spatial memory, and promotes hippocampal proliferation and newborn neuronal survival. Pathophysiological measures including lesion volume and axon degeneration were not altered by exercise. Taken together, these data reveal that carefully titrated physical activity may be a safe and effective approach to promoting recovery after brain injury.
A stroke is sudden and shocking. This guide can help you
understand the effect this could have on the way you feel.
It explains how a stroke can affect your emotions, some of the
problems that this can cause and what you can do about them.
It’s aimed at people who have had a stroke, and there is
information for family and friends as well.
[Abstract] Is neurotrophin-3 (NT-3): a potential therapeutic target for depression and anxiety? – Review
Neurotrophin-3 (NT-3) is thought to play a role in the neurobiological processes implicated in mood and anxiety disorders. NT-3 is a potential pharmacological target for mood disorders because of its effects on monoamine neurotransmitters, regulation of synaptic plasticity and neurogenesis, brain-derived neurotrophic factor (BDNF) signaling boosting and modulation of the hypothalamic–pituitary–adrenal (HPA) axis. The mechanisms underlying NT-3 anxiolytic properties are less clear and require further exploration and definition.
The evidence that supports NT-3 as a pharmacological target for anxiety and mood disorders is presented and this is followed by a reflection on the quandaries, stumbling blocks and future perspectives for this novel target.
There is evidence for miRNAs being key post-transcriptional regulators of neurotrophin-3 receptor gene (NTRK3) in anxiety disorders; however, the anxiolytic properties of NT-3 need further examination and delineation. Moreover, NT-3 expression by non-neuronal cells and its role in brain circuits which participate in anxiety and mood disorders require further scrutiny. Further work is vital before progression into clinical trials can be realized.
[ARTICLE] The effects of anxiety and dual-task on upper limb motor control of chronic stroke survivors – Full Text
This study was designed to investigate the effects of anxiety and dual-task on reach and grasp motor control in chronic stroke survivors compared with age- and sex-matched healthy subjects (HC). Reach and grasp kinematic data of 68 participants (high-anxiety stroke (HA-stroke), n = 17; low-anxiety stroke (LA-stroke), n = 17; low-anxiety HC, n = 17; and high-anxiety HC, n = 17) were recorded under single- and dual-task conditions. Inefficient reach and grasp of stroke participants, especially HA-stroke were found compared with the control groups under single- and dual-task conditions as evidenced by longer movement time (MT), lower and earlier peak velocity (PV) as well as delayed and smaller hand opening. The effects of dual-task on reach and grasp kinematic measures were similar between HCs and stroke participants (i.e., increased MT, decreased PV that occurred earlier, and delayed and decreased hand opening), with greater effect in stroke groups than HCs, and in HA-stroke group than LA-stroke group. The results indicate that performing a well-learned upper limb movement with concurrent cognitive task leads to decreased efficiency of motor control in chronic stroke survivors compared with HCs. HA-stroke participants were more adversely affected by challenging dual-task conditions, underlying importance of assessing anxiety and designing effective interventions for it in chronic stroke survivors.
Approximately 60% of stroke survivors suffer from permanent upper limb dysfunctions despite receiving rehabilitation1. Stroke-induced motor impairments (e.g., muscle weakness, spasticity, and impaired coordination), sensory deficits (proprioceptive and/or tactile sensory loss) and perceptual-cognitive dysfunctions (e.g., attentional problems and visuospatial impairments), as well as secondary physiological adaptations (e.g., contractures, and muscle atrophy) can directly affect skilled/well-learned upper limb movements such as reach and grasp2. Slowed and segmented movement, dysmetria, inadequate aperture and impairments of hand preshaping have been reported as common problems, involved in clumsy function or disuse of the upper limb following stroke2,3,4,5. Reach and grasp, a fundamental part of object manipulation, requires the integration of sensory, motor and cognitive information6,7 and frequently performed with a concurrent cognitive task (e.g., reach and grasp of a cup of coffee while talking on the phone or reach and grasp goods from store shelves while recalling shopping list8.
Typically, a dual-task paradigm is used to investigate whether and to what extent control of a motor action requires attentional resources. Based on limited processing capacity theory, if a motor and cognitive task compete for shared attentional resources, performing the two task simultaneously may result in disruption of performance in one or both task, known as dual-task interference (for example, enhanced error and slower performance compared with the single-task condition)9. Individuals are frequently challenged by dual-task conditions in daily life, hence, flexible adaptation to the changing motor and cognitive requirements of daily functions, as well as environment is necessary for successfully and independently performing activities of daily livings (ADLs)10.
Stroke survivors may experience greater dual-task interference compared to healthy subjects because of impaired cognitive and motor function11. Although the effects of dual-task have been widely studied on balance and gait in stroke survivors11,12, few studies have been conducted on the effects of dual-task on upper limb function of these patients. In this regard, Shin et al. reported a significant dual-task effect on upper limb movement smoothness and reach error in chronic stroke survivors using a robotic-assisted planar reaching. However, they did not compare stroke survivors with healthy participants10. Bank et al. used a virtual goal-directed upper limb movement (i.e., controlling the movement of the virtual mouse to collect virtual targets), which performed with or without auditory stroop task in order to compare the cognitive-motor interference in patients with neurological disorders (stroke and Parkinson’s disease) with sex-and age-matched healthy controls. They did not find greater cognitive-motor interference in stroke participants than the healthy controls. They explained this finding might be related to their measure that was not precise. They suggested using a more precise measure for assessing upper limb motor control such as a motion analysis system13. Houwink et al. used a motion analysis system to investigate the effect of an auditory stroop task on upper limb motor control in chronic stroke survivors while drawing a circle. They found dual-task interference only in the affected upper limb of patients who had moderate upper limb paresis. However, they used an experimentally designed upper limb task, not a natural everyday task such as reach and grasp, which based on their stated limitation is susceptible to learning that is different among stroke survivors and healthy subjects14. It remains to be determined, however, whether dual-task would affect motor control of a well-learned/skillful upper limb movement such as reach and grasp in chronic stroke survivors.
Anxiety is the second most common psychological disorders among stroke survivors15, affecting up to 24% of patients15,16. It has been suggested that anxiety symptoms persist for up to 10 years after stroke17 and are associated with low functional outcomes17, increased dependency in ADLs18, and decreased quality of life17. Anxiety increases distraction by task-irrelevant stimuli (i.e., impaired attentional control), leading to decreased processing efficiency needed for motor planning and execution of a well-learned/skillful movement19. Kotani et al. recently showed that anxiety disrupted the hand’s fine motor control of expert pianists through incoordination of multi-joints movements20. Despite the high prevalence of anxiety in stroke survivors and its potential to affect motor control, to the best of our knowledge, no attention has been paid to the effects of anxiety on upper limb motor control of these patients. Understanding the effects of anxiety on upper limb motor control is therefore needed to develop and target interventions to address this common psychological disorder, improve upper limb motor control, and enhance the independence of stroke survivors in ADLs. Therefore, the aim of this study was to investigate whether dual-task interference would be observed in upper limb motor control of stroke survivors when performing a well-learned everyday motor task compared with age-and sex-matched healthy subjects. The study also aimed to determine the effect of anxiety on upper limb motor control of these patients.[…]