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Using a Pavlovian learning paradigm with frequent reversals within and across aversive modalities in combination with SCR recordings and high-resolution fMRI, we were able to investigate signed and unsigned representations of PEs in the human brain. The data showed an unsigned representation of intensity PEs in the anterior insula indistinguishable for pain and aversive sounds, supporting a role of the anterior insula in coding unspecific arousal or salience. In addition, the same part of the anterior insula also strongly activated for PEs concerning stimulus modality. Most importantly, we could identify a circumscribed part of the dorsal posterior insula representing a signed PE for pain only, collocated with areas processing pain intensity per se.
Furthermore, as exemplified by the predominance of unsigned over signed PEs, aversiveness is confounded with salience: It is possible that the intentionally similar salience between the 2 inherently aversive modalities had overshadowed some modality-specific and supramodal mechanisms. It seems promising that future protocols include equisalient appetitive conditions to tease out these mechanisms. For example, the involvement of different structures for reward and punishment has been demonstrated in studies using instrumental learning tasks [57,58] including intracranial recordings [30] or lesion studies [59]. In theory, the paradigm presented here also includes similar aspects, such as relief in the form of negative PEs (when more pain is expected, receiving less may be experienced as rewarding). Still, specifics of the protocol may have prevented more widespread overlaps between the modalities even though such supramodal parallels exist. Such specifics include a presumptive focus on contingencies as opposed to passive sensory perception or differences related to Pavlovian versus instrumental learning designs incorporating different decision-making processes, experiences of reward and punishment, and forms of feedback.
Subject-level analyses were performed on the 3D (volume) data in native space without smoothing, as required for surface mapping. We computed a general linear model with a canonical response function to identify brain structures involved in the processing of each stimulus modality and corresponding to various predictions and PEs inherent in the protocol. Realignment (motion) parameters were included as nuisance variables, to further mitigate motion-related artifacts.
As laid out above and because pain is the modality of interest in this study, we focused the analyses on the contralateral (right) periinsular cortices as regions of interest used for small volume correction of significance level [12,19,22]. The region of interest included the entire insular cortex (dorsal hypergranular, dorsal granular, dorsal dysgranular, dorsal agranular ventral dysgranular/granular, and ventral agranular), as well as dorsally adjacent areas of the parietal operculum (A40rv), central operculum (A1/2/3ll, A4tl), and frontal operculum (A44op, A12/47l). It was created using the Human Brainnetome Atlas [76]. Results were considered after correction for family-wise error rate of p < 0.05 within the region of interest (denoted p[corr.]) or after correction for whole brain/all vertices (denoted p[corr. wb.]), unless otherwise noted. No extent threshold was used.
VR activities constitute another approach to UE stroke rehabilitation, where patients typically perform movements without physical assistance. Reviews examining the use of VR for the improvement of UE function show promising results [11, 12]. In our view, VR could consolidate the UE functional gains obtained through robotic rehabilitation. While most VR activities typically focus on shoulder and elbow movements, some recent technical advances now allow the inclusion of hand movements as well. Specifically, the Microsoft Kinect version 2, used to track movements in VR, can detect hand opening and closing in addition to shoulder, elbow and wrist movements. These capabilities have been included in a new rehabilitation application, targeting UE reaching and grasping movements [13], which was part of our rehabilitation approach. 59ce067264