This is not a graded assignment or writing assignment. Create a reverse outline for the article using this format. Provide enough bullets for each section1. Treatment: Neuroplasticity-Based Therapeutics - Sound Therapy Using Structured Acoustic Signals -Computerized Brain Training - Stimulus Timing-Dependent Plasticity -Vagus Nerve Stimulation Treatment: Neuroplasticity-Based TherapeuticsFortunately, many alternative strategies are available for treating tinnitus that do notcarry known risks for exacerbating symptoms in the long term and are free from adverseeffects known to be induced by long-term exposure to unstructured noise. Herein, wefocus on several recently developed approaches for tinnitus treatment that harness itsadaptive potential in the service of restoring the structural and functional integrity of thecentral auditory system. Thus, whereas noise pathologically undermines inhibitorycontrol throughout the central auditory pathway, each of the treatment optionsconsidered in this section are associated with restoration of lost compromised inhibitorytransmission long believed to underlie hearing loss associated with tinnitus. Althoughnot all of these strategies have yet been tested in large human clinical trials, there isenough supportive evidence to justify their investigation.Sound Therapy Using Structured Acoustic SignalsPerhaps the most straightforward alternative to sound therapy with unstructured noise isto simply replace the masking stimulus with a structured (nonrandom) acoustic signal,such as music or speech. 11,45 As noted herein, the simultaneous, random activation ofthe auditory system by broadband stimuli results in neurons firing together and thuswiring together. In the long term, spectral and temporal receptive fields broaden as aresult of the increased capacity of one neuron to activate another. From thisperspective, it follows that exposure to sounds with rich spectrotemporal structure suchas music and speech might instantiate changes in the central auditory pathway oppositeto noise, preserving or enhancing receptive field selectivity. This hypothesis has beenlargely confirmed in animal studies of enriched acoustic environments featuring dynamicchanges in spectral and temporal modulation, which have reported sharpened receptivefields, 45as well as facilitated recovery from and protection against the deleteriousconsequences of noise,46 including reduced behavioral signs of tinnitus.47Additional studies in humans have obtained promising results using music that hasbeen filtered to match an individual patient's tinnitus percept profile. For example, musicthat has been altered or "notched" to exclude frequencies neighboring the tinnitus48have suppressed tinnitus-related hyperactivity via synaptic lateral inhibition across thenotched region.49 Another example includes acoustic coordinated resetneuromodulation, which randomly presents brief tones both above and below the pitchof the tinnitus to improve desynchronization and cortical map differentiation (ie,abnormal frequency couplings). Under this method, participants reported perceivedreductions of tinnitus loudness and annoyance, and reduced oscillatory activity as measured by electroencephalogram mirrored these improved clinical outcomes. 50 Notethat such therapies carry additional costs to develop personalized programs for theindividual's tinnitus symptoms. For patients who cannot afford such programs, cliniciansmay recommend exposure to unmodified music or speech.Computerized Brain TrainingIt is now recognized that the neuroplastic processes responsible for initiating,perpetuating, and elaborating deficits associated with many neurological conditions canbe redirected to drive changes in a corrective trajectory, potentially ameliorating ratherthan exacerbating symptoms. 10 From this perspective, abnormally organized auditoryand nonauditory systems, and their associated perceptual and cognitive deficits, shouldalso be amenable to intensive training-based remediation. Indeed, many promisingexamples of training-induced rehabilitation have recently been reported for partiallyrestoring pathological auditory cortical function associated with traumatic hearing loss,presbycusis, or tinnitus in both animal models 51,52 and humans.53In an initial demonstration of the potential for positively affecting tinnitus by intensivetraining, Kallogjeri and colleagues54 applied BrainHQ's validated progressively adaptivecomputerized exercises targeted at auditory speed of processing, accuracy,sequencing, working memory, and attentional control in an open-label, intent-to-treatrandomized clinical trial in emergency workers with severe bothersome tinnitus.Participants with tinnitus were randomized to either auditory training exercises ortreatment-as-usual. Magnetic resonance neuroimaging, as well as a number ofneuropsychological and self-report measures, including the Tinnitus Handicap Inventory(THI), were taken before and after an epoch of approximately 40 hours of training.There was a numerical, although not significant, reduction in THI scores in the trainedgroup over controls, with more than twice the number of trained participants showing aclinically meaningful reduction in THI scores (35% vs 15%), and self-reporting animprovement in their tinnitus (50%) or in their ability to learn and remember (70%). Thatis, for approximately half of trainees, tinnitus was brought under effective attentionalcontrol (the percepts could be "put out of mind" at will), enabling a restoration of normalsleep and an amelioration of tinnitus disruptions affecting sustained employment andmore normal everyday functioning. Resting-state functional connectivity in neuralnetworks largely responsible for attention and cognitive control mirrored the behavioralgains and reliably improved at post-test in the tinnitus trained group only.Although a small set of tinnitus-nonspecific auditory training programs demonstrated abenefit for some patients with tinnitus in this independent study, the mechanism ofaction was not through remediation of the tinnitus itself but rather through secondarilyaffected networks, most notably those involved in attentional control. Auditory exercisesstrengthened functional connectivity so that the tinnitus percept was easier to ignore butdid not necessarily modify the tinnitus percept itself, thus helping individuals control theirattention to the tinnitus "from the top down."Stimulus Timing-Dependent PlasticityAttentional-based brain training may be insufficient to remediate tinnitus for manypatients. Additional computerized training exercises may be needed, specificallydesigned to drive corrective changes across the auditory nervous system in waysdesigned to weaken or override the neurological distortions giving rise to the tinnituspercept, thus approaching remediation "from the bottom up.""55If tinnitus is perpetuated by abnormally enlarged, system-wide, cortical and subcorticalrepresentational assemblies amplifying the power of tinnitus-associated sounds, thenreducing the neural real estate maintaining the tinnitus should lead to a reduction in thetinnitus percepts. Research has shown that representation of any arbitrary frequencycan be sharply reduced by applying conditioning strategies that produce long-termsynaptic depression (LTD),56 In a recent study, Marks and colleagues 57 significantlyreduced symptoms in humans with chronic somatic tinnitus using the principles of LTD.In a double-blind, placebo-controlled crossover study, repeated presentation of auditoryand somatosensory bimodal stimulation (targeting the fusiform cell circuit in the dorsalcochlear nucleus at an interval shown to produce LTD in guinea pig models of tinnitus)significantly and cumulatively decreased perceived tinnitus loudness and intrusivenessas assessed by the Tinnitus Functional Index in humans. Relief from tinnitus may havebeen mediated by LTD of strengthened somatosensory inputs to deafferented auditorypathways. This approach of stimulus timing-dependent plasticity differs significantlyfrom existing neurosensory rehabilitation approaches in that its goal is to restoreauditory mapping rather than simply compensate for negative plastic reorganization.Vagus Nerve StimulationAnother, albeit invasive and experimental, neuroplasticity-based therapy is vagus nervestimulation (VNS). Vagus nerve stimulation eventuates in the release of acetylcholinewhich, when paired with a stimulus such as a tone, increases cortical representation ofthat stimulus through neuroplastic processes. In animal models, the general strategy ofthe VNS approach has been to induce tinnitus, map the tonotopic organization ofauditory cortex, and pair VNS with tones other than the tinnitus-match frequencies tonormalize tonotopic map organization.58 Through competitive reorganization, thenontinnitus maps increase in size and representation while the tinnitus maps decrease,ultimately extinguishing the tinnitus percept. In human studies that use these sameprinciples of paired brief electrical stimulation of the vagus nerve with nontinnitussounds, participants with severe chronic tinnitus benefited from VNS as measured bythe THI.5⁹ Notable exceptions to this form of therapy were those who were takingmedications known to interfere with instantiation of neural plasticity. A noninvasive formof VNS may well be feasible in the near future. 60Association of Tinnitus Wiss Progressive Downstream Cognitive ConsequencesAlthough pathoplavelelogic Tenomens of trseem to be the sine qua non of mintis.central auditory pathway reviewed hereinThuman and amiñal studies reveal that the

In the article, novel therapies based on neuroplasticity are discussed for the treatment of…

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Phlebotomy Essentials

6th Edition

ISBN:9781451194524

Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Chapter1: Phlebotomy: Past And Present And The Healthcare Setting

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This is not a graded assignment or writing assignment. Create a reverse outline for the article using this format. Provide enough bullets for each section

1. Treatment: Neuroplasticity-Based Therapeutics

- Sound Therapy Using Structured Acoustic Signals

-Computerized Brain Training

- Stimulus Timing-Dependent Plasticity

-Vagus Nerve Stimulation

Transcribed Image Text:Treatment: Neuroplasticity-Based Therapeutics Fortunately, many alternative strategies are available for treating tinnitus that do not carry known risks for exacerbating symptoms in the long term and are free from adverse effects known to be induced by long-term exposure to unstructured noise. Herein, we focus on several recently developed approaches for tinnitus treatment that harness its adaptive potential in the service of restoring the structural and functional integrity of the central auditory system. Thus, whereas noise pathologically undermines inhibitory control throughout the central auditory pathway, each of the treatment options considered in this section are associated with restoration of lost compromised inhibitory transmission long believed to underlie hearing loss associated with tinnitus. Although not all of these strategies have yet been tested in large human clinical trials, there is enough supportive evidence to justify their investigation. Sound Therapy Using Structured Acoustic Signals Perhaps the most straightforward alternative to sound therapy with unstructured noise is to simply replace the masking stimulus with a structured (nonrandom) acoustic signal, such as music or speech. 11,45 As noted herein, the simultaneous, random activation of the auditory system by broadband stimuli results in neurons firing together and thus wiring together. In the long term, spectral and temporal receptive fields broaden as a result of the increased capacity of one neuron to activate another. From this perspective, it follows that exposure to sounds with rich spectrotemporal structure such as music and speech might instantiate changes in the central auditory pathway opposite to noise, preserving or enhancing receptive field selectivity. This hypothesis has been largely confirmed in animal studies of enriched acoustic environments featuring dynamic changes in spectral and temporal modulation, which have reported sharpened receptive fields, 45 as well as facilitated recovery from and protection against the deleterious consequences of noise,46 including reduced behavioral signs of tinnitus.47 Additional studies in humans have obtained promising results using music that has been filtered to match an individual patient's tinnitus percept profile. For example, music that has been altered or "notched" to exclude frequencies neighboring the tinnitus48 have suppressed tinnitus-related hyperactivity via synaptic lateral inhibition across the notched region.49 Another example includes acoustic coordinated reset neuromodulation, which randomly presents brief tones both above and below the pitch of the tinnitus to improve desynchronization and cortical map differentiation (ie, abnormal frequency couplings). Under this method, participants reported perceived reductions of tinnitus loudness and annoyance, and reduced oscillatory activity as

measured by electroencephalogram mirrored these improved clinical outcomes. 50 Note
that such therapies carry additional costs to develop personalized programs for the
individual's tinnitus symptoms. For patients who cannot afford such programs, clinicians
may recommend exposure to unmodified music or speech.
Computerized Brain Training
It is now recognized that the neuroplastic processes responsible for initiating,
perpetuating, and elaborating deficits associated with many neurological conditions can
be redirected to drive changes in a corrective trajectory, potentially ameliorating rather
than exacerbating symptoms. 10 From this perspective, abnormally organized auditory
and nonauditory systems, and their associated perceptual and cognitive deficits, should
also be amenable to intensive training-based remediation. Indeed, many promising
examples of training-induced rehabilitation have recently been reported for partially
restoring pathological auditory cortical function associated with traumatic hearing loss,
presbycusis, or tinnitus in both animal models 51,52 and humans.53
In an initial demonstration of the potential for positively affecting tinnitus by intensive
training, Kallogjeri and colleagues54 applied BrainHQ's validated progressively adaptive
computerized exercises targeted at auditory speed of processing, accuracy,
sequencing, working memory, and attentional control in an open-label, intent-to-treat
randomized clinical trial in emergency workers with severe bothersome tinnitus.
Participants with tinnitus were randomized to either auditory training exercises or
treatment-as-usual. Magnetic resonance neuroimaging, as well as a number of
neuropsychological and self-report measures, including the Tinnitus Handicap Inventory
(THI), were taken before and after an epoch of approximately 40 hours of training.
There was a numerical, although not significant, reduction in THI scores in the trained
group over controls, with more than twice the number of trained participants showing a
clinically meaningful reduction in THI scores (35% vs 15%), and self-reporting an
improvement in their tinnitus (50%) or in their ability to learn and remember (70%). That
is, for approximately half of trainees, tinnitus was brought under effective attentional
control (the percepts could be "put out of mind" at will), enabling a restoration of normal
sleep and an amelioration of tinnitus disruptions affecting sustained employment and
more normal everyday functioning. Resting-state functional connectivity in neural
networks largely responsible for attention and cognitive control mirrored the behavioral
gains and reliably improved at post-test in the tinnitus trained group only.
Although a small set of tinnitus-nonspecific auditory training programs demonstrated a
benefit for some patients with tinnitus in this independent study, the mechanism of
action was not through remediation of the tinnitus itself but rather through secondarily
affected networks, most notably those involved in attentional control. Auditory exercises
strengthened functional connectivity so that the tinnitus percept was easier to ignore but
did not necessarily modify the tinnitus percept itself, thus helping individuals control their
attention to the tinnitus "from the top down."
Stimulus Timing-Dependent Plasticity
Attentional-based brain training may be insufficient to remediate tinnitus for many
patients. Additional computerized training exercises may be needed, specifically
designed to drive corrective changes across the auditory nervous system in ways
designed to weaken or override the neurological distortions giving rise to the tinnitus
percept, thus approaching remediation "from the bottom up."
"55
If tinnitus is perpetuated by abnormally enlarged, system-wide, cortical and subcortical
representational assemblies amplifying the power of tinnitus-associated sounds, then
reducing the neural real estate maintaining the tinnitus should lead to a reduction in the
tinnitus percepts. Research has shown that representation of any arbitrary frequency
can be sharply reduced by applying conditioning strategies that produce long-term
synaptic depression (LTD),56 In a recent study, Marks and colleagues 57 significantly
reduced symptoms in humans with chronic somatic tinnitus using the principles of LTD.
In a double-blind, placebo-controlled crossover study, repeated presentation of auditory
and somatosensory bimodal stimulation (targeting the fusiform cell circuit in the dorsal
cochlear nucleus at an interval shown to produce LTD in guinea pig models of tinnitus)
significantly and cumulatively decreased perceived tinnitus loudness and intrusiveness
as assessed by the Tinnitus Functional Index in humans. Relief from tinnitus may have
been mediated by LTD of strengthened somatosensory inputs to deafferented auditory
pathways. This approach of stimulus timing-dependent plasticity differs significantly
from existing neurosensory rehabilitation approaches in that its goal is to restore
auditory mapping rather than simply compensate for negative plastic reorganization.
Vagus Nerve Stimulation
Another, albeit invasive and experimental, neuroplasticity-based therapy is vagus nerve
stimulation (VNS). Vagus nerve stimulation eventuates in the release of acetylcholine
which, when paired with a stimulus such as a tone, increases cortical representation of
that stimulus through neuroplastic processes. In animal models, the general strategy of
the VNS approach has been to induce tinnitus, map the tonotopic organization of
auditory cortex, and pair VNS with tones other than the tinnitus-match frequencies to
normalize tonotopic map organization.58 Through competitive reorganization, the
nontinnitus maps increase in size and representation while the tinnitus maps decrease,
ultimately extinguishing the tinnitus percept. In human studies that use these same
principles of paired brief electrical stimulation of the vagus nerve with nontinnitus
sounds, participants with severe chronic tinnitus benefited from VNS as measured by
the THI.5⁹ Notable exceptions to this form of therapy were those who were taking
medications known to interfere with instantiation of neural plasticity. A noninvasive form
of VNS may well be feasible in the near future. 60
Association of Tinnitus Wiss Progressive Downstream Cognitive Consequences
Although pathoplavelelogic Tenomens of tr
seem to be the sine qua non of mintis.
central auditory pathway reviewed herein
Thuman and amiñal studies reveal that the

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