Rewards are known to influence neural activity associated with both motor preparation and execution. This influence can be exerted directly upon the primary motor (M1) and somatosensory (S1) cortical areas via the projections from reward-sensitive dopaminergic neurons of the midbrain ventral tegmental areas. However, the neurophysiological manifestation of reward-related signals in M1 and S1 are not well understood. Particularly, it is unclear how the neurons in these cortical areas multiplex their traditional functions related to the control of spatial and temporal characteristics of movements with the representation of rewards. To clarify this issue, we trained rhesus monkeys to perform a center-out task in which arm movement direction, reward timing, and magnitude were manipulated independently. Activity of several hundred cortical neurons was simultaneously recorded using chronically implanted microelectrode arrays. Many neurons (9-27%) in both M1 and S1 exhibited activity related to reward anticipation. Additionally, neurons in these areas responded to a mismatch between the reward amount given to the monkeys and the amount they expected: A lower-than-expected reward caused a transient increase in firing rate in 60-80% of the total neuronal sample, whereas a larger-than-expected reward resulted in a decreased firing rate in 20-35% of the neurons. Moreover, responses of M1 and S1 neurons to reward omission depended on the direction of movements that led to those rewards. These observations suggest that sensorimotor cortical neurons corepresent rewards and movement-related activity, presumably to enable reward-based learning.

Background and Objectives This study tests the feasibility of using virtual reality (VR) with older adults with mild cognitive impairment (MCI) or mild-to-moderate dementia with a family member who lives at a distance. Research Design and Methods 21 residents in a senior living community and a family member (who participated in the VR with the older adult from a distance) engaged in a baseline telephone call, followed by 3 weekly VR sessions. Results Residents and family members alike found the VR safe, extremely enjoyable, and easy to use. The VR was also acceptable and highly satisfying for residents with MCI and dementia. Human and automated coding revealed that residents were more conversationally and behaviorally engaged with their family member in the VR sessions compared to the baseline telephone call and in the VR sessions that used reminiscence therapy. The results also illustrate the importance of using multiple methods to assess engagement. Residents with dementia reported greater immersion in the VR than residents with MCI. However, the automated coding indicated that residents with MCI were more kinesically engaged while using the VR than residents with dementia. Discussion and Implications Combining networking and livestreaming features in a single VR platform can allow older adults in senior living communities to still travel, relive their past, and engage fully with life with their family members, despite geographical separation and physical and cognitive challenges.

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Background and study aims Conscious sedation is routinely administered for colonoscopy but is associated with risks and inconveniences. We sought to determine whether virtual reality (VR) may be a feasible alternative. Patients and methods Twenty-seven individuals scheduled for screening/surveillance colonoscopy participated. The VR device was activated throughout the colonoscopy, but subjects could opt out and request standard medications. Questionnaires were administered, and variables were assessed on a scale of 1 to 10. Results Cecal intubation was achieved in all cases without adverse events (AEs). Study colonoscopies were completed without pharmacological rescue in 26 of 27 patients (96.3 %) and procedure times were comparable to baseline. Subjects reported minimal pain, high satisfaction, and willingness to use VR for future colonoscopies to avoid narcotics and resume normal activities including driving. Conclusion Replacing pharmacological sedation with VR did not impact colonoscopy completion rates, procedure time, or AEs. Satisfaction was high and only one subject (3.7 %) chose to suspend VR. VR can be an effective alternative for patients undergoing colonoscopy who prefer to avoid narcotics.

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