Art is a characteristic of mankind, which requires superior central nervous processing and integration of motor functions with visual information. At the present time, a significant amount of information related to neurobiological basis of artistic creation has been derived from neuro-radiological cognitive studies, which have revealed that subsequent to tissue destruction, the artists continue to create art. The current study aims to review the most important cases of visual artists with stroke and to discuss artistic skills recovery and compensation as well as artistic style after stroke.
Methods:
The role of various central nervous system regions in artistic creation was reviewed on the basis of previously published functional studies. Our PubMed search (1995-2015) has identified 10 famous artists with right cerebral stroke as well as 5 with left cerebral stroke who survived and continued to create art after stroke. As the artists included in this review lived at various times during the twentieth century and in different countries, clinical information related to their case was limited. However, it appears that artistic skills recovery and compensation appear within days after stroke. Some of the artists would subsequently change their artistic style. All these elements have been evaluated within the context of specific clinical cases.
Conclusion:
The poststroke artistic skills recovery and compensation with development of a new style or the opposite, regaining the previous prestroke style, represents a significant element of clinical importance in medical rehabilitation as well as neuroesthetics, which requires further evaluation. At the present time, the molecular mechanisms of artistic creation are poorly understood, and more standardized clinical and experimental studies are needed.
Mentions:
One of the best documented cases associated with development of a new painting style is represented by Anton Raderscheidt (1892–1970), a significant member of the Dada current as well as a prolific Magischer Realismus adept from Koln, Germany (32). Anton Raderscheid developed a right cerebral stroke, which was associated with left hemiplegia and loss of the left visual field as well as left-side neglect. In addition, he showed prosopagnosia, which relates to difficulty in identifying familiar faces (32). Prior to his right hemispheric stroke, the artist represented icon-like characters with great accuracy and in great detail (Figure 2).
What is a Stroke?
Science - Stroke & Art
Helpful Resources
What is a stroke?
A stroke happens when normal blood flow in an area of your brain is interrupted. This can happen either because a blood vessel (a tube-like structure carrying blood around the body) has become blocked by a clot or has broken or burst. Our brain cells need a constant supply of fresh blood carrying oxygen and nutrients to stay alive. Therefore, if blood is unable to get to these cells, even for a very short time, the cells start to die very quickly. As a result, a person may suffer brain damage in the affected area. For this reason, a stroke is sometimes called a “brain attack.” Another term for stroke is “cerebrovascular accident,” or CVA.
Depending on the location of the stroke, a stroke may cause a disability because the affected part of the brain can no longer send signals to some parts of the body to control movements, sensations. and other bodily functions For example, if the cells die in an area of the brain that controls speech, a person may have trouble speaking or understanding speech. In some strokes, the person may have trouble moving certain parts of their body, or their memory may be affected.
Types of Stroke
Most strokes are categorized as either an ischemic stroke or a hemorrhagic stroke.
Types of Stoke
ISCHEMIC STROKE
Ischemic stroke is the most common type of stroke. This type of stroke occurs if a blood vessel gets blocked by a blood clot (thrombus) or by fat deposits (plaque). Ischemic strokes are further described by the location of the clot.
Thrombotic Stroke
A thrombotic stroke is caused by a blood clot that forms along the wall of a blood vessel or because of a blockage of fat deposits.
Embolic Stroke/Cerebral Embolism
An embolic stroke or cerebral embolism happens when a clot (an embolus) from another part of your body travels into the brain and blocks a blood vessel there. Most commonly, those blood clots come from the heart after a heart attack or when someone has irregular heartbeats, like with atrial fibrillation.
HEMORRHAGIC STROKE
A hemorrhagic stroke is much less common than an ischemic stroke. This type of stroke occurs when a blood vessel carrying blood to part of the brain hemorrhages (breaks or bursts). This allows blood to leak into the brain. The two main types of hemorrhagic strokes are intracerebral and subarachnoid.
Intracerebral Hemorrhagic Stroke
In an intracerebral hemorrhagic stroke, blood from a broken blood vessel leaks into the brain and damages brain cells. Also, cells beyond the broken blood vessel die because they are unable to get their normal blood supply.
Subarachnoid Hemorrhagic Stroke
A subarachnoid hemorrhagic stroke occurs when a blood vessel near the surface of the brain breaks, causing blood to collect between the skull and the surface of the brain. This causes irritation to the lining of the brain and is often very painful.
Transient Ischemic Attack (TIA)
A TIA, also known as a “mini” stroke, is an ischemic stroke that goes away quickly because the blockage breaks up. Symptoms may last for only a few minutes or one or two hours. Since the blockage resolves quickly, brain cells do not die, and the TIA doesn’t cause permanent disability.
A TIA is often a warning sign of a full-blown ischemic stroke — possibly the same day or in the very near future. Therefore, if you or someone you care for experiences symptoms of a TIA that resolve, an immediate and thorough medical evaluation is necessary.
How Common are Strokes?
Almost 800,000 people have strokes each year in the United States. Of these, about 140,000 people die annually from their strokes, making it the third most common cause of death in this country. Older men tend to have more strokes than older women. But older women are more likely to die from strokes than older men. Also, African Americans have twice the risk of a first stroke compared to white Americans. The likelihood of suffering a TIA also increases with age. Up to 40% of all people who suffer a TIA will go on to have a full stroke later in life.
Although just over 1 out of 10 strokes are the hemorrhagic type, they account for 3 of 10 deaths from stroke each year.
Causes and Symptoms of Stroke
Introduction
Visual artistic creation represents one of the most intriguing characteristics of mankind. The artists and the public are inherently linked by the actual act of art appraisal, which cannot be achieved without a superior integration of the cognitive functions. Moreover, concerning the artist, his work requires superior processing and fine tuning of fine motor skills and visual information. However, both the artists and spectators must be capable of relating to each other, at various degrees, via a set of complex neuro-psychological and philosophical concepts defined within and decontextualized from a series of specific social environments. Without any doubt, the artistic creation and esthetic evaluation of artistic output represents one of many facets of central nervous functionality. In this context, neuroesthetics is advocated by some authors as a “science” bordering arts, medicine, neurosciences, and empiric esthetics, capable of explaining various processes associated with neurobiology of art. Perhaps, the grandfather of neuroesthetics could be considered Giovanni Paolo Lomazzo (1538–1600) who was the first to describe the link between emotional states and colors in his “Trattato dell’arte della pittura, scultura et architettura” published in 1584. However, it would have been impossible to attempt an initial description of neuroesthetics without functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG), non-invasive methods, which allow an efficient real-time functional evaluation of various brain structures. Before the advent of these revolutionary methods of investigation, the role of various parts of the brain was established after experimental and incidental trauma to the brain. The most well-known such case is the discovery of prefrontal cortex function in 1868, in a railroad worker who survived an accident, which destroyed his anterior portion of the left frontal lobe. Although surprisingly, the accident had no impact on the motor function, language, intellect and memory of Phineas Gage, it was soon obvious that his personality has changed dramatically. Formerly known as a gentle person, hard-working and trustworthy he changed so much that he became “no longer Gage” for his entourage displaying serious behavioral problems which were not present before the accident. Therefore, it was suggested that frontal lobe modulates personality and behavior. In 1994, a possible destruction of the ventral–medial region of the frontal lobe was indicated after an extensive evaluation of Gage’s skull by modern radiological methods. If we extrapolate the principles suggested by this case, it becomes obvious that the initial information on neurobiology of art could be derived from clinical observational cases of artists that had developed central nervous lesions associated with tissue destruction such as stroke. Theoretically, stroke is associated with arrest of the activity in some cerebral areas and centers but remarkably some of these artists–patients have shown recovery and compensation of their artistic skills. Meantime, based on functional radiological studies (fMRI, CT), other authors have reported additional information, which could explain the complex central nervous system processing associated with art evaluation and potentially with artistic creation. Although both categories of studies, clinical reports as well as prospective functional evaluations have attempted to define the basic mechanisms of art creativity and interpretation, this is far from been achieved. At the present time, it is obvious that art creation represents the result of both psychological and morphological changes associated with functional states and/or central nervous system pathology described in an individual living in a specific cultural context. However, there is an acute need for experimental standardization and new artistic-clinical parameters in order to facilitate the understanding of neurobiology of artistic creation and its appraisal. In this manuscript, we will review the current knowledge related to the role of various regions of the central nervous system in artistic creation and appraisal in parallel with selected cases of famous visual artists with stroke trying to identify the most important aspects related to poststroke artistic creation and interpretation including the recovery and compensation of the artistic skills.
The role of (Pre) Frontal Lobe in Artistic Creation
Artistic creation represents a complex sensory–motor act modulated by the personality of artists as well as by numerous cultural, religious, and philosophical factors. It also depends on the integrity of the structures which modulate memory, attention, and semantics.
Recently, fMRI studies conducted in patients with severe abnormalities related to thought, memory, and attention, such as schizophrenia, have reported abnormalities in the prefrontal cortex/inferior frontal gyrus. It is suggested that the background of these functional issues would be related to a severe disconnection between the frontal and the parietal/temporal cortex affecting the left semantic network. Also in schizophrenic patients, Brodman area 9 of frontal lobe displays an altered gene expression profile in parallel with attention deficit problems, hallucinations, and delirium. At the present time, it is accepted that there is a strong link between the microscopic and macroscopic morphology of the (pre)frontal lobe and personality of the subjects. More specifically, extroversion is associated with an increased volume of the orbitofrontal area, which regulates reward processing. Remarkably, it seems that the lateral (pre) frontal cortex is associated not only with voluntary modulation of behavior but also with conscientiousness. However, the prefrontal cortex represents the most specialized structure, which mediates artistic creation and appreciation. Several groups have reported that medial orbito-frontal lobe represents the integrative center for evaluation of artistic visual stimuli. Also, esthetic interpretation and art production in general requires cognition, symbol processing, and memorization. In this setting, the prefrontal lobe acts as an executive center modulating symbol processing and cognition, but its activity is supervised by basal ganglia. Neuroimaging studies, based on an esthetic-artistic perspective, have revealed simultaneous activation of both basal ganglia and (pre)frontal lobes during assessment of various visual stimuli . Magneto-encephalographic studies recording the activity of the frontal cortex during evaluation of abstract and classic art representations as well as visual assessment of photographs of landscapes, artifacts, and urban scenes have shown that this cortical region becomes “responsive” subsequent to visualization of “beautiful” art or photographs. Complex functional magnetic resonance imaging studies (fMRI) evaluating judgments of symmetry and esthetics have indicated activation of specific regions, such as bilateral ventral (pre)frontal cortex. However, when the subjects identified a certain pattern to be “beautiful” left intra-parietal sulcus, an area responsible for symmetry evaluation was also activated showing an increased signal on fMRI. The results suggest that symmetry perception was increased if in parallel the participants evaluated a beautiful object. Interestingly, transcranial magnetic stimulation studies have revealed that left (pre)frontal cortex is activated in parallel with right posteriors parietal cortex in “like–dislike” studies evaluating various paintings. All of these data support the fact that artistic creation is strongly linked to the functionality of the (pre)frontal lobe substantiating a neurobiological basis of neuroesthetics but at molecular level the chain of events is currently unknown.
The role of parietal lobe and temporal-parietal junction in artistic creation
It is known that parietal cortex is specialized in coordinating eye movements, grasping, and other visual–motor actions. Moreover, this part of the cortex is activated by perception of object orientation, manual learning including the use various devices and machinery. At this stage, we can only speculate that it may very well relate to any type of manual art production as well. More importantly, in the realm of neuroesthetics, the activation of parietal cortex is associated with positive esthetic experiences. If healthy non-artistically trained subjects are requested to compare representational realist/figurative paintings or drawings and indeterminate/abstract art, fMRI records an increased activity in an area between the parietal and temporal lobes as well as in the temporal–parietal junction only after evaluating representational art. This suggests that specific content recognition in various paintings is determined by activation of this higher cortical region. Moreover, Kawabata and Zeki have reported that the left temporal–parietal junction area is stimulated when the subjects describe “beautiful” visual art rather than neutral art.
Interestingly, magnetoencephalographic recordings of male and female parietal brain activity while evaluating artistic “beauty” have suggested different activation in men compared with women. In men, the activation was recorded in the right parietal cortex while in women the stimulation was equally represented in left and right parietal cortex. While the authors speculate that this significant difference might be related to human evolution, currently it is certain that men have a different activation than women when it comes to artistic evaluation. The activation of the right parietal lobe in men indicates that artistic “beauty” depends on global attention, and men use an exploratory strategy based on spatial coordinates only.
The role of other corical regions in artistic creation
Neuro-radiological research indicates that apart from (pre)frontal, parietal lobe, and temporal–parietal junction, other cerebral structures are also needed in art evaluation. Chakravarty proposes a “neural circuitry of visual artistic production and appreciation” to include other cortical areas in addition to (pre)frontal, parietal, and temporal–parietal regions. Artistic creation and appraisal would include a “talk-back” between various part of the brain and also fine tuning of memory circuitry in the temporal cortex via the uncus. It is suggested that while “planning and execution” are modulated by various parts of the (pre)frontal lobe, “the actual “impulse” of creation is transferred from frontal cortex to the parietal cortex via superior longitudinal fasciculus. However, the (pre)frontal lobe functionality is influenced by stimuli received from temporal lobe via limbic pathways and uncinated fasciculus. In addition, artistic “beauty” signals are also processed in the amygdala and hippocampus. It is hypothesized that all these complex structures must be activated simultaneously in artistic evaluation as well as creation. Subsequently, once the image is conceptualized in the visual areas, the motor brain is activated for execution of that particular art. In fact, this hypothesis is complementary to Zeki’s “theory of multistage integration (TMI),” which states that visual brain is the most important integrative region modulating the functionality of brain in the context of neuroesthetics. However, more studies are needed to confirm both Chakravarty’s and Zeki’s concepts, but the most important difficulty related to experimental work in this context is represented by standardization of clinical experiments. Nadal et al. have highlighted that activation of certain parts of the brain related to neuroesthetics depends in an experimental setting not only on the subjects but also on the quality of the stimuli and of course on the actual experimental design. The current knowledge in this field revealed by the above mentioned functional studies including Zeki’s “TMI” and Charkravarty’s neural circuitry of visual artistic production and appreciation” is not sufficient to explain the relationships between cellular molecular changes described in brain parenchyma and artistic creation, but it represents a starting point for future research.
The inter-relationship between the artistic creation, positive aesthetic experience and various CNS regions.
Stroke and Artistic Creation
Cerebral stroke represents the final result of an ischemic or hemorrhagic event in a cerebral area. Depending on the clinical circumstances, stroke patients may survive and overcome their neurological deficit, which ensues after the acute episode. Experiments conducted in a murine model of stroke induced by middle cerebral artery occlusion have shown that cerebral necrosis is counteracted by neuroplasticity, which includes a process of neuronal regeneration starting very early after the acute event. However, neuroplasticity requires poststroke angiogenesis to promote survival of newly formed neurons and neuronal steam cells. Remarkably, clinical improvements observed in some patients after stroke could be explained by neuroplasticity in the context of neurological recovery and compensation. In addition, after stroke, a visual artist may show active motor artistic skills related to artistic output with or without development of a totally different style compared with the prestroke period. We believe that in the poststroke period, active artistic skills re-appear as a result of motor recovery and/or compensation and are modulated directly by neuroplasticity.
Regarding the premordid style, we must highlight that all the artists discussed in this paper had previously acquired international fame and notoriety through their drawings and paintings created in a very specific individual style. The individual artistic style could be defined by certain traits and characteristics, which allows a potential recognition of the author. The theories explaining the style have evolved over time from Renaissance to modern times. While the Renaissance Alberti promotes a balanced realistic representation, modern authors, such as Martindale, suggest a psychological explanation of style, which claims that the artists is in a continuous quest for novel works in order to counteract the effects of habituation. More importantly, for neurobiology of artistic creation, regardless the premorbid style, after a right hemispheric stroke, the new style is mainly characterized by a loss of correct spatial relationships, asymmetry determined by left-side neglect, use of elementary bold colors, simplification of images, as well as loss of both tri-dimensionality and “claire-obscure.” After a left hemispheric stroke, the new style is characterized by rigidity, loss of perspective and tri-dimensionality, and repetitiveness. However, these features have to be regarded with great caution as both right and left stroke artists are capable of circumventing these elements. In theory, any type of painting could be evaluated by Chatterjee’s assessment of art attributes. According to this method, a painting has perceptual attributes (balance, color saturation and temperature, depth, complexity, stroke) and representational attributes (abstraction, movement, emotion, realism, objective accuracy, and symbolism).
AUTHOR=Petcu Eugen Bogdan, Sherwood Katherine, Popa-Wagner Aurel, Buga Ana Maria, Aceti Lanfranco, Miroiu Rodica Ileana
TITLE=Artistic Skills Recovery and Compensation in Visual Artists after Stroke
JOURNAL=Frontiers in Neurology, VOLUME=7, YEAR=2016, PAGES=76, URL=https://www.frontiersin.org/article/10.3389/fneur.2016.00076, DOI=10.3389/fneur.2016.00076, ISSN=1664-2295
ABSTRACT=>Background: Art is a characteristic of mankind, which requires superior central nervous processing and integration of motor functions with visual information. At the present time, a significant amount of information related to neurobiological basis of artistic creation has been derived from neuro-radiological cognitive studies, which have revealed that subsequent to tissue destruction, the artists continue to create art. The current study aims to review the most important cases of visual artists with stroke and to discuss artistic skills recovery and compensation as well as artistic style after stroke. >Methods: The role of various central nervous system regions in artistic creation was reviewed on the basis of previously published functional studies. Our PubMed search (1995–2015) has identified 10 famous artists with right cerebral stroke as well as 5 with left cerebral stroke who survived and continued to create art after stroke. As the artists included in this review lived at various times during the twentieth century and in different countries, clinical information related to their case was limited. However, it appears that artistic skills recovery and compensation appear within days after stroke. Some of the artists would subsequently change their artistic style. All these elements have been evaluated within the context of specific clinical cases. Conclusion: The poststroke artistic skills recovery and compensation with development of a new style or the opposite, regaining the previous prestroke style, represents a significant element of clinical importance in medical rehabilitation as well as neuroesthetics, which requires further evaluation. At the present time, the molecular mechanisms of artistic creation are poorly understood, and more standardized clinical and experimental studies are needed.
There are a number of large charitable not-for-profit organisations that offer support and a wealth of information to the survivors of stroke and their families. Here are some of them below.
The Brain Foundation
The Brain Foundation is a nationally registered charity dedicated to funding world-class research Australia-wide into neurological disorders, brain disease and brain injuries.
The American Stroke Association team with millions of volunteers to fund research, fight for public health policies, and provide lifesaving tools and information to prevent and treat stroke.
The Stroke Foundation is a national charity that partners with the community to prevent, treat and beat stroke. They stand alongside stroke survivors, families, healthcare professionals and researchers.
The Stroke Association charity works across the UK to support people to rebuild their lives after stroke. From local support services and groups, to online information and support.
There are a significant number of stroke survivors, of all ages and walks of life, including celebrities, who publish their path to recovery on Instagram. Strokes can be indiscriminate any many survivors have encouraging and helpful stories to share.
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Art Therapy and Stroke
Art Therapy and Stroke
There have been a number of significant studies undertaken to research the effects that a stroke can have on an established artist and also how art can help a stroke survivor improve their general recovery. The following organisations offer a wealth of information supporting stroke survivors and there are many providers of art therapy. We look forward to sharing a directory of art therapists on this page soon.
Spindpals
The main focus of creative art therapy is to allow patients to communicate their feelings via body language, speech, pictures, language and symbols.
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