Anticipation and Medicine – Hanse-Wissenschaftskolleg Institute for Advanced Study & The antÉ Institute for Research in Anticipatory Systems

September 28 – 30, 2015

The conference “Anticipation and Medicine” will illuminate and discuss the implications of anticipation-based concepts on medical research and practice, engaging a set of about 25 speakers from the medical fields and related areas.

Planned Themes

1. Anticipation and the broad spectrum of neurological conditions
This session is meant to bring together those researchers who examine, among similar problems,PTSD (post-traumatic stress disorder), autism, Huntington’s disease, Parkinson’s, Alzheimer’s, and aging-related maladies, from the perspective of anticipation.

2. Evaluating the risk factors and opportunities of new medical procedures
This concerns anticipating the long-term consequences of genetics and genomics-based medicine, molecular medicine, translational methods, etc. Individualized medicine is of particular interest.

3. Anticipation and medical care
A major problem facing medical practitioners is the lack of unified procedures and record-keeping. More deaths are associated with errors committed due to improperly shared data than with the disease to be treated. From mass medicine to individualized medicine means also the anticipation of the impact of unequal access to modern means.

4. Anticipation and psychological aspects of patient treatments
This session should bring together medical practitioners who study anticipation of pain, of cancer treatment (chemotherapy in particular), of children’s reactions, in order to mitigate their consequences.

5. Anticipation and medical data processing
There is currently a widespread interest in associating algorithmic diagnostics in individual communication devices with the acquisition of vital information (temperature, blood pressure, heartbeat, and much more), and transmission of the data to medical expert systems. Tracking an individual’s anticipatory profile could prevent the spread of disease or delayed intervention in cases where death or irreversible damage could result.

6. Anticipation and alternative medicine
There is much research in alternative forms of medicine that rely on data acquired through means different from those of laboratory-based testing.

Papers presented at the conference will be published in the volume Anticipation and Medicine in the Cognitive Systems Monographs (Springer). Webcast of the entire conference is under consideration.

Dr. Hans Jörgen Grabe
Environment, genes and mental health
The vulnerability-stress-model has gained much attention in mental disorders as it captures the multifactorial nature of the disorders. During the last years, research activities aimed to identify biological and genetic components that operate in interaction with psychosocial factors like stressful life-events and urbanicity within this model increasing or lowering ones vulnerability for mental disorders. The interplay between environmental factors and biological systems like the stress-axis (HPA-axis) and the clinical outcomes will be analyzed from an anticipatory perspective.Based on the SHIP-LEGEND & TREND study (currently N=2500 subjects with MRI scans) empirical data on the impact of smoking, obesity, low education and childhood abuse on the grey matter brain volumes in adults from the general population will be presented. Previous findings have implicated limbic regions like the hippocampus, amygdala, anterior cingulate cortex and frontal areas in the structural mediation of long-term effects of childhood adversities. The putative impact of the genetic variants like 5-HTTLPR and FKBP5 polymorphisms on those structural changes will be presented. The societal and clinical impact of those findings and models will be discussed.

Dr. David Knight
Anticipation and the Neural Response to Threat
Abstract: An important function of emotion is that it allows one to respond more effectively to threats in our environment. The response to threat is an important aspect of emotional behavior given the direct biological impact it has on survival. More specifically, survival is dependent upon the ability to avoid, escape, or defend against a threat once it is encountered. Anticipatory processes supported by neural circuitry that includes the prefrontal cortex and amygdala are critical for the expression and regulation of the emotional response. Further, these anticipatory processes appear to regulate the response to the threat itself. Healthy emotional functioning is characterized by anticipatory mechanisms that diminish the emotional response to threat. In contrast, emotional dysfunction is characterized by anticipatory processes that lead to an exaggerated threat response. Thus, anticipatory mechanisms play an important role in both healthy and dysfunctional emotional behavior.

Dr. Julie Brisson
Anticipation and autism
In the field of developmental psychology, researchers try to point out how children develop, what they already know at birth, how/what they learn and how/what they think about their environment. Children come to the world within a social environment. They progressively learn from observing this environment. They observe and experience several repeated situations, for instance routines like meal times, bath or care periods, play times… If these situations are understood and the repetitive patterns are assimilated, children can adapt and respond quickly to these various repeated solicitations. Seen in this light, anticipation is a tool to observe the child’s understanding of the situation. Our studies can be split in two main questions, 1- how typically developing infants understand their world and what can help then to understand it more quickly? 2- do infants later diagnosed with autism display a lack of anticipation, implying that they do not understand as fast as typically developing infants do? These questions will be tackled in the talk.

Dr. Larry Burk
Anticipate the Diagnosis of Breast Cancer
Mass population screening programs, such as mammography, represent an attempt to use technology to predict the presence of the early development of disease in asymptomatic individuals. Unfortunately sometimes the benefits are outweighed by the risks which occur when there are too many false positives that require further invasive diagnostic procedures, and when detection of carcinoma-in-situ leads to aggressive treatment of disease that may have never become clinically relevant. With the options of using other imaging approaches such MRI and ultrasound, it is also a timely opportunity to investigate an intuitive approach to self-care using dreams as a supplement to breast self-examination. This presentation will review a recent survey of 18 women from around the world who had life-changing warning dreams of breast cancer prior to symptoms that prompted medical attention leading directly to diagnosis.

Heuten, Dr. Wilko, OFFIS Institut für Informatik, Oldenburg; Hoffmann, Jan-Dirk, Schüchtermann-Klinik, Bad Rothenfelde; Technau, Johannes, GewiNet – Kompetenzzentrum Gesundheitswirtschaft, Osnabrück; Timmermann, Janko, OFFIS Institut für Informatik, Oldenburg; Willemsen, Dr. Detlev, Schüchtermann-Klinik, Bad Rothenfelde; Workowski, Anke, Schüchtermann-Klinik, Bad Rothenfelde
Coaching of body awareness through an App-Guide: The “HealthNavigator”
A lot of people avoid physical activity because they are afraid of overexertion. Current sports applications support these people using the objective parameter of the heart rate as a control value for physical endurance activities. However, users of such systems are not trained to rate their exertion themselves and perceive their body signals which give a good feedback about healthy or unhealthy behavior. Specific hints and questions about the self-perceived physical exertion of the user can train the body perception as subjective control parameter. The aim of the project “HealthNavigator” is to coach the body awareness while hiking by requesting users to reflect their perceived exertion, while still recording vital parameters using common sensors for objective feedback. These functionalities are combined with a navigation system especially developed for hiking which also contains touristic information for motivation purposes. An especially developed algorithm, using the heart rate and perceived exertion based on the Borg scale, coaches people who want to improve their physical performance by preselected paths around the Schüchtermann-Klinik in Bad Rothenfelde (Lower Saxony) and Roessingh Research and Development in Enschede. To support the user in moving around on unknown paths the project also aimed on getting as much relevant information about transport, resting places and places worth mentioning and implementing those into the software. The APP interface of the “HealthNavigator” has been developed user-friendly using the Human-centred design process and several user studies.
By using the “HealthNavigator” the body awareness can be coached and thus movement anxiety can be reduced.

Rainer Malaka, Marc Herrlich, Jan Smeddinck
Adaptive Games for Health
Digital motion-based games allow users to play computer games with body movements. They can also be used as so called Exergames combining Exercises and Games. Such computer games are a relatively new phenomenon. Low-cost tracking methods for game consoles allow for full body tracking. Exergames have three major benefits. First, they can raise the motivation addressing the homo ludens and the immersion of interactive computer software can lead to a sustainable motivation for doing exercises. Second, they can give users feedback on doing physiologically positive movements. Third they can adapt to individual users. The latter is not only a great chance but also a great challenge in developing exergames. In physiotherapy, for instance, many patients (users) have quite individual pre-dispositions, abilities and depending on the reason for their condition might have phases with more or less restrictions. Adapting to and anticipation of physical ability and individual training goals on various time scales needs subtle mechanisms for individual users.

Rainer Malaka, Thomas Barkowsky, Frank Dylla, Christian Freksa, , Marc Herrlich, Ron Kikinis
Intelligent Support for Surgeons
Modern technology allows surgeons to plan operations with complex 3D information tools. Before the operation data need to be integrated, analyzed and visualized. In the operation room however, most of the tools are not at hand. In the situation of the operation, however, it might be useful to access these data and to visualize certain aspects depending on the actual context. In an interdisciplinary approach we look at such situations and look for novel solutions for intraoperative support for surgeons to access 3D information: what they need, when they need it. We integrate medical image processing, cognitive modelling and human computer interaction in order to anticipate the needs of surgeons. In order to develop such systems, we address three questions: How to identify what information the surgeon needs? How to adapt pre- and intra-procedure information to the surgical situation? How to present the relevant information to the surgeon? This paper presents the vision and preliminary results of a collaborative research project.

Dr Kylie Tucker
Anticipation, Perception and Confidence in the motor adaptation to pain.
Movement control is altered during acute and chronic pain. This change is in part related to central factors. Anticipation of acute pain alters recruitment of muscle fibres and anticipatory motor commands. Confidence and perception of the ability to perform a task are also critical factors in altered motor performance with pain. There is still much to be learnt about the complex interaction of these factors in the development, persistence and recovery of musculoskeletal pain conditions.

Prof. Dr. Thomas Schack, Bielefeld University
Anticipation in traditional healing ceremonies: the call from our past
Given my long term work in the field of mental coaching and psychological training in rehabilitation and high performance sport I was able to rediscover healing ceremonies. The presentation will document traditional healing ceremonies such as sweatlodges of the native indians in US, as well as Santeria and Palo Monte ceremonies in Cuba, Mexico and in North America.

Mihai Nadin
Anticipation and Medicine
The anticipatory perspective challenges the reductionist-deterministic understanding of nature. It is therefore not surprising that the acceptance of anticipation is at best marginal. The most common attitude favors the attempt to explain away anticipation either by reducing it to an expression of genetic determinism, or by stubbornly reducing anticipation to prediction. The decisive battle to be won in order to ascertain anticipation will probably take place in the field of medicine. If the anticipation perspective does not succeed in medicine, chances are that it will have to resist the fundamental opposition of mainstream scientific thought for a long time before being accepted.

We shall discuss concrete aspect of medicine around the classic distinction between healthcare and disease management—that is, between a proactive understanding of the role of medicine, and its current state as mechanics of the human being considered as just a machine. In particular, we shall focus on the spectrum condition (autism, Parkinson’s, Alzheimer’s, PTSD, etc.), advancing the thesis that it is an expression of skewed anticipation. We shall also argue that alternative medicine is becoming a critical option under circumstances of unsustainable reactive medicine as practiced today.

Dr. Federico Licastro
New therapeutic opportunity for the treatment of the age related cognitive decline and prevention of dementia.
Alzheimer’s disease (AD) is a heterogeneous progressive degenerative dementia usually with a senile onset that affects specific areas of the brain. Neuritic senile plaques, neurofibrillary tangles, synapsis loss, neuronal atrophy and cortical neurodegeneration are neuropathological hallmarks of the disease. No therapy is available at the present and the etiology of the disease remains obscure. Environmental risk factors are still largely unrevealed in AD however they may accumulate with advancing age and play the role of disease multiple triggers in the susceptible brain. Recent GWA studies reported that the allele ε4 of APOE gene and SNPs in other genes regulating inflammation pathways were associated with AD. Our previous works suggested that all these genes may be linked to different herpes viral infection and we argued that the concomitant presence of these gene variations in the same individual might represent a genetic signature predisposing to AD (Licastro et al., 2011, Porcellini et al., 2010). Our findings showing that gene variations in anti-virus defensive mechanisms affect anti-EBV and HHV-6 immune responses in AD, suggest that sub-clinical infections by persistent virus may contribute to age associated cognitive deterioration. Differential genetic backgrounds in genes regulating immune defenses against herpes viruses may affect sub-clinical cycles of virus latency/ infections and contribute to brain neuro-degeneration in the susceptible elderly. Therefore, dementia appears to be a heterogeneous condition where the interaction of host genetic background with different environmental factors might trigger the age-related cognitive decline and AD. The discovery of these diverse components might open new therapeutic opportunity for the treatment of the age related cognitive decline and prevention of dementia.

Dr. Dagmar Ehling
Integrative Techniques for Diabetes, Obesity and Polycystic Ovarian Syndrome
Metabolic syndrome is rampant in our society with epidemic increases in obesity and diabetes. This lecture will provide an overview of integrative medical diagnostic and treatment options that favor proactive intervention to prevent the long term consequences of these modern maladies. Topics include Oriental medicine, blood sugar balance, adrenal health, immune system, hormones, brain health, blood chemistry, dietary modifications, genetics vs epigenetics, including their application for patients with polycystic ovarian syndrome (PCOS), a major cause of infertility. This approach offers useful and safe alternatives to drug therapy, bariatric surgery, and in the case of PCOS, assisted reproductive technologies, which have known risks and complications. This lecture suggests new possibilities for managing these issues effectively. Anticipation of the predictable outcomes of dysfunctional lifestyle choices offers the opportunity to prevent disease before it occurs.

Dr. Roozbeh Jafari
Wearable Computers on the Edge of the Cloud
Wearable computers bring to fruition many opportunities to continuously monitor human body with sensors placed on body. These platforms provide new avenues to continuously monitor individuals, whether it is intended to detect an early onset of a disease, assess human performance or the effectiveness of a treatment. In the past few years, the community has observed a large number of applications that have been developed using wearable computers. There are a number of fundamental challenges that need to be addressed before realizing the true ubiquitous use of the wearable systems. In this presentation, we highlight several wearable applications including a brain computer interface (BCI), a watch capable of monitoring ECG, PPG and blood pressure and a wearable system with biofeedback intended for fall prevention. We will present several components of the wearable computing systems including the state-of-the-art technology and the signal processing/ resource management algorithms. We highlight challenges associated with reducing the form factor and enhancing the usability of the data obtained in users’ natural environment. We describe several techniques aimed at reducing the power consumption of the analog front-end and sensing components. We will also cover several solutions aimed at enhancing the usability of wearable applications on the edge of the cloud including a repository framework and services like anomaly detection.

Dr. Thomas O. Staiger
Implementing and Evaluating an Anticipatory Systems Model of Complexity for Improving Safety in a Healthcare Organization.
The theoretical biologist, Robert Rosen, proposed that a capacity for anticipatory change is a fundamental characteristic of complex adaptive systems. As defined in his Anticipatory Systems: Philosophic, Mathematic, and Methodological Foundations, an anticipatory system contains “a predictive model of itself and/or its environment, which allows it to change state at an instant in accord with the model’s prediction pertaining to a later instant.” Healthcare organizations are complex adaptive systems in which reducing serious adverse events are an ongoing challenge. If Rosen’s anticipatory systems hypothesis is correct an enhanced understanding of the characteristics and failure modes of anticipatory systems could supplement existing safety practices and help an organization further reduce the risk of certain serious adverse events. Potential organizational interventions based on an anticipatory model of complexity and options for assessing their impact on safety in a healthcare organization will be discussed and evaluated during this presentation. Such interventions might include aspects of one or more of the following: 1) Education that anticipatory inputs can be useful for identifying and mitigating some clinical situations for which there is an increased risk of a serious adverse event. 2) Promoting optimal team functioning in which team members are encouraged to identify discrepant current state and anticipatory assessments among clinical team members and from patients and families, especially in high-risk situations. 3) Promoting awareness that significantly discrepant present-state or anticipatory mental models between clinical team members or between team and patients/families may indicate an increased risk for an adverse event and offer the opportunity to mitigate risk in advance of an adverse event.

Dr. Wanpracha Art Chaovalitwongse
Improving the accuracy and interpretability of medical decision models—a prerequisite for an anticipatory approach to medicine.
The overarching goal of our research is to develop new data analytics techniques based on applied optimization and machine learning. The main driving application of our techniques is to assist physicians/scientists in recognizing abnormality patterns (and/or patterns of interest) in medical signal and imaging data. The main focus of our work is on feature selection, which has become an emerging problem in machine learning and optimization. Searching for the optimal set of features in decision models is computationally challenging, and it also needs to avoid model overfitting. While the main objective of most decision models is to provide an accurate decision or prediction outcome, physical/physiological interpretation of such models are extremely important in medical domain. Our group has developed a host of feature selection techniques that can improve the accuracy and interpretability of our medical decision models. The main focus of this work is on multi-voxel pattern analysis (MVPA) of functional magnetic resonance imaging (fMRI) data, which is an emerging research area that investigates the neural correlates of cognition. MVPA constructs a neural activity model of cognitive representations and processing to predict activity patterns according to stimulus conditions. The problem of activity pattern prediction is commonly cast as a complex classification problem. Such a problem is very challenging because the number of voxels (features) greatly exceeds the number of data instances (stimuli). This can lead to model overfitting, which will deteriorate the classification accuracy. In this research, we developed a feature selection framework to select informative voxels based on mutual information (MI) and partial least square (PLS), which are used to quantify the statistical dependency between features and stimulus conditions. To evaluate the utility of our approach, we employed several linear classification algorithms on a publicly available fMRI data set that has been widely used to benchmark MVPA performance. The computational results suggest that feature selection based on the MI and PLS rankings can drastically improve the classification accuracy. Additionally, high-ranked features provide meaningful insights into the functional-anatomical relationship of neural activity and the associated tasks.

Dr. Peter Cariani
Time in the brain: anticipatory predictive mechanisms based on temporal memory traces.
“The purpose of memory is to anticipate the future.” Anticipatory prediction in humans and animals involves not only what events are expected, but also when they are expected to occur. Conditioning studies suggest that the timings of all correlated events relative to the arrival of a reward are implicitly stored in both short and long term memory, such that any of them can serve as anticipatory temporal predictors. Mismatch negativity potentials are generated from temporal deviations from previously repetitive patterns. Music utilizes temporal expectations and their violations to generate and relieve tension (predictive uncertainty) and also to signify expressive timing. Spike timings of dopaminergic neurons reflect discrepancies between anticipated and observed courses of the neural concomitants of events associated with rewards. Brains can be considered as anticipatory temporal prediction machines that operate on temporal patterns of spikes that are produced by distinct events. Temporal mechanisms for both short-term and long-term memory are conceivable. If temporal patterns of event-related spikes can be actively regenerated within reverberant neural delay paths, then delayed, circulating temporal memory traces of the immediate past can be cross-correlated with the time structure of present events. We have proposed neural timing nets that operate on spike correlations in the time domain to build up rhythmic expectancies and to separate independent auditory streams (Neural Networks 2001; 14/6-7:737-753; J. New Music Res. 2002; 30(2):107-136; IEEE Trans. Neural Networks, 2004; 15(5):1100-1111). Further, tape-recorder-like molecular long-term memory mechanisms can also be envisioned that store and read-out the temporal relations between past salient and rewarded events in faster-than-real time, such that the temporal memory traces that are read-out become automatic predictors of future time courses of events and their hedonic consequences.

Dr. Olga Golubnitschaja
The Paradigm Shift from Reactive to Predictive, Preventive and Personalised Medicine: Who is the Beneficiary?
At the international EPMA Summit carried out in the EU-Parliament (September 2013), main challenges have been emphasised and strategies nominated in Predictive, Preventive and Personalised Medicine (PPPM): PPPM is the emerging field considered as the medicine of the future; PPPM is the patient-centred approach meeting healthcare challenges, running treatments efficiently and keeping costs of medical services under control; PPPM objectives promote innovation in science, technologies, education, healthcare, economical and social aspects of the societies in Europe and worldwide. Successful PPPM implementation needs unprecedented level of collaboration amongst all stakeholders, long-term multidisciplinary professional partnerships including public-private ones, robust juristic platform, and smart political regulations. Gathering funding instruments focused on integration of different PPPM related branches is essential to be introduced by new strategic programmes such as “Horizon 2020”

Dr. Pascal Hilber
Influence of the cerebellum in anticipation and mental disorders
Lot of studies showed that the cerebellum is involved in both motor coordination and motor learning. Cerebellar plasticity recorded in the Purkinje cells was also proposed as a cellular basis of motor learning. Data obtained in humans and animals suposed that this structure could act as a comparator which plays a crucial role in sensory prediction and online sensorimotor control via its involvement in internal models. These models permit to “predict the future” and therefore to anticipate. They help the brain to perform the movement precisely and harmoniously with or without sensory feedback. The possible involvement of the cerebellum in non motor mental functions was proposed at the beginning of the 90’s when some authors suggested an analogy between the control of the movement of body parts and the manipulation of mental representation. Clinical data obtained not only in cerebellar patients but also in a large variety of mental disease reinforced this hypothesis. Moreover cerebellar-lesioned or mutant animals exhibit both cognitive and emotional disturbances, more particularly high reactivity to environmental changes, behavioural disinhibition and stereotyped behaviour. All these results and theoretical approaches consolidate the fact that the cerebellum and its role in anticipation could represent an interesting field of investigation in the pathophysiology and the treatment of neuropsychiatric disorders such as autism.

Shiv Gaglani
Medical data—where to locate it, who should be responsible for it?
While smartphone usage among health care professionals has been consistently growing over the past few years—this year, 75% of US physicians reported using their smartphones at work and 30% claimed to make prescribing decisions from these devices—last June was an inflection month for mobile health. WellDoc, a Baltimore-based health care technology company, received FDA approval to sell the first prescription-only smartphone app. More impressively, they convinced insurance companies to offer reimbursements for their app, which is designed specifically for type 2 diabetes management. The billion dollar question is whether this development has opened the floodgates for physicians prescribing apps in addition to, or in lieu of, pills. Put into an individual clinician’s perspective: Beyond using reference and medical calculator apps, how should a clinician be using his or her smartphone in practice? Where should patient-generated health data from wearable technologies be located, and who should be responsible for analyzing it?

Veljko Pejovic (University of Ljubljana, Slovenia), Mirco Musolesi (University of Birmingham, England)
Anticipatory Mobile Computing for Behaviour Change Interventions: the Road Ahead.
Behavioural change interventions represent a powerful means for tackling a number of health and well-being issues, from obesity to stress and addiction. In the current medical practice, the change is induced through tailored coaching, support and information delivery.
However, with the advent of smartphones, innovative ways of delivering interventions are emerging. Indeed, mobile phones, equipped with an array of sensors, and carried by their users at all times, enable therapists to both learn about the user behaviour, and impact the behaviour through the delivery of more relevant and personalised information. In this work we propose harnessing pervasive computing to not only learn from users’ past behaviour, but also predict future actions and emotional states, deliver interventions proactively, evaluate their impact at run-time, and over time learn a personal intervention-effect model of a participant.

In this talk we will discuss the challenge and the opportunities for researchers and practitioners, focusing in particular on the potential obstacles to the design, implementation and deployment of anticipatory mobile systems for behavioural intervention.

Dr. Massimo Delledonne
From Next Generation Sequencing to Next Generation Diagnostics and Therapy.
The DNA sequencing technologies keep evolving at an impressive speed. We are now extensively using 2nd generation technologies, also called Next Generation Sequencing (NGS) despite the fact that they are not “next” anymore, and that 3rd generation technologies (sometime called Next Next Generations Sequencing) are not far away. This has led to an increasing adoption of whole genome or exome sequencing world-wide, boosting the discovery of variants associated to disease that will be translated to new diagnostic, prognostic and therapeutic targets for individual patients. The lecture will give an overview of current and emerging technologies for clinical use, and some of the challenges that lie ahead.

Dean Radin
Intuition in Medicine: Orthodox and Unorthodox
While modern medicine aspires to be firmly based on evidence and a thorough consideration of the relevant literature, in the chaos of the daily clinic decisions must often be made quickly and without access to a medical library or to full diagnostic workups. As a result, the physician’s intuition is an essential component of the actual practice of medicine. Intuition may be understood, in part, as expertise that has become routinized and is no longer easily retrievable by the conscious mind. This type of intuition allows one to “know without knowing how one knows.” But there are other forms of intuition that do not appear to rely on unconscious knowledge or inference. We call such experiences intuitive hunches, gut feelings, premonitions or presentiments. These phenomena challenge conventional concepts of intuition because they suggest we have access to information unbound by the usual constraints of space or time. In this article we will focus on one form of these surprising intuitions — experimental investigations of physiological anticipations to unpredictable future events — to assess whether orthodox explanations of intuition are sufficient. We will find that from an evidence-based perspective we must consider a range of unorthodox possibilities to gain a comprehensive understanding of intuition.

Andres Kurismaa
From virtual to real movement: some basic theoretical concepts and clinical implications
This paper will consider the problem of anticipation from the point of view of virtual movement concept, as conceived by the philosopher M. Palagyi, and later introduced into biology by F.S. Rothschild. Parallels are sought between Rothschild’s interpretation of virtual movement within biosemiotics and the approach to movement structure and coordination developed by N.A. Bernstein within his physiology of action. Both frameworks drew strongly on clinical and neurological material in substantiating their approaches to anticipation and localization, and presented some of the most detailed analysis to date of the body schema and image concepts, including their anticipatory dimensions. The implications of these views are briefly analyzed in the context of modern clinical and theoretical research in motor control.

Neurology, neurosurgery, psychosomatics, and psychotherapy, gastroenterology, and psychology are medical endeavors in which the anticipatory perspective has been adopted to a certain extent. For instance, anticipation of stressful situations accelerates cellular aging; anticipation of back pain (extremely frequent) seems to predispose to back trouble (anticipatory postural adjustments are affected); neuroticism (the tendency to experience negative emotions) affects brain processing during the expectation of pain; fibromyalgia is an expression of pain anticipation; the pathophysiology of autism (in infants) or of Alzheimer’s disease evinces the role of anticipation.

These are only examples of research subjects currently pursued. In the area of brain activity and cognitive functions, there is a broad consensus that anticipation cannot be ignored if we want to make progress in addressing the changed condition of the human being. The action-reaction type of medicine (of “spare parts”, e.g. knee and hip replacements, liver and kidney transplants) is being re-evaluated in view of progress in genetic methods and genetics-based medicine. The reactive procedure of treating various behavioral problems (attention deficit disorder, hyperactivity, schizophrenia) through drugs can also be re-evaluated from the perspective of anticipation (proactive treatments that avoid the dangerous side effects of drugs and withdrawal from them).