Use Of Attentional Strategies Research Articles

Added value of the instrumented Timed-Up and Go test (iTUG) in the long-term assessment of PD patients with bilateral subthalamic nucleus deep brain stimulation (STN-DBS)

STN-DBS is an effective long-term treatment in PD, improving a broad spectrum of symptoms, including tremor, rigidity, and bradykinesia (Fig. 1a) together with dopaminergic treatment. Among axial symptoms, gait disorders are common in PD. This study examines the long-term effects of different combinations of these two treatments in a cohort of advanced PD patients by means of the iTUG. Observational study on consecutive PD patients previously treated with bilateral STN-DBS. Disease severity was assessed using the UPDRS part III. Accelerometric data were acquired using an inertial sensor (G-WALK, BTS Bioengineering). Three iTUG trials were recorded in each of four stimulation and drug conditions: on-stimulation/off-medication, off-stimulation/off-medication, on-stimulation/on- medication and while preforming a cognitive task (counting backward, DUAL TASK) with both stimulation and medication on. Data were segmented into six phases (e.g., rising from chair, walking) as in [1]. A set of indices was computed including durations, RMS amplitudes, peak accelerations, peak angular velocities, indices of symmetry (improved Harmonic Ratio) and smoothness (Spectral Arc) [1]. A one-way non-parametric ANOVA was carried out, with the condition as a factor, followed by paired comparisons when appropriated. Statistical significance was set at 5% for all analyses. Twenty-five patients were re-evaluated 3 to 7 years after STN-DBS surgery, with a mean five-year postoperative follow-up. Clinical characteristics were age 64(5) y, 8/17 F/M, PD duration 16(5) y, distance from STN-DBS intervention 5(1) y, median (IQR) UPDRS-III 12(12), WHS 5(1), FAC 5(2). Most patients were able to perform the test in all conditions. Both STN-DBS alone and the combination of STN-DBS and medications led to an improvement of clinical motor scores and most iTUG parameters (p<0.001). In particular: 1) the elevation/sitting gestures and the turn phases differently improved in the different conditions; 2) on average, the effect of the DUAL TASK condition led to indices similar to those in the off-off condition 3) data from the DUAL TASK condition suggest the existence of two subgroups of patients, whose performance is either affected or not affected by the cognitive task ( Fig. 1 ). The protocol resulted feasible. Our results indicate that both STN-DBS and levodopa can improve walking ability even in the long-term after surgery. Results during DUAL TASK suggest the use of attentional strategies in the rehabilitation of selected patients, as indicated in the EU physiotherapy guidelines for PD [2]. A rehabilitative intervention should be strongly recommended in those patients whose performance in DUAL TASK becomes so impaired as in the STIM-OFF/MED-OFF, as measured by the iTUG. In conclusion, the iTUG test could be used in PD patients with STN-DBS to support the selection of tailored rehabilitative interventions and to identify patients whose performance is highly affected during cognitive tasks.

Thematic role information is maintained in the visual object-tracking system.

Thematic roles characterise the functions of participants in events, but there is no agreement on how these roles are identified in the real world. In three experiments, we examined how role identification in push events is supported by the visual object-tracking system. Participants saw one to three push events in visual scenes with nine identical randomly moving circles. After a period of random movement, two circles from one of the push events and a foil object were given different colours and the participants had to identify their roles in the push with an active sentence, such as red pushed blue. It was found that the participants could track the agent and patient targets and generate descriptions that identified their roles at above chance levels, even under difficult conditions, such as when tracking multiple push events (Experiments 1-3), fixating their gaze (Experiment 1), performing a concurrent speeded-response task (Experiment 2), and when tracking objects that were temporarily invisible (Experiment 3). The results were consistent with previous findings of an average tracking capacity limit of four objects, individual differences in this capacity, and the use of attentional strategies. The studies demonstrated that thematic role information can be maintained when tracking the identity of visually identical objects, then used to map role fillers (e.g., the agent of a push event) into their appropriate sentence positions. This suggests that thematic role features are stored temporarily in the visual object-tracking system.

Effects of attentional direction, age, and coping style on cold-pressor pain in children

This study assessed the relative efficacy of two imagery-based attentional strategies for modifying pain experience in children. Children aged 7–14 years (n=120) were randomly assigned to one of three conditions: distraction, sensory-focussing or control (no imagery). The distraction condition prompted children to focus their attention externally; the sensory-focussing condition prompted the child to focus internally on physical sensations. Self-report measures of pain coping style preferences and imagery ability were completed. Children's pain tolerance and perceptions of pain intensity were assessed using a 10 °C cold-pressor task. Results showed pain intensity ratings after 1min were lower for both intervention conditions than for the controls. Younger children (7–9 years) showed higher pain tolerance in the distraction condition than in the sensory-focussing condition, whereas both interventions were equally effective for older children (10–14 years). Among older children, coping style interacted with the intervention type: in the sensory-focussing condition, pain tolerance was negatively associated with self-reported distraction-based coping style, whereas in the distraction condition this association was positive. The results are interpreted with reference to current models of attention. The implications for use of attentional strategies in helping children to cope with clinical pain are discussed.

Attention processes in the maintenance and treatment of social phobia: hypervigilance, avoidance and self-focused attention

Four domains of evidence regarding the relationship between attention and social phobia are reviewed: (1) possible maintaining factor, (2) causal relationship, (3) specific relationship and (4) mediator of change during treatment. Two areas of research are covered and integrated: vigilance-avoidance of social threat stimuli and self-focused attention. There is empirical support for these processes as possible maintaining factors that are specific to patients and non-clinical samples with high levels of social anxiety. There is reasonable evidence to promote the use of attentional strategies in the treatment of social phobia, although better controlled studies are required. We propose six overlapping mechanisms that could be responsible for change: reduced vigilance; reduced avoidance; reduced self-focused attention; mindfulness; increased attentional control; increased self-esteem.

Movement-related potentials in Parkinson's disease: external cues and attentional strategies.

Hypokinetic movement can be greatly improved in Parkinson's disease patients by the provision of external cues to guide movement. It has recently been reported, however, that movement performance in parkinsonian patients can be similarly improved in the absence of external cues by using attentional strategies, whereby patients are instructed to consciously attend to particular aspects of the movement which would normally be controlled automatically. To study the neurophysiological basis of such improvements in performance associated with the use of attentional strategies, movement-related cortical potentials were examined in Parkinson's disease and control subjects using a reaction time paradigm. One group of subjects were explicitly instructed to concentrate on internally timed responses to anticipate the presentation of a predictably timed go signal. Other subjects were given no such instruction regarding attentional strategies. Early-stage premovement activity of movement-related potentials was significantly increased in amplitude and reaction times were significantly faster for Parkinson's disease subjects when instructed to direct their attention toward internally generating responses rather than relying on external cues. It is therefore suggested that the use of attentional strategies may allow movement to be mediated by less automatic and more conscious attentional motor control processes which may be less impaired by basal ganglia dysfunction, and thereby improve movement performance in Parkinson's disease.

Movement‐related potentials in Parkinson's disease: External cues and attentional strategies

Hypokinetic movement can be greatly improved in Parkinson's disease patients by the provision of external cues to guide movement. It has recently been reported, however, that movement performance in parkinsonian patients can be similarly improved in the absence of external cues by using attentional strategies, whereby patients are instructed to consciously attend to particular aspects of the movement which would normally be controlled automatically. To study the neurophysiological basis of such improvements in performance associated with the use of attentional strategies, movement-related cortical potentials were examined in Parkinson's disease and control subjects using a reaction time paradigm. One group of subjects were explicitly instructed to concentrate on internally timed responses to anticipate the presentation of a predictably timed go signal. Other subjects were given no such instruction regarding attentional strategies. Early-stage premovement activity of movement-related potentials was significantly increased in amplitude and reaction times were significantly faster for Parkinson's disease subjects when instructed to direct their attention toward internally generating responses rather than relying on external cues. It is therefore suggested that the use of attentional strategies may allow movement to be mediated by less automatic and more conscious attentional motor control processes which may be less impaired by basal ganglia dysfunction, and thereby improve movement performance in Parkinson's disease.

Attentional Strategy Use by Experienced Distance Runners: Physiological and Psychological Effects

The purpose of this investigation was twofold: (a) to compare most and least economical runners on use of attentional strategies and (b) to determine whether the least economical runners within the subject sample could improve running economy (RE) with the use of an active associative (relaxation) attentional strategy. Subjects (N = 36) completed an initial assessment of attentional style and RE; then the 12 least economical runners ran in each of three laboratory sessions using control, passive associative, and active associative attentional strategies. Results showed that the most economical and least economical runners did not differ in associative style use. The most economical runners, however, reported less dissociation use and more use of relaxation than did the least economical runners. No significant physiological or psychological changes were associated with any of the three attentional strategy conditions. The findings are related to possible differences in how most and least economical runners use associative strategies.

Focused and Divided Attention in Each Half of Space with Disconnected Hemispheres

The effects of spatial location and strategy of attention on the processing of speech messages were investigated in ten right-handed subjects and four persons with complete forebrain commissurotomy and one case of right hemispherectomy. Lists of simultaneous but different words, with one of each pair spoken by a male and the other by a female, were monitored for target words. The lists were presented to the left ear, the right ear and to both ears (central) in separate conditions. Unimanual responses were made to targets in either voice (divided attention) or to only one of the voices (focused attention). The performance of the clinical subjects was generally less efficient than that of the controls. In contrast to intact subjects, they responded to more distractor and unattended items. They also showed a nonsignificant tendency for better processing of right rather than centrally-presented words. With right-sided presentation two clinical subjects, with extracallosal damage to the right cortex, were unable to divide attention and responded to only one of the voices. These results implicate an intact corpus callosum for efficient use of attention strategies as well as hemispheric differences in the control of attention.