The Use of Biofluid Markers to Evaluate the Consequences of Sport-Related Subconcussive Head Impact Exposure: A Scoping Review.

BACKGROUND: Amidst growing concern about the safety of sport-related repetitive subconcussive head impacts (RSHI), biofluid markers may provide sensitive, informative, and practical assessment of the effects of RSHI exposure. OBJECTIVE: This scoping review aimed to systematically examine the extent, nature, and quality of available evidence from studies investigating the effects of RSHI on biofluid markers, to identify gaps and to formulate guidelines to inform future research. METHODS: PRISMA extension for Scoping Reviews guidelines were adhered to. The protocol was pre-registered through publication. MEDLINE, Scopus, SPORTDiscus, CINAHL, PsycINFO, Cochrane Library, OpenGrey, and two clinical trial registries were searched (until March 30, 2022) using descriptors for subconcussive head impacts, biomarkers, and contact sports. Included studies were assessed for risk of bias and quality. RESULTS: Seventy-nine research publications were included in the review. Forty-nine studies assessed the acute effects, 23 semi-acute and 26 long-term effects of RSHI exposure. The most studied sports were American football, boxing, and soccer, and the most investigated markers were (in descending order): S100 calcium-binding protein beta (S100B), tau, neurofilament light (NfL), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), phosphorylated tau (p-tau), ubiquitin C-terminal hydrolase L1 (UCH-L1), and hormones. High or moderate bias was found in most studies, and marker-specific conclusions were subject to heterogeneous and limited evidence. Although the evidence is weak, some biofluid markers-such as NfL-appeared to show promise. More markedly, S100B was found to be problematic when evaluating the effects of RSHI in sport. CONCLUSION: Considering the limitations of the evidence base revealed by this first review dedicated to systematically scoping the evidence of biofluid marker levels following RSHI exposure, the field is evidently still in its infancy. As a result, any recommendation and application is premature. Although some markers show promise for the assessment of brain health following RSHI exposure, future large standardized and better-controlled studies are needed to determine biofluid markers' utility.

Contrasting Characteristics and Outcomes of Sports-Related and Non-Sports-Related Traumatic Brain Injury.

Importance: Exposure to traumatic brain injury (TBI) has raised widespread concern over participation in sports, particularly over possible long-term consequences. However, little is known about the outcomes of individuals presenting to hospitals with sports-related TBI. Objective: To compare the characteristics and outcomes of individuals presenting to hospitals with sports-related and non-sports-related TBI. Design, Setting, and Participants: The CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) observational cohort study was conducted at hospitals in 18 countries. The study enrolled 4509 patients who had TBI and had an indication for computed tomography (CT), of whom 4360 were 16 years or older. Outcomes were assessed at 3 and 6 months, and groups were compared using regression analyses adjusting for clinical and demographic differences. Data were collected between December 9, 2014, and December 17, 2017, and analyzed from August 2022 to March 2023. Exposure: Sports-related and non-sports-related TBI with subgroups selected by severity of injury. Main Outcomes and Measures: The main outcome was the Glasgow Outcome Scale-Extended (GOSE) at 6 months, with secondary outcomes covering postconcussion symptoms, health-related quality of life, and mental health. Results: A total of 4360 patients were studied, including 256 (6%) with sports-related TBI (mean [SD] age, 38.9 [18.1] years; 161 [63%] male) and 4104 with non-sports-related TBI (mean [SD] age, 51.0 [20.2] years; 2773 [68%] male). Compared with patients with non-sports-related TBI, patients with sports-related TBI were younger, more likely to have tertiary education, more likely to be previously healthy, and less likely to have a major extracranial injury. After adjustment, the groups did not differ in incomplete recovery (GOSE scores <8) at 6 months (odds ratio [OR], 1.27; 95% CI, 0.90-1.78; P = .22 for all patients; OR, 1.20; 95% CI, 0.83-1.73; P = .34 for those with mild TBI; and OR, 1.19; 95% CI, 0.74-1.92; P = .65 for those with mild TBI and negative CT findings). At 6 months, there was incomplete recovery in 103 of 223 patients (46%) with outcomes in the sports-related TBI group, 65 of 168 (39%) in those with mild sports-related TBI, and 30 of 98 (31%) in those with mild sports-related TBI and negative CT findings. In contrast, at 6 months, the sports-related TBI group had lower prevalence of anxiety, depression, posttraumatic stress disorder, and postconcussion symptoms than the non-sports-related group. Conclusions and Relevance: In this cohort study of 4360 patients with TBI, functional limitations 6 months after injury were common after sports-related TBI, even mild sports-related TBI. Persisting impairment was evident in the sports-related TBI group despite better recovery compared with non-sports-related TBI on measures of mental health and postconcussion symptoms. These findings caution against taking an overoptimistic view of outcomes after sports-related TBI, even if the initial injury appears mild.

Characterizing neurocognitive impairments in Parkinson's disease with mobile EEG when walking and stepping over obstacles.

The neural correlates that help us understand the challenges that Parkinson's patients face when negotiating their environment remain under-researched. This deficit in knowledge reflects the methodological constraints of traditional neuroimaging techniques, which include the need to remain still. As a result, much of our understanding of motor disorders is still based on animal models. Daily life challenges such as tripping and falling over obstacles represent one of the main causes of hospitalization for individuals with Parkinson's disease. Here, we report the neural correlates of naturalistic ambulatory obstacle avoidance in Parkinson's disease patients using mobile EEG. We examined 14 medicated patients with Parkinson's disease and 17 neurotypical control participants. Brain activity was recorded while participants walked freely, and while they walked and adjusted their gait to step over expected obstacles (preset adjustment) or unexpected obstacles (online adjustment) displayed on the floor. EEG analysis revealed attenuated cortical activity in Parkinson's patients compared to neurotypical participants in theta (4-7 Hz) and beta (13-35 Hz) frequency bands. The theta power increase when planning an online adjustment to step over unexpected obstacles was reduced in Parkinson's patients compared to neurotypical participants, indicating impaired proactive cognitive control of walking that updates the online action plan when unexpected changes occur in the environment. Impaired action planning processes were further evident in Parkinson's disease patients' diminished beta power suppression when preparing motor adaptation to step over obstacles, regardless of the expectation manipulation, compared to when walking freely. In addition, deficits in reactive control mechanisms in Parkinson's disease compared to neurotypical participants were evident from an attenuated beta rebound signal after crossing an obstacle. Reduced modulation in the theta frequency band in the resetting phase across conditions also suggests a deficit in the evaluation of action outcomes in Parkinson's disease. Taken together, the neural markers of cognitive control of walking observed in Parkinson's disease reveal a pervasive deficit of motor-cognitive control, involving impairments in the proactive and reactive strategies used to avoid obstacles while walking. As such, this study identified neural markers of the motor deficits in Parkinson's disease and revealed patients' difficulties in adapting movements both before and after avoiding obstacles in their path.

Capturing Cognitive Events Embedded in the Real World Using Mobile Electroencephalography and Eye-Tracking.

The study of cognitive processes underlying natural behaviors implies departing from computerized paradigms and artificial experimental probes. The present study aims to assess the feasibility of capturing neural markers (P300 ERPs) of cognitive processes evoked in response to the identification of task-relevant objects embedded in a real-world environment. To this end, EEG and eye-tracking data were recorded while participants attended stimuli presented on a tablet and while they searched for books in a library. Initial analyses of the library data revealed that P300-like features shifted in time. A Dynamic Time Warping analysis confirmed the presence of P300 ERP in the library condition. Library data were then lag-corrected based on cross-correlation coefficients. Together, these approaches uncovered P300 ERP responses in the library recordings. These findings highlight the relevance of scalable experimental designs, joint brain and body recordings, and template-matching analyses to capture cognitive events during natural behaviors.

The neural response is heightened when watching a person approaching compared to walking away: Evidence for dynamic social neuroscience.

The action observation network has been proposed to play a key role in predicting the action intentions (or goals) of others, thereby facilitating social interaction. Key information when interacting with others is whether someone (an agent) is moving towards or away from us, indicating whether we are likely to interact with the person. In addition, to determine the nature of a social interaction, we also need to take into consideration the distance of the agent relative to us as the observer. How this kind of information is processed within the brain is unknown, at least in part because prior studies have not involved live whole-body motion. Consequently, here we recorded mobile EEG in 18 healthy participants, assessing the neural response to the modulation of direction (walking towards or away) and distance (near vs. far distance) during the observation of an agent walking. We evaluated whether cortical alpha and beta oscillations were modulated differently by direction and distance during action observation. We found that alpha was only modulated by distance, with a stronger decrease of power when the agent was further away from the observer, regardless of direction. Critically, by contrast, beta was found to be modulated by both distance and direction, with a stronger decrease of power when the agent was near and facing the participant (walking towards) compared to when they were near but viewed from the back (walking away). Analysis revealed differences in both the timing and distribution of alpha and beta oscillations. We argue that these data suggest a full understanding of action observation requires a new dynamic neuroscience, investigating actual interactions between real people, in real world environments.

Repeated Sub-Concussive Impacts and the Negative Effects of Contact Sports on Cognition and Brain Integrity.

Sports are yielding a wealth of benefits for cardiovascular fitness, for psychological resilience, and for cognition. The amount of practice, and the type of practiced sports, are of importance to obtain these benefits and avoid any side effects. This is especially important in the context of contact sports. Contact sports are not only known to be a major source of injuries of the musculoskeletal apparatus, they are also significantly related to concussion and sub-concussion. Sub-concussive head impacts accumulate throughout the active sports career, and thus can cause measurable deficits and changes to brain health. Emerging research in the area of cumulative sub-concussions in contact sports has revealed several associated markers of brain injury. For example, recent studies discovered that repeated headers in soccer not only cause measurable signs of cognitive impairment but are also related to a prolonged cortical silent period in transcranial magnetic stimulation measurements. Other cognitive and neuroimaging biomarkers are also pointing to adverse effects of heading. A range of fluid biomarkers completes the picture of cumulating effects of sub-concussive impacts. Those accumulating effects can cause significant cognitive impairment later in life of active contact sportswomen and men. The aim of this review is to highlight the current scientific evidence on the effects of repeated sub-concussive head impacts on contact sports athletes' brains, identify the areas in need of further investigation, highlight the potential of advanced neuroscientific methods, and comment on the steps governing bodies have made to address this issue. We conclude that there are indeed neural and biofluid markers that can help better understand the effects of repeated sub-concussive head impacts and that some aspects of contact sports should be redefined, especially in situations where sub-concussive impacts and concussions can be minimized.

The Reliability of Transcranial Magnetic Stimulation-Derived Corticomotor Inhibition as a Brain Health Evaluation Tool in Soccer Players.

BACKGROUND: The suitability of corticomotor inhibition and corticospinal excitability to measure brain health outcomes and recovery of sport-related head impact (concussion and subconcussion) depends on good inter-day reliability, which is evaluated in this study. Transcranial magnetic stimulation (TMS) reliability in soccer players is assessed by comparing soccer players, for whom reliability on this measure may be reduced due to exposure to head impacts, to generally active individuals not engaged in contact sport. METHODS: TMS-derived corticomotor inhibition and corticospinal excitability were recorded from the rectus femoris muscle during two testing sessions, spaced 1-2 weeks apart in 19 soccer players (SOC-age 22 ± 3 years) and 20 generally active (CON-age 24 ± 4 years) healthy volunteers. Inter-day reliability between the two time points was quantified by using intra-class correlation coefficients (ICC). Intra-group reliability and group differences on actual measurement values were also explored. RESULTS: Good inter-day reliability was evident for corticomotor inhibition (ICCSOC = 0.61; ICCCON = 0.70) and corticospinal excitability (ICCSOC = 0.59; ICCCON = 0.70) in both generally active individuals and soccer players routinely exposed to sport-related head impacts. Corticomotor inhibition showed lower coefficients of variation than excitability for both groups (InhibSOC = 15.2%; InhibCON = 9.7%; ExcitabSOC = 41.6%; ExcitabCON = 39.5%). No group differences between soccer players and generally active individuals were found on the corticomotor inhibition value (p > 0.05), but levels of corticospinal excitability were significantly lower in soccer players (45.1 ± 20.8 vs 85.4 ± 6.2%Mmax, p < 0.0001). Corticomotor inhibition also showed excellent inter-rater reliability (ICC = 0.87). CONCLUSIONS: Corticomotor inhibition and corticospinal excitability are stable and maintain good degrees of reliability when assessed over different days in soccer players, despite their routine exposure to head impacts. However, based on intra-group reliability and group differences of the levels of excitability, we conclude that corticomotor inhibition is best suited for the evaluation of neuromuscular alterations associated with head impacts in contact sports.

Effects of sport-related repetitive subconcussive head impacts on biofluid markers: a scoping review protocol.

INTRODUCTION: Sport-related repetitive subconcussive head impacts (RSHIs) are increasingly thought to be associated with adverse long-term outcomes. However, owing to potentially subtle effects, accurate assessment of harm to the brain as a consequence of RSHI is a major challenge and an unmet need. Several studies suggest that biofluid markers can be valuable objective tools to aid the diagnosis and injury characterisation and help in medical decision-making. Still, by and large, the results have been limited, heterogeneous and inconsistent. The main aims of this scoping review are therefore (1) to systematically examine the extent, nature and quality of available evidence from studies investigating effects of RSHI on fluid biomarkers and (2) to formulate guidelines and identify gaps with the aim to inform future clinical studies and the development of research priorities. METHODS AND ANALYSES: We will use a comprehensive search strategy to retrieve all available and relevant articles in the literature. The following electronic databases will be systematically searched: MEDLINE (EBSCO host; from 1809 to 2020); Scopus (from 1788 to 2020); SPORTDiscus (from 1892 to 2020); CINAHL Complete (from 1937 to 2020); PsycINFO (from 1887 to 2020); Cochrane Library (to 2020); OpenGrey (to 2020); ClinicalTrials.gov (to 2020) and WHO International Clinical Trials Registry Platform (to 2020). We will consider primarily biomedical studies evaluating the biofluid markers following RSHI. Two independent reviewers will screen articles for inclusion using predefined eligibility criteria and extract data of retained articles. Disagreements will be resolved through consensus or arbitrated by a third reviewer if necessary. Data will be reported qualitatively given the heterogeneity of the included studies. In synthesising the evidence, we will structure results by markers, sample types, outcomes, sport and timepoints. ETHICS AND DISSEMINATION: Ethics approval is not required. We will submit results for peer-review publication, and present at relevant conferences.

Mobile EEG reveals functionally dissociable dynamic processes supporting real-world ambulatory obstacle avoidance: Evidence for early proactive control.

The ability to safely negotiate the world on foot takes humans years to develop, reflecting the extensive cognitive demands associated with real-time planning and control of walking. Despite the importance of walking, methodological limitations mean that surprisingly little is known about the neural and cognitive processes that support ambulatory motor control. Here, we report mobile EEG data recorded from 32 healthy young adults during real-world ambulatory obstacle avoidance. Participants walked along a path while stepping over expected and unexpected obstacles projected on the floor, allowing us to capture the dynamic oscillatory response to changes in environmental demands. Compared to obstacle-free walking, time-frequency analysis of the EEG data revealed clear neural markers of proactive and reactive forms of movement control (occurring before and after crossing an obstacle), visible as increases in frontal theta and centro-parietal beta power respectively. Critically, the temporal profile of changes in frontal theta allowed us to arbitrate between early selection and late adaptation mechanisms of proactive control. Our data show that motor plans are updated as soon as an upcoming obstacle appears, rather than when the obstacle is reached. In addition, regardless of whether motor plans required updating, a clear beta rebound was present after obstacles were crossed, reflecting the resetting of the motor system. Overall, mobile EEG recorded during real-world walking provides novel insight into the cognitive and neural basis of dynamic motor control in humans, suggesting new routes to the monitoring and rehabilitation of motor disorders such as dyspraxia and Parkinson's disease.

Mobile EEG identifies the re-allocation of attention during real-world activity.

The distribution of attention between competing processing demands can have dramatic real-world consequences, however little is known about how limited attentional resources are distributed during real-world behaviour. Here we employ mobile EEG to characterise the allocation of attention across multiple sensory-cognitive processing demands during naturalistic movement. We used a neural marker of attention, the Event-Related Potential (ERP) P300 effect, to show that attention to targets is reduced when human participants walk compared to when they stand still. In a second experiment, we show that this reduction in attention is not caused by the act of walking per se. A third experiment identified the independent processing demands driving reduced attention to target stimuli during motion. ERP data reveals that the reduction in attention seen during walking reflects the linear and additive sum of the processing demands produced by visual and inertial stimulation. The mobile cognition approach used here shows how limited resources are precisely re-allocated according to the sensory processing demands that occur during real-world behaviour.

Understanding the Consequences of Repetitive Subconcussive Head Impacts in Sport: Brain Changes and Dampened Motor Control Are Seen After Boxing Practice.

OBJECTIVES: The potential effects of exposure to repetitive subconcussive head impacts through routine participation in sport are not understood. To investigate the effects of repetitive subconcussive head impacts we studied boxers following customary training (sparring) using transcranial magnetic stimulation (TMS), decomposition electromyographic (EMG) and tests of memory. METHODS: Twenty amateur boxers performed three 3-min sparring bouts. Parameters of brain function and motor control were assessed prior to sparring and again immediately, 1 h and 24 h post-sparring. Twenty control participants were assessed following mock-sparring. RESULTS: One hour after sparring boxers showed increased corticomotor inhibition, altered motor unit recruitment strategies, and decreased memory performance relative to controls, with values returning to baseline by the 24 h follow up. CONCLUSION: Repetitive subconcussive head impacts associated with sparring resulted in acute and transient brain changes similar to those previously reported in soccer heading, providing convergent evidence that sport-related head impacts produce a GABAergic response. These acute changes in brain health are reminiscent of effects seen following brain injury, and suggest a potential mechanism underlying the damaging long-term effects of routine repetitive head impacts in sport.

Weight and see: Line bisection in neglect reliably measures the allocation of attention, but not the perception of length.

Line bisection has long been a routine test for unilateral neglect, along with a range of tests requiring cancellation, copying or drawing. However, several studies have reported that line bisection, as classically administered, correlates relatively poorly with the other tests of neglect, to the extent that some authors have questioned its status as a valid test of neglect. In this article, we re-examine this issue, employing a novel method for administering and analysing line bisection proposed by McIntosh et al. (2005). We report that the measure of attentional bias yielded by this new method (EWB) correlates significantly more highly with cancellation, copying and drawing measures than the classical line bisection error measure in a sample of 50 right-brain damaged patients. Furthermore when EWB was combined with a second measure that emerges from the new analysis (EWS), even higher correlations were obtained. A Principal Components Analysis found that EWB loaded highly on a major factor representing neglect asymmetry, while EWS loaded on a second factor which we propose may measure overall attentional investment. Finally, we found that tests of horizontal length and size perception were related poorly to other measures of neglect in our group. We conclude that this novel approach to interpreting line bisection behaviour provides a promising way forward for understanding the nature of neglect.

Dissociation between Semantic Representations for Motion and Action Verbs: Evidence from Patients with Left Hemisphere Lesions.

This multiple single case study contrasted left hemisphere stroke patients (N = 6) to healthy age-matched control participants (N = 15) on their understanding of action (e.g., holding, clenching) and motion verbs (e.g., crumbling, flowing). The tasks required participants to correctly identify the matching verb or associated picture. Dissociations on action and motion verb content depending on lesion site were expected. As predicted for verbs containing an action and/or motion content, modified t-tests confirmed selective deficits in processing motion verbs in patients with lesions involving posterior parietal and lateral occipitotemporal cortex. In contrast, deficits in verbs describing motionless actions were found in patients with more anterior lesions sparing posterior parietal and lateral occipitotemporal cortex. These findings support the hypotheses that semantic representations for action and motion are behaviorally and neuro-anatomically dissociable. The findings clarify the differential and critical role of perceptual and motor regions in processing modality-specific semantic knowledge as opposed to a supportive but not necessary role. We contextualize these results within theories from both cognitive psychology and cognitive neuroscience that make claims over the role of sensory and motor information in semantic representation.

Evidence for Acute Electrophysiological and Cognitive Changes Following Routine Soccer Heading.

INTRODUCTION: There is growing concern around the effects of concussion and sub-concussive impacts in sport. Routine game-play in soccer involves intentional and repeated head impacts through ball heading. Although heading is frequently cited as a risk to brain health, little data exist regarding the consequences of this activity. This study aims to assess the immediate outcomes of routine football heading using direct and sensitive measures of brain function. METHODS: Nineteen amateur football players (5 females; age 22±3y) headed machine-projected soccer balls at standardized speeds, modelling routine soccer practice. The primary outcome measure of corticomotor inhibition measured using transcranial magnetic stimulation, was assessed prior to heading and repeated immediately, 24h, 48h and 2weeks post-heading. Secondary outcome measures were cortical excitability, postural control, and cognitive function. RESULTS: Immediately following heading an increase in corticomotor inhibition was detected; further to these electrophysiological alterations, measurable reduction memory function were also found. These acute changes appear transient, with values normalizing 24h post-heading. DISCUSSION: Sub-concussive head impacts routine in soccer heading are associated with immediate, measurable electrophysiological and cognitive impairments. Although these changes in brain function were transient, these effects may signal direct consequences of routine soccer heading on (long-term) brain health which requires further study.

Perceptual decisions regarding object manipulation are selectively impaired in apraxia or when tDCS is applied over the left IPL.

This study evaluated whether apraxia can be understood as due to impaired motor representations or motor imagery necessary for appropriate object-use, imitation, and pantomime. The causal role of the left inferior parietal lobe (IPL), which is heavily implicated in apraxia, is also evaluated. These processes are appraised in light of the proposed ventro-dorsal sub-stream of the classic two visual pathway model, where perceptual information from the ventral stream and the dorsal action stream are integrated and essential for object manipulation. Using a task assessing object-use perception, stroke patients with apraxia demonstrated a selective deficit during perceptual decisions reliant on the integration of visible and known object properties to select the appropriate grasp for object-use. This deficit increased with apraxia severity. A dissociation was evident in these patients showing intact non-motoric perceptual decisions regarding the functional semantic relationship between two objects in the absence of the actor (e.g. how a hammer hits a nail). Converging evidence was found using a modified version of the same task in a neuromodulation study that directly targeted the left IPL in healthy participants using transcranial direct current stimulation (tDCS). Application of inhibitory stimulation over the left IPL reduced performance during perceptual decisions regarding object manipulation whilst performance was unaffected during functional semantic decisions. Excitatory stimulation of the left IPL did not affect performance in either task. Combined, these results suggest that the left inferior parietal lobe is critical for motor imagery, and that apraxia may be caused by an inability to use internal motor representations of object manipulation. These results are discussed in terms of motoric and non-motoric perceptual processes and the proposal of an additional ventro-dorsal sub-stream within the dorsal and ventral visual pathways model.

Impaired Communication Between the Dorsal and Ventral Stream: Indications from Apraxia.

Patients with apraxia perform poorly when demonstrating how an object is used, particularly when pantomiming the action. However, these patients are able to accurately identify, and to pick up and move objects, demonstrating intact ventral and dorsal stream visuomotor processing. Appropriate object manipulation for skilled use is thought to rely on integration of known and visible object properties associated with "ventro-dorsal" stream neural processes. In apraxia, it has been suggested that stored object knowledge from the ventral stream may be less readily available to incorporate into the action plan, leading to an over-reliance on the objects' visual affordances in object-directed motor behavior. The current study examined grasping performance in left hemisphere stroke patients with (N = 3) and without (N = 9) apraxia, and in age-matched healthy control participants (N = 14), where participants repeatedly grasped novel cylindrical objects of varying weight distribution. Across two conditions, object weight distribution was indicated by either a memory-associated cue (object color) or visual-spatial cue (visible dot over the weighted end). Participants were required to incorporate object-weight associations to effectively grasp and balance each object. Control groups appropriately adjusted their grasp according to each object's weight distribution across each condition, whereas throughout the task two of the three apraxic patients performed poorly on both the memory-associated and visual-spatial cue conditions. A third apraxic patient seemed to compensate for these difficulties but still performed differently to control groups. Patients with apraxia performed normally on the neutral control condition when grasping the evenly weighted version. The pattern of behavior in apraxic patients suggests impaired integration of visible and known object properties attributed to the ventro-dorsal stream: in learning to grasp the weighted object accurately, apraxic patients applied neither pure knowledge-based information (the memory-associated condition) nor higher-level information given in the visual-spatial cue condition. Disruption to ventro-dorsal stream predicts that apraxic patients will have difficulty learning to manipulate new objects on the basis of information other than low-level visual cues such as shape and size.

Understanding Minds in Real-World Environments: Toward a Mobile Cognition Approach.

There is a growing body of evidence that important aspects of human cognition have been marginalized, or overlooked, by traditional cognitive science. In particular, the use of laboratory-based experiments in which stimuli are artificial, and response options are fixed, inevitably results in findings that are less ecologically valid in relation to real-world behavior. In the present review we highlight the opportunities provided by a range of new mobile technologies that allow traditionally lab-bound measurements to now be collected during natural interactions with the world. We begin by outlining the theoretical support that mobile approaches receive from the development of embodied accounts of cognition, and we review the widening evidence that illustrates the importance of examining cognitive processes in their context. As we acknowledge, in practice, the development of mobile approaches brings with it fresh challenges, and will undoubtedly require innovation in paradigm design and analysis. If successful, however, the mobile cognition approach will offer novel insights in a range of areas, including understanding the cognitive processes underlying navigation through space and the role of attention during natural behavior. We argue that the development of real-world mobile cognition offers both increased ecological validity, and the opportunity to examine the interactions between perception, cognition and action-rather than examining each in isolation.

Representational content of occipitotemporal and parietal tool areas.

It is now established that the perception of tools engages a left-lateralized network of frontoparietal and occipitotemporal cortical regions. Nevertheless, the precise computational role played by these areas is not yet well understood. To address this question, we used functional MRI to investigate the distribution of responses to pictures of tools and hands relative to other object categories in the so-called "tool" areas. Although hands and tools are visually not alike and belong to different object categories, these are both functionally linked when considering the common role of hands and tools in object manipulation. This distinction can provide insight into the differential functional role of areas within the "tool" network. Results demonstrated that images of hands and tools activate a common network of brain areas in the left intraparietal sulcus (IPS), left lateral occipitotemporal cortex (LOTC) and ventral occipitotemporal cortex (VOTC). Importantly, multivoxel pattern analysis revealed that the distribution of hand and tool response patterns in these regions differs. These observations provide support for the idea that the left IPS, left LOTC and VOTC might have distinct computational roles with regard to tool use. Specifically, these results suggest that while left IPS supports tool action-related computations and VOTC primarily encodes category specific aspects of objects, left LOTC bridges ventro occipitotemporal perception-related and parietal action-related representations by encoding both types of object information.