A Comparison of Mental Workload in Individuals with Transtibial and Transfemoral Lower Limb Loss during Dual-Task Walking under Varying Demand.

OBJECTIVES: This study aimed to evaluate the influence of lower limb loss (LL) on mental workload by assessing neurocognitive measures in individuals with unilateral transtibial (TT) versus those with transfemoral (TF) LL while dual-task walking under varying cognitive demand. METHODS: Electroencephalography (EEG) was recorded as participants performed a task of varying cognitive demand while being seated or walking (i.e., varying physical demand). RESULTS: The findings revealed both groups of participants (TT LL vs. TF LL) exhibited a similar EEG theta synchrony response as either the cognitive or the physical demand increased. Also, while individuals with TT LL maintained similar performance on the cognitive task during seated and walking conditions, those with TF LL exhibited performance decrements (slower response times) on the cognitive task during the walking in comparison to the seated conditions. Furthermore, those with TF LL neither exhibited regional differences in EEG low-alpha power while walking, nor EEG high-alpha desynchrony as a function of cognitive task difficulty while walking. This lack of alpha modulation coincided with no elevation of theta/alpha ratio power as a function of cognitive task difficulty in the TF LL group. CONCLUSIONS: This work suggests that both groups share some common but also different neurocognitive features during dual-task walking. Although all participants were able to recruit neural mechanisms critical for the maintenance of cognitive-motor performance under elevated cognitive or physical demands, the observed differences indicate that walking with a prosthesis, while concurrently performing a cognitive task, imposes additional cognitive demand in individuals with more proximal levels of amputation.

Biomechanical and neurocognitive performance outcomes of walking with transtibial limb loss while challenged by a concurrent task.

Individuals who have sustained loss of a lower limb may require adaptations in sensorimotor and control systems to effectively utilize a prosthesis, and the interaction of these systems during walking is not clearly understood for this patient population. The aim of this study was to concurrently evaluate temporospatial gait mechanics and cortical dynamics in a population with and without unilateral transtibial limb loss (TT). Utilizing motion capture and electroencephalography, these outcomes were simultaneously collected while participants with and without TT completed a concurrent task of varying difficulty (low- and high-demand) while seated and walking. All participants demonstrated a wider base of support and more stable gait pattern when walking and completing the high-demand concurrent task. The cortical dynamics were similarly modulated by the task demand for both groups, to include a decrease in the novelty-P3 component and increase in the frontal theta/parietal alpha ratio power when completing the high-demand task, although specific differences were also observed. These findings confirm and extend prior efforts indicating that dual-task walking can negatively affect walking mechanics and/or neurocognitive performance. However, there may be limited additional cognitive and/or biomechanical impact of utilizing a prosthesis in a stable, protected environment in TT who have acclimated to ambulating with a prosthesis. These results highlight the need for future work to evaluate interactions between these cognitive-motor control systems for individuals with more proximal levels of lower limb loss, and in more challenging (ecologically valid) environments.

Cerebral cortical networking for mental workload assessment under various demands during dual-task walking.

While several studies have examined attentional reserve (via event-related potentials) and mental effort (via EEG spectral content) from various cortical regions during dual-task walking, none have assessed changes in the magnitude of interregional (cortico-cortical) communication as a measure of mental workload. Therefore, by deploying a traditional montage of electrode sites centered over the motor planning region as well as a more comprehensive graph theory-based approach encompassing the entire scalp, this study aimed to systematically examine changes in the magnitude of functional connectivity underlying cortico-cortical communication to assess changes in mental workload under various levels of challenge. Specifically, the Weighted Phase Lag Index (WPLI) was computed to assess the changes in magnitude of functional connectivity as participants performed a cognitive task under two demands (low and high) and two conditions (seated and walking). The results revealed enhanced fronto-centro-temporo-parietal theta connectivity during dual-task walking relative to being seated as well as a reduced inhibition of fronto-centro-temporo-parieto-occipital alpha networking as the demand on the secondary cognitive task increased. Collectively, these findings may reflect greater recruitment of task relevant processes to respond to increased cognitive-motor demands and thus an elevation of mental workload in an effort to maintain performance under varying levels of challenge. This work has the potential to inform future mental workload assessment applications in patient populations, including those who employ prostheses during cognitive-motor performance under various task demands.

Cerebral peak alpha frequency predicts individual differences in pain sensitivity.

The identification of neurobiological markers that predict individual predisposition to pain are not only important for development of effective pain treatments, but would also yield a more complete understanding of how pain is implemented in the brain. In the current study using electroencephalography (EEG), we investigated the relationship between the peak frequency of alpha activity over sensorimotor cortex and pain intensity during capsaicin-heat pain (C-HP), a prolonged pain model known to induce spinal central sensitization in primates. We found that peak alpha frequency (PAF) recorded during a pain-free period preceding the induction of prolonged pain correlated with subsequent pain intensity reports: slower peak frequency at pain-free state was associated with higher pain during the prolonged pain condition. Moreover, the degree to which PAF decreased between pain-free and prolonged pain states was correlated with pain intensity. These two metrics were statistically uncorrelated and in combination were able to account for 50% of the variability in pain intensity. Altogether, our findings suggest that pain-free state PAF over relevant sensory systems could serve as a marker of individual predisposition to prolonged pain. Moreover, slowing of PAF in response to prolonged pain could represent an objective marker for subjective pain intensity. Our findings potentially lead the way for investigations in clinical populations in which alpha oscillations and the brain areas contributing to their generation are used in identifying and formulating treatment strategies for patients more likely to develop chronic pain.

Determining Levels of Upper Extremity Movement Impairment by Applying a Cluster Analysis to the Fugl-Meyer Assessment of the Upper Extremity in Chronic Stroke.

OBJECTIVE: To quantitatively determine levels of upper extremity movement impairment by using a cluster analysis of the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) with and without reflex items. DESIGN: Secondary analysis. SETTING: University and research centers. PARTICIPANTS: Individuals (N=247) with chronic stroke (>6mo poststroke). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cutoff scores defined by FMA-UE total scores of clusters identified by 2 hierarchical cluster analyses performed on the full sample of FMA-UE individual item scores (with and without reflexes). Patterns of motor function defined by aggregate item scores of clusters. RESULTS: FMA-UE scores ranged from 2 to 63 (mean, 26.9±15.7) with reflex items and from 0 to 57 (mean, 22.1±15.3) without reflex items. Three clusters were identified. The distributions of the FMA-UE scores revealed considerable overlap between the clusters; therefore, 4 distinct stroke impairment levels were derived. CONCLUSIONS: For chronic stroke, the cluster analysis of the FMA-UE supports either a 3- or a 4-impairment level classification scheme.

Measurement of attentional reserve and mental effort for cognitive workload assessment under various task demands during dual-task walking.

Previous work focused on cognitive workload assessment suggests EEG spectral content and component amplitudes of the event-related potential (ERP) waveform may index mental effort and attentional reserve, respectively. Although few studies have assessed attentional reserve and mental effort during upper-extremity performance, none have employed a combined approach to measure cognitive workload during locomotion. Therefore, by systematically considering ERPs, spectral content and importantly their combination, this study aimed to examine whether concurrent changes in spectral content and ERPs could collectively serve as an index of cognitive workload during locomotion. Specifically, ERP and EEG biomarkers were assessed as participants performed a cognitive task under two levels of difficulty (easy or hard) and two conditions (seated or walking). Changes in attentional reserve and mental effort appeared to collectively index cognitive workload under varying demands due to changes in task difficulty or performance conditions. This work can inform cognitive workload assessment in patient populations with gait deficiencies for future applications.

Combined assessment of attentional reserve and cognitive-motor effort under various levels of challenge with a dry EEG system.

A novel ERP approach was proposed to index variations in mental workload, particularly in attentional reserve, which is complementary to EEG spectral content thought to reflect mental effort. To our knowledge, no study has assessed mental effort and attentional reserve simultaneously in EEG gel-based and, importantly, dry systems, which are particularly well suited for real-world settings. Therefore, by systematically considering ERP, EEG spectral, and importantly the combination of both, this study examined if a small set of dry EEG electrodes could detect changes in both spectral and ERP metrics to assess the mental workload under various challenges with a similar fidelity to their gel-based counterparts in a laboratory setting. By employing both EEG gel-based and dry systems, the ERP and spectral markers were computed while participants executed a visuomotor task under three levels of challenge. For both EEG systems, more challenging levels of difficulty were associated with concomitant changes in ERP amplitude, and spectral power reflected a reduction of the attentional reserve and an increase in cognitive-motor effort, respectively. Those variations in attentional reserve and cognitive-motor effort collectively indexed mental workload with nearly identical fidelity for both gel-based and dry EEG systems. These findings promise to assess the mental workload in situations where the use of dry EEG systems could be advantageously employed to examine human cognitive-motor performance.

Empirical evidence for the relationship between cognitive workload and attentional reserve.

While the concepts of cognitive workload and attentional reserve have been thought to have an inverse relationship for some time, such a relationship has never been empirically tested. This was the purpose of the present study. Aspects of the electroencephalogram were used to assess both cognitive workload and attentional reserve. Specifically, spectral measures of cortical activation were used to assess cognitive workload, while amplitudes of the event-related potential from the presentation of unattended "novel" sounds were used to assess attentional reserve. The relationship between these two families of measures was assessed using canonical correlation. Twenty-seven participants performed a flight simulator task under three levels of challenge. Verification of manipulation was performed using self-report measures of task demand, objective task performance, and heart rate variability using electrocardiography. Results revealed a strong, negative relationship between the spectral measures of cortical activation, believed to be representative of cognitive workload, and ERP amplitudes, believed to be representative of attentional reserve. This finding provides support for the theoretical and intuitive notion that cognitive workload and attentional reserve are inversely related. The practical implications of this result include improved state classification using advanced machine learning techniques, enhanced personnel selection/recruitment/placement, and augmented learning/training.

The efficacy of auditory probes in indexing cognitive workload is dependent on stimulus complexity.

We examined whether the utility of a recently developed auditory probe technique for indexing cognitive workload was dependent on the stimulus properties of the probes. EEG was recorded while participants played a videogame under various levels of cognitive workload. At each level of workload, participants were probed with one of four different types of auditory stimuli: novel complex, repeated complex, novel simple, or repeated simple sounds. Probe efficacy at indexing cognitive workload was assessed by determining which probes elicited ERP components that decreased monotonically as a function of workload. Results suggest that complex auditory stimuli were significantly more effective in indexing cognitive workload than simple stimuli. The efficacy of complex stimuli was due to their ability to elicit a robust orienting response, indexed by the early P3a component of the ERP, which decreased monotonically as a function of cognitive workload.

Cerebral cortical activity associated with non-experts' most accurate motor performance.

This study's specific aim was to determine if non-experts' most accurate motor performance is associated with verbal-analytic- and working memory-related cerebral cortical activity during motor preparation. To assess this, EEG was recorded from non-expert golfers executing putts; EEG spectral power and coherence were calculated for the epoch preceding putt execution; and spectral power and coherence for the five most accurate putts were contrasted with that for the five least accurate. Results revealed marked power in the theta frequency bandwidth at all cerebral cortical regions for the most accurate putts relative to the least accurate, and considerable power in the low-beta frequency bandwidth at the left temporal region for the most accurate compared to the least. As theta power is associated with working memory and low-beta power at the left temporal region with verbal analysis, results suggest non-experts' most accurate motor performance is associated with verbal-analytic- and working memory-related cerebral cortical activity during motor preparation.

Increased reward in ankle robotics training enhances motor control and cortical efficiency in stroke.

Robotics is rapidly emerging as a viable approach to enhance motor recovery after disabling stroke. Current principles of cognitive motor learning recognize a positive relationship between reward and motor learning. Yet no prior studies have established explicitly whether reward improves the rate or efficacy of robotics-assisted rehabilitation or produces neurophysiologic adaptations associated with motor learning. We conducted a 3 wk, 9-session clinical pilot with 10 people with chronic hemiparetic stroke, randomly assigned to train with an impedance-controlled ankle robot (anklebot) under either high reward (HR) or low reward conditions. The 1 h training sessions entailed playing a seated video game by moving the paretic ankle to hit moving onscreen targets with the anklebot only providing assistance as needed. Assessments included paretic ankle motor control, learning curves, electroencephalograpy (EEG) coherence and spectral power during unassisted trials, and gait function. While both groups exhibited changes in EEG, the HR group had faster learning curves (p = 0.05), smoother movements (p

Psychophysiological support of increasing attentional reserve during the development of a motor skill.

The aim of this study was to determine the relationship between motor skill and attentional reserve. Participants practiced a reaching task with the dominant upper extremity, to which a distortion of the visual feedback was applied, while a control group performed the same task without distortion. Event-related brain potentials (ERPs), elicited by auditory stimuli were recorded throughout practice. Performance, as measured by initial directional error, was initially worse relative to controls and improved over trials. Analyses of the ERPs revealed that exogenous components, N1 and P2, were undifferentiated between the groups and did not change with practice. Notably, amplitude of the novelty P3 component, an index of the involuntary orienting of attention, was initially attenuated relative to controls, but progressively increased in amplitude over trials in the learning group only. The results provide psychophysiological evidence that attentional reserve increases as a function of motor skill acquisition.

Brain biomarkers based assessment of cognitive workload in pilots under various task demands.

Cognitive workload is an important element of cognitive-motor performance such as that exhibited during the piloting of an aircraft. Namely, an increase in task demands on the pilot can elevate cognitive information processing and, thus, the risk of human error. As such, there is a need to develop methods that reliably assess mental workload in pilots within operational settings. The present study contributes to this research goal by identifying physiological and brain biomarkers of cognitive workload and attentional reserve during a simulated aircraft piloting task under three progressive levels of challenge. A newly developed experimental method was employed by which electroencephalography (EEG) was acquired via a dry (i.e., gel-free sensors) system using few scalp sites. Self-reported responses to surveys and piloting performance indicators were analyzed. The findings revealed that as the challenge (task demands) increased, the perceived mental load increased, attentional reserve was attenuated, and task performance decreased. Such an increase in task demands was also reflected by changes in heart rate variability (HRV), as well as in the amplitude of the P300 component of event-related potentials to auditory probes, and in the spectral power of specific EEG frequency bands. This work provides a first step towards a long-term goal to develop a composite system of biomarkers for real-time cognitive workload assessment and state assessment of pilots in operational settings.

Stress, emotion regulation and cognitive performance: the predictive contributions of trait and state relative frontal EEG alpha asymmetry.

The relationship between trait and state measures of frontal lobe EEG alpha-band asymmetry in regard to indexing the approach-withdrawal dimension of emotion is unclear. The comparative predictive power of these constructs to explain emotion regulation and cognitive performance was examined under varying degrees of emotional challenge. The Capability Model posits the neural underpinnings of the relative difference in electrical activity between the left and right frontal lobes as a situational mechanism possibly indexing prefrontal-amygdalar interactions and psychological state. EEG, skin conductance, heart rate and acoustic startle amplitude were collected during a working memory task under three increasing levels of stress (final level was threat of shock). During threat of shock participants with higher state asymmetry exhibited greater emotion regulation compared to those with lower scores as indexed by significant attenuation of eyeblink startle magnitudes. The trait measure of frontal EEG asymmetry failed to account for significant variability in emotion regulation. Results implicate state-specific relative left frontal lobe activity as having an adaptive role in the regulation of emotion during cognitive challenge, but only under conditions of sufficient stress.

The influence of social evaluation on cerebral cortical activity and motor performance: a study of "Real-Life" competition.

Motor performance in a social evaluative environment was examined in participants (N = 19) who completed a pistol shooting task under both performance-alone (PA) and competitive (C) conditions. Electroencephalographic (EEG), autonomic, and psychoendocrine activity were recorded in addition to kinematic measures of the aiming behavior. State anxiety, heart rate, and cortisol were modestly elevated during C and accompanied by relative desynchrony of high-alpha power, increased cortico-cortical communication between motor and non-motor regions, and degradation of the fluency of aiming trajectory, but maintenance of performance outcome (i.e., score). The findings reveal that performance in a complex social-evaluative environment characterized by competition results in elevated cortical activity beyond that essentially required for motor performance that translated as less efficient motor behavior.

Cerebral-cortical networking and activation increase as a function of cognitive-motor task difficulty.

Excessive increases in task difficulty typically result in marked attenuation of cognitive-motor performance. The psychomotor efficiency hypothesis suggests that poor performance is mediated by non-essential neural activity and cerebral cortical networking (inefficient cortical dynamics). This phenomenon may underlie the inverse relationship between excessive task difficulty and performance. However, investigation of the psychomotor efficiency hypothesis as it relates to task difficulty has not been conducted. The present study used electroencephalography (EEG) to examine cerebral cortical dynamics while participants were challenged with both Easy and Hard conditions during a cognitive-motor task (Tetris(®)). In accord with the psychomotor efficiency hypothesis, it was predicted that with increases in task difficulty, participants would demonstrate greater 'neural effort,' as indexed by EEG spectral power and cortical networking (i.e., EEG coherence) between the premotor (motor planning) region and sensory, executive, and motor regions. Increases in neural activation and cortical networking were observed during the Hard condition relative to the Easy condition, thus supporting the psychomotor efficiency hypothesis. To further determine the unique contributions of cognitive versus sensory-motor demands, a control experiment was conducted in which cognitive demand was increased while sensory-motor demand was held constant. This experiment revealed that regionally specific neural activation was influenced by changes in cognitive demand, whereas cortical networking to the motor planning region was sensitive only to changes in sensory-motor demand. Crucially, the present study is the first, to our knowledge, to characterize the separate impact of cognitive versus sensory-motor demands on cerebral cortical dynamics. The findings further inform the dynamics of the cortical processes that underlie the quality of cognitive-motor performance particularly with regard to task difficulty. A broader understanding of the brain and muscle interactions during varying levels of challenge may inform the design of effective training protocols aimed at optimizing cognitive-motor performance.

A novel approach to the physiological measurement of mental workload.

While performing a visuo-motor task under incrementally-varied levels of difficulty, individuals were probed with a variety of novel, task-irrelevant, auditory stimuli. To determine the effect of task load on cerebral-cortical processing of these stimuli, event-related potentials were recorded while participants performed the task. We found that N1, P2, P3 and late positive potential (LPP) component amplitudes were inversely related to task-difficulty. This suggests that a variant of the oddball paradigm - in which the stimulus stream comprises novel sounds - is capable of providing a reliable index of mental workload.

Cerebral cortical dynamics and the quality of motor behavior during social evaluative challenge.

To determine the influence of arousal on cerebral cortical dynamics and motor behavior, 58 channels of EEG were recorded in 13 college-age men (n=6) and women during an aiming task performed alone and in a social evaluation condition. Moderate arousal, as measured by heart rate, skin conductance, and self-reported mood, was induced during the social evaluation. In accord with the Yerkes-Dodson Hypothesis, which posits optimal performance during moderate arousal, improved performance (i.e., quality of the aiming trajectories) was observed. During social evaluation, changes in electroencephalogram dynamics included decreased coherence between the motor planning (Fz) and right temporal region (T4), increased coherence in the sensorimotor networks subserving the task, and increased local processing (gamma, 30-44 Hz) in the temporal regions. The results imply that moderate arousal promotes specific alterations in cortical dynamics that facilitate motor performance.

Evidence for a new late positive ERP component in an attended novelty oddball task.

In attended novelty oddball tasks, rare nontarget stimuli can elicit two late positive ERP components: P3a and P300. In passive oddball tasks, P300 is not elicited by these stimuli. In passive tasks, however, P3a is accompanied by another positive component, termed eP3a, which may have evaded detection in attended oddball tasks because of its spatiotemporal overlap with P300. To address this, temporal-spatial principal components analysis was used to quantify ERPs recorded in attended three-tone and novelty oddball tasks. As expected, novel stimuli elicited both P3a and P300. The analysis also identified a third component, evident in novelty ERPs as an inflection on the leading edge of P3a. This component has the same antecedent conditions as P3a, but is earlier and more centrally distributed. Its spatiotemporal characteristics suggest that it may be the eP3a component recently described in passive oddball tasks.

Changes in physical fitness parameters during a competitive field hockey season.

Competitive field hockey requires a substantial amount of muscular strength, speed, and cardiovascular endurance. It is unknown how these parameters of physical fitness change between preseason conditioning to postseason recovery. Therefore, Division III female field hockey athletes (n = 13) completed tests of muscular strength, body composition, and maximal oxygen uptake (Vo(2)max) during each phase of their season. Muscular strength was assessed using 1 repetition maximum (RM) leg and bench press tests. Body composition was assessed by anthropometry (skinfolds [SKF]), circumferences ([CC]), and bioelectrical impedance analysis (BIA). Incremental treadmill testing was administered to assess Vo(2)max. Vo(2)max was unchanged during the season, although a trend (p > 0.05) was shown for a higher Vo(2)max during and after the season vs. before the season. Upper- (10%) and lower-body strength (14%) decreased (p > 0.05) during the season. Percent body fat (%BF) from BIA, fat mass (FM) from CC, and body mass index (BMI) were significantly lower (p < 0.05) in-season and postseason vs. preseason. In conclusion, preseason training was effective in decreasing %BF and increasing Vo(2)max, yet muscular strength was lost. Coaches should incorporate more rigorous in-season resistance training to prevent strength decrements. Moreover, these data support the superior levels of muscular strength and leanness in these athletes compared with age-matched peers.