Influence of a distraction task on the involuntary reflex contraction of the pelvic floor muscles following cough.

AIMS: To explore the involvement of a distraction task in involuntary reflex pelvic floor muscle contraction following cough. METHODS: Informed consent was obtained from 33 healthy volunteers. Involuntary contraction of the external anal sphincter (EAS) was induced by means of coughing. Cough efforts were elicited by electronic order. The electromyographic (EMG) activity of the EAS was recorded during involuntary contraction elicited by coughing. The trials were carried out twice: combined (or not) with a mental distraction task; the paced auditory serial additional test (PASAT). Reaction time (RT) defined as latency between the stimulus and maximum EAS EMG activity (RT1), latency between the stimulus and external intercostal (EIC) muscle EMG activity (RT2), latency between EIC EMG activity and EAS EMG activity (RT3), duration of the contraction, and the area under the EAS EMG activity curve (perineal contraction) were measured. RESULTS: The distraction task altered anticipation of the PFM contraction: RT3 was -80.00 ms (IQR -107; -56) without the PASAT versus -56.67 ms (IQR: -94; -2) with the distraction task (ratio 0.71, P = 0.0045, Wilcoxon test). RT2 was altered during the distraction task: 583.33 ms (IQR: 344-775) without PASAT versus 652.71 ms (503-790) during PASAT (ratio 1.12, P = 0.031, Wilcoxon test). Finally, when the two conditions (respectively with and without the mental distraction task) were compared, there was a significant difference between the area under the EAS EMG activity curve (0.0115 mv sec vs. 0.0103 mv sec, ratio 0.90, P = 0.023). CONCLUSIONS: The mental distraction task altered involuntary reflex contraction of the pelvic floor muscles. Neurourol. Urodynam. 36:160-165, 2017. © 2015 Wiley Periodicals, Inc.

Influence of cognitive rehabilitation on pelvic floor muscle contraction: A randomized controlled trial.

AIM: Distraction task (DT), which led to a modification of voluntary and involuntary reflex pelvic floor muscle (PFM) activation, might potentiate urinary incontinence, through an alteration of the temporal course between intra-abdominal pressure and PFM contraction. We evaluated whether cognitive rehabilitation (dual-task method) could prevent the effect of a mental distraction task on the reaction time of PFM contraction. METHODS: Thirty-nine healthy volunteers underwent two sessions of electromyographic (EMG) PFM recordings separated by a 2-week interval. We recorded external anal sphincter EMG activity during voluntary and involuntary PFM contraction with and without a DT (Paced Auditory Serial Addition Task). Two main parameters were recorded: RT1 (latency between an order for PFM contraction and the onset of the external anal sphincter EMG activation during voluntary PFM contraction) and RT3 (latency between the onset of the involuntary external anal sphincter EMG activation and the onset of the external intercostal muscle EMG activation during involuntary PFM contraction). Volunteers were randomized (ratio 1:2) in two groups: dual task cognitive (an attentional test, the n-back test, and PFM exercises) rehabilitation program (n = 13) and control group (n = 26). The control group had no specific instructions and did not have to do PFM exercises. RESULTS: Concerning voluntary PFM contraction, following a 2-week interval, in the study group RT1 in DT conditions decreased from 461.11 ms [357.14-557.41] to 290.74 ms [262.96-308.88] (ratio 0.63, P = 0.0063). In the control group, RT1 in DT conditions was not significantly different. Concerning involuntary PFM contraction, in the study group RT3 without a DT increased from -68.52 ms [-107.40; -40] to -127.78 ms [-163.06; -93.33] (ratio 1.86, P = 0.0327). In DT conditions, in the study group RT3 increased from -42.59 ms [-52.09; -6.66] to -59.25 ms [-119.44; -44.44] (ratio 1.39, P = 0.0478). CONCLUSION: The alteration of the reaction time of PFM provoked by a distraction task can be prevented by specific cognitive rehabilitation.

Autism spectrum disorder phenotype and intellectual disability in females with epilepsy and PCDH-19 mutations.

INTRODUCTION: Autism features and various degrees of cognitive deficit are reported in patients with PCDH-19 mutations and epilepsy. Autism spectrum disorder (ASD) and, often, cognitive profile are usually assessed clinically. We studied autism phenotype and cognitive outcome in a series of patients using standardized tools for development and ASD. We aimed to describe the phenotype of ASD in this series and to understand whether ASD is strictly linked to intellectual disability (ID) or is present as a comorbidity. METHODS: Eight females aged 5 to 17years old with PCDH-19 mutations and epilepsy were recruited. For ASD diagnosis, the Autism Diagnostic Interview - Revised (ADI-R) and the Autism Diagnosis Observation Schedule (ADOS) were administered. Patients underwent a neuropsychological examination with tests measuring global intellectual efficiency (WPPSI-III and WISC-IV), language, and executive and social cognition abilities. Parental adaptive behavioral questionnaires were also obtained (VABS, CBCL, and BRIEF). RESULTS: Six out of eight patients presented with ASD and ID. Two patients had neither ASD nor ID, and both had the latest age of onset for their epilepsy. All cognitive functions were deficient, but theory-of-mind abilities compared to other cognitive features were even impaired. Features of ASD lacked major repetitive and stereotyped behaviors and show some differences with the classical ASD features related to ID. CONCLUSION: Our results show a large spectrum of ID and a very high rate of ASD in patients with epilepsy and PCDH-19 mutations. Autism spectrum disorder seems to be a genuine comorbidity, more than a consequence of ID. It highlights the importance of standardized psychiatric and cognitive evaluation in order to establish a tailored rehabilitation program.

Reading impairment in an adolescent with temporo-occipital epilepsy. Pre- and post-surgical evaluation.

We present a 16 year-old right-handed case who underwent a left temporo-occipital resection to treat intractable epilepsy. Pre- and post-surgical evaluations showed an average intellectual quotient, preserved abilities in language and visuo-spatial functions and increased reading and spelling deficits (difficulties with irregular words, homophones and phonologically valid spelling errors of irregularly spelled words, associated with preserved performances in non-words). This pattern of characteristic lexical route deficits highlights the major role of the temporo-occipital areas in reading acquisition. We discussed the consequences of temporo-occipital dysfunction on reading.

Need to void and attentional process interrelationships.

OBJECTIVES: To determine whether a strong urge to void could affect a person's attentional performance. To determine whether an attentional task could decrease a strong urge to void a prospective study was performed. SUBJECTS AND METHODS: Healthy adults were asked to perform two neuropsychological tests, the modified Paced Auditory Serial Addition Test (mPASAT) and the Psychology Experiment Building Language Continuous Performance Test (pCPT), under two different conditions: no need to void, and a strong urge to void defined by a score of >70/100 mm on a visual analogue scale. RESULTS: In all, 21 healthy volunteers were included. There was no statistical difference between the mPASAT scores from the two sessions (P = 0.57). The mean total error score of the pCPT increased with the individual's urge to void (P = 0.043). The mean omission score decreased, but was not statistically different (P = 0.129), the commission error score increased with the urge to void (P = 0.017), with a shorter reaction time for the inter-stimuli intervals of 1 (P<0.001) and 2 s (P = 0.036), suggesting a tendency to hurry. CONCLUSIONS: A strong urge to void can alter attentional performance, with a tendency to hurry, in healthy volunteers taking part in a sustained attention test pCPT involving the use of the anterior cingulate cortex.

Where are your body parts? A pure case of heterotopagnosia following left parietal stroke.

We studied the involvement of the parietal cortex in interpersonal body representation in a left parietal stroke patient. We used tasks assessing different types of body representations and localization of object parts. The patient performed normally on all tasks of body knowledge. However, she was unable to locate body parts on another person or on body representations. In contrast, she pointed correctly to the same body parts on herself or object representations. The data support the important role of the left parietal cortex in the transformation of intrinsic spatial coding of body parts localization in extrinsic body part coordinates.

A case of spatial neglect dysgraphia in Wilson's Disease.

We report here on a single neuropsychological case study of a young girl, KH, who presented with Wilson's Disease (WD) associated with a peripheral spatial neglect dysgraphia without major problems in the standard clinical tests of spatial neglect. Few studies have demonstrated a visuospatial deficit in WD and to date there has been no report of neglect syndrome arising from WD. However, recent studies have demonstrated that neglect is frequently associated with brain damage including the primary site of WD, the basal ganglia. KHs writing abilities were evaluated just after her admission to the rehabilitation department and 6 months later. The baseline evaluation demonstrated that KH had neglect dysgraphia with verbal stimuli (e.g., words or sentences) although her deficit was less evident in drawing multiple geometric shapes. Six months after the initial evaluation, KH showed evidence of neglect dysgraphia only when writing was associated with a secondary memory task. KHs writing performance is discussed with reference to previous cases of spatial neglect dysgraphia and in the context of spatial neglect. We suggest that the asymmetry between verbal writing and nonverbal drawing disturbances was caused by different attentional loads.

Internal model of gravity influences configural body processing.

Human bodies are processed by a configural processing mechanism. Evidence supporting this claim is the body inversion effect, in which inversion impairs recognition of bodies more than other objects. Biomechanical configuration, as well as both visual and embodied expertise, has been demonstrated to play an important role in this effect. Nevertheless, the important factor of body inversion effect may also be linked to gravity orientation since gravity is one of the most fundamental constraints of our biology, behavior, and perception on Earth. The visual presentation of an inverted body in a typical body inversion paradigm turns the observed body upside down but also inverts the implicit direction of visual gravity in the scene. The orientation of visual gravity is then in conflict with the direction of actual gravity and may influence configural processing. To test this hypothesis, we dissociated the orientations of the body and of visual gravity by manipulating body posture. In a pretest we showed that it was possible to turn an avatar upside down (inversion relative to retinal coordinates) without inverting the orientation of visual gravity when the avatar stands on his/her hands. We compared the inversion effect in typical conditions (with gravity conflict when the avatar is upside down) to the inversion effect in conditions with no conflict between visual and physical gravity. The results of our experiment revealed that the inversion effect, as measured by both error rate and reaction time, was strongly reduced when there was no gravity conflict. Our results suggest that when an observed body is upside down (inversion relative to participants' retinal coordinates) but the orientation of visual gravity is not, configural processing of bodies might still be possible. In this paper, we discuss the implications of an internal model of gravity in the configural processing of observed bodies.

Lexical-semantic body knowledge in 5- to 11-year-old children: How spatial body representation influences body semantics.

This study addresses the relation between lexico-semantic body knowledge (i.e., body semantics) and spatial body representation (i.e., structural body representation) by analyzing naming performances as a function of body structural topography. One hundred and forty-one children ranging from 5 years 2 months to 10 years 5 months old were asked to provide a lexical label for isolated body part pictures. We compared the children's naming performances according to the location of the body parts (body parts vs. head features and also upper vs. lower limbs) or to their involvement in motor skills (distal segments, joints, and broader body parts). The results showed that the children's naming performance was better for facial body parts than for other body parts. Furthermore, it was found that the naming of body parts was better for body parts related to action. These findings suggest that the development of a spatial body representation shapes the elaboration of semantic body representation processing. Moreover, this influence was not limited to younger children. In our discussion of these results, we focus on the important role of action in the development of body representations and semantic organization.

Postural control system influences intrinsic alerting state.

OBJECTIVE: Numerous studies using dual-task paradigms (postural and cognitive) have shown that postural control requires cognitive resources. However, the influence of postural control on attention components has never been directly addressed. METHOD: Using the attention network test (ANT), which assesses specifically each of the 3 components of attention-alertness, orientation, and executive control-within a single paradigm, we investigated the effect of postural balance demand on these 3 components. Forty-two participants completed the ANT in 3 postural conditions: (a) supine, a very stable position; (b) sitting on a chair, an intermediate position; and (c) standing with feet lined up heel to toe, a very instable position known as the Romberg position. RESULTS: Our results revealed that the difficulty of postural control does modulate alerting in such a way that it improves with the level of instability of the position. Regarding the orienting and executive control components of attention, performance was not different when participants were standing upright or seated, whereas in the supine position, performance dropped. CONCLUSIONS: The strong and specific interaction between postural control and the alerting system suggests that these mechanisms may share parts of the underlying neural circuits. We discuss the possible implication of the locus coeruleus, known to be involved in both postural balance and alerting. Also, our findings concerning orienting and executive control systems suggest that supine posture could have a specific effect on cognitive activities. These effects are discussed in terms of particularities resulting from the supine position.

Where are my hands? Influence of limb posture on tactile extinction.

OBJECTIVE: Tactile localization on the skin involves both a somatotopic and a postural schema (body-schema) representation. The present study determines the extent to which body posture influences tactile perception in right-brain-damaged patients. METHOD: In a first set of experiments, patients were asked to detect single tactile stimulation delivered to their left or right hands or to both hands simultaneously (double stimulation) in different arm postures. Only patients who had no difficulty localizing single and double tactile stimulations when their hands were placed in anatomic position were tested. Participant's hands were crossed, one over the other, and the tactile stimuli were delivered either to the hand (beyond the crossing point, Experiment 1) or to the forearm (before the crossing point, Experiment 2). In Experiment 3, the left hand was placed in the right hemispace and the right hand in the left hemispace without crossing over (opposite condition). In a second set of experiments, patients were asked to detect stimulation delivered to the forefinger. The fingers were crossed, one over the other at the level of the middle phalanx, and stimuli were delivered either beyond or before the crossing point. RESULTS: In all experimental conditions, control participants performed at ceiling. We observed a left-hand tactile extinction on double stimulation in the crossed condition. CONCLUSIONS: These results suggest that tactile stimuli can be encoded based on multiple specific body-part representations rather than on an integrated body-schema representation.

Attentional cueing effect in the identification of words and pseudowords of different length.

Three experiments studied the influence of spatial attention on familiar and unfamiliar letter string identification. Siéroff and Posner's (1988) cueing procedure was used: A cue indicated in advance either the beginning (left) or the end (right) of a foveally presented letter string that participants were instructed to read aloud. Results showed that the precue had a stronger influence on pseudoword than on word identification. Similar results were obtained when participants were instructed to report the identity of the cue or not. For pseudowords, a cueing effect was obtained regardless of length (6, 8, and 10 letters), whereas only 10-letter words showed such an effect, though to a lesser degree than pseudowords of the same length. However, results showed that shorter words were also influenced by the cue location when the exposure duration was reduced. Results are compatible with an early role of spatial attention in letter string processing, but they also suggest that the lexical status of a letter string can directly influence the distribution of attention before the identification process is completely achieved. Although orienting of spatial attention seems heavily involved in a pseudoword identification, some spatial attention mechanism could also take place in the case of familiar words. The results are discussed within two theoretical frameworks concerning the involvement of spatial attention in word identification: The "replacement" theory and the "redistribution" theory.

Effect of gaze orientation on tactilo-kinesthetic performance.

Twenty-two normal right-handed subjects indicated with their index finger the midpoint of a horizontal rod that they could not see. Subjects performed this task while directing their gaze either centrally or toward four different locations (5 degrees or 30 degrees to the left or to the right of the midline). Results showed an overall leftward bias in rod bisection, which increased when subjects used their right hand and fixated a right-sided visual target. Thus, orienting of gaze can affect a nonvisual, tactilo-kinesthetic spatial task. The possible mechanisms of this interaction are discussed with respect to activation-orienting theories egocentric hypotheses and directional trends.

Deficit of preparatory attention in frontotemporal dementia.

We studied preparatory attention in patients suffering from frontotemporal dementia in the beginning stages of the disease, using an experimental test developed by LaBerge, Auclair, and Siéroff (2000). In this experimental test, a distracter can appear while subjects have to prepare to respond to a simple target. The probability that a distracter can appear in a trial is varied across three blocks. Normal controls show an increase of response times to targets (slope) as a function of the distracter probability, preparatory attention to the target is reduced by the increase of the distracter probability. Patients suffering from frontotemporal dementia show a slope of response times which is more than twice as large as the slope obtained by their matched controls. Such an abnormal increase of response times to targets is interpreted as a deficit in preparatory attention. Patients also show more omissions than controls. We suggest that this deficit in preparatory attention is related to the frontal lesion presented by the patients and can result in higher distractibility, a symptom frequently encountered in these patients.