Cognitive Assessment in Grappling Athletes Following Choke Versus Non-Choke Submissions.

PURPOSE: Participation in Brazilian jiu-jitsu (BJJ) and mixed martial arts has increased over the last 3 decades. These sports feature submission attacks, including strangles. These strangles, termed "chokes" in this context, primarily limit blood flow to the brain via compression of neck vasculature. There has been discussion in literature of the possibility of measurable cognitive effects following transient choking episodes. The present study used the King-Devick test (KDT) platform, a tablet-based reaction time and accuracy task designed to measure participants' number recognition, cognition, and verbal expression. This task requires functional vision, saccadic eye movements, comprehension and expression. METHODS: Volunteer participants were screened for exclusion (prior brain injury) criteria and survey information prior to testing. Athletes were tested with the KDT immediately prior to a BJJ training session, again immediately after succumbing to either a choke ("Choke" arm) or non-choke ("Non-Choke" arm) submission while sparring, and again after a 10-minute rest period following the post-submission test. Analysis was done on Test Failures, Total Test Times, and Individual Difference Scores between baseline and subsequent testing. RESULTS: 62 (32 Choke, 30 Non-Choke) participants were analyzed. There was no significant difference between Choke and Non-Choke in Test failures (X2(1,62) = 1.25, p = 0.263), Total Times (t(60) = 0.62, p = 0.540, 95% CI [-3.44, 6.51]), and Individual Difference Scores (t(60) = 0.29, p = 0.776, 95% CI [-2.41, 3.21]). CONCLUSIONS: There were no significant differences between study arms in any of the 3 analyzed measures. This suggests that cognitive functioning, as measured by the King-Devick test, is not affected by transient choking episodes.

Impact of repeated sportive chokes on carotid intima media thickness and brain injury biomarkers in grappling athletes.

PURPOSE: Vascular neck compression techniques, referred to as 'chokes' in combat sports, reduce cerebral perfusion, causing loss of consciousness or voluntary submission by the choked athlete. Despite these chokes happening millions of times yearly around the world, there is scant research on their long-term effects. This pilot study evaluated whether repeated choking in submission grappling impacts the carotid intima media thickness (CIMT) and brain injury biomarkers (NFL, hGFAP, t-Tau, and UCH-L1). METHODS: Participants (n = 39, 29 male; ages 27-60 years) were assigned to one of two study arms: Grapplers (n = 20, 15 male) and 19 age/sex/body size matched controls. Grapplers had been exposed to >500 choke events while training for >5 years in a choke-inclusive sport. Exclusion criteria were recent TBI or deficits from a past TBI or stroke. Bilateral ultrasound measurement of the CIMT was performed, and blood was collected for quantitative analysis of four brain injury markers. Subgroup analyses were performed within the Grappler group to account for blunt head trauma as a possible confounder. RESULTS: There was no overall difference in CIMT measurements between Grapplers (mean 0.55 mm, SD 0.07) and Controls (mean 0.57 mm, SD 0.10) p = 0.498 [95% CI -0.04-0.08], nor were there CIMT differences between Grappler subgroups of blunt Trauma and No-Trauma. There were no significant differences in any biomarkers comparing Grapplers and Controls or comparing Grappler subgroups of Trauma and No-Trauma. CONCLUSION: This study found no significant difference in CIMT and serum brain injury biomarkers between controls and grapplers with extensive transient choke experience, nor between grapplers with extensive past blunt head trauma and those without.

Program evaluation of cognitive behavioral therapy in burn survivors.

Mental health is a component of care that should be addressed for burn patients while they are hospitalized. Unfortunately, dedicated burn psychotherapists are rare in burn centers in the United States (US), and it can take months for patients to be seen by a mental health professional after referral. Our burn center has a dedicated licensed clinical social worker who sees patients within two business days of referral. She uses cognitive behavioral therapy (CBT), which is designed to alleviate symptoms of anxiety, depression, and acute stress by modifying the individual's maladaptive thoughts. To evaluate the timely use of CBT as a treatment for depression in burn patients, we measured depressive symptoms before and after psychotherapy. Burn clinic nurses administered the Patient Health Questionnaire (PHQ-9) depression screener as part of standard care. We computed difference scores to determine change in PHQ-9 scores at both group and individual levels. At a group level, psychotherapy significantly improved symptoms of depression, indicated by a decreased mean PHQ-9 score. On an individual level, half of the patients (50.7%) experienced a meaningful improvement in their symptoms, indicated by a change in their PHQ-9 depression category, while 35.6% showed no change. Although it was not an effective solution for all patients in this study, timely use of CBT could be an important component of burn care for many and should be considered as part of standard care in burn centers across the US.

Eye tracking: empirical foundations for a minimal reporting guideline.

In this paper, we present a review of how the various aspects of any study using an eye tracker (such as the instrument, methodology, environment, participant, etc.) affect the quality of the recorded eye-tracking data and the obtained eye-movement and gaze measures. We take this review to represent the empirical foundation for reporting guidelines of any study involving an eye tracker. We compare this empirical foundation to five existing reporting guidelines and to a database of 207 published eye-tracking studies. We find that reporting guidelines vary substantially and do not match with actual reporting practices. We end by deriving a minimal, flexible reporting guideline based on empirical research (Section "An empirically based minimal reporting guideline").

The Use of Video Laryngoscopy Did Not Lead to Greater First-Pass or Overall Success Rates Compared to Direct Laryngoscopy in Pediatric Intubation in a Helicopter Emergency Medical Service.

OBJECTIVE: We hypothesized that video laryngoscopy (VL) would significantly increase the first attempt and final success rates over direct laryngoscopy (DL) in helicopter emergency medical services. METHODS: This was a study of an emergency medical service in the Midwestern United States. Pediatric patients (age < 18 years) transported between January 1, 2010, and July 31, 2016, with an attempted intubation were identified. Demographics (age group and sex), first-pass success (FPS), and total attempts by intubation type were abstracted and compared with a historical control. RESULTS: Fifty-five pediatric patient runs were abstracted (DL: n = 28, VL: n = 27). There were no significant differences between the DL and VL groups based on sex (DL: 54% male, VL: 70% male; P = .200) or age group (P = .239). Analyses of FPS between DL and VL showed no difference (DL: 82.1% success vs. VL: 70.4% success; P = .304). There was no difference for final success rate between DL and VL (DL: 85.7%, VL: 96.3%; P = .172). A significantly larger number of difficult airways were reported in the VL group (37.0%) compared with DL (7.1%, P = .007). CONCLUSION: VL did not improve FPS over DL nor did it improve the final endotracheal intubation success rate over DL. The VL group had more airways reported as being difficult by the flight crew than the DL group.

Visual input to the left versus right eye yields differences in face preferences in 3-month-old infants.

From birth, infants prefer looking at faces over scrambled faces. This face input is important for the development of face processing: individuals who experienced early visual deprivation due to congenital cataracts have long-lasting face processing deficits. Interestingly, the deficits are eye-specific such that left eye cataracts disrupt the development of face processing, whereas right eye cataracts do not. This raises the question of whether infant face preferences are driven primarily by faces observed through the left eye. To investigate this, we presented 3-month-old infants with intact faces paired with scrambled faces. Infants viewed the moving stimuli binocularly, only with their left eye, or only with their right eye. Infants viewing stimuli binocularly or with only the left eye spent significantly more time looking at intact faces than scrambled faces, but this effect was equivocal in infants viewing stimuli through only their right eye. Infants in the binocular group had the greatest preference for faces, and this preference was greater than the right eye group's preference for faces. The left eye group's preference for faces was not statistically different from the other two groups' preference for faces, but additional analyses revealed a correlation between preference for faces and age for the right eye group only, indicating that preference for faces seen with the right eye increase from 3 to 4 months of age. These results indicate that the left eye plays a special role in face processing at, or before 3 months of age, but a preference for faces through the right eye emerges soon after.

Machine learning accurately classifies age of toddlers based on eye tracking.

How people extract visual information from complex scenes provides important information about cognitive processes. Eye tracking studies that have used naturalistic, rather than highly controlled experimental stimuli, reveal that variability in looking behavior is determined by bottom-up image properties such as intensity, color, and orientation, top-down factors such as task instructions and semantic information, and individual differences in genetics, cognitive function and social functioning. These differences are often revealed using areas of interest that are chosen by the experimenter or other human observers. In contrast, we adopted a data-driven approach by using machine learning (Support Vector Machine (SVM) and Deep Learning (DL)) to elucidate factors that contribute to age-related variability in gaze patterns. These models classified the infants by age with a high degree of accuracy, and identified meaningful features distinguishing the age groups. Our results demonstrate that machine learning is an effective tool for understanding how looking patterns vary according to age, providing insight into how toddlers allocate attention and how that changes with development. This sensitivity for detecting differences in exploratory gaze behavior in toddlers highlights the utility of machine learning for characterizing a variety of developmental capacities.

Using High Frequency Transcranial Random Noise Stimulation to Modulate Face Memory Performance in Younger and Older Adults: Lessons Learnt From Mixed Findings.

High-frequency transcranial random noise stimulation (tRNS) has been shown to improve a range of cognitive and perceptual abilities. Here we sought to examine the effects of a single session of tRNS targeted at the ventrolateral prefrontal cortices (VLPFC) on face memory in younger and older adults. To do so, we conducted three experiments. In Experiment 1, we found that younger adults receiving active tRNS outperformed those receiving sham stimulation (i.e., using a between-participant factor for stimulation condition; Experiment 1). This effect was not observed for object memory (car memory) in younger adults (Experiment 2), indicating that the effect is not a general memory effect. In Experiment 3, we sought to replicate the effects of Experiment 1 using a different design (within-participant factor of stimulation - active or sham tRNS to the same individual) and to extend the study by including older adult participants. In contrast to Experiment 1, we found that active tRNS relative to sham tRNS reduced face memory performance in both younger and older adults. We also found that the degree of decline in performance in the active tRNS relative to sham tRNS condition was predicted by baseline ability, with higher performing participants showing the largest decreases in performance. Overall, the results indicate that tRNS to the VLPFC modulates face memory, but that there may be performance and protocol specific moderators of this effect. We discuss these findings in the context of the broader literature showing the importance of individual variation in the outcome of non-invasive brain stimulation intervention approaches. We conclude that while tRNS may have potential as an intervention approach, generalizing from single experiment studies to wide application is risky and caution should be adopted in interpreting findings.

Rapid face orienting in infants and school-age children with and without autism: Exploring measurement invariance in eye-tracking.

Questions concerning the ontogenetic stability of autism have recently received increased attention as long-term longitudinal studies have appeared in the literature. Most experimental measures are designed for specific ages and functioning levels, yet developing experimental tasks appropriate for a wide range of ages and functioning levels is critical for future long-term longitudinal studies, and treatment studies implemented at different ages. Accordingly, we designed an eye-tracking task to measure preferential orienting to facial features and implemented it with groups of participants with varying levels of functioning: infants, and school-age children with and without autism. All groups fixated eyes first, revealing an early and stable orienting bias. This indicates common bias towards the eyes across participants regardless of age or diagnosis. We also demonstrate that this eye-tracking task can be used with diverse populations who range in age and cognitive functioning. Our developmental approach has conceptual implications for future work focused on task development and particularly new experimental measures that offer measurement equivalence across broad age ranges, intellectual functioning and verbal abilities.

An Examination of Recording Accuracy and Precision From Eye Tracking Data From Toddlerhood to Adulthood.

The quantitative assessment of eye tracking data quality is critical for ensuring accuracy and precision of gaze position measurements. However, researchers often report the eye tracker's optimal manufacturer's specifications rather than empirical data about the accuracy and precision of the eye tracking data being presented. Indeed, a recent report indicates that less than half of eye tracking researchers surveyed take the eye tracker's accuracy into account when determining areas of interest for analysis, an oversight that could impact the validity of reported results and conclusions. Accordingly, we designed a calibration verification protocol to augment independent quality assessment of eye tracking data and examined whether accuracy and precision varied between three age groups of participants. We also examined the degree to which our externally quantified quality assurance metrics aligned with those reported by the manufacturer. We collected data in standard laboratory conditions to demonstrate our method, to illustrate how data quality can vary with participant age, and to give a simple example of the degree to which data quality can differ from manufacturer reported values. In the sample data we collected, accuracy for adults was within the range advertised by the manufacturer, but for school-aged children, accuracy and precision measures were outside this range. Data from toddlers were less accurate and less precise than data from adults. Based on an a priori inclusion criterion, we determined that we could exclude approximately 20% of toddler participants for poor calibration quality quantified using our calibration assessment protocol. We recommend implementing and reporting quality assessment protocols for any eye tracking tasks with participants of any age or developmental ability. We conclude with general observations about our data, recommendations for what factors to consider when establishing data inclusion criteria, and suggestions for stimulus design that can help accommodate variability in calibration. The methods outlined here may be particularly useful for developmental psychologists who use eye tracking as a tool, but who are not experts in eye tracking per se. The calibration verification stimuli and data processing scripts that we developed, along with step-by-step instructions, are freely available for other researchers.

Concurrent development of facial identity and expression discrimination.

Facial identity and facial expression processing both appear to follow a protracted developmental trajectory, yet these trajectories have been studied independently and have not been directly compared. Here we investigated whether these processes develop at the same or different rates using matched identity and expression discrimination tasks. The Identity task begins with a target face that is a morph between two identities (Identity A/Identity B). After a brief delay, the target face is replaced by two choice faces: 100% Identity A and 100% Identity B. Children 5-12-years-old were asked to pick the choice face that is most similar to the target identity. The Expression task is matched in format and difficulty to the Identity task, except the targets are morphs between two expressions (Angry/Happy, or Disgust/Surprise). The same children were asked to pick the choice face with the expression that is most similar to the target expression. There were significant effects of age, with performance improving (becoming more accurate and faster) on both tasks with increasing age. Accuracy and reaction times were not significantly different across tasks and there was no significant Age x Task interaction. Thus, facial identity and facial expression discrimination appear to develop at a similar rate, with comparable improvement on both tasks from age five to twelve. Because our tasks are so closely matched in format and difficulty, they may prove useful for testing face identity and face expression processing in special populations, such as autism or prosopagnosia, where one of these abilities might be impaired.

Face-specific and domain-general visual processing deficits in children with developmental prosopagnosia.

Evidence suggests that face and object recognition depend on distinct neural circuitry within the visual system. Work with adults with developmental prosopagnosia (DP) demonstrates that some individuals have preserved object recognition despite severe face recognition deficits. This face selectivity in adults with DP indicates that face- and object-processing systems can develop independently, but it is unclear at what point in development these mechanisms are separable. Determining when individuals with DP first show dissociations between faces and objects is one means to address this question. In the current study, we investigated face and object processing in six children with DP (5-12-years-old). Each child was assessed with one face perception test, two different face memory tests, and two object memory tests that were matched to the face memory tests in format and difficulty. Scores from the DP children on the matched face and object tasks were compared to within-subject data from age-matched controls. Four of the six DP children, including the 5-year-old, showed evidence of face-specific deficits, while one child appeared to have more general visual-processing deficits. The remaining child had inconsistent results. The presence of face-specific deficits in children with DP suggests that face and object perception depend on dissociable processes in childhood.

Prosopagnosia: current perspectives.

Prosopagnosia is a selective visual agnosia characterized by the inability to recognize the identity of faces. There are both acquired forms secondary to brain damage and developmental forms without obvious structural lesions. In this review, we first discuss the diagnosis of acquired and developmental prosopagnosia, and the challenges present in the latter case. Second, we discuss the evidence regarding the selectivity of the prosopagnosic defect, particularly in relation to the recognition of other objects, written words (another visual object category requiring high expertise), and voices. Third, we summarize recent findings about the structural and functional basis of prosopagnosia from studies using magnetic resonance imaging, functional magnetic resonance imaging, and event-related potentials. Finally, we discuss recent attempts at rehabilitation of face recognition in prosopagnosia.

Impaired face detection may explain some but not all cases of developmental prosopagnosia.

Developmental prosopagnosia (DP) is defined by severe face recognition difficulties due to the failure to develop the visual mechanisms for processing faces. The two-process theory of face recognition (Morton & Johnson, 1991) implies that DP could result from a failure of an innate face detection system; this failure could prevent an individual from then tuning higher-level processes for face recognition (Johnson, 2005). Work with adults indicates that some individuals with DP have normal face detection whereas others are impaired. However, face detection has not been addressed in children with DP, even though their results may be especially informative because they have had less opportunity to develop strategies that could mask detection deficits. We tested the face detection abilities of seven children with DP. Four were impaired at face detection to some degree (i.e. abnormally slow, or failed to find faces) while the remaining three children had normal face detection. Hence, the cases with impaired detection are consistent with the two-process account suggesting that DP could result from a failure of face detection. However, the cases with normal detection implicate a higher-level origin. The dissociation between normal face detection and impaired identity perception also indicates that these abilities depend on different neurocognitive processes.

Guidelines for studying developmental prosopagnosia in adults and children.

Developmental prosopagnosia (DP) is a neurodevelopmental condition characterized by severe face identity recognition problems that results from a failure to develop the mechanisms necessary for adequate face processing (Duchaine BC, Nakayama K. Developmental prosopagnosia: a window to content-specific face processing. Curr Opin Neurobiol 2006, 16:166-173.). It occurs in children and adults with normal visual acuity, and without intellectual impairments or known brain injuries. Given the importance of face recognition in daily life, and the detrimental effects of impaired face recognition, DP is an important area of study. Yet conventions for classifying individuals as DP for research purposes are poorly defined. In this focus paper, we discuss: (1) criteria for an operational definition of DP; 2) tests of face recognition and conventions for classifying individuals as DP; and 3) important considerations regarding common associations and dissociations, and cognitive heterogeneity in DP. We also highlight issues unique to studying DP in children, a relatively new endeavor that is proving to be an important complement to the work with adults. Ultimately, we hope to identify challenges researchers face when studying DP, and offer guidelines for others to consider when embarking on their own research pursuits on the topic. For further resources related to this article, please visit the WIREs website.

Temporal dynamics of the face familiarity effect: bootstrap analysis of single-subject event-related potential data.

Prior event-related potential studies using group statistics within a priori selected time windows have yielded conflicting results about familiarity effects in face processing. Our goal was to evaluate the temporal dynamics of the familiarity effect at all time points at the single-subject level. Ten subjects were shown faces of anonymous people or celebrities. Individual results were analysed using a point-by-point bootstrap analysis. While familiarity effects were less consistent at later epochs, all subjects showed them between 130 and 195 ms in occipitotemporal electrodes. However, the relation between the time course of familiarity effects and the peak latency of the N170 was variable. We concluded that familiarity effects between 130 and 195 ms are robust and can be shown in single subjects. The variability of their relation to the timing of the N170 potential may lead to underestimation of familiarity effects in studies that use group-based statistics.

"A room full of strangers every day": the psychosocial impact of developmental prosopagnosia on children and their families.

OBJECTIVE: Individuals with developmental prosopagnosia ('face blindness') have severe face recognition difficulties due to a failure to develop the necessary visual mechanisms for recognizing faces. These difficulties occur in the absence of brain damage and despite normal low-level vision and intellect. Adults with developmental prosopagnosia report serious personal and emotional consequences from their inability to recognize faces, but little is known about the psychosocial consequences in childhood. Given the importance of face recognition in daily life, and the potential for unique social consequences of impaired face recognition in childhood, we sought to evaluate the impact of developmental prosopagnosia on children and their families. METHODS: We conducted semi-structured interviews with 8 children with developmental prosopagnosia and their parents. A battery of face recognition tests was used to confirm the face recognition impairment reported by the parents of each child. We used thematic analysis to develop common themes among the psychosocial experiences of the children and their parents. RESULTS: Three themes were developed from the child reports: 1) awareness of their difficulties, 2) coping strategies, such as using non-facial cues to identify others, and 3) social implications, such as discomfort in, and avoidance of, social situations. These themes were paralleled by the parent reports and highlight the unique social and practical challenges associated with childhood developmental prosopagnosia. CONCLUSION: Our findings indicate a need for increased awareness and treatment of developmental prosopagnosia to help these children manage their face recognition difficulties and to promote their social and emotional wellbeing.

Dissociation between face perception and face memory in adults, but not children, with developmental prosopagnosia.

Cognitive models propose that face recognition is accomplished through a series of discrete stages, including perceptual representation of facial structure, and encoding and retrieval of facial information. This implies that impaired face recognition can result from failures of face perception, face memory, or both. Studies of acquired prosopagnosia, autism spectrum disorders, and the development of normal face recognition support the idea that face perception and face memory are distinct processes, yet this distinction has received little attention in developmental prosopagnosia (DP). To address this issue, we tested the face perception and face memory of children and adults with DP. By definition, face memory is impaired in DP, so memory deficits were present in all participants. However, we found that all children, but only half of the adults had impaired face perception. Thus, results from adults indicate that face perception and face memory are dissociable, while the results from children provide no evidence for this division. Importantly, our findings raise the possibility that DP is qualitatively different in childhood versus adulthood. We discuss theoretical explanations for this developmental pattern and conclude that longitudinal studies are necessary to better understand the developmental trajectory of face perception and face memory deficits in DP.

Spontaneous perceptual facial distortions correlate with ventral occipitotemporal activity.

Prosopometamorphopsia is a disorder of face perception in which faces appear distorted to the perceiver. The neural basis of prosopometamorphopsia is unclear, but may involve abnormal activity in face-selective areas in the ventral occipito-temporal pathway. Here we present the case of AS, a 44-year-old woman who reports persistent perceptual distortions of faces with no known cause. AS was presented with facial images and rated the magnitude of her distortions while activity in her core face areas and other areas in the ventral visual pathway was measured using functional magnetic resonance imaging. The magnitude of her distortions was positively correlated with signal changes in the right occipital face area (OFA) and right fusiform face area (FFA), as well as right V1-V3, and right lateral occipital cortex (LOC). There was also a trend for a significant correlation with signal in the left OFA and right inferior frontal gyrus (IFG), but not in the right or left superior temporal sulcus (STS). These results suggest that AS' prosopometamorphopsia reflects anomalous activity in face-processing network, particularly in the ventral occipitotemporal cortex.