Active mobility and mental health: A scoping review towards a healthier world.

Research has proven that engaging in active mobility (AM), namely walking and cycling for transportation, significantly enhances physical activity levels, leading to better physical health. It is still unclear whether AM could also offer any mental health benefits. This scoping review aims to provide a comprehensive understanding of the current knowledge on the relationship between AM and mental health, given its crucial role in public health. The authors searched online databases to isolate primary studies written in English involving an adult sample (16 or over). AM was the exposure factor. Many mental health elements were included as outcomes (depression, anxiety, self-esteem, self-efficacy, stress, psychological and subjective well-being, resilience, loneliness and social support, quality of life, mood, life satisfaction and sleep). The results were organised in a narrative summary per each outcome selected, graphical syntheses and an overview of gaps to be further examined. The authors identified a total of 55 papers as relevant. The results show inconsistency in study designs, definition and operationalisation of the variables, approach and methodologies used. A cross-sectional design was the dominant choice, primarily examining data from national public health surveys. Nonetheless, there has been improvement in outcomes of interests, initially mainly the quality of life and affect. Lately, authors have focused on a broader range of mental health-related factors (such as travel satisfaction). The experimental studies showed promising mental health improvements in those who used active modes more than those who used motorised vehicles. It creates a rationale for further research towards implementing a unified theoretical and methodological framework to study the link between AM and mental health. The ultimate goal is to generate solid conclusions that could support building societies and cities through public health promotion and sustainable strategies, like walking and cycling as a means of transport.

rTMS over the human medial parietal cortex impairs online reaching corrections.

Indirect correlational evidence suggests that the posteromedial sector of the human parietal cortex (area hV6A) is involved in reaching corrections. We interfered with hV6A functions using repetitive transcranial magnetic stimulation (rTMS) while healthy participants performed reaching movements and in-flight adjustments of the hand trajectory in presence of unexpected target shifts. rTMS over hV6A specifically altered action reprogramming, causing deviations of the shifted trajectories, particularly along the vertical dimension (i.e., distance). This study provides evidence of the functional relevance of hV6A in action reprogramming while a sudden event requires a change in performance and shows that hV6A also plays a role in state estimation during reaching. These findings are in line with neurological data showing impairments in actions performed along the distance dimension when lesions occur in the dorsal posterior parietal cortex.

Co-designing an interactive artificial intelligent system with post-stroke patients and caregivers to augment the lost abilities and improve their quality of life: a human-centric approach.

Objectives: The motor disability due to stroke compromises the autonomy of patients and caregivers. To support autonomy and other personal and social needs, trustworthy, multifunctional, adaptive, and interactive assistive devices represent optimal solutions. To fulfill this aim, an artificial intelligence system named MAIA would aim to interpret users' intentions and translate them into actions performed by assistive devices. Analyzing their perspectives is essential to develop the MAIA system operating in harmony with patients' and caregivers' needs as much as possible. Methods: Post-stroke patients and caregivers were interviewed to explore the impact of motor disability on their lives, previous experiences with assistive technologies, opinions, and attitudes about MAIA and their needs. Interview transcripts were analyzed using inductive thematic analysis. Results: Sixteen interviews were conducted with 12 post-stroke patients and four caregivers. Three themes emerged: (1) Needs to be satisfied, (2) MAIA technology acceptance, and (3) Perceived trustfulness. Overall, patients are seeking rehabilitative technology, contrary to caregivers needing assistive technology to help them daily. An easy-to-use and ergonomic technology is preferable. However, a few participants trust a system based on artificial intelligence. Conclusion: An interactive artificial intelligence technology could help post-stroke patients and their caregivers to restore motor autonomy. The insights from participants to develop the system depends on their motor ability and the role of patients or caregiver. Although technology grows exponentially, more efforts are needed to strengthen people's trust in advanced technology.

The effects of an active breaks intervention on physical and cognitive performance: results from the I-MOVE study.

BACKGROUND: The present quasi-experimental study aimed to evaluate the effects of active breaks intervention (ABs) to promote physical and cognitive improvement in primary school. METHODS: The active breaks group (ABsG) performed 10 min of ABs three times per school day and the control group (CG) did normal lessons. The baseline and follow-up evaluation was conducted respectively in October 2019 and in May 2021. Cognitive performance was assessed using working memory test, physical performance was analyzed with ActiGraph accelerometers and physical fitness tests, quality of life was monitored using the Paediatric Quality of Life questionnaire (PedsQL) and classroom behavior was collected with an ad hoc questionnaire. RESULTS: We enrolled 153 children (age: 7.61 ± 1.41, 54.2% males). Working memory significantly increased in the ABsG (ΔWM: 1.30 ± 1.17) than in CG (ΔWM: 0.96 ± 1.20). The 6 min Cooper test increased in the ABsG (Δ: 1.77 ± 136.03) but not in CG (Δ: -156.42 ± 187.53), P < 0.05. The weekly physical activity levels increased in both groups; however, the sedentary behavior significantly increased both in ABsG and CG. Children reported improvements in their quality of school life including feeling better in class and in school when using ABs; moreover, children improved their time on task behaviors in ABsG. CONCLUSION: The present study has proven to be effective on children's physical and cognitive performance.

An active inference model of hierarchical action understanding, learning and imitation.

We advance a novel active inference model of the cognitive processing that underlies the acquisition of a hierarchical action repertoire and its use for observation, understanding and imitation. We illustrate the model in four simulations of a tennis learner who observes a teacher performing tennis shots, forms hierarchical representations of the observed actions, and imitates them. Our simulations show that the agent's oculomotor activity implements an active information sampling strategy that permits inferring the kinematic aspects of the observed movement, which lie at the lowest level of the action hierarchy. In turn, this low-level kinematic inference supports higher-level inferences about deeper aspects of the observed actions: proximal goals and intentions. Finally, the inferred action representations can steer imitative responses, but interfere with the execution of different actions. Our simulations show that hierarchical active inference provides a unified account of action observation, understanding, learning and imitation and helps explain the neurobiological underpinnings of visuomotor cognition, including the multiple routes for action understanding in the dorsal and ventral streams and mirror mechanisms.

Acceptance of Assistive Technology by Users with Motor Disabilities Due to Spinal Cord or Acquired Brain Injuries: A Systematic Review.

Acquired motor limits can be provoked by neurological lesions. Independently of the aetiologies, the lesions require patients to develop new coping strategies and adapt to the changed motor functionalities. In all of these occasions, what is defined as an assistive technology (AT) may represent a promising solution. The present work is a systematic review of the scientific AT-related literature published in the PubMed, Cinahl, and Psychinfo databases up to September 2022. This review was undertaken to summarise how the acceptance of AT is assessed in people with motor deficits due to neurological lesions. We review papers that (1) dealt with adults (≥18 years old) with motor deficits due to spinal cord or acquired brain injuries and (2) concerned user acceptance of hard AT. A total of 615 studies emerged, and 18 articles were reviewed according to the criteria. The constructs used to assess users' acceptance mainly entail people's satisfaction, ease of use, safety and comfort. Moreover, the acceptance constructs varied as a function of participants' injury severity. Despite the heterogeneity, acceptability was mainly ascertained through pilot and usability studies in laboratory settings. Furthermore, ad-hoc questionnaires and qualitative methods were preferred to unstandardized protocols of measurement. This review highlights the way in which people living with acquired motor limits greatly appreciate ATs. On the other hand, methodological heterogeneity indicates that evaluation protocols should be systematized and finely tuned.

Paradoxical decrease of imitation performance with age in children.

Imitation development was studied in a cross-sectional design involving 174 primary-school children (aged 6-10), focusing on the effect of actions' complexity and error analysis to infer the underlying cognitive processes. Participants had to imitate the model's actions as if they were in front of a mirror ('specularly'). Complexity varied across three levels: movements of a single limb; arm and leg of the same body side; or arm and leg of opposite body sides. While the overall error rate decreased with age, this was not true of all error categories. The rate of 'side' errors (using a limb of the wrong body side) paradoxically increased with age (from 9 years). However, with increasing age, the error rate also became less sensitive to the complexity of the action. This pattern is consistent with the hypothesis that older children have the working memory (WM) resources and the body knowledge necessary to imitate 'anatomically', which leads to additional side errors. Younger children might be paradoxically free from such interference because their WM and/or body knowledge are insufficient for anatomical imitation. Yet, their limited WM resources would prevent them from successfully managing the conflict between spatial codes involved in complex actions (e.g. moving the left arm and the right leg). We also found evidence that action side and content might be stored in separate short-term memory (STM) systems: increasing the number of sides to be encoded only affected side retrieval, but not content retrieval; symmetrically, increasing the content (number of movements) of the action only affected content retrieval, but not side retrieval. In conclusion, results suggest that anatomical imitation might interfere with specular imitation at age 9 and that STM storages for side and content of actions are separate.

A Short Route for Reach Planning between Human V6A and the Motor Cortex.

In the macaque monkey, area V6A, located in the medial posterior parietal cortex, contains cells that encode the spatial position of a reaching target. It has been suggested that during reach planning this information is sent to the frontal cortex along a parieto-frontal pathway that connects V6A-premotor cortex-M1. A similar parieto-frontal network may also exist in the human brain, and we aimed here to study the timing of this functional connection during planning of a reaching movement toward different spatial positions. We probed the functional connectivity between human area V6A (hV6A) and the primary motor cortex (M1) using dual-site, paired-pulse transcranial magnetic stimulation with a short (4 ms) and a longer (10 ms) interstimulus interval while healthy participants (18 men and 18 women) planned a visually-guided or a memory-guided reaching movement toward positions located at different depths and directions. We found that, when the stimulation over hV6A is sent 4 ms before the stimulation over M1, hV6A inhibits motor-evoked potentials during planning of either rightward or leftward reaching movements. No modulations were found when the stimulation over hV6A was sent 10 ms before the stimulation over M1, suggesting that only short medial parieto-frontal routes are active during reach planning. Moreover, the short route of hV6A-premotor cortex-M1 is active during reach planning irrespectively of the nature (visual or memory) of the reaching target. These results agree with previous neuroimaging studies and provide the first demonstration of the flow of inhibitory signals between hV6A and M1.SIGNIFICANCE STATEMENT All our dexterous movements depend on the correct functioning of the network of brain areas. Knowing the functional timing of these networks is useful to gain a deeper understanding of how the brain works to enable accurate arm movements. In this article, we probed the parieto-frontal network and demonstrated that it takes 4 ms for the medial posterior parietal cortex to send inhibitory signals to the frontal cortex during reach planning. This fast flow of information seems not to be dependent on the availability of visual information regarding the reaching target. This study opens the way for future studies to test how this timing could be impaired in different neurological disorders.

Complementary contribution of the medial and lateral human parietal cortex to grasping: a repetitive TMS study.

The dexterous control of our grasping actions relies on the cooperative activation of many brain areas. In the parietal lobe, 2 grasp-related areas collaborate to orchestrate an accurate grasping action: dorsolateral area AIP and dorsomedial area V6A. Single-cell recordings in monkeys and fMRI studies in humans have suggested that both these areas specify grip aperture and wrist orientation, but encode these grasping parameters differently, depending on the context. To elucidate the causal role of phAIP and hV6A, we stimulated these areas, while participants were performing grasping actions (unperturbed grasping). rTMS over phAIP impaired the wrist orientation process, whereas stimulation over hV6A impaired grip aperture encoding. In a small percentage of trials, an unexpected reprogramming of grip aperture or wrist orientation was required (perturbed grasping). In these cases, rTMS over hV6A or over phAIP impaired reprogramming of both grip aperture and wrist orientation. These results represent the first direct demonstration of a different encoding of grasping parameters by 2 grasp-related parietal areas.

Mediterranean diet, physical activity, and family characteristics associated with cognitive performance in Italian primary school children: analysis of the I-MOVE project.

Working memory (WM) is a multicomponent system that supports cognitive functioning. It has been linked to a wide variety of outcomes including academic success and general well-being. The present study examined the relations between adherence to the Mediterranean diet (MD) and WM among Italian children, adjusting for important parent characteristics and children's lifestyle habits. Data for this study was obtained from 106 children attending primary school in Imola (Italy) who were part of the I-MOVE study emphasizing school-based physical activity. Children's adherence to the MD was calculated using the KIDMED index (KI) based on the ZOOM-8 questionnaire. Physical activity (PA) levels were assessed using an actigraph accelerometer and WM using the backward digit span test. Univariate regression was used to select significant child-level and family measures associated with WM, which were then tested in a single multivariate regression model. Older age is positively associated with higher WM (ß = 0.36; 95% CI 0.25, 0.47). Dietary adherence (KI) (ß = 0.07; 95% CI 0.01, 0.14) and engagement in organized PA outside school hours (ß = 0.58; 95% CI 0.09, 1.10) are positively related to WM. Among the family measures, father's education was positively associated with WM for high school education and for university vs. middle school or lower, respectively. CONCLUSION: Adherence to the MD was associated with better WM capacity in primary school children. These findings can be used to guide policymakers in designing health promotion programs and instituting policies emphasizing healthy nutrition to improve physical health and boost cognitive functioning. WHAT IS KNOWN: • The development of working memory involves the entire childhood with a rapid spurt between 2 and 8 years of age. • Working memory plays a critical role in children's learning and academic performance and underlies higher-order cognitive abilities. WHAT IS NEW: • Adherence to the Mediterranean Diet was associated with higher working memory capacity in primary school children. • Health promotion interventions based on PA and sound nutrition involving children benefit not only physical and mental health, but also cognitive health.

A Multifunctional Adaptive and Interactive AI system to support people living with stroke, acquired brain or spinal cord injuries: A study protocol.

BACKGROUND: Acquired brain injury and spinal cord injury are leading causes of severe motor disabilities impacting a person's autonomy and social life. Enhancing neurological recovery driven by neurogenesis and neuronal plasticity could represent future solutions; however, at present, recovery of activities employing assistive technologies integrating artificial intelligence is worthy of examining. MAIA (Multifunctional, adaptive, and interactive AI system for Acting in multiple contexts) is a human-centered AI aiming to allow end-users to control assistive devices naturally and efficiently by using continuous bidirectional exchanges among multiple sensorimotor information. METHODS: Aimed at exploring the acceptability of MAIA, semi-structured interviews (both individual interviews and focus groups) are used to prompt possible end-users (both patients and caregivers) to express their opinions about expected functionalities, outfits, and the services that MAIA should embed, once developed, to fit end-users needs. DISCUSSION: End-user indications are expected to interest MAIA technical, health-related, and setting components. Moreover, psycho-social issues are expected to align with the technology acceptance model. In particular, they are likely to involve intrinsic motivational and extrinsic social aspects, aspects concerning the usefulness of the MAIA system, and the related ease to use. At last, we expect individual factors to impact MAIA: gender, fragility levels, psychological aspects involved in the mental representation of body image, personal endurance, and tolerance toward AT-related burden might be the aspects end-users rise in evaluating the MAIA project.

Does the body talk to the body? The relationship between different body representations while observing others' body parts.

The way human bodies are represented is central in everyday activities. The cognitive system must combine internal, visceral, and somatosensory, signals to external, visually driven information generated from the spatial placement of others' bodies and the own body in the space. However, how different body representations covertly interact among them when observing human body parts is still unclear. Therefore, we investigated the implicit processing of body parts by manipulating either the body part stimuli' posture (conditions a and b) or the participants' response body posture (conditions c, d, and e) in healthy participants (N = 70) using a spatial compatibility task called Sidedness task. The task requires participants to judge the colour of a circle superimposed on a task-irrelevant body part picture. Responses are facilitated when the spatial side of the responding hand corresponds to the spatial code generated by the hand stimulus's position with respect to a body of reference. Results showed that the observation of the task-irrelevant body parts oriented participants' attention and facilitated responses that were spatial compatible with the spatial position such body parts have within a configural representation of the body structure (i.e., Body Structural Representation) in all the five experimental conditions. Notably, the body part stimuli were mentally attached to the body according to the most comfortable and less awkward postures, following the anatomo-physiological constraints. Moreover, the pattern of the results was not influenced by manipulating the participants' response postures, suggesting that the automatic and implicit coding of the body part stimuli does not rely on proprioceptive information about one's body (i.e., Body Schema). We propose that the human body's morphometry knowledge is enriched by biomechanical and anatomo-physiological information about the real body movement possibilities. Moreover, we discuss the importance of the automatic orienting of attention based on the sidedness within the context of imitational learning.

The impact of COVID-19 on physical activity behaviour in Italian primary school children: a comparison before and during pandemic considering gender differences.

BACKGROUND: The World Health Organization stated an average of 60 min of Moderate to Vigorous Physical Activity (MVPA) that children should accumulate every day. Nevertheless physical inactivity is growing and, due to restrictions imposed during pandemic, PA levels of children might be more negatively affected. The study aimed to analyse the impact of COVID-19 on the PA of an Italian sample of primary school children by comparing it before and during COVID-19 considering gender differences. METHODS: A pre-post analysis (October 2019-January 2021) was conducted using a randomized sample (N = 77) from the I-MOVE study settled in an Italian primary school. Both objective (Actigraph accelerometers) and self-reported (PAQ-c questionnaires) assessments of PA were performed. Changes were compared using T-Student and Chi-Square test. Gender differences were calculated using Anova. RESULTS: Weekly and daily minutes time spent in MVPA significantly decreased respectively by - 30.59 ± 120.87 and - 15.32 ± 16.21 from before to during pandemic while the weekly time spent in sedentary behaviour increased (+ 1196.01 ± 381.49). PAQ-c scores followed the same negative trend (- 0.87 ± 0.72). Boys seem to have suffered more than girls from the imposed restrictions. CONCLUSION: These findings outline the need for strategies to promote PA and reduce sedentary behaviours in children to prevent COVID-19 restriction long-term effects.

Functional Connectivity at Rest between the Human Medial Posterior Parietal Cortex and the Primary Motor Cortex Detected by Paired-Pulse Transcranial Magnetic Stimulation.

The medial posterior parietal cortex (PPC) is involved in the complex processes of visuomotor integration. Its connections to the dorsal premotor cortex, which in turn is connected to the primary motor cortex (M1), complete the fronto-parietal network that supports important cognitive functions in the planning and execution of goal-oriented movements. In this study, we wanted to investigate the time-course of the functional connectivity at rest between the medial PPC and the M1 using dual-site transcranial magnetic stimulation in healthy humans. We stimulated the left M1 using a suprathreshold test stimulus to elicit motor-evoked potentials in the hand, and a subthreshold conditioning stimulus was applied over the left medial PPC at different inter-stimulus intervals (ISIs). The conditioning stimulus affected the M1 excitability depending on the ISI, with inhibition at longer ISIs (12 and 15 ms). We suggest that these modulations may reflect the activation of different parieto-frontal pathways, with long latency inhibitions likely recruiting polisynaptic pathways, presumably through anterolateral PPC.

The Effect of Structured Exercise on Short-Term Memory Subsystems: New Insight on Training Activities.

It has been shown that exercise positively affects cognitive abilities, such as frontal functions and long-term memory processes. We tried to understand whether different exercises (i.e., an open-skill activity, a team game, vs. a closed-skill activity, a circuit) might specifically influence different short-term-memory (STM) subsystems of working memory. We examined the effect of a single bout of open- and closed-skill exercises on three STM tasks (i.e., verbal, visuo-spatial, and motor) in children attending the 3rd and 4th classes at primary school. One group was tested before and after (T0 and T1) an Italian class (control group), one group before and after 30-min exercise on a circuit, and one group before and after 30-min of a team game. The control group presented no improvement. The open-skill activity improved short-term memory performance in all the participants at T1 (p < 0.001 for children attending the 3rd class, and p = 0.007 for children attending the 4th class). In contrast, closed-skill activity improved short-term memory performance in older children (those attending the 4th class; p = 0.046) at T1. Importantly, this finding was found in a school setting and might have ecological validity. Therefore, the exercise protocol here used might help to structure specific training activities for both normal children and those with learning deficits to positively improve short-term memory abilities.

The Effect of Sport Practice on Enhanced Cognitive Processing of Bodily Indices: A Study on Volleyball Players and Their Ability to Predict Hand Gestures.

To program proper reactions, athletes must anticipate opponents' actions on the basis of previous visuomotor experience. In particular, such abilities seem to rely on processing others' intentions to act. We adopted a new approach based on an attentional spatial compatibility paradigm to investigate how elite volleyball players elaborate both spatial and motor information at upper-limb posture presentation. Forty-two participants (18 volleyball players and 17 nonathlete controls assigned to Experiments 1 a and b, and eight basketball players assigned to Experiment 2) were tested to study their ability to process the intentions to act conveyed by hands and extract motor primitives (i.e., significant components of body movements). Analysis looked for a spatial compatibility effect between direction of the spike action (correspondence factor) and response side for both palm and back of the hand (view factor). We demonstrated that volleyball players encoded spatial sport-related indices from bodily information and showed preparatory motor activation according to the direction of the implied spike actions for the palm view (Experiment 1; hand simulating a cross-court spike, p = 0.013, and a down-the-line spike, p = 0.026) but both nonathlete controls (Experiment 1; both p < 0.05) and other sports athletes (basketball players, Experiment 2; p = 0.34, only cross-court spike) did not. Results confirm that elite players' supremacy lies in the predictive abilities of coding elementary motor primitives for their sport discipline.

Body representation in people with apraxia post Stroke- an observational study.

Objective: To investigate how two types of body representation (body schema and body image) were affected in people with and without apraxia following a supratentorial stroke.Design: Observational cross-sectional studySetting: Level 1 Specialist Neurological Rehabilitation UnitParticipants: 30 participants post-stroke diagnosed with (n = 10) and without apraxia (n = 20) according to a modified version of the short Ideomotor Apraxia Test.Interventions: Not applicableMain Outcome Measures: Body schema assessed using the hand laterality recognition test and body part knowledge test; Implicit body image assessed using the sidedness test.Results: Left-sided lesions were more common in the apraxic group. Compared to people without apraxia post-stroke, those with apraxia showed significantly reduced accuracy and longer reaction times on the hand laterality test and fewer correct responses on the body part knowledge test. There was no between-groups difference in the sidedness test.Conclusions: People with apraxia showed deficits in online body representations (body schema) that are used to plan and execute actions. Future research studies could target body schema deficits as an adjunct in the rehabilitation of apraxia.

Bottom-up and top-down modulation of route selection in imitation.

The cognitive system selects the most appropriate action imitative process: a semantic process - relying on long-term memory representations for known actions, and low-level visuomotor transformations for unknown actions. These two processes work in parallel; however, how context regularities and cognitive control modulate them is unclear. In this study, process selection was triggered contextually by presenting mixed known and new actions in predictable or unpredictable lists, while a cue on the forthcoming action triggered top-down control. Known were imitated faster than the new actions in the predictable lists only. Accuracy was higher and reaction times faster in the uncued conditions, and the predictable faster than the unpredictable list in the uncued condition only. In the latter condition, contextual factors modulate process selection, as participants use statistical regularities to perform the task at best. With the cue, the cognitive system tries to control response selection, resulting in more errors and longer reaction times.

Transcranial Magnetic Stimulation Over the Human Medial Posterior Parietal Cortex Disrupts Depth Encoding During Reach Planning.

Accumulating evidence supports the view that the medial part of the posterior parietal cortex (mPPC) is involved in the planning of reaching, but while plenty of studies investigated reaching performed toward different directions, only a few studied different depths. Here, we investigated the causal role of mPPC (putatively, human area V6A-hV6A) in encoding depth and direction of reaching. Specifically, we applied single-pulse transcranial magnetic stimulation (TMS) over the left hV6A at different time points while 15 participants were planning immediate, visually guided reaching by using different eye-hand configurations. We found that TMS delivered over hV6A 200 ms after the Go signal affected the encoding of the depth of reaching by decreasing the accuracy of movements toward targets located farther with respect to the gazed position, but only when they were also far from the body. The effectiveness of both retinotopic (farther with respect to the gaze) and spatial position (far from the body) is in agreement with the presence in the monkey V6A of neurons employing either retinotopic, spatial, or mixed reference frames during reach plan. This work provides the first causal evidence of the critical role of hV6A in the planning of visually guided reaching movements in depth.

Visual Scanning Techniques and Mental Workload of Helicopter Pilots During Simulated Flight.

INTRODUCTION: The visual scanning techniques used by helicopter pilots are a critical skill to accomplish safe and correct landing. According to the human information processing theory, visual scanning techniques can be analyzed as a function of fixation location, number, and duration of fixations.METHODS: This study assessed these techniques in expert and novice pilots during an open sea flight simulation in a low-workload condition, consisting of a daylight and good weather simulation, and in a high-workload condition of night-time, low visibility, and adverse weather conditions. Taking part in the study were 12 helicopter pilots. Mental workload was assessed through psychological measures (NASA-TLX). The pilots performance was assessed and eye movements were recorded using an eye-tracker during four phases of the flight simulations.RESULTS: Overall, pilots made more fixations out of the window (OTW; 22.54) than inside the cockpit (ITC; 11.08), Fixations were longer OTW (830.17 ms) than ITC (647.97 ms) and they were shorter in the low-demand condition (626.27 ms). Further, pilots reported higher mental workload (NASA-TLX) in the high-demand condition compared to the low-demand condition, regardless of their expertise, and expert pilots reported a lower mental workload compared to novice pilots.DISCUSSION: Pilots performance and perceived mental workload varied as a function of expertise and flight conditions. Pilots rely on instrument support during the cruise phase and external visual cues during the landing phase. The implications for a new visual landing system design are discussed.Rainieri G, Fraboni F, Russo G, Tul M, Pingitore A, Tessari A, Pietrantoni L. Visual scanning techniques and mental workload of helicopter pilots during simulated flight. Aerosp Med Hum Perform. 2021; 92(1):1119.