Abnormal visual scanning and impaired mental state recognition in pre-manifest Huntington disease.

Huntington's disease (HD) is a genetic neurodegenerative disorder that affects not only the motor but also the cognitive and the neuropsychiatric domain. In particular, deficits in mental state recognition may emerge already at early pre-manifest stages of the disease. The aim of this research was to explore the relation between visual scanning behavior and complex mental state recognition in individuals with pre-manifest HD (preHD). Eighteen preHD and eighteen age- and gender-matched healthy controls took the revised "Reading the Mind in the Eyes" test while their eye-movements were tracked. In addition to the expected deficits in mental state recognition, preHD showed abnormalities concerning all three scanning variables we considered, namely the absolute number of fixations (FC), the average fixation duration (AFD), and the percentage of time spent fixating (FTR). In preHD, FC and FTR but not AFD predicted mental state recognition over and beyond general disease-related declines in cognition and motor functioning. Notably, preHD showed abnormal vertical and horizontal fixation patterns, and these patterns predicted mental state recognition, suggesting the involvement of mechanisms related to the embodied processing of emotional stimuli. Overall, our results suggest that impaired facial mental state recognition in pre-manifest HD is partly due to emotional-motivational factors affecting the visual scanning of facial expressions.

The format of mental imagery: from a critical review to an integrated embodied representation approach.

The issue of the format of mental imagery is still an open debate. The classical analogue (depictive)-propositional (descriptive) debate has not provided definitive conclusions. Over the years, the debate has shifted within the frame of the embodied cognition approach, which focuses on the interdependence of perception, cognition and action. Although the simulation approach still retains the concept of representation, the more radical line of the embodied cognition approach emphasizes the importance of action and clearly disregards the concept of representation. In particular, the enactive approach focuses on motor procedures that allow the body to interact with the environment, whereas the sensorimotor approach focuses on the possession and exercise of sensorimotor knowledge about how the sensory input changes as a function of movement. In this review, the embodied approaches are presented and critically discussed. Then, in an attempt to show that the format of mental imagery varies according to the ability and the strategy used to represent information, the role of individual differences in imagery ability (e.g., vividness and expertise) and imagery strategy (e.g., object vs. spatial imagers) is reviewed. Since vividness is mainly associated with perceptual information, reflecting the activation level of specific imagery systems, whereas the preferred strategy used is mainly associated with perceptual (e.g., object imagery) or amodal and motor information (e.g., spatial imagery), the format of mental imagery appears to be based on dynamic embodied representations, depending on imagery abilities and imagery strategies.

From "Einfühlung" to empathy: exploring the relationship between aesthetic and interpersonal experience.

Is there a relationship between aesthetic and interpersonal experience? This question is motivated not only by the fact that historically experiences of both kinds have often been accounted for in terms of "empathy", the English translation of the German term "Einfühlung", but also by the fact that some contemporary theories refer to mechanisms underlying both aesthetic and interpersonal experience. In this Editorial introducing the special section titled "From 'Einfühlung' to empathy: exploring the relationship between aesthetic and interpersonal experience", we briefly sketch these two motivations and the relationship between the different mechanisms that have been associated with both aesthetic and interpersonal experience.

Working Memory Maintenance of Visual and Auditory Spatial Information Relies on Supramodal Neural Codes in the Dorsal Frontoparietal Cortex.

The frontoparietal attention network plays a pivotal role during working memory (WM) maintenance, especially under high-load conditions. Nevertheless, there is ongoing debate regarding whether this network relies on supramodal or modality-specific neural signatures. In this study, we used multi-voxel pattern analysis (MVPA) to evaluate the neural representation of visual versus auditory information during WM maintenance. During fMRI scanning, participants maintained small or large spatial configurations (low- or high-load trials) of either colour shades or sound pitches in WM for later retrieval. Participants were less accurate in retrieving high- vs. low-load trials, demonstrating an effective manipulation of WM load, irrespective of the sensory modality. The frontoparietal regions involved in maintaining high- vs. low-load spatial maps in either sensory modality were highlighted using a conjunction analysis. Widespread activity was found across the dorsal frontoparietal network, peaking on the frontal eye fields and the superior parietal lobule, bilaterally. Within these regions, MVPAs were performed to quantify the pattern of distinctness of visual vs. auditory neural codes during WM maintenance. These analyses failed to reveal distinguishable patterns in the dorsal frontoparietal regions, thus providing support for a common, supramodal neural code associated with the retention of either visual or auditory spatial configurations.

Cognitive reserve and its implications for rehabilitation and Alzheimer's disease.

According to the Cognitive reserve hypothesis, several factors related to mental engagement, such as level of education, type of occupation, leisure activities and social network, appear to affect the risk of developing clinical dementia. The present article provides an overview of the studies that have investigated the effects of mental engagement and cognitive stimulation specifically on dementia of the Alzheimer's type (AD). Mental training and cognitive stimulation interventions in AD have been shown to be useful in increasing patients' ability in performing activities of daily living (ADL), allowing them to maintain relative independence. Since cognitive engagement and stimulation are known to modify the brain processes to perform tasks, by recruiting alternative and more efficient networks, this review is especially focused on cognitive rehabilitation in AD patients, which has been shown to improve their global functioning and cognition. This perspective stresses the idea that cognitive reserve is not a fixed factor, but can be continuously modified by life experiences, even when the brain is already affected by neuropathology.

Technology-based intervention to help persons with minimally conscious state and pervasive motor disabilities perform environmentally relevant adaptive behavior.

Persons with a diagnosis of minimally conscious state and pervasive motor disabilities tend to be passive and isolated. A way to help them improve their adaptive behavior (relate to their environment) involves the use of intervention packages combining assistive technology with motivational strategies. The types of assistive technology included in those packages may consist of (a) microswitches allowing direct access to environmental stimuli, (b) combinations of microswitches and voice output communication devices (VOCAs) allowing stimulus access and calls for caregivers' attention, respectively, and (c) computer presentations of stimulus options and microswitches allowing choice among those options and access to them.

Cross-cultural differences in intercultural mindreading: Evidence from a sample of Palestinian, Italian, and German adolescents.

Despite the fact that the "Reading the Mind in the Eyes" Test (RMET) is now available in more than 20 languages, there are only very few cross-cultural researchers using this test, and these researchers generally focus on North American versus East Asian cultures. Considering that the RMET stimuli were selected and constructed in the United Kingdom, this research explored cross-cultural differences in intercultural mindreading with a large sample of adolescents from Palestine (PAL), Italy (ITA), and Germany (GER). In addition to significant main effects of age (younger < older) and gender (male < female), we found a significant main effect of country (PAL < ITA < GER) and a significant interaction between gender and country. Individualism was not related to mindreading in any of the three countries whereas collectivism was positively related in PAL, but not in ITA or GER, accounting only for a very small amount of the variance. Our results suggest that (a) there may be cultural ingroup effects on mindreading, (b) the known female superiority in mindreading may be moderated by cultural factors, and (c) depending on cultural factors, individualism and collectivism may be differently related to mindreading.

Vegetative state: efforts to curb misdiagnosis.

Media reports on the case of Rom Houben have constituted a new reminder of the risks of misdiagnosis with cases with apparent vegetative state, particularly when following the clinical consensus of the care team as diagnostic criterion. Systematic use of behavioral and non-behavioral assessment strategies (e.g., behavioral scales, event-related potentials, and neuro-imaging) may help reduce the aforementioned risks. A new learning assessment strategy could also be considered part of the assessment to extend the evaluation process. Signs of learning might be viewed as forms of concrete knowledge representing a basic level of non-reflective consciousness.

World Health Organisation Disability Assessment Schedule II: contribution to the Italian validation.

INTRODUCTION: The World Health Organisation Disability Assessment Schedule II (WHODAS II) is an instrument developed by the World Health Organisation in order to assess behavioural limitations and restrictions to participation experienced by an individual, independently from a medical diagnosis. The conceptual frame of reference of this instrument is the International Classification of Functioning, Disability and Health: ICF. Specifically, the instrument is designed to evaluate the functioning of the individual in six activity domains: Understanding and communicating, Getting around, Self-care, Getting along with people, Life activities, Participation in society. PURPOSES: Considering the widespread consent about the usefulness of the WHODAS II, the general aim of the present study is to provide a contribution to the validation of the Italian version. METHOD: The WHODAS II Italian version has been administered to a sample of 500 participants subdivided in two groups: 271 normal adults and 229 disabled adults. The disabled participants group has been subdivided in three sub-groups, according to their disability: 111 motor disabled, 45 mental disabled, 73 sensory disabled. RESULTS: The mean Total score of the WHODAS II is 12.95 for the normal adults and 22.93 for the disabled group. Either group obtains the least impairment in the Self-care domain. This could be probably due to the presence of social-health workers in everyday life for all Italian disabled people. For the three disabled participant groups separately computed the mean Total score is: 28.66 for the motor disabled, 24.60 for the mental disabled, and 14.97 for the sensory disabled, confirming that sensory disabled do not perceive their disability as a personal functioning problem but a socially constructed one. Some subscales of WHODAS II show relatively strong floor effects. The Cronbach's Alpha calculated for each of the subscales is found to be high. The correlations of the subscales show strong correlations in all subscales. CONCLUSIONS: The WHODAS II is a useful instrument for measuring disability and functioning in normal and disabled people. It shows high reliability and a stable factor structure; although an additional psychometric evaluation of a representative sample of Italian disabled should be carried out in order to reach standard scores for each macro-category of disability.

Recent Technology-Aided Programs to Support Adaptive Responses, Functional Activities, and Leisure and Communication in People With Significant Disabilities.

This paper presents an overview of recent technology-aided programs (i. e., technology-aided support tools) designed to help people with significant disabilities (a) engage in adaptive responses, functional activities, and leisure and communication, and thus (b) interact with their physical and social environment and improve their performance/achievement. In order to illustrate the support tools, the paper provides an overview of recent studies aimed at developing and assessing those tools. The paper also examines the tools' accessibility and usability, and comments on possible ways of modifying and advancing them to improve their impact. The tools taken into consideration concern, among others, (a) microswitches linked to computer systems, and aimed at promoting (i.e., through positive stimulation) minimal responses or functional body movements in individuals with intellectual disabilities and motor impairments; (b) computer systems, tablets, or smartphones aimed at supporting functional activity engagement of individuals with intellectual disabilities or Alzheimer's disease; and (c) microswitches with computer-aided systems, elaborate communication devices, and specifically arranged smartphones or tablets, directed at promoting leisure, communication, or both.

Multisensory integration affects ERP components elicited by exogenous cues.

Previous studies have shown that the amplitude of event related brain potentials (ERPs) elicited by a combined audiovisual stimulus is larger than the sum of a single auditory and visual stimulus. This enlargement is thought to reflect multisensory integration. Based on these data, it may be hypothesized that the speeding up of responses, due to exogenous orienting effects induced by bimodal cues, exceeds the sum of single unimodal cues. Behavioral data, however, typically revealed no increased orienting effect following bimodal as compared to unimodal cues, which could be due to a failure of multisensory integration of the cues. To examine this possibility, we computed ERPs elicited by both bimodal (audiovisual) and unimodal (either auditory or visual) cues, and determined their exogenous orienting effects on responses to a to-be-discriminated visual target. Interestingly, the posterior P1 component elicited by bimodal cues was larger than the sum of the P1 components elicited by a single auditory and visual cue (i.e., a superadditive effect), but no enhanced orienting effect was found on response speed. The latter result suggests that multisensory integration elicited by our bimodal cues plays no special role for spatial orienting, at least in the present setting.

On the Relationship Between Attention Processing and P300-Based Brain Computer Interface Control in Amyotrophic Lateral Sclerosis.

Our objective was to investigate the capacity to control a P3-based brain-computer interface (BCI) device for communication and its related (temporal) attention processing in a sample of amyotrophic lateral sclerosis (ALS) patients with respect to healthy subjects. The ultimate goal was to corroborate the role of cognitive mechanisms in event-related potential (ERP)-based BCI control in ALS patients. Furthermore, the possible differences in such attentional mechanisms between the two groups were investigated in order to unveil possible alterations associated with the ALS condition. Thirteen ALS patients and 13 healthy volunteers matched for age and years of education underwent a P3-speller BCI task and a rapid serial visual presentation (RSVP) task. The RSVP task was performed by participants in order to screen their temporal pattern of attentional resource allocation, namely: (i) the temporal attentional filtering capacity (scored as T1%); and (ii) the capability to adequately update the attentive filter in the temporal dynamics of the attentional selection (scored as T2%). For the P3-speller BCI task, the online accuracy and information transfer rate (ITR) were obtained. Centroid Latency and Mean Amplitude of N200 and P300 were also obtained. No significant differences emerged between ALS patients and Controls with regards to online accuracy (p = 0.13). Differently, the performance in controlling the P3-speller expressed as ITR values (calculated offline) were compromised in ALS patients (p < 0.05), with a delay in the latency of P3 when processing BCI stimuli as compared with Control group (p < 0.01). Furthermore, the temporal aspect of attentional filtering which was related to BCI control (r = 0.51; p < 0.05) and to the P3 wave amplitude (r = 0.63; p < 0.05) was also altered in ALS patients (p = 0.01). These findings ground the knowledge required to develop sensible classes of BCI specifically designed by taking into account the influence of the cognitive characteristics of the possible candidates in need of a BCI system for communication.

Why Early Tactile Speech Aids May Have Failed: No Perceptual Integration of Tactile and Auditory Signals.

Tactile speech aids, though extensively studied in the 1980's and 1990's, never became a commercial success. A hypothesis to explain this failure might be that it is difficult to obtain true perceptual integration of a tactile signal with information from auditory speech: exploitation of tactile cues from a tactile aid might require cognitive effort and so prevent speech understanding at the high rates typical of everyday speech. To test this hypothesis, we attempted to create true perceptual integration of tactile with auditory information in what might be considered the simplest situation encountered by a hearing-impaired listener. We created an auditory continuum between the syllables /BA/ and /VA/, and trained participants to associate /BA/ to one tactile stimulus and /VA/ to another tactile stimulus. After training, we tested if auditory discrimination along the continuum between the two syllables could be biased by incongruent tactile stimulation. We found that such a bias occurred only when the tactile stimulus was above, but not when it was below its previously measured tactile discrimination threshold. Such a pattern is compatible with the idea that the effect is due to a cognitive or decisional strategy, rather than to truly perceptual integration. We therefore ran a further study (Experiment 2), where we created a tactile version of the McGurk effect. We extensively trained two Subjects over 6 days to associate four recorded auditory syllables with four corresponding apparent motion tactile patterns. In a subsequent test, we presented stimulation that was either congruent or incongruent with the learnt association, and asked Subjects to report the syllable they perceived. We found no analog to the McGurk effect, suggesting that the tactile stimulation was not being perceptually integrated with the auditory syllable. These findings strengthen our hypothesis according to which tactile aids failed because integration of tactile cues with auditory speech occurred at a cognitive or decisional level, rather than truly at a perceptual level.

The suppression of reflexive visual and auditory orienting when attention is otherwise engaged.

Two experiments were conducted to examine whether abrupt onsets are capable of reflexively capturing attention when they occur outside the current focus of spatial attention, as would be expected if exogenous orienting operates in a truly automatic fashion. The authors established a highly focused attentional state by means of the central presentation of a stream of visual or auditory characters, which participants sometimes had to monitor. No intramodal reflexive cuing effects were observed in either audition or vision when participants performed either an exogenous visual or auditory orthogonal cuing task together with the central focused attention task. These results suggest that reflexive unimodal orienting is not truly automatic. The fact that cuing effects were eliminated under both unimodal and cross-modal conditions is consistent with the view that auditory and visual reflexive spatial orienting are controlled by a common underlying neural substrate.

The head-centered meridian effect: auditory attention orienting in conditions of impaired visuo-spatial information.

This paper examines the characteristics of spatial attention orienting in situations of visual impairment. Two groups of subjects, respectively schizophrenic and blind, with different degrees of visual spatial information impairment, were tested. In Experiment 1, the schizophrenic subjects were instructed to detect an auditory target, which was preceded by a visual cue. The cue could appear in the same location as the target, separated from it respectively by the vertical visual meridian (VM), the vertical head-centered meridian (HCM) or another meridian. Similarly to normal subjects tested with the same paradigm (Ferlazzo, Couyoumdjian, Padovani, and Olivetti Belardinelli, 2002), schizophrenic subjects showed slower reactions times (RTs) when cued, and when the target locations were on the opposite sides of the HCM. This HCM effect strengthens the assumption that different auditory and visual spatial maps underlie the representation of attention orienting mechanisms. In Experiment 2, blind subjects were asked to detect an auditory target, which had been preceded by an auditory cue, while staring at an imaginary point. The point was located either to the left or to the right, in order to control for ocular movements and maintain the dissociation between the HCM and the VM. Differences between crossing and no-crossing conditions of HCM were not found. Therefore it is possible to consider the HCM effect as a consequence of the interaction between visual and auditory modalities. Related theoretical issues are also discussed.

Checking an integrated model of web accessibility and usability evaluation for disabled people.

A combined objective-oriented and subjective-oriented method for evaluating accessibility and usability of web pages for students with disability was tested. The objective-oriented approach is devoted to verifying the conformity of interfaces to standard rules stated by national and international organizations responsible for web technology standardization, such as W3C. Conversely, the subjective-oriented approach allows assessing how the final users interact with the artificial system, accessing levels of user satisfaction based on personal factors and environmental barriers. Five kinds of measurements were applied as objective-oriented and subjective-oriented tests. Objective-oriented evaluations were performed on the Help Desk web page for students with disability, included in the website of a large Italian state university. Subjective-oriented tests were administered to 19 students labeled as disabled on the basis of their own declaration at the University enrolment: 13 students were tested by means of the SUMI test and six students by means of the 'Cooperative evaluation'. Objective-oriented and subjective-oriented methods highlighted different and sometimes conflicting results. Both methods have pointed out much more consistency regarding levels of accessibility than of usability. Since usability is largely affected by individual differences in user's own (dis)abilities, subjective-oriented measures underscored the fact that blind students encountered much more web surfing difficulties.

Usability and Workload of Access Technology for People With Severe Motor Impairment: A Comparison of Brain-Computer Interfacing and Eye Tracking.

BACKGROUND: Eye trackers are widely used among people with amyotrophic lateral sclerosis, and their benefits to quality of life have been previously shown. On the contrary, Brain-computer interfaces (BCIs) are still quite a novel technology, which also serves as an access technology for people with severe motor impairment. OBJECTIVE: To compare a visual P300-based BCI and an eye tracker in terms of information transfer rate (ITR), usability, and cognitive workload in users with motor impairments. METHODS: Each participant performed 3 spelling tasks, over 4 total sessions, using an Internet browser, which was controlled by a spelling interface that was suitable for use with either the BCI or the eye tracker. At the end of each session, participants evaluated usability and cognitive workload of the system. RESULTS: ITR and System Usability Scale (SUS) score were higher for the eye tracker (Wilcoxon signed-rank test: ITR T = 9, P = .016; SUS T = 12.50, P = .035). Cognitive workload was higher for the BCI (T = 4; P = .003). CONCLUSIONS: Although BCIs could be potentially useful for people with severe physical disabilities, we showed that the usability of BCIs based on the visual P300 remains inferior to eye tracking. We suggest that future research on visual BCIs should use eye tracking-based control as a comparison to evaluate performance or focus on nonvisual paradigms for persons who have lost gaze control.