User-centered practices in the eyes of informal caregivers of in-patients with severe acquired brain injury: needs, caring experience, and satisfaction.

OBJECTIVE: This study examines the perceived needs, experience, and satisfaction of informal caregivers (ICGs) in in-hospital settings, related to their involvement in the design and delivery of services together with hospital staff, namely co-production. DESIGN: To obtain a picture of current ICG-staff relationship, a multicenter observational study was carried out. Participants were 75 ICGs recruited in five dedicated in-patient neurorehabilitation wards. Participants answered a self-report questionnaire tapping perceived information/communication needs, emotional/social needs, and their satisfaction; family-centered practices implemented by the staff (namely involving practices and cooperative communication); and ICGs' satisfaction with the service. RESULTS: Need satisfaction related positively to staff practices aimed at involving IGCs in treatment and training, but not in decision-making. Involving practices concerning treatment also related positively to ICGs' information/communication needs. In addition, the more the staff involved ICGs in decision-making and promoted cooperative communication regarding treatment, the more ICGs felt that their collaboration in the healthcare process was valuable. Finally, all involvement practices and cooperative communication were positively related to ICGs' overall satisfaction with the service. CONCLUSION: The results of the study help to identify gaps in meeting ICGs' needs and to promote strategies to implement family participation toward co-production in in-hospital settings.

Temporal preparation in adults with autistic spectrum disorder: The variable foreperiod effect.

Research suggested the possibility that temporal cognition may be different in autistic spectrum disorder (ASD). Although there are some empirical studies examining timing ability in these individuals, to our knowledge, no one directly assessed the ability to predict when an event will occur. Here, we report a study on implicit temporal preparation in individuals with ASD as indexed by the variable foreperiod (FP) effect. We compared a group of adult ASD participants to a group of typically-developed (TD) controls, for their respective abilities to utilize implicit temporal information in a simple detection task with three different preparatory intervals (FP, short, middle and long). Participants were given a warning tone to signal an imminent stimulus, and asked to press a key as quickly as they could upon detection of the stimulus. Both groups were able to use implicit temporal information, as revealed by both the variable-FP effect (i.e., faster response for targets appearing after a long FP) and asymmetric sequential effects (i.e., slower response in short-FP trials following a previous long-FP trial). The TD group exhibited a faster response in a long-FP trial that was preceded by short-FP one, whereas the ASD group did not, as reflected in their higher percentage of response omissions for a target that appeared later than in the previous trial. The reduced ability of ASD participants to modulate their responses under these conditions might reflect a difficulty in time-based monitoring of stimulus occurrence. LAY SUMMARY: Time-processing may be different in autistic spectrum disorder (ASD). This study addressed the ability to anticipate a relevant stimulus's onset according to predictable interstimulus intervals comparing adults with ASD and typically developed controls. We found that ASD participants did not benefit from temporal preparation when stimulus appeared later than previously attended. This suggests a reduced ability in detecting implicit temporal regularities between events.

Caregivers' engagement during in-hospital care of sABI's patients: Evaluation of informal co-production from the health providers' perspective.

One of the challenges of providing healthcare services is to enhance its value (for patients, staff and the service) by integrating the informal caregivers into the care process, both concretely managing their patient's health conditions and treatment (co-executing) and participating in the whole healthcare process (co-planning). This study aims at exploring the co-production contribution to the healthcare process, analysing whether and how it is related to higher caregivers' satisfaction with service care and reduced staff burnout, in the eyes of the staff. It also investigated two possible factors supporting caregivers in their role of co-producers, namely relationship among staff and informal caregivers related to knowledge sharing (i.e. an ability determinant supporting co-production) and related to role social conflict (i.e. a willingness determinant reducing co-production). Results of a structural equation model on a sample of 119 healthcare providers employed by neurorehabilitation centers in Italy with severe acquired brain injury confirmed that knowledge sharing positively related with caregivers' co-executing and co-planning. Also, social role conflict was negatively related with co-executing but positively with co-planning. Furthermore, co-planning resulted in being unrelated to both outcomes, whereas co-executing was associated with caregivers' satisfaction, as measured by staff perceptions. Overall, our data provided initial empirical evidence supporting the ability of the determinant's contribution in allowing informal caregivers to assume an active role in both co-production domains. Furthermore, as expected, the role of conflict willingness determinant was found to be a hindering factor for co-executing but, conversely, a trigger for co-planning. This result should be considered more carefully in future studies.

Associative cueing of attention through implicit feature-location binding.

In order to assess associative learning between two task-irrelevant features in cueing spatial attention, we devised a task in which participants have to make an identity comparison between two sequential visual stimuli. Unbeknownst to them, location of the second stimulus could be predicted by the colour of the first or a concurrent sound. Albeit unnecessary to perform the identity-matching judgment the predictive features thus provided an arbitrary association favouring the spatial anticipation of the second stimulus. A significant advantage was found with faster responses at predicted compared to non-predicted locations. Results clearly demonstrated an associative cueing of attention via a second-order arbitrary feature/location association but with a substantial discrepancy depending on the sensory modality of the predictive feature. With colour as predictive feature, significant advantages emerged only after the completion of three blocks of trials. On the contrary, sound affected responses from the first block of trials and significant advantages were manifest from the beginning of the second. The possible mechanisms underlying the associative cueing of attention in both conditions are discussed.

Timing the events of directional cueing.

To explore the role of temporal context on voluntary orienting of attention, we submitted healthy participants to a spatial cueing task in which cue-target stimulus onset asynchronies (SOAs) were organized according to two-dimensional parameters: range and central value. Three ranges of SOAs organized around two central SOA values were presented to six groups of participants. Results showed a complex pattern of responses in terms of spatial validity (faster responses to correctly cued target) and preparatory effect (faster responses to longer SOAs). Responses to validly and neutrally cued targets were affected by the increase in SOA duration if the difference between longer and shorter SOA was large. On the contrary, responses to invalidly cued targets did not vary according to SOA manipulations. The observed pattern of cueing effects does not fit in the typical description of spatial attention working as a mandatory disengaging-shifting-engaging routine. In contrast, results rather suggest a mechanism based on the interaction between context sensitive top-down processes and bottom-up attentional processes.

Cueing spatial attention through timing and probability.

Even when focused on an effortful task we retain the ability to detect salient environmental information, and even irrelevant visual stimuli can be automatically detected. However, to which extent unattended information affects attentional control is not fully understood. Here we provide evidences of how the brain spontaneously organizes its cognitive resources by shifting attention between a selective-attending and a stimulus-driven modality within a single task. Using a spatial cueing paradigm we investigated the effect of cue-target asynchronies as a function of their probabilities of occurrence (i.e., relative frequency). Results show that this accessory information modulates attentional shifts. A valid spatial cue improved participants' performance as compared to an invalid one only in trials in which target onset was highly predictable because of its more robust occurrence. Conversely, cuing proved ineffective when spatial cue and target were associated according to a less frequent asynchrony. These patterns of response depended on asynchronies' probability and not on their duration. Our findings clearly demonstrate that through a fine decision-making, performed trial-by-trial, the brain utilizes implicit information to decide whether or not voluntarily shifting spatial attention. As if according to a cost-planning strategy, the cognitive effort of shifting attention depending on the cue is performed only when the expected advantages are higher. In a trade-off competition for cognitive resources, voluntary/automatic attending may thus be a more complex process than expected.

Context effects on the processing of action-relevant object features.

In 4 experiments, we investigated the effects of object affordance in reach-to-grasp actions. Participants indicated whether a depicted small or large object was natural or manmade by means of different object-grasping responses (i.e., with a power or a precision grip). We observed that the size of the depicted object affected the grasping kinematics (grip aperture) and the reach-onset times of compatible and incompatible actions. Additional experiments showed that the effect of perceived object size on motor response was modulated by contextual action information and the observation of others' actions with the object. Thus, beyond the observation of object affordance effects in natural grasping actions, this study suggests that the coupling between object perception and action is not static and obligatory. Behavioral effects of action-relevant object features seem rather to depend on contextual action information.

Getting a grip on numbers: numerical magnitude priming in object grasping.

To investigate the functional connection between numerical cognition and action planning, the authors required participants to perform different grasping responses depending on the parity status of Arabic digits. The results show that precision grip actions were initiated faster in response to small numbers, whereas power grips were initiated faster in response to large numbers. Moreover, analyses of the grasping kinematics reveal an enlarged maximum grip aperture in the presence of large numbers. Reaction time effects remained present when controlling for the number of fingers used while grasping but disappeared when participants pointed to the object. The data indicate a priming of size-related motor features by numerals and support the idea that representations of numbers and actions share common cognitive codes within a generalized magnitude system.