Feasibility and acceptability of a new web-based cognitive training platform for cognitively healthy older adults: the breakfast task.

BACKGROUND: Developing efficient cognitive training for the older population is a major public health goal due to its potential cognitive benefits. A promising training target is executive control, critical for multitasking in everyday life. The aim of this pilot study was to establish the feasibility and acceptability of the Breakfast Task training in older adults, a new web-based cognitive training platform that simulates real-life multitasking demands. METHODS: A community-based sample of 24 cognitively healthy participants aged between 60 and 75 (M = 69.12, SD = 3.83) underwent 5-session cognitive training protocol, delivered online. Each session lasted 45 min and occurred twice a week at participant's homes. Performance was recorded, and participants completed questionnaires at baseline and after the intervention. RESULTS: Feasibility metrics showed overall high recruitment (82.7%), adherence and retention rates (100%). Acceptability was considered good based on participant's quantitative and qualitative responses. On average, participants rated the game as interesting, enjoyable and did not report difficulties in accessing the game online without supervision or in understanding the instructions. Participants showed a learning curve across sessions, suggesting improvement in the game outcomes and potential benefits from the emphasis change training approach. The study identified relevant areas that need improvements and adjustments, such as technical issues, session's structure, and dose. CONCLUSIONS: The findings provide preliminary support for the feasibility and acceptability of the web-based Breakfast Task training platform in cognitively healthy older adults. Results suggest the value of further research to investigate the Breakfast Task training features and dose-response relationship, as well as its potential efficacy in older adults via larger randomized controlled trials. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04195230 (Registered 11 December 2019).

Imposed load versus voluntary investment: Executive control and attention management in dual-task performance.

Dual task performance is one of the most frequently used paradigm in the evaluation of coping with concurrent task demands. The Breakfast Task experimented in this paper, was originally developed as a general indicator of coping ability with high demand executive control and attention management requirements. It is a computer-based simulation, in which the performer is required to cook several food items while concurrently setting table for guests. The task was employed in different studies, to compare young to old adults, monolinguals to bilinguals, influence of Parkinson disease and brain injury. However, in a closer examination, it is a dual task setting, in which cooking reflects coping with imposed load while table setting is an indicator of strategy free, voluntary invested effort. Models of workload did not examine the impact of such asymmetric flexibility on concurrent performance. Three experiments with elaborated versions of the breakfast task, show that the difference between the tasks affects concurrent performance formats in response to manipulations of task difficulty, priority change and practice. These results and their implications are discussed in reference to limited capacity, resource and executive control models of multitasking and task load.

The Effect of Confidence Rating on a Primary Visual Task.

The current study explored the influence of confidence rating on visual acuity. We used brief exposures of the Landolt gap discrimination task, probing the primary visual ability to detect contrast. During 200 practice trials, participants in the Confidence Rating group rated their response-confidence in each trial. A second (Time Delay) group received a short break at the end of each trial, equivalent to the average rating response time of the Confidence Rating group. The third (Standard Task) group performed the Landolt gap task in its original form. During practice, the Confidence Rating group developed an efficient monitoring ability indicated by a significant correlation between accuracy and confidence rating and a moderate calibration index score. Following practice, all groups performed 400 identical test trials of the standard Landolt gap task. In the test trials, the Confidence Rating group responded more accurately than the control groups, though it did not differ from them in response time for correct answers. Remarkably, the Confidence Rating group was significantly slower when making errors, compared the control groups. An interaction in learning efficiency occurred: the Confidence Rating group significantly improved its reaction times after the initial practice, as compared to both control groups. The findings demonstrate an effect of confidence rating on the formation of processing and response strategies, which granted participants significant benefits in later performance.

The Joint Effects of Spatial Cueing and Transcranial Direct Current Stimulation on Visual Acuity.

The present study examined the mutual influence of cortical neuroenhancement and allocation of spatial attention on perception. Specifically, it explored the effects of transcranial Direct Current Stimulation (tDCS) on visual acuity measured with a Landolt gap task and attentional precues. The exogenous cues were used to draw attention either to the location of the target or away from it, generating significant performance benefits and costs. Anodal tDCS applied to posterior occipital area for 15 min improved performance during stimulation, reflecting heightened visual acuity. Reaction times were lower, and accuracy was higher in the tDCS group, compared to a sham control group. Additionally, in post-stimulation trials tDCS significantly interacted with the effect of precuing. Reaction times were lower in valid cued trials (benefit) and higher in invalid trials (cost) compared to neutrally cued trials, the effect which was pronounced stronger in tDCS group than in sham control group. The increase of cost and benefit effects in the tDCS group was of a similar magnitude, suggesting that anodal tDCS influenced the overall process of attention orienting. The observed interaction between the stimulation of the visual cortex and precueing indicates a magnification of attention modulation.

Age-Based Differences in Task Switching Are Moderated by Executive Control Demands.

Objectives: Recent work has identified different aspects of executive function that may underlie cognitive changes associated with age. The current study used a multifactorial design to investigate age sensitivity in the ability to shift between different task sets and the interaction of this ability with several specific aspects of executive control. Method: A large, well-characterized sample of younger (n = 40) and clinically healthy older (n = 51) adults completed a task switching paradigm in which 3 aspects of executive control were manipulated between subjects: a) sensorimotor demand (the number of distinct stimulus-response options); b) stimulus-level interference (i.e., flanker effects); and c) updating/monitoring (the frequency of task switches). Results: Unique age-related deficits were observed for different aspects of local task switching performance costs and updating/monitoring, but not for interference. Sensorimotor demand was also an important additional factor that interacted with task switching performance. Discussion: Our findings suggest that task switching, coupled with infrequent and unexpected transitions from one task set to another, in the context of high motoric demands, is particularly difficult for older adults.

Guiding Principles for a Pediatric Neurology ICU (neuroPICU) Bedside Multimodal Monitor: Findings from an International Working Group.

BACKGROUND: Physicians caring for children with serious acute neurologic disease must process overwhelming amounts of physiological and medical information. Strategies to optimize real time display of this information are understudied. OBJECTIVES: Our goal was to engage clinical and engineering experts to develop guiding principles for creating a pediatric neurology intensive care unit (neuroPICU) monitor that integrates and displays data from multiple sources in an intuitive and informative manner. METHODS: To accomplish this goal, an international group of physicians and engineers communicated regularly for one year. We integrated findings from clinical observations, interviews, a survey, signal processing, and visualization exercises to develop a concept for a neuroPICU display. RESULTS: Key conclusions from our efforts include: (1) A neuroPICU display should support (a) rapid review of retrospective time series (i.e. cardiac, pulmonary, and neurologic physiology data), (b) rapidly modifiable formats for viewing that data according to the specialty of the reviewer, and (c) communication of the degree of risk of clinical decline. (2) Specialized visualizations of physiologic parameters can highlight abnormalities in multivariable temporal data. Examples include 3-D stacked spider plots and color coded time series plots. (3) Visual summaries of EEG with spectral tools (i.e. hemispheric asymmetry and median power) can highlight seizures via patient-specific "fingerprints." (4) Intuitive displays should emphasize subsets of physiology and processed EEG data to provide a rapid gestalt of the current status and medical stability of a patient. CONCLUSIONS: A well-designed neuroPICU display must present multiple datasets in dynamic, flexible, and informative views to accommodate clinicians from multiple disciplines in a variety of clinical scenarios.

Human factors-focused reporting system for improving care quality and safety in hospital wards.

OBJECTIVE: The aim was to develop a reporting system for collecting human factors problem reports to establish a database to guide activities for improving health care quality and patient safety. BACKGROUND: The current error and incident report systems do not provide sufficient and adequate coverage of the factors contributing to impaired safety and care quality. They fail to examine the range of difficulties that clinical staff encounters in the conduct of daily work. METHOD: A voluntary problem-reporting system was developed to be used by hospital wards' clinicians and was tested in four wards of two hospitals in Israel. The system is based on human factors--formatted problem reports submitted by physicians and nurses on difficulties and hazards they confront in their daily work. Reports are grouped and evaluated by a team of human factor professionals. RESULTS: A total of 359 reports were collected in the wards during 12 weeks, as compared with a total of 200 incidents reports that were collected during a period of 5 years with the existing obligatory incident reporting system. In-depth observational studies conducted on the wards confirmed the ability of the new system to highlight major human factors problems, differentially identifying specific problems in each of the wards studied. Problems reported were directly related to general factors affecting care quality and patient safety. CONCLUSION: Validation studies confirmed the reliability of the reporting system in pinpointing major problems per investigated unit according to its specific characteristics. APPLICATION: This type of reporting system could fill an important information gap with the potential to be a cost-effective initial database source to guide human factors efforts to improve care quality, reduce errors, and increase patient safety.

Skill training in multimodal virtual environments.

Multimodal, immersive, virtual reality (VR) techniques open new perspectives for perceptual-motor skill trainers. They also introduce new risks and dangers. This paper describes the benefits and pitfalls of multimodal training and the cognitive building blocks of a multimodal, VR training simulators.

Space Fortress game training and executive control in older adults: a pilot intervention.

We investigated the feasibility of using the Space Fortress (SF) game, a complex video game originally developed to study complex skill acquisition in young adults, to improve executive control processes in cognitively healthy older adults. The study protocol consisted of 36 one-hour game play sessions over 3 months with cognitive evaluations before and after, and a follow-up evaluation at 6 months. Sixty participants were randomized to one of three conditions: Emphasis Change (EC)--elders were instructed to concentrate on playing the entire game but place particular emphasis on a specific aspect of game play in each particular game; Active Control (AC)--game play with standard instructions; Passive Control (PC)--evaluation sessions without game play. Primary outcome measures were obtained from five tasks, presumably tapping executive control processes. A total of 54 older adults completed the study protocol. One measure of executive control, WAIS-III letter-number sequencing, showed improvement in performance from pre- to post-evaluations in the EC condition, but not in the other two conditions. These initial findings are modest but encouraging. Future SF interventions need to carefully consider increasing the duration and or the intensity of the intervention by providing at-home game training, reducing the motor demands of the game, and selecting appropriate outcome measures.

Effect of descriptive information and experience on automation reliance.

OBJECTIVE: The present research addresses the issue of reliance on decision support systems for the long-term (DSSLT), which help users develop decision-making strategies and long-term planning. It is argued that providing information about a system's future performance in an experiential manner, as compared with a descriptive manner, encourages users to increase their reliance level. BACKGROUND: Establishing appropriate reliance on DSSLT is contingent on the system developer's ability to provide users with information about the system's future performance. METHOD: A sequence of three studies contrasts the effect on automation reliance of providing descriptive information versus experience for DSSLT with two different positive expected values of recommendations. RESULTS: Study I demonstrated that when automation reliance was determined solely on the basis of description, it was relatively low, but it increased significantly when a decision was made after experience with 50 training simulations. Participants were able to learn to increase their automation reliance levels when they encountered the same type of recommendation again. Study 2 showed that the absence of preliminary descriptive information did not affect the automation reliance levels obtained after experience. Study 3 demonstrated that participants were able to generalize their learning about increasing reliance levels to new recommendations. CONCLUSION: Using experience rather than description to give users information about future performance in DSSLT can help increase automation reliance levels. APPLICATIONS: Implications for designing DSSLT and decision support systems in general are discussed.

Training cognitive control in older adults with the space fortress game: the role of training instructions and basic motor ability.

This study examined if and how cognitively healthy older adults can learn to play a complex computer-based action game called the Space Fortress (SF) as a function of training instructions [Standard vs. Emphasis Change (EC); e.g., Gopher et al., 1989] and basic motor ability. A total of 35 cognitively healthy older adults completed a 3-month SF training program with three SF sessions weekly. Twelve 3-min games were played during each session. Basic motor ability was assessed with an aiming task, which required rapidly rotating a spaceship to shoot targets. Older adults showed improved performance on the SF task over time, but did not perform at the same level as younger adults. Unlike studies of younger adults, overall SF performance in older adults was greater following standard instructions than following EC instructions. However, this advantage was primarily due to collecting more bonus points and not - the primary goal of the game - shooting and destroying the fortress, which in contrast benefited from EC instructions. Basic motor ability was low and influenced many different aspects of SF game learning, often interacted with learning rate, and influenced overall SF performance. These findings show that older adults can be trained to deal with the complexity of the SF task but that overall SF performance, and the ability to capitalize on EC instructions, differs when a basic ability such as motor control is low. Hence, the development of this training program as a cognitive intervention that can potentially compensate for age-related cognitive decline should consider that basic motor ability can interact with the efficiency of training instructions that promote the use of cognitive control (e.g., EC instructions) - and the confluence between such basic abilities and higher-level cognitive control abilities should be further examined.

Preoperative briefing in the operating room: shared cognition, teamwork, and patient safety.

Contemporary preoperative team briefings conducted to improve patient safety focus mainly on supplying identification details regarding the patient and the surgical procedure. Drawing on cognitive theory principles, in this study a briefing protocol was developed that presents a broader perspective model of the patient and the planned procedure. In addition to customary identification details and drug sensitivities, the new briefing also includes review of significant background information, needed equipment, planned surgery stages, and so forth. The briefing content was developed following 130 continuous, nonstructured observations conducted in gynecologic and orthopedic operating rooms. The briefing form was designed as a large poster hung in a visible position on the operating room wall. The poster guides the team members (ie, nurses, surgeons, and anesthesiologists) in their conduct. Briefing is conducted orally, and no written records are required. The number of nonroutine events (ie, situations that, if not corrected, might lead to patient harm) observed in the 130 surgeries conducted without briefing was compared with the number of events in 102 surgeries in which briefing was conducted. There was a 25% reduction in the number of nonroutine events when briefing was conducted and a significant increase in the number of surgeries in which no nonroutine event was observed. Team members evaluated the briefing as most valuable for their own work, the teamwork, and patient safety. Following the study, the new briefing format was accepted and adopted for routine use. Team briefings designed to supply a broader-perspective surgery model may be an easy-to-apply tool to reduce the number of nonroutine events during surgery and increase patient safety.

Effects of task difficulty and invested mental effort on peripheral vasoconstriction.

We ran two experiments to investigate whether peripheral arterial tone reflects changes in mental effort. Finger pulse wave amplitude, interpulse interval, and pulse variability in the mid- and high-frequency bands were recorded by means of a newly developed finger plethysmograph during both rest and cognitive performance. Using a modified version of the Sternberg memory task, we selectively manipulated either the difficulty of the task (Experiment 1) or the subjects' level of engagement in the task (Experiment 2). We found a significant difference in finger pulse wave amplitude between rest and task periods, suggesting that the measure reflects changes in sympathetic activity due to task engagement. In addition, our results suggest that reduced pulse wave amplitude, signaling vasoconstriction, occurs when subjects are investing effort.

Melioration and the transition from touch-typing training to everyday use.

Previous research shows that success in touch-typing training does not ensure its continuation into everyday use. It is postulated that an important contributor to this problem is melioration--that is, maximizing local rates of reinforcement. In the context of typing, melioration implies an intuitive tendency to choose typing strategies that lead to a better immediate performance level than that obtained by touchtyping. One such strategy is visually guided typing, in which the performer looks at the keys to locate their position. The present research describes a training approach that changes the reinforcement structure by increasing the attractiveness of looking at the screen while typing. This approach is implemented by using a secondary task that requires typists to respond to signals appearing on the screen. In an experiment that evaluated this solution, 22 students were given a touch-typing training course followed by a period in which they had to type their own homework. The results showed that under a modified reinforcement condition, the effect of melioration on touch-typing scores in the posttraining phase decreased. In addition, the experimental manipulation facilitated the acquisition and maintenance of the touch-typing skill. Actual or potential applications of this research include research in training, choice behavior, and human-computer interaction.

Residual effects of daytime administration of melatonin on performance relevant to flight.

There is a general consensus that melatonin possesses time-dependent hypnotic effects, but there is no information yet whether it has residual effects on neurobehavioral performance, especially after daytime administration. In the present study we investigated the possible residual effects of 3 mg melatonin on performance relevant to flight and on subjective feelings of sleepiness, arousal, activation and affect after a daytime nap, as a function of nap length. Fifteen reserve pilots of the Israeli Air Force participated in the study. The experiment consisted of four sessions during which either melatonin or placebo was administered at 16:00 h. In two conditions, subjects were allowed to sleep for 2 h (17:00-19:00 h) whereas in the other two only a 0.5-h nap was allowed. After the naps they started performing a flight simulator task every 2 h. Sleep efficiency significantly increased and sleep latency significantly decreased in both melatonin conditions compared to placebo. Flight performance was only mildly affected in the 0.5-h nap condition. Subjective assessment of sleepiness significantly differed between the two treatment conditions, only in the 0.5-h nap condition. Subjects felt sleepier 2-4 h after melatonin administration. To conclude, our data suggest that administration of melatonin before a brief daytime nap (about 0.5 h) may be associated with mild residual effects on psychomotor performance and may significantly affect subjective feeling of sleepiness for 2-4 h.