The influence of input and output modality on following instructions in working memory

Exploring techniques for encoding spoken instructions in working memory: a comparison of verbal rehearsal, motor imagery, self-enactment and action observation

Encoding and recalling spoken instructions is subject to working memory capacity limits. Previous research suggests action-based encoding facilitates instruction recall, but has not directly compared benefits across different types of action-based techniques. The current study addressed this in two experiments with young adults. In Experiment 1, participants listened to instructional sequences containing four action-object pairs, and encoded these instructions using either a motor imagery or verbal rehearsal technique, followed by recall via oral repetition or enactment. Memory for instructions was better when participants used a motor imagery technique during encoding, and when recalling the instructions by enactment. The advantage of using a motor imagery technique was present in both verbal and enacted recall. In Experiment 2, participants encoded spoken instructions whilst implementing one of four techniques (verbal rehearsal, motor imagery, observation of others' actions or self-enactment), and then recalled the instructions by oral repetition or enactment. For both verbal and enacted recall, memory for instructions was least accurate in the rehearsal condition, while the other encoding conditions did not differ from each other. These novel findings indicate similar benefits of imagining, observation and execution of actions in encoding spoken instructions, and enrich current understanding of action-based benefits in working memory.

Hanging on the telephone: Maintaining visuospatial bootstrapping over time in working memory

Visuospatial bootstrapping (VSB) refers to the phenomenon in which performance on a verbal working memory task can be enhanced by presenting the verbal material within a familiar visuospatial configuration. This effect is part of a broader literature concerning how working memory is influenced by use of multimodal codes and contributions from long-term memory. The present study aimed to establish whether the VSB effect extends over a brief (5-s) delay period, and to explore the possible mechanisms operating during retention. The VSB effect, as indicated by a verbal recall advantage for digit sequences presented within a familiar visuospatial configuration (modelled on the T-9 keypad) relative to a single-location display, was observed across four experiments. The presence and size of this effect changed with the type of concurrent task activity applied during the delay. Articulatory suppression (Experiment 1) increased the visuospatial display advantage, while spatial tapping (Experiment 2) and a visuospatial judgment task (Experiment 3) both removed it. Finally, manipulation of the attentional demands placed by a verbal task also reduced (but did not abolish) this effect (Experiment 4). This pattern of findings demonstrates how provision of familiar visuospatial information at encoding can continue to support verbal working memory over time, with varying demands on modality-specific and general processing resources.

Improving older adults' ability to follow instructions: benefits of actions at encoding and retrieval in working memory

The ability to follow instructions is critical for learning new skills and may support successful aging. Recent evidence indicates a close link between following instructions and working memory, and that action-based processing at encoding and retrieval can improve this ability. In this study, we examined the ability to follow instructions and the benefits of action-based processing in young and older adults. In Experiment 1, participants were presented with spoken or silent demonstrated instructions, then recalled them by oral repetition or physical enactment. Older adults produced fewer correct responses in all conditions. Both age groups were better at recalling demonstrated than spoken instructions in the verbal but not the enacted recall condition. Older adults also benefited from enacted recall relative to verbal recall, but to a smaller extent than younger adults. In Experiment 2, the additional benefit of dual modalities (spoken instructions with simultaneous demonstration) relative to single modality presentation (spoken instructions, or silent demonstration) was examined. Both age groups showed superior performance in dual modality conditions relative to spoken instructions when using verbal recall. These findings suggest that although following instruction ability appears to decline with age, older adults can still benefit from action at encoding and retrieval.

EXPRESS: Translating words into actions in working memory: the role of spatial-motoric coding

Research from a working memory perspective on the encoding and temporary maintenance of sequential instructions has established a consistent advantage for enacted over verbal recall. This is thought to reflect action planning for anticipated movements at the response phase. We describe five experiments investigating this, comparing verbal and enacted recall of a series of action–object pairings under different potentially disruptive concurrent task conditions, all requiring repetitive movements. A general advantage for enacted recall was observed across experiments, together with a tendency for concurrent action to impair sequence memory performance. The enacted recall advantage was reduced by concurrent action for both fine and gross concurrent movement with the degree of disruption influenced by both the complexity and the familiarity of the movement. The results are discussed in terms of an output buffer store of limited capacity capable of holding motoric plans for anticipated action.

Validation of the Cognitive Telephone Screening Instruments COGTEL and COGTEL+ in Identifying Clinically Diagnosed Neurocognitive Disorder Due to Alzheimer's Disease in a Naturalistic Clinical Setting

Background:

Telephone-based neurocognitive instruments embody valuable tools in identifying cognitive impairment in research settings and lately also in clinical contexts due to the pandemic crisis. The accuracy of the Cognitive Telephone Screening Instrument (COGTEL) in detecting mild- (MiND) and major (MaND) neurocognitive disorder has not been studied yet.

Objective:

Comparison of the utility of COGTEL and COGTEL+, which is enriched with orientation items, with the modified Mini-Mental State Examination (3MS) in detecting MiND and MaND due to Alzheimer’s disease (AD) and assessment of the impact of COGTEL face-to-face-versus telephone administration on individual performance.

Methods:

The study included 197 cognitively intact individuals (CI), being at least 45 years old, 95 and 65 patients with MiND and MaND due to AD, respectively. In 20 individuals COGTEL was administered both in face-to-face and telephone sessions. Statistical analyses included proportional odds logistic regression models, stratified repeated random subsampling used to recursive partitioning to training and validation set (70/30 ratio), and an appropriate F-test.

Results:

All studied instruments were significant predictors of diagnostic outcome, but COGTEL+ and 3MS explained more variance relative to the original COGTEL. Except for the validation regression models including COGTEL in which the average misclassification error slightly exceeded 15%, in all other cases the average misclassification errors (%) were lower than 15%. COGTEL administration modality was not related to systematic over- or underestimation of performance on COGTEL.

Conclusion:

COGTEL+ is a valuable instrument in detecting MiND and MaND and can be administered in face-to-face or telephone sessions.

Following Instructions in Working Memory: Do Older Adults Show the Enactment Advantage?

OBJECTIVES

In young adults, the ability to verbally recall instructions in working memory is enhanced if the sequences are physically enacted by the participant (self-enactment) or the experimenter (demonstration) during encoding. Here we examine the effects of self-enactment and demonstration at encoding on working memory performance in older and younger adults.

METHOD

Fifty young (18-23 years) and 40 older (60-89 years) adults listened to sequences of novel action-object pairs before verbally recalling them in the correct order. There were three different encoding conditions: spoken only, spoken + demonstration, and spoken + self-enactment. We included two different levels of difficulty to investigate whether task complexity moderated the effect of encoding condition and whether this differed between age groups.

RESULTS

Relative to the spoken only condition, demonstration significantly improved young and older adults' serial recall performance, but self-enactment only enhanced performance in the young adults, and this boost was smaller than the one gained through demonstration.

DISCUSSION

Our findings suggest that additional spatial-motoric information is beneficial for older adults when the actions are demonstrated to them, but not when the individual must enact the instructions themselves.

Comparing motor imagery and verbal rehearsal strategies in children's ability to follow spoken instructions

The ability to follow spoken instructions is critical for children's learning in school and relies on the storage and processing of information in working memory. This study compared the effects of two encoding strategies (motor imagery and verbal rehearsal) on children's ability to follow spoken instructions in a working memory paradigm. A total of 146 children aged 7-12 years completed an instruction span task. In this task, children listened to a series of action-object commands and encoded them by either motor imagery or verbal rehearsal. They then attempted to recall the sequence in serial order by either enacted recall or verbal recall. Overall, children's ability to follow spoken instructions increased with age. In all age groups, children showed superior recall of instructions when they imagined the actions compared with verbal rehearsal of the actions during encoding, and this benefit of motor imagery was similar for verbal recall and enacted recall. Younger children reported motor imagery as more helpful than verbal rehearsal for remembering instructions, whereas older children considered verbal rehearsal as more useful. The study provides novel evidence for motor imagery as a superior strategy (relative to verbal rehearsal) for remembering spoken instructions in school-age children.

Effects of Visual and Aural Presentation Styles and Rhythm on Working Memory as Measured by Monosyllabic Sequential Digit Recall

Although information is frequently paired with music to enhance recall, there is a lack of basic research investigating how aspects of recorded music, as well as how it is presented, facilitate working memory. Therefore, the purpose of this study was to determine the effects of visual and aural presentation styles, rhythm, and participant major on working memory as measured by sequential monosyllabic digit recall performance. We isolated visual and aural presentation styles and rhythm conditions during six different treatment stimuli presented on a computer screen in the study: (a) Visual Rhythm; (b) Visual No Rhythm; (c) Aural Rhythm; (d) Aural No Rhythm; (e) Visual + Aural Rhythm; (f) Visual + Aural No Rhythm. Participants' (N = 60; 30 nonmusic majors and 30 music majors) task was to immediately recall the information paired with music within each condition. Analyses of variance indicated a significant difference between the visual and visual + aural presentation style conditions with the visual + aural condition having more accurate recall. While descriptive data indicated that rhythm tended to facilitate recall, there was no significant difference between rhythm and no rhythm conditions. Nonmusic major participants tended to have slightly more accurate recall than music major participants, although this difference was not significant. Participants tended to have higher recall accuracy during primacy and recency serial positions. As participants had most accurate recall during the visual + aural presentation style conditions, it seems that the multi-sensory presentation modes can be effective for teaching information to be immediately recalled as long as they do not contain too much information and overload the limited storage capacity of working memory. Implications for clinical practice, limitations, and suggestions for future research are provided.

Exploring the effects of demonstration and enactment in facilitating recall of instructions in working memory

Across the lifespan the ability to follow instructions is essential for the successful completion of a multitude of daily activities. This ability will often rely on the storage and processing of information in working memory, and previous research in this domain has found that self-enactment at encoding or observing other-enactment at encoding (demonstration) improves performance at recall. However, no working memory research has directly compared these manipulations. Experiment 1 explored the effects of both self-enactment and demonstration on young adults’ (N=48) recall of action-object instruction sequences (e.g. ‘spin the circle, tap the square’). Both manipulations improved recall, with demonstration providing relatively larger boosts to performance across conditions. More detailed analyses suggested that this improvement was driven by improving the representations of actions, rather than objects, in these action-object sequences. Experiment 2 (N=24) explored this further, removing the objects from the physical environment and comparing partial demonstration (i.e. action-only or object-only) with no or full demonstration. The results showed that partial demonstration only benefitted features that were demonstrated, while full demonstration improved memory for actions, objects and their pairings. Overall these experiments indicate how self-enactment, and particularly demonstration, can benefit verbal recall of instruction sequences through the engagement of visuo-motor processes that provide additional forms of coding to support working memory performance.

Forward and backward recall of serial actions: Exploring the temporal dynamics of working memory for instruction

The ability to flexibly retrieve and implement sequences of actions is essential to motor learning and planning. Recent research has indicated that serial memory for instructions is influenced by presentation modality (spoken vs. visual demonstration) and recall modality (verbal vs. enacted recall). The present study extended this work by investigating the impact of recall direction (forward vs. backward), in addition to that of presentation and recall modality, on working memory for instruction sequences in healthy young adults. Experiment 1 (N = 24) showed that adults were more accurate in backward than forward verbal recall following spoken instructions. In contrast, enacted recall was not influenced by recall direction. Experiment 2 (N = 24) used visual demonstration of instruction sequences and found similar performance levels in forward and backward recall. Experiment 3 (N = 24) replicated the findings from Experiment 1 and 2, along with the previous observation of an advantage for demonstrated over spoken presentation. In addition, the beneficial effects of enacted recall and visual demonstration also emerged in an analysis of response times, specifically in reduced preparation and recall duration. Demonstrated instructions improved maintenance of all items while backward recall enhanced memory of later items in the sequence. These findings provide new insights into the cognitive processes and temporal dynamics of working memory for serial actions and instructions.

Effects of Visual and Auditory Presentation Styles and Musical Elements on Working Memory as Measured by Monosyllabic Sequential Digit Recall

Information is often paired with music to facilitate memory and learning. However, there is a lack of basic research investigating how visual and auditory presentation styles and musical elements might facilitate recall. The purpose of this study is to isolate and determine the effects of visual and auditory presentation styles and musical elements on working memory as measured by sequential monosyllabic digit recall performance. Recall was tested on 60 undergraduate university students during six different conditions: (a) Visual + Auditory Chant, (b) Visual + Auditory Melody, (c) Visual + Auditory Speech, (d) Auditory Chant, (e) Auditory Melody, and (f) Auditory Speech. There was a significant interaction between presentation style and musical element conditions. There were significant differences between auditory and visual + auditory conditions in the melody and speech conditions but not in the chant condition. In all cases, the auditory condition had more accurate recall than the visual + auditory condition, with recall differences largest during the speech condition. There was no significant difference between chant and melody but significant differences between chant and speech and melody and speech in the visual + auditory condition. In the auditory condition, recall accuracy was lower for speech than for melody or chant. There was no significant difference between chant and melody, chant and speech, or melody and speech in the visual + auditory condition. Congruent with existing research, the addition of visual input likely overloaded working memory resulting in worse recall. Implications for clinical practice, limitations, and suggestions for future research are provided.

Following Instructions in Patients With Schizophrenia: The Benefits of Actions at Encoding and Recall

The ability to follow spoken instructions is important to everyday functioning but has seldom been studied in patients with schizophrenia (SZ). Recent evidence suggests that action-based processing may facilitate the ability to follow instructions, which relies largely on working memory. In this study, we tested the hypothesis that SZ patients may also benefit from action-based advantages in following instructions. Forty-eight clinically stable SZ patients and 48 demographic- and IQ-matched controls completed a following spoken instruction span task involving varied encoding and recall conditions. While SZ patients were impaired in the overall performance of following spoken instructions, this deficit could be attributed to working memory impairment. More importantly, SZ patients showed action-based advantages both at the encoding and retrieval stage to the same extent as healthy controls. Specifically, both healthy controls and SZ patients showed improved memory performance when they additionally performed the actions, or watched the experimenter carrying out the actions compared with simply listening to spoken instructions during the encoding stage. During the retrieval stage, memory was improved when they recalled the instructions by physical enactment compared with oral repetition. The present study provides the first empirical evidence for the impairment in the ability to follow instructions in SZ. We have shown that involving action-based processing in the encoding and retrieval stage facilitated memory of instructions, indicating that the enactment advantage in working memory also applies to SZ patients. These findings provide useful insights for clinical interventions and cognitive remediation for SZ patients.

Following instructions in a dual-task paradigm: Evidence for a temporary motor store in working memory

Evidence from dual-task studies suggests that working memory supports the retention and implementation of verbal instructions. One key finding that is not readily accommodated by existing models of working memory is that participants are consistently more accurate at physically performing rather than verbally repeating a sequence of commands. This action advantage has no obvious source within the multi-component model of working memory and has been proposed to be driven by an as yet undetected limited-capacity store dedicated to the temporary maintenance of spatial, motoric, and temporal features of intended movements. To test this hypothesis, we sought to selectively disrupt the action advantage with concurrent motor suppression. In three dual-task experiments, young adults' immediate memory for sequences of spoken instructions was assessed by both action-based and spoken recall. In addition to classic interference tasks known to tax the phonological loop and central executive, motor suppression tasks designed to impair the encoding and retention of motoric representations were included. These required participants to produce repetitive sequences of either fine motor gestures (Experiment 1, N = 16) or more basic ones (Experiments 2, N = 16, and 3, N = 16). The benefit of action-based recall was reduced following the production of basic gestures but remained intact under all other interference conditions. These results suggest that the mnemonic advantage of enacted recall depends on a cognitive system dedicated to the temporary maintenance of motoric representations of planned action sequences.

Following instructions in a virtual school: Does working memory play a role?

Accumulating evidence that working memory supports the ability to follow instructions has so far been restricted to experimental paradigms that have greatly simplified the practical demands of performing actions to instructions in everyday tasks. The aim of the present study was to investigate whether working memory is involved in maintaining information over the longer periods of time that are more typical of everyday situations that require performing instructions to command. Forty-two children 7-11 years of age completed assessments of working memory, a real-world following-instructions task employing 3-D objects, and two new computerized instruction-following tasks involving navigation around a virtual school to complete a sequence of practical spoken commands. One task involved performing actions in a single classroom, and the other, performing actions in multiple locations in a virtual school building. Verbal working memory was closely linked with all three following-instructions paradigms, but with greater association to the virtual than to the real-world tasks. These results indicate that verbal working memory plays a key role in following instructions over extended periods of activity.

Impaired Memory for Instructions in Children with Attention-Deficit Hyperactivity Disorder Is Improved by Action at Presentation and Recall

Children with attention deficit hyperactivity disorder (ADHD) often fail to comply with teacher instructions in the classroom. Using action during presentation or recall can enhance typically developing children's abilities to complete multi-step instruction sequences. In this study, we tested the ability to following instructions in children with ADHD under different conditions to explore whether they show the same beneficial effects of action. A total of 24 children with ADHD and 27 typically developing children either listened to or viewed demonstrations of instructions during encoding, and then either verbally repeated or physically performed the sequences during recall. This resulted in four conditions: spoken-verbal, spoken-enacted, demonstration-verbal, and demonstration-enacted. Children with ADHD were significantly impaired in all conditions of the following instructions task relative to the typically developing group. Both groups showed an enacted-recall advantage, with superior recall by physical performance than oral repetition. Both groups also benefitted from demonstration over spoken presentation, but only when the instructions were recalled verbally. These findings suggest that children with ADHD struggle to complete multi-step instructions, but that they benefit from action-based presentation and recall in the same way as typically developing children. These findings have important implications for educators, suggesting that motor-based methods of instruction-delivery might enhance classroom learning both for children with and without developmental disorders.