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Zhang S, Ji M, Cui W, Wei J, Ding S, Wu Y. Impact of delirium intervention on cognitive load among nurses in the intensive care unit: A multi-centre cluster randomized controlled trial. Int J Nurs Pract 2024; 30:e13200. [PMID: 37680110 DOI: 10.1111/ijn.13200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND High cognitive load in nurses is a common problem in the intensive care unit (ICU). However, it remains unclear what different types of cognitive load the ICU nurses have experienced during the implementation of delirium interventions. AIM To describe the characteristics and explore the effect of implementing a delirium intervention on the cognitive load of nurses working in the ICU. METHODS A cluster-randomized controlled clinical trial was conducted. Six ICUs were randomized in a 1:1 ratio, and eligible nurses from these units provided either a delirium bundle intervention in addition to usual care (27 nurses) or usual care alone. An instrument was used to measure different types of cognitive load (MDT-CL), assessing intrinsic, extraneous and germane cognitive load. The repeated measures analysis of variance was used to detect between-group differences. RESULTS Among these nurses, significant between-group differences were identified in terms of their overall (P < 0.001), intrinsic (P < 0.001) and extraneous (P < 0.001) cognitive load. There was no significant change observed in the germane cognitive load (P = 0.489) in the delirium intervention group. CONCLUSION It is important to understand how the implementation of a delirium intervention affects different types of cognitive load in nurses, in order that tailored strategies can be applied to reduce cognitive load in ICU nurses.
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Affiliation(s)
- Shan Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Meihua Ji
- School of Nursing, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Wei Cui
- School of Nursing, Capital Medical University, Beijing, China
| | - Jun Wei
- Respiratory Intensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shu Ding
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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2
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Schierhorst NJ, Rick VB, Czerniak JN, Brandl C, Mertens A, Nitsch V. Comparison of two pupillometric measures as indicators of cognitive strain and under the influence of screen luminance. APPLIED ERGONOMICS 2024; 117:104242. [PMID: 38306742 DOI: 10.1016/j.apergo.2024.104242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
The pupil diameter has been shown to provide insight to a person's experienced cognitive strain. Pupillary light responses, however, make this measure unreliable in uncontrolled settings. Two derived indicators-Index of Cognitive Activity (ICA) and Index of Pupillary Activity (IPA)-aim to 'eliminate' lighting influences, changing based only on the perceived cognitive strain. The IPA potentially offers a valuable alternative to the ICA through its fully transparent calculation, which lifts the restrictions to proprietary software and supported eye trackers. The measures are examined and compared based on two experimental studies; (i) as indicators of cognitive strain during mental arithmetic tasks and (ii) under different conditions of computer screen luminance. Results indicate that neither indicator differentiates between the increasing levels of cognitive strain. Differences in screen luminance are reflected in both indicators, although differently between the conditions. Both results contradict the claims of the indicators and further investigations are thus required.
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Affiliation(s)
- Nikolas J Schierhorst
- Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Germanny.
| | - Vera B Rick
- Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Germanny
| | | | - Christopher Brandl
- Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Germanny; Fraunhofer Institute for Communication, Information Processing and Ergonomics FKIE, Germany
| | - Alexander Mertens
- Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Germanny
| | - Verena Nitsch
- Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Germanny; Fraunhofer Institute for Communication, Information Processing and Ergonomics FKIE, Germany
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Zhang S, Ding S, Cui W, Li X, Wei J, Wu Y. Impact of Clinical Decision Support System Assisted prevention and management for Delirium on guideline adherence and cognitive load among Intensive Care Unit nurses (CDSSD-ICU): Protocol of a multicentre, cluster randomized trial. PLoS One 2023; 18:e0293950. [PMID: 38015867 PMCID: PMC10684021 DOI: 10.1371/journal.pone.0293950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/17/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Adherence to the delirium bundle intervention is sub-optimal in routine practice, and inappropriate use of the instructional design of interventions may result in higher cognitive load among nurses. It remains unclear whether the Clinical Decision Support System (CDSS) Assisted Prevention and Management for Delirium (CDSS-AntiDelirium) results in the improvement of adherence to delirium intervention and the reduction of extraneous cognitive load, as well as improving adherence to delirium intervention, among nurses in the intensive care unit (ICU). METHODS This study (named the CDSSD-ICU) is a multicentre, prospective, cluster randomized controlled clinical trial. A total of six ICUs in two hospitals will be randomized in a 1:1 ratio to receive either the CDSS-AntiDelirium group or the delirium guidelines group. The CDSS-AntiDelirium consists of four modules: delirium assessment tools, risk factor assessment, a nursing care plan, and a nursing checklist module. Each day, nurses will assess ICU patients with the assistance of the CDSS-AntiDelirium. A total of 78 ICU nurses are needed to ensure statistical power. Outcome assessments will be conducted by investigators who are blinded to group assignments. The primary endpoint will be adherence to delirium intervention, the secondary endpoint will be nurses' cognitive load measured using an instrument to assess different types of cognitive load. Repeated measures analysis of variance will be used to detect group differences. A structural equation model will be used to clarify the mechanism of improvement in adherence. DISCUSSION Although the CDSS has been widely used in hospitals for disease assessment, management, and recording, the applications thereof in the area of delirium are still in infancy. This study could provide scientific evidence regarding the impact of a CDSS on nurses' adherence and cognitive load and promote its further development in future studies. CLINICAL TRIAL REGISTRATION ChiCTR1900023711 (Chinese Clinical Trial Registry).
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Affiliation(s)
- Shan Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Shu Ding
- School of Nursing, Capital Medical University, Beijing, China
- Cardiology Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wei Cui
- School of Nursing, Capital Medical University, Beijing, China
| | - Xiangyu Li
- School of Nursing, Capital Medical University, Beijing, China
| | - Jun Wei
- Respiratory Intensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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4
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Majcen Rosker Z, Mocnik G, Kristjansson E, Vodicar M, Rosker J. Pupillometric parameters of alertness during unpredictable but not predictable smooth pursuit neck torsion test are altered in patients with neck pain disorders: a cross-sectional study. Exp Brain Res 2023:10.1007/s00221-023-06648-z. [PMID: 37454001 PMCID: PMC10386920 DOI: 10.1007/s00221-023-06648-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/26/2023] [Indexed: 07/18/2023]
Abstract
Despite commonly investigated predictable smooth-pursuit neck-torsion tasks (SPNT) in neck pain patients, unpredictable conditions have been seldom investigated but are indicative of preserved oculomotor functions during neck torsion. Although not previously studied, some speculations about compensatory cognitive mechanisms such as increased phasic alertness during unpredictable tasks were suggested. The aim of this study was to investigate eye movement accuracy and pupillometric responses during predictable and unpredictable SPNT test in neck pain patients and asymptomatic controls. Eye movements (gain and SPNT-difference) and pupillometry indicative of tonic (average and relative pupil diameter) and phasic (index of cognitive activity-ICA) alertness were measured in 28 idiopathic neck pain patients and 30 asymptomatic individuals using infrared video-oculography during predictable and unpredictable SPNT test. Gain in unpredictable SPNT test was lower as compared to predictable tasks and presented with similar levels in neutral and neck torsion positions, but not in the predictable SPNT test. ICA was lower during neutral position in all tasks in patients as compared to control group but increased during neck torsion positions in unpredictable tasks. Relative pupil diameters presented with no differences between the groups or neck positions, but the opposite was observed for average pupil diameter. Higher ICA indicates an increase in phasic alertness in neck pain patients despite no alterations in oculomotor control during SPNT test. This is the first study to indicate cognitive deficits in oculomotor task in neck pain patients. The latter could negatively affect other tasks where additional cognitive resources must be involved.
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Affiliation(s)
| | - Grega Mocnik
- Laboratory for Digital Signal Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000, Maribor, Slovenia
| | | | - Miha Vodicar
- Chair of Orthopaedics, Medical Faculty, University of Ljubljana, 1000, Ljubljana, Slovenia
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia
| | - Jernej Rosker
- Faculty of Health Sciences, University of Primorska, 6310, Izola, Slovenia
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5
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Do pupillary responses during authentic slot machine use reflect arousal or screen luminance fluctuations? A proof-of-concept study. PLoS One 2022; 17:e0272070. [PMID: 35877672 PMCID: PMC9312385 DOI: 10.1371/journal.pone.0272070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 07/12/2022] [Indexed: 12/03/2022] Open
Abstract
Modern slot machines are among the more harmful forms of gambling. Psychophysiological measures may provide a window into mental processes that underpin these harms. Here we investigated pupil dilation derived from eye tracking as a means of capturing changes in sympathetic nervous system arousal following outcomes on a real slot machine. We hypothesized that positively reinforcing slot machine outcomes would be associated with increases in arousal, reflected in larger pupil diameter. We further examined the contribution of game luminance fluctuations on pupil diameter. In Experiment 1A, experienced slot machine gamblers (N = 53) played a commercially-available slot machine in a laboratory for 20 minutes while wearing mobile eye tracking glasses. Analyses differentiated loss outcomes, wins, losses-disguised-as-wins, and (free-spin) bonus features. Bonus features were associated with rapid increases in pupil diameter following the onset of outcome-related audiovisual feedback, relative to losses. In Experiment 1B, luminance data were extracted from captured screen videos (derived from Experiment 1A) to characterize on-screen luminance changes that could modulate pupil diameter. Bonus features and wins were associated with pronounced and complex fluctuations in screen luminance (≈50 L and ≈25L, respectively). However, the pupil dilation that was observed to bonus features in Experiment 1A coincided temporally with only negligible changes in screen luminance, providing partial evidence that the pupil dilation to bonus features may be due to arousal. In Experiment 2, 12 participants viewed pairs of stimuli (scrambled slot machine images) at luminance difference thresholds of ≈25L, ≈50L, and ≈100L. Scrambled images presented at luminance differences of ≈25L and greater were sufficient to cause pupillary responses. Overall, pupillometry may detect event-related changes in sympathetic nervous system arousal following gambling outcomes, but researchers must pay careful attention to substantial in-game luminance changes that may confound arousal-based interpretations.
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D'Silva L, Chalise P, Rippee M, Devos H. Challenging the Vestibular System Affects Gait Speed and Cognitive Workload in Chronic Mild Traumatic Brain Injury and Healthy Adults. Front Neurol 2022; 13:819169. [PMID: 35812099 PMCID: PMC9259866 DOI: 10.3389/fneur.2022.819169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
People with persistent symptoms after mild traumatic brain injury (mTBI) report imbalance during walking with head movements. The purpose of this study was (1) to compare usual walk gait speed to walking with head turns (HT) between people with mTBI and controls, (2) to compare the cognitive workload from usual walk to HT walk between groups, and (3) to examine if gaze stability deficits and mTBI symptoms influence gait speed. Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after mTBI (between 3 months to 2 years post-injury) were compared with 23 age and sex-matched controls. Participants walked a 12-inch wide, 60-foot walkway when looking ahead and when walking with HT to identify letters and their colors. Gait speed during usual walk and HT walk were calculated. Pupillary responses during both walks were converted to the Index of Cognitive Activity (ICA) as a measure of cognitive workload. Gaze stability was examined by the dynamic visual acuity (DVA) test in the yaw plane. The post-concussion symptom scale (PCSS) was used to collect symptom severity. Within group analysis showed that gait speed was lower during HT walk compared to usual walk in the people with mTBI (p < 0.001) as well as in controls (p < 0.001). ICA was higher with HT compared to usual walk in the mTBI group in the right eye (p = 0.01) and left eye (p = 0.001), and in controls in the right eye (p = 0.01) and left eye (p = 0.01). Participants in the mTBI group had slower usual (p < 0.001), and HT gait speed (p < 0.001) compared to controls. No differences were noted in ICA in the right or left eye during usual walk and HT walk between groups (p > 0.05). DVA loss in the yaw plane to the right and left was not different between groups (p > 0.05) and were not correlated with gait speed. PCSS scores were correlated with usual walk (r = −0.50, p < 0.001) and HT gait speed (r = −0.44, p = 0.002). Slower gait speed, poorer stability, and higher cognitive workload during walking with head turns may reduce community participation in people with mTBI and persistent symptoms.
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Affiliation(s)
- Linda D'Silva
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
- *Correspondence: Linda D'Silva
| | - Prabhakar Chalise
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, MO, United States
| | - Michael Rippee
- Department of Neurology, University of Kansas Medical Center, Kansas City, MO, United States
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
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7
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Rann JC, Almor A. Effects of verbal tasks on driving simulator performance. Cogn Res Princ Implic 2022; 7:12. [PMID: 35119569 PMCID: PMC8817015 DOI: 10.1186/s41235-022-00357-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 01/08/2022] [Indexed: 11/10/2022] Open
Abstract
We report results from a driving simulator paradigm we developed to test the fine temporal effects of verbal tasks on simultaneous tracking performance. A total of 74 undergraduate students participated in two experiments in which they controlled a cursor using the steering wheel to track a moving target and where the dependent measure was overall deviation from target. Experiment 1 tested tracking performance during slow and fast target speeds under conditions involving either no verbal input or output, passive listening to spoken prompts via headphones, or responding to spoken prompts. Experiment 2 was similar except that participants read written prompts overlain on the simulator screen instead of listening to spoken prompts. Performance in both experiments was worse during fast speeds and worst overall during responding conditions. Most significantly, fine scale time-course analysis revealed deteriorating tracking performance as participants prepared and began speaking and steadily improving performance while speaking. Additionally, post-block survey data revealed that conversation recall was best in responding conditions, and perceived difficulty increased with task complexity. Our study is the first to track temporal changes in interference at high resolution during the first hundreds of milliseconds of verbal production and comprehension. Our results are consistent with load-based theories of multitasking performance and show that language production, and, to a lesser extent, language comprehension tap resources also used for tracking. More generally, our paradigm provides a useful tool for measuring dynamical changes in tracking performance during verbal tasks due to the rapidly changing resource requirements of language production and comprehension.
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Affiliation(s)
- Jonathan C Rann
- Department of Psychology, University of South Carolina, 1512 Pendelton Street, Columbia, SC, 29208, USA. .,Institute for Mind and Brain, University of South Carolina, Columbia, SC, 29208, USA.
| | - Amit Almor
- Department of Psychology, University of South Carolina, 1512 Pendelton Street, Columbia, SC, 29208, USA.,Institute for Mind and Brain, University of South Carolina, Columbia, SC, 29208, USA.,Linguistics Program, University of South Carolina, Columbia, SC, 29208, USA
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8
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Tolvanen O, Elomaa AP, Itkonen M, Vrzakova H, Bednarik R, Huotarinen A. Eye-Tracking Indicators of Workload in Surgery: A Systematic Review. J INVEST SURG 2022; 35:1340-1349. [PMID: 35038963 DOI: 10.1080/08941939.2021.2025282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BackgroundEye tracking is a powerful tool for unobtrusive and real time assessment of workload in clinical settings. Before the complex eye tracking derived surrogates can be proactively utilized to improve surgical safety, the indications, validity and reliability requires careful evaluation.MethodsWe conducted a systematic review of literature from 2010 to 2020 according to PRISMA guidelines. A search on PubMed, Cochrane, Scopus, Web of science, PsycInfo and Google scholar databases was conducted on July 2020. The following search query was used" ("eye tracking" OR "gaze tracking") AND (surgery OR surgical OR operative OR intraoperative) AND (workload OR stress)". Short papers, no peer reviewed or papers in which eye-tracking methodology was not used to investigate workload or stress factors in surgery, were omitted.ResultsA total of 17 (N = 17) studies were identified eligible to this review. Most of the studies (n = 15) measured workload in simulated setting. Task difficulty and expertise were the most studied factors. Studies consistently showed surgeon's eye movements such as pupil responses, gaze patterns, blinks were associated with the level of perceived workload. However, differences between measurements in operational room and simulated environments have been found.ConclusionPupil responses, blink rate and gaze indices are valid indicators of workload. However, the effect of distractions and non-technical factors on workload is underrepresented aspect in the literature even though recognized as underlying factors in successful surgery.
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Affiliation(s)
- Otto Tolvanen
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Microsurgery Training Center, Kuopio University Hospital, Kuopio, Finland.,Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Matti Itkonen
- Center of Brain Science (CBS), CBS-TOYOTA Collaboration Center, RIKEN, Nagoya, Japan
| | - Hana Vrzakova
- Microsurgery Training Center, Kuopio University Hospital, Kuopio, Finland
| | - Roman Bednarik
- School of Computing, University of Eastern Finland, Kuopio, Finland
| | - Antti Huotarinen
- School of Computing, University of Eastern Finland, Kuopio, Finland
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9
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Ferencová N, Višňovcová Z, Bona Olexová L, Tonhajzerová I. Eye pupil – a window into central autonomic regulation via emotional/cognitive processing. Physiol Res 2021. [DOI: 10.33549//physiolres.934749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
If the eyes are windows into the soul, then the pupils represent at least the gateway to the brain and can provide a unique insight into the human mind from several aspects. The changes in the pupil size primarily mediated by different lighting conditions are controlled by the autonomic nervous system regulated predominantly at the subcortical level. Specifically, parasympathetically-linked pupillary constriction is under the Edinger-Westphal nucleus control and sympathetically-mediated pupillary dilation is regulated from the posterior hypothalamic nuclei. However, the changes in the pupil size can be observed at resting state even under constant lighting, these pupillary changes are mediated by global arousal level as well as by various cognitive factors. In this context, autonomic pathways modulating changes in the pupil size in response to the different light levels can be influenced by multiple central descending inputs driving pupillary changes under steady lighting conditions. Moreover, as the pupillary response is involved in emotional (task-evoked pupillary dilation as an index of emotional arousal) and cognitive (task-evoked pupillary dilation as an index of cognitive workload) stimulation, it can be used to detect the impact of mutual subcortical and cortical structures (i.e. overlapping brain structures included in autonomic, emotional and cognitive regulation) on the pupillary innervation system. Thus, complex understanding of the baseline pupil size´ and pupillary dynamics´ mechanisms may provide an important insight into the central nervous system functioning pointing to the pupillometry as a promising tool in the clinical application.
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Affiliation(s)
| | | | | | - I Tonhajzerová
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
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10
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Ferencová N, Višňovcová Z, Bona Olexová L, Tonhajzerová I. Eye pupil - a window into central autonomic regulation via emotional/cognitive processing. Physiol Res 2021; 70:S669-S682. [PMID: 35199551 DOI: 10.33549/physiolres.934749] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
If the eyes are windows into the soul, then the pupils represent at least the gateway to the brain and can provide a unique insight into the human mind from several aspects. The changes in the pupil size primarily mediated by different lighting conditions are controlled by the autonomic nervous system regulated predominantly at the subcortical level. Specifically, parasympathetically-linked pupillary constriction is under the Edinger-Westphal nucleus control and sympathetically-mediated pupillary dilation is regulated from the posterior hypothalamic nuclei. However, the changes in the pupil size can be observed at resting state even under constant lighting, these pupillary changes are mediated by global arousal level as well as by various cognitive factors. In this context, autonomic pathways modulating changes in the pupil size in response to the different light levels can be influenced by multiple central descending inputs driving pupillary changes under steady lighting conditions. Moreover, as the pupillary response is involved in emotional (task-evoked pupillary dilation as an index of emotional arousal) and cognitive (task-evoked pupillary dilation as an index of cognitive workload) stimulation, it can be used to detect the impact of mutual subcortical and cortical structures (i.e. overlapping brain structures included in autonomic, emotional and cognitive regulation) on the pupillary innervation system. Thus, complex understanding of the baseline pupil size´ and pupillary dynamics´ mechanisms may provide an important insight into the central nervous system functioning pointing to the pupillometry as a promising tool in the clinical application.
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Affiliation(s)
- N Ferencová
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
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11
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Tourtouri EN, Delogu F, Crocker MW. Rational Redundancy in Referring Expressions: Evidence from Event-related Potentials. Cogn Sci 2021; 45:e13071. [PMID: 34897768 DOI: 10.1111/cogs.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 10/29/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
In referential communication, Grice's Maxim of Quantity is thought to imply that utterances conveying unnecessary information should incur comprehension difficulties. There is, however, considerable evidence that speakers frequently encode redundant information in their referring expressions, raising the question as to whether such overspecifications hinder listeners' processing. Evidence from previous work is inconclusive, and mostly comes from offline studies. In this article, we present two event-related potential (ERP) experiments, investigating the real-time comprehension of referring expressions that contain redundant adjectives in complex visual contexts. Our findings provide support for both Gricean and bounded-rational accounts. We argue that these seemingly incompatible results can be reconciled if common ground is taken into account. We propose a bounded-rational account of overspecification, according to which even redundant words can be beneficial to comprehension to the extent that they facilitate the reduction of listeners' uncertainty regarding the target referent.
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Affiliation(s)
- Elli N Tourtouri
- Department of Language Science and Technology, Saarland University
| | - Francesca Delogu
- Department of Language Science and Technology, Saarland University
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12
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Czerniak JN, Schierhorst N, Brandl C, Mertens A, Schwalm M, Nitsch V. A meta-analytic review of the reliability of the Index of Cognitive Activity concerning task-evoked cognitive workload and light influences. Acta Psychol (Amst) 2021; 220:103402. [PMID: 34506977 DOI: 10.1016/j.actpsy.2021.103402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
The Index of Cognitive Activity (ICA) was introduced as a promising pupillary workload measure for field investigations since, unlike pupil dilation, it is not affected by illumination. Recent studies have investigated the ICA for task-evoked cognitive workload with contradictory findings. However, few studies investigated the influence of illumination on the ICA. Therefore, to examine inconsistencies regarding the reliability for workload measurement and the effects of light, a meta-analysis was conducted based on a structured literature review. The meta-analysis considered k = 14 studies with a total sample size of N = 751 participants. Results showed significant effects for workload (r = 0.61) and light (r = 0.45) on the ICA. Since moderating effects were found for several between-study differences, it seems likely that different cognitive processes and settings affect the indicator and should be considered in empirical investigations. According to the findings, the ICA is a reliable indicator for task-evoked workload. However, light influences were found which indicates that evidence-based conclusions regarding the ICA's practical applicability require further research.
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Affiliation(s)
- Julia N Czerniak
- Institute of Industrial Engineering and Ergonomics (IAW), RWTH Aachen University, Eilfschornsteinstraße 18, 52062 Aachen, Germany.
| | - Nikolas Schierhorst
- Institute of Industrial Engineering and Ergonomics (IAW), RWTH Aachen University, Eilfschornsteinstraße 18, 52062 Aachen, Germany.
| | - Christopher Brandl
- Institute of Industrial Engineering and Ergonomics (IAW), RWTH Aachen University, Eilfschornsteinstraße 18, 52062 Aachen, Germany.
| | - Alexander Mertens
- Institute of Industrial Engineering and Ergonomics (IAW), RWTH Aachen University, Eilfschornsteinstraße 18, 52062 Aachen, Germany.
| | - Maximilian Schwalm
- Institute of Highway Engineering (ISAC), RWTH Aachen University, Mies-van-der-Rohe-Straße 1, 52074 Aachen, Germany.
| | - Verena Nitsch
- Institute of Industrial Engineering and Ergonomics (IAW), RWTH Aachen University, Eilfschornsteinstraße 18, 52062 Aachen, Germany.
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13
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Amanhoud W, Hernandez Sanchez J, Bouri M, Billard A. Contact-initiated shared control strategies for four-arm supernumerary manipulation with foot interfaces. Int J Rob Res 2021. [DOI: 10.1177/02783649211017642] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In industrial or surgical settings, to achieve many tasks successfully, at least two people are needed. To this end, robotic assistance could be used to enable a single person to perform such tasks alone, with the help of robots through direct, shared, or autonomous control. We are interested in four-arm manipulation scenarios, where both feet are used to control two robotic arms via bi-pedal haptic interfaces. The robotic arms complement the tasks of the biological arms, for instance, in supporting and moving an object while working on it (using both hands). To reduce fatigue, cognitive workload, and to ease the execution of the foot manipulation, we propose two types of assistance that can be enabled upon contact with the object (i.e., based on the interaction forces): autonomous-contact force generation and auto-coordination of the robotic arms. The latter relates to controlling both arms with a single foot, once the object is grasped. We designed four (shared) control strategies that are derived from the combinations (absence/presence) of both assistance modalities, and we compared them through a user study (with 12 participants) on a four-arm manipulation task. The results show that force assistance positively improves human–robot fluency in the four-arm task, the ease of use and usefulness; it also reduces the fatigue. Finally, to make the dual-assistance approach the preferred and most successful among the proposed control strategies, delegating the grasping force to the robotic arms is a crucial factor when controlling them both with a single foot.
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Affiliation(s)
- Walid Amanhoud
- Learning Algorithms and Systems Laboratory (LASA), Swiss Federal School of Technology in Lausanne EPFL, Lausanne, Switzerland
| | - Jacob Hernandez Sanchez
- Learning Algorithms and Systems Laboratory (LASA), Swiss Federal School of Technology in Lausanne EPFL, Lausanne, Switzerland
- Biorobotics Laboratory (BIOROB), Swiss Federal School of Technology in Lausanne EPFL, Lausanne, Switzerland
| | - Mohamed Bouri
- Biorobotics Laboratory (BIOROB), Swiss Federal School of Technology in Lausanne EPFL, Lausanne, Switzerland
- Translational Neural Engineering Laboratory (TNE), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Aude Billard
- Learning Algorithms and Systems Laboratory (LASA), Swiss Federal School of Technology in Lausanne EPFL, Lausanne, Switzerland
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14
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Wilbanks BA, Aroke E, Dudding KM. Using Eye Tracking for Measuring Cognitive Workload During Clinical Simulations: Literature Review and Synthesis. Comput Inform Nurs 2021; 39:499-507. [PMID: 34495011 DOI: 10.1097/cin.0000000000000704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
High-fidelity clinical simulations can be used by clinicians to acquire technical (physical ability and knowledge) and non-technical (cognitive and social processes) skills. Excessive cognitive workload contributes to medical errors because of the impact on both technical and non-technical skills. Many studies measure cognitive workload with psychometric instruments that limit the assessment of cognitive workload to a single time period and may involve response bias. Using eye tracking to measure task-evoked pupillary responses allows the measurement of changes in pupil diameter related to the cognitive workload associated with a specific activity. Incorporating eye tracking with high-fidelity clinical simulations provides a reliable and continuous assessment of cognitive workload. The purpose of this literature review is to summarize the use of eye-tracking technology to measure cognitive workload of healthcare providers to generate evidence-based guidelines for measuring cognitive workload during high-fidelity clinical simulations. What this manuscript adds to the body of literature is a summary of best practices related to the different methods of measuring cognitive workload, benefits and limitations of using eye tracking, and high-fidelity clinical simulation design considerations for successful integration of eye tracking.
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15
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Czerniak JN, Schierhorst N, Villani V, Sabattini L, Brandl C, Mertens A, Schwalm M, Nitsch V. The Index of Cognitive Activity - Eligibility for task-evoked informational strain and robustness towards visual influences. APPLIED ERGONOMICS 2021; 92:103342. [PMID: 33373789 DOI: 10.1016/j.apergo.2020.103342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
Various researchers have proposed pupillometric indicators to assess a person's cognitive strain. However, to distinguish the variation of pupil light response from psychosensory pupil response in experimental field conditions is a challenge. The Index of Cognitive Activity (ICA) addresses this problem by wavelet separation. This research investigates the ICA's sensitivity for multiple level task-evoked cognitive activity and visual influences concerning informational work tasks. Objective and subjective measures assessed cognitive strain of participants (N = 22) during various tasks. In a first experiment, mental arithmetic tasks were used to induce different levels of cognitive activity. In a second experiment, influences of screen polarity and presentation of information were investigated (N = 18). The results indicate that eye metrics are rarely sensitive to slight variations in task difficulty. Moreover, the ICA is likely to be sensitive towards constant screen illumination and shows tendencies regarding changes in displayed information. Possible ramifications for the objective assessment of cognitive strain are discussed.
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Affiliation(s)
- Julia N Czerniak
- Institute of Industrial Engineering and Ergonomics (IAW), RWTH Aachen University, Aachen, Germany.
| | - Nikolas Schierhorst
- Institute of Industrial Engineering and Ergonomics (IAW), RWTH Aachen University, Aachen, Germany.
| | - Valeria Villani
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy.
| | - Lorenzo Sabattini
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy.
| | - Christopher Brandl
- Institute of Industrial Engineering and Ergonomics (IAW), RWTH Aachen University, Aachen, Germany.
| | - Alexander Mertens
- Institute of Industrial Engineering and Ergonomics (IAW), RWTH Aachen University, Aachen, Germany.
| | - Maximilian Schwalm
- Institute of Highway Engineering (ISAC), RWTH Aachen University, Aachen, Germany.
| | - Verena Nitsch
- Institute of Industrial Engineering and Ergonomics (IAW), RWTH Aachen University, Aachen, Germany.
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16
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Devos H, Gustafson K, Ahmadnezhad P, Liao K, Mahnken JD, Brooks WM, Burns JM. Psychometric Properties of NASA-TLX and Index of Cognitive Activity as Measures of Cognitive Workload in Older Adults. Brain Sci 2020; 10:E994. [PMID: 33339224 PMCID: PMC7766152 DOI: 10.3390/brainsci10120994] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
Cognitive workload is increasingly recognized as an important determinant of performance in cognitive tests and daily life activities. Cognitive workload is a measure of physical and mental effort allocation to a task, which can be determined through self-report or physiological measures. However, the reliability and validity of these measures have not been established in older adults with a wide range of cognitive ability. The aim of this study was to establish the test-retest reliability of the National Aeronautics and Space Administration Task Load Index (NASA-TLX) and Index of Cognitive Activity (ICA), extracted from pupillary size. The convergent validity of these measures against event-related potentials (ERPs) was also investigated. A total of 38 individuals with scores on the Montreal Cognitive Assessment ranging between 17 and 30 completed a working memory test (n-back) with three levels of difficulty at baseline and at a two-week follow-up. The intraclass correlation coefficients (ICC) values of the NASA-TLX ranged between 0.71 and 0.81, demonstrating good to excellent reliability. The mean ICA scores showed fair to good reliability, with ICCs ranging between 0.56 and 0.73. The mean ICA and NASA-TLX scores showed significant and moderate correlations (Pearson's r ranging between 0.30 and 0.33) with the third positive peak of the ERP at the midline channels. We conclude that ICA and NASA-TLX are reliable measures of cognitive workload in older adults. Further research is needed in dissecting the subjective and objective constructs of cognitive workload.
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Affiliation(s)
- Hannes Devos
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Kathleen Gustafson
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA; (K.G.); (W.M.B.); (J.M.B.)
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Pedram Ahmadnezhad
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Ke Liao
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Jonathan D. Mahnken
- University of Kansas Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS 66160, USA;
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - William M. Brooks
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA; (K.G.); (W.M.B.); (J.M.B.)
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS 66160, USA;
- University of Kansas Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Jeffrey M. Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA; (K.G.); (W.M.B.); (J.M.B.)
- University of Kansas Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS 66160, USA;
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17
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Moon S, Kahya M, Lyons KE, Pahwa R, Akinwuntan AE, Devos H. Cognitive workload during verbal abstract reasoning in Parkinson's disease: a pilot study. Int J Neurosci 2020; 131:504-510. [PMID: 32202180 DOI: 10.1080/00207454.2020.1746309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pupillary response reflects cognitive workload during processing speed, working memory, and arithmetic tasks in Parkinson's disease (PD). Abstract reasoning, a higher-order cognitive function that relates different objects, events, or thoughts in a similar manner, may also be compromised in PD. The aim of this study was to compare pupillary response as a measure of cognitive workload while completing a verbal abstract reasoning test between patients with PD and age-matched controls. METHODS Nineteen non-demented individuals with PD (66.6 ± 8.9 years) and 10 healthy controls (65.3 ± 7.3 years) were recruited. A remote eye tracker recorded the pupillary response at 60 Hz, while the participants were performing the Similarities test of Wechsler Adult Intelligence Scale-IV. Outcome measures included pupillary response, evaluated by the Index of Cognitive Activity (ICA), and behavioral responses of the Similarities test. RESULTS The PD group (scaled scores = 8.9 ± 2.2) did not show impairment in behavioral performance on Similarities test compared with healthy controls (scaled scores = 8.8 ± 2.3; p = .91). However, the PD group (ICA = .32 ± .09) demonstrated significantly greater cognitive workload during the Similarities test compared to controls (ICA = .24 ± .08; p = .03). CONCLUSIONS Non-demented individuals with PD exerted greater cognitive workload to complete a verbal abstract reasoning task despite similar behavioral performance compared to healthy controls. Clinical utilities of pupillary response to detect and monitor early impairment in higher-order executive function will be the subject of further study in the PD population.
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Affiliation(s)
- Sanghee Moon
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Melike Kahya
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly E Lyons
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rajesh Pahwa
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Abiodun E Akinwuntan
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.,Office of the Dean, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
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18
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Zhang S, Wu Y, Fu Z, Lu Y, Wang Q, Mingxuan L. Psychometric properties of the Chinese version of the instrument for measuring different types of cognitive load (MDT‐CL). J Nurs Manag 2020; 28:277-285. [PMID: 31789434 PMCID: PMC7161924 DOI: 10.1111/jonm.12919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/04/2019] [Accepted: 11/29/2019] [Indexed: 11/28/2022]
Abstract
Aim Background Methods Results Conclusions Implications for nursing management
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Affiliation(s)
- Shan Zhang
- School of Nursing Capital Medical University Beijing China
| | - Ying Wu
- School of Nursing Capital Medical University Beijing China
| | - Ziyuan Fu
- School of Nursing Capital Medical University Beijing China
| | - Yating Lu
- School of Nursing Capital Medical University Beijing China
| | - Qingyu Wang
- School of Nursing Capital Medical University Beijing China
| | - Liu Mingxuan
- School of Nursing Capital Medical University Beijing China
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19
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Ranchet M, Morgan JC, Akinwuntan AE, Devos H. Visual search and target detection during simulated driving in Parkinson's disease. ACCIDENT; ANALYSIS AND PREVENTION 2020; 134:105328. [PMID: 31639583 DOI: 10.1016/j.aap.2019.105328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 09/04/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
Patients with Parkinson's Disease (PD) often exhibit difficulties with visual search that may impede their ability to recognize landmarks and cars while driving. The main objective of this study was to investigate visual search performances of both billboards and cars in patients with PD using a driving simulator. A second objective was to examine the role of cognitive functions in performing the visual search task while driving. Nineteen patients with PD (age: 68 ± 8yo, sex (Men/Women): 15/4) and 14 controls (age: 60 ± 11yo, sex: 7/7) first performed a battery of cognitive tests. They then drove in a simulator and were instructed to follow a lead vehicle while searching for billboards with the letter A (stationary target) or red cars (moving target) among other distractors. Accuracy and response times of visual search were the main outcome variables. Standard deviation of lateral position (SDLP) was the secondary outcome. During driving, patients were less accurate in identifying the targets, particularly for the stationary billboards located in the outer periphery. Within the group of patients, significant correlations were found between several measures of cognitive tests and simulator-based visual search accuracy. By contrast, only the score on the MOCA test correlated significantly with visual search accuracy in controls. Findings suggest that patients with PD have impaired visual search for more eccentric stationary targets while driving a simulator, which is likely due to cognitive deficits. Difficulties identifying objects in the outer periphery may have implications for driving safety. Decreased functional field of view under increased cognitive load may have attributed to the difficulties identifying these landmarks. This may impact the ability to identify, anticipate, and respond to important information (e.g., pedestrians, navigation signs, landmarks), especially in complex driving situations (e.g. urban driving or intersections).Future studies should be conducted in a larger sample size to determine whether a visual search task on a driving simulator may predict on-road driving performances.
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Affiliation(s)
- M Ranchet
- Univ Lyon, F-69000 Lyon, France; IFSTTAR, TS2, LESCOT, F-69500, Bron, France.
| | - J C Morgan
- Parkinson's Foundation Center of Excellence, Movement and Memory Disorder Programs, Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - A E Akinwuntan
- Dean's Office, School of Health Professions, The University of Kansas Medical Center, Kansas City, KS, USA
| | - H Devos
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, The University of Kansas Medical Center, Kansas City, KS, USA
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20
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Rational over-specification in visually-situated comprehension and production. JOURNAL OF CULTURAL COGNITIVE SCIENCE 2019. [DOI: 10.1007/s41809-019-00032-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abstract
Contrary to the Gricean maxims of quantity (Grice, in: Cole, Morgan (eds) Syntax and semantics: speech acts, vol III, pp 41–58, Academic Press, New York, 1975), it has been repeatedly shown that speakers often include redundant information in their utterances (over-specifications). Previous research on referential communication has long debated whether this redundancy is the result of speaker-internal or addressee-oriented processes, while it is also unclear whether referential redundancy hinders or facilitates comprehension. We present an information-theoretic explanation for the use of over-specification in visually-situated communication, which quantifies the amount of uncertainty regarding the referent as entropy (Shannon in Bell Syst Tech J 5:10, 10.1002/j.1538-7305.1948.tb01338.x, 1948). Examining both the comprehension and production of over-specifications, we present evidence that (a) listeners’ processing is facilitated by the use of redundancy as well as by a greater reduction of uncertainty early on in the utterance, and (b) that at least for some speakers, listeners’ processing concerns influence their encoding of over-specifications: Speakers were more likely to use redundant adjectives when these adjectives reduced entropy to a higher degree than adjectives necessary for target identification.
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