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Zhou X, Wong PCM. Hyperscanning to explore social interaction among autistic minds. Neurosci Biobehav Rev 2024; 163:105773. [PMID: 38889594 DOI: 10.1016/j.neubiorev.2024.105773] [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: 05/08/2024] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/20/2024]
Abstract
Hyperscanning - the monitoring of brain activity of two or more people simultaneously - has emerged to be a popular tool for assessing neural features of social interaction. This perspective article focuses on hyperscanning studies that use functional near-infrared spectroscopy (fNIRS), a technique that is very conducive to studies requiring naturalistic paradigms. In particular, we are interested in neural features that are related to social interaction deficits among individuals with autism spectrum disorders (ASD). This population has received relatively little attention in research using neuroimaging hyperscanning techniques, compared to neurotypical individuals. The study is outlined as follows. First, we summarize the findings about brain-behavior connections related to autism from previously published fNIRS hyperscanning studies. Then, we propose a preliminary theoretical framework of inter-brain coherence (IBC) with testable hypotheses concerning this population. Finally, we provide two examples of areas of inquiry in which studies could be particularly relevant for social-emotional/behavioral development for autistic children, focusing on intergenerational relationships in family units and learning in classroom settings in mainstream schools.
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Affiliation(s)
- Xin Zhou
- Brain and Mind Institute, the Chinese University of Hong Kong, Hong Kong Special Administrative Region of China.
| | - Patrick C M Wong
- Brain and Mind Institute, the Chinese University of Hong Kong, Hong Kong Special Administrative Region of China; Department of Linguistics and Modern Languages, the Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
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Zhang M, Yin Z, Zhang X, Zhang H, Bao M, Xuan B. Neural mechanisms distinguishing two types of cooperative problem-solving approaches: An fNIRS hyperscanning study. Neuroimage 2024; 291:120587. [PMID: 38548038 DOI: 10.1016/j.neuroimage.2024.120587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024] Open
Abstract
Collaborative cooperation (CC) and division of labor cooperation (DLC) are two prevalent forms of cooperative problem-solving approaches in daily life. Despite extensive research on the neural mechanisms underlying cooperative problem-solving approaches, a notable gap exists between the neural processes that support CC and DLC. The present study utilized a functional near-infrared spectroscopy (fNIRS) hyperscanning technique along with a classic cooperative tangram puzzle task to investigate the neural mechanisms engaged by both friends and stranger dyads during CC versus DLC. The key findings of this study were as follows: (1) Dyads exhibited superior behavioral performance in the DLC task than in the CC task. The CC task bolstered intra-brain functional connectivity and inter-brain synchrony (IBS) in regions linked to the mirror neuron system (MNS), spatial perception (SP) and cognitive control. (2) Friend dyads showed stronger IBS in brain regions associated with the MNS than stranger dyads. (3) Perspective-taking predicted not only dyads' behavioral performance in the CC task but also their IBS in brain regions associated with SP during the DLC task. Taken together, these findings elucidate the divergent behavioral performance and neural connection patterns between the two cooperative problem-solving approaches. This study provides novel insights into the various neurocognitive processes underlying flexible coordination strategies in real-world cooperative contexts.
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Affiliation(s)
- Mingming Zhang
- School of Psychology, Shanghai Normal University, 100, Guilin Road, Shanghai 200234, China
| | - Zijun Yin
- School of Educational Science, Anhui Normal University, 2, Beijing Middle Road, Wuhu 241000, China
| | - Xue Zhang
- School of Educational Science, Anhui Normal University, 2, Beijing Middle Road, Wuhu 241000, China
| | - Hui Zhang
- School of Educational Science, Anhui Normal University, 2, Beijing Middle Road, Wuhu 241000, China
| | - Mingjing Bao
- School of Educational Science, Anhui Normal University, 2, Beijing Middle Road, Wuhu 241000, China
| | - Bin Xuan
- School of Educational Science, Anhui Normal University, 2, Beijing Middle Road, Wuhu 241000, China.
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Réveillé C, Vergotte G, Perrey S, Bosselut G. Using interbrain synchrony to study teamwork: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 159:105593. [PMID: 38373643 DOI: 10.1016/j.neubiorev.2024.105593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/19/2024] [Accepted: 02/14/2024] [Indexed: 02/21/2024]
Abstract
It has been proposed that interbrain synchrony (IBS) may help to elucidate the neural mechanisms underpinning teamwork. As hyperscanning studies have provided abundant findings on IBS in team environments, the current review aims to synthesize the findings of hyperscanning studies in a way that is relevant to the teamwork research. A systematic review was conducted. Included studies were classified according to the IPO (i.e. input, process, output) model of teamwork. Three multi-level meta-analyses were performed to quantify the associations between IBS and the three IPO variables. The methodology followed PRISMA guidelines and the protocol was pre-registered (https://osf.io/7h8sa/). Of the 229 studies, 41 were included, representing 1326 teams. The three meta-analyses found statistically significant positive effects, indicating a positive association between IBS and the three IPO teamwork variables. This study provides evidence that IBS is a relevant measure of the teamwork process and argues for the continued use of IBS to study teamwork.
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Affiliation(s)
- Coralie Réveillé
- EuroMov Digital Health in Motion (Univ Montpellier, IMT Mines d'Alès), 700 avenue du Pic Saint Loup, Montpellier 34090, France.
| | - Grégoire Vergotte
- EuroMov Digital Health in Motion (Univ Montpellier, IMT Mines d'Alès), 700 avenue du Pic Saint Loup, Montpellier 34090, France
| | - Stéphane Perrey
- EuroMov Digital Health in Motion (Univ Montpellier, IMT Mines d'Alès), 700 avenue du Pic Saint Loup, Montpellier 34090, France
| | - Grégoire Bosselut
- EuroMov Digital Health in Motion (Univ Montpellier, IMT Mines d'Alès), 700 avenue du Pic Saint Loup, Montpellier 34090, France
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Hernandez-Pena L, Hoppe W, Koch J, Keeler C, Waller R, Habel U, Sijben R, Wagels L. The role of dominance in sibling relationships: differences in interactive cooperative and competitive behavior. Sci Rep 2023; 13:11863. [PMID: 37481667 PMCID: PMC10363155 DOI: 10.1038/s41598-023-38936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023] Open
Abstract
Siblings strongly influence each other in their social development and are a major source of support and conflict. Yet, studies are mostly observational, and little is known about how adult sibling relationships influence social behavior. Previous tasks exploring dynamically adjusting social interactions have limitations in the level of interactivity and naturalism of the interaction. To address these limitations, we created a cooperative tetris puzzle-solving task and an interactive version of the chicken game task. We validated these two tasks to study cooperative and competitive behavior in real-time interactions (N = 56). Based on a dominance questionnaire (DoPL), sibling pairs were clustered into pairs that were both low in dominance (n = 7), both high in dominance (n = 8), or one low and one high in dominance (n = 13). Consistent with our hypothesis, there were significantly more mutual defections, less use of turn-taking strategies, and a non-significant trend for reduced success in solving tetris puzzles together among high dominance pairs compared to both other pair types. High dominant pairs also had higher Machiavellian and hypercompetitiveness traits and more apathetic sibling relationships. Both tasks constitute powerful and reliable tools to study personality and relationship influences on real and natural social interactions by demonstrating the different cooperative and competitive dynamics between siblings.
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Affiliation(s)
- Lucia Hernandez-Pena
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
- JARA - Translational Brain Medicine, Aachen, Germany.
| | - Wiebke Hoppe
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Julia Koch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- JARA - Translational Brain Medicine, Aachen, Germany
| | - Charlotte Keeler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Rebecca Waller
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Rik Sijben
- Brain Imaging Facility, Interdisciplinary Center for Clinical Research (IZKF), RWTH Aachen University, Aachen, Germany
| | - Lisa Wagels
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- JARA - Translational Brain Medicine, Aachen, Germany
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Park J, Shin J, Lee J, Jeong J. Inter-Brain Synchrony Pattern Investigation on Triadic Board Game Play-Based Social Interaction: An fNIRS Study. IEEE Trans Neural Syst Rehabil Eng 2023; 31:2923-2932. [PMID: 37410649 DOI: 10.1109/tnsre.2023.3292844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Recent advances in functional neuroimaging techniques, including methodologies such as fNIRS, have enabled the evaluation of inter-brain synchrony (IBS) induced by interpersonal interactions. However, the social interactions assumed in existing dyadic hyperscanning studies do not sufficiently emulate polyadic social interactions in the real world. Therefore, we devised an experimental paradigm that incorporates the Korean folk board game "Yut-nori" to reproduce social interactions that emulate social activities in the real world. We recruited 72 participants aged 25.2 ± 3.9 years (mean ± standard deviation) and divided them into 24 triads to play Yut-nori, following the standard or modified rules. The participants either competed against an opponent (standard rule) or cooperated with an opponent (modified rule) to achieve a goal efficiently. Three different fNIRS devices were employed to record cortical hemodynamic activations in the prefrontal cortex both individually and simultaneously. Wavelet transform coherence (WTC) analyses were performed to assess prefrontal IBS within a frequency range of 0.05-0.2 Hz. Consequently, we observed that cooperative interactions increased prefrontal IBS across overall frequency bands of interest. In addition, we also found that different purposes for cooperation generated different spectral characteristics of IBS depending on the frequency bands. Moreover, IBS in the frontopolar cortex (FPC) reflected the influence of verbal interactions. The findings of our study suggest that future hyperscanning studies should consider polyadic social interactions to reveal the properties of IBS in real-world interactions.
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Zhao H, Zhang C, Tao R, Duan H, Xu S. Distinct inter-brain synchronization patterns underlying group decision-making under uncertainty with partners in different interpersonal relationships. Neuroimage 2023; 272:120043. [PMID: 37003448 DOI: 10.1016/j.neuroimage.2023.120043] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/04/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
Humans may behave in different manners when making decisions with friends and strangers. Whether the interpersonal relationship and the characteristics of the individuals in the group affected the group decision-making under uncertainty in the real-time interaction remains unknown. Using the turn-based Balloon Analogue Risk Task (BART), the present study examined the group decision-making propensity under uncertainty with partners in different interpersonal relationships and interpersonal orientations. Corresponding inter-brain synchronization (IBS) patterns at the prefrontal cortex (PFC) were also uncovered with the fNIRS-based hyperscanning approach. Behavioral results identified that dyads in the friend group exhibited the uncertainty-averse propensity when comparing with the stranger group. The fNIRS results reported that feedback-related IBS at the left inferior frontal gyrus (l-IFG) and medial frontopolar cortex (mFPC) during different feedbacks was modulated by interpersonal relationships. The IBS at all channels in the PFC during the positive and negative feedbacks, respectively, predicted the decision-making propensity under uncertainty in the stranger and friend groups based on the support vector machine (SVM) algorithm. The moderating role of the social value orientation (SVO) was also verified in the mediation effect of the dyad closeness on the decision-making propensity under uncertainty via the IBS at the right lateral frontopolar cortex (r-FPC). These findings demonstrated disparate behavioral responses and inter-brain synchronization patterns underlying group decision-making under uncertainty with partners in different interpersonal relationships.
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Affiliation(s)
- Hanxuan Zhao
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, 550, Dalian West Street, Shanghai 200083, China; College of International Business, Shanghai International Studies University, Shanghai, China
| | - Can Zhang
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, 550, Dalian West Street, Shanghai 200083, China; College of International Business, Shanghai International Studies University, Shanghai, China
| | - Ruiwen Tao
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, 550, Dalian West Street, Shanghai 200083, China; College of International Business, Shanghai International Studies University, Shanghai, China
| | - Haijun Duan
- Key Laboratory of Modern Teaching Technology, Ministry of Education, Shaanxi Normal University, 199 South Chang' an Road, Xi'an 710062, China.
| | - Sihua Xu
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, 550, Dalian West Street, Shanghai 200083, China; College of International Business, Shanghai International Studies University, Shanghai, China; School of Education, Huaibei Normal University, Huaibei, China; Anhui Engineering Research Center for Intelligent Computing and Application on Cognitive Behavior, Huaibei Normal University, Huaibei, China.
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Balters S, Miller JG, Li R, Hawthorne G, Reiss AL. Virtual (Zoom) Interactions Alter Conversational Behavior and Interbrain Coherence. J Neurosci 2023; 43:2568-2578. [PMID: 36868852 PMCID: PMC10082458 DOI: 10.1523/jneurosci.1401-22.2023] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 03/05/2023] Open
Abstract
A growing number of social interactions are taking place virtually on videoconferencing platforms. Here, we explore potential effects of virtual interactions on observed behavior, subjective experience, and neural "single-brain" and "interbrain" activity via functional near-infrared spectroscopy neuroimaging. We scanned a total of 36 human dyads (72 participants, 36 males, 36 females) who engaged in three naturalistic tasks (i.e., problem-solving, creative-innovation, socio-emotional task) in either an in-person or virtual (Zoom) condition. We also coded cooperative behavior from audio recordings. We observed reduced conversational turn-taking behavior during the virtual condition. Given that conversational turn-taking was associated with other metrics of positive social interaction (e.g., subjective cooperation and task performance), this measure may be an indicator of prosocial interaction. In addition, we observed altered patterns of averaged and dynamic interbrain coherence in virtual interactions. Interbrain coherence patterns that were characteristic of the virtual condition were associated with reduced conversational turn-taking. These insights can inform the design and engineering of the next generation of videoconferencing technology.SIGNIFICANCE STATEMENT Videoconferencing has become an integral part of our lives. Whether this technology impacts behavior and neurobiology is not well understood. We explored potential effects of virtual interaction on social behavior, brain activity, and interbrain coupling. We found that virtual interactions were characterized by patterns of interbrain coupling that were negatively implicated in cooperation. Our findings are consistent with the perspective that videoconferencing technology adversely affects individuals and dyads during social interaction. As virtual interactions become even more necessary, improving the design of videoconferencing technology will be crucial for supporting effective communication.
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Affiliation(s)
- Stephanie Balters
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California 94305
| | - Jonas G Miller
- Department of Psychology, Stanford University, Stanford, California 94305
| | - Rihui Li
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California 94305
| | - Grace Hawthorne
- Department of Mechanical Engineering, Stanford University, Stanford, California 94305
| | - Allan L Reiss
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California 94305
- Department of Pediatrics, Stanford University, Stanford, California 94305
- Department of Radiology, Stanford University, Stanford, California 94305
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Ye X, Peng L, Sun N, He L, Yang X, Zhou Y, Xiong J, Shen Y, Sun R, Liang F. Hotspots and trends in fNIRS disease research: A bibliometric analysis. Front Neurosci 2023; 17:1097002. [PMID: 36937686 PMCID: PMC10017540 DOI: 10.3389/fnins.2023.1097002] [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: 11/13/2022] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
Objective To summarize the general information and hotspots of functional near-infrared spectroscopy (fNIRS)-based clinical disease research over the past 10 years and provide some references for future research. Methods The related literature published between 1 January 2011 and 31 January 2022 was retrieved from the Web of Science core database (WoS). Bibliometric visualization analysis of countries/regions, institutions, authors, journals, keywords and references were conducted by using CiteSpace 6.1.R3. Results A total of 467 articles were included, and the annual number of articles published over nearly a decade showed an upward trend year-by-year. These articles mainly come from 39 countries/regions and 280 institutions. The representative country and institution were the USA and the University of Tubingen. We identified 266 authors, among which Andreas J Fallgatter and Ann-Christine Ehlis were the influential authors. Neuroimage was the most co-cited journal. The major topics in fNIRS disease research included activation, prefrontal cortex, working memory, cortex, and functional magnetic resonance imaging (fMRI). In recent years, the Frontier topics were executive function, functional connectivity, performance, diagnosis, Alzheimer's disease, children, and adolescents. Based on the burst of co-cited references, gait research has received much attention. Conclusion This study conducted a comprehensive, objective, and visual analysis of publications, and revealed the status of relevant studies, hot topics, and trends concerning fNIRS disease research from 2011 to 2022. It is hoped that this work would help researchers to identify new perspectives on potential collaborators, important topics, and research Frontiers.
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Affiliation(s)
- Xiangyin Ye
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Li Peng
- Department of Ultrasound, The First People’s Hospital of Longquanyi District, Chengdu, China
| | - Ning Sun
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lian He
- Department of Ultrasound, The First People’s Hospital of Longquanyi District, Chengdu, China
| | - Xiuqiong Yang
- Department of Ultrasound, The First People’s Hospital of Longquanyi District, Chengdu, China
| | - Yuanfang Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jian Xiong
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuquan Shen
- Department of Rehabilitation Medicine, The First People’s Hospital of Longquanyi District, Chengdu, China
| | - Ruirui Sun
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Ruirui Sun,
| | - Fanrong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Fanrong Liang,
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Huang X, Izumi SI, Suzukamo Y. Neural and behavioral alterations of a real-time interpersonal distance (IPD) development process in differing social status interactions. Front Behav Neurosci 2022; 16:969440. [PMCID: PMC9616044 DOI: 10.3389/fnbeh.2022.969440] [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: 06/16/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEvidence showed neural changes in interpersonal distance (IPD) interaction, and neural activities are affected by relationships (such as friends or strangers). Behavior studies proved that social status strongly affects IPD between two persons. However, how the differing social status impacts neural alterations in the IPD interactions remains unknown.ObjectivesThe teacher-student relationship is a typical representation of the difference in social status. The present study aims to investigate the IPD performance and brain processes underlying real-time differing social status during the development process from teacher-student interactions.Materials and methodsWe designed three within-subject experiments corresponding to the inclusion, control, and affection stages of IPD. Altogether, 38 valid healthy participants participated in three experiments with a teacher (differing social status condition, DS condition) and a peer student (peer social status condition, PS condition) separately. This study employed functional near-infrared spectroscopy (fNIRS) and modified real-time stop-distance paradigms to record IPD performance and neural processes.ResultsFor IPD performance, significantly larger IPD gaps were shown in the DS condition than in the PS condition, and IPD feedback affected IPD performance. For neural alterations, activated frontopolar area (FPA, BA10), dorsolateral prefrontal cortex (DLPFC, BA9/BA46), and Broca’s area (BA45) were observed across the IPD stages. Importantly, brain activation shifts with the development of IPD. In addition, results showed that differences in Oxy-Hb changes were located in the FPA (BA10), DLPFC (BA9/BA46), and Broca’s area (BA45) between the DS and PS conditions across IPD stages. Additionally, negative correlations were found between Oxy-Hb changes and IPD performance.ConclusionWe propose prefrontal cortex (PFC) and Broca’s area involvement in IPD interactions, initially focusing on evaluation and action periods, and later on IPD-evaluation processes after feedback. In addition, a difference in Oxy-Hb activities implies the complexity of relationships and social status in IPD interactions.
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Affiliation(s)
- Xinxin Huang
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Physical Medicine and Rehabilitation, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- *Correspondence: Shin-Ichi Izumi,
| | - Yoshimi Suzukamo
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
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