Age-related hearing impairments significantly impact social interactions and physical activities for older adults. Recent studies have highlighted potential benefits of cognitive-motor training but lack specificity regarding the unique needs of this population. This study aimed to determine the preferences and specific needs of older adults with hearing impairments to develop tailored cognitive-motor training systems. A three-round Delphi survey was conducted involving health and exercise professionals (round 1: n = 18; round 2: n = 12; round 3: n = 11) and older adults with hearing impairments (round 1: n = 18; round 2: n = 14; round 3: n = 15). Round 1 collected qualitative input; rounds 2 and 3 assessed relevance and agreement of the items (≥ 70

Background and objectives This is a protocol for a living systematic review and meta-analysis. This review will assess the effects of state-of-the-art exercise interventions designed to promote functional mobility. Therefore, after identifying all potential interventions, we will use the F.I.T.T. principles (frequency, intensity, time, type) as well as the physical and health status of the participants as moderators to analyse the mechanisms for the positive benefits of exercise interventions. The main research questions are: Which exercise types are most beneficial for improving functional mobility in various populations of older adults? Which physical exercise characteristics in terms of frequency, intensity, time and duration will achieve the greatest benefit in terms of the defined outcomes, i.e, the functional mobility of older adults? Methods The systematic literature research according to PRISMA guidelines will search databases like MEDLINE, APA Psych-Info and Web of Science. Inclusion criteria are: healthy older people ≥ 50 years, randomized-controlled trials including exercise intervention and a walking or mobility assessments (eg., TUG, SPPB) as an outcome measure. A preliminary search revealed more than 33,000 hits that will be screened by pairs of independent reviewers. The results will be summarized according to the effects regarding functional mobility and potential dose-response relations via respective meta-analysis. Conclusion The systematic review will comprise the knowledge of the existing literature with regards to the effects of the physical activity interventions compared to an active or inactive control group. We will summarize the effects with respect to the F.I.T.T.. They provide a foundation for structuring an optimal exercise training program. If possible, we will also compare interventions from the different categories (eg. cardiovascular, resistance, motor-coordinative, multicomponent or mind-body exercise) as a network analysis and report the influence of moderator variables. Based on the results evidence-based guidelines following GRADE for physical exercise interventions to improve functional mobility in older adults will be provided.

Abstract Background Hearing impairments are a rising burden in our aging society. Hearing loss is associated with reduced cognitive performance as well as decrements in balance and gait. Therefore, impaired hearing affects also dual tasking (DT). The aim of this review is to summarize the evidence for DT performance decrements of older adults with hearing impairments during maintaining balance or walking. Methods The systematic literature research according to PRISMA guidelines was conducted using MEDLINE, APA Psych-Info, and Web of Science. Inclusion criteria were: Independent living older people ≥ 60 years with hearing impairments, use of a DT paradigm to test hearing impaired older adults within a balance or walking condition. Results N = 57 studies were found within the databases. Eight studies were included (N = 456 participants (58% women), including n = 200 older hearing-impaired persons with different levels of hearing loss). Most of the included studies oriented their inclusion criteria for hearing-impairments at thresholds for mild hearing loss with Pure Tone Average (0.5-4 kHz) ≥ 25 and < 40 dB. Three of the studies focused on DT balance performance and five used DT walking comparing participants with and without hearing loss. For DT balance and gait performance, higher decrements for the hearing-impaired group were observed compared to healthy older adults. Performance decrements were accompanied by reduced compensatory strategies in balance performance. Conclusion More pronounced decrements in DT performance were observed for participants with hearing impairments compared to those without. This implies that hearing-impaired older adults might need specific interventions to reduce the cognitive-motor interference (CMI) to maintain balance control or walking stability in daily situations that require managing of cognitive and motor tasks simultaneously. However, taking all results into account the underlying mechanisms of CMI for this target group needs to be further examined. Trial registration This review was registered at Prospero with the ID CRD42022340232.

The augmentation of landmarks in auditory navigation instructions has been shown to improve incidental spatial knowledge acquisition during assisted navigation. Here, two driving simulator experiments are reported that replicated this effect even when adding a three-week delay between navigation and spatial tasks and varying the degree of detail in the provided landmark information. Performance in free- and cued-recall of landmarks and driving the route again without assistance demonstrated increased landmark and route knowledge when navigating with landmark-based compared to common GPS instructions. The results emphasize that adding auditory landmark references to existing navigation systems can potentiate processing of spatial features of the environment during every-day navigation.

The continuous assessment of pedestrians' cognitive load during a naturalistic mobile map-assisted navigation task is challenging because of limited experimental control over stimulus presentation, human-map-interactions, and other participant responses. To overcome this challenge, the present study takes advantage of navigators' spontaneous eye blinks during navigation to serve as event markers in continuously recorded electroencephalography (EEG) data to assess cognitive load in a mobile map-assisted navigation task. We examined if and how displaying different numbers of landmarks (3 vs. 5 vs. 7) on mobile maps along a given route would influence navigators' cognitive load during navigation in virtual urban environments. Cognitive load was assessed by the peak amplitudes of the blink-related fronto-central N2 and parieto-occipital P3. Our results show increased parieto-occipital P3 amplitude indicating higher cognitive load in the 7-landmark condition, compared to showing 3 or 5 landmarks. Our prior research already demonstrated that participants acquire more spatial knowledge in the 5- and 7-landmark conditions compared to the 3-landmark condition. Together with the current study, we find that showing 5 landmarks, compared to 3 or 7 landmarks, improved spatial learning without overtaxing cognitive load during navigation in different urban environments. Our findings also indicate a possible cognitive load spillover effect during map-assisted wayfinding whereby cognitive load during map viewing might have affected cognitive load during goal-directed locomotion in the environment or vice versa. Our research demonstrates that users' cognitive load and spatial learning should be considered together when designing the display of future navigation aids and that navigators' eye blinks can serve as useful event makers to parse continuous human brain dynamics reflecting cognitive load in naturalistic settings.

Background:Neuromuscular dysfunction is common in older adults and more pronounced in neurodegenerative diseases. In Parkinson's disease (PD), a complex set of factors often prevents the effective performance of activities of daily living that require intact and simultaneous performance of the motor and cognitive tasks.Methods:The cross-sectional study includes a multifactorial mixed-measure design. Between-subject factor grouping the sample will be Parkinson's Disease (early PD vs. healthy). The within-subject factors will be the task complexity (single- vs. dual-task) in each motor activity, i.e., overground walking, semi-tandem stance, and isometric knee extension, and a walking condition (wide vs. narrow lane) will be implemented for the overground walking activity only. To study dual-task (DT) effects, in each motor activity participants will be given a secondary cognitive task, i.e., a visual discrimination task for the overground walking, an attention task for the semi-tandem, and mental arithmetic for the isometric extension. Analyses of DT effects and underlying neuronal correlates will focus on both gait and cognitive performance where applicable. Based on an a priori sample size calculation, a total N = 42 older adults (55-75 years) will be recruited. Disease-specific changes such as laterality in motor unit behavior and cortical control of movement will be studied with high-density surface electromyography and electroencephalography during static and dynamic motor activities, together with whole-body kinematics.Discussion:This study will be one of the first to holistically address early PD neurophysiological and neuromuscular patterns in an ecologically valid environment under cognitive-motor DT conditions of different complexities. The outcomes of the study aim to identify the biomarker for early PD either at the electrophysiological, muscular or kinematic level or in the communication between these systems.Clinical Trial Registration:ClinicalTrials.Gov, NCT05477654. This study was approved by the Medical Ethical Committee (106/2021).

IntroductionSpatial navigation is a complex cognitive function that declines in older age. Finding one’s way around in familiar and new environments is crucial to live and function independently. However, the current literature illustrates the efficacy of spatial navigation interventions in rehabilitative contexts such as pathological aging and traumatic injury, but an overview of existing training studies for healthy older adults is missing. This scoping review aims to identify current evidence on existing spatial navigation interventions in healthy older adults and analyze their efficacy.MethodsTo identify spatial navigation interventions and assessments and investigate their effectiveness, four electronic databases were searched (Pubmed, Web of Science, CINAHL and EMBASE). Two independent reviewers conducted a screening of title, abstract and full-texts and performed a quality assessment. Studies were eligible if (1) published in English, (2) the full text was accessible, (3) at least one group of healthy older adults was included with (4) mean age of 65 years or older, (5) three or more spatial navigation-related training sessions were conducted and (6) at least one spatial ability outcome was reported.ResultsTen studies were included (N = 1,003, age-range 20–95 years, 51.5% female), only healthy older adults (n = 368, mean age ≥ 65) were assessed further. Studies differed in sample size (n = 22–401), type of training, total intervention duration (100 min–50 h), and intervention period (1–16 weeks).ConclusionThe spatial navigation abilities addressed and the measures applied to elicit intervention effects varied in quantity and methodology. Significant improvements were found for at least one spatial ability-related outcome in six of 10 interventions. Two interventions achieved a non-significant positive trend, another revealed no measurable post-training improvement, and one study did not report pre-post-differences. The results indicate that different types of spatial navigation interventions improve components of spatial abilities in healthy older adults. The existing body of research does not allow conclusions on transferability of the trained components on everyday life spatial navigation performance. Future research should focus on reproducing and extending the promising approaches of available evidence. From this, valuable insights on healthy aging could emerge.Trial RegistrationThis scoping review was preregistered at Open Science Framework (https://osf.io/m9ab6).

The frequent use of GPS-based navigation assistance is found to negatively affect spatial learning. Displaying landmarks effectively while providing wayfinding instructions on such services could facilitate spatial learning because landmarks help navigators to structure and learn an environment by serving as cognitive anchors. However, simply adding landmarks on mobile maps may tax additional cognitive resources and thus adversely affect cognitive load in mobile map users during navigation. To address this potential issue, we set up the present study experimentally to investigate how the number of landmarks (i.e., 3 vs. 5 vs. 7 landmarks), displayed on a mobile map one at a time at intersections during turn-by-turn instructions, affects spatial learning, cognitive load, and visuospatial encoding during map consultation in a virtual urban environment. Spatial learning of the environment was measured using a landmark recognition test, a route direction test, and Judgements of Relative Directions (JRDs). Cognitive load and visuospatial encoding were assessed using electroencephalography (EEG) by analyzing power modulations in distinct frequency bands as well as peak amplitudes of event-related brain potentials (ERPs). Behavioral results demonstrate that landmark and route learning improve when the number of landmarks shown on a mobile map increases from three to five, but that there is no further benefit in spatial learning when depicting seven landmarks. EEG analyses show that relative theta power at fronto-central leads and P3 amplitudes at parieto-occipital leads increase in the seven-landmark condition compared to the three- and five-landmark conditions, likely indicating an increase in cognitive load in the seven-landmark condition. Visuospatial encoding indicated by greater theta ERS and alpha ERD at occipital leads with a greater number of landmarks on mobile maps. We conclude that the number of landmarks visualized when following a route can support spatial learning during map-assisted navigation but with a potential boundary-visualizing landmarks on maps benefits users' spatial learning only when the number of visualized landmarks shown does not exceed users' cognitive capacity. These results shed more light on neuronal correlates underlying cognitive load and visuospatial encoding during spatial learning in map-assisted navigation. Our findings also contribute to the design of neuro-adaptive landmark visualization for mobile navigation aids that aim to adapt to users' cognitive load to optimize their spatial learning in real time.

Landmarks support navigation and spatial learning of environments by serving as cognitive anchors. However, little research has been done to investigate how the design of landmarks on mobile maps affects cognitive processing. To address this gap, the present study utilized a within-subjects design to experimentally examine how three different landmark densities (3 vs. 5 vs. 7 landmarks) on mobile maps influence users’ spatial learning and cognitive load during navigation. Cognitive load was measured using electroencephalography (EEG). We applied an event-related analysis approach by utilizing eye blinks as naturalistic event markers to segment the EEG data. Results demonstrate that showing five landmarks along a given route to follow on a mobile map, compared to three and seven landmarks, improved spatial learning performance without taxing more cognitive resources. Our study shows that users’ cognitive load and spatial learning outcomes should be considered when designing landmark-based navigation assistance systems.

Although beacon- and map-based spatial strategies are the default strategies for navigation activities, today’s navigational aids mostly follow a beacon-based design where one is provided with turn-by-turn instructions. Recent research, however, shows that our reliance on these navigational aids is causing a decline in our spatial skills. We are processing less of our surrounding environment and relying too heavily on the instructions given. To reverse this decline, we need to engage more in map-based learning, which encourages the user to process and integrate spatial knowledge into a cognitive map built to benefit flexible and independent spatial navigation behaviour. In an attempt to curb our loss of skills, we proposed a navigation assistant to support map-based learning during active navigation. Called the virtual global landmark (VGL) system, this augmented reality (AR) system is based on the kinds of techniques used in traditional orienteering. Specifically, a notable landmark is always present in the user’s sight, allowing the user to continuously compute where they are in relation to that specific location. The efficacy of the unit as a navigational aid was tested in an experiment with 27 students from the University of Technology Sydney via a comparison of brain dynamics and behaviour. From an analysis of behaviour and event-related spectral perturbation, we found that participants were encouraged to process more spatial information with a map-based strategy where a silhouette of the compass-like landmark was perpetually in view. As a result of this technique, they consistently navigated with greater efficiency and better accuracy.

Advancements in hardware technology and analysis methods allow more and more mobility in electroencephalography (EEG) experiments. Mobile Brain/Body Imaging (MoBI) studies may record various types of data such as motion or eye tracking in addition to neural activity. Although there are options available to analyze EEG data in a standardized way, they do not fully cover complex multimodal data from mobile experiments. We thus propose the BeMoBIL Pipeline, an easy-to-use pipeline in MATLAB that supports the time-synchronized handling of multimodal data. It is based on EEGLAB and fieldtrip and consists of automated functions for EEG preprocessing and subsequent source separation. It also provides functions for motion data processing and extraction of event markers from different data modalities, including the extraction of eye-movement and gait-related events from EEG using independent component analysis. The pipeline introduces a new robust method for region-of-interest-based group-level clustering of independent EEG components. Finally, the BeMoBIL Pipeline provides analytical visualizations at various processing steps, keeping the analysis transparent and allowing for quality checks of the resulting outcomes. All parameters and steps are documented within the data structure and can be fully replicated using the same scripts. This pipeline makes the processing and analysis of (mobile) EEG and body data more reliable and independent of the prior experience of the individual researchers, thus facilitating the use of EEG in general and MoBI in particular. It is an open-source project available for download at https://github.com/BeMoBIL/bemobil-pipeline which allows for community-driven adaptations in the future.

The repeated use of navigation assistance systems leads to decreased processing of the environment. Previous studies demonstrated that auditory references to landmarks in navigation instructions can improve incidental spatial knowledge acquisition when driving a single route through an unfamiliar virtual environment. Based on these results, three experiments were conducted to investigate the generalizability and ecological validity of incidental landmark and route knowledge acquisition induced by landmark-based navigation instructions. In the first experiment, spatial knowledge acquisition was tested after watching an interactive video showing the navigation of a real-world urban route. A second experiment investigated incidental spatial knowledge acquisition during assisted navigation when participants walked through the same real-world, urban environ-ment. The third experiment tested the acquired spatial knowledge two weeks after participants had walked through the real-world environment. All experiments demonstrated better performance in a cued-recall task for participants navigating with landmark-based navigation instructions as compared to standard instructions. Different levels of information provided with landmark-based instructions impacted landmark recognition dependent on the delay between navigation and test. The results replicated an improved landmark and route knowledge when using landmark-based navigation instructions emphasizing that auditory landmark augmentation enhances incidental spatial knowledge acquisition, and that this enhancement can be generalized to real-life settings. This research is paving the way for navigation assistants that, instead of impairing spatial knowledge acqui-sition, incidentally foster the acquisition of landmark and route knowledge during every-day navigation.

Background: Hearing impairments are associated with reduced walking performance under Dual-task (DT) conditions. Little is known about the neural representation of DT performance while walking in this target group compared to healthy controls or younger adults. Therefore, utilizing the Mobile Brain/Body Imaging approach (MoBI), we aim at gaining deeper insights into the brain dynamics underlying the interaction of cognitive and motor processes during different DT conditions (visual and auditory) controlling for age and the potential performance decrements of older adults with hearing impairments.Methods: The cross-sectional study integrates a multifactorial mixed-measure design. Between-subject factors grouping the sample will be age (younger vs. older adults) and hearing impairment (mild vs. not hearing impaired). The within-subject factors will be the task complexity (single- vs. DT) and cognitive task modality (visual vs. auditory). Stimuli of the cognitive task will vary according to the stimulus modality (visual vs. auditory), presentation side (left vs. right), and presentation-response compatibility (ipsilateral vs. contralateral). Analyses of DT costs and underlying neuronal correlates focus either on gait or cognitive performance. Based on an a priori sample size calculation 96 (48 healthy and 48 mildly hearing impaired) community-dwelling older adults (50-70 years) and 48 younger adults (20-30 years) will be recruited. Gait parameters of speed and rhythm will be captured. EEG activity will be recorded using 64 active electrodes.Discussion: The study evaluates cognitive-motor interference (CMI) in groups of young and older adults as well as older adults with hearing impairment. The underlying processes of the interaction between motor and cognitive tasks will be identified at a behavioral and neurophysiological level comparing an auditory or a visual secondary task. We assume that performance differences are linked to different cognitive-motor processes, i.e., stimulus input, resource allocation, and movement execution. Moreover, for the different DT conditions (auditory vs. visual) we assume performance decrements within the auditory condition, especially for older, hearing-impaired adults. Findings will provide evidence of general mechanisms of CMI (ST vs. DT walking) as well as task-specific effects in dual-task performance while over ground walking.

The augmentation of landmarks in auditory navigation instructions had been shown to improve incidental spatial knowledge acquisition during assisted navigation. Here, two driving simulator experiments are reported that replicated this effect even when adding a three-week delay between navigation and spatial tasks and varying the degree of detail in the provided landmark information. Performance in free- and cued-recall of landmarks and driving the route again without assistance demonstrated increased landmark and route knowledge when navigating with landmark-based compared to standard instructions. The results emphasize that small changes to existing navigation systems can foster spatial knowledge acquisition during every-day navigation.

Quality of Experience is traditionally evaluated by using short stimuli usually representing parts or single usage episodes. This opens the question on how the overall service perception involving multiple usage episodes can be evaluated—a question of high practical relevance to service operators. Despite initial research on this challenging aspect of multi-episodic perceived quality, the question of the underlying quality formation processes and its factors are still to be discovered. We present a multi-episodic experiment of an Audio-on-Demand service over a usage period of 6 days with 93 participants. Our work directly extends prior work investigating the impact of time between usage episodes. The results show similar effects — although the recency effect is not statistically significant. In addition, we extend prediction of multi-episodic judgments by accounting for the observed saturation.

Conducting neuroscience research in the real world remains challenging because of movement- and environment-related artifacts as well as missing control over stimulus presentation. The present study demonstrated that it is possible to investigate the neuronal correlates underlying visuo-spatial information processing during real-world navigation. Using mobile EEG allowed for extraction of saccade- and blink-related potentials as well as gait-related EEG activity. In combination with source-based cleaning of non-brain activity and unfolding of overlapping event-related activity, brain activity of naturally behaving humans was revealed even in a complex and dynamic city environment.

The use of Navigation Assistance Systems for spatial orienting has become increasingly popular. Such automated navigation support, however, comes with a reduced processing of the surrounding environment and often with a decline of spatial orienting ability. To prevent such deskilling and to support spatial learning, the present study investigated incidental spatial learning by comparing standard navigation instructions with two modified navigation instruction conditions. The first modified instruction condition highlighted landmarks and provided additional redundant information regarding the landmark (contrast condition), while the second highlighted landmarks and included personal relevant information regarding the landmark (personal-reference condition). Participants’ spatial knowledge of the previously unknown virtual city was tested three weeks later. Behavioral and electroencephalographic (EEG) data demonstrated enhanced memory performance for participants in the modified navigation instruction conditions without further differentiating between modified instructions. Recognition performance of landmarks was better and the late positive complex of the event-related potential (ERP) revealed amplitude differences reflecting an increased amount of recollected information for modified navigation instructions. The results indicate a significant long-term spatial learning effect when landmarks are highlighted during navigation instructions.

The impact of varying performance and its effect on the perceived quality is an important aspect of quality of experience . Especially for service providers, it is important to understand how the perceived quality of a user, who is interacting with their services repeatedly, evolves. Repeated-use of a service is actually common for telecommunication services, such as speech telephony. For telecommunication services, it is very likely that a user encounters varying performance, for example due to varying network load conditions. For repeated-use taking place in a usage period covering several days, initial work on the formation process of the so-called multi-episodic perceived quality (i.e., distinct, meaningful interactions, denoted as usage episodes ) has been conducted. In this paper, we present our work investigating the multi-episodic perceived quality for usage episodes taking place in one session (i.e., in a time frame of up to 45 min) with a speech telephony service. We investigate two aspects and their impact on the multi-episodic perceived quality: (a) increasing the number of low performance (LP) usage episodes and (b) varying the temporal position of LP usage episodes towards the assessment of multi-episodic perceived quality. Additionally, the impact of the user’s behavioral freedom (i.e., two-party conversation vs. 3rd-party listening) on the two investigated aspects is examined. With regard to (a), the results show that an increasing number of LP usage episodes lead to a reduced multi-episodic perceived quality until saturation is reached. No impact of the user’s behavioral freedom was found. For (b), an impact of the varied behavioral freedom was observed. Varying the temporal position had an impact on the multi-episodic perceived quality for two-party conversation. For 3rd-party-listening, this could only be observed in one out of two cases.

In this paper, the occurrence of duration neglect for multi-episodic perceived quality is investigated. Such an effect has been observed for retrospective judgments of individual experiences, showing that the actual duration of exceptional parts of an experience are not reflected in retrospective judgments. Duration neglect has, so far, only received limited attention for perceived quality, but represents an important aspect especially for multi-episodic usage. Here, it is not known if a duration neglect occurs and thus the actual duration of an individual usage episode affects judgments on multi-episodic perceived quality. The results of a subjective experiment are reported that investigated the occurrence of duration neglect in one session of multiepisodic use. In this experiment, the duration of a single degraded episode was varied between two multi-episodic conditions. The results show that a duration neglect occurs for the multi-episodic judgments as well as the episodic judgments of this usage episode. Keywords—Quality of Experience; Telecommunication Services