Objective:To examine whether prefrontal cortex activation measured by functional near‑infrared spectroscopy (fNIRS) during the St. Louis University Mental Status (SLUMS) exam differs by cognitive status and whether relative neural efficiency (RNE) can serve as a physiological marker of cognitive impairment. Methods:This exploratory study was conducted in 2024 at a senior center in a small Mid‑Atlantic U.S. city. Thirteen community‑dwelling adults aged 65-85 years completed the SLUMS while wearing an fNIRS sensor positioned over the prefrontal cortex. Participants were classified as having normal cognition (NOR), mild cognitive disorder (MCD), or dementia (DEM) based on SLUMS scores. ΔHbO served as the indicator of cognitive effort, and RNE was calculated by combining normalized SLUMS performance and oxygenation values. Group differences were tested using ANOVA with confirmatory nonparametric analyses. Results:RNE differed significantly among groups (F₂,₁₀ = 5.26, p = 0.0275). Post‑hoc comparisons showed lower RNE in the DEM group compared with the NOR group (p = 0.0224). Confirmatory Kruskal‑Wallis testing supported these findings (p = 0.0287), with a significant DEM-NOR difference on Dunn's test (p = 0.0311). Descriptive hemodynamic patterns indicated higher ΔHbO and ΔHbR variability in the DEM group across SLUMS question blocks. Conclusions:Older adults with dementia demonstrated reduced neural efficiency during SLUMS administration, suggesting greater cognitive effort relative to performance. These preliminary findings indicate that SLUMS items impose different cognitive workloads depending on impairment level. Policy Implications:Integrating physiological markers such as neural efficiency into cognitive screening may enhance early identification of impairment, support more targeted referral pathways, and inform public health planning for Delaware's aging population.

Portable electromyography biofeedback (EMG-BFB) may support gait rehabilitation, but whole-gait responses across increasing portable auditory feedback goals are unclear. Twenty-four adults completed baseline treadmill walking and four counterbalanced right medial gastrocnemius activation-goal conditions set at 20%, 40%, 60%, and 80% above baseline; 23 contributed primary biomechanical data. Treadmill speed was adjusted within each condition to support achievement of the activation goal. Outcomes included walking speed, ground-reaction forces, force-time metrics, step length, temporal measures, and asymmetry. Repeated-measures MANOVA, outcome-specific repeated-measures ANOVAs, dose-response coefficients, bootstrap intervals, and leave-one-participant-out analyses were used. The combined gait-biomechanics outcomes differed significantly across activation-goal conditions (p < 0.001), with large condition effects for walking speed, propulsion, braking magnitude, and step length. From baseline to the highest goal, treadmill speed increased from 1.07 to 1.44 m/s, mean propulsion by 0.086 N/BW, braking magnitude by 0.109 N/BW, and mean step length by 0.150 m. Exploratory speed-adjusted models retained anterior–posterior and vertical loading-response associations but not peak propulsion; activation goal and achieved speed were strongly collinear. Unilateral feedback was not associated with systematic step-length or step-time asymmetry. Portable auditory EMG-BFB at increasing activation goals was accompanied by coordinated changes across gait mechanics.

Educational games enhance learning experiences by integrating touchscreens, making interactions more engaging and intuitive for learners. However, the cognitive impacts of educational game input modalities, such as the hand and stylus technique, are not clear. We compared the experience of using hands vs. a stylus for touchscreens while educational gameplay by analyzing oxygenated hemoglobin collected by functional Near-Infrared Spectroscopy and self-reported measures. In addition, we measured the hand vs. the stylus modalities of the task and calculated the relative neural efficiency and relative neural involvement using the mental demand and the quiz score. Our findings show that the hand condition had a significantly lower neural involvement, yet higher neural efficiency than the stylus condition. This result suggests the requirement of less cognitive effort while using the hand. Additionally, the self reported measures show significant differences, and the results suggest that hand-based input is more intuitive, less cognitively demanding, and less frustrating. On the other hand, the use of a stylus required higher cognitive effort due to the cognitive balance of controlling the pen and answering questions. These findings highlight the importance of designing educational games that allow learners to engage with the system while minimizing cognitive effort.

PURPOSE:Prior research has emphasized the superiority of an external focus of attention for motor learning. According to the Constrained Action Hypothesis, an external focus encourages automaticity by directing attention to movement outcomes, while an internal focus is thought to impair learning by promoting controlled processing directed at biomechanics. However, prior research has largely conflated two attentional constructs: the locus of attention (external vs internal) and the target of attention (movement outcomes vs biomechanics). Therefore, the purpose of this study was to experimentally separate these constructs within the context of a voice learning task. METHOD:Sixteen participants ages 18-38 years with no history of voice disorders or voice training, were randomly assigned to either an external or internal focus of attention group. The task was to produce voice as "clearly" as possible, using an external (sound in the room) or an internal (anterior oral vibrations) focus. A cognitive control task was the Tower of Hanoi game (TOH). Dependent variables across baseline, intervention, and retention phases were spectral moments, spectral slope, and formant cluster prominence (FCP), as well as cognitive effort estimated from functional near-infrared spectroscopy (fNIRS). RESULTS:The external focus group showed significant increases in spectral mean, standard deviation, and FCP over time, while the internal focus group showed declines or stabilization for the same measures. Neurophysiological oxygenation measures were lower during voice tasks than for the TOH, with no group effect. CONCLUSIONS:Findings challenge the notion that an internal focus is inferior for motor learning. When locus of attention (external vs internal) and target (outcomes vs biomechanics) are decoupled, external focus does not consistently outperform internal focus. Rather than magnitude of learning, locus of attention appeared to affect learning content. Participants instructed to focus on oral vibratory sensations aligned spectral output with oral vibratory receptor frequency sensitivities, while those focused on room sound aligned spectral output with auditory receptor frequency sensitivities. An internal focus on movement outcomes was not associated with increased cognitive effort over an external focus. Findings also call into question traditional stage models of motor learning suggesting a fixed progression from controlled to automatic processes earlier vs later in learning.

For serious games on education, understanding the effectiveness of different learning methods in influencing cognitive processes remains a significant challenge. This study investigates the impact of serious games on graph structure learning. For this, we compared our in-house game-based learning (GBL) and video-based learning (VBL) methodologies by evaluating their effectiveness on cognitive processes by oxygenated hemoglobin levels using functional near-infrared spectroscopy (fNIRS). We conducted a 2 x 1 between subjects preliminary study with twelve participants, involving two conditions: game and video. Both groups received equivalent content related to the basic structure of a graph, with comparable session lengths. The game group interacted with a quiz-based game, while the video group watched a pre-recorded video. The fNIRS was employed to capture cerebral signals from the prefrontal cortex, and participants completed pre- and post- questionnaires capturing user experience and knowledge gain. In our study, we noted that the mean levels of oxygenated hemoglobin were higher in the GBL group, suggesting the potential enhanced cognitive involvement. Our results show that the lateral prefrontal cortex (LPFC) has greater hemodynamic activity during the learning period. Moreover, knowledge gain analysis showed an increase in mean score in the GBL group compared to the VBL group. Although we did not observe statistically significant changes due to participant variability and sample size, this preliminary work contributes to understanding how GBL and VBL impact cognitive processes, providing insights for enhanced instructional design and educational game development. Additionally, it emphasizes the necessity for further investigation into the impact of GBL on cognitive engagement and learning outcomes.

OBJECTIVES:The purpose was to examine the influence of auditory vs visual vs combined audiovisual input on perception and production of one's own voice, using immersive virtual reality technology. METHODS:Thirty-one vocally healthy men and women were investigated under 18 sensory input conditions, using immersive virtual reality technology. Conditions included two auditory rooms with varying reverberation times, two visual rooms with varying volumes, and the combination of audiovisual conditions. All conditions were repeated with and without background noise. Speech tasks included counting, sustained vowel phonation, an all-voiced sentence from the Consensus Auditory-Perceptual Evaluation of Voice, and the first sentence from the Rainbow Passage, randomly ordered. Perception outcome measures were participants' self-reported perceptions of their vocal loudness, vocal effort, and vocal comfort in speech. Production outcome measures were sound pressure level (SPL) and spectral moments (spectral mean and standard deviation in Hz, skewness, and kurtosis). Statistical analyses used self-reported vocal effort, vocal loudness, and vocal comfort in percent (0 = "not at all," 100 = extremely), SPL in dB, and spectral moments in Hz. The reference level was a baseline audiovisual deprivation condition. RESULTS:Results suggested (i) increased self-perceived vocal loudness and effort, and decreased comfort, with increasing room volume, speaker-to-listener distance, audiovisual input, and background noise, and (ii) increased SPL and fluctuations in spectral moments across conditions. CONCLUSIONS:Not only auditory, but also visual and audiovisual input influenced voice perception and production in ways that have not been previously documented. Findings contribute to the basic science understanding the role of visual, audiovisual and auditory input in voice perception and production, and also to models of voice training and therapy. The findings also set the foundation for the use of virtual reality in voice and speech training, as a potentially power solution to the generalization problem.

BACKGROUND:“Contextual interference” (CI) describes a counterintuitive phenomenon related to practice organization when learning multiple tasks that are presented in a non-repetitive order. In CI, the lack of repetitiveness introduces a high level of interference within the learning context such that task performance during initial skill acquisition is frequently poorer than if tasks are practiced in a repetitive fashion. However, these learners often perform better on retention and transfer tasks than individuals who learn within a low CI environment. AIM:We provide a tutorial on several novel ways in which researchers can investigate brain activity in a CI paradigm using functional near-infrared spectroscopy: Relative neural efficiency (RNE), relative neural involvement (RNI), and laterality index (LI). METHOD:RNE integrates measures of cognitive effort and behavioral performance; in high CI learning environments, RNE should initially be poor (high cognitive effort, low behavioral performance), then improve during retention and transfer. RNI provides an index of the relationship among motivation, mental effort, and performance. Finally, LI allows for the exploration of lateralization between the two hemispheres of the cerebral cortex. RESULTS:Significant differences were found for total hemoglobin, RNE and LI for the right and left prefrontal cortex regions. The differences were accompanied by moderate-to-large effect size with random using less effort, better performance and was more oriented to goal orientation and learning processes than blocked who focused more on visuomotor attentional components and used more effort with lower behavioral performance scores. CONCLUSION:RNE, RNI, and LI provide innovative methods to better understand cognitive effort within CI paradigms.

Background : Previous research suggests that children with or at risk of probable developmental coordination disorder (pDCD) activate different areas of the brain when performing certain motor skills compared with typically developing (TD) children. This study used functional near-infrared spectroscopy to compare prefrontal cortex (PFC) activity in TD and pDCD during the completion of manual (three-dimensional [3D]) and computerized versions (two-dimensional) of the Tower of Hanoi (ToH) puzzle. Method : A total of 12 children (TD and pDCD; one female/11 male, , SD ± 1.52 years) performed the two-dimensional and 3D conditions of the ToH disk tasks, with equivalent executive function but different motor requirements, with functional near-infrared spectroscopy to compare PFC activity. Results : Interestingly, brain oxygenation levels were more apparent in the 3D versus two-dimensional ToH. In the 3D, there were large differences between pairs of discordant sibling sets and this was located to the right medial PFC, with pDCD exhibiting less activation in this region. Conclusion : While only exploratory, we have identified potential differences in the right medial PFC region, which differs within sibling sets with different pDCD status. These results concur with previous studies and are an area that needs to be explored further with a larger cohort of TD and pDCD.

For serious games on education, understanding the effectiveness of different learning methods in influencing cognitive processes remains a significant challenge. This study investigates the impact of serious games on graph structure learning. For this, we compared our in-house game-based learning (GBL) and video-based learning (VBL) methodologies by evaluating their effectiveness on cognitive processes by oxygenated hemoglobin levels using functional near-infrared spectroscopy (fNIRS). We conducted a 2 x 1 between subjects preliminary study with twelve participants, involving two conditions: game and video. Both groups received equivalent content related to the basic structure of a graph, with comparable session lengths. The game group interacted with a quiz-based game, while the video group watched a pre-recorded video. The fNIRS was employed to capture cerebral signals from the prefrontal cortex, and participants completed pre- and post- questionnaires capturing user experience and knowledge gain. In our study, we noted that the mean levels of oxygenated hemoglobin were higher in the GBL group, suggesting the potential enhanced cognitive involvement. Our results show that the lateral prefrontal cortex (LPFC) has greater hemodynamic activity during the learning period. Moreover, knowledge gain analysis showed an increase in mean score in the GBL group compared to the VBL group. Although we did not observe statistically significant changes due to participant variability and sample size, this preliminary work contributes to understanding how GBL and VBL impact cognitive processes, providing insights for enhanced instructional design and educational game development. Additionally, it emphasizes the necessity for further investigation into the impact of GBL on cognitive engagement and learning outcomes.

Background Motor competence has important developmental associations with aspects of physical health, but there has been no synthesis of longitudinal associations with cognitive and social-emotional health. Objectives The first aim was to present a conceptual model that positions motor competence as a mediator between physical activity and cognitive and social-emotional outcomes. The second aim was to synthesize the association of motor competence and cognitive and social-emotional development using longitudinal observational and experimental evidence, in particular to (i) identify the role of task, individual, and environmental characteristics in moderating the association between motor and cognitive and social-emotional outcomes and (ii) synthesize the strength of evidence pertaining to domain-specific relationships. Methods This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting systematic reviews and meta-analyses. Five electronic databases (PubMed, Web of Science, Scopus, PsycINFO, and SPORTDiscus) were systematically searched. Following study screening and risk-of-bias assessment by two authors, 49 eligible studies were identified for inclusion and grouped by study design. Evidence for domain-specific paths between motor competence and cognitive and social-emotional outcomes was synthesized by calculating the significant analyses in the hypothesized direction, divided by the total number of analyses for that path. These percentages were then collated for each domain outcome. This collated influence was classified as either no association (0–33%), written as ‘0’, or indeterminate/inconsistent (34–59%), written as ‘?’ If there were fewer than three studies in the domain, the strength of evidence was classified as insufficient (I). Results Of the 49 studies, 35% were able to satisfy six or more of the seven risk-of-bias criteria. Longitudinal observational evidence about domain-specific and global associations of motor competence and cognitive and social-emotional development is indeterminate. The included studies also did not provide evidence for a consistent moderating role of age and sex. Some preliminary experimental evidence does support the role of motor competence in moderating the influence of cognitively enriched physical activity on cognitive outcomes, especially working memory and social-emotional skills. However, too few studies were appropriately designed to acknowledge the moderating role of contextual mechanisms. Conclusions Between-study heterogeneity means it was not possible to identify definitive domain- and construct-specific relationships between motor competence and cognitive and social-emotional outcomes. To further develop our understanding, it is important that researchers acknowledge the complexity of these relationships within rigorous study designs.

By 2030, an estimated 21.6% of the U.S. population will exceed 65 years old. Within this demographic, ongoing broad efforts are needed to address modifiable factors related to common chronic conditions of aging. Digital, or “serious,” health games offer one innovative approach to reach and engage older adults, with documented positive impacts on physical, mental/cognitive, and social health. Informed by healthy aging theory and community-engaged, user-centered design methods, our multidisciplinary team has developed a prototype multicomponent educational exergame designed to educate about and promote healthy lifestyle behaviors (i.e., healthy eating, physical activity), stimulate cognitive functioning, engage movement, and promote social connection. Additionally, we included functional near infrared spectroscopy (fNIRS) in our pilot work to measure real time brain activation during gameplay. Our objectives are to: 1) describe the formative development and testing process of an example multi-component educational exergame, including multidisciplinary team science collaboration, application of aging theory, and use of community-engaged and user-centered approaches; and 2) present a pilot study examining implementation and multiple aspects of an innovative educational exergame, including usability, acceptability, preliminary impact, and cognitive function measurement using brain imaging technology (fNIRS) to measure changes in cognitive load during gameplay. The results provide initial support for acceptability, usability, and positive perceived impact, as well as the preliminary encouraging pre to post improvements in behavioral intention, content knowledge, and relative neural efficiency. This paper also explores the potential of implementing serious health games in senior centers as part of their regular programming.

Detailed Assessment of Speed of Handwriting (DASH 17+) assessment provides information about the speed and legibility of handwriting. Handwriting difficulties in general and DASH17+ performance, in particular, are signs of neuromotor difficulties. Individualized interventions can be developed with a better understanding of both the biomechanical and neurological underpinnings of the task. We used a multimodal assessment strategy to deconstruct the product and process of handwriting measures in adults. A total of 23 neurotypical college age adults took part in the study. We combined the standardized norm-referenced test DASH17+ and explored the online process of handwriting using the MovAlyzeR software, and simultaneously explored prefrontal cortex activity, using functional near infrared spectroscopy (fNIRS), during the task execution. Our research indicated that underlying neural and kinematic mechanisms changed between tasks, within tasks, and even from one trial block to another that are not reflected in the DASH17+ performance assessment alone. Therefore, this multi-modal approach provides a promising method in clinical populations to further investigate any subtle change in handwriting.

Fidget spinners have been marketed as repetitive motion devices that improve attention and motor performance, and as such, they have become quite appealing to individuals with Attention Deficit Hyperactive Disorder (ADHD). To date, no studies have explored changes in brain activity that may occur due to fidgeting in ADHD. Our aim was to use functional Near-Infrared Spectroscopy (fNIRS) to examine the prefrontal cortex (PFC) during the performance of a standardized fine motor skills test after using a fidget spinner. Eight right-handed adults with ADHD and eight age and gender matched adults without ADHD (4F/4M, 4 control/4 fidget) performed the Purdue Pegboard Test (PPT) while their brain oxygenation was monitored using fNIRS. Relative neural efficiency (RNE) and involvement (RNI) were calculated and analyzed for all subtasks of PPT including the less cognitively demanding fine motor subtasks and more complex assembly tasks. The fidget spinner improved both task performance and RNE in the ADHD group but not the non-ADHD group for the less cognitively demanding subtasks. Our results indicate Fidget spinners may improve both relative neural efficiency and fine motor performance in adults with ADHD for less cognitively demanding tasks.