Name: setup and execution of the blindfolded code training exercise
Uploaded: 2019-03-29T14:45:00.000+00:00
Duration: 5 min 25 s
Description: Watch this Scientific Journal Video about Setup and Execution Of the Blindfolded Code Training Exercise at JoVE.com

The authors have no acknowledgments.

All methods described here were exempt from review by the Summa Institutional Review Board.&#160;
1. Preparation
<ol>
	<li>Prepare the simulation lab prior to beginning the blindfolded code training exercise.&#160;
	<ol>
		<li>Prepare all supplies needed for code resuscitation, including an intravenous (IV) start kit, IV fluids, a code cart, a defibrillator with pads, a bag valve mask, a non-rebreather mask, a nasal cannula, a pulse oximeter, and intubating supplies (including a laryngoscope, an endotracheal tube, a stylet, a syringe, an end-tidal carbon dioxide monitor, and a cardiac monitor).</li>
		<li>Place the human-patient simulator on an emergency department bed. Turn on the simulator and connect it to the wireless network. Set the simulator vitals to match the case scenario.</li>
		<li>Provide a chair or stool and blindfold for the code team leader. Place the team leader 5 feet away from the foot of the bed, facing away from the team.&#160;</li>
	</ol>
	</li>
	<li>Print code resuscitation simulation scenarios for the faculty. Read the simulation scenarios prior to the start of the session.&#160;</li>
	<li>Upload any necessary radiographic images and electrocardiograms for each patient scenario.</li>
</ol>
2. Blindfolded Code Training Exercise
<ol>
	<li>Review the rules of the exercise with the learners. Provide a demonstration for the learners of the blindfolded code training exercise.</li>
	<li>Select a code team leader from the group of learners. Initially, start with more experienced learners as code team leaders.</li>
	<li>Sit the code team leader down on a chair or stool at the foot of the bed, facing away from the patient. Blindfold the code team leader.&#160; 
	NOTE: The best resuscitation team configuration is one embedded nurse, three resident physicians, and one resident as code team leader.</li>
	<li>Ensure that resuscitation team members verbally introduce themselves by role, name, and position in relation to the patient in the bed to the blindfolded code team leader prior to the start of the scenario.&#160; 
	NOTE: For example, &#8220;I am resident John at the head of the bed.&#8221;</li>
	<li>Start the scenario by reading the stem for the case scenario to the code team leader.</li>
	<li>Run the case scenario for approximately 8&#8211;10 min. Change the patient vitals and cardiac rhythms in alignment with the case scenario outline.&#160;</li>
</ol>
3. Blindfolded Code Team Debriefing
<ol>
	<li>Debrief the code team at the conclusion of the case scenario for approximately 10 min.&#160; 
	NOTE: Focus on the utilization of closed-loop communication, the leader&#8217;s effectiveness in leading the resuscitation, and the management decisions as they relate to the advanced cardiac life support (ACLS) or advanced trauma life support (ATLS) algorithms.&#160;</li>
	<li>Select another code team leader and repeat the process at the conclusion of the debriefing.</li>
</ol>

<ol>
	<li>Brindley, P. G., Hudson, D., Lord, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+blindfolded+learner+&#8211;+a+simple+intervention+to+improve+crisis+resource+management+skills.">The blindfolded learner &#8211; a simple intervention to improve crisis resource management skills.</a> Journal of Critical Care. 23 (2), 253-254 (2008).</li><li>Accreditation Council for Graduate Medical Education. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> ACGME Program Requirements for Graduate Medical Education in Pulmonary Disease and Critical Care Medicine (Internal Medicine). , (2017).</li><li>Accreditation Council for Graduate Medical Education and American Board of Emergency Medicine. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> The Emergency Medicine Milestone Project. , (2015).</li><li>Murphy, M., Curtis, K., McCloughen, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=What+is+the+impact+of+multidisciplinary+team+simulation+training+on+team+performance+and+efficiency+of+patient+care?+An+integrative+review.">What is the impact of multidisciplinary team simulation training on team performance and efficiency of patient care? An integrative review.</a> Australasian Emergency Nursing Journal. 19 (1), 44-53 (2016).</li><li>Ahmed, R., Hughes, K., Hughes, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+blindfolded+code+training+exercise.">The blindfolded code training exercise.</a> The Clinical Teacher. 15 (2), 120-125 (2018).</li><li>Ryoo, E. N., Ha, E. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Importance+of+Debriefing+in+Simulation-Based+Learning:+Comparison+Between+Debriefing+and+No+Debriefing.">The Importance of Debriefing in Simulation-Based Learning: Comparison Between Debriefing and No Debriefing.</a> Computers, Informatics, Nursing. 33 (12), 538-545 (2015).</li><li>Shinnick, M. A., Woo, M., Horwich, T. B., Steadman, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Debriefing:+The+Most+Important+Component+in+Simulation?.">Debriefing: The Most Important Component in Simulation?.</a> Clinical Simulation in Nursing. 7 (3), e105-e111 (2011).</li><li>Bergs, E. A., Rutten, F. L., Tadros, T., Krijnen, P., Schipper, I. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Communication+during+trauma+resuscitation:+do+we+know+what+is+happening?.">Communication during trauma resuscitation: do we know what is happening?.</a> Injury. 36 (8), 905-911 (2005).</li><li>Carter, E. A., Waterhouse, L. J., Kovler, M. L., Fritzeen, J., Burd, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adherence+to+ATLS+primary+and+secondary+surveys+during+pediatric+trauma+resuscitation.">Adherence to ATLS primary and secondary surveys during pediatric trauma resuscitation.</a> Resuscitation. 84 (1), 66-71 (2013).</li><li>Spanjersberg, W. R., Bergs, E. A., Mushkudiani, N., Klimek, M., Schipper, I. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Protocol+compliance+and+time+management+in+blunt+trauma+resuscitation.">Protocol compliance and time management in blunt trauma resuscitation.</a> Emergency Medicine Journal. 26 (1), 23-27 (2009).</li><li>Fitzgerald, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+video+audit+to+improve+trauma+resuscitation&#8212;time+for+a+new+approach.">Using video audit to improve trauma resuscitation&#8212;time for a new approach.</a> Canadian Journal of Surgery. 49 (3), 208-211 (2006).</li><li>Hughes, P. G., Ahmed, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Blindfolded+Trauma+Team+Resuscitation:+a+strategy+for+improved+leadership+and+communication.">The Blindfolded Trauma Team Resuscitation: a strategy for improved leadership and communication.</a> BMJ Simulation &amp; Technology Enhanced Learning. , (2017).</li></ol>

The authors have nothing to disclose.

The blindfolded code exercise consists of several critical steps. First, the exercise requires an initial faculty demonstration to decrease the learners&#8217; intimidation and anxiety toward performing a resuscitation blindfolded. It also serves to give learners an example of a successful performance of the blindfolded resuscitation. Facing the code team leader away from the resuscitation team ensures that the leader is unable to visualize the scenario and forces them to give loud, clear orders (Figure 1). In addition, start senior residents as code team leaders, as this exercise requires leaders to maintain a conceptual framework to organize their management and multitask without visual stimuli. The team leader must give explicit orders in closed-loop fashion to successfully manage the resuscitation. Running the scenario for 8&#8211;10 min allows the leader to manage the case for four to five cycles of CPR. This provides ample opportunity to evaluate effective usage of closed-loop communication and adherence to resuscitation algorithms. Lastly, it is important to debrief the learners at the conclusion of each resuscitation. Debriefing is the most critical portion of a simulation and is the key to maximizing knowledge and skills gained during the exercise6,7.&#160;
This innovative teaching technique can be applied to the management of any critically ill patient, with a primary focus on developing high-risk communication skills. During high-acuity trauma resuscitations, effective communication is critical to optimal management8. Removing visual stimuli forces learners to use closed-loop communication strategies and methodically approach the resuscitation, focusing on the execution of the primary survey without prematurely progressing to the secondary survey. Scholars have demonstrated that teams have fewer errors, fewer delays in diagnosis, and better patient outcomes when systematically following ATLS protocol9,10,11,12.&#160;
There are only a few limitations of the blindfolded code training exercise as it does not require any special simulation equipment, setup, or added costs. The exercise can be performed in situ or in a simulation lab. However, this exercise is typically limited to more experienced learners from acute care specialties, as novice participants may become overwhelmed without the ability to use visual prompts during resuscitation management.&#160;
Presently, there is a paucity of literature on innovative techniques to improve resident physician communication and leadership strategies in high-acuity situations. This novel teaching technique provides a nontraditional approach to force closed-loop communication. Future directions for this study include utilizing validated assessment tools to evaluate closed-loop communication, crisis resource management strategies, and resuscitation performance when comparing blindfolded leaders to nonblindfolded leaders in the management of critically ill patients.&#160;

The blindfolded code training exercise was developed to improve closed-loop communication, the utilization of a conceptual framework to organize the management of a resuscitation, and critical thinking skills. Previous scholars reported that communication, role clarity, and teamwork were enhanced by blindfolding physicians during simulated resuscitations1. Resident physicians, especially in critical care specialties, are frequently placed in high-acuity situations. In order to appropriately manage these high-risk cases, resident physicians require training in both leadership strategies and communication in high-risk environments2,3. Simulation is commonly used and is effective in teaching crisis resource management principles and communication skills4.&#160;
Currently, there is limited knowledge of innovative techniques to improve resident physician communication and leadership strategies in high-acuity situations. Ineffective communication may continue despite correct management and leadership observed in the simulation lab. A previous study highlights that the blindfolded code training exercise, when compared to typical code training, is more challenging and forces learners to use critical thinking skills and closed-loop communication. Learners felt the exercise solidified leadership skills and challenged them to maintain mental organization without visual cues5.&#160;
In preparation for the blindfolded code training exercise, the faculty provides a demonstration explaining how this advanced approach is performed, to decrease learner intimidation by the exercise. Once the demonstration is finished, the team leader is blindfolded. The team leader must use closed-loop communication and give explicit orders to the resuscitation team with a request to have all orders repeated back. The team cannot independently initiate any procedure or management without clear direction from the team leader. Team members can only execute orders from the team leader that are explicitly directed to them by name. If the team leader does not identify a specific person to perform the action, it is not performed. For example, if the team leader states, &#8220;Start compressions&#8221; without directing it to a specific team member, the order is not completed. All members of the team stand motionless. If a team member is given an order by the leader but is not requested to repeat the order as confirmation, the order can be executed but the team leader is not given verbal feedback at the completion of the order. This should prompt the team leader to ask that subsequent orders are to be repeated back, as the leader does not have visual stimuli to confirm order completion.&#160;
If the team leader asks team members to repeat the orders back, team members must reply to the team leader using closed-loop communication. This alerts the team leader when the order is received and completed. For example, if team leader Dr. Jones asks John to &#8220;Give 1 mg of epinephrine intravenously&#8221;, John will reply &#8220;I will get 1 mg of epinephrine. Dr. Jones, 1 mg of epinephrine has been administered intravenously&#8221;. The team leader can ask questions about the monitor. However, team members can only describe the appearance of the cardiac rhythm in layman&#8217;s terms (Table 1). For example, ventricular tachycardia would be described as a wide complex regular rhythm at the rate displayed on the monitor. Team members cannot use medical terms when describing the cardiac monitor, such as ventricular tachycardia or pulseless electrical activity. Lastly, faculty will verbally clarify all physical exam findings if the code team leader directs a team member to perform a physical exam.
By removing visual stimuli, the blindfolded code training exercise forces the team leader to maintain mental organization and use closed-loop communication to effectively manage a resuscitation. The purpose of the description of the blindfolded code training exercise is to provide guidance on how to perform this innovative teaching technique to force closed-loop communication.

<table><tbody><tr><td>Bag valve mask</td><td></td><td></td><td></td></tr><tr><td>Blindfold</td><td></td><td></td><td></td></tr><tr><td>Blood pressure cuff</td><td></td><td></td><td></td></tr><tr><td>Cardiac monitor</td><td></td><td></td><td></td></tr><tr><td>Chair</td><td></td><td></td><td></td></tr><tr><td>Code Cart</td><td></td><td></td><td>ACLS medications</td></tr><tr><td>Defibrillator with pads</td><td></td><td></td><td></td></tr><tr><td>Emergency department bed</td><td></td><td></td><td></td></tr><tr><td>End-tidal carbon dioxde monitor</td><td></td><td></td><td></td></tr><tr><td>Human-patient simulator</td><td></td><td></td><td></td></tr><tr><td>Intubation Kit&amp;nbsp;</td><td></td><td></td><td>endotracheal tube, laryngoscope, stylet, 10 mL syringe, endotracheal tube holder</td></tr><tr><td>IV fluids</td><td></td><td></td><td>1 L normal saline or lactated ringer&#039;s</td></tr><tr><td>IV start kit</td><td></td><td></td><td>tourniquet, tape, tegaderm, IV catheter</td></tr><tr><td>Nasal cannula</td><td></td><td></td><td></td></tr><tr><td>Non-rebreather mask</td><td></td><td></td><td></td></tr><tr><td>Pulse oximeter</td><td></td><td></td><td></td></tr><tr><td>Step stool</td><td></td><td></td><td></td></tr><tr><td>Stethoscope</td><td></td><td></td><td></td></tr></tbody></table>

setup and execution of the blindfolded code training exercise

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to improve resident physician communication and leadership strategies in high-acuity situations. The blindfolded code training exercise removes visual stimuli from the team leader, forcing the team leader to effectively utilize closed-loop communication. The simple act of blindfolding the team leader creates a learning environment where the leader must utilize a conceptual framework and critical thinking strategies to organize the team and manage the resuscitation. An advantage to this teaching technique is that it does not require any special simulation equipment, making it a low-cost approach. The blindfolded code training exercise can be applied to the management of any critically ill patient where the primary objective is to focus on developing communication skills in acute resuscitations. The purpose of the description of the blindfolded code training exercise is to provide guidance on how to perform this innovative teaching technique to force effective closed-loop communication.

As noted in Ahmed et al., all residents (100%, 27/27) agreed/strongly agreed that knowledge obtained during the blindfolded code training exercise could be transferred to the clinical setting5. In addition, most residents strongly agreed that the blindfolded code training exercise was more challenging (81.5%, 22/27), allowed them to apply critical thinking skills (81.5%, 22/27), and improved use closed-loop communication (88.9%, 24/27) when compared to typical code training exercises (Table 2).
Qualitative themes identified from the resident surveys in Ahmed et al. included solidifying leadership skills and ACLS knowledge and improving closed-loop communication5. Residents felt that maintaining mental organization without visual cues was the most challenging part of this exercise.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/59248/59248fig1.jpg" /> 
Figure 1: Blindfolded team leader and resuscitation team. Blindfolded team leader, seated and rear-facing, with the surrounding resuscitation team members and simulation manikin. <a href="https://www.jove.com/files/ftp_upload/59248/59248fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Electrical Rhythm</td>
			<td>Verbal description</td>
		</tr>
		<tr>
			<td>Ventricular fibrillation</td>
			<td>Irregular rhythm without discernable P, QRS, or T waves; varying amplitude</td>
		</tr>
		<tr>
			<td>Ventricular tachycardia</td>
			<td>Wide complex regular rhythm, rate &#62;120</td>
		</tr>
		<tr>
			<td>Torsades de Pointes</td>
			<td>Regular wide-complex tachycardic rhythm with varying amplitude of QRS complexes, described as &#8220;twisting&#8221; morphology</td>
		</tr>
		<tr>
			<td>Asystole</td>
			<td>Flat line</td>
		</tr>
		<tr>
			<td>Normal Sinus Rhythm</td>
			<td>Regular, narrow complex rhythm with P waves before every QRS complex, rate 60-100</td>
		</tr>
		<tr>
			<td>2nd degree heart block- Type 1 Mobitz (Wenckebach)</td>
			<td>Progressively lengthening PR intervals with dropped QRS complex after P wave.</td>
		</tr>
		<tr>
			<td>2nd degree heart block- Type 2 Mobitz</td>
			<td>Consistent PR interval with intermittent dropped QRS complexes after P wave.</td>
		</tr>
		<tr>
			<td>3rd degree heart block</td>
			<td>Complete A-V dissociation with constant P-P and R-R intervals, ventricular rate 20&#8211;40</td>
		</tr>
		<tr>
			<td>Atrial fibrillation with rapid ventricular response</td>
			<td>Irregularly irregular narrow complex rhythm without P waves, rate &#62;100</td>
		</tr>
		<tr>
			<td>Pulseless electrical activity (PEA)</td>
			<td>Regular, narrow complex rhythm with P waves before every QRS complex, rate 60-100, only mention pulse if asked by team leader to palpate</td>
		</tr>
	</tbody>
</table>
Table 1: Rhythm description. Acceptable layman&#8217;s terms for specific cardiac rhythm descriptions. This table has been modified from research by Ahmed et al.5.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td rowspan="2">Survey Questions</td>
			<td>Strongly Disagree</td>
			<td>Disagree</td>
			<td>Neutral</td>
			<td>Agree</td>
			<td>Strongly Agree</td>
		</tr>
		<tr>
			<td>1</td>
			<td>2</td>
			<td>3</td>
			<td>4</td>
			<td>5</td>
		</tr>
		<tr>
			<td>Faculty clearly communicated the objectives and expected outcomes to the participants of the simulation training exercises&#160;</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>7.4% (2)</td>
			<td>92.6% (25)</td>
		</tr>
		<tr>
			<td>Faculty support a safe learning environment that advocates active learning</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>11.1% (3)</td>
			<td>88.9% (24)</td>
		</tr>
		<tr>
			<td>Faculty modeled professional integrity during the individual scenario</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>11.1% (3)</td>
			<td>88.9% (24)</td>
		</tr>
		<tr>
			<td>Faculty provided constructive feedback and discussion after the simulation scenarios</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>11.1% (3)</td>
			<td>88.9% (24)</td>
		</tr>
		<tr>
			<td>Faculty in the room made an effort to make the exercise less intimidating</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>14.8% (4)</td>
			<td>25.9% (7)</td>
			<td>59.2% (16)</td>
		</tr>
		<tr>
			<td>The knowledge gained through the blindfolded code training can be transferred to the clinical setting</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>11.1% (3)</td>
			<td>88.9% (24)</td>
		</tr>
		<tr>
			<td>&#160;I felt the blindfolded code training exercise was more challenging than typical code training exercises&#160;</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>3.7% (1)</td>
			<td>14.8% (4)</td>
			<td>81.5% (22)</td>
		</tr>
		<tr>
			<td>The blindfolded code training allowed me to use the critical thinking skills I have acquired throughout residency&#160;</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>18.5% (5)</td>
			<td>81.5% (22)</td>
		</tr>
		<tr>
			<td>The blindfold code training&#160; made me better utilize closed loop communication in comparison to typical code training to ensure task performance and/or completion&#160;</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>11.1% (3)</td>
			<td>88.9% (24)</td>
		</tr>
		<tr>
			<td>I felt confident in my ability to&#160; perform a code blindfolded</td>
			<td>0% (0)</td>
			<td>11.1% (3)</td>
			<td>18.5% (5)</td>
			<td>48.1% (13)</td>
			<td>22.2% (6)</td>
		</tr>
		<tr>
			<td>The blindfolded training exercises allowed me to demonstrate my leadership ability to direct the healthcare team during a resuscitation</td>
			<td>0% (0)</td>
			<td>0% (0)</td>
			<td>3.7% (1)</td>
			<td>29.6% (8)</td>
			<td>66.7% (18)</td>
		</tr>
	</tbody>
</table>
Table 2: Survey results. Written survey responses from participants (N = 27). This table has been modified from research by Ahmed et al.5.

Watch this Scientific Journal Video about Setup and Execution Of the Blindfolded Code Training Exercise at JoVE.com

Setup and Execution Of the Blindfolded Code Training Exercise

The blindfolded code training exercise, which blindfolds the team leader in a code resuscitation simulation, is an advanced teaching technique to improve closed-loop communication, organizational skills, and critical thinking.&#160;

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to ...

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9.3K Views.  Florida Atlantic University Schmidt College of Medicine. The blindfolded code training exercise, which blindfolds the team leader in a code resuscitation simulation, is an advanced teaching technique to improve closed-loop communication, organizational skills, and critical thinking. 

Video: Setup and Execution Of the Blindfolded Code Training Exercise

Automated Visual Cognitive Tasks for Recording Neural Activity Using a Floor Projection Maze

Neuropsychological tasks used in primates to investigate mechanisms of learning and memory are typically visually guided cognitive tasks. We have developed visual cognitive tasks for rats using the Floor Projection Maze1,2&#160;that are optimized for visual abilities of rats permitting stronger comparisons of experimental findings with other species.
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We describe protocols for a model system that combines automated visual presentation of information to rodents and intracranial reward with electrophysiological approaches. Our model system offers a sophisticated set of tools as a framework for other cognitive tasks to better isolate and identify specific mechanisms contributing to particular cognitive processes.

We describe protocols for training rats for chronic electrophysiological recordings in fully automated cognitive tasks on a Floor Projection Maze.

Neuropsychological tasks used in primates to investigate mechanisms of learning and memory are typically visually guided cognitive tasks. We have ...

Behavior

One Dimensional Turing-Like Handshake Test for Motor Intelligence

In the Turing test, a computer model is deemed to "think intelligently" if it can generate answers that are not distinguishable from those of a human. However, this test is limited to the linguistic aspects of machine intelligence. A salient function of the brain is the control of movement, and the movement of the human hand is a sophisticated demonstration of this function. Therefore, we propose a Turing-like handshake test, for machine motor intelligence. We administer the test through a telerobotic system in which the interrogator is engaged in a task of holding a robotic stylus and interacting with another party (human or artificial). Instead of asking the interrogator whether the other party is a person or a computer program, we employ a two-alternative forced choice method and ask which of two systems is more human-like. We extract a quantitative grade for each model according to its resemblance to the human handshake motion and name it "Model Human-Likeness Grade" (MHLG). We present three methods to estimate the MHLG. (i) By calculating the proportion of subjects' answers that the model is more human-like than the human; (ii) By comparing two weighted sums of human and model handshakes we fit a psychometric curve and extract the point of subjective equality (PSE); (iii) By comparing a given model with a weighted sum of human and random signal, we fit a psychometric curve to the answers of the interrogator and extract the PSE for the weight of the human in the weighted sum. Altogether, we provide a protocol to test computational models of the human handshake. We believe that building a model is a necessary step in understanding any phenomenon and, in this case, in understanding the neural mechanisms responsible for the generation of the human handshake.

We present a Turing-like Handshake test administered through a telerobotic system in which the interrogator is holding a robotic stylus and interacting with another party (human or artificial). We use a forced choice method, and extract a measure for the similarity of the artificial model to a human handshake.

In the Turing test, a computer model is deemed to "think intelligently" if it can generate answers that are not distinguishable from those of a human.  ...

Neuroscience

Frame-by-Frame Video Analysis of Idiosyncratic Reach-to-Grasp Movements in Humans

Prehension, the act of reaching to grasp an object, is central to the human experience. We use it to feed ourselves, groom ourselves, and manipulate objects and tools in our environment. Such behaviors are impaired by many sensorimotor disorders, yet our current understanding of their neural control is far from complete. Current technologies for investigating human reach-to-grasp movements often utilize motion tracking systems that can be expensive, require the attachment of markers or sensors to the hands, impede natural movement and sensory feedback, and provide kinematic output that can be difficult to interpret. While generally effective for studying the stereotypical reach-to-grasp movements of healthy sighted adults, many of these technologies face additional limitations when attempting to study the unpredictable and idiosyncratic reach-to-grasp movements of young infants, unsighted adults, and patients with neurological disorders. Thus, we present a novel, inexpensive, and highly reliable yet flexible protocol for quantifying the temporal and kinematic structure of idiosyncratic reach-to-grasp movements in humans. High speed video cameras capture multiple views of the reach-to-grasp movement. Frame-by-frame video analysis is then used to document the timing and magnitude of pre-defined behavioral events such as movement start, collection, maximum height, peak aperture, first contact, and final grasp. The temporal structure of the movement is reconstructed by documenting the relative frame number of each event while the kinematic structure of the hand is quantified using the ruler or measure function in photo editing software to calibrate 2 dimensional linear distances between two body parts or between a body part and the target. Frame-by-frame video analysis can provide a quantitative and comprehensive description of idiosyncratic reach-to-grasp movements and will enable researchers to expand their area of investigation to include a greater range of naturalistic prehensile behaviors, guided by a wider variety of sensory modalities, in both healthy and clinical populations.

This protocol describes how to use frame-by-frame video analysis to quantify idiosyncratic reach-to-grasp movements in humans. A comparative analysis of reaching in sighted versus unsighted healthy adults is used to demonstrate the technique, but the method can also be applied to the study of developmental and clinical populations.

Prehension, the act of reaching to grasp an object, is central to the human experience. We use it to feed ourselves, groom ourselves, and manipulate ...

A Fully Automated and Highly Versatile System for Testing Multi-cognitive Functions and Recording Neuronal Activities in Rodents

We have developed a fully automated system for operant behavior testing and neuronal activity recording by which multiple cognitive brain functions can be investigated in a single task sequence. The unique feature of this system is a custom-made, acoustically transparent chamber that eliminates many of the issues associated with auditory cue control in most commercially available chambers. The ease with which operant devices can be added or replaced makes this system quite versatile, allowing for the implementation of a variety of auditory, visual, and olfactory behavioral tasks. Automation of the system allows fine temporal (10 ms) control and precise time-stamping of each event in a predesigned behavioral sequence. When combined with a multi-channel electrophysiology recording system, multiple cognitive brain functions, such as motivation, attention, decision-making, patience, and rewards, can be examined sequentially or independently.

In this report, we present a fully automated and highly versatile system capable of simultaneously testing multi-cognitive behaviors and recording neuronal activities for rodents.

We have developed a fully automated system for operant behavior testing and neuronal activity recording by which multiple cognitive brain functions can be ...

Development of an Audio-based Virtual Gaming Environment to Assist with Navigation Skills in the Blind

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio based cues and set within the context of a video game metaphor, users gather relevant spatial information regarding a building's layout. This allows the user to develop an accurate spatial cognitive map of a large-scale three-dimensional space that can be manipulated for the purposes of a real indoor navigation task. After game play, participants are then assessed on their ability to navigate within the target physical building represented in the game. Preliminary results suggest that early blind users were able to acquire relevant information regarding the spatial layout of a previously unfamiliar building as indexed by their performance on a series of navigation tasks. These tasks included path finding through the virtual and physical building, as well as a series of drop off tasks. We find that the immersive and highly interactive nature of the AbES software appears to greatly engage the blind user to actively explore the virtual environment. Applications of this approach may extend to larger populations of visually impaired individuals.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio ...

A Standardized Obstacle Course for Assessment of Visual Function in Ultra Low Vision and Artificial Vision

We describe an indoor, portable, standardized course that can be used to evaluate obstacle avoidance in persons who have ultralow vision. Six sighted controls and 36 completely blind but otherwise healthy adult male (n=29) and female (n=13) subjects (age range 19-85 years), were enrolled in one of three studies involving testing of the BrainPort sensory substitution device. Subjects were asked to navigate the course prior to, and after, BrainPort training. They completed a total of 837 course runs in two different locations. Means and standard deviations were calculated across control types, courses, lights, and visits. We used a linear mixed effects model to compare different categories in the PPWS (percent preferred walking speed) and error percent data to show that the course iterations were properly designed. The course is relatively inexpensive, simple to administer, and has been shown to be a feasible way to test mobility function. Data analysis demonstrates that for the outcome of percent error as well as for percentage preferred walking speed, that each of the three courses is different, and that within each level, each of the three iterations are equal. This allows for randomization of the courses during administration.
Abbreviations: 
preferred walking speed (PWS) 
course speed (CS) 
percentage preferred walking speed (PPWS)

We describe an indoor, portable, standardized course that can be used to evaluate obstacle avoidance in persons who have ultralow vision. The course is relatively inexpensive, simple to administer, and has been shown to be reliable and reproducible.

We describe an indoor, portable, standardized course that can be used to evaluate obstacle avoidance in persons who have ultralow vision. Six sighted ...

An Open-Source, Fully Customizable 5-Choice Serial Reaction Time Task Toolbox for Automated Behavioral Training of Rodents

The 5-choice serial reaction time task (5-CSRTT) is a behavioral test often used to study visuospatial attention and impulsiveness in rodents. The task requires animals to allocate attention to a horizontal array of five small apertures equipped with light sources and, within a limited time window, nose-poke one illuminated target aperture to get a food reward at the food magazine located in the opposite wall of the chamber. The task considers behavioral control measures such as response accuracy and reaction times and allows to infer selective attention and impulsivity. Task difficulty can be controlled by modifying the stimulus duration and task design in general. Commercially available apparatus usually consists of an experimental chamber and particular software to specify task parameters, but due to fixed hard- and software, they pose many limitations on changes in the general experimental design and specific task requirements and the related data output. This article explains a fully customizable alternative based on an easy-to-use single-board microcontroller and standard electrotechnical components, an open-access Arduino script, and a Matlab-toolbox for hardware control and behavioral task specifications, respectively. The toolbox includes an optional staircase procedure, enabling automated behavioral training. The complete hardware setup, which can be installed in customized chambers, and the freely adaptable software encourage non-standardized task and chamber design. The design of the system and the open-source code for hardware control and experimental setup are described.

The present protocol describes the development of an open-source 5-choice serial reaction time task toolbox for rodent animal models, using Arduino and related hardware and a versatile Matlab toolbox, including an optional script for automated behavioral training. The scripts are customizable and facilitate the implementation of different trial-and-test designs.

The 5-choice serial reaction time task (5-CSRTT) is a behavioral test often used to study visuospatial attention and impulsiveness in rodents. The task ...

Motor Imagery Using VR Digital Avatars in a Brain-Computer Interface System

Motor Imagery Performance Through Embodied Digital Twins in a Virtual Reality-Enabled Brain-Computer Interface Environment

This study introduces an innovative framework for neurological rehabilitation by integrating brain-computer interfaces (BCI) and virtual reality (VR) technologies with the customization of three-dimensional (3D) avatars. Traditional approaches to rehabilitation often fail to fully engage patients, primarily due to their inability to provide a deeply immersive and interactive experience. This research endeavors to fill this gap by utilizing motor imagery (MI) techniques, where participants visualize physical movements without actual execution. This method capitalizes on the brain's neural mechanisms, activating areas involved in movement execution when imagining movements, thereby facilitating the recovery process. The integration of VR's immersive capabilities with the precision of electroencephalography (EEG) to capture and interpret brain activity associated with imagined movements forms the core of this system. Digital Twins in the form of personalized 3D avatars are employed to significantly enhance the sense of immersion within the virtual environment. This heightened sense of embodiment is crucial for effective rehabilitation, aiming to bolster the connection between the patient and their virtual counterpart. By doing so, the system not only aims to improve motor imagery performance but also seeks to provide a more engaging and efficacious rehabilitation experience. Through the real-time application of BCI, the system allows for the direct translation of imagined movements into virtual actions performed by the 3D avatar, offering immediate feedback to the user. This feedback loop is essential for reinforcing the neural pathways involved in motor control and recovery. The ultimate goal of the developed system is to significantly enhance the effectiveness of motor imagery exercises by making them more interactive and responsive to the user's cognitive processes, thereby paving a new path in the field of neurological rehabilitation.

Author Spotlight: Enhancing Neurorehabilitation Through EEG, Motor Imagery, and Virtual Reality

Motor imagery in a virtual reality environment has wide applications in brain-computer interface systems. This manuscript outlines the use of personalized digital avatars that resemble the participants performing movements imagined by the participant in a virtual reality environment to enhance immersion and a sense of body ownership.

This study introduces an innovative framework for neurological rehabilitation by integrating brain-computer interfaces (BCI) and virtual reality (VR) ...

Bioengineering

A Visuospatial Planning Task Coupled with Eye-Tracker and Electroencephalogram Systems

The planning process, characterized by the capability to formulate an organized plan to reach a goal, is essential for human goal-directed behavior. Since planning is compromised in several neuropsychiatric disorders, the implementation of proper clinical and experimental tests to examine planning is critical. Due to the nature of the deployment of planning, in which several cognitive domains participate, the assessment of planning and the design of behavioral paradigms coupled with neuroimaging methods are current challenges in cognitive neuroscience. A planning task was evaluated in combination with an electroencephalogram (EEG) system and eye movement recordings in 27 healthy adult participants. Planning can be separated into two stages: a mental planning stage in which a sequence of steps is internally represented and an execution stage in which motor action is used to achieve a previously planned goal. Our protocol included a planning task and a control task. The planning task involved solving 36 maze trials, each representing a zoo map. The task had four periods: i) planning, where the subjects were instructed to plan a path to visit the locations of four animals according to a set of rules; ii) maintenance, where the subjects had to retain the planned path in their working memory; iii) execution, where the subjects used eye movements to trace the previously planned path as indicated by the eye-tracker system; and iv) response, where the subjects reported the order of the visited animals. The control task had a similar structure, but the cognitive planning component was removed by modifying the task goal. The spatial and temporal patterns of the EEG revealed that planning induces a gradual and lasting rise in frontal-midline theta activity (FM&#952;) over time. The source of this activity was identified within the prefrontal cortex by source analyses. Our results suggested that the experimental paradigm combining EEG and eye-tracker systems was optimal for evaluating cognitive planning.

The study of cognitive planning combining EEG and eye-tracking systems provides a multimodal approach to investigate the neural mechanisms that mediate cognitive control and goal-directed behavior in humans. Here, we describe a protocol for investigating the role of brain oscillations and eye movements in planning performance.

The planning process, characterized by the capability to formulate an organized plan to reach a goal, is essential for human goal-directed behavior. Since ...

A Setup for Human Vision, Cognition, and Interaction in Real-Life Scenarios

A Naturalistic Setup for Presenting Real People and Live Actions in Experimental Psychology and Cognitive Neuroscience Studies

Perception of others&#39; actions is crucial for survival, interaction, and communication. Despite decades of cognitive neuroscience research dedicated to understanding the perception of actions, we are still far away from developing a neurally inspired computer vision system that approaches human action perception. A major challenge is that actions in the real world consist of temporally unfolding events in space that happen &#34;here and now&#34; and are actable. In contrast, visual perception and cognitive neuroscience research to date have largely studied action perception through 2D displays (e.g., images or videos) that lack the presence of actors in space and time, hence these displays are limited in affording actability. Despite the growing body of knowledge in the field, these challenges must be overcome for a better understanding of the fundamental mechanisms of the perception of others&#39; actions in the real world. The aim of this study is to introduce a novel setup to conduct naturalistic laboratory experiments with live actors in scenarios that approximate real-world settings. The core element of the setup used in this study is a transparent organic light-emitting diode (OLED) screen through which participants can watch the live actions of a physically present actor while the timing of their presentation is precisely controlled. In this work, this setup was tested in a behavioral experiment. We believe that the setup will help researchers reveal fundamental and previously inaccessible cognitive and neural mechanisms of action perception and will be a foundation for future studies investigating social perception and cognition in naturalistic settings.

Author Spotlight: A Novel Setup to Conduct Naturalistic Laboratory Experiments with Real Human Actors in Scenarios 

This study presents a naturalistic experimental setup that allows researchers to present real-time action stimuli, obtain response time and mouse tracking data while participants respond after each stimulus display, and change actors between experimental conditions with a unique system including a special transparent organic light-emitting diode (OLED) screen and light manipulation.

Perception of others&#39; actions is crucial for survival, interaction, and communication. Despite decades of cognitive neuroscience research dedicated to ...