The following lecture has been approved for University Undergraduate Students

1. The following lecture has been approved for University Undergraduate Students This lecture may contain information, ideas, concepts and discursive anecdotes that may be thought provoking and challenging It is not intended for the content or delivery to cause offence Any issues raised in the lecture may require the viewer to engage in further thought, insight, reflection or critical evaluation

2. Neurobehavioural Testing Dr. Craig A. Jackson Senior Lecturer in Health Psychology Division of Trauma & Critical CareUCE Birmingham hcc.uce.ac.uk/craigjackson

3. Brain Training

4. Brain Training

5. Multiple Toxic Substances Industrial Chemicals Pesticides Therapeutic Drugs Drugs of Abuse Food Additives Brain is highly vulnerable to toxic effects In utero Post-natal Ingestion Inhalation Absorption Multiple toxic exposures: Alter cell migration, synaptic connections, cell death

6. The Exposed Brain Structural Changes Functional Changes Behavioural Changes Susceptibility to other neurotoxins Possibly largest contributor to: Learning disability Attentional Disorders Development Disabilities

7. Head Injuries Severity depends on amount of Primary and Secondary brain injury Main cause of Secondary injury = hypoxia Categories: Open or Closed Forces: Shearing and Compression

8. Rationale of Neurobehavioural Testing Evaluate functioning in individuals exposed to pathogens Normal population exhibits a range of performance function Exposure moves individuals outside of the normal range of functioning Some factors affect performance: age sex education

9. Testing Must Be Cross-Cultural, Valid, & Reliable Higher proportion of: Minorities Foreign born get exposures to neurotoxins Poor status May not speak English May be developmentally delayed Test batteries must be suitable for people of all abilities & backgrounds

10. Factors to be Aware of in Testing STABLE FACTORSSITUATIONAL FACTORS Age Alcohol (recent use) Education Caffeine (recent use) Sex Nicotine (recent use) Socioeconomics Medication (recent use) Language Paints, glues, pesticides (recent) Handedness Near visual acuity Computer experience Restricted movement (injury) Caffeine (habitual use) Cold / flu Alcohol (habitual use) Stress Nicotine (habitual use) Arousal / Fatigue Medication (habitual use) Sleep Paints, glues, pesticides (habitual use) Screen luminance Diabetes Time of day Epilepsy Time of year Other CNS / PNS disease Alcohol / drug addiction Head injury (out >1 hr) Physical activity

11. Domains of Performance Assessed 1. Motor Control - fine and gross, speed and motor control 2. Attention - vigilance, selective, divided attention 3. Visual Perception Ability 4. Visual Motor Skills (eye-hand co-ordination) 5. Memory - immediate, delayed 6. Emotional / Psychiatric Symptoms

12. History Behavioural testing began in 1960s Neuropsychology & Experimental psychology Hanninen (1979) developed first behavioural test battery Assess effects of chemicals and neurotoxins 1980 - 60 unique tests 1990 - 250 unique tests WHO 1983 - wanted battery to screen / identify nervous system effects

13. Neurobehavioural Core Test Battery (NCTB) 1983 WHO & NIOSH Seven behavioural tests: Digit Span Santa Ana Dexterity Digit Symbol Pursuit Aiming II Benton Visual Retention Profile of Mood States Simple Reaction Time Johnson et al. 1987

14. Speed / Accuracy Trade-off slow and accurate Accuracy optimum fast but sloppy Reaction Time (sec)

15. n Numbers recalled Example of Neurobehavioural Tests Digit Span 1) Worker presented with number list 2) Worker must recall numbers in order 3) Number string gets longer each time Outcome: Length of longest correct recall

16. Example of Neurobehavioural Tests Trail-making 1) Worker presented diagram 2) Worker must join dots 1 – A – 2 – B etc Outcomes: a) Time to complete b) No. of errors made error

17. Example of Neurobehavioural Tests Complex Reaction Time Worker presented with 4 stimuli Worker must click button on cue (4 possible responses) Outcomes: a) Time taken to react (milliseconds) b) No. correct responses c) No. errors

18. Pencil and Paper Tests - Line Tracing

19. Digit Span Subject presented with numbers Subject must recall numbers Number string gets longer each time Outcome: Length of longest correct recall

20. Digit Symbol Subject presented with number and symbol code Subject must fill in blanks, working left to right Outcome: Number of correct cells completed Time taken to get to bottom of list

21. Benton Visual Retention Subject presented with stimulus Subject must find target Outcome: Time taken to react Correct responses Errors

22. Profile of Mood States (POMS) 60 questions e.g. “I feel nervous about doing something new” “I enjoy eating meals in company” Subject must respond 0 = not at all 1 = a little 2 = moderately 3 = quite a bit 4 = extremely Outcome: Energy Tension Pep & Vigour Fatigue Confusion Annoyance

23. Pattern Memory Test Subject presented with stimulus Subject must decide which is target after rotation Outcome: Time taken to react Correct responses Errors

24. Continuous Performance Test Focused attention Divided attention Sustained attention Sustained & Focused attention Efficiency = Accuracy / Speed F F F F E F F F F F F E F F E F F F F F F F E V V V V W W W V W W W W W V W W V W F F F F E F F F F F F E F F E F F F F F F F E X X X X X Y Y Y Y Y Y X Y Y Y Y Y Y Y Y Y Y Y Y Y X Y Y Y Y Y Y Y Y Y Y Y X Y Y Y Y X Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y X Y Y Y Y Y Y Y Y Y Y X Y Y Y Y Y

25. Colour Word Vigilance REDGREEN YELLOW BLUE BLACK RED YELLOWBLUEGREEN Subject presented with stimulus Subject must find target word which matches colour Outcome: Time taken to react Correct responses Errors

26. Pre-Test Procedures Pre-test questionnaire Determine subjects’ general state at time of test Exclude subjects with: Seizures Functional visual impairment Language problems Drug effects Temporary physical impairment Mental impairment Illiteracy

27. Testing Conditions All subjects tested under same conditions Standardized testing Not always possible in the field Furniture Lighting Visual distraction Ambient sound Temperature

28. Instructions to Patients “Your (suspected) condition may affect your eye-hand coordination, memory, or reaction time. We have a set of standardised tasks on a computer designed to measure how quickly and accurately you can respond. It is important you try as hard as you can. Most people find the tasks to be challenging and fun. The computer will present the tasks and record your performance. You will not need to type anything, just touch a button or key. I will be nearby to answer your questions. You can stop at anytime.”

29. Summary of Neurobehavioural Testing Vast data production Not truly clinically useful Sub-clinical effects Epidemiological tool Ethicality Subject learning Sub-populations unsuitable Cheap Improving

30. Hemispherical test I always wear a watch 1

31. Hemispherical test I keep a journal 2

32. Hemispherical test I believe there is a right and wrong way to do everything 3

33. Hemispherical test I hate following directions 4

34. Hemispherical test The expression "Life is just a bowl of cherries" makes no sense to me 5

35. Hemispherical test I find that sticking to a schedule is boring 6

36. Hemispherical test I'd rather draw someone a map the tell them how to get somewhere 7

37. Hemispherical test If I lost something, I'd try to remember where I saw last 8

38. Hemispherical test If I don't know which way to turn, I let my emotions guide me 9

39. Hemispherical test I'm pretty good at math 10

40. Hemispherical test If I had to assemble something, I'd read the directions first 11

41. Hemispherical test I'm always late getting places 12

42. Hemispherical test Some people think I'm psychic 13

43. Hemispherical test Setting goals for myself helps keep me from slacking off 14

44. Hemispherical test When somebody asks me a question, I turn my head to the left 15

45. Hemispherical test If I have a tough decision to make, I write down the pros and the cons 16

46. Hemispherical test I'd make a good detective 17

47. Hemispherical test I am musically inclined 18

48. Hemispherical test If I have a problem, I try to work it out by relating it to one I've had in the past 19

49. Hemispherical test When I talk, I gesture a lot 20

50. Hemispherical test If someone asks me a question, I turn my head to the right 21