Building a transdisciplinary expert consensus on the cognitive drivers of performance under pressure: An international multi-panel Delphi study

IntroductionThe ability to perform optimally under pressure is critical across many occupations, including the military, first responders, and competitive sport. Despite recognition that such performance depends on a range of cognitive factors, how common these factors are across performance domains remains unclear. The current study sought to integrate existing knowledge in the performance field in the form of a transdisciplinary expert consensus on the cognitive mechanisms that underlie performance under pressure.MethodsInternational experts were recruited from four performance domains [(i) Defense; (ii) Competitive Sport; (iii) Civilian High-stakes; and (iv) Performance Neuroscience]. Experts rated constructs from the Research Domain Criteria (RDoC) framework (and several expert-suggested constructs) across successive rounds, until all constructs reached consensus for inclusion or were eliminated. Finally, included constructs were ranked for their relative importance.ResultsSixty-eight experts completed the first Delphi round, with 94% of experts retained by the end of the Delphi process. The following 10 constructs reached consensus across all four panels (in order of overall ranking): (1) Attention; (2) Cognitive Control—Performance Monitoring; (3) Arousal and Regulatory Systems—Arousal; (4) Cognitive Control—Goal Selection, Updating, Representation, and Maintenance; (5) Cognitive Control—Response Selection and Inhibition/Suppression; (6) Working memory—Flexible Updating; (7) Working memory—Active Maintenance; (8) Perception and Understanding of Self—Self-knowledge; (9) Working memory—Interference Control, and (10) Expert-suggested—Shifting.DiscussionOur results identify a set of transdisciplinary neuroscience-informed constructs, validated through expert consensus. This expert consensus is critical to standardizing cognitive assessment and informing mechanism-targeted interventions in the broader field of human performance optimization

Distinguishing left from right: A large-scale investigation of left–right confusion in healthy individuals

The ability to distinguish left from right has been shown to vary substantially within healthy individuals, yet its characteristics and mechanisms are poorly understood. In three experiments, we focused on a detailed description of the ability to distinguish left from right and the role of individual differences, and further explored the potential underlying mechanisms. In Experiment 1, a questionnaire concerning self-reported left–right identification (LRI) and strategy use was administered. Objective assessment was used in Experiment 2 by means of vocal responses to line drawings of a figure, with the participants’ hands in a spatially neutral position. In Experiment 3, the arm positions and visibility of the hands were manipulated to assess whether bodily posture influences left–right decisions. Results indicate that 14.6% of the general population reported insufficient LRI and that 42.9% of individuals use a hand-related strategy. Furthermore, we found that spatial alignment of the participants’ arms with the stimuli increased performance, in particular with a hand-related strategy and females. Performance was affected only by the layout of the stimuli, not by the position of the participant during the experiment. Taken together, confusion about left and right occurs within healthy population to a limited extent, and a hand-related strategy affects LRI. Moreover, the process involved appears to make use of a stored body representation and not bottom-up sensory input. Therefore, we suggest a top-down body representation is the key mechanism in determining left and right, even when this is not explicitly part of the task

The man who lost his body: Suboptimal multisensory integration yields body awareness problems after a right temporoparietal brain tumour

Reports on patients who lack ownership over their entire body are extremely rare. Here, we present patient SA who suffered from complete body disownership after a tumour resection in the right temporoparietal cortex. Neuropsychological assessment disclosed selective bilateral ownership problems, despite intact primary visual and somatosensory senses. SA's disownership seems to stem from a suboptimal multimodal integration, as shown by the rubber hand illusion and the beneficial effect during and after simple exercises aiming at multisensory recalibration

The man who lost his body: Suboptimal multisensory integration yields body awareness problems after a right temporoparietal brain tumour

Reports on patients who lack ownership over their entire body are extremely rare. Here, we present patient SA who suffered from complete body disownership after a tumour resection in the right temporoparietal cortex. Neuropsychological assessment disclosed selective bilateral ownership problems, despite intact primary visual and somatosensory senses. SA's disownership seems to stem from a suboptimal multimodal integration, as shown by the rubber hand illusion and the beneficial effect during and after simple exercises aiming at multisensory recalibration

No consistent cooling of the real hand in the rubber hand illusion

In the rubber hand illusion (RHI), participants view a rubber hand that is stroked synchronously with their real, hidden hand. This procedure results in experiencing an increased sense of ownership over the rubber hand and demonstrates how multisensory information (vision, touch) can influence the sense of body ownership. However, it has also been suggested that a (lack of) sense of ownership over an own body part may in turn influence bodily processes. This suggestion has previously been supported by the observation that a decrease in skin temperature in the real hand correlated with ownership over the rubber hand. However, this finding has not been consistently replicated. Our lab has conducted several studies in which we recorded temperature of the hands during the RHI using various measures and in different circumstances, including continuous temperature measurements in a temperature-controlled room. An overall analysis of our results, covering five attempts to replicate the traditional RHI experiment and totalling 167 participants, does not show a reliable cooling of the real hand during the RHI. We discuss this failure to replicate and consider several possible explanations for inconsistencies between reports of hand temperature during the RHI

Distinguishing left from right: A large-scale investigation of left–right confusion in healthy individuals

The ability to distinguish left from right has been shown to vary substantially within healthy individuals, yet its characteristics and mechanisms are poorly understood. In three experiments, we focused on a detailed description of the ability to distinguish left from right and the role of individual differences, and further explored the potential underlying mechanisms. In Experiment 1, a questionnaire concerning self-reported left–right identification (LRI) and strategy use was administered. Objective assessment was used in Experiment 2 by means of vocal responses to line drawings of a figure, with the participants’ hands in a spatially neutral position. In Experiment 3, the arm positions and visibility of the hands were manipulated to assess whether bodily posture influences left–right decisions. Results indicate that 14.6% of the general population reported insufficient LRI and that 42.9% of individuals use a hand-related strategy. Furthermore, we found that spatial alignment of the participants’ arms with the stimuli increased performance, in particular with a hand-related strategy and females. Performance was affected only by the layout of the stimuli, not by the position of the participant during the experiment. Taken together, confusion about left and right occurs within healthy population to a limited extent, and a hand-related strategy affects LRI. Moreover, the process involved appears to make use of a stored body representation and not bottom-up sensory input. Therefore, we suggest a top-down body representation is the key mechanism in determining left and right, even when this is not explicitly part of the task

Body representation disorders predict left right orientation impairments after stroke : A voxel-based lesion symptom mapping study

Introduction: Deficits in the ability to distinguish between the left and right side of the body can severely impair daily life functioning. The current study examined the relation between left right orientation (LRO) impairments and somatosensory related deficits, ranging from primary somatosensory impairments to body representation impairments, in patients who suffered a recent stroke. We also examined which areas in the brain are associated with LRO impairments using a Voxel-based Lesion Symptom Mapping (VLSM) analysis. Method: We tested 47 first-ever stroke patients and 48 age-matched healthy controls. LRO was assessed with the Bergen Right Left Discrimination Test (BRLD). Impairments on primary somatosensory function (touch perception, proprioception), higher order somatosensory function (finger gnosis, subjective sense of body ownership) and other cognitive functions (language, attention & working memory, visuospatial neglect) were entered as predictors in a logistic regression analyses. Outcome measures consisted of the BRLD-total performance which was further subdivided in performance for 1) first person perspective stimuli, 2) third person perspective stimuli, 3) alternating between first- and third person perspective. Results: Impairments on BRLD-total performance was predicted by impairments in finger gnosis and visuospatial neglect. For items placed in third person perspective, performance was predicted by body representation impairments; finger agnosia and the subjective sense of body ownership. VLSM analysis showed a significant association between LRO impairments and damage to the right insula. Discussion: The current study suggests that the somatosensory system is important for LRO. Furthermore, the results indicate that an affected body representation may hinder adopting a third person perspective that may subsequently also lead to LRO impairments. The right insular cortex appeared crucially involved in these processes

Process evaluation of the Restore4stroke Self-Management intervention 'Plan Ahead!': a stroke-specific self-management intervention

OBJECTIVE: To investigate whether the self-management intervention was implemented as intended. Additionally, we studied involvement in and satisfaction with the intervention among patients, their partners and therapists. DESIGN: Mixed method, prospective study. SETTING: Outpatient facilities of hospitals/rehabilitation centres. PARTICIPANTS: Stroke patients, their partners and therapists from the experimental arm of the Restore4Stroke Self-Management study. INTERVENTION: ‘Plan Ahead!’ is a 10-week self-management intervention for stroke patients and partners, consisting of seven two-hour group sessions. Proactive action planning, education and peer support are main elements of this intervention. MAIN MEASURES: Session logs, questionnaires for therapists, patients and their partners, and focus groups. DATA ANALYSIS: Qualitative data were analysed with thematic analysis supplemented by quasi-statistics. Quantitative data were reported as descriptive statistics. RESULTS: The study sample consisted of 53 patients and 26 partners taking part in the intervention, and all therapists delivering the intervention (N = 19). At least three-quarters of the intervention sessions were attended by 33 patients and 24 partners. On a scale from 1 to 10, patients, partners and therapists rated the intervention with mean scores of 7.5 (SD1.6), 7.8 (SD.7) and 7.4 (SD.7), respectively. Peer support was the most frequently appreciated element for participants and therapists. The proactive action planning tool was adequately applied in 76 of the 96 sessions. CONCLUSION: Although the target audience was reached and both participants and therapists were satisfied with the intervention, the proactive action planning tool that distinguishes the current intervention from existing stroke-specific self-management interventions was only partly implemented according to protocol

No consistent cooling of the real hand in the rubber hand illusion

In the rubber hand illusion (RHI), participants view a rubber hand that is stroked synchronously with their real, hidden hand. This procedure results in experiencing an increased sense of ownership over the rubber hand and demonstrates how multisensory information (vision, touch) can influence the sense of body ownership. However, it has also been suggested that a (lack of) sense of ownership over an own body part may in turn influence bodily processes. This suggestion has previously been supported by the observation that a decrease in skin temperature in the real hand correlated with ownership over the rubber hand. However, this finding has not been consistently replicated. Our lab has conducted several studies in which we recorded temperature of the hands during the RHI using various measures and in different circumstances, including continuous temperature measurements in a temperature-controlled room. An overall analysis of our results, covering five attempts to replicate the traditional RHI experiment and totalling 167 participants, does not show a reliable cooling of the real hand during the RHI. We discuss this failure to replicate and consider several possible explanations for inconsistencies between reports of hand temperature during the RHI