EXPRESS: Translating words into actions in working memory: the role of spatial-motoric coding

Digital training for self-injectable contraceptives: a feasibility and acceptability pilot study

BACKGROUND

Self-injectable contraceptives, namely subcutaneous depot medroxyprogesterone acetate 104 mg micronised formulation delivered via uniject system, reduce the need to travel to a facility for contraceptive access, but the initial, in-person, training may be a barrier to starting this method. This article reports on a small, exploratory pilot in Kenya to test the feasibility and acceptability of digital self-injection training.

METHODS

Participants (n=11) who were currently using injectable contraceptives, intramuscular depot medroxyprogesterone acetate 150 mg injected by a healthcare worker, received digital self-injection training from a trained clinician via a WhatsApp video call. Participants administered a simulated self-injection on a model and an actual self-injection (under supervision) on themselves. The participants' self-injection proficiency, a measure of the feasibility of remote training, was documented using a checklist, and participants were administered a questionnaire about their training experience. The training was observed, and content analysis was used to understand the functionality of training.

RESULTS

All participants were proficient when performing the self-injection on themselves after receiving the remote training and reported that the training was acceptable. A barrier to training via a video call was lack of access to quality digital devices. Eight training 'lessons learnt' emerged from the training observations.

CONCLUSIONS

Training participants to administer self-injectable contraceptives via WhatsApp video call was feasible and acceptable. Training lessons learnt offer pragmatic adaptations for communicating about a practical skill via a digital channel. Further research is needed to ascertain the efficacy of digital training for self-injection and feasibility and acceptability for wider groups.

Working memory prioritisation effects in tactile immediate serial recall

There is a growing body of evidence that higher-value information can be prioritised for both visual and auditory working memory. The present study examines whether valuable items can similarly be prioritised for the tactile domain. Employing an immediate serial recall procedure (ISR), participants reconstructed a 6-item tactile sequence by moving their fingers in the order of original stimulation. Participants were informed either that one serial position was worth notionally more points (prioritisation condition) or that all items were of equal value (control condition). For Experiment 1 (N = 48), significant boosts in correct recall were evident when serial positions 4 or 5 were more valuable (i.e., prioritisation effects). Experiment 2 (N = 24) demonstrated that the prioritisation effect persisted with concurrent articulation, suggesting that task performance was not a function of verbal recoding and rehearsal of the tactile information. Importantly, a significant recall cost for low-value (non-prioritised) items within the sequence was evident for both experiments. Taken together, these findings demonstrate that (1) prioritisation effects transfer to the tactile domain and (2) finite attentional resources can be deliberately and strategically redistributed to specific items within a sequence, dependent upon the prevailing task demands.

Dissociable Codes in Motor Working Memory

Working memory has been comprehensively studied in sensory domains, like vision, but little attention has been paid to how motor information (e.g., kinematics of recent movements) is maintained and manipulated in working memory. "Motor working memory" (MWM) is important for short-term behavioral control and skill learning. Here, we employed tasks that required participants to encode and recall reaching movements over short timescales. We conducted three experiments (N = 65 undergraduates) to examine MWM under varying cognitive loads, delays, and degrees of interference. The results support a model of MWM that includes an abstract code that flexibly transfers across effectors, and an effector-specific code vulnerable to interfering movements, even when interfering movements are irrelevant to the task. Neither code was disrupted by increasing visuospatial working memory load. These results echo distinctions between representational formats in other domains, suggesting that MWM shares a basic computational structure with other working memory subsystems.

Exploring techniques for encoding spoken instructions in working memory: a comparison of verbal rehearsal, motor imagery, self-enactment and action observation

Encoding and recalling spoken instructions is subject to working memory capacity limits. Previous research suggests action-based encoding facilitates instruction recall, but has not directly compared benefits across different types of action-based techniques. The current study addressed this in two experiments with young adults. In Experiment 1, participants listened to instructional sequences containing four action-object pairs, and encoded these instructions using either a motor imagery or verbal rehearsal technique, followed by recall via oral repetition or enactment. Memory for instructions was better when participants used a motor imagery technique during encoding, and when recalling the instructions by enactment. The advantage of using a motor imagery technique was present in both verbal and enacted recall. In Experiment 2, participants encoded spoken instructions whilst implementing one of four techniques (verbal rehearsal, motor imagery, observation of others' actions or self-enactment), and then recalled the instructions by oral repetition or enactment. For both verbal and enacted recall, memory for instructions was least accurate in the rehearsal condition, while the other encoding conditions did not differ from each other. These novel findings indicate similar benefits of imagining, observation and execution of actions in encoding spoken instructions, and enrich current understanding of action-based benefits in working memory.

Actions versus Words: Exploring the contributions of working memory and motoric coding in children's instruction following using a dual-task paradigm

Previous research in adults has showed that physical performance (i.e., enactment) of instructions at recall leads to better memory compared to verbal recall and that this effect does not rely solely on Working Memory resources. The current study aimed to replicate this finding in children. A group of 32 children encoded simple instructions verbally while engaging in a series of distractor tasks (articulatory suppression, backwards counting and a motor suppression task). Participants recalled information verbally or physically through enactment. The findings showed that although distractors impaired performance compared to a control condition (no distractor task), the enactment advantage remained intact in all conditions. These findings show that children's memory is superior when they perform, rather than when they verbally repeat instructions and crucially it is suggested that this effect does not rely solely on Working Memory resources.

Hanging on the telephone: Maintaining visuospatial bootstrapping over time in working memory

Visuospatial bootstrapping (VSB) refers to the phenomenon in which performance on a verbal working memory task can be enhanced by presenting the verbal material within a familiar visuospatial configuration. This effect is part of a broader literature concerning how working memory is influenced by use of multimodal codes and contributions from long-term memory. The present study aimed to establish whether the VSB effect extends over a brief (5-s) delay period, and to explore the possible mechanisms operating during retention. The VSB effect, as indicated by a verbal recall advantage for digit sequences presented within a familiar visuospatial configuration (modelled on the T-9 keypad) relative to a single-location display, was observed across four experiments. The presence and size of this effect changed with the type of concurrent task activity applied during the delay. Articulatory suppression (Experiment 1) increased the visuospatial display advantage, while spatial tapping (Experiment 2) and a visuospatial judgment task (Experiment 3) both removed it. Finally, manipulation of the attentional demands placed by a verbal task also reduced (but did not abolish) this effect (Experiment 4). This pattern of findings demonstrates how provision of familiar visuospatial information at encoding can continue to support verbal working memory over time, with varying demands on modality-specific and general processing resources.

Improving older adults' ability to follow instructions: benefits of actions at encoding and retrieval in working memory

The ability to follow instructions is critical for learning new skills and may support successful aging. Recent evidence indicates a close link between following instructions and working memory, and that action-based processing at encoding and retrieval can improve this ability. In this study, we examined the ability to follow instructions and the benefits of action-based processing in young and older adults. In Experiment 1, participants were presented with spoken or silent demonstrated instructions, then recalled them by oral repetition or physical enactment. Older adults produced fewer correct responses in all conditions. Both age groups were better at recalling demonstrated than spoken instructions in the verbal but not the enacted recall condition. Older adults also benefited from enacted recall relative to verbal recall, but to a smaller extent than younger adults. In Experiment 2, the additional benefit of dual modalities (spoken instructions with simultaneous demonstration) relative to single modality presentation (spoken instructions, or silent demonstration) was examined. Both age groups showed superior performance in dual modality conditions relative to spoken instructions when using verbal recall. These findings suggest that although following instruction ability appears to decline with age, older adults can still benefit from action at encoding and retrieval.