Utilization behavior
Encyclopedia
Utilization behavior is a type of neurobehavioral disorder that involves patients grabbing objects in view and starting the 'appropriate' behavior associated with it at an 'inappropriate' time. Utilization behavior patients have difficulty resisting the impulse
to operate or manipulate objects which are in their visual field
and within reach. Characteristics of UB include unintentional, unconscious actions triggered by the immediate environment. The unpreventable excessive behavior has been linked to lesion
s in the frontal lobe
. UB has also been referred to as "bilateral magnetic apraxia" and "hypermetamorphosis
."
and not others.
A disorder related to UB consists of the feeling that a body part is separate from the rest of the body and has a mind of its own. The patient does not recognize the limb as one that he/she owns and believes it to be a foreign object which he cannot control. This set of symptoms is related to Alien hand syndrome
(AHS), a neurological disorder in which the subject does not acknowledge ownership of a limb when visual cues are lacking. AHS can involve damage to the anterior cingulate gyrus, the medial prefrontal cortex and the anterior corpus callosum
when a patient has frontal AHS. The other type of AHS, Callosal AHS, is due to an anterior callosal lesion and affects dominant hemisphere control.
, Cerebrovascular disease
, Frontotemporal dementia
, neoplasm, and corticobasal degeneration
.
is responsible for problem solving, motor function, memory, judgment, impulse control, and social behavior. It is also needed for goal-directed behavior. Patients with frontal lobe injury
may have problems in the selection, production, and organization of goal-directed behavior.
One category of frontal lobe damage is the exhibition of behaviors that may not be usually displayed. This is the category that involves behaviors such as manual grasping and groping, imitation behavior and utilization behavior. The rest of this article will be discussing the latter, utilization behavior.
while objects that could elicit UB were present. 23 patients were found to have symptoms of UB.
forms connections with dorsolateral prefrontal cortex
meaning prefrontal regions have strong connections with limbic structures. This can be seen in the following study conducted by Eslinger et al. A woman with bilateral encephalomalacia had a damaged medial thalamus
and showed behavioral problems including utilization behavior. She conducted unnecessary motor use of objects in her immediate environment. The effect of the damage to the paramedian thalamic region did not astonish researchers because of its connection to the cingulate cortex. Thalamic infarctions have produced hypometabolism, a decrease in metabolic rate, in the frontal areas and hypoperfusion resulting in UB. The patient was marked with the behavior, and brain imaging noticed the infarctions in the thalamus.
of the frontal lobe. Ishihara et al. sought to demonstrate this linkage by observing a patient who was experiencing loss of consciousness. The patient, a 72 year old male, exhibited utilization behavior after admission into the hospital. An examiner placed objects such as a tissue box, toothpaste and a toothbrush in front of the patient and before any instruction the patient brushed his teeth and picked up the tissue in a manner as if to blow his nose. When asked why he did these actions, he had no reason other than that he wanted to use the objects. Later, the patient was placed in front of a paper and pen and he immediately stated to write correct letters and sentences without being told to do so because he felt compelled to write.
The results showed that a lesion
in the subcortical white matter of the superior frontal gyrus
was the cause of utilization behavior in the patient. A coronal section of the brain confirmed an infarct, tissue death due to lack of oxygen, in the left superior frontal gyrus
with the main lesion in the subcortical white matter. Fiber bundles are also present in the subcortical white matter connecting the prefrontal area with the nucleus of the thalamus. The researchers believed that utilization behavior could also be a result of the disordering of these fibers. The researchers established that a network exists between the frontal cortical and some subcortical lesions, especially the thalamus, and a white matter lesion may disconnect this network.
is known to help a patient function with their disorder.
, a brief limb extension, and draw the object towards the body thus increasing the strength of the grip. The patient seems to not be able to let go of the object. This behavior is normal in infants but abnormal in older children and adults. A video is included below portraying GR in a baby.
. Similar to the grasp reflex, MGB is normal in infants but worrisome in adults.
Impulse
In classical mechanics, an impulse is defined as the integral of a force with respect to time. When a force is applied to a rigid body it changes the momentum of that body...
to operate or manipulate objects which are in their visual field
Visual field
The term visual field is sometimes used as a synonym to field of view, though they do not designate the same thing. The visual field is the "spatial array of visual sensations available to observation in introspectionist psychological experiments", while 'field of view' "refers to the physical...
and within reach. Characteristics of UB include unintentional, unconscious actions triggered by the immediate environment. The unpreventable excessive behavior has been linked to lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
s in the frontal lobe
Frontal lobe
The frontal lobe is an area in the brain of humans and other mammals, located at the front of each cerebral hemisphere and positioned anterior to the parietal lobe and superior and anterior to the temporal lobes...
. UB has also been referred to as "bilateral magnetic apraxia" and "hypermetamorphosis
Hypermetamorphosis
Hypermetamorphosis is a kind of complete insect metamorphosis in which the different larval instars represent two or more different forms of larva. As the larva molts its morphology can change from that of a campodeiform to scarabaeiform or to vermiform...
."
Background
The patients who display utilization behavior tend to reach out and begin to automatically use objects in the visual field of their environment. This may not seem incorrect but the difference in action of a person without UB is that the "object-appropriate" action taken is performed at the inappropriate time. For example, a patient in a doctor's office sees a toothbrush and will involuntarily start brushing his teeth. This demonstrates the appropriate action (brushing) at the inappropriate time (office). This dysfunction of the frontal area causes the inappropriate motor responses to specific objects in the environment.Symptoms
Patients with utilization behavior feel they are functioning normally and do not believe that their actions are anything out of the ordinary. Sufferers are unable to resist grasping or using an object placed in front of them, regardless of the context or environment. It is not known what triggers them to exhibit UB with certain external stimuliStimulus (physiology)
In physiology, a stimulus is a detectable change in the internal or external environment. The ability of an organism or organ to respond to external stimuli is called sensitivity....
and not others.
A disorder related to UB consists of the feeling that a body part is separate from the rest of the body and has a mind of its own. The patient does not recognize the limb as one that he/she owns and believes it to be a foreign object which he cannot control. This set of symptoms is related to Alien hand syndrome
Alien hand syndrome
Alien hand syndrome is a neurological disorder in which the afflicted person's hand appears to take on a mind of its own...
(AHS), a neurological disorder in which the subject does not acknowledge ownership of a limb when visual cues are lacking. AHS can involve damage to the anterior cingulate gyrus, the medial prefrontal cortex and the anterior corpus callosum
Corpus callosum
The corpus callosum , also known as the colossal commissure, is a wide, flat bundle of neural fibers beneath the cortex in the eutherian brain at the longitudinal fissure. It connects the left and right cerebral hemispheres and facilitates interhemispheric communication...
when a patient has frontal AHS. The other type of AHS, Callosal AHS, is due to an anterior callosal lesion and affects dominant hemisphere control.
Causes
The cause of utilization behavior can be attributed to many diseases including Alzheimer's diseaseAlzheimer's disease
Alzheimer's disease also known in medical literature as Alzheimer disease is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death...
, Cerebrovascular disease
Cerebrovascular disease
Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels supplying the brain. Hypertension is the most important cause; it damages the blood vessel lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a repairing process...
, Frontotemporal dementia
Frontotemporal dementia
Frontotemporal dementia is a clinical syndrome caused by degeneration of the frontal lobe of the brain and may extend back to the temporal lobe...
, neoplasm, and corticobasal degeneration
Corticobasal degeneration
Corticobasal degeneration or Corticobasal Ganglionic Degeneration is a rare progressive neurodegenerative disease involving the cerebral cortex and the basal ganglia. It is characterized by marked disorders in movement and cognitive dysfunction...
.
Frontal lobe
The frontal lobeFrontal lobe
The frontal lobe is an area in the brain of humans and other mammals, located at the front of each cerebral hemisphere and positioned anterior to the parietal lobe and superior and anterior to the temporal lobes...
is responsible for problem solving, motor function, memory, judgment, impulse control, and social behavior. It is also needed for goal-directed behavior. Patients with frontal lobe injury
Frontal lobe injury
Frontal lobe injury is caused by a number of conditions such as trauma, meningitis, or even hypoxia , such as in drowning. The frontal lobe is an extremely vulnerable spot to injury due to its location at the front of the brain, and even minor trauma, such as a concussion, can cause permanent,...
may have problems in the selection, production, and organization of goal-directed behavior.
One category of frontal lobe damage is the exhibition of behaviors that may not be usually displayed. This is the category that involves behaviors such as manual grasping and groping, imitation behavior and utilization behavior. The rest of this article will be discussing the latter, utilization behavior.
Lhermitte (1983)
Lhermitte first coined the term utilization behavior. He observed six patients with unilateral and bilateral lesions in the frontal lobe while the patients were enticed to grab objects. The patients with the frontal lobe lesions grasped the objects and started to use them appropriately even if it was not the appropriate time. Lhermitte used this study to attribute UB to damage of the orbital frontal structures and the caudate nuclei. It should be noted that imitation behavior (IB) has been studied by Lhermitte et al. in conjunction with UB which showed an imbalance between the dependence on and independence from external stimuli. It was thought that UB was an imbalance the frontal and parietal lobes, but the study demonstrated that only damage to the frontal lobe affects UB as patients with damage to both areas did not demonstrate UB or IB.Shallice et al. (1989)
Shallice et al. believed that Lhermitte's experiments led the patients to perform the behaviors that they thought were expected of them as the researchers either placed the objects in the patients hands or enticed them to pick up the objects. Shallice performed two procedures, Lhermitte's experiment ("induced UB") and an 'incidental' which included a neurological examinationNeurological examination
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired...
while objects that could elicit UB were present. 23 patients were found to have symptoms of UB.
Thalamus
The anterior cingulate cortexAnterior cingulate cortex
The anterior cingulate cortex is the frontal part of the cingulate cortex, that resembles a "collar" form around the corpus callosum, the fibrous bundle that relays neural signals between the right and left cerebral hemispheres of the brain...
forms connections with dorsolateral prefrontal cortex
Dorsolateral prefrontal cortex
The dorsolateral prefrontal cortex , according to a more restricted definition, is roughly equivalent to Brodmann areas 9 and 46. According to a broader definition DL-PFC consists of the lateral portions of Brodmann areas 9 – 12, of areas 45, 46, and the superior part of area 47. These regions...
meaning prefrontal regions have strong connections with limbic structures. This can be seen in the following study conducted by Eslinger et al. A woman with bilateral encephalomalacia had a damaged medial thalamus
Thalamus
The thalamus is a midline paired symmetrical structure within the brains of vertebrates, including humans. It is situated between the cerebral cortex and midbrain, both in terms of location and neurological connections...
and showed behavioral problems including utilization behavior. She conducted unnecessary motor use of objects in her immediate environment. The effect of the damage to the paramedian thalamic region did not astonish researchers because of its connection to the cingulate cortex. Thalamic infarctions have produced hypometabolism, a decrease in metabolic rate, in the frontal areas and hypoperfusion resulting in UB. The patient was marked with the behavior, and brain imaging noticed the infarctions in the thalamus.
White matter
In conjunction with the thalamus, UB has also been linked to the white matterWhite matter
White matter is one of the two components of the central nervous system and consists mostly of myelinated axons. White matter tissue of the freshly cut brain appears pinkish white to the naked eye because myelin is composed largely of lipid tissue veined with capillaries. Its white color is due to...
of the frontal lobe. Ishihara et al. sought to demonstrate this linkage by observing a patient who was experiencing loss of consciousness. The patient, a 72 year old male, exhibited utilization behavior after admission into the hospital. An examiner placed objects such as a tissue box, toothpaste and a toothbrush in front of the patient and before any instruction the patient brushed his teeth and picked up the tissue in a manner as if to blow his nose. When asked why he did these actions, he had no reason other than that he wanted to use the objects. Later, the patient was placed in front of a paper and pen and he immediately stated to write correct letters and sentences without being told to do so because he felt compelled to write.
The results showed that a lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
in the subcortical white matter of the superior frontal gyrus
Superior frontal gyrus
The superior frontal gyrus makes up about one-third of the frontal lobe of the human brain. It is bounded laterally by the superior frontal sulcus....
was the cause of utilization behavior in the patient. A coronal section of the brain confirmed an infarct, tissue death due to lack of oxygen, in the left superior frontal gyrus
Superior frontal gyrus
The superior frontal gyrus makes up about one-third of the frontal lobe of the human brain. It is bounded laterally by the superior frontal sulcus....
with the main lesion in the subcortical white matter. Fiber bundles are also present in the subcortical white matter connecting the prefrontal area with the nucleus of the thalamus. The researchers believed that utilization behavior could also be a result of the disordering of these fibers. The researchers established that a network exists between the frontal cortical and some subcortical lesions, especially the thalamus, and a white matter lesion may disconnect this network.
Diagnosis
Quantitative methods of assessing utilization behavior are not available for use and because of this those who notice changes in behavior similar to that of the signs of UB should see a doctor. Many functional disorders can be mistaken for frontal dysfunction as several neurological causes can be attributed to frontal dysfunction. Proper criteria need to be in place for determining UB but because this disorder is in the elementary stage, researchers have not arrived at a full understanding of the disorder. Doctors can test the patient's response, communication and motor skills but the only way to fully diagnose this disorder is to do a scan of the brain to see if the frontal lobe has been damaged. This can be done with the following scan types:- CT Scan (X-ray computed tomography)
- MRI (Magnetic resonance imagingMagnetic resonance imagingMagnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
) - PET (Positron emission tomographyPositron emission tomographyPositron emission tomography is nuclear medicine imaging technique that produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide , which is introduced into the body on a...
) - SPECT (Single photon emission computed tomographySingle photon emission computed tomographySingle-photon emission computed tomography is a nuclear medicine tomographic imaging technique using gamma rays. It is very similar to conventional nuclear medicine planar imaging using a gamma camera. However, it is able to provide true 3D information...
)
Treatment
Although no specific cure has been found for UB, steps can be taken to reduce its symptoms and severity. If UB is a symptom of an underlying disease or disorder, treatment of the disease itself can reduce the severity of UB and may eradicate it completely. This was seen in patients with Moyamoya disease who had bilateral frontal lobe infractions which resulted in UB. Upon treatment, the UB was resolved due to 60–70% shrinkage of the anterior lobe hypodensities. Concerning general frontal lobe damage, rehabilitationRehabilitation (neuropsychology)
Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that has been diminished by disease or traumatic injury....
is known to help a patient function with their disorder.
Diseases
Utilization behavior is present in patients that have ranging diseases and disorders. The diseases mentioned below are some of those that include UB as a symptom.- Frontotemporal dementiaFrontotemporal dementiaFrontotemporal dementia is a clinical syndrome caused by degeneration of the frontal lobe of the brain and may extend back to the temporal lobe...
- Moyamoya disease
- Primary cerebral malignant lymphoma (see Primary central nervous system lymphomaPrimary central nervous system lymphomaA primary central nervous system lymphoma , also known as microglioma and primary brain lymphoma, is a primary intracranial tumor appearing mostly in patients with severe immunosuppression . PCNSLs represent around 20% of all cases of lymphomas in HIV infections...
) - ADHD
- Children with ADHD were found to display significantly higher utilization behavior compared to children of a control group. ADHD is associated with frontal lobe abnormalities and with the knowledge that UB involves the frontal lobe, researchers have started to form a connection between the two. In two studies, mentioned by Fontenelle when talking about "short-circuit movement," utilization behavior was experienced by ADHD persons. Boys with ADHD demonstrated utilization behavior more so than the boys of a control group (without ADHD) and Archibald et al. found that those with ADHD exhibited UB that was more common with those objects familiar and in the field of view of the patient.
Environmental dependency syndrome
Environmental dependency syndrome (EDS) illustrates an overreliance on environmental stimuli to guide behavior in social experiences. A person with EDS would change his actions if told of a change in the surrounding environment. For example, if the patient is told that he was in an art gallery he would start to look at pictures hung on the wall and interpret them as if in an actually art gallery. EDS is known as a more context based form on UB as it involves more complex involvement of motor behavior.Grasp reflex
Grasp reflex (GR) is the tendency to seize objects that are usually presented between the patient's thumb and index finger. The patient would grasp the stimulus in tonic flexionFlexion
In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...
, a brief limb extension, and draw the object towards the body thus increasing the strength of the grip. The patient seems to not be able to let go of the object. This behavior is normal in infants but abnormal in older children and adults. A video is included below portraying GR in a baby.
Manual groping behavior
With manual groping behavior (MGB), the patient's hand or eye is attracted to an object and follows it in a magnetic manner while manipulating the object. This behavior is involuntary and occurs constantly except for the brief stops due to diverted attentionAttention
Attention is the cognitive process of paying attention to one aspect of the environment while ignoring others. Attention is one of the most intensely studied topics within psychology and cognitive neuroscience....
. Similar to the grasp reflex, MGB is normal in infants but worrisome in adults.