Nervous System Commons^™

The Effects Of Asymmetric Cervical Muscle Fatigue On Cervical Proprioception, Stepping, And Standing Postural Sway, Maryam Homafar

LSU Master's Theses

Background: The cervical spine contributes critically to proprioception and postural control through its dense mechanoreceptor population. The acute effects of asymmetrical cervical muscle fatigue on proprioception, gait, and balance remain understudied, especially considering its widespread occurrence in multiple populations.

Objective: To investigate the acute effects of asymmetrical cervical muscle fatigue on cervical proprioception, stepping ability, and standing postural sway in healthy young adults.

Methods: Eighteen of 25 healthy participants, who met the inclusion criterion of baseline cervical joint position error (CJPE) below 4.5° for left and right rotational directions, completed pre-fatigue and post-fatigue assessments with eyes closed, including CJPE test, …

From Fog To Function: An Occupational Therapist's Guide To Evaluating And Treating Cancer-Related Cognitive Impairments, Lauren E. Toner

Entry-Level Occupational Therapy Doctorate - Doctoral Capstone Symposium

Cancer – related cognitive impairment (CRCI) is a common side effect of cancer treatment that interferes with cancer survivors’ occupational performance, independence, and quality of life. Despite its high prevalence, CRCI remains under recognized and inconsistently addressed within oncology care. About 70% of individuals diagnosed with cancer report cognitive changes during or after treatment, yet many do not receive treatment. Occupational therapists are clinically trained to evaluate and treat functional cognition, activities of daily activities, instrumental activities of daily living, and client centered goals, positioning them as key providers in addressing CRCI. However, limited occupational therapy specific resources have hindered …

Soft Tissue Envelope Compromise Following Low-Side Motorcycle Accident: A Case Study And Literature Review, Steven A. Bolton, Ali Ahmad, Jonathan Rodriguez, Hooman Mir

School of Podiatric Medicine - Student Research

Purpose: This case report details a staged approach in managing a patient who presented to the ER with a displaced proximal second phalanx fracture, extensive soft tissue damage, and diffuse fracture blistering following a motorcycle crash. This case highlights that soft tissue damage may not always correlate with severe osseous injury.

Methodology: This case is a concurrent chart review of a 40-year-old who sustained a low side motorcycle injury resulting in a minimally displaced avulsion fracture of the medial 2nd toe proximal phalanx base with extensive soft tissue damage, fracture blisters, and lower extremity edema.

Procedures: Radiographic evaluation demonstrated no …

The Science Of Sound: Studying The Cognitive, Emotional, And Physiological Effects Of Frequency, Genre, And Music, Jett Yarborough

Senior Honors Theses

Music influences emotion, physiology, and cognition, yet little is known about how the frequency it is tuned to affects these influences. Prior research has shown that music tuned to 432 Hz can reduce stress, lower blood pressure, and improve sleep. My colleagues and I conducted two studies to investigate this. Our research found that music tuned to 432 Hz promotes a significant increase in memory retention and induces a state of focus and relaxation. These results suggest that shifting from the standard tuning frequency of 440 Hz to 432 Hz could have a profoundly positive impact on our daily lives. …

Functional Electrical Stimulation For Foot Drop: A Narrative Review, Garrett R. Watson

Honors Thesis

Foot drop (FD) is a neuromuscular impairment that limits ankle dorsiflexion during walking. It often leads to unsafe gait patterns, increases the risk of falls, and reduces independence. Functional electrical stimulation (FES) has emerged as a promising rehabilitation tool that activates muscles or nerves to improve foot clearance and support motor recovery. Unlike passive devices such as ankle-foot orthoses, FES promotes active neuromuscular engagement and may foster long-term improvements through neuroplastic adaptation. This narrative review examines the causes and clinical consequences of FD and evaluates the role of FES in restoring functional mobility. Key topics include FES technologies, stimulation parameters, …

Gray Matter Morphology And Pain-Related Disability In Young Adults With Low Back Pain, Jo Armour Smith, Rongwen Tain, Isaac Chrisman, Kelli G. Sharp, Laura M. Glynn, Linda R. Van Dillen, Jesse V. Jacobs, Steven C. Cramer

Physical Therapy Faculty Articles and Research

Structural neuroplasticity in the brain may contribute to the persistence of low back pain (LBP) symptoms and the disability associated with them. It is not known if structural adaptations are evident early in the lifespan in young adults with LBP. This study compared gray matter in cortical sensorimotor regions in young adults with and without persistent LBP and identified gray matter and clinical predictors of pain-related disability. Eighty-two individuals with and without a history of LBP participated. Peak and average gray matter density in cortical sensorimotor regions of interest was quantified using voxel-based morphometry. Pain-related disability, pain intensity, pain duration, …

Optimizing Decision-Making In A Cerebral Palsy Model Using Reinforcement Learning, Richard Ampah

Pitzer Senior Theses

This study presents an original interdisciplinary investigation into how reinforcement learning (RL) can model motor and cognitive defects and potentially improve motor and cognitive functions in individuals with cerebral palsy (CP), a non-progressive neurological disorder that impairs movement and adaptability. Integrating computational neuroscience and machine learning, the research applies policy gradient methods and Markov Decision Processes (MDPs) to simulate adaptive learning in agents with and without CP-related constraints.

The central aim is to compare the cumulative rewards of optimal policies, derived from value iteration, and human-like learning policies using the REINFORCE algorithm, both with and without the Bellman baseline. The …

Using Machine Learning To Determine A Functional Classifier Of Reward Responsiveness And Its Association With Adolescent Psychiatric Symptomatology, Robert James Richard Blair, Johannah Bashford-Largo, Ahria Dominguez, Matthew Dobbertin, Karina S. Blair, Sahil Bajaj

Center for Brain, Biology, and Behavior: Faculty Publications

Background. Machine learning (ML) has developed classifiers differentiating patient groups despite concerns regarding diagnostic reliability. An alternative strategy, used here, is to develop a functional classifier (hyperplane) (e.g. distinguishing the neural responses to received reward v. received punishment in typically developing (TD) adolescents) and then determine the functional integrity of the response (reward response distance from the hyperplane) in adolescents with externalizing and internalizing conditions and its associations with symptom clusters.

Methods. Two hundred and ninety nine adolescents (mean age = 15.07 ± 2.30 years, 117 females) were divided into three groups: a training sample of TD adolescents …

Second Language Learning In Older Adults Modulates Stroop Task Performance And Brain Activation, Douglas H. Schultz, Alison Gansemer, Kiley Allgood, Mariah Gentz, Lauren Secilmis, Zoha Deldar, Cary R. Savage, Ladan Ghazi Saidi

Center for Brain, Biology, and Behavior: Faculty Publications

Introduction: Numerous studies have highlighted cognitive benefits in lifelong bilinguals during aging, manifesting as superior performance on cognitive tasks compared to monolingual counterparts. Yet, the cognitive impacts of acquiring a new language in older adulthood remain unexplored. In this study, we assessed both behavioral and fMRI responses during a Stroop task in older adults, pre- and post language-learning intervention.

Methods: A group of 41 participants (age: 60–80) from a predominantly monolingual environment underwent a four-month online language course, selecting a new language of their preference. This intervention mandated engagement for 90 minutes a day, five days a week. …

Less Activity Means Improved Welfare? How Pair Housing Influences Pinyon Jay (Gymnorhinus Cyanocephalus) Behaviour, London M. Wolff, Jeffrey R. Stevens

Center for Brain, Biology, and Behavior: Faculty Publications

The activity level and specific behaviours exhibited by captive animals are crucial indicators of welfare. Stereotypies, or repetitive behaviours that have no apparent function or goal, are performed by animals experiencing poor conditions in their environment and indicate welfare concerns. Changes in the housing environment in particular may have critical influences on behaviour and welfare. Here, we measured behavioural changes in a captive pinyon jay (Gymnorhinus cyanocephalus) population (n = 10) associated with a shift from single to pair housing. Using automated video processing, we show that pair housing greatly reduced overall activity levels in these birds. The …

Reliability Of The International Spinal Cord Injury Physical Therapy-Occupational Therapy Basic Data Set, Edelle C. Field-Fote, Kim D. Anderson, Maclain Capron, Ruediger Rupp, Linda Jones, M. Schmidt-Read, Vanessa K. Noonan, Anne Bryden, Sara Mulroy, Walter Weiss, Mario Widmer, Henrik Hagen Poder, Vivien Jørgensen, Eimear Smith, Mariel Purcell, Fin Biering-Sørensen

Department of Rehabilitation Medicine Faculty Papers

In interventional clinical trials for persons with spinal cord injury (SCI), the influence of experimental biological, pharmacological, or device-related interventions must be differentiated from that of physical and occupational therapy interventions, as rehabilitation influences motor-related outcomes. The International Spinal Cord Injury (ISCI) Physical Therapy–Occupational Therapy Basic Data Set (PT-OT BDS) was developed with the intent to track the content and time of rehabilitation interventions that are delivered concurrently with experimental interventions. We assessed the reliability of the PT-OT BDS based on agreement between users. Following an online training session, physical therapists (PTs) and occupational therapists (OTs) from 10 SCI clinical …

Spatiotemporal Gait Parameter Consistency Across Two Days Of Treadmill Walking In Stroke Survivors, Alejandro Aguirre Ramirez, Samantha N. Jeffcoat, Natalia Sanchez, Andrian Kuch

Student Scholar Symposium Abstracts and Posters

Retraining impaired gait is essential in post-stroke recovery. This project aims to determine between day variability of spatiotemporal gait measures in treadmill walking post-stroke to differentiate between changes due to the intervention and measurement errors due to between day test-retest variability. Six individuals post-stroke performed a two-minute walk test at a self-selected speed (SSS) for two consecutive days. SSS was assessed through the six-minute walk test. Reflective markers were placed on anatomical landmarks (van den Bogert et al. 2013). The heel markers were used for step detection. We calculated spatiotemporal parameters: stride length, stride time, step length, stance time, and …

Idiopathic And Neuromuscular Scoliosis In A Female College Basketball Player Requiring Spinal Correction Surgery, Magan Kim

UNO Student Research and Creative Activity Fair

The purpose of this report is to present the case of a 20-year-old female collegiate basketball player who was diagnosed with a combination of idiopathic and neuromuscular scoliosis. Patient underwent thoracic spinal fusion surgery when she was 15 to resolve her extreme scoliosis. The uniqueness of this case stems from the athlete’s urgency to have to undergo a life-altering spine operation and still be able to successfully contribute to a collegiate basketball team. Athletic trainers should be knowledgeable and aware of how to maintain treatment/rehabilitation for athletes with scoliosis, operative or non-operative. Scoliosis should no longer be a reason to …

Associations Of Sex And Sport Contact‑Level With Recovery Timelines Among Collegiate Athletes With Sport‑Related Concussion, Bernadette A. D'Alonzo, Andrea L. C. Schneider, Ian J. Barnett, Christina L. Master, Abigail C. Bretzin, Douglas J. Wiebe, Ivy League-Big Ten Epidemiology Of Concussion Study Investigators

Center for Brain, Biology, and Behavior: Faculty Publications

Background

Growing interest has motivated recent studies to examine differences in recovery after sportrelated concussion (SRC) by sex. However, heterogeneity in study design, participants, and recovery outcomes has led to mixed findings. Further work is needed to evaluate potential differences by sex and to investigate the role of related characteristics, such as sport contact-level, in recovery timelines. This study aimed to investigate whether concussion recovery trajectories differ by sex, considering a priori clinical and demographic covariates, and accounting for the sequence of recovery outcomes. Our secondary question was whether sport contact-level modifies the relationship between sex and time to outcomes. …

Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).

Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …

Health-Outcomes Related To Smartphone Use In The College Student Population: A Scoping Review, Gregory Deglomine

Honors Undergraduate Theses

Objective: A scoping review was employed to consolidate what is currently being studied and reported on concerning interactions with smartphone devices and correlated negative health-outcomes, specifically within the college student population. We are specifically concerned with this population due to the unique demands of technology use coupled with free time use of smartphone devices. Information such as study focus, study design, and summarized results are be provided within this compilation of available data. Results: The existing data findings are heavily skewed in favor of a positive correlation between smartphone use and negative health-outcomes. Sampling 17,069 total participants across 41 studies, …

Covid‑19‑Related Risk, Resilience, And Mental Health Among Mexican American Mothers Across The First Year Of The Pandemic, Amy L. Non, Elizabeth S. Clausing, Sandraluz Lara‑Cinisomo, Kimberly L. D’Anna Hernandez

Center for Brain, Biology, and Behavior: Faculty Publications

Background Latina mothers have been especially affected by the pandemic and historically exhibit high rates of depression and anxiety. However, few longitudinal studies have assessed the effect of the pandemic on this vulnerable population. We hypothesized that COVID-19-related stressors would associate with psychological distress among Latina mothers across the first year of the pandemic.

Methods We investigated COVID-19-related impact, stigma, and fears across two critical time points and changes in these measures in relation to changes in maternal anxiety and depression among mothers of Mexican descent living in Southern California (n=152). Surveys were administered within 5–16 weeks of …

Botulinum Toxin Type A Injections For Refractory Abdominal Dystonia: A Case Report, William J. Naber Ii, Jodi M. Wilhelm, Kurt A. Kuhlman, Gabriel Howard

Graduate Medical Education Research Journal

Background: A 58-year-old male with chronic bilateral treatment resistant abdominal spasms secondary complications of ascites/ alcoholic cirrhosis. Spasms would occur 4-5 times/day, lasting minutes to hours despite a 2-year course of therapeutic and pharmacological interventions. Due to treatment refraction, 6 uniformly spaced botulinum toxin type A (BTX-A) injections were placed per side, using electromyography for audible intramuscular syringe placement confirmation, while visual confirmation was made via ultrasound. During the initial trial, 6 evenly spaced injections were performed bilaterally, uniformly distributing 80U/side. Injections began bilaterally just medial to the junction of the inferior rib cage border/ anterior axillary line and progressed …

Reduced Grey Matter Volume In Adolescents With Conduct Disorder: A Region‑Of‑Interest Analysis Using Multivariate Generalized Linear Modeling, Ru Zhang, Robert James R. Blair, Karina S. Blair, Matthew Dobbertin, Jaimie Elowsky, Johannah Bashford‑Largo, Ahria J. Dominguez, Melissa Hatch, Sahil Bajaj

Center for Brain, Biology, and Behavior: Faculty Publications

Background

Conduct disorder (CD) involves a group of behavioral and emotional problems that usually begins during childhood or adolescence. Structural brain alterations have been observed in CD, including the amygdala, insula, ventrolateral and medial prefrontal cortex, anterior cingulate cortex, and fusiform gyrus. The current study developed a multivariate generalized linear model (GLM) to differentiate adolescents with CD from typically developing (TD) adolescents in terms of grey matter volume (GMV).

Methods

The whole‐brain structural MRI data were collected from 96 adolescents with CD (mean age = 16.188 ± 1.259 years; mean IQ = 104.292 ± 8.107 ; 63 males) and 90 …

Specialized Late Cingulo-Opercular Network Activation Elucidates The Mechanisms Underlying Decisions About Ambiguity, Jordan E. Pierce, Nathan M. Petro, Elizabeth Clancy, Caterina Gratton, Steven E. Petersen, Maital Neta

Center for Brain, Biology, and Behavior: Faculty Publications

Cortical task control networks, including the cingulo-opercular (CO) network play a key role in decision-making across a variety of functional domains. In particular, the CO network functions in a performance reporting capacity that supports successful task performance, especially in response to errors and ambiguity. In two studies testing the contribution of the CO network to ambiguity processing, we presented a valence bias task in which masked clearly and ambiguously valenced emotional expressions were slowly revealed over several seconds. This slow reveal task design provides a window into the decision-making mechanisms as they unfold over the course of a trial. In …

The Level Of Functionality Of The Affected Upper Limb In Stroke Patients Depends On The Type Of Therapy Used And The Lateralization Of The Subjects' Body - A Randomized Observational Study., Anna Olczak, Marcin Dornowski

Baltic Journal of Health and Physical Activity

Introduction: Impairment of the functions of the upper limb and hand is a major problem in stroke patients. The aim of the study was to evaluate various therapies in terms of their influence on changes in the activity of the affected, dominant, and non-dominant upper limb in patients after ischemic stroke. Material/Methods: This is a randomized, double-blinded study. The research was carried out in a rehabilitation clinic on a group of 60 stroke patients who were randomly assigned to groups differing in the rehabilitation program. The study group had physiotherapy based on the NDT Bobath concept and the control group …

Assessing Blood Oxygen Level–Dependent Signal Variability As A Biomarker Of Brain Injury In Sport-Related Concussion, Evan D. Anderson, Tanveer Talukdar, Grace Goodwin, Valentina Di Pietro, Kamal M. Yakoub, Christopher E. Zwilling, David Davies, Antonio Belli, Aron K. Barbey

Center for Brain, Biology, and Behavior: Faculty Publications

Mild traumatic brain injury is a complex neurological disorder of significant concern among athletes who play contact sports. Athletes who sustain sport-related concussion typically undergo physical examination and neurocognitive evaluation to determine injury severity and return-to-play status. However, traumatic disruption to neurometabolic processes can occur with minimal detectable anatomic pathology or neurocognitive alteration, increasing the risk that athletes may be cleared for return-to-play during a vulnerable period and receive a repetitive injury. This underscores the need for sensitive functional neuroimaging methods to detect altered cerebral physiology in concussed athletes. The present study compared the efficacy of Immediate Post-concussion Assessment and …

Identification Of Structural Brain Alterations In Adolescents With Depressive Symptomatology, J. Bashford‑Largo, R. James R. Blair, Karina S. Blair, Matthew Dobbertin, Ahria Dominguez, Melissa Hatch, Sahil Bajaj

Center for Brain, Biology, and Behavior: Faculty Publications

Introduction: Depressive symptoms can emerge as early as childhood and may lead to adverse situations in adulthood. Studies have examined structural brain alternations in individuals with depressive symptoms, but findings remain inconclusive. Furthermore, previous studies have focused on adults or used a categorical approach to assess depression. The current study looks to identify grey matter volumes (GMV) that predict depressive symptomatology across a clinically concerning sample of adolescents.

Methods: Structural MRI data were collected from 338 clinically concerning adolescents (mean age = 15.30 SD=2.07; mean IQ = 101.01 SD=12.43; 132 F). Depression symptoms were indexed via the Mood …

Specialized Late Cingulo-Opercular Network Activation Elucidates The Mechanisms Underlying Decisions About Ambiguity, Jordan E. Pierce, Nathan M. Petro, Elizabeth Clancy, Caterina Gratton, Steven E. Petersen, Maital Neta

Center for Brain, Biology, and Behavior: Faculty Publications

Cortical task control networks, including the cingulo-opercular (CO) network play a key role in decision-making across a variety of functional domains. In particular, the CO network functions in a performance reporting capacity that supports successful task performance, especially in response to errors and ambiguity. In two studies testing the contribution of the CO network to ambiguity processing, we presented a valence bias task in which masked clearly and ambiguously valenced emotional expressions were slowly revealed over several seconds. This slow reveal task design provides a window into the decision-making mechanisms as they unfold over the course of a trial. In …

Immobilization And Its Effects On Functional Recovery After Spinal Cord Injury., William H. Gregory

College of Arts & Sciences Senior Theses

Recovery, or rather the failure to recover, is a perplexing issue of spinal cord injury that is currently being investigated. This issue becomes more puzzling when investigating models in which spinal cord injury (SCI) is studied. There appears to be greater functional recovery experienced by animals within these models after injury as compared to patients in the clinical setting. While many things could contribute to this disparity, one difference that stands out when comparing the basic research model and clinical experience of SCI is the inactivity and limb disuse after the injury. This same level of immobility is rarely accounted …

Higher Sexual Excitation Is Associated With An Increase In Sex-Linked Substance Use In Women With A History Of Unwanted Sexual Contact, Harper R. Jones, Tierney K. Lorenz

Center for Brain, Biology, and Behavior: Faculty Publications

Survivors of unwanted sexual contact have an increased likelihood of using substances in sexual situations, which puts them at heightened risk for intoxication-related harms. Separately, research has indicated that women may intentionally use substances in sexual situations to either enhance pleasure (i.e., increase sexual excitation) and/or reduce sexual anxiety or shame (i.e., reduce sexual inhibition), a phenomenon termed sex-linked substance use (SLSU). A predominant assumption in the literature is that women with unwanted sex histories are more likely to disengage during sex, suggesting greater inhibition-related SLSU; however, there is little prior research directly examining if women who have unwanted sex …

Pre–Post Intervention Exploring Cognitive Function And Relationships With Weight Loss, Intervention Adherence And Dropout, Amanda N. Szabo-Reed, Laura E. Martin, Cary R. Savage, Richard A. Washburn, Joseph E. Donnelley

Center for Brain, Biology, and Behavior: Faculty Publications

Objective: To evaluate the association between baseline cognitive function, intervention dropout, adherence and 3-month weight loss (WL) when controlling for confounding demographic variables.

Methods: 107 (Mage = 40.9 yrs.), BMI in the overweight and obese range (BMI = 35.6 kg/m2), men (N = 17) and women (N = 90) completed a 3-month WL intervention. Participants attended weekly behavioral sessions, comply with a reduced calorie diet, and complete 100 min of physical activity (PA)/wk. Cognitive function tasks at baseline included Flanker (attention), Stroop (executive control) and working memory, demographics, body weight and cardiovascular fitness were assessed at baseline. Session attendance, adherence …

Concussion-Related Disruptions To Hub Connectivity In The Default Mode Network Are Related To Symptoms And Cognition, Heather C. Bouchard, Kate L. Higgins, Grace Amadon, Julia M. Laing-Young, Arthur C. Maerlender, Seima Al-Momani, Maital Neta, Cary R. Savage, Douglas H. Schultz

Center for Brain, Biology, and Behavior: Faculty Publications

Concussions present with a myriad of symptomatic and cognitive concerns; however, the relationship between these functional disruptions and the underlying changes in the brain are not yet well understood. Hubs, or brain regions that are connected to many different functional networks, may be specifically disrupted after concussion. Given the implications in concussion research, we quantified hub disruption within the default mode network (DMN) and between the DMN and other brain networks. We collected resting-state functional magnetic resonance imaging data from collegiate student-athletes (n = 44) at three timepoints: baseline (prior to beginning their athletic season), acute post-injury (approximately 48 hours …

Manydogs Project: A Big Team Science Approach To Investigating Canine Behavior And Cognition, Daniela Alberghina, Emily E. Bray, Daphna Buchsbaum, Sarah- Elizabeth Byosiere, Julia Espinosa, Gitanjali E. Gnanadesikan, C.-N. Alexandrina Guran, Elizabeth Hare, Daniel J. Horschler, Ludwig Huber, Valerie A. Kuhlmeier, Evan L. Maclean, Madeline H. Pelgrim, Bryan Perez, Dana Ravid-Schurr, Liza Rothkoff, Courtney L. Sexton, Zachary A. Silver, Jeffrey R. Stevens

Center for Brain, Biology, and Behavior: Faculty Publications

Dogs have a special place in human history as the first domesticated species and play important roles in many cultures around the world. However, their role in scientific studies has been relatively recent. With a few notable exceptions (e.g., Darwin, Pavlov, Scott, and Fuller), domestic dogs were not commonly the subject of rigorous scientific investigation of behavior until the late 1990s. Although the number of canine science studies has increased dramatically over the last 20 years, most research groups are limited in the inferences they can draw because of the relatively small sample sizes used, along with the exceptional diversity …

The Accuracy Of Recreational Athletes In Self Detecting Ventilation Threshold During A Maximal Exercise Test, Andrew Biegner

Williams Honors College, Honors Research Projects

INTRODUCTION: Ventilatory threshold (VT) is where minute ventilation (VE) increases nonlinearly with increasing exercise intensity. Prior studies have shown that subjects can recognize VT by changes in breathing during exercise. Teaching recreational athletes to use VT as a training method could result in better quality training. PURPOSE: Determine if recreational athletes can accurately perceive changes in ventilation associated with VT during maximal exercise testing. METHODS: Subjects were recruited (n=20, age= 20.5 ± 1.7 yrs.) to participate in the study. Subjects performed a modified maximal treadmill protocol with gas analysis. Subjects indicated when they noticed a considerable change …