Utilization behavior (UB) is a type of neurobehavioral phenomena that involves someone grabbing objects in view and starting the 'appropriate' behavior associated with it at an 'inappropriate' time.Ishihara, K., Nishino, H., Maki, T., Kawamura, M., & Murayama, S. (2012). Utilization behavior as a white matter disconnection syndrome. Cortex, 38(3), 379-387. Utilization behavior people have difficulty resisting the

impulse Impulse or Impulsive may refer to: Science * Impulse (physics), in mechanics, the change of momentum of an object; the integral of a force with respect to time * Impulse noise (disambiguation) * Specific impulse, the change in momentum per unit ...

to operate or manipulate objects which are in their

visual field The visual field is the "spatial array of visual sensations available to observation in introspectionist psychological experiments". Or simply, visual field can be defined as the entire area that can be seen when an eye is fixed straight at a point ...

and within reach. Characteristics of UB include unintentional, unconscious actions triggered by the immediate environment. The unpreventable excessive behavior has been linked to

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classif ...

s in the

frontal lobe The frontal lobe is the largest of the four major lobes of the brain in mammals, and is located at the front of each cerebral hemisphere (in front of the parietal lobe and the temporal lobe). It is parted from the parietal lobe by a groove b ...

. UB has also been referred to as "bilateral magnetic apraxia" and "hypermetamorphosis".Eslinger, P. (2002). The Anatomic Basis Of Utilization: A Shift From Frontal-Parietal To Intra-Frontal Mechanisms. Division of Neurology, 1-4.

Background

The people 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 to a person without UB is that the "object-appropriate" action taken is performed at the inappropriate time. For example, a person will be shown a pair of glasses and automatically put them on. This demonstrates the appropriate action at the "inappropriate" time. This causes the inappropriate motor responses to specific objects in the environment.

Symptoms

People with utilization behavior may be 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

stimuli A stimulus is something that causes a physiological response. It may refer to: *Stimulation ** Stimulus (physiology), something external that influences an activity **Stimulus (psychology), a concept in behaviorism and perception *Stimulus (econom ...

and not others. An effect 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. This set of symptoms may be related to

Alien Hand Syndrome Alien hand syndrome (AHS) or Dr. Strangelove syndrome is a category of conditions in which a person experiences their limbs acting seemingly on their own, without conscious control over the actions. There are a variety of clinical conditions that ...

(AHS), a neurological disorder in which the subject does not acknowledge ownership of a limb when visual cues are lacking.Espinosa, P., Smith, C., Berger, J. (2006). Alien hand syndrome. Neurology, 67(12), E21. AHS can involve damage to the

anterior cingulate gyrus In the human brain, the anterior cingulate cortex (ACC) is the frontal part of the cingulate cortex that resembles a "collar" surrounding the frontal part of the corpus callosum. It consists of Brodmann areas 24, 32, and 33. It is involved i ...

, the

medial prefrontal cortex In mammalian brain anatomy, the prefrontal cortex (PFC) covers the front part of the frontal lobe of the cerebral cortex. The PFC contains the Brodmann areas BA8, BA9, BA10, BA11, BA12, BA13, BA14, BA24, BA25, BA32, BA44, BA45, BA4 ...

and the anterior

corpus callosum The corpus callosum (Latin for "tough body"), also callosal commissure, is a wide, thick nerve tract, consisting of a flat bundle of commissural fibers, beneath the cerebral cortex in the brain. The corpus callosum is only found in placental ...

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 disease,

Cerebrovascular disease Cerebrovascular disease includes a variety of medical conditions that affect the blood vessels of the brain and the cerebral circulation. Arteries supplying oxygen and nutrients to the brain are often damaged or deformed in these disorders. The ...

Frontotemporal dementia Frontotemporal dementia (FTD), or frontotemporal degeneration disease, or frontotemporal neurocognitive disorder, encompasses several types of dementia involving the progressive degeneration of frontal and temporal lobes. FTDs broadly present a ...

neoplasm A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

, and

corticobasal degeneration Corticobasal degeneration (CBD) is a rare neurodegenerative disease involving the cerebral cortex and the basal ganglia. CBD symptoms typically begin in people from 50 to 70 years of age, and the average disease duration is six years. It is chara ...

Frontal lobe

The

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.

Lhermitte (1983)

Lhermitte first coined the term ''Utilization Behavior'' (UB). He observed six patients with

unilateral __NOTOC__ Unilateralism is any doctrine or agenda that supports one-sided action. Such action may be in disregard for other parties, or as an expression of a commitment toward a direction which other parties may find disagreeable. As a word, ''un ...

and

bilateral Bilateral may refer to any concept including two sides, in particular: *Bilateria, bilateral animals *Bilateralism, the political and cultural relations between two states *Bilateral, occurring on both sides of an organism ( Anatomical terms of l ...

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 The caudate nucleus is one of the structures that make up the corpus striatum, which is a component of the basal ganglia in the human brain. While the caudate nucleus has long been associated with motor processes due to its role in Parkinson's di ...

.Lhermitte, F. (1983). Utilization behavior and its relation to lesions of the frontal lobes. Brain 106: 237–255. '' 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 The parietal lobe is one of the four major lobes of the cerebral cortex in the brain of mammals. The parietal lobe is positioned above the temporal lobe and behind the frontal lobe and central sulcus. The parietal lobe integrates sensory informa ...

, 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 examination A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical h ...

while objects that could elicit UB were present. 23 patients were found to have symptoms of UB.Shallice, T., Burgess, P. W., Schon, F., and Baxter, D. M. (1989). The origins of utilization behaviour. Brain 112: 1587–1598.

Thalamus

The

anterior cingulate cortex In the human brain, the anterior cingulate cortex (ACC) is the frontal part of the cingulate cortex that resembles a "collar" surrounding the frontal part of the corpus callosum. It consists of Brodmann areas 24, 32, and 33. It is involve ...

forms connections with

dorsolateral prefrontal cortex The dorsolateral prefrontal cortex (DLPFC or DL-PFC) is an area in the prefrontal cortex of the primate brain. It is one of the most recently derived parts of the human brain. It undergoes a prolonged period of maturation which lasts until adultho ...

meaning prefrontal regions have strong connections with

limbic The limbic system, also known as the paleomammalian cortex, is a set of brain structures located on both sides of the thalamus, immediately beneath the medial temporal lobe of the cerebrum primarily in the forebrain.Schacter, Daniel L. 2012. ''Ps ...

structures. This can be seen in the following study conducted by Eslinger et al. A woman with bilateral

encephalomalacia Cerebral softening, also known as encephalomalacia, is a localized softening of the substance of the brain, due to bleeding or inflammation. Three varieties, distinguished by their color and representing different stages of the disease progress, ar ...

had a damaged medial

thalamus The thalamus (from Greek θάλαμος, "chamber") is a large mass of gray matter located in the dorsal part of the diencephalon (a division of the forebrain). Nerve fibers project out of the thalamus to the cerebral cortex in all direction ...

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 Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue. Perfusion is measured as the rate at which blood is deliver ...

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 matter White matter refers to areas of the central nervous system (CNS) that are mainly made up of myelinated axons, also called tracts. Long thought to be passive tissue, white matter affects learning and brain functions, modulating the distributi ...

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 started to write correct letters and sentences without being told to do so because he felt compelled to write. The results showed that a

in the subcortical white matter of the

superior frontal gyrus In neuroanatomy, the superior frontal gyrus (SFG, also marginal gyrus) is a gyrus – a ridge on the brain's cerebral cortex – which makes up about one third of the frontal lobe. It is bounded laterally by the superior frontal sulcus. The su ...

was the cause of utilization behavior in the patient. A

coronal section The coronal plane (also known as the frontal plane) is an anatomical plane that divides the body into dorsal and ventral sections. It is perpendicular to the sagittal and transverse planes. Details The coronal plane is an example of a longit ...

of the brain confirmed an infarct, tissue death due to lack of oxygen, in the left

with the main lesion in the subcortical white matter.

Fiber bundles In mathematics, and particularly topology, a fiber bundle (or, in Commonwealth English: fibre bundle) is a space that is a product space, but may have a different topological structure. Specifically, the similarity between a space E and a p ...

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 ‘Functional disorder’ is an umbrella term for a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body. Functional disord ...

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 A motor skill is a function that involves specific movements of the body's muscles to perform a certain task. These tasks could include walking, running, or riding a bike. In order to perform this skill, the body's nervous system, muscles, and br ...

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 X-rays (or rarely, ''X-radiation'') are a form of high-energy electromagnetic radiation. In many languages, it is referred to as Röntgen radiation, after the German scientist Wilhelm Conrad Röntgen, who discovered it in 1895 and named it ' ...

) * MRI ( Magnetic resonance imaging) * PET (

Positron emission tomography Positron emission tomography (PET) is a functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in metabolic processes, and in other physiological activities including blood flow, ...

) * SPECT (

Single-photon emission computed tomography Single-photon emission computed tomography (SPECT, or less commonly, SPET) is a nuclear medicine tomographic imaging technique using gamma rays. It is very similar to conventional nuclear medicine planar imaging using a gamma camera (that is, ...

)

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 Moyamoya disease is a disease in which certain arteries in the brain are constricted. Blood flow is blocked by constriction and blood clots ( thrombosis). A collateral circulation develops around the blocked vessels to compensate for the blockage ...

who had bilateral frontal lobe infarctions which resulted in UB. Upon treatment, the UB was resolved due to 60–70% shrinkage of the

anterior lobe The anterior lobe of cerebellum is the portion of the cerebellum responsible for mediating unconscious proprioception. Inputs into the anterior lobe of the cerebellum are mainly from the spinal cord. It is sometimes equated to the "paleocerebellum ...

hypodensities.Archibald, S. J., Mateer, C. A., & Kerns, K. A. (2001). Utilization behavior: Clinical manifestations and neurological mechanisms. Neuropsychology Review, 11(3), 117-130. Concerning general frontal lobe damage, rehabilitation 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. *

* Primary cerebral malignant lymphoma (see

Primary central nervous system lymphoma Primary central nervous system lymphoma (PCNSL), also termed primary diffuse large B-cell lymphoma of the central nervous system (DLBCL-CNS), is a primary intracranial tumor appearing mostly in patients with severe immunodeficiency (typically pa ...

) * 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. 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.

Related disorders

Environmental dependency syndrome

Environmental dependency syndrome Environmental dependency syndrome, also called Zelig syndrome or Zelig-like syndrome from the name of the protagonist of Woody Allen's ''Zelig'', is a syndrome where the affected individual relies on environmental cues in order to accomplish goals ...

(EDS) illustrates an overreliance on environmental stimuli to guide behavior in social experiences. A person with EDS would change their actions if told of a change in the surrounding environment. For example, if the patient was told that they were in an art gallery, they would start to look at pictures hung on the wall and interpret them as if in an actual 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

flexion Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relativ ...

, 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.Grasp Reflex

ideo IDEO () is a design and consulting firm with offices in the U.S., England, Germany, Japan, and China. It was founded in Palo Alto, California, in 1991. The company's 700 staff uses a design thinking approach to design products, services, environ ...

(2009). Retrieved December 1, 2010, from https://www.youtube.com/watch?v=TidY4XPnFUM *

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

attention Attention is the behavioral and cognitive process of selectively concentrating on a discrete aspect of information, whether considered subjective or objective, while ignoring other perceivable information. William James (1890) wrote that "Att ...

. Similar to the grasp reflex, MGB is normal in infants but presents as a symptom in adults.

Imitation behavior

Imitation behavior (IB) is another behavior established by Lhermitte (1983) and it explains a patient's replication of the examiner's movements. This may be seen if for example, the experimenter claps their hands and yawns, the patient would do the same in the same order. The behavior is still present even when the patient is told not to follow the actions of the experimenter resulting in the belief that a patient with IB cannot stop the involuntary response. IB is important in the development of children but if it is present in adulthood, it is an abnormality.

References

{{Reflist Impulse-control disorders