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'''Utilization behavior''' (UB) is a type of neurobehavioral disorder that involves patients grabbing objects in view and starting the ‘appropriate’'appropriate' behavior associated with it at an 'inappropriate' time .<ref name=" Ishihara">Ishihara, K., Nishino, H., Maki, T., Kawamura, M., & Murayama, S. (2002). Utilization behavior as a white matter disconnection syndrome. Cortex, 38(3), 379-387.</ref> A Utilization behavior patient has difficulty resisting the [[impulse]] to operate or manipulate objects which are in his/her [[visual field]] and within reach.<ref>Lhermitte, F. (1986) Human autonomy and the frontal lobes. Part II: Patient behavior in complex and social situations: the 'environmental dependency syndrome'. Ann. Neurol. 19, 335–343 </ref> Characteristics of UB include unconsciously unintentional actions triggered by the immediate environment. The unpreventable excessive behavior has been linked to [[lesions]] in the [[frontal lobe]]. UB has also been referred to as “bilateral"bilateral magnetic apraxia”apraxia" and “"[[hypermetamorphosis]].” "<ref name=" Eslinger">Eslinger, P. (2002). The Anatomic Basis Of Utilization: A Shift From Frontal-Parietal To Intra-Frontal Mechanisms. Division of Neurology, 1-4.</ref>
[[File:Frontal lobe animation.gif|Frontal lobe animation]]
==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"object-appropriate”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==
==Causes==
The cause of utilization behavior can be attributed to many diseases including [[Alzheimer’s disease]], [[Cerebrovascular disease]], [[Frontotemporal dementia]], [[neoplasm]], and [[corticobasal degeneration]]. <ref name=" Eslinger"/>
===Frontal Lobelobe===
The [[frontal lobe]] 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.<ref name="Archibald"/>
===Thalamus===
The [[anterior cingulate cortex]] 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. <ref>Eslinger, P. J., Warner, G. C., Grattan, L. M., and Easton, J. D. (1991). “Frontal lobe” utilization behavior associated with paramedian thalamic infarction. Neurology 41: 450–452. </ref> The effect of the damage to the paramedian thalamic region did not astonish researchers because of its connection to the cingulated 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. <ref>Hashimoto, R., Yoshida, M., and Tanaka, Y. (1995). Utilization behavior after right thalamic infarction. European Neurology 35: 58–62.</ref>
====White Mattermatter====
In conjunction with the thalamus, UB has also been linked to the [[white matter]] 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.<ref name=" Ishihara " />
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. <ref name="Ishihara"/> [[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.<ref name=" Eslinger"/>
==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. <ref>Stuss, D.T., Grow, C. A., Hetherington, C.R. (1992). "No longer gage": Frontal lobe dysfunction and emotional changes. Journal of Consulting and Clinical Psychology, 60(3), 349-359.</ref> 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 imaging]])
* PET ([[Positron emission tomography]])
* SPECT ([[Single photon emission computed tomography]])
==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. <ref name="Archibald">Archibald, S. J., Mateer, C. A., & Kerns, K. A. (2001). Utilization behavior: Clinical manifestations and neurological mechanisms. Neuropsychology Review, 11(3), 117-130.</ref> Concerning general frontal lobe damage, [[Rehabilitation (neuropsychology)|rehabilitation]] is known to help a patient function with their disorder. ▼
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. <ref name="Archibald">Archibald, S. J., Mateer, C. A., & Kerns, K. A. (2001). Utilization behavior: Clinical manifestations and neurological mechanisms. Neuropsychology Review, 11(3), 117-130.</ref> Concerning general frontal lobe damage, [[Rehabilitation (neuropsychology)|rehabilitation]] is known to help a patient function with their disorder.
==Diseases==
Utilization behavior is present in patients that have ranging diseases and disorders. <ref name="Archibald"/> The diseases mentioned below are some of those that include UB as a symptom.
* [[Frontotemporal dementia]]
* [[Moyamoya disease]]
* Primary cerebral malignant lymphoma (see [[Primary central nervous system lymphoma]])
* [[ADHD]]
**Children with ADHD were found to display significantly higher utilization behavior compared to children of a control group. <ref name="Archibald"/> 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"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) <ref> Fontenelle, L., Mendlowicz, M. (2008). The Wernicke–Kleist–Leonhard ‘‘short-circuiting’’: A missing link between attention deficit hyperactivity disorder, Tourette syndrome, and obsessive–compulsive disorder? Medical Hypotheses, 71, 418–425.</ref> 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. <ref name="Archibald"/>
==Related Disordersdisorders==
====[[Environmental Dependencydependency Syndrome]] (EDS)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. <ref>Conchiglia, G., Rocca, G., Grossi, D. (2007). On a Peculiar Environmental Dependency Syndrome in a Case with Frontal-Temporal Damage: Zelig-like Syndrome. Neurocase, 13, 1–5.</ref> 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. <ref name="Archibald"/> EDS is known as a more context based form on UB as it involves more complex involvement of [[motor behavior]].
====Grasp Reflex (GR)reflex====
Grasp reflex (GR) is the tendency to seize objects that are usually presented between the patient’s thumb and index finger.<ref name="Archibald"/>. The patient would grasp the stimulus in tonic [[flexion]], 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. <ref>Grasp Reflex [Video]. (2009). Retrieved December 1, 2010, from http://www.youtube.com/watch?v=TidY4XPnFUM</ref>
*{{youtube|id= TidY4XPnFUM|title=Grasp Reflex}}
====Manual Gropinggroping Behavior (MGB)behavior====
TheWith 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 .<ref name="Archibald"/>. This behavior is involuntary and occurs constantly except for the brief stops due to diverted [[attention]]. Similar to the grasp reflex, MGB is normal in infants but worrisome in adults.
====Imitation Behavior (IB)behavior====
Imitation behavior (IB) is another behavior established by Lhermitte (1983) and it explains a patient’s replication of the examiners movements .<ref name="Archibald"/>. This may be seen if for example, the experimenter claps his 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 .<ref name="Archibald"/>. IB is important in the development of children but if it is present in adulthood, it is an abnormality.
==See also==
*[[Impulse control disorder]]
==References==
{{Reflist}}
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