Biomedical subjects

N N Byl

Publications and source records attributed to N N Byl.

At least 19 recordsLinked to original sources

PubMed2003

Somatosensory representation of the digits and clinical performance in patients with focal hand dystonia.

OBJECTIVE: The purpose of this study was to incorporate magnetoencephalography and clinical testing to describe differences in somatosensory organization and sensorimotor function of the hand in patients with focal hand dystonia, a target-specific disorder of voluntary movement that interferes with fine motor control during the performance of rapid, repetitive, skilled movements. DESIGN: This descriptive study included prospective, quasi-experimental comparisons between groups. RESULTS: Patients with focal hand dystonia demonstrated deficits in physical variables, sensory processing, and motor control when compared with age- and sex-matched controls. They also had altered patterns of firing (amplitude and latency integrated over time) and abnormal somatosensory representations on magnetoencephalography. CONCLUSIONS: These study findings suggest that there are alterations in both somatosensory representation of the digits and clinical performance in patients with focal hand dystonia. Future studies to determine if alterations in the sensorimotor feedback loop contribute to the development of focal hand dystonia are indicated. If so, intervention strategies may need to include specific types of somatosensory retraining as part of the rehabilitation program for patients with focal hand dystonia.

Adult↗

PubMed2003

What can we learn from animal models of focal hand dystonia?

Focal hand dystonia (FHd) is a disabling disorder of hand control characterized by a loss of inhibition and involuntary co-contractions of agonists and antagonists that can develop in motivated, productive individuals performing highly repetitive, intensive hand tasks. It is our hypothesis that FHd can result from aberrant learning. We summarize three behavioral animal models (Nancymae aotus owl monkeys and Sprague Dawley rats) that provide evidence supporting aberrant learning as one origin of FHd. Hand task behaviors that increase the risk for repetitive strain injury-FHd include: attended, precise, repetitive behaviors that involve near coincident inputs-outputs (e.g. rapid reversal of agonists-antagonists, stereotypical movements, stressful end range motions, cutaneous stimulation across broad surfaces). High force, vibration, congenital abnormalities, and stress can further increase the risk. The central consequences of aberrant learning include large sensory receptive fields (rfs), significant overlap of rfs across adjacent digits and across glabrous and dorsal surfaces, and the persistence of digital representations across a broad cortical distance (>600 microm). Behavioral animal models are valid for the study of FHd etiology and could logically be applied to study the effects of pharmaceutical, surgical, anatomical, and behavioral enrichment intervention strategies, but these models may have limitations in the study of the recovery of fine motor, articulated, interdigitated movements following progressive, learning based, complex sensorimotor training.

Animals↗

PubMed1999

Movement dysfunction following repetitive hand opening and closing: anatomical analysis in Owl monkeys.

Repetitive strain injuries are thought to result from biomechanical stress and tissue microtrauma. The purpose of this study was to investigate the presence of local inflammation, scarring or anatomical variations of the flexor tendons and the median and ulnar nerves in four Owl monkeys behaviorally trained at a repetitive motor or sensory task. Three monkeys were trained to repetitively open and close a handpiece. The two monkeys that used rapid, stereotypical hand squeezing developed a task-specific movement dysfunction (one in 5 weeks and one in 24 weeks). The third monkey used a variable shoulder-pulling strategy and did not develop movement problems. The fourth monkey served as a control subject for the repetitive motor movements, trained on a repetitive sensory task, and did not develop a task-specific movement dysfunction. On dissection and histologic staining, there were no signs of active inflammation in the median nerve, the ulnar nerve, or the flexor tendons in any of the monkeys. However, the monkey that developed movement problems after 5 weeks of repetitive hand squeezing had an anatomical restriction of the flexor profundus tendon on the fourth digit of the trained side and the third digit of the untrained side. Reorganization of the representation of the hand on the contralateral somatosensory cortex (area 3b) was noted in the two monkeys that developed motor control problems and in the monkey performing the repetitive sensory task. These findings suggest that repetitive, stereotypical motor behaviors can lead to motor control problems without local signs of tendon or nerve inflammation. Preexisting anatomical restrictions may modify the time course for the development of movement dysfunction under conditions of stressful repetition. This animal model may simulate clinical focal hand dystonia (or occupational hand cramps) which can develop in human subjects who perform prolonged, repetitive, stereotypical movements.

Animals↗

PubMed1999

Reorganization in the cutaneous core of the human thalamic principal somatic sensory nucleus (Ventral caudal) in patients with dystonia.

A wide range of observations suggest that sensory inputs play a significant role in dystonia. For example, the map of the hand representation in the primary sensory cortex (area 3b) is altered in monkeys with dystonia-like movements resulting from overtraining in a gripping task. We investigated whether similar reorganization occurs in the somatic sensory thalamus of patients with dystonia (dystonia patients). We studied recordings of neuronal activity and microstimulation-evoked responses from the cutaneous core of the human principal somatic sensory nucleus (ventral caudal, Vc) of 11 dystonia patients who underwent stereotactic thalamotomy. Fifteen patients with essential tremor who underwent similar procedures were used as controls. The cutaneous core of Vc was defined as the part of the cellular thalamic region where the majority of cells had receptive fields (RFs) to innocuous cutaneous stimuli. The proportion of RFs including multiple parts of the body was greater in dystonia patients (29%) than in patients with essential tremor (11%). Similarly, the percentage of projected fields (PFs) including multiple body parts was higher in dystonia patients (71%) than in patients with essential tremor (41%). A match at a thalamic site was said to occur if the RF and PF at that site included a body part in common. Such matches were significantly less prevalent in dystonia patients (33%) than in patients with essential tremor (58%). The average length of the trajectory where the PF included a consistent, cutaneous RF was significantly longer in patients with dystonia than in control patients with essential tremor. The findings of sensory reorganization in Vc thalamus are congruent with those reported in the somatic sensory cortex of monkeys with dystonia-like movements resulting from overtraining in a gripping task.

Age of Onset↗

PubMed1998

Symptoms of patients with myasthenia gravis receiving treatment.

The symptoms of myasthenia gravis (MG) are often simply classified as excessive fatigue rather than evaluated as different signs of disease progression. The purpose of this study was to evaluate the medical symptoms of patients with MG who had been under treatment for many years. Patients diagnosed with MG were compared to healthy controls. A survey questionnaire was used and differences were evaluated using non-parametric statistics. Health care givers should be aware of these differences in order to facilitate early appropriate treatment, to decrease disability, and to increase the quality of life.

Humans↗

PubMed1997

Sensory perception in Parkinson disease.

OBJECTIVE: To determine whether there is a complex sensory disturbance that may be contributing to the motor deficit in patients with Parkinson disease. DESIGN: Comparison of performance by patients and healthy, age- and sex-matched subjects in tests of various sensory functions. SETTING: The Center for Human Performance and Testing at a university hospital and research center. PARTICIPANTS: Ten subjects with Parkinson disease and 10 control subjects matched for age and sex. MAIN OUTCOME MEASURE: Performance on 4 subjects of the Sensory Integration and Praxis Test: finger identification, graphesthesia, localization of tactile stimuli, and kinesthesia. RESULTS: Data were analyzed using paired t tests for ratio data and the paired Wilcoxon test for ordinal data. Patients with Parkinson disease performed significantly worse (P = .001) than the control patients on the test of kinesthesia. There were no significant differences between the 2 groups on the other subtests. CONCLUSIONS: Without visual guidance, patients with Parkinson disease had more difficulty in perceiving the extent of a movement made to a target away from the body, a task requiring reliance on proprioceptive feedback. Parkinsonian patients had no more difficulty than controls in making movements to a target on the surface of the body when they could use tactile sensations. Movement difficulties in patients with Parkinson disease may relate in part to a decrease in proprioception. Activities that enhance kinesthetic awareness may be an important adjunct to the treatment of these patients.

Humans↗

PubMed1997

A primate model for studying focal dystonia and repetitive strain injury: effects on the primary somatosensory cortex.

BACKGROUND AND PURPOSE: Job-related repetitive strain injuries (RSIs) are increasing, and current treatment strategies often fail to return injured people to work. This study documented the neural consequences of using two different movement strategies for active, repetitive hand closing and opening. METHODS: Two owl monkeys were trained for 20 weeks to repetitively close a handpiece against an 80-g force (3-400 trials per day, training at 80%-90% accuracy). One monkey used a highly articulated hand-squeezing strategy, and the other monkey used a proximal arm-pulling strategy. Changes in motor performance were analyzed, and the electrophysiological maps of the hand representation on the trained primary sensory cortex (area 3b) were compared with those of untrained control animals and the untrained sides of the trained monkeys. RESULTS: The monkey using the articulated hand-squeezing strategy showed motor deterioration and dedifferentiation of the normally sharply segregated areas of the hand representation in area 3b. Mild degradation of the hand representation was measured in the monkey using the proximal arm-pulling strategy, but there was no motor dysfunction. CONCLUSION AND DISCUSSION: Attended, highly articulated, repetitive finger squeezing degrades the hand representation and interferes with motor control. A proximal, more variable repetitive strategy minimized the sensory degradation and preserved motor control. Restoring the hand representation may be a critical part of treatment for patients with chronic RSI and focal hand dystonia.

Animals↗

PubMed1997

Postural imbalance and vibratory sensitivity in patients with idiopathic scoliosis: implications for treatment.

Sporadic research reports of decreased proprioception and balance problems have been reported in subjects with idiopathic scoliosis, yet these sensory motor deficits have not been addressed in conservative clinical management programs. The purpose of this study was to compare both balance reactions and vibratory sensitivity (as an estimate of proprioception) in patients with idiopathic scoliosis (N = 24) and age-matched controls (N = 24). Balance was measured by the ability to pass a series of simple static and complex sensory-challenged balance tasks. Vibratory thresholds were measured with the Bio-Thesiometer at the cervical spine, wrist, and foot. Compared with age-matched controls, regardless of curve severity or spinal fusion, the subjects with idiopathic scoliosis had similar simple static balance responses when the somatosensory system was stable (with or without vision or head turning), but they were significantly more likely to fail the complex, sensory-challenged balance tasks when the somatosensory system was challenged by an unstable position of the feet, particularly when the eyes were closed. The vibratory thresholds were similar in subjects with scoliosis and their age-matched controls, but individuals with moderate to severe scoliosis (> 25 degrees) had significantly higher vibratory thresholds than those with mild curves. These findings suggest there may be problems with postural righting in patients with idiopathic scoliosis, particularly when the balance task challenges the vestibular pathways. Although vibration sensitivity did not distinguish normal healthy individuals from individuals with idiopathic scoliosis, those with more severe scoliotic curves appear to have a high threshold to vibration. These balance and vibratory differences could either be interpreted as etiologic risk factors or as consequences of spinal asymmetry. In either case, given that curves can continue to progress even into the adult years, improving the ability to right the body with gravity could help maintain the balance of the spine despite structural asymmetry.

Adolescent↗

PubMed1996

A primate genesis model of focal dystonia and repetitive strain injury: I. Learning-induced dedifferentiation of the representation of the hand in the primary somatosensory cortex in adult monkeys.

In this study we tested a neuroplasticity/learning origins hypothesis for repetitive strain injuries (RSIs), including occupationally induced focal dystonia. Repetitive movements produced in a specific form and in an appropriate behavioral context cause a degradation of the sensory feedback information controlling fine motor movements, resulting in the "learned" genesis of RSIs. Two adult New World owl monkeys were trained at a behavioral task that required them to maintain an attended grasp on a hand grip that repetitively and rapidly (20 msec) opened and closed over short distances. The monkeys completed 300 behavioral trials per day (1,100 to 3,000 movement events) with an accuracy of 80 to 90%. A movement control disorder was recorded in both monkeys. Training was continued until the performance accuracy dropped to below 50%. We subsequently conducted an electrophysiologic mapping study of the representations of the hand within the primary somatosensory (SI) cortical zone. The hand representation in the true primary somatosensory cortical field, SI area 3b, was found to be markedly degraded in these monkeys, as characterized by (1) a dedifferentiation of cortical representations of the skin of the hand manifested by receptive fields that were 10 to 20 times larger than normal, (2) the emergence of many receptive fields that covered the entire glabrous surface of individual digits or that extended across the surfaces of two or more digits, (3) a breakdown of the normally sharply segregated area 3b representations of volar glabrous and dorsal hairy skin of the hand, and (4) a breakdown of the local shifted-overlap receptive field topography of area 3b, with many digital receptive fields overlapping the fields of neurons sampled in cortical penetrations up to more than four times farther apart than normal. Thus, rapid, repetitive, highly stereotypic movements applied in a learning context can actively degrade cortical representations of sensory information guiding fine motor hand movements. This cortical plasticity/learning-based dedifferentiation of sensory feedback information from the hand contributes to the genesis of occupationally derived repetitive strain injuries, including focal dystonia of the hand. Successful treatment of patients with RSI will plausibly require learning-based restoration of differentiated representations of sensory feedback information from the hand.

Animals↗

PubMed1995

A two-year program of aerobics and weight training enhances bone mineral density of young women.

Previous research suggests that physical activity may have a beneficial effect on bone mineral density (BMD) in women. This relationship was explored in a 2-year, randomized, intervention trial investigating the efficacy of exercise and calcium supplementation on increasing peak bone mass in young women. One hundred and twenty-seven subjects (ages of 20-35 years) were randomly assigned either to an exercise program that contained both aerobics and weight training components or to a stretching program. Calcium supplementation (up to 1500 mg/day including dietary intake) or placebo was given in a double-blinded design to all subjects. Spinal trabecular BMD was determined using quantitative computed tomography (QCT). Spinal integral, femoral neck, and trochanteric BMD were measured by dual X-ray absorptiometry (DXA) and calcaneal BMD by single photon absorptiometry (SPA). Fitness variables included maximal aerobic capacity (VO2max), and isokinetic muscle performance of the trunk and thigh. Measurements were made at baseline, 1 year, and 2 years. Sixty-three subjects (32 exercise, 31 stretching) completed the study, and all the measured bone parameters indicated a positive influence of the exercise intervention. There were significant positive differences in BMD between the exercise and stretching groups for spinal trabecular (2.5%), femoral neck (2.4%), femoral trochanteric (2.3%), and calcaneal (6.4%) measurements. The exercise group demonstrated a significant gain in BMD for spinal integral (1.3 +/- 2.8%, p < 0.02), femoral trochanteric (2.6 +/- 6.1%, p < 0.05), and calcaneal (5.6 +/- 5.1, p < 0.01) measurements. In contrast to exercise, the calcium intervention had no positive effect on any of the bone parameters. In regard to fitness parameters, the exercise group completed the study with significant gains in VO2max and isokinetic (peak torque) values for the knee flexion and extension and trunk extension. This study indicates that over a 2-year period, a combined regimen of aerobics and weight training has beneficial effects on BMD and fitness parameters in young women. However, the addition of daily calcium supplementation does not add significant benefit to the intervention.

Absorptiometry, Photon↗

PubMed1995

The use of ultrasound as an enhancer for transcutaneous drug delivery: phonophoresis.

Phonophoresis is the use of ultrasound (US) to enhance the delivery of topically applied drugs. The purposes of this article are (1) to review the basic principles of transcutaneous drug delivery, (2) to summarize the functional anatomy of the skin pertinent to phonophoresis, (3) to outline the physiological principles of US as an enhancer of topically applied drugs, (4) to review the literature on the efficacy of phonophoresis, (5) to discuss the relevance of US as an enhancer of topical drugs in the practice of physical therapy, and (6) to outline areas of needed research. Seventy-five percent of the studies reviewed reported positive effects of US on local subcutaneous drug diffusion, but some systemic effects were reported. This research review indicates that to maximize the clinical effectiveness of phonophoresis: (1) the topical drug (both the drug and the carrying agent) should transmit US; (2) the skin should be pretreated with US, heating, moistening, or shaving; (3) the patient needs to be positioned to maximize circulation during treatment; (4) a dressing that seals the area and prevents the escape of moisture should be applied after treatment; (5) an intensity of 1.5 W/cm2 should be used to capture both the thermal and nonthermal effects of the US; and (6) low-intensity US (0.5 W/cm2) should be used when treating open wounds or acute injuries. Research is needed to clarify what parameters of US will most efficiently facilitate topical drug diffusion, how often and for what duration US should be used to maximize local absorption of drugs, and which topical drugs can most effectively be used for phonophoresis.

Adrenal Cortex Hormones↗

PubMed1994

Pulsed microamperage stimulation: a controlled study of healing of surgically induced wounds in Yucatan pigs.

BACKGROUND AND PURPOSE: Microamperage direct current and microamperage electromagnetic stimulation are used to accelerate healing in bone. Although many clinicians are using microamperage stimulation to relieve pain and facilitate wound healing, there is significant question regarding whether this low-intensity direct current significantly accelerates soft tissue wound repair. The purpose of this study was to determine whether low-voltage pulsed microamperage current (100 microA, 60 V, 0.1 Hz) enhances the healing of superficial, full-thickness, or incisional wounds created to simulate acute abrasions, ulcers, and lacerations. SUBJECTS: Ten adult Yucatan mini pigs served as the subjects for this study. METHODS: Variables associated with healing were measured in 60 matched pairs of surgically induced partial-thickness, full-thickness, and incisional wounds after either sham or anodal (positive-polarity) stimulation with pulsed microamperage current (100 microA) was administered for 1 hour per day for 5 days. Sterile, disposable electrodes (2 x 4 cm) were placed over each wound, which was kept wrapped and protected throughout the study. RESULTS: At 7 days postinjury, all wounds were healing well with no signs of infection. There were no differences in tensile strength, collagen density, maturity, or deposition (hydroxyproline), wound size, or visual appearance between the sham treatment and treatment lesions. No changes in local subcutaneous oxygen or temperature were found in the swine during or after microamperage stimulation. CONCLUSION AND DISCUSSION: This study did not provide any evidence to support the use of microamperage stimulation to accelerate wound healing. No negative effects, however, were found. Further research is needed to determine whether there is a critical interaction between the size of the electrode relative to the wound, the density of the current, the duration of the treatment, the polarity of the treatment electrode, and the acuity or chronicity of wounding and the effectiveness of microcurrent stimulation for wound healing.

Animals↗

PubMed1993

Complex balance reactions in different sensory conditions: adolescents with and without idiopathic scoliosis.

We measured simple and complex balance responses with a force plate stabiliometer in 70 adolescents: 50 with idiopathic scoliosis (IS) and 20 controls. In stable static balance positions, the two groups performed similarly, but when the visual and somatosensory systems were challenged simultaneously, the IS group had a significantly higher mean body sway than the controls. Within the IS group, children with mild, nonprogressive curves that had not been operated on were significantly more likely to maintain their balance when the visual and somatosensory systems were challenged simultaneously than those with curves > or = 40 degrees, who had had surgery, and who had more rapid progression of the curve. These findings suggest that adolescents with IS have normal balance in static, stable positions but are not able to perform as well as normal adolescents in sensory-challenged positions, particularly if they have a severe, progressive curve. Longitudinal studies are needed to determine whether balance dysfunction can be used to predict progression of the curve.

Adolescent↗

PubMed1993

The effects of phonophoresis with corticosteroids: a controlled pilot study.

Although physical therapists and physicians often treat patients with local musculoskeletal inflammation using topically applied steroids enhanced with ultrasound, there is a paucity of research confirming that phonophoresis significantly enhances drug diffusion. The purpose of this study was to determine if ultrasound enhances the diffusion of transdermally applied corticosteroids. Diffusion was measured secondarily in terms of collagen deposition [estimated by levels of hydroxyproline in polytetrafluroethylene (ePTFE) tubing] and cellular activity (measured by levels of DNA). Sixteen pieces of ePTFE tubing were subcutaneously implanted on the dorsum of five mini Yucatan pigs. Pairs of tubing were randomly assigned to sham control or treatment groups. Over the paired ePTFE tubes in the treatment groups, a single transdermal application of hydrocortisone acetate (HC) or dexamethasone (DX) was applied to the skin by rubbing, sonating with the drug mixed in the acoustic gel (1.5 W/cm2, 1 MHz, 5 minutes), or injecting the drug into the tubing. Four additional ePTFE tubes were threaded in the extremities, two submuscularly and two subtendinously, with random assignment to a sham control or a DX sonation treatment group. At the end of a week, the mean hydroxyproline levels in the swine were lower than expected (mean = 9.3 micrograms/cm compared to an expected mean = 22.2 micrograms/cm). Comparing the control and skin-applied groups with the injected and sonated treatment groups, the hydroxyproline was found to be 50% lower in the DX-injected, DX-sonated, and HC-injected sites. However, statistically there were no significant differences in DNA or hydroxyproline levels between the HC subcutaneous control and treatment groups or the DX submuscular and subtendinous groups. There was a significant main effect of group on hydroxyproline levels in the group of DX-treated, subcutaneously implanted ePTFE tubes (p = 0.001). Post hoc testing revealed a significant difference between the skin-rubbed and control groups together compared to the DX-injected and DX-sonated groups together (p = 0.001). These findings indicate that the effects of phonophoresed DX can be measured in terms of reduced collagen deposition as far down as the subcutaneous tissue but not in the submuscular or subtendinous tissue. However, a single application may not have a measurable effect on cellular activity after 7 days of healing. The unusually low level of hydroxyproline across all groups suggests that phonophoresis with steroids may have had a systemic as well as a local effect.

Administration, Cutaneous↗

PubMed1993

Incisional wound healing: a controlled study of low and high dose ultrasound.

Ultrasound is commonly used by physical therapists, but there is no consensus regarding the most effective therapeutic dose for accelerating healing of open or closed wounds. A controlled, single-blind, posttest experimental study was carried out to compare differences in wound breaking strength and collagen deposition [hydroxyproline (HoPro)]. Forty-eight incisions were surgically induced in three mini Yucatan pigs. Each incision was randomly assigned to a control or an ultrasound treatment group with the sonated incisions further randomly assigned to 5 or 10 days of ultrasound treatment with either high dose ultrasound (HUS) (1.5 W/cm2, continuous mode, 1 MHz, 5 minutes) or low dose ultrasound (LUS) (0.5 W/cm2, pulsed mode, 20% duty cycle, 1 MHz, 5 minutes). Using the nonparametric two-sample Wilcoxon test, the breaking strength was found to be significantly higher in the sonated incisions compared with the control incisions (p < or = 0.02), but there were no significant differences in HoPro. For all groups, the level of HoPro measured the second week was significantly higher (an average of 60%) than measured the first week (p < or = 0.001). A significant interaction was found between the number of days of treatment and the dose of ultrasound. Hydroxyproline was significantly higher in the LUS group compared with the HUS group after 5 days of ultrasound. Both the wound breaking strength and the HoPro levels were significantly higher in the LUS group compared with the HUS group after 10 days of treatment (p < or = 0.02 and 0.01, respectively). The findings from this study suggest that physical therapists can use either LUS or HUS for approximately 1 week to enhance wound breaking strength in an acute incisional wound. However, if the goal is to continue to facilitate collagen deposition and wound strength, then a low dose of ultrasound should be used when treatment is continued for 2 weeks or more.

Animals↗

PubMed1992

Low-dose ultrasound effects on wound healing: a controlled study with Yucatan pigs.

This study reports on the effect of low-dose ultrasound in accelerating wound healing in matched pairs of surgically induced incisions and full-thickness and partial-thickness lesions in 11 Yucatan mini-pigs after 7 days of healing and 5 days of sonation. Tensile strength, collagen deposition (hydroxyproline), reduction in wound size (full-thickness lesion), and mast-cell degranulation were significantly greater in the sonated lesions than in the sham-treated controls (p = 0.01). Sonation enhanced strength by 24% and collagen deposition by 29%, when compared with controls. There were no significant differences in the quality of healing as measured by an ordinal scale. The results suggest that within the first week of healing, low-dose ultrasound facilitates wound healing. More research is needed to confirm the most effective dose, frequency, and treatment duration and intervention time for maximum healing.

Animals↗

PubMed1989

Interaction of spatial perception, vestibular function, and exercise in young school age boys with learning disabilities.

Form rotation, figure directionality, and figure-ground discrimination were evaluated before and after 10 days of vestibular or aerobic exercises for 30 boys (7 to 12 yr.) who showed problems in learning, reading, and inattention. Eight subjects had normal vestibulo-ocular reflex (VOR) responses as determined by caloric and rotational testing. They were assigned to a vestibular program (Control Group I). The 22 subjects with abnormal VOR test responses were randomly assigned to either aerobic exercises (Experimental Group II) or a vestibular program (Experimental Group III). Spatial perceptual test scores varied widely, with the majority performing below age-expected norms but no significant differences on vestibular status appeared. Postexercise, only subjects completing the vestibular program made significant gains: Experimental Group III (abnormal VOR) made significant gains in accuracy and normal test responses compared to the other groups, and Control Group I made significantly greater gains in speed of spatial perceptual processing. For boys with problems in learning, reading, inattention, and vestibular function, a vestibular exercise program complementing a traditional or special educational program may enhance the spatial perceptual skills needed for reading.

Attention↗

PubMed1979

Teaching the concepts of rehabilitation in a primary care setting.

To teach the concepts of rehabilitation to undergraduates in a clinical, primary-care setting, it is essential to first mobilize student awareness regarding patient dysfunction. After some sensitivity has developed, faculty can focus on rehabilitation theories and processes. This method of teaching is generally accepted positively by students. A daily chart review has proved useful for identifying rehabilitation issues for students and is suggested for other health care agencies as a practical way to promote rehabilitation among primary-care providers.

Adult↗