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PubMed2006

The examination assessment of technical competence in vascular surgery.

BACKGROUND: The European Board of Surgery Qualification in Vascular Surgery is a pan-European examination for vascular surgeons who have attained a national certificate of completion of specialist training. A 2-year study was conducted before the introduction of a technical skills assessment in the examination. METHODS: The study included 30 surgeons: 22 candidates and eight examiners. They were tested on dissection (on a synthetic saphenofemoral junction model), anastomosis (on to anterior tibial artery of a synthetic leg model) and dexterity (a knot-tying simulator with electromagnetic motion analysis). Validated rating scales were used by two independent examiners. Composite knot-tying scores were calculated for the computerized station. The stations were weighted 35, 45 and 20 percent, respectively. RESULTS: Examiners performed better than candidates in the dissection (P<0.001), anastomosis (P=0.002) and dexterity (P=0.005) stations. Participants performed consistently in the examination (dissection versus anastomosis: r=0.79, P<0.001; dexterity versus total operative score: r=-0.73, P<0.001). Interobserver reliability was high (alpha=0.91). No correlation was seen between a candidate's technical skill and oral examination performance or logbook-accredited scores. CONCLUSION: Current surgical examinations do not address technical competence. This model appears to be a valid assessment of technical skills in an examination setting. The standards are set at a level appropriate for a specialist vascular surgeon.

Clinical Competence↗

PubMed1995

Correlation of axon projections and peptide immunoreactivity in mesocerebral neurons of the snail Helix aspersa.

The purpose of this investigation was to elucidate the organization of efferent neurons in the mesocerebrum of a terrestrial snail. The mesocerebrum is one of three regions, or lobes, that can be identified by gross inspection. Previous studies have indicated a possible function for the mesocerebrum in the control of mating behavior. We used both anterograde and retrograde tracing methods to determine the axon projections of mesocerebral neurons. Virtually all the neurons (96%) send an axon into the cerebropedal connective nerve, and about 25% of these fibers continue into the nervus cutaneous pedalis primus dexter, which innervates the dart sac. Many neurons have additional axon branches in other nerves, especially the penial nerve, which receives projections from about 25% of mesocerebral cells. Neurons that are backfilled from the nervus cutaneus pedalis primus dexter are predominantly immunoreactive for FMRF amide, whereas neurons that are backfilled from the penial nerve are predominately immunoreactive for APGWamide. These results suggest a functional association between FMRFamide and dart shooting on the one hand, and between APGWamide and penial eversion on the other. Some cells contain both APGWamide and FMRFamide; these cells may have dual projections in both the penial nerve and the nervus cutaneous pedalis primus dexter.

Animals↗

PubMed2003

Evaluation of an exercise-based treatment for children with reading difficulties.

An evaluation is reported of an exercise-based approach to remediation of dyslexia-related disorders. Pupils in three years of a Warwickshire junior school were screened for risk of literacy difficulty using the Dyslexia Screening Test (DST). The 35 children scoring 0.4 or over on the DST were divided randomly into two groups matched for age and DST score. One quarter of the participants had an existing diagnosis of dyslexia, dyspraxia or ADHD. Both groups received the same treatment at school but the intervention group used the DDAT exercise programme daily at home. Performance on the DST and specialist cerebellar/vestibular and eye movement tests were assessed initially and after six months. Cerebellar/vestibular signs were substantially alleviated following the exercise treatment whereas there were no significant changes for the control group. Even after allowing for the passage of time, there were significant improvements for the intervention group in postural stability, dexterity, phonological skill, and (one-tailed) for naming fluency and semantic fluency. Reading fluency showed a highly significant improvement for the intervention group, and nonsense passage reading was also improved significantly. Significantly greater improvements for the intervention group than the control group occurred for dexterity, reading, verbal fluency and semantic fluency. Substantial and significant improvements (compared with those in the previous year) also occurred for the exercise group on national standardized tests of reading, writing and comprehension. It is concluded that, in addition to its direct effects on balance, dexterity and eye movement control, the benefits of the DDAT exercise treatment transferred significantly to cognitive skills underlying literacy, to the reading process, and to standardized national literacy attainment tests.

Apraxias↗

PubMed2000

Human bone marrow stromal cell: coexpression of markers specific for multiple mesenchymal cell lineages.

The role of hematopoietic stem cells in blood cell development is reasonably understood, whereas the identity and the function of bone marrow stromal cells are much less clear. Using stromal cells in bone marrow cultures of the Dexter type, a favorite medium for the study of hematopoiesis, we show that stromal cells actually represent a unique cell type. Conventional wisdom has held that stromal cells in Dexter cultures comprise a mixture of macrophages, hematopoietic cells, adipocytes, osteoblasts, fibroblasts, muscle cells, and endothelial cells. Our findings demonstrate that Dexter cultures consist of three cell types: macrophages ( approximately 35%), hematopoietic cells ( approximately 5%), and nonhematopoietic cells ( approximately 60%). We have purified the nonhematopoietic cells free of macrophages and hematopoietic cells to produce compelling evidence that they in fact represent a single cell type (multidifferentiated mesenchymal progenitor cell, MPC) which coexpresses genes specific for various mesenchymal cell lineages including adipocytes, osteoblasts, fibroblasts, and muscle cells. We further show that these multi- or pluridifferentiated MPCs are capable of supporting hematopoiesis by demonstrating the expression of several hematopoietic growth factors and extracellular matrix receptors including G-CSF, SCF, VCAM-1, ICAM-1, and ALCAM. Since the MPCs can be easily purified to near homogeneity (95%), they can be of value in enhancing engraftment of hematopoietic stem cells. Also, this new understanding of bone marrow stromal cells as "one cell with many different faces" promises to advance our knowledge of regulatory cellular interactions within bone marrow.

Bone Marrow Cells↗

PubMed1997

Deep brain stimulation and thalamotomy for tremor compared.

Deep brain stimulation (DBS) and thalamotomy are both capable of abolishing tremor. However, no technique is perfect and if thalamotomy proves inadequate so that tremor recurs, presumably because of suboptimal lesion location, the only option is to repeat the thalamotomy. With DBS all that has been necessary to date is to change the parameters of stimulation. Similarly with complications such as the "cerebellar" ones and paraesthesiae. If these occur after thalamotomy one can only wait and hope that they will subside and they do not always do so. With DBS, changing the parameters in the authors' patients has so far been successful in eliminating them. DBS, like thalamotomy is very effective for controlling tremor in Parkinson's disease (PD) and essential tremor (ET) and for improving dexterity in ET, but both techniques are less useful for the control of dopa dyskinesia, Parkinsonian rigidity, or impaired dexterity in PD, though DBS may be better than thalamotomy for the latter condition. On the other hand, both DBS and thalamotomy are very effective in improving dexterity in PD and ET may depend upon the fact that in PD bradykinesia is a major component, whereas in ET only the tremor is. The advantages of DBS over thalamotomy have to be weighed against the peculiar risks of DBS and of course, its cost.

Adult↗

PubMed2004

Predicting baseline laparoscopic surgery skills.

BACKGROUND: Laparoscopic surgery requires specialized dexterity even beyond that required for open surgery. Decreased tactile feedback, different eye-hand coordination, and translation of a two-dimensional video image into a three-dimensional working area are just some of the obstacles in the performance of laparoscopic surgery. Possession of certain nonsurgical skills may help in overcoming some of these obstacles. Prediction of baseline laparoscopic surgery skills may help further to refine the education of basic laparoscopic surgery skills. This investigation explores whether nonsurgical skills and demographic data can predict baseline laparoscopic surgery tasks. METHODS: First- and second-year students were given a survey regarding nonsurgical dexterity skills. The survey inquired about typing skills, play with computer games, ability to sew, skill with music instruments, use of chopsticks, and experience operating tools. Demographic data were requested as well. All the students underwent four tasks: placing a piece of bowel in a retrieval bag, placing a stapler on the bowel, measuring a piece of bowel, and performing a liver biopsy in a porcine animal model. Both objective (time and error) and subjective evaluation were assessed for all the tasks. Statistical analysis using analysis of variances (ANOVA) Kruskal-Wallis test with post hoc tests, two-tailed unpaired t-tests/Mann-Whitney test, and Fischer's exact tests/chi-square tests was performed when appropriate. RESULTS: There were 68 students in this investigation. Gender, medical student year, ethnicity, desire to enter a surgical field, and age were not associated with increased performance in any of the tasks. Chopstick use was associated with statistically significantly better mean time in placing a piece of bowel in a retrieval bag and measuring a piece of bowel (p < 0.04). The other nonsurgical dexterity skills did not statistically increase performance, as indicated by time, errors, or subjective scores, for the four tasks. CONCLUSIONS: It is difficult to predict baseline laparoscopic surgery skills.

Adult↗

PubMed1987

Detecting changes in functional ability in women with premenstrual syndrome.

There has been a lack of objective assessment of the disruptive effect that the symptomatology of premenstrual syndrome has on the functional performance of affected women. This study assessed the functional performance of women with premenstrual syndrome at four phases of the menstrual cycle. Twelve women with premenstrual syndrome and nine asymptomatic women were tested on four functional instruments at the menstrual, early follicular, early luteal, and late luteal phases. Two tests of a paper-and-pencil type measured perceptual parameters, and two tests involving manipulation of objects measured manual dexterity. Mean performance on the Crawford Small Parts Dexterity Test--Part II, which tests fine motor function, was better at the late luteal testing, compared to the early follicular testing, in asymptomatic women but was worse in the women with premenstrual syndrome. This difference was statistically significant (p = 0.015). No significant differences between groups in performance changes were observed for the other functional tests. The Crawford Small Parts Dexterity Test-Part II is an objective measure that is potentially valuable in therapeutic trials involving patients with premenstrual syndrome.

Adult↗

PubMed1995

Physiological criteria for functioning of hands in the cold: a review.

Hands are important instruments in daily life. Without hands man is hardly able to function independently. Proper functioning of the hands is determined by several physiological parameters. These physiological parameters in turn are influenced by environmental factors. In this view of the literature, physiological processes in manual dexterity are described and the influence of a cold environment on separate physiological processes is studied. In general, cold means loss of dexterity. For reasons of safety and performance, it is important to restrict the loss of manual dexterity. For this purpose, in this study minimum criteria are given for all separate physiological components. Most important minimum criteria are: a local skin temperature of 15 degrees C, a nerve temperature of 20 degrees C and a muscle temperature of 28 degrees C. Only during maximum dynamic work is a muscle temperature of 38 degrees C recommended. These temperatures are average values, and of course individual differences are evident.

Journal Article↗

PubMed1985

Effect of different husbandry systems on the reproductive development of post-weaning ram lambs under tropical conditions.

Two groups of three-to four-month-old weaning ram lambs were studied for 20 months, beginning with weaning at between three and four months. Group 1 was comprised of nine ram lambs which were reared under an intensive husbandry system, and given standard nutrition and mineral supplements throughout the study. Group 2 was comprised of nine rams which were reared under the traditional nomadic/extensive management system, in which the only source of feed was the available pasture. The reproductive traits studied include: age, weight and scrotal circumference at puberty and at all corresponding ages up to 23 months, libido and sexual dexterity and semen characteristics at puberty and all corresponding ages. In the intensively managed rams, the average age at puberty was 6.4+/-0.5 mos. The averages of the other parameters at puberty were: body weight (BW), 21.7+/-2.5kg; scrotal circumference (SC), 18.5+/-1.3cm; libido score, 1.7+/-0.7 and sexual dexterity, 1.7:0.8. In the extensively managed rams, the average age at puberty was 7.8+/-0.3 mos. The average values of the various parameters at puberty were: BW, 17.3+/-1.2kg; SC, 15.2+/-1.4cm; libido score, 3.2+/-0.6 and sexual dexterity, 3.2:1.8. The inter- and intra-group variations in all the parameters at puberty and at all corresponding ages were significant. The average morphological sperm cell abnormalities at puberty were: 25.2+/-3.4% and 31.6+/-8.3% for rams reached puberty and at all corresponding ages than the extensively reared flock. Certain factors that influence post-weaning reproductive development and performance are discussed.

Journal Article↗

PubMed1995

Upper extremity performance test for the elderly (TEMPA): normative data and correlates with sensorimotor parameters. Test d'Evaluation des Membres Supérieurs de Personnes Agées.

OBJECTIVES: Objectives of this study were to develop normative data for the Test d'Evaluation des Membres Supérieurs de Personnes Agées (TEMPA) and determine its relation to upper extremity sensorimotor parameters such as fine and gross dexterity, coordination, strength, endurance, range of motion, and several types of sensibility. DESIGN: Cross-sectional study. SETTING: Community-dwelling subjects. PARTICIPANTS: Three hundred sixty healthy subjects randomly recruited by age and sex strata (60 to 69, 70 to 79, and 80 or older). MAIN OUTCOME MEASURES: Length of execution of the tasks in the TEMPA. RESULTS: Normative data are reported by gender and age group. The time taken to execute the tasks increased significantly with age. The women were faster on the tasks requiring a higher degree of fine dexterity, whereas the task requiring a lesser degree of fine dexterity and sensibility and more grip strength was accomplished faster by the men. Subjects who were more active and described themselves as being in excellent or good health performed better. CONCLUSION: The norms will help clinicians differentiate better between normal and pathological aging in upper extremity performance.

Aged↗

PubMed1995

Improved quality of life and sexuality with continent urinary diversion in quadriplegic women with umbilical stoma.

Quality of life issues prompted us to offer continent urinary diversion to quadriplegic women who required cystectomy for end-stage neurogenic vesical dysfunction complicated by urethral destruction as a result of chronic indwelling catheterization. Three women with spinal cord injury (SCI) and resultant quadriplegia of 5 to 15 years duration underwent continent urinary diversion. Preoperative evaluation and urodynamic studies in each showed a bladder capacity of less than 150mL, bilateral vesicoureteral reflux, recurrent febrile urinary tract infections, an incompetent urethral sphincter, and incontinence around an indwelling catheter in all three patients. Although highly motivated, these women showed minimal dexterity and were unable to perform urethral self-catheterization. Each was opposed to having an incontinent abdominal urinary stoma. The urinary reservoir was created from 30cm of detubularized right colon. The continence mechanism used an intussuscepted and imbricated ileocecal valve. The umbilicus was chosen as the urostomy site because of cosmetic appearance and ease of catheterization for a patient with minimal dexterity. Follow-up ranged from 18 to 30 months. Reservoir capacity ranged from 550 to 800mL without evidence of reflux or stomal leakage. The incidence of symptomatic autonomic dysreflexia and urinary tract infection decreased postoperatively in all patients. Of the two women who were sexually active, the frequency of activity increased from 8 to 15 episodes per month in one and 3 to 4 episodes per month in the other. Both reported improved sexual enjoyment. Body image and satisfaction with urologic management increased in all three patients. In conclusion, continent urinary diversion in selected quadriplegic patients is a reasonable alterative to incontinent intestinal urinary diversion. The umbilical stoma provides an excellent cosmetic result which patients with minimal dexterity are able to catheterize easily. Continent urinary diversion in women results in improved self-image, quality of life, and enables greater sexual satisfaction.

Adult↗

PubMed1997

Transcranial magnetic stimulation reveals a hemispheric asymmetry correlate of intermanual differences in motor performance.

Hemispheric asymmetries in the threshold for eliciting motor evoked potentials (MEPs) with transcranial magnetic stimulation (TMS) are associated with hand preference. We posited that hemispheric asymmetries in TMS thresholds may be strongly correlated with some hand-differences in motor performance. MEPs result from the activation of neuronal networks targeting large cortical motoneurons. Thus, MEP thresholds might reflect physiological features of the corticospinal motor system. Considering the role of corticospinal pathways in the control of independent finger movement, we hypothesized that MEP thresholds would better predict speed and dexterity than strength. In 30 right-handers and 30 left-handers, we correlated right and left hand-differences in the threshold for eliciting MEPs with hand-differences in the performance of three manual tasks: finger-tapping speed, pegboard dexterity, and grip strength. Correlations of hand-differences in TMS thresholds with hand-differences in performance indicated that a lower TMS threshold for one hand is strongly associated with greater ability with that hand. The correlations of hand-differences in TMS thresholds with hand-differences in finger-tapping and pegboard dexterity were significantly larger than the correlation of hand-differences in TMS thresholds with hand-differences in grip strength. Our results indicate that hemispheric asymmetries in MEP thresholds may have functional significance related to basic parameters of movement. These results are consistent with the critical role of the corticospinal motor system in the control of independent finger movement. Furthermore, they imply that asymmetry in the corticospinal motor system may be an important substrate for asymmetries in hand preference and performance.

Adult↗

PubMed2002

Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve?

OBJECTIVES: To evaluate the learning curve between robot-assisted and manual laparoscopic suturing, as well as to assess other skills. Laparoscopic reconstructive procedures have been limited by instrumentation, small working spaces, and fixed angles at the trocar level to place sutures. Robot-assisted laparoscopic suture placement may provide one means of increasing dexterity and facilitating laparoscopic reconstructive procedures. METHODS: Eight physicians participated in this study. A series of five trials were performed to assess dexterity (task 1) and free-hand suturing (task 2). Each task was performed using robot-assisted and manual laparoscopy. The participants were categorized as novice and experienced laparoscopists. Task 1 involved passing sutures through the eye of seven needles positioned 1 cm apart in a P configuration. Task 2 involved tying one surgeon's knot, followed by two subsequent knots. RESULTS: The average time for trials 1 and 5 of task 1, robot-assisted laparoscopy, was 242.6 and 101.8 seconds, respectively (P <0.001). Both groups demonstrated a statistically significant difference (P <0.001) between the first and last trial. The average time for trials 1 and 5 of task 1, manual laparoscopy, was 205.3 and 169 seconds, respectively. The differences in the learning curves for robot-assisted and manual laparoscopy were statistically significant in favor of robotic assistance. Manual laparoscopic suturing did not demonstrate as much of a difference for the experienced surgeon. Overall, the difference in improvement between robot-assisted and manual laparoscopy was not statistically significant. CONCLUSIONS: Robot-assisted laparoscopic allows suturing and dexterity skills to be performed quicker than does manual laparoscopy.

Clinical Competence↗

PubMed2003

Is physical function a more appropriate measure than volume excess in the assessment of breast cancer-related lymphoedema (BCRL)?

The aim of this study was to objectively measure impairment of arm function in women with breast cancer-related lymphoedema (BCRL), and investigate possible associations between this, arm volume excess, and psychological morbidity as measured by the Medical Outcomes Study 36-item short form (SF-36) questionnaire. A total of 48 patients were recruited. Manual dexterity was significantly impaired in the affected arm, independent of dominant or non-dominant arm involvement, but was not associated with arm volume excess. Psychological morbidity was significantly impaired in the domains of 'physical function' and 'bodily pain' when compared with population controls. Degree of impairment in the 'physical function' domain correlated with the absolute level of objectively tested manual dexterity. Impairment of manual dexterity appears to have a greater impact than arm volume excess on the overall psychological morbidity associated with BCRL, suggesting that greater emphasis should be placed upon arm function in the assessment, treatment targeting, and monitoring of patients with this condition.

Adult↗

PubMed1994

Acquisition of Eye-hand Coordination Skills for Videoendoscopic Surgery

Evaluation of eye-hand coordination skills in relation to experiential human factors may lead to improved instruction for videoendoscopic surgical skills acquisition. Twenty-nine subjects (medical students or residents in surgical specialties) volunteered to perform three exercises of increasing complexity in an "inanimate" trainer system that simulated the eye-hand coordination tasks inherent in a laboratory videoendoscopic surgical environment. Fourteen subjects participated in a biweekly practice program of 4 weeks duration using an inanimate trainer. Fifteen subjects had no practice on the laparoscopic trainer during the 4 weeks. Both groups were tested after demonstration on three exercises at the beginning and end of a 4 week period and all performed the procedures in solitude. Both groups of subjects increased performance levels (time and accuracy) over the four weeks, but improvement was significantly greater for the practicing subjects. After eight sessions, convergence of performance levels was observed, but plateauing of performance levels was not evident, even with the simple paradigms evaluated. To investigate what factors contribute to learning, subjects were assessed with respect to their surgical experiences, personality, and self-evaluated motor skills. Subjects with prior endoscopic surgical experience, interest in mechanical activities (as measured by the Strong Interest Inventory), or regular engagement in video game play tended to be more skillful initially, but demonstrated less improvement in performance levels after practice than subjects who had lower levels of experience, interest, or video game play. Manual dexterity (as measured by the Purdue Pegboard Manual Dexterity Test) was positively related to the degree of observed improvement. We conclude that "inanimate" videoendoscopic paradigms offer relatively inexpensive and useful training exercises for acquiring basic eye-hand coordination skills. Relevance for animate laboratory skills requirements are probable but can only be inferred. Subjects with manual dexterity skills used in video games may perform better initially in the inanimate videoendoscopic situation but this advantage is shortlived.

Journal Article↗

PubMed2006

Fine motor skills and effects of methylphenidate in children with attention-deficit-hyperactivity disorder and developmental coordination disorder.

The aims of this study were to investigate fine motor skills of children with both attention-deficit-hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) and those of a control group, and to examine the effects of methylphenidate on these skills. A group of 12 children with ADHD-DCD (11 males, one female; mean age 9y 8mo [SD 1y 7mo]) and 12 age- and sex-matched controls (mean age 9y 7mo [SD 1y 2 mo]) participated. The manual dexterity subtests of the Movement Assessment Battery for Children, the concise assessment method for children's handwriting, and a computerized graphomotor task were used. Results demonstrated that children with ADHD-DCD performed more poorly on the manual dexterity subtests, had poorer quality of handwriting, and drew more rapidly, more fluently, but less accurately than controls on the graphomotor task. On methylphenidate, manual dexterity and quality of handwriting improved, and strokes on the graphomotor task became less fluent but more accurate. ADHD is characterized by persistent symptoms of inattention, impulsivity, and hyperactivity, affecting 3 to 5% of school-age children. Up to 50% of children with ADHD also have motor coordination problems that are severe enough to meet criteria for DCD. In DCD, children demonstrate functional motor performance deficits not explained by the child's (chronological) age or intellect, or by other neurological or psychiatric disorders.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Automated speciated mercury measurements in Michigan.

Automated speciated mercury measurements were made at a rural (Dexter, MI) and an urban (Detroit, MI) site in Michigan during selected times from 1999 to 2002 to assess the concentrations of elemental (Hg0), reactive gaseous (RGM), and particulate mercury (Hgp) in these environments. Here we present the first-ever reported values for RGM in Michigan. Median RGM concentrations were 2.21-2.93 pg m(-3) at Dexter and were 3-11 times higher in Detroit at 6.41-22.0 pg m(-3). Maximum RGM concentrations of 38.7 pg m(-3) and 270 pg m(-3) were observed in Dexter and Detroit, respectively. Measured RGM/Hg0 ratios were in the range of 0.04-11.60% indicating that at times RGM comprises greater than the currently held view of 5% of total gaseous mercury in the air. Well-pronounced diurnal patterns of RGM were observed at the rural site, whereas the urban site exhibited patterns that were influenced by nighttime emissions and regional transport. An analysis of RGM/Hgp ratios at the urban site when combined with trajectory analysis suggests that the site receives mercury inputs from both local and regional sources. Episodes of elevated ozone concentrations which were accompanied by increases in RGM concentrations were observed to occur in the late afternoon and overnight. These may be evidence of advection of ozone and RGM over long distances to the site.

Air Pollutants↗

PubMed2000

[Motor assymetry].

Although the study of handedness and its association with hemispheric specialisation represents the prevailing focus of motor dominance research, recent inquiry into footedness and other motoric asymmetries has stimulated several interesting propositions. The present review show the variability of assessing motoric asymmetries. Asymmetry in hand use takes two forms: differential hand preference and differential dexterity between the hands. Motoric asymmetries are strongest and most manifest for handedness (hand preference, performance and dexterity), descending through footedness and other less known asymmetries (tonguedness, chewing preference). Handedness is the most easily observed expression of cerebral lateralization. The alpha and omega of relating handedness to other neuropsychological variables or indices of lateral specialization lies in the classification of handedness. A vast range of testing techniques have been used to assess handedness. Writing hand and self-report are two of the most popular techniques. Other preference measures include observation of how people use tools and questionnaires. Performance tests assess speed and accuracy in tasks stressing manipulative dexterity. Although questionnaires are generally thought to be reliable and valid instruments, there is a disagreement as to the nature, the number and weighting of the items to be included. The least stable results will be obtained if a categorization into "right-handers" and "non-right-handers" is made on the basis of exclusive "right" answers. Slightly more stable is a classification that is based on "right-handers", "mixed preference handers" and "left-hander" based on extreme choices in either direction and intermediate choices. We present shortly a possible inventory assessing motoric asymmetries.

Foot↗