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PubMed2001

The effects of mesial temporal and cerebellar hypometabolism on learning and memory.

The effects of mesial temporal (MT) and cerebellar hypometabolism were studied using measures of verbal, visual and motor skill learning. Twelve patients with refractory temporal lobe epilepsy who showed asymmetrical mesial temporal lobe hypometabolism on [18F] fluoro-2-deoxy-glucose positron emission tomography (FDG-PET) were given tests involving 4 consecutive learning trials and a 30-min delayed recall trial. Delayed recognition was also assessed for the words and designs, and skill transfer was evaluated for mirror drawing. Compared to 9 normal control participants, patients with more marked MT hypometabolism on the left had impaired delayed recall of words and patients with more marked MT hypometabolism on the right showed impaired learning of novel designs, but normal retention over delay. Patients were not impaired in their mirror-drawing performance. The findings for MT hypometabolism correspond well to those obtained in other studies where patients have been classified on the basis of side of hippocampal atrophy or temporal lobe excision.

Adult↗

PubMed1990

Learning disability, inferential skills, and postfailure reflectivity.

Children with learning disabilities (LD) were compared with normally achieving children (NA) on two aspects of problem solving: inferential skills and response to errors in an academic content-free task. We tested 33 normally achieving children and 69 children with LD, aged 7 years 10 months to 16 years 4 months, on the PAR (PAttern Recognition) task, a computer-based, self-paced learning sequence. The children with LD were subtyped in two different ways: first, as children with only an arithmetic disability (AD), or with both arithmetic and word-recognition disabilities (AD/WRD); and second, as children with LD and attention deficit disorder (ADD), or LD without ADD. Results showed that on inferential skills, children with LD (without subtyping), children with AD/WRD, and children with LD with and without ADD scored significantly lower on the PAR task than children in the NA group. Also, an interaction was found between the NA and LD (without subtyping) groups and age, whereby children with LD improved their scores on PAR with age significantly more than normally achieving children. On attention to errors, children with both arithmetic and word-recognition disabilities scored significantly lower than children with only arithmetic disability or NA. It appears that the meta-cognitive skill of monitoring errors may be a major source of difficulty in problem solving for children with both arithmetic and word-recognition disabilities.

Achievement↗

PubMed2002

Motor sequence learning with the nondominant left hand. A PET functional imaging study.

Whereas the human right hemisphere is active during execution of contralateral hand movements, the left hemisphere is engaged for both contra- and ipsilateral movements, at least for right-handed subjects. Whether this asymmetry is also found during motor learning remains unknown. Implicit sequence learning by the nondominant left hand was examined with the serial reaction time (SRT) task during functional brain imaging. As learning progressed, increases in brain activity were observed in left lateral premotor cortex (PMC) and bilaterally in supplementary motor areas (SMA), with the increase significantly greater in the left hemisphere. The left SMA site was similar to one previously identified with right-hand learning, suggesting that this region is critical for representing a sequence independent of effector. Learning with the left hand also recruited a widespread set of temporal and frontal regions, suggesting that motor skill learning with the nondominant hand develops within both cognitive and motor-related functional networks. After skill acquisition, subjects performed the SRT task with their right hands, and sequence transfer was tested with the original and a mirror-ordered sequence. With the original sequence, the stimulus sequence and series of response locations remained unchanged, but the finger movements were different. With the mirror-ordered sequence, the response sequence involved finger movements homologous to those used during training. Performance of the original and mirror sequence by the right hand was significantly better than with random stimuli. Mirror transformation of the sequence by the right hand was associated with a marked increase in regional activity in the left motor cortex, consistent with a role for sequential transformation at this level of the motor output pathway.

Adult↗

PubMed2004

A failure of sleep-dependent procedural learning in chronic, medicated schizophrenia.

BACKGROUND: Schizophrenia patients have difficulty mastering even rote procedural tasks in rehabilitation settings. Although most studies demonstrate intact procedural learning in schizophrenia, recent findings demonstrate that a critical component of procedural learning is dependent on sleep. This study tested the hypothesis that patients with schizophrenia have a deficit in sleep-dependent procedural learning. METHODS: Using a simple, well-characterized test of motor skill learning, the finger tapping motor sequence task (MST), 26 patients with chronic, medicated schizophrenia and 14 demographically matched healthy control subjects were tested on two occasions, 24 hours apart. The main outcome measures were learning of the MST on day 1 (practice-dependent learning) and overnight, sleep-dependent improvement in performance. RESULTS: Although schizophrenia patients and control subjects did not differ in practice-dependent learning, patients failed to show overnight improvement (4% deterioration) and differed significantly from control subjects who showed a significant 11% improvement. CONCLUSIONS: We present here the first demonstration of a failure of sleep-dependent consolidation of procedural learning in chronic, medicated schizophrenia. This deficit occurred in the context of normal practice-dependent learning within a training session. This behavioral dissociation is consistent with evidence that practice- and sleep-dependent motor learning reflect independent processes and suggests that they are differentially affected in schizophrenia.

Adult↗

PubMed2000

Learning in primary care--a report.

A symposium on Learning in Primary Care was held in Cape Town, South Africa, as a pre-conference workshop to the 9th International Ottawa Conference on Medical Education. The aim of this report is to inform medical educationalists of important issues in learning in primary care and to stimulate further debate. Four international speakers gave presentations on their experiences in teaching and learning in primary care. Objective positive outcome measures include acquiring clinical skills equally well in general practice as in hospital, and improved history taking, physical examination and communication skills learning. Students regard the course as an essential requirement for learning and are appreciative of the wider aspect to learning provided by the community, giving a more holistic view of health. A SWOT analysis (strengths, weaknesses, opportunities and threats) of teaching and learning in primary care identified that learning in primary care is of a generalist nature and reality based, but is hampered by a lack of resources. The increased professionalization of teaching in primary care results in better training, cost containment, and improved quality of health care at community level. It is important to focus on turning threats into opportunities. Academic credibility needs to be established by conducting research on learning in primary care and developing the conceptual basis of primary care.

Clinical Competence↗

PubMed1993

A new way to assess practical physiotherapy skills.

This paper describes an innovative method of assessing the practical skills of physiotherapy students. The practice of identifying quality in Quality Circles and using Standards as guidelines is applied to the teaching of pre-clinical skills. The Standards, as identified by the students are then used as marking criteria in an assessment which utilises the principles of self and peer review. The assessment appears to encourage evaluative skills early in the undergraduate programme and bridges the gap between learning skills merely at a technical level and clinical work.

Clinical Competence↗

PubMed1995

General surgical laparoscopic procedures for the "nonlaparologist".

OBJECTIVE: To assess our initial experience with a variety of laparoscopic procedures that can be performed by general surgeons with the basic skills used for laparoscopic cholecystectomy and without advanced laparoscopic expertise. MATERIAL AND METHODS: We retrospectively reviewed a 36-month experience (1991 through 1994) at our institution with a consecutive series of patients who underwent basic laparoscopic surgical procedures but specifically excluding cholecystectomy, appendectomy, herniorrhaphy, and colectomy. RESULTS: Procedures performed laparoscopically included gastrostomy, jejunostomy, small bowel resection, intra-abdominal and retroperitoneal biopsy, staging of intra-abdominal malignant lesions, and adhesiolysis for relief of small bowel obstruction. During the 3-year study period, 106 patients underwent 107 procedures, 89 of which were successful. Four patients had substantial complications, two of whom underwent surgical repair. CONCLUSION: A spectrum of procedures may be safely performed with the skills learned from laparoscopic cholecystectomy and without the need for advanced laparoscopic skills such as intracorporeal suturing or tying of knots.

Biopsy↗

PubMed1977

The effects of the distribution of training on learning feedback-assisted cardiac acceleration.

In order to test a hypothesis derived from a motor skills learning model of cardiac acceleration control, groups of subjects were given biofeedback training for four sessions to learn cardiac acceleration under four different training schedules: (1) all sessions in one day, (2) daily sessions, (3) sessions every other day, and (4) weekly sessions. Ability to accelerate heart rate both with and without feedback was determined at each session. Also ability to accelerate heart rate without feedback was determined 1 week after the last training session as a measure of retention. Although there was highly significant (p less than.0001) evidence of heart rate control both with and without feedback, there were no differences in degree of control attributable to distribution of training sessions. There was, however, a trend (p less than .10) for subjects trained under the most distributed training schedule (weekly) to show more retention than subjects trained under a less distributed schedule (daily).

Adolescent↗

PubMed2003

Learning from implicit learning literature: comment on Shea, Wulf, Whitacre, and Park (2001).

In their analysis of complex motor skill learning, Shea, Wulf, Whitacre, and Park (2001) have overlooked one of the most robust conclusions of the experimental studies on implicit learning conducted during the last decade--namely that participants usually learn things that are different from those that the experimenter expected them to learn. We show that the available literature on implicit learning strongly suggests that the improved performance in Shea et al.'s Experiments 1 and 2 (and similar earlier experiments, e.g., Wulf & Schmidt, 1997) was due to the exploitation of regularities in the target pattern different from those on which the postexperimental interview focused. This rules out the conclusions drawn from the failure of this interview to reveal any explicit knowledge about the task structure on the part of the participants. Similarly, because the information about the task structure provided to an instructed group of participants in Shea et al.'s Experiment 2 did not concern the regularities presumably exploited by the standard, so-called implicit, group, Shea et al.'s claim that explicit knowledge may be less effective than implicit knowledge is misleading.

Humans↗

PubMed1987

Motor learning: nonspecific subcortical mechanisms in rats.

Adult rats with bilateral lesions in the globus pallidus, substantia nigra, median raphe, midbrain central gray, or pontine reticular formation were tested for novel motor skill learning (sliding a barrel bolt to the right in order to open a door leading to a reward). Significantly impaired learning was found in animals with lesions to globus pallidus, substantia nigra, median raphe, or pontine reticular formation. These results combined with earlier findings suggest that the foregoing subcortical structures along with the regions of the ventrolateral and parafascicular nuclei of the thalamus constitute a nonspecific mechanism involved not only in motor learning but in discrimination and maze learning as well. This mechanism is contrasted with the more fashionable specific mechanisms which are involved in particular classes of learning; the sensorimotor cortex, for example, would be a component of the specific mechanism underlying motor learning. A subcortical nonspecific learning mechanism may also inhabit the human brain, as suggested by the clinical condition of "subcortical dementia."

Animals↗

PubMed1992

Neuropsychological efficiency measures in male and female alcoholics.

The role of time in performance on many neuropsychological tests has been relatively neglected in the literature to date. Neuropsychological functioning in 90 male and female alcoholics and 65 peer controls was examined using both accuracy and time measures for four basic types of neuropsychological functioning: verbal skills, learning and memory, problem-solving and abstracting, and perceptual-motor skills. Alcoholics had significantly lower efficiency ratios (accuracy/time) than controls in each of the four areas, and had significantly lower overall accuracy and time scores. There were no significant Group x Gender interactions for efficiency, speed or accuracy scores, indicating that male and female alcoholics have similar deficits as a result of chronic alcoholism. The study is the first to apply systematically an empirical measure of neuropsychological efficiency to different areas of cognitive function; the results have implications for neuropsychological testing procedures.

Adult↗

PubMed2004

The evolution of learning.

Most processes or forms of learning have been treated almost as special creations, each as an independent process unrelated to others. This review offers an evolutionary cladogram linking nearly one hundred forms of learning and showing the paths through which they evolved. Many processes have multiple forms. There are at least five imprinting processes, eleven varieties of Pavlovian conditioning, ten of instrumental conditioning, and eight forms of mimicry and imitation. Song learning evolved independently in at least six groups of animals, and movement imitation in three (great apes, cetaceans and psittacine birds). The cladogram also involves at least eight new processes: abstract concept formation, percussive mimicry, cross-modal imitation, apo-conditioning, hybrid conditioning, proto-pantomime, prosodic mimicry, and image-mediated learning. At least eight of the processes evolved from more than one source. Multiple sources are of course consistent with modern evolutionary theory, as seen in some obligate symbionts, and gene-swapping organisms. Song learning is believed to have evolved from two processes: auditory imprinting and skill learning. Many single words evolved from three sources: vocal mimicry, discrimination learning, and abstract concept formation.

Animals↗

PubMed1986

Evaluation of family therapy trainees: acquisition of cognitive and therapeutic behavior skills.

In this study, which describes the evaluation of a structural family therapy training program, we developed an evaluation procedure that can be used with other similar training programs. Trainees were evaluated before and after training as to their improvement in cognitive, case-planning and in-therapy intervention skills. Results suggest a progression of skill learning, beginning with cognitive understanding, followed by case planning, and then intervention skills. Though trainees made significant progress in cognitive and planning skills, this was not the case with intervention skills. Trainees' self-evaluations were similar to their results on other measures.

Curriculum↗

PubMed1977

Learning child psychiatry skills on the adult inpatient service.

Integration of child psychiatry training into general psychiatric residency programs is often unsuccessful. The authors describe an innovative model of training in child psychiatry that involves the children of adult inpatients. This model offers several advantages: splitting of child-adult psychiatric training is avoided, child diagnostic and evaluative skills tend to be learned rapidly, preventive orientations develop, and family process is both learned and used. Preliminary experience with this model on two inpatient services suggests that it is both didactically effective and economical in child psychiatry staff hours.

Adolescent↗

PubMed1983

Stacking the deck: teaching social skills to retarded adults with a modified table game.

This study developed and evaluated a social skills training program for institutionalized mildly or moderately retarded and dually diagnosed individuals. Social skills were conceptualized as requiring an action or reaction within six skill areas: compliments, social interactions, politeness, criticism, social confrontation, and questions/answers. The program taught social skills using a commercially available table game, Sorry, and a specially designed card deck. Each card represented one of the skill areas and was designed to train either an actor or reactor response. The program featured response specific feedback, self-monitoring, individualized reinforcers, and individualized performance criterion levels. A multiple baseline across two groups (N = 3 per group) revealed that the game contingencies increased social skills in all targeted areas. After training, the subjects displayed their newly learned skills at or above their trained levels in two different settings with novel persons present. Although untargeted, the complexity of the subjects' responses increased across conditions, since there was a steady increase in the number of words they used per response. The program appears to be a viable means of training social skills since it uses standardized training procedures, requires only one facilitator, and is in itself a social situation that may encourage interactions with peers, cooperation, competition, and politeness.

Adult↗

PubMed1992

Learning contracts in clinical education: evaluation by clinical supervisors.

Learning contracts can be a useful learning and evaluation tool within a clinical setting provided the supervisor shifts their role from one of imparter of knowledge to facilitator of learning. If this role is not assumed then a student's learning experience could be jeopardized. In a survey of 59 student supervisors, 90 percent found the learning contract to be a useful evaluation and teaching tool. Advantages stated suggest that the learning contract promotes negotiation between student and teacher, provides a flexible learning environment and promotes acquisition of self-directed learning skills. These qualities are important in a clinical or practical setting where learning experiences cannot be standardized.

Canada↗

PubMedDate not supplied

Providing explicit information disrupts implicit motor learning after basal ganglia stroke.

Despite their purported neuroanatomic and functional isolation, empirical evidence suggests that sometimes conscious explicit processes can influence implicit motor skill learning. Our goal was to determine if the provision of explicit information affected implicit motor-sequence learning after damage to the basal ganglia. Individuals with stroke affecting the basal ganglia (BG) and healthy controls (HC) practiced a continuous implicit motor-sequencing task; half were provided with explicit information (EI) and half were not (No-EI). The focus of brain damage for both BG groups was in the putamen. All of the EI participants were at least explicitly aware of the repeating sequence. Across three days of practice, explicit information had a differential effect on the groups. Explicit information disrupted acquisition performance in participants with basal ganglia stroke but not healthy controls. By retention (day 4), a dissociation was apparent--explicit information hindered implicit learning in participants with basal ganglia lesions but aided healthy controls. It appears that after basal ganglia stroke explicit information is less helpful in the development of the motor plan than is discovering a motor solution using the implicit system alone. This may be due to the increased demand placed on working memory by explicit information. Thus, basal ganglia integrity may be a crucial factor in determining the efficacy of explicit information for implicit motor-sequence learning.

Adult↗

PubMed1999

[Practical procedures in Oslo '96].

In connection with the planning of a new problem-based curriculum, it was decided to develop a detailed plan for the learning of practical clinical procedures. The process involved faculty members from all clinical disciplines and students. For each procedure, level of proficiency, learning methods, time of learning, and control routines were defined. Specific lists like those presented here may help to assure high and even quality of procedural skills acquired during medical pre-graduate training. Furthermore, they may be necessary to achieve optimal co-ordination between pre-graduate and postgraduate training. We recommend that other medical schools initiate processes similar to the one described in this article. However, emphasis of procedural-skills learning should not lead to less attention being paid to the learning of the many complex, non-technical skills of medical practice that cannot be adequately described in operational terms.

Clinical Competence↗