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PubMed2004

Distinct temporal activity patterns in the rat M1 and red nucleus during skilled versus unskilled limb movement.

The mammalian motor system contains multiple interconnected supraspinal networks, but little is known about their relative roles in producing different movements and behaviors, particularly given their apparently fused activity in primates. We tested whether the task context, as well as using a phylogenetically older mammal, rats, could distinguish the separate contributions of these networks. We obtained simultaneous multi-single neuron recordings from the forelimb motor cortex and magnocellular red nucleus as rats performed two contextually different, but kinematically similar, forelimb reach-like tasks: highly learned, skilled reaching for food through a narrow slot, a task requiring extensive training, versus the swing phases of treadmill locomotion. In both the M1 and the mRN, large subpopulations of neurons peaked in their spike firing rates near the onset and the end of the swing phase during treadmill locomotion. In contrast, neural subgroups in the two areas displayed different temporal sequences of activity during the skilled reaching task. In the mRN, the majority of task-modulated neurons peaked in their firing rate in the middle of the reach when the rat was preparing to project the arm through the slot, whereas large subgroups of M1 neurons displayed elevated firing rates during the initial and terminal phases of the reach. These results suggest that motor-behavioral context can alter the degree of overlapping activity in different supraspinal sensorimotor networks. Moreover, results for the skilled reaching task in rats may have highlighted a distinct processing role of the rubral complex: adapting natural muscle synergies across joints and limbs to novel task demands, in concert with cortically based learning.

Animals↗
PubMed2006

Teaching communication and stress management skills to junior physicians dealing with cancer patients: a Belgian Interuniversity Curriculum.

BACKGROUND: Ineffective physicians' communication skills have detrimental consequences for patients and their relatives, such as insufficient detection of psychological disturbances, dissatisfaction with care, poor compliance, and increased risks of litigation for malpractice. These ineffective communication skills also contribute to everyday stress, lack of job satisfaction, and burnout among physicians. Literature shows that communication skills training programs may significantly improve physicians' key communication skills, contributing to improvements in patients' satisfaction with care and physicians' professional satisfaction. This paper describes a Belgian Interuniversity Curriculum (BIC) theoretical roots, principles, and techniques developed for junior physicians specializing in various disciplines dealing with cancer patients. CURRICULUM DESCRIPTION: The 40-h training focuses on two domains: stress management skills and communication skills with cancer patients and their relatives. The teaching method is learner-centered and includes a cognitive, behavioral, and affective approach. The cognitive approach aims to improve physicians' knowledge and skills on the two domains cited. The behavioral approach offers learners the opportunity to practice these appropriate skills through practical exercises and role plays. The affective approach allows participants to express attitudes and feelings that communicating about difficult issues evoke. Such an intensive course seems to be necessary to facilitate the transfer of learned skills in clinical practice. CONCLUSIONS: The BIC is the first attempt to bring together a stress management training course and a communication training course that could lead not only to communication skills improvements but also to burnout prevention.

Adaptation, Psychological↗
PubMed2002

Intermittent intensive physiotherapy in children with cerebral palsy: a pilot study.

The aims of the study were: (1) to determine the feasibility of a rehabilitation program combining intensive therapy periods (4 times/week for 4 weeks) with periods without therapy (8 weeks) over a 6-month period in severely impaired children with cerebral palsy (CP); and (2) to measure changes in gross motor function after intensive therapy periods (immediate effects) and rest periods (retention). A convenient sample included five children (two females, three males; mean age 22.6 months [SD 9.9]) with severe forms of CP with impairment of four limbs and trunk (GMFCS levels IV and V). A multiple-baseline design was used. Changes in motor performance were assessed by a blind evaluator using the Gross Motor Function Measure. Visual and statistical analyses followed. Level of compliance during intensive therapy was 93.1%. Children received a mean of 30 treatments over the 24 weeks of the experimental phase compared with the 48 treatments they would have received routinely. Increases in GMFM scores (mean 9.2%; range 3 to 15%) were significant in three children (p<0.05) and all participants maintained their motor performance during the two 8-week rest periods. Results showed that four treatments per week over a 4-week period were well tolerated when separated by rest periods. The intermittent program led to improvements in motor function that were maintained over the rest periods. Results underline the need to reconsider the organization of physical rehabilitation programs. A regime that is intensive enough without being tiring and one that provides practice conditions for consolidating motor skills learned during the intensive therapy period may best optimize motor training.

Cerebral Palsy↗
PubMed2001

Enhancing conversation skills in children with autism via video technology. Which is better, "self" or "other" as a model?

The present study was designed to compare the efficacy of "self" versus "other" video-modeling interventions. Five children with autism ranging in age from 4 to 11 were taught to answer a series of conversation questions in both self and other video-modeled conditions. Results were evaluated using a combination of a multiple baseline and alternating treatments design. Three out of the five participants performed at levels of 100% accuracy at posttreatment. Results indicated no overall difference in rate of task acquisition between the two conditions, implying that children who were successful at learning from video in general, learned equally as well via both treatment approaches. Anecdotal evidence suggested that participants who were successful with video treatment had higher visual learning skills than children who were unsuccessful with this approach. Results are discussed in terms of a visual learning model for children with autism.

Autistic Disorder↗
PubMed1996

A new method for teaching the repair of perineal trauma of birth.

BACKGROUND AND OBJECTIVES: Repair of perineal birth trauma is one of the most common surgical techniques in pregnancy care. Because of the three-dimensional nature of the required repair, students and residents often have difficulty learning this procedure. METHODS: We developed a new method to teach learners the repair of second-degree perineal birth trauma by using a simple three-dimensional model. We evaluated resident learning by testing their performance 8 months after training with the model. RESULTS: Surveyed residents who participated in the training reported having used the learned skills and having an improved understanding of the three-dimensional aspect of the repair. Eight months after the initial teaching session, learners were able to consistently perform the simulation and rated it to be superior to learning from textbooks. CONCLUSION: Repair of postdelivery perineal tears can be taught with a simple teaching model.

Curriculum↗
PubMed2002

Reflective practise in clinical teaching.

The present paper describes the process of reflective practise in clinical teaching through a workshop entitled 'Effective Clinical Teaching'. The clinical teachers were invited to analyze the content of a videotape in which various clinical teaching scenarios were presented. Following this, they discussed a series of questions designed to promote reflective activities and evaluated the interaction among the student, the client and the clinical teachers in each scenario. The teachers also identified the positive and negative aspects of the teaching approaches portrayed on the tape. Finally, the participants made recommendations that would improve the interaction and suggested alternate teaching strategies to enhance the learning outcome. In addition, there was sharing of clinical teaching experiences among the clinical teachers. Through this process of reflection on action, the clinical teachers were able to understand various teaching approaches as perceived by students, and to address the issues that might hinder student learning in clinical settings. Different reflective activities have also been proposed to enhance student's reflective learning skills.

Clinical Medicine↗
PubMed2006

Effect of reducing frequency of augmented feedback on manual dexterity training and its retention.

OBJECTIVE: The study addressed the impact of the frequency of tutorial-enriched augmented visual feedback, provided by a virtual simulation system (DentSim), on the skill acquisition for a cavity preparation task in novice dental students. METHODS: Thirty-six subjects were assigned to two training groups and a control group. The task consisted of a geometrical cross preparation on the lower left first molar. All subjects performed a pre-test to assess their basic skill level. The training groups received simulation feedback, enriched with tutorial information, across acquisition. One group trained under continuous augmented feedback, while a second group trained under an intermittent (66% of the time) feedback. At both 1-day and 4-month interval, subjects performed a retention test to explore learning specific effects. Two transfer tests were added to assess the extrapolation of the learned skills to an adjacent molar. All tests were performed in the absence of feedback. A control group performed all the tests, without preceding training. All preparations were graded by the simulation system. RESULTS: The training groups performed similarly across acquisition and improved with practice (ANOVA, P<0.001). After 1 day and 4 months of no practice, the training groups outperformed the control group on a retention test (ANOVA, P<0.001) and transfer test (ANOVA, P<0.001). CONCLUSIONS: Performance and learning of a cavity preparation task on a simulation unit was independent of the frequency of tutorial-enriched augmented visual feedback within the range tested. Training sessions on a simulation unit could be alternated with training sessions in the traditional phantom head laboratory.

Adolescent↗
PubMed2003

The interplay between education and research about patient-provider communication.

Attention to providers' communication skills is likely to increase, given the confluence of forces that have highlighted the importance of communication in healthcare. In the United States, interpersonal and communication skills have been explicitly identified as a priority throughout the continuum of medical education and practice. Ideally, theory and research inform teaching and assessment efforts by suggesting how communication behavior affects outcomes and by providing a conceptual framework for learning skills. This article illustrates the interplay between education and research by discussing examples of useful concepts (models of communication, issues of perceived control, and patterns of non-verbal communication) and understudied topics (physician verbalizations during patients' initial narratives, the mundane aspects of communication in healthcare, conceptual and operational definitions of empathy, and the effect of patient narratives on both patients and providers). Given the breadth and depth of experience, from screening and prevention to treatment and support, the context of cancer offers a promising laboratory for enhancing both education and research about provider-patient communication.

Clinical Competence↗
PubMed1977

Significance of crossed eye-hand dominance for the adult neuropsychological evaluation.

The variable of opposit eye and hand dominance is reviewed as a possible sign of learning problems and as an indication of congenital or early developmental brain impairment. It is considered as an independent variable in examining differences along several dimensions of psychological functioning as a possible discriminator of performance levels. It is also considered as a variable in discriminant function analysis to predict brain lesion process. Although few results were statistically significant, the numerous analyses were remarkably convergent in suggesting that crossed dominance is related to poorer verbal learning skills and is a useful variable in differentiating various process diagnostic groups.

Adult↗
PubMedDate not supplied

Advanced cardiac life support education: a self-directed, scenario-based approach.

BACKGROUND: The American Heart Association adopted new curriculum guidelines for Advanced Cardiac Life Support (ACLS) education. Requirements include the incorporation of case-based learning strategies in the course format. METHOD: A self-directed, scenario-based course format was developed to incorporate principles of adult learning and to meet the newest curriculum guidelines of the American Heart Association. A post-course survey was used to evaluate the participants' perceptions of the course format and its effects on their learning. RESULTS: Twenty-seven participants completed the course. Analysis of the post-course survey responses indicated participants favored the self-directed, scenario-based design and felt the format contributed to their learning. Additionally, this format was more cost-effective than the traditional 2-day course design. CONCLUSION: The use of a self-directed, scenario-based format creates an optimal environment that fosters the complex cognitive and psychomotor skills learning required to perform ACLS. This format meets the expectations of the American Heart Association curriculum guidelines and should be considered a viable and valuable option for providing ACLS education.

Advanced Cardiac Life Support↗
PubMed2004

Motor learning in children with spina bifida: dissociation between performance level and acquisition rate.

The cerebellum is part of a neural circuit involved in procedural motor learning. We examined how congenital cerebellar malformations affect mirror drawing performance, a procedural learning task that involves learning to trace the outline of a star while looking at the reflection of the star in a mirror. Participants were 88 children with spina bifida myelomeningocele, a neural tube defect that results in lesions of the spinal cord, dysmorphology of the cerebellum, and requires shunt treatment for hydrocephalus, and 35 typically developing controls. Participants completed 10 trials in the morning and 10 trials following a 3-hr delay. Although children with spina bifida myelomeningocele were initially slower at tracing and made more errors than controls, all participants improved their performance of the task, as demonstrated by increased speed and accuracy across trials. Moreover, degree of cerebellar dysmorphology was not correlated with level of performance, rate of acquisition, or retention of mirror drawing. The results suggest that congenital cerebellar dysmorphology in spina bifida does not impair motor skill learning as measured by acquisition and retention of the mirror drawing task.

Adolescent↗
PubMed1999

Explicit and implicit learning in patients with Alzheimer disease and Parkinson disease with dementia.

OBJECTIVE: To examine the differential impairment of implicit and explicit memory systems in cortical and subcortical dementias. BACKGROUND: Whereas verbal priming was reported to be impaired in patients with Alzheimer Disease (AD), patients with Parkinson Disease (PD) may be relatively more impaired on tasks of motor skill learning. METHODS: We examined 15 patients with Alzheimer disease, 10 patients with Parkinson disease and dementia (PD-D), 15 patients with PD but no dementia, and 24 age-comparable normal control subjects with a neuropsychologic battery that included tests of explicit memory (Buschke Selective Reminding Test, Benton Visual Retention Test, Digits Span), and tests of implicit memory (Word-Stem Completion task and the Maze Test). RESULTS: AD and PD-D groups showed similar deficits on all measures of explicit memory, and performed significantly worse than PD patients without dementia and normal control subjects. On the other hand, there were no significant between-group differences in any of the measures of implicit memory. CONCLUSIONS: Our study demonstrated preserved implicit learning in the context of severe explicit learning deficits in patients with dementia, but could not demonstrate a different profile of memory deficits between so-called cortical and subcortical dementias.

Aged↗
PubMed2004

Cognitive and cognate-based treatments for bilingual aphasia: a case study.

Two consecutive treatments were conducted to investigate skill learning and generalization within and across cognitive-linguistic domains in a 62-year-old Spanish-English bilingual man with severe non-fluent aphasia. Treatment 1 was a cognitive-based treatment that emphasized non-linguistic skills, such as visual scanning, categorization, and simple arithmetic. Treatment 2 was a lexically based treatment that trained cognates (cross-linguistic word pairs that are similar in meaning and form, such as rosa/rose) and non-cognates (cross-linguistic word pairs with shared meaning but different forms, such as mesa/table). Treatment 1 resulted in modest gains in both Spanish and English. Treatment 2 resulted in improved naming for non-cognates as well as cognates within each language. However, the generalization of gains from Spanish to English was apparent only for cognate stimuli.

Aphasia↗
PubMedDate not supplied

Problem-based learning: a review of current issues relevant to physiotherapy education.

This article reviews the development of problem-based learning (PBL) over the past decade within the context of physiotherapy practice. Although there is an emerging literature in physiotherapy, the research is primarily from medical education. Some of the original claims of superiority of PBL in developing problem-solving and self-directed learning skills have not been supported. Results from studies comparing traditional and PBL curricula are inconsistent and have numerous methodological shortcomings. There is no evidence to suggest there is one best way of implementing PBL, however it appears faculty training is required to be most successful. There is a need for physiotherapy specific research; although based on the experiences of our medical colleagues long term studies comparing the outcomes of programs of different curricular designs may not be warranted. PBL may help promote skills important for current practice and remains a viable alternative for those interested in curricular innovation.

Education, Medical↗
PubMed2006

Learning spinal manipulation: the importance of augmented feedback relating to various kinetic parameters.

BACKGROUND CONTEXT: Spinal manipulation is a widely accepted therapeutic approach in the treatment of back pain. In standard training programs, feedback on student performances is provided by an instructor based on teaching and clinical experience. Systematic study of the type of augmented feedback provided and skill learning is lacking in the literature. PURPOSE: The goal of this investigation is to compare the performance of two groups of chiropractic students, one receiving traditional training from experienced instructors, and the other, augmented feedback on specific biomechanical aspects of spinal manipulation therapy using an instrumented manikin. STUDY DESIGN: Randomized controlled study. PATIENT SAMPLE: Thirty-one fourth-year students from the Department of Chiropractic of Université du Québec à Trois-Rivières participated in this study. OUTCOME MEASURES: Kinetic parameters (force-time curves) of spinal manipulation were evaluated. METHODS: Spinal manipulation parameters were measured before and after a 5-week training period in which one group received standard chiropractic training while a second group received augmented feedback about specific biomechanical parameters of spinal manipulation. For both groups, practice scheduling and time duration were similar and consisted of a weekly practice session of 90 minutes for five consecutive weeks. Both groups had to practice thoracic spine manipulation throughout the training period. RESULTS: Both groups showed a decrease in peak force applied, with a diminution in the number of trials where a downward incisural point was present in preload force. Participants in the feedback training group significantly reduced their peak force variability and significantly increased their preload force. No significant difference was observed for time to peak force. CONCLUSIONS: The results of this study highlight the merits of practicing with an instrumented manikin or other instrumented training aids. Such a device can provide specific feedback on specific parameters of the task during learning; it can also serve as a tool to assess the progress of students and eliminate the risks relating to repetitive spinal manipulative therapy practice on student colleagues.

Adult↗
PubMed2001

Social cognitive factors predicting the health of elders.

The social cognitive model of health is primarily concerned with influences on a person's decisions to perform health behaviors. In this study, the relationships among social cognitive factors reflecting enabling skills (learned resourcefulness), internal motivation for health (health self-determinism), and help responses (coping responses) and a measure of physical and psychosocial health were examined in 137 chronically ill elders. Gender, race, and number of chronic conditions were predictors of learned resourcefulness. Learned resourcefulness was associated with the use of informal help, whereas health self-determinism was related to self-help and formal help. None of the help responses were significant predictors of health. Model testing revealed that greater resourcefulness or skill in coping with stressful situations was the most important predictor of health. Strategies are recommended to help elders achieve optimal health.

Adaptation, Psychological↗
PubMed1984

Teaching social/vocational skills to retarded adults with a modified table game: an analysis of generalization.

In this study, a social skills training program for institutionalized mildly or moderately retarded adults was extended to include skills relevant to vocational settings. Target behaviors involving a verbal action or reaction within six skill areas were taught using a commercially available board game, Sorry, and a specially designed card deck. The training program featured response specific feedback, self-monitoring, individualized reinforcers, and individualized performance criterion levels. Using a multiple baseline across two groups (n = 3 per group), the game contingencies increased social/vocational skills in all targeted areas. Generalization was assessed in two settings: a simulated workshop in which pre and post measures were taken and in the institutional workshop where the residents worked. The posttraining simulated workshop results revealed that the residents' newly learned skills had generalized. However, repeated generalization measures of the residents' social interactions in the institutional workshop were equivocal as were measures of their productivity.

Adult↗