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PubMed2001

Intransitive limb gestures and apraxia following unilateral stroke.

Apraxia is the loss of the ability to perform learned, skilled movements correctly, and is frequently attributed to left hemisphere damage (Heilman & Rothi, 1985). Recent work (Dumont, Ska, & Schiavetto, 1999) has shown a dissociation between transitive (tool based; e.g., hammering a nail) and intransitive (expressive/ communicative; e.g., waving goodbye) actions; however, few group studies have specifically addressed apraxia for intransitive gestures. The present investigation examined the frequency and severity of praxis errors related to the production of intransitive gestures in left (LHD) or right hemisphere stroke (RHD) patients in the context of Roy's (1996) model of limb praxis. A total of 119 consecutive stroke patients (LHD = 57, RHD = 62) and 20 healthy age-matched controls performed eight intransitive gestures to pantomime and imitation. Performance was quantified via a multi-dimensional error notation system, providing detail about specific elements of performance (e.g., location), and a composite score reflecting overall gestural accuracy. Analyses of pantomime and imitation performance revealed an equal percentage of apraxic patients in each stroke group, and the severity of apraxia in these groups was also equivalent. Further, analyses of the patterns of apraxia specified by Roy (1996) revealed that patients in each stroke group demonstrated selective impairments in pantomime (LHD = 38%, RHD = 42%), or imitation (LHD = 9%, RHD = 5%) conditions, whereas others demonstrated concurrent impairments (LHD = 30%, RHD = 22%) indicating that stroke to either hemisphere can selectively impair each stage in the production of an intransitive action.

Aged↗

PubMed2000

Training in virtual environments: transfer to real world tasks and equivalence to real task training.

Virtual environments (VEs) are extensively used in training but there have been few rigorous scientific investigations of whether and how skills learned in a VE are transferred to the real world. This research aimed to measure and evaluate what is transferring from training a simple sensorimotor task in a VE to real world performance. In experiment 1, real world performances after virtual training, real training and no training were compared. Virtual and real training resulted in equivalent levels of post-training performance, both of which significantly exceeded task performance without training. Experiments 2 and 3 investigated whether virtual and real trained real world performances differed in their susceptibility to cognitive and motor interfering tasks (experiment 2) and in terms of spare attentional capacity to respond to stimuli and instructions which were not directly related to the task (experiment 3). The only significant difference found was that real task performance after training in a VE was less affected by concurrently performed interference tasks than was real task performance after training on the real task. This finding is discussed in terms of the cognitive load characteristics of virtual training. Virtual training therefore resulted in equivalent or even better real world performance than real training in this simple sensorimotor task, but this finding may not apply to other training tasks. Future research should be directed towards establishing a comprehensive knowledge of what is being transferred to real world performance in other tasks currently being trained in VEs and investigating the equivalence of virtual and real trained performances in these situations.

Acoustic Stimulation↗

PubMed1998

Hypnotic analgesia: 1. Somatosensory event-related potential changes to noxious stimuli and 2. Transfer learning to reduce chronic low back pain.

Fifteen adults with chronic low back pain (M = 4 years), age 18 to 43 years (M = 29 years), participated. All but one were moderately to highly hypnotizable (M = 7.87; modified 11-point Stanford Hypnotic Susceptibility Scale, Form C [Weitzenhoffer & Hilgard, 1962]), and significantly reduced pain perception following hypnotic analgesia instructions during cold-pressor pain training. In Part 1, somatosensory event-related potential correlates of noxious electrical stimulation were evaluated during attend and hypnotic analgesia (HA) conditions at anterior frontal (Fp1, Fp2), midfrontal (F3, F4), central (C3, C4), and parietal (P3, P4) regions. During HA, hypothesized inhibitory processing was evidenced by enhanced N140 in the anterior frontal region and by a prestimulus positive-ongoing contingent cortical potential at Fp1 only. During HA, decreased spatiotemporal perception was evidenced by reduced amplitudes of P200 (bilateral midfrontal and central, and left parietal) and P300 (right midfrontal and central). HA led to highly significant mean reductions in perceived sensory pain and distress. HA is an active process that requires inhibitory effort, dissociated from conscious awareness, where the anterior frontal cortex participates in a topographically specific inhibitory feedback circuit that cooperates in the allocation of thalamocortical activities. In Part 2, the authors document the development of self-efficacy through the successful transfer by participants of newly learned skills of experimental pain reduction to reduction of their own chronic pain. Over three experimental sessions, participants reported chronic pain reduction, increased psychological well-being, and increased sleep quality. The development of "neurosignatures of pain" can influence subsequent pain experiences (Coderre, Katz, Vaccarino, & Melzack, 1993; Melzack, 1993) and may be expanded in size and easily reactivated (Flor & Birbaumer, 1994; Melzack, 1991, 1993). Therefore, hypnosis and other psychological interventions need to be introduced early as adjuncts in medical treatments for onset pain before the development of chronic pain.

Adult↗

PubMed1997

Consequences of error production in a perceptual-motor task.

In 2 experiments, U.S. college students engaged in a computerized version of a tracing task in which a cursor on a monitor screen could be guided through 16 segments of an 8-pointed, star-shaped track into targets at the vertices of the track by moving a joystick handle. The presence or absence of consequences for errors was manipulated. With restricted consequences, the cursor was confined to the track, freezing in position if the joystick handle was moved to an unsuitable position. With unrestricted consequences, the cursor always moved corresponding to the position of the joystick handle, even through and beyond the borders of the track. Time to reach each of the 16 successive targets was recorded on each of 4 training trials, as well as on 2 transfer trials in which consequences were unrestricted, but only the cursor and next target were visible (the contextual cue of the star-shaped track was absent). Times were longer on diagonal segments and when consequences were unrestricted, but there was no consistent carryover to the test trials. The results suggest that feedback, to serve an effective "guidance" function in skill learning, requires production of unrestricted feedback about errors. True guidance, however, prevents response errors, so consequences and feedback about errors are precluded.

Analysis of Variance↗

PubMed2002

Strategic calibration and spatial alignment: a model from prism adaptation.

Two types of adaptive processes involved in prism adaptation have been identified&colon: Slower spatial realignment among the several unique sensorimotor coordinate systems (spatial maps) and faster strategic motor control responses(including skill learning and calibration) to spatial misalignment. One measures the 1st process by assessing the aftereffects of prism exposure, whereas direct effects of the prism during exposure are a measure of the 2nd process. A model is described that relates those adaptive processes and distinguishes between extraordinary alignment and ordinary calibration. A conformal translation algorithm that operates on the hypothesized circuitry is proposed. The authors apply to the model to explain the advantage of visual calibration when the limb is seen in the starting position prior to movement initiation. Implications of the model for the use of prism adaptation as a tool for investigation of motor control and learning are discussed.

Adaptation, Physiological↗

PubMed1982

Biofeedback for headache.

Biofeedback has proven effective in treatment of vascular and muscle contraction headache. However, many factors have not yet been explored. Research into personality and psychologic aspects that can predict success or failure with biofeedback is necessary, as is research into the applicability of skills learned in the laboratory to nonlaboratory situations. The possibility of symptom substitution should be investigated, and the problem of using study volunteers who do not adequately represent the headache population must be dealt with. Biofeedback represents a significant step forward in control of migraine and muscle contraction headache. Further experience with biofeedback techniques is necessary, but the future seems to promise continued success with this new method of treatment.

Biofeedback, Psychology↗

PubMed2006

Assessing proficiency in adult basic life support: student and expert assessment and the impact of video recording.

Self-assessment is an important aspect in the development of lifelong learning skills for medical students, crucial to maintaining a high level of competence in practice. Basic Life Support (BLS) is a skill that all health professionals must acquire and maintain competence in. This paper reports data from a study of 95 first-year graduate entry medical students at Flinders University in Australia, determining how well the students could assess their own BLS performance. These students were videotaped performing a short CPR scenario using a Resusci Anne with SkillReporter (Laerdal, Norway). Using a six-point descriptive ratings scale, students graded themselves twice: once immediately after completing the task, and again after viewing a video of their performance. A single expert assessor viewed all the video recordings and, based on International Liaison Committee on Resuscitation (ILCOR) Guidelines, graded the students using the same scale. The hypothesis was that the intervention of viewing their performance on video would improve the correlation of their ratings with the expert assessor. The results showed that the students' assessments did not agree with the expert assessor either before (weighted kappa = 0.03) or after seeing the video (weighted kappa = 0.002). Possible reasons, including student attitudes and lack of benchmarking, are discussed. Self-assessment skills of students warrant further attention.

Cardiopulmonary Resuscitation↗

PubMed2006

A manageable approach to integrating personal digital assistants into a family medicine clerkship.

Personal digital assistants (PDAs) were incorporated into the six-week Family Medicine Clerkship in 2002 to achieve two major goals: tracking students' outpatient encounters at preceptor sites and providing opportunities to use PDAs during medical visits. Each student collects information on each patient seen. Data are then retrieved and presented to students individually and as a group twice during the rotation. Each PDA also contains several clinical resources that students use during both small group didactic sessions and real clinical encounters. These results are based on data collected from 85 students who completed the clerkship over the course of one year who recorded information on demographics, presenting problems, procedures, and type of precepting for a total of 11,146 patient encounters. The cumulative results have allowed clerkship faculty and administrators to set standard expectations of individual students and preceptors with respect to numbers of patients seen and type of precepting received. This PDA project is manageable in terms of costs as well as effort on the part of both students and faculty and has numerous benefits to the clerkship, one of which is the ability to provide real-time feedback to clerkship students and thus promote adult learning skills.

Ambulatory Care↗

PubMed1991

The biasing of weight judgments in Alzheimer's and Huntington's disease: a priming or programming phenomenon.

The performances of Huntington's disease (HD) patients and patients with dementia of the Alzheimer type (DAT) were compared on an adaptation-level task involving the judgment of weights. In this task, subjects were first exposed to either a relatively heavy (heavy bias) or a relatively light (light bias) set of weights, and were later asked to rate the heaviness of a standard set of 10 weights using a 9-point scale. Patients with DAT and intact control subjects both perceived the standard set of weights as heavier following the light bias trials and lighter following the heavy bias trials, despite the DAT patients' poor explicit memory for the initial biasing session. In contrast, the weight judgments of the HD group as a whole was not significantly influenced by prior exposure to relatively heavy or light weights, and the size of the bias effect for this group was significantly correlated with the severity of their dementia. It is suggested that the impaired biasing performance of the HD patients, like their previously demonstrated impairment in motor skill learning, is due to a motor programming deficit resulting from neostriatal dysfunction.

Alzheimer Disease↗

PubMed1991

Implicit and explicit memory in Alzheimer's disease and Parkinson's disease.

Several tasks examined implicit and explicit memory in demographically matched samples of Alzheimer's (AD) and Parkinson's disease (PD) patients, and healthy elderly subjects. A fragmented pictures test, word stem-completion repetition priming, and a pursuit-rotor tracking task, followed by explicit memory tests, were given. AD patients were impaired on all explicit tests and on word stem-completion priming, but were intact on pursuit-rotor tracking and the skill learning (SL) component of the fragmented pictures test. PD patients were significantly better than AD patients on all explicit memory tests, but were selectively impaired on the SL component of the fragmented pictures test. Finally, a mirror-reading test was given to the PD patients and control subjects, with no significant differences found in performances between the two groups. Results are discussed in terms of hypothetical cognitive processes and brain circuits underlying different implicit and explicit memory domains.

Aged↗

PubMed1997

Beyond one-bun, two-shoe: recent advances in the psychological rehabilitation of memory disorders after acquired brain injury.

Memory disorders are one of the most frequent types of cognitive impairment encountered in neurological populations. The more severe degrees of such impairment case major disability and handicap, and have a profound impact on a person's capacity to engage in independent living. To date, commonly used remediation strategies range from drills and practice, including computer-based tasks, to mnemonic techniques and memory notebooks. In general, these therapies have met with varying degrees of success. The last decade has seen exciting developments in remediation techniques for memory disorders, a number of which are based on implicit learning skills, as well as programmes tailored to an individual's unique pattern of deficits. The present paper provides an overview of this literature and discusses issues relating to their application in rehabilitation programmes.

Adult↗

PubMed2005

Anxiety-induced changes in movement behaviour during the execution of a complex whole-body task.

We investigated the impact of anxiety on movement behaviour during the execution of a complex perceptual-motor task. Masters' (1992) conscious processing hypothesis suggests that under pressure an inward focus of attention occurs, resulting in more conscious control of the movement execution of well-learned skills. The conscious processes interfere with automatic task execution hereby inducing performance decrements. Recent empirical support for the hypothesis has focused on the effects of pressure on end performance. It has not been tested so far whether the changes in performance are also accompanied by changes in movement execution that would be expected following Masters' hypothesis. In the current study we tested the effects of anxiety on climbing movements on a climbing wall. Two identical traverses at different heights on a climbing wall provided different anxiety conditions. In line with the conscious processing hypothesis we found that anxiety had a significant effect on participants' movement behaviour evidenced by increases in climbing time and the number of explorative movements (Experiments 1 and 2) and by longer grasping of the holds and slower movements (Experiment 2). These results provide additional support for the conscious processing hypothesis and insight into the relation between anxiety, performance, and movement behaviour.

Adult↗

PubMedDate not supplied

Memory for items and memory for relations in the procedural/declarative memory framework.

A major area of research in memory and amnesia concerns the item specificity of implicit memory. In this paper we address several issues about the nature of implicit memory phenomena and about what constitutes an "item", using the procedural/declarative memory theory to guide us. We consider the nature of memory for items and of memory for relations among items, within the context of the procedural/declarative framework, providing us with the foundation necessary to analyse the basis for item-specific implicit memory phenomena. We review recent work from our laboratories demonstrating the fundamentally relational and flexible nature of declarative memory representation, in both humans and animals, and the essential role of the hippocampal system in relational memory processing. We show, further, that the memory representations supporting implicit memory phenomena are inflexible and nonrelational, and are tied to specific processing modules. Finally, we introduce empirical approaches that blur the distinction between skill learning and repetition priming, and show computational modelling results that demonstrate how these two implicit memory phenomena can be mediated by a single incremental learning mechanism, in accord with the claims of the procedural-declarative theory. Taken together, these various analyses of memory for items and memory for relations help to illuminate the nature of the functional deficit in amnesia and the memory systems of the brain.

Amnesia↗

PubMed1990

Three-dimensional computergraphic analysis of apraxia. Neural representations of learned movement.

The left cerebral hemisphere in man contains anatomical structures specialized not only for language but also for higher-order motor programming. One method of studying the nature of these motor programs is by observing the type of errors made by patients who have left hemisphere damage. A major problem, however, in investigating the disorders that result from failure of this specialized left hemisphere system (the apraxias) has been the difficulty in obtaining objective measurement of movement in three-dimensional space. To this end, we provide the first three-dimensional analysis of the nature of movement errors in apraxia. Two apraxic subjects with lesions to the left hemisphere and 5 matched control subjects were studied. The apraxic subjects showed impairments in the control of movement timing and spatial relations, as well as decoupling in the normally tight relation between certain spatial and temporal aspects of their movement trajectories. Further, the use of the distal musculature by apraxic subjects was more impaired than their use of the proximal musculature, suggesting more distal representation in any space-time maps of learned movement. These data provide further insight into the nature of the representations of learned skilled movements in the left cerebral hemisphere.

Aged↗

PubMed1998

Event-related potential evidence for a specific recognition memory deficit in adult survivors of cerebral hypoxia.

Transient global ischaemia due to cardiac arrest may lead to profound neuropsychological disorders. Recent research indicates that memory processes are particularly impaired after hypoxic brain injury. Visual recognition memory functions were examined in these patients by means of event-related potential (ERP) and performance data. Eight chronic hypoxic patients, matched with controls for sex and age, performed a visual recognition memory task requiring recognition judgements for either object forms or spatial locations and a visual classification (i.e. oddball) task that imposed negligible memory demands. Reliable P300 oddball effects were obtained both for patients and for controls, whereas the two groups differed in P300 latency and P300 scalp topography. In the memory task, old/new effects (i.e. larger ERP waveforms for previously studied than for unstudied items) were found for the controls. In contrast, in patients these old/new effects were absent or even inverted in polarity while recognition performance was well above chance level, except for one patient. These results suggest that recognition, based on the retrieval of an item's study episode, is degraded in patients who have suffered a period of transient global ischaemia. In the light of the patients' above-chance level of recognition performance and the outcome of post hoc analysis of practice-related changes in recognition performance, it is argued that the patients' memory disorders are best characterized as a degradation of explicit memory functions such as episodic retrieval of a study episode. Implicit functions such as cognitive skill learning were intact.

Adult↗

PubMed1992

Evaluation of a summer prematriculation program for black and other nontraditional students.

This study evaluated the effectiveness of the Medical College of Georgia School of Medicine's Summer Prematriculation Program in facilitating participants' first-year achievement and retention from 1980 to 1989. The four-week curriculum included biochemistry, anatomy, immunology, learning skills, medical or anatomy terminology, and clinical forums. Of 101 black and 96 other nontraditional, at-risk students who had been invited to attend the program, the 115 attendees were compared with the 82 nonattendees on a variety of demographic and academic measures. For all measures examined, no statistically significant difference was found between the two groups. Several factors may have obscured the results. However, there were indications that the program had a favorable effect, including the evaluation by over 90% of the attendees that the program had contributed positively to their adjustment to medical school.

Black or African American↗

PubMed1994

The longer road to medical school graduation.

The authors followed the academic progress and graduation rates of students matriculating in U.S. medical schools each year between 1976 and 1988. The four-year graduation rates of medical students in MD programs declined from 91.4% for students who matriculated in 1976 to 81.2% for 1988 matriculants. During the same period, the percentage graduating in five years increased from 5.5% to 10.6%, while those still enrolled or on leaves of absence after five years rose from 1.9% to 4.1%. The lengthening of undergraduate medical education is associated with students' spending extra time on special studies or research, but to a greater extent graduation has been delayed for remediation of academic difficulty or slowing of the pace of education to overcome handicaps in academic preparation and learning skills. Underrepresented minority students, particularly black Americans, have lower four-year graduation rates than majority students, and the rate has fallen steadily across successive classes matriculating between 1976 and 1988. The longer periods of undergraduate medical education since 1984, however, have been accompanied by a reversal of the growing attrition rate for black-American students, probably the result of more appropriate pacing of education over the first year or two and the wider availability of student academic support. The longer road to graduation also accumulates greater educational costs, contributing to the escalation in student indebtedness that has been out of proportion to increases in tuition and fees.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1996

A state university's model program to increase the number of its disadvantaged students who matriculate into health professions schools.

Health professions schools often provide support for minority and disadvantaged students in high school or in a single college summer program. However, long-term support for students during their undergraduate years is also crucial. Since 1990, San Diego State University (SDSU), a large urban public university, has implemented the Health Careers Opportunity Program (HCOP) to increase the number of the university's disadvantaged students (most of whom are from minority groups) who matriculate into medical, dental, veterinary, and physician assistant schools. The program's 11 components, each dedicated to some form of educational intervention and support, emphasize developing students' collaborative learning skills, fostering their pride in accomplishment, and helping them achieve positive self-images and self-confidence; these goals are linked with building students' analytical and problem-solving skills. Weekly journals kept by students' mentors serve as an "early warning system" for "bad" feelings, attitudes, and behaviors that reflect students' personal problems and correlate with lower grades, and help the program staff work intensively with students immediately, before problems become severe. The SDSU's HCOP increased the number of disadvantaged (mostly minority) students staying in the prehealth career path (not counting those in the schools of nursing and public health) from 70 in 1989 to 360 in 1995. In 1992 through 1994, the students who had completed the HCOP's Summer Academic Program (to help them bridge into a science curriculum) had pass rates for entry-level math, writing competency, and math placement that were consistently higher than the rates for other SDSU students. The overall grade-point average of HCOP students in the spring of 1995 (3.05) was significantly higher than the overall GPA of all minority students in prehealth training before the HCOP began (2.59 in 1988). The number of SDSU's minority students accepted by health professions schools (primarily medical schools) rose significantly from six in 1990 to 23 in 1995. It is clear that the labor-intensive interventions of the HCOP throughout students' years at SDSU until they matriculate into health professions schools are working.

California↗