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PubMed1995

Apraxia during Wada testing.

Apraxia is the loss of the ability to perform learned skilled movements correctly. In right-handers, apraxia and aphasia are most frequently associated with left-hemisphere lesions. When they are dissociated, however, aphasia is more common in the absence of apraxia than vice versa. There are two hypotheses that can account for this discrepancy: (1) in right-handers, praxis is more likely than language to be mediated by the right hemisphere, or (2) the left-hemisphere network that mediates language is either more widely distributed than the network that mediates praxis or is more likely to be in the middle cerebral artery distribution. We studied apraxia in a group of right-handers undergoing selective hemispheric anesthesia, or Wada testing. All nine subjects had language lateralized to the left hemisphere, and seven of the nine had praxis lateralized to the left hemisphere. Two of the subjects had praxis bilaterally represented. Although our data suggest that speech and praxis functions tend to be lateralized to the left hemisphere in most right-handers, praxis appears to be more distributed between the hemispheres than speech-language functions. Furthermore, an analysis of the types of errors made during praxis testing suggests differential roles of the hemispheres in praxis functions.

Adolescent↗

PubMed1997

Selective deficit of praxis imagery in ideomotor apraxia.

We studied imagery for learned, skilled movements (praxis imagery) in a patient with severe ideomotor apraxia and intact language abilities. This patient, who made predominantly spatial and movement errors when performing transitive movements demonstrating the use of tools (transitive gestures), was also impaired in her ability to answer imagery questions about joint movement or the spatial position of the hands during action. However, visual object imagery was spared. The finding of parallel praxis production and praxis imagery deficits in this patient suggests that the same representations used for gesture production are also activated during imagery of motor acts. Our findings also suggest that certain aspects of motor imagery may be dissociable from general object imagery.

Apraxias↗

PubMed1999

Cerebral lateralization: relationship of language and ideomotor praxis.

OBJECTIVE: To determine the relationship of language lateralization and hand preference to praxis performance following left and right hemispheric amobarbital-induced inactivations. BACKGROUND: Patients who are aphasic from left cerebral dysfunction also frequently exhibit ideomotor apraxia in which they make temporal, spatial, and postural errors of learned skilled movements. However, hemispheric lateralization of the systems mediating ideomotor praxis in patients with atypical cerebral language dominance (i.e., bilateral or right hemispheric language function) remains uncertain. METHODS: Subjects included 90 patients with intractable seizures who were undergoing the intracarotid amobarbital procedure (IAP) as part of their preoperative evaluation for epilepsy surgery. Hand preference was determined by the Benton Handedness Questionnaire. Praxis was assessed by the subject's performance when pantomiming the use of four pictured tools. RESULTS: During left IAP, patients with typical language dominance made more ideomotor apraxic errors than did patients with atypical language dominance. During right IAP, patients with atypical language dominance made more ideomotor apraxic errors than did patients with typical language dominance. Overall, patients with atypical language dominance made fewer ideomotor apraxic errors than did patients with typical language dominance. These relationships were present irrespective of hand preference. CONCLUSIONS: Language dominance is more closely associated with the laterality of temporal and spatial movement representations (i.e., ideomotor praxis dominance) than is hand preference. Patients with atypical language dominance exhibit more bilateral cerebral distribution of both language and praxis function.

Adult↗

PubMed2004

Medical chemists and the origins of clinical chemistry in Britain (circa 1750-1850).

In this history, I review developments leading toward the establishment of clinical chemistry in Britain. Chemical research by certain physicians occurred in the context of medical traditions founded on vitalism, distillation analysis, and limited chemical knowledge. Urine chemistry figured prominently in this period together with the analysis of kidney and bladder stones. Bright's team studying albuminuria was the first clinical research school in Britain, whereas Prout's survey of physiological chemistry, based on meticulous attention to analysis, was the best summary of human metabolism before Liebig's Animal Chemistry. Liebig's ideas influenced all physicians who were interested in chemistry. Henry Bence Jones based his medical practice on Liebig's theories. His research relating urinary phosphates to diet and exercise revealed the so-called Bence Jones proteins and investigated the distribution and persistence of drugs in the body. J.L.W. Thudichum used analytical skills learned from Liebig in his brain chemistry work. George Owen Rees investigated urine analysis and the relationship between urine and blood, using Liebig's practical methods while condemning an uncritical acceptance of his theories. These and similar studies showed that chemistry could improve clinical medicine, and because it could also reveal the onset of disease even before clinical symptoms developed, it offered valuable support to preventive medicine. However, so many physicians resisted the introduction of chemistry that progress toward the establishment of clinical chemistry in nineteenth-century Britain was slow.

Animals↗

PubMed2002

A model for capacity-building in AIDS prevention programs.

This article discusses a collaboratively organizational capacity-building model for agencies engaged in HIV/AIDS prevention. The cooperative training approach (CTA) utilized by the Training and Technical Assistance Program trained participants to incorporate learned skills into their daily work practices, and to become trainers to help disseminate their newly acquired skills, first to others in their own organization and later to other organizations. The CTA was successfully implemented among 285 community-based organizations (CBOs) serving predominantly Hispanics in the U.S.-Mexico border region. The program evaluation demonstrated that it has significantly upgraded the program implementation capability and the organizational infrastructure of the participating organizations resulting in improved delivery of services to their clients. Furthermore, it fostered networking and collaboration for the development of sustainable training and technical assistance networks of agency staff skilled in organizational capacity building. It is suggested that funding agencies examine the feasibility of using this approach to increase the organizational capacity of CBOs involved in HIV/AIDS prevention.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Transcranial direct current stimulation during sleep improves declarative memory.

In humans, weak transcranial direct current stimulation (tDCS) modulates excitability in the motor, visual, and prefrontal cortex. Periods rich in slow-wave sleep (SWS) not only facilitate the consolidation of declarative memories, but in humans, SWS is also accompanied by a pronounced endogenous transcortical DC potential shift of negative polarity over frontocortical areas. To experimentally induce widespread extracellular negative DC potentials, we applied anodal tDCS (0.26 mA) [correction] repeatedly (over 30 min) bilaterally at frontocortical electrode sites during a retention period rich in SWS. Retention of declarative memories (word pairs) and also nondeclarative memories (mirror tracing skills) learned previously was tested after this period and compared with retention performance after placebo stimulation as well as after retention intervals of wakefulness. Compared with placebo stimulation, anodal tDCS during SWS-rich sleep distinctly increased the retention of word pairs (p < 0.005). When applied during the wake retention interval, tDCS did not affect declarative memory. Procedural memory was also not affected by tDCS. Mood was improved both after tDCS during sleep and during wake intervals. tDCS increased sleep depth toward the end of the stimulation period, whereas the average power in the faster frequency bands (,alpha, and beta) was reduced. Acutely, anodal tDCS increased slow oscillatory activity <3 Hz. We conclude that effects of tDCS involve enhanced generation of slow oscillatory EEG activity considered to facilitate processes of neuronal plasticity. Shifts in extracellular ionic concentration in frontocortical tissue (expressed as negative DC potentials during SWS) may facilitate sleep-dependent consolidation of declarative memories.

Adult↗

PubMed2005

Changes in brain activation during the acquisition of a multifrequency bimanual coordination task: from the cognitive stage to advanced levels of automaticity.

Little is known about activation changes reflecting overlearning, i.e., extensive motor training beyond asymptotic performance. Here we used functional magnetic resonance imaging to trace the neural shifts from an initial to a skilled (learning) and finally overlearned stage (automatization). Scanning occurred before training (PRE) and after 1 (MID) and 2 weeks (POST) of intensive practice on a new bimanual coordination task (>10,500 cycles). Kinematics revealed major improvements between PRE and MID sessions, whereas MID to POST session performance leveled off, indicative of learning and automatization, respectively. Imaging findings showed that activation decreased in bilateral opercular areas, bilateral ventrolateral prefrontal cortex, the right ventral premotor and supramarginal gyrus, and the anterior cingulate sulcus during the learning stage and in the supplementary motor area during the automatization stage. These changes are hypothesized to reflect decreases in attention-demanding sensory processing, as well as suppression of preferred coordination tendencies as a prelude to acquiring new coordination modes. Conversely, learning-related increases were observed in the primary motor cortex (M1), posterior cingulate zone (PCZ), putamen, and right anterior cerebellum. Importantly, both M1 and PCZ activation decreased again to initial level (PRE) during automated performance (POST). Only the putamen and anterior cerebellum remained more activated across both learning and automatization stages, supporting their crucial role in long-term motor memory formation for coordination tasks.

Adult↗

PubMed2006

Synaptic bombardment modulates muscarinic effects in forelimb motor cortex.

Neocortical neurons in vivo exist in an environment of continuous synaptic bombardment, receiving a complex barrage of excitatory and inhibitory inputs. This background activity (by depolarizing neurons, increasing membrane conductance, and introducing fluctuations) strongly alters many aspects of neuronal responsiveness. In this study, we asked how it shapes neuromodulation of postsynaptic responses. Specifically, we examined muscarinic modulation of forelimb motor cortex, a brain area in which cholinergic stimulation is known to be necessary for modifications during motor skill learning. Using a dynamic clamp system to inject simulated conductances into pyramidal neurons in motor cortical slices, we mimicked in vivo-like activity by introducing a random background of excitatory and inhibitory inputs. When muscarinic receptors were stimulated with the agonist oxotremorine-M, several previously described currents were modified, and excitability was increased. However, the presence of the background conductances strongly attenuated most muscarinic agonist effects, with the notable exception that sustained firing responses to trains of inputs were well preserved. This may be important for promoting plasticity in vivo.

Action Potentials↗

PubMed2003

Diagnosis and treatment of dysthymia in children and adolescents.

Dysthymic disorder is a chronic depressive condition occurring in 0.6-4.6% of children and 1.6-8.0% of adolescents. Although symptoms are less severe than those observed in major depression, childhood-onset dysthymic disorder is characterised by a persistent and long-term depressed or irritable mood (mean episode duration 3-4 years), a worse outcome than major depression and, frequently, comorbid disorders (in around 50% of patients). Long-lasting depressive symptoms seem responsible for long-term disabling consequences on social skill learning, psychosocial functioning and consequent professional life, probably contributing to a higher risk of relapse or development of major depression. Consistently, the first episode of major depression occurs 2-3 years after the onset of dysthymic disorder, suggesting that the latter is one of the gateways to recurrent mood disorders. The primary aims of treatment for dysthymic disorder should be to resolve depressive symptoms, reduce the risk of developing other mood disorders over time and strengthen psychosocial functioning, especially in children and adolescents, in order to prevent the potentially serious sequelae of this disorder. As children with dysthymia often have multiple problems, interventions should involve multiple levels and measures: individual psychotherapy, family therapy/education and pharmacological treatment. Psychotherapeutic techniques, such as cognitive-behaviour therapy and interpersonal therapy, have been found to be efficacious interventions in treating children and adolescents with mild to moderate depression in studies including patients with either dysthmia or double depression. SSRIs are the first-line drug treatment for children and adolescents because of their safety, adverse effect profile and ease of use (the safety of paroxetine is currently under investigation). Several nonblind studies have shown the efficacy and good tolerability of SSRIs in children and adolescents with dysthymic disorder, but further research is needed to confirm their efficacy and that of newer antidepressants in the treatment of this disorder. Regardless of whether psychotherapeutic or medical treatments are planned, according to clinical experience, psychoeducational interventions and psychosocial support should be provided to parents and other caregivers during the acute treatment phase to help manage the child's irritable mood and foster a therapeutic alliance and better compliance with treatment. Unfortunately, no studies have focused on continuation treatment of paediatric dysthymic disorder. Given the chronicity, recurrence, psychosocial consequences and peculiar response pattern to treatment of dysthymic disorder, establishing effective 'acute' and 'continuation' interventions in this group of patients should be a priority in mental health management.

Adolescent↗

PubMed1995

Observation of response strategies in cycling time trials.

Athletes in sprint events use various mental and physical starting strategies prior to beginning a race. Included among these strategies are sensory-set and motor-set strategies. A sensory-set strategy is one in which the athlete concentrates on reacting as fast as possible to an auditory or visual stimulus. A motor-set strategy is one in which the athlete consciously attends to a component of a well-learned skill rather than to the stimulus which evokes the initiation of the skill. The purpose of this study was to observe differences in starting techniques of 20 championship cyclist responded significantly faster after the auditory stimulus and recorded faster 1/2-lap split times than 10 proficient cyclists. Strategy selection and use of elite cyclists should be investigated further to examine efficient starting strategies and procedures.

Adult↗

PubMed2003

Knowledge and imagery of contractile mechanisms do not improve muscle strength.

Improving performance in strength tasks requires modifications charateristic of motor skill learning, such as more efficacious motor-unit firing behavior. Because domain-specific knowledge is integral to learning and performing motor kills, the present purpose was to examine selected factors of strength-specific knowledge and effects they might have on acquiring strength. Following baseline testing for maximal strength on a knee-extension task, participants were matched by sex and strength and placed into control (n=8) and treatment (n=8) groups. Quadriceps muscle electromyographic data were also collected. The treatment group underwent two educational sessions detailing muscle physiology, neural control of muscle force, and imagery training using this knowledge. The control group underwent two educational sessions about health and fitness. Following the educational sessions the participants were retested for strength. Analysis indicated that the education and imagery treatment had no effect on strength, nor did electromyographic measures indicate that the treatment group benefitted from intervention. It was concluded that the knowledge was simply not relevant to knee extension-force production or that use of the knowledge involved a disadvantageous internal focus of attention away from relevant task demands.

Adolescent↗

PubMed1999

Internal consistency and discriminant validity of the Luria Nebraska Neuropsychological Battery-III.

This research presents data pertaining to the development of the recently revised Luria Nebraska Neuropsychological Battery-III. The final version of this test battery consists of 31 clinical scales yielding 35 scores. The battery was given to 109 non brain-injured controls and 119 brain-injured subjects. High internal consistency was demonstrated for each clinical scale. Results further indicated that the test battery was very effective at discriminating between normal and brain-injured subjects, as significant between-group differences on 33 of 35 scores were observed. Significant between-group differences were also observed on 25 of the 35 scores when age and education were covaried out of the analyses; those scales not displaying significant between-group differences generally measured very basic over-learned skills.

Adolescent↗

PubMed1991

Achievement of objectives: internal medicine fourth year clinical clerkship.

The clinical clerkship in Canadian Medical Schools is intended to provide senior medical students with opportunities to gain practical knowledge of clinical medicine, develop technical skills, learn to use judgement and experience first-hand clinical decision making. Assessment of rotations in internal medicine were undertaken in order to understand more fully the nature of medical clerkship experiences. We found that medical clerks in our programme were exposed to a high proportion of undifferentiated problems and an adequate case mix. They performed a wide range of technical procedures. There were, however, certain gaps in the clerks' experiences both in the specialty areas, and in therapeutic and technical procedures. Recognition of these gaps in the clerkship experiences suggest that further deliberation of goals and objectives is required and issues of achievement of competencies need to be addressed.

Adult↗

PubMedDate not supplied

Nursing program to meet the challenge of caring for patients with water intoxication.

This article describes a program that is effective in working with psychiatric patients who have trouble with excessive water intake. The purpose of the program is to provide consistent treatment in a controlled and therapeutic environment in which the special needs of these patients can be met. We incorporate a variety of nursing interventions suggested by the literature to help meet the goals of the program. As a result of the program, disruptive behavior has decreased and patients have learned skills to help them manage their illness. An additional benefit of the program is that working with water intoxication patients is no longer stressful for staff.

Hospital Units↗

PubMed1997

Virtual reality, disability and rehabilitation.

Virtual reality, or virtual environment computer technology, generates simulated objects and events with which people can interact. Existing and potential applications for this technology in the field of disability and rehabilitation are discussed. The main benefits identified for disabled people are that they can engage in a range of activities in a simulator relatively free from the limitations imposed by their disability, and they can do so in safety. Evidence that the knowledge and skills acquired by disabled individuals in simulated environments can transfer to the real world is presented. In particular, spatial information and life skills learned in a virtual environment have been shown to transfer to the real world. Applications for visually impaired people are discussed, and the potential for medical interventions and the assessment and treatment of neurological damage are considered. Finally some current limitations of the technology, and ethical concerns in relation to disability, are discussed.

Activities of Daily Living↗

PubMed1993

Age differences in implicit memory: more apparent than real.

Elderly subjects and a group of young subjects identified fragmented picture sequences under conditions of focused attention. Two other groups of young subjects carried out this task under divided-attention conditions. Implicit memory, as measured by item-specific savings, was found in all groups, but this effect was smaller in the elderly group. The young subjects, but not elderly subjects, performed better on new items. The divided-attention conditions equated recall and recognition by the young and the elderly, but only the young subjects showed greater savings for recalled items. The elderly subjects' reduced implicit memory therefore stemmed from their inability to facilitate implicit memory with explicit memory. A second experiment, involving only young subjects tested after delay, produced findings similar to those for the young divided-attention subjects. Implicit memory, as measured by savings in picture completion, does not show an age-related change when the role of explicit memory is considered. Age does, however, reduce skill learning.

Adult↗

PubMedDate not supplied

Institute for Nursing Excellence: a retention model.

In 1989, the General Assembly funded initiatives for the recruitment and retention of nurses, including two pilot "Institutes for Nursing Excellence" designed to develop, recognize, and reward excellent staff nurses. The Wake Area Health Education Center (AHEC) implemented the pilot projects. In 1991, additional funding was obtained to replicate the pilot projects. The grant was awarded to the Wake AHEC from the General Assembly, through the newly established Center for Nursing. This cooperative effort between the legislature and nursing is considered a model of its kind in this state and possibly the nation. The purpose of the Institute was to develop mentoring, role-modeling, change, and lifelong learning skills in an atmosphere of renewal, rejuvenation, and trust.

Academies and Institutes↗

PubMed1998

Enabling student nurses to use the information superhighway.

Nursing graduates must be sophisticated in the use of information technologies and understand how these technologies interface with various health care systems. The purpose of this project was to evaluate the impact of a newly developed Internet course, focusing on current information technologies, on 20 RN-to-MSN students. Author-developed instruments were used to measure weekly computer use, perceived computer skill, and knowledge related to the information superhighway. The Stronge & Brodt Nurses Attitudes Toward Computerization Questionnaire was used to assess attitudes toward computerization. Qualitative data was elicited using weekly evaluation forms. When compared to 23 students at a similar stage of their nursing program, quantitative findings indicated that, at the end of the semester, students in the pilot course had more computer knowledge, reported greater computer skill, and used computers more. Qualitative findings suggested that pilot students: * Were connected with nursing networks and expressed their intent to maintain these networks. * Were able to use current health information found on the Internet in their nursing practices. * Used skills learned in the pilot class to complete projects in other classes. * Communicated with classmates via the Internet, thus forming a potentially valuable professional support system. * Used the library and librarians early in their programs. * Understood the relevancy of telemedicine and the Internet to the future survival of nursing in a changing health care arena. While the authors caution that an adequate infrastructure must be available to support such an endeavor, they emphasize that knowledge of the relevancy and use of the information superhighway is crucial to the future survival of nursing in a rapidly changing health care arena.

Adult↗