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Nonverbal social interaction skills of children with learning disabilities.

Many children with learning disabilities (LD) face problems in their nonverbal communication, which constitutes an important component of their social skills. This study explores the frequency of nonverbal initiations and responses of 36 children with LD and 36 children without LD matched for age and gender, who were observed for 40 min during the break. Younger and older children with and without LD did not differ significantly in their nonverbal responses, but there was a statistically significant difference in terms of younger children's nonverbal initiations. Younger children with LD exhibited significantly fewer nonverbal initiations than younger children without LD. Findings are discussed and suggestions are made for further research.

Adaptation, Psychological↗

No effects of enhanced central norepinephrine on finger-sequence learning and attention.

RATIONALE: When paired with training, substances that increase monoaminergic transmission in the brain support motor and language learning in healthy subjects and in rehabilitation after brain lesions. OBJECTIVES: To test the hypotheses that enhancement of central norepinephrine by the selective norepinephrine reuptake inhibitor reboxetine (1) improves skilled motor performance, (2) promotes skilled motor learning, and (3) does not exert these effects by modulation of attention. METHODS: In a double blind, placebo-controlled, crossover study in healthy, adult subjects (n=16), finger-sequence performance and learning was measured after the stimulation of the central noradrenergic system with a single dose (8 mg) of reboxetine and placebo. Effects on attention were assessed by the standardized continuous performance test "CPT-M". RESULTS: No differential effects of reboxetine or placebo on finger-sequence performance, learning and parameters of attention were found. CONCLUSION: Selective stimulation of the central noradrenergic system did not promote skilled motor learning or performance as assessed by finger-sequences. The plasticity-enhancing effect of reboxetine, documented in other studies, appears to be dependent on specific neurophysiological and neuropsychological characteristics of the task, and cannot be generalized to other behavioral paradigms.

Adrenergic Uptake Inhibitors↗

Interactive videodisc instruction is an alternative method for learning and performing a critical nursing skill.

A study was conducted to compare the effectiveness of interactive videodisc instruction (IVDI) with the traditional lecture/demonstration as an alternative method for learning and performing a critical nursing skill. Students were assigned randomly to a treatment group that worked in small groups to complete the IVDI on intravenous therapy skills and a control group receiving the same content in a classroom lecture/demonstration format. After the instruction, each subject performed a re-demonstration of the learned skills using specific guidelines. Results revealed that although the IVDI group scored higher on the overall re-demonstration, there was no significant difference in the ability of the two groups to effectively perform this critical nursing skill. These findings support the use of IVDI as an alternative self-paced, independent study method for learning psychomotor skills and are consistent with previous studies, which indicate that working in small groups on the computer has a positive effect on self-efficacy and achievement.

Computer-Assisted Instruction↗

The role of kinematic redundancy in adaptation of reaching.

Although important differences exist between learning a new motor skill and adapting a well-learned skill to new environmental constraints, studies of force field adaptation have been used frequently in recent years to identify processes underlying learning. Most of these studies have been of reaching tasks that were each hand position was specified by a unique combination of joint angles. At the same time, evidence has been provided from a variety of tasks that the central nervous system takes advantage of the redundancy available to it when planning and executing functional movements. The current study attempted to determine whether a change in the use of joint motion redundancy is associated with the adaptation process. Both experimental and control subjects performed 160 trials of reaching in each of four adaptation phases, while holding the handle of a robot manipulandum. During the first and last adaptation phases, the robot motors were turned off. During phases 2 and 3 the motors produced a velocity-dependent force field to which experimental subjects had to adapt to regain relatively straight line hand movements during reaching to a target, while the motors remained off for the control group. The uncontrolled manifold (UCM) method was used to partition the variance of planar clavicle-scapular, shoulder, elbow and wrist joint movements into two orthogonal components, one (V(UCM)) that reflected combinations of joint angles that were equivalent with respect to achieving the average hand path and another (V(ORT)) that took the hand away from its average path. There was no change in either variance component for the control group performing 640 non-perturbed reaches across four 'pseudo-adaptation' phases. The experimental group showed adaptation to reaching in the force field that was accompanied initially by an increase in both components of variance, followed by a smaller decrease of V(UCM) than V(ORT) during 320 practice reaches in the force field. After initial re-adaptation to reaching to the null field, V(UCM) was higher in experimental than in control subjects after performing a comparable number of reaches. V(UCM) was also larger in the experimental group after re-adaptation when compared to the 160 null field reaching trials performed prior to initial force field introduction. The results suggest that the central nervous system makes use of kinematic redundancy, or flexibility of motor patterns, to adapt reaching performance to unusual force fields, a fact that has implications for the hypothesis that motor adaptation requires learning of formal models of limb and environmental dynamics.

Adaptation, Physiological↗

Mental practice and acquisition of motor skills: examples from sports training and surgical education.

Learning surgical skills involves both fine and gross motor skills, and necessitates performance in stressful situations. This environment is similar to the environment in which an athlete performs. Mental imagery has been used successfully in training athletes of all levels of proficiency and enhances both motor skills and motivational skills of performing under stress. The literature of using mental imagery to train surgeons is limited to the teaching of simple surgical skills, but shows promise as another tool to teach technical skills.

Clinical Competence↗

Developing essential professional skills: a framework for teaching and learning about feedback.

BACKGROUND: The ability to give and receive feedback effectively is a key skill for doctors, aids learning between all levels of the medical hierarchy, and provides a basis for reflective practice and life-long learning. How best to teach this skill? DISCUSSION: We suggest that a single "teaching the skill of feedback" session provides superficial and ineffective learning in a medical culture that often uses feedback skills poorly or discourages feedback. Our experience suggests that both the skill and the underlying attitude informing its application must be addressed, and is best done so longitudinally and reiteratively using different forms of feedback delivery. These feedback learning opportunities include written and oral, peer to peer and cross-hierarchy, public and private, thereby addressing different cognitive processes and attitudinal difficulties. SUMMARY: We conclude by asking whether it is possible to build a consensus approach to a framework for teaching and learning feedback skills?

Assertiveness↗

Learning manual pursuit tracking skills in patients with Parkinson's disease.

Evidence from a number of sources identifies the putamen and its ultimate cortical projection sites as forming a possible substrate for motor learning. The present paper describes two experiments which explored motor learning of a pursuit tracking task under first (position) and second (velocity) order control dynamics, in patients with Parkinson's disease on and off (experiment 2 only) their normal dopaminergic medication. In neither experiment did the medicated patients show evidence of significant impairment in learning the tasks. In the velocity tracking task, however, the patients off medication showed significantly less improvement in performance with practice. The discussion considers a number of possible interpretations of this finding. Contemporary cognitive theories of motor learning consider behavioural change with practice to be the combined action of an automatic procedural system, together with input from a conscious declarative system. Development of declarative knowledge about the task may have changed the nature of the process involved, from a visually guided task to a more predictive one based upon an internal representation. Evidence from various sources suggests that patients with Parkinson's disease have particular problems with this mode of control, thus making the task more difficult. It is suggested that motor control deficits have not been adequately considered in previous studies on motor learning, and that the evidence from clinical studies for a role of the putamen/supplementay motor area in motor learning remains equivocal.

Aged↗

Dissociable stages of human memory consolidation and reconsolidation.

Historically, the term 'memory consolidation' refers to a process whereby a memory becomes increasingly resistant to interference from competing or disrupting factors with the continued passage of time. Recent findings regarding the learning of skilled sensory and motor tasks ('procedural learning') have refined this definition, suggesting that consolidation can be more strictly determined by time spent in specific brain states such as wake, sleep or certain stages of sleep. There is also renewed interest in the possibility that recalling or 'reactivating' a previously consolidated memory renders it once again fragile and susceptible to interference, therefore requiring periods of reconsolidation. Using a motor skill finger-tapping task, here we provide evidence for at least three different stages of human motor memory processing after initial acquisition. We describe the unique contributions of wake and sleep in the development of different forms of consolidation, and show that waking reactivation can turn a previously consolidated memory back into a labile state requiring subsequent reconsolidation.

Fingers↗

Impaired learning of a motor skill in patients with Huntington's disease.

The ability of patients with Huntington's disease (HD), patients with dementia of the Alzheimer's type (DAT), and amnesic patients (AMN) to acquire the motor skills underlying a pursuit rotor task was assessed. Differences between groups in initial levels of performance were minimized by adjusting the rotation speed of the disk. The HD and DAT groups were also administered a verbal recognition span test. The results showed that the DAT, AMN, and intact control groups all significantly improved their time on target over six test blocks whereas the HD group was severely impaired in the acquisition of this motor skill. On the verbal recognition span test, the DAT and HD groups were significantly and equally impaired, but the HD group evidenced better immediate and delayed recall than did the DAT group. These results provide further evidence that the basal ganglia are critically involved in the acquisition of motor skills.

Alzheimer Disease↗

The obstetrics and gynecology clerkship: building a better model from past experience.

OBJECTIVE: The study was undertaken to identify factors contributing to the poor student perception of the obstetrics and gynecology clerkship. STUDY DESIGN: Third-year medical students at the University of Michigan complete an annual questionnaire about the overall quality of their clinical experiences. In addition, at the end of each rotation, the students complete an evaluation form assessing various aspects of their learning experience. We reviewed data collected from 2000 to 2002. We calculated effect sizes using mean scores and SDs to compare individual aspects of the learning environment across the clerkships. RESULTS: Twenty-six percent of the third-year medical students at the University of Michigan rated the strength of their obstetrics and gynecology experience as very or exceptionally strong. Compared with the other 6 clerkships, the rotation had one of the lowest ratings for overall quality. Aspects of the clerkship experience we identified as potentially explaining this overall poor rating include the clarity of the clerkship goals and objectives, clarity of expectations for student performance, accessibility of faculty, experiences in learning history-taking skills, experiences in learning physical examination skills, and student perception that they were treated in a respectful/professional manner. CONCLUSION: Aspects of the clerkship experience identified by this study as potentially explaining the low ratings of the obstetrics and gynecology rotation should be studied in greater detail. Addressing these factors will be critical for improving the overall student perception of the obstetrics and gynecology clerkship.

Adult↗

Health professionals' views of informatics education: findings from the AMIA 1999 spring conference.

Health care leaders emphasize the need to include information technology and informatics concepts in formal education programs, yet integration of informatics into health educational programs has progressed slowly. The AMIA 1999 Spring Congress was held to address informatics educational issues across health professions, including the educational needs in the various health professions, goals for health informatics education, and implementation strategies to achieve these goals. This paper presents the results from AMIA work groups focused on informatics education for non-informatics health professionals. In the categories of informatics needs, goals, and strategies, conference attendees suggested elements in these areas: educational responsibilities for faculty and students, organizational responsibilities, core computer skills and informatics knowledge, how to learn informatics skills, and resources required to implement educational strategies.

Computer User Training↗

Finding a new path.

When a clinician becomes a physician-executive, the shift is abrupt, confusing, and marked by few signposts. To be an organizational leader-especially in the 1990s, in health care more than in any other industry-is to be a master of teamwork, a maven of process, at home with ambiguity, comfortable with change, a nurturer of consensus, yet decisive, ready to move in the face of all the ambiguity. The hyphenated physician-executive lives in a state of culture shock. The first major step to overcoming this unfamiliar terrain is to recognize that the traits of the true organizational leader are, in fact, skills. The second step is to learn these skills, to set out deliberately, this far along in life, on a new kind of training, a new path.

Career Mobility↗

Program director satisfaction with leadership skills.

CONTEXT: Educators in radiologic technology help students mature into health care professionals; however, not all educators receive formal training in education. The majority of radiologic technology educators train first as practitioners and later become educators. OBJECTIVE: Identify areas for professional development and effective methods to learn leadership skills. METHODS: Radiologic technology program directors from Joint Review Committee on Education in Radiologic Technology (JRCERT) accredited programs were surveyed and interviewed to determine their level of satisfaction with their leadership skills. RESULTS: Results indicate program directors are satisfied with most of their leadership skills. Budget and resources, conflict resolution and communication were identified as areas for improvement. Program directors identified workshops and lectures as their preferred method of learning leadership skills. SUMMARY: Program directors need to use a variety of skills for the successful operation of their programs. Even though results from this study indicate that radiologic technology program directors were satisfied overall with their leadership skills, there were areas that could use improvement.

Administrative Personnel↗