Diagnostic Palpation in Osteopathic Medicine: A Putative Neurocognitive Model of Expertise

This thesis examines the extent to which the development of expertise in diagnostic palpation in osteopathic medicine is associated with changes in cognitive processing. Chapter 2 and Chapter 3 review, respectively, the literature on the role of analytical and non-analytical processing in osteopathic and medical clinical decision making; and the relevant research on the use of vision and haptics and the development of expertise within the context of an osteopathic clinical examination. The two studies reported in Chapter 4 examined the mental representation of knowledge and the role of analogical reasoning in osteopathic clinical decision making. The results reported there demonstrate that the development of expertise in osteopathic medicine is associated with the processes of knowledge encapsulation and script formation. The four studies reported in Chapters 5 and 6 investigate the way in which expert osteopaths use their visual and haptic systems in the diagnosis of somatic dysfunction. The results suggest that ongoing clinical practice enables osteopaths to combine visual and haptic sensory signals in a more efficient manner. Such visuo-haptic sensory integration is likely to be facilitated by top-down processing associated with visual, tactile, and kinaesthetic mental imagery. Taken together, the results of the six studies reported in this thesis indicate that the development of expertise in diagnostic palpation in osteopathic medicine is associated with changes in cognitive processing. Whereas the experts’ diagnostic judgments are heavily influenced by top-down, non-analytical processing; students rely, primarily, on bottom-up sensory processing from vision and haptics. Ongoing training and clinical practice are likely to lead to changes in the clinician’s neurocognitive architecture. This thesis proposes an original model of expertise in diagnostic palpation which has implications for osteopathic education. Students and clinicians should be encouraged to appraise the reliability of different sensory cues in the context of clinical examination, combine sensory data from different channels, and consider using both analytical and nonanalytical reasoning in their decision making. Importantly, they should develop their skills of criticality and their ability to reflect on, and analyse their practice experiences in and on action

Augmented visual, auditory, haptic, and multimodal feedback in motor learning: A review

It is generally accepted that augmented feedback, provided by a human expert or a technical display, effectively enhances motor learning. However, discussion of the way to most effectively provide augmented feedback has been controversial. Related studies have focused primarily on simple or artificial tasks enhanced by visual feedback. Recently, technical advances have made it possible also to investigate more complex, realistic motor tasks and to implement not only visual, but also auditory, haptic, or multimodal augmented feedback. The aim of this review is to address the potential of augmented unimodal and multimodal feedback in the framework of motor learning theories. The review addresses the reasons for the different impacts of feedback strategies within or between the visual, auditory, and haptic modalities and the challenges that need to be overcome to provide appropriate feedback in these modalities, either in isolation or in combination. Accordingly, the design criteria for successful visual, auditory, haptic, and multimodal feedback are elaborate

An aesthetics of touch: investigating the language of design relating to form

How well can designers communicate qualities of touch? This paper presents evidence that they have some capability to do so, much of which appears to have been learned, but at present make limited use of such language. Interviews with graduate designer-makers suggest that they are aware of and value the importance of touch and materiality in their work, but lack a vocabulary to fully relate to their detailed explanations of other aspects such as their intent or selection of materials. We believe that more attention should be paid to the verbal dialogue that happens in the design process, particularly as other researchers show that even making-based learning also has a strong verbal element to it. However, verbal language alone does not appear to be adequate for a comprehensive language of touch. Graduate designers-makers’ descriptive practices combined non-verbal manipulation within verbal accounts. We thus argue that haptic vocabularies do not simply describe material qualities, but rather are situated competences that physically demonstrate the presence of haptic qualities. Such competencies are more important than groups of verbal vocabularies in isolation. Design support for developing and extending haptic competences must take this wide range of considerations into account to comprehensively improve designers’ capabilities

Haptic-Enhanced Learning in Preclinical Operative Dentistry

Background: Virtual reality haptic simulators represent a new paradigm in dental education that may potentially impact the rate and efficiency of basic skill acquisition, as well as pedagogically influence the various aspects of students’ preclinical experience. However, the evidence to support their efficiency and inform their implementation is still limited. Objectives: This thesis set out to empirically examine how haptic VR simulator (Simodont®) can enhance the preclinical dental education experience particularly in the context of operative dentistry. We specify 4 distinct research themes to explore, namely: simulator validity (face, content and predictive), human factors in 3D stereoscopic display, motor skill acquisition, and curriculum integration. Methods: Chapter 3 explores the face and content validity of Simodont® haptic dental simulator among a group of postgraduate dental students. Chapter 4 examines the predictive utility of Simodont® in predicting subsequent preclinical and clinical performance. The results indicate the potential utility of the simulator in predicting future clinical dental performance among undergraduate students. Chapter 5 investigates the role of stereopsis in dentistry from two different perspectives via two studies. Chapter 6 explores the effect of qualitatively different types of pedagogical feedback on the training, transfer and retention of basic manual dexterity dental skills. The results indicate that the acquisition and retention of basic dental motor skills in novice trainees is best optimised through a combination of instructor and visualdisplay VR-driven feedback. A pedagogical model for integration of haptic dental simulator into the dental curriculum has been proposed in Chapter 7. Conclusion: The findings from this thesis provide new insights into the utility of the haptic virtual reality simulator in undergraduate preclinical dental education. Haptic simulators have promising potential as a pedagogical tool in undergraduate dentistry that complements the existing simulation methods. Integration of haptic VR simulators into the dental curriculum has to be informed by sound pedagogical principles and mapped into specific learning objectives

How to achieve synergy between medical education and cognitive neuroscience? An exercise on prior knowledge in understanding

A major challenge in contemporary research is how to connect medical education and cognitive neuroscience and achieve synergy between these domains. Based on this starting point we discuss how this may result in a common language about learning, more educationally focused scientific inquiry, and multidisciplinary research projects. As the topic of prior knowledge in understanding plays a strategic role in both medical education and cognitive neuroscience it is used as a central element in our discussion. A critical condition for the acquisition of new knowledge is the existence of prior knowledge, which can be built in a mental model or schema. Formation of schemas is a central event in student-centered active learning, by which mental models are constructed and reconstructed. These theoretical considerations from cognitive psychology foster scientific discussions that may lead to salient issues and questions for research with cognitive neuroscience. Cognitive neuroscience attempts to understand how knowledge, insight and experience are established in the brain and to clarify their neural correlates. Recently, evidence has been obtained that new information processed by the hippocampus can be consolidated into a stable, neocortical network more rapidly if this new information fits readily into a schema. Opportunities for medical education and medical education research can be created in a fruitful dialogue within an educational multidisciplinary platform. In this synergetic setting many questions can be raised by educational scholars interested in evidence-based education that may be highly relevant for integrative research and the further development of medical education

Interactive Virtual Suturing Simulations: Enhancement of Student Learning in Veterinary Medicine

A capstone submitted in partial fulfillment of the requirements for the degree of Doctor of Education in the College of Education at Morehead State University by Christine B. Boyd and Amy J. Staton on December 29, 2013

Factors related to braille acquisition among adult and senior learners : establishing evidence-based practice

Les difficultés de lecture sont les raisons les plus fréquentes pour lesquelles des personnes sont orientées vers un service de réadaptation visuelle. Bien qu’il existe une base historique solide à propos de l’enseignement du braille chez les enfants aveugles, il existe très peu de données probantes concernant l’apprentissage du braille chez les personnes en âge de travailler et les personnes âgées. De surcroît, bien qu’il soit clair que le vieillissement est associé à un déclin des capacités tactiles, motrices et cognitives, on sait peu de choses sur la manière dont ces variables peuvent influencer les résultats de la lecture du braille. Pour examiner cette problématique, une étude en quatre phases a été conceptualisée. Dans la première phase, une étude de la portée a été menée afin de synthétiser les connaissances existantes concernant la relation entre le déclin des capacités lié au vieillissement et la performance de la lecture en braille. La seconde a voulu étudier les obstacles et les facilitateurs rencontrés par les adultes qui suivent une formation en braille. La troisième a exploré les variables qui sont en corrélation avec la performance de lecture en braille à l’âge adulte. Enfin, la dernière phase a voulu se pencher sur l’influence du support de lecture sur la performance de lecture des adultes ayant une sensibilité tactile réduite. Les preuves antérieures concernant le braille et le vieillissement restent rares. Il existe une variété de facteurs personnels, sociaux et institutionnels qui façonnent le processus d’apprentissage du braille chez les adultes, incluant la stigmatisation envers le braille et le vieillissement perçue par certains praticiens, des services inadéquats et des difficultés à l’accès aux équipements brailles. Des données soulignent la nécessité de commencer l’apprentissage du braille le plus tôt possible, d’évaluer des mesures objectives de l’acuité tactile tout en considérant le rôle de la fonction du toucher, de fournir une formation accrue en matière de perception tactile et d’envisager une plus grande intégration d’appareils braille. Les résultats font également ressortir la nécessité d’augmenter le financement et les services ; de définir des critères d’éligibilité qui tiennent compte des réalités uniques des clients âgés et l’accès au braille ; et d’étudier plus avant le rôle de la stigmatisation vis-à-vis du braille et du vieillissement. En somme, tous ces éléments réunis peuvent influencer à la fois les décisions cliniques et les résultats d’apprentissage.Reading difficulties are the most common reasons for referral to vision rehabilitation. Though there is a strong historical basis for the provision of braille instruction among blind children, there is little evidence-based research on the needs of working-age and older adults. Aging is associated with declines in tactile, motor and cognitive capacities. Moreover, learning in adulthood is distinct from childhood learning, owing to differences in cortical plasticity and development. Little is known about how these variables may influence braille reading outcomes, but such knowledge is needed to inform the design of evidence-based strategies. For example, low-cost braille devices incorporate dots of greater height and density, but the extent to which such approaches may enhance reading performance for older adults with reduced tactile sensitivity remains unexplored. These questions are especially imperative as the prevalence of age-related vision loss continues to increase. A four-phase study was devised to synthesize prior evidence on the interrelationship between factors known to decline with age and braille reading performance; to investigate the barriers and facilitators encountered by working-age and older adults who pursue braille training; to identify variables that correlate with braille reading performance in adulthood; and to explore the influence of reading medium on the reading performance of adults with reduced tactile sensitivity. This thesis confirms that prior evidence on braille and aging remains scant, heightening the imperative for further research in this domain. Moreover, there are a variety of personal, social and institutional factors which shape the adult braille learning process, including perceived stigma towards braille and aging among some practitioners, inadequate services and access to braille devices. Braille learning age, frequency of usage, and measures of active tactile acuity emerged as significant correlates of braille reading speed. Preliminary evidence suggests that using braille displays with greater dot height enhances performance for those with reduced tactile sensitivity, while also enabling immediate access to relevant reading content. Collectively, these findings point to the need for rehabilitation practitioners to introduce braille as early as possible, evaluate objective measures of tactile acuity while also considering the role of functional touch, provide increased training in tactile perception, and consider a wider integration of braille devices. Findings also highlight the need for increased funding and services, eligibility criteria which takes into account the unique realities of older braille clients, and the need to further explore the role of stigma towards braille and aging which may influence both clinical decisions and learning outcomes

Osteopathic clinical reasoning: an ethnographic study of perceptual diagnostic judgments, metacognition, and reflective practice

A thesis submitted to the University of Bedfordshire in partial fulfilment of the requirements for the degree of Professional DoctorateThis thesis explores the use of reflective practice in osteopathic medicine and uses the method to narrate my work as an osteopathic practitioner. It explores the development of perceptual diagnostic judgments, and the role of metacognition, intuition and palpation in osteopathic clinical reasoning. A qualitative interpretive approach was used with a novel narrative method as an organising structure. This was broadly based around reflective practice models of Gibbs, (1988), Kolb, (1984) and Carper (1978) and the ideas of Schön (1983). Descriptive texts were constructed from notes taken of my thoughts whilst in the presence of patients. This allowed access, as closely as possible, to my decision making process. Finally, the descriptive texts were expanded into narratives through dialogue with the existing literature and peer review. The narratives were then analysed using thematic analysis to derive an understanding of concepts arising from the data. This thesis argues that osteopathic clinical reasoning involves multisensory perceptual diagnostic judgments that begin as soon as the patient enters the clinic, and arise as a result of the use of mental and visual imagery and embodied senses. The multisensory information that is detected by a practitioner activates pattern recognition, analytic reasoning and provides explicit feedback used in decision making. Diagnosis occurs as a result of piecing together and interpreting the multisensory information whilst maintaining awareness of other diagnostic possibilities. The findings also suggest that osteopathic clinical reasoning involves the supervision of cognition by the metacognitive processes of meta-knowledge (MK), meta-experiences (ME), and meta-skills (MS). The latter are used to plan, monitor, analyse, predict, evaluate and revise the consultation and patient management as suggested by Pesut and Herman (1992). ME is demonstrated by the presence of judgments of learning used to ensure sufficient information has been gathered, and feelings of rightness that are used to perceive the correctness of information arriving and decisions made. The use of reflective practice in this research has developed the understanding of osteopathic clinical reasoning, and demonstrated that it provides a powerful conduit for change in practice. As a result, it enables the provision of better patient-centred osteopathic healthcare incorporating the biopsychosocial model of healthcare. Although rooted in my own osteopathic practice style and strategies, it should have resonance for those within the discipline of osteopathy and has implications for osteopathic education, training and research

Development and Validation of a Hybrid Virtual/Physical Nuss Procedure Surgical Trainer

With continuous advancements and adoption of minimally invasive surgery, proficiency with nontrivial surgical skills involved is becoming a greater concern. Consequently, the use of surgical simulation has been increasingly embraced by many for training and skill transfer purposes. Some systems utilize haptic feedback within a high-fidelity anatomically-correct virtual environment whereas others use manikins, synthetic components, or box trainers to mimic primary components of a corresponding procedure. Surgical simulation development for some minimally invasive procedures is still, however, suboptimal or otherwise embryonic. This is true for the Nuss procedure, which is a minimally invasive surgery for correcting pectus excavatum (PE) – a congenital chest wall deformity. This work aims to address this gap by exploring the challenges of developing both a purely virtual and a purely physical simulation platform of the Nuss procedure and their implications in a training context. This work then describes the development of a hybrid mixed-reality system that integrates virtual and physical constituents as well as an augmentation of the haptic interface, to carry out a reproduction of the primary steps of the Nuss procedure and satisfy clinically relevant prerequisites for its training platform. Furthermore, this work carries out a user study to investigate the system’s face, content, and construct validity to establish its faithfulness as a training platform

Virtual Reality Games for Motor Rehabilitation

This paper presents a fuzzy logic based method to track user satisfaction without the need for devices to monitor users physiological conditions. User satisfaction is the key to any product’s acceptance; computer applications and video games provide a unique opportunity to provide a tailored environment for each user to better suit their needs. We have implemented a non-adaptive fuzzy logic model of emotion, based on the emotional component of the Fuzzy Logic Adaptive Model of Emotion (FLAME) proposed by El-Nasr, to estimate player emotion in UnrealTournament 2004. In this paper we describe the implementation of this system and present the results of one of several play tests. Our research contradicts the current literature that suggests physiological measurements are needed. We show that it is possible to use a software only method to estimate user emotion