Kaasaegsete kognitiivsete ja sotsiaalsete sekkumistehnikate loomine pediaatrilises neurorehabilitatsioonis ajukahjustusega lastel

Väitekirja elektrooniline versioon ei sisalda publikatsiooneOmandatud ajukahjustusega lapsed vajavad kaasuva kognitiivse ja sotsiaalse defitsiidi diagnostikat ja rehabilitatsiooni, mis on oluline lapse akadeemilise edukuse ja elukvaliteedi parandamisel. Neurorehabilitatsioon on plaanipärane sekkumine, mille eesmärk on kompenseerida või kergendada ajukahjustusest põhjustatud defitsiiti. Antud doktoritöö eesmärk oli uute arvutipõhiste meetodite kasutuselevõtmine omandatud ajukahjustusega laste kognitiivses ja sotsiaalses neurorehabilitatioonis. Treeningdisainid loodi tähelepanu, ruumitaju ja sotsiaalse kompetentsi häirete raviks. Uuringus osales 59 epilepsia, ajutrauma või tikkide diagnoosiga ja 47 tervet kontrollgrupi last vanuses 8–12 aastat. Patsiendid läbisid rehabilitatsiooni (10 treeningut) koos eelneva ja treeningujärgse testimisega. Tähelepanu ja ruumitaju treeningus kasutati arvutipõhist ForamenRehab lastele kohandatud programmi väljatöötatud treeningprotokollidega. Sotsiaalsete häirete raviks loodi esmalt struktureeritud neurorehabilitatsiooni mudel, mis koosnes sotsiaalse kompetentsi olulistest komponentidest, nende hindamismeetoditest ja rehabilitatsiooni vahenditest: puutetundlikud lauad Snowflake Multiteach Tabletop ja Diamond Touch Table, ning virtuaalreaalsuse keskkonnad. Tulemusena esines patsientidel treeningu eelselt väljendunud tähelepanu, ruumitaju ja sotsiaalse kompetentsi defitsiit. Arvutipõhised ja virtuaalreaalsuse programmid olid efektiivsed kognitiivsete häirete ravis. Patsientidel esines treeningute järgselt oluline paranemine kahes tähelepanu komponendis (tähelepanu jagamine ja seiramine) ja kolmes ruumitaju komponendis (visuaal-konstruktiivsed võimed, visuaalne tähelepanu ja nägemis-ruumitaju) ning raviefekt oli säilinud järeltestimisel 1,3 aastat hiljem. Sotsiaalse rehabilitatsiooni järgselt paranesid oluliselt patsientide vaimuteooria (Theory of Mind) ja emotsioonide äratundmine, kasutati rohkem koostööoskuseid, verbaalset ja mitteverbaalset kommunikatsiooni ning pragmaatika oskuseid. Uuringute tugevuseks oli sajaprotsendiline ravisoostumus ning positiivne tagasiside. Olulised on töö käigus välja töötatud teaduspõhised sekkumisprotokollid ja uued tehnoloogiapõhised rehabilitatsioonimeetodid häirunud funktsioonide spetsiifiliseks raviks lastel.Children with acquired brain injury (ABI) need diagnosis of accompanying cognitive and socio-emotional deficits and neurorehabilitation to enhance their future academic success and quality of life. Neurorehabilitation is a systematic intervention designed to compensate for or remediate the impairments caused by brain injury. The main aim of the thesis was implementing new computer-based programs, multitouch-multiuser tabletops and virtual reality in cognitive and social neurorehabilitation for children with ABI. Rehabilitation designs were developed for the treatment of attention, visuospatial, and social competence deficits. 59 children aged 8–12 years with ABI diagnosis (epilepsy, traumatic brain injury or tic disorder) and 47 healthy controls participated. Study group patients completed 10 training sessions guided by therapists. Pre-intervention assessments, and outcome assessments immediately and 1.31 years after the rehabilitation were carried out. ForamenRehab computer-programme was adapted to children and intervention protocols were created for attention and visuospatial function remediation. For social deficit remediation, the structured neurorehabilitation model was created, composed of the main components of social competence with evaluation and intervention tools: Snowflake Multiteach Tabletop, Diamond Touch Table and virtual reality programmes. Pre-intervention assessments showed that children with ABI had significant deficits in attention, visuospatial abilities and social competence functions. Computer-based and virtual reality programs were effective in the remediation of cognitive deficits in patients. After training, the patients had improved performance in two attention (complex attention and tracking) and three visuospatial components (visual organization, visual attention and visuospatial perception). The positive training effect had preserved after 1.3 years in follow-up assessments. Additionally, after social deficit rehabilitation, the patients showed improvements in Theory of Mind and emotion recognition, and they used more cooperation, communication, and pragmatic skills. The patients’ compliance was 100% and feedback was positive for all three interventions. In sum, the developed evidence-based intervention protocols and new technology-based rehabilitation methods are important in the remediation of specific cognitive deficits in children.https://www.ester.ee/record=b528718

Investigating the modality specific cognitive abilities predictive of arithmetic competence, using a developmental trajectories approach

Mathematics is complex, with multiple cognitive abilities utilised to solve even relatively simple problems. Research highlights working memory, executive function, intelligence, and numerical acuity as possible predictors of mathematical ability however, findings are inconsistent. While the impact of modality of stimuli presentation has been investigated for working memory and intelligence, it is limited for executive functioning and numerical acuity, with much research focussed on atypical mathematical development, particularly populations with visuospatial deficits. The current study examines which modality specific cognitive abilities are predictive of arithmetic ability in three populations: the general population, girls with Turner syndrome, and children with maths learning disabilities (N = 214; M = 11.5 years, SD = 3.9) Phase one, a quasi-experimental study, investigates pathways between intelligence, executive functions, number cognition, and arithmetic competence in both auditory and visual modalities, for children (N = 182) across development (4- to 18- years; M = 11.6 years, SD = 4.1). Structural equation modelling highlighted direct paths between modality specific latent executive functioning and working memory variables, and arithmetic ability, with the visual latent variable showing the strongest associations (auditory: B = .40; visual: B = .57). Paths between intelligence and age were indirect. Given its complexity, looking to identify a single construct that underpins mathematical outcomes may be erroneous. Phase two looked to identify differential patterns of development between arithmetic and bimodal cognitive predictors, for each disorder group and a matched typically developing group (Turner syndrome: n = 32; typical development matched with Turner syndrome: n = 32; maths learning disability; n = 40; typical development matched with maths learning disability: n = 40), within a developmental trajectories approach. Despite similar difficulties in arithmetic, differential areas of deficit were observed. Deficits were related to both visual and verbal abilities. Findings highlight the importance of future research overtly considering modality when investigating the cognitive underpinnings of maths ability. Additionally, executive functioning and working memory were found to be a group of abilities with a strong association to arithmetic ability in both typical and atypical development

Is it all about the money? : The effects of low and high cost simulator training scenarios in surgical training

Background: The learning process is complex and dependent on several factors such as for instance, the environment to learn, prior knowledge and distinct abilities, motivation, goal-orientation as well as the effects of instructor feedback. Medical education, in particular within surgical domains is imperative due to its influence on patient safety. The demand for training surgeons has shifted from the “master-apprentice/practice on patients”, towards a safer modality, involving simulators. The positive effects laparoscopic simulator training has on laparoscopic performance is extensive, as well as its impact on operating room performance. Nonetheless, the difference in learning effect using either low-cost or high-fidelity laparoscopic simulators were not totally clear prior to study start. Aims 1. To examine whether laparoscopic surgical training may be offered at a lower cost, with maintained equivalent level of training and effect in knowledge/learning using a low-cost laparoscopic Blackbox (Paper I). 2. To study the impact of PC-gaming experience, visuospatial ability and gender on the various parameters of the MIST-VR simulator and its effect on the score (Paper II). 3. To further investigate the Blackbox, and if different adjuncts (video analysis) could provide more information regarding the effects of training (Paper III). 4. To study the effects on time to learn laparoscopic knot- and suturing skills in novices using two different laparoscopic needle holders in a more advanced Blackbox, evaluate outcomes regarding performance, ergonomic discomfort and time to perform laparoscopic knot- and suturing skills, as well as to evaluate an objective video evaluation scoring table (OVEST) (Paper IV). Materials and Methods: The participants were medical students from the surgical semester at Karolinska Institutet, Stockholm (Studies I-III) and medical students at Athens University Medical School in Athens, Athens, Greece (Study IV). The studies were conducted at CAMST (Center for Advanced Medical Simulation and Training), Karolinska University Hospital, Stockholm (Studies I-III), and at MPLSC (Medical Physics-Lab Simulation Center), Athens University Medical School, Athens, Greece (Study IV). In conjunction with inclusion, the students (Studies I-II) performed a test (MRT-A; Mental Rotation Test – A) for the assessment of their visuospatial ability, and questionnaires including baseline questions (Studies I-IV). The simulator training/tests were done using different laparoscopic simulators; Blackbox (Studies I and III); LapMentor (Study I); MIST-VR (Studies I-III); Simball box (Study IV). The participants’ simulator performance analyzed; time to completion and economy of movement (Studies I-IV); optical flow metrics (path-length and total number of particles) as displayed by the automated video analysis software (Study III); knot- and suturing skills (Study IV). Results: Studies I and II showed, as previous studies, that the visuospatial ability correlated with the initial simulator training sessions. Study I showed no significant difference in performance between laparoscopic basic skills training regardless of simulator used; low-cost or high-fidelity laparoscopy simulator. Studies I, II and III showed discrepancies between prior PC-gaming experience and the simulator performance, as well as some gender-specific differences. Study III also showed that the use of a low-cost automated video analysis software may be feasibly comparable to the build-in software of the MIST-VR simulator. Study IV presented a shortened time to learn for novices performing laparoscopic knot- and suturing tasks in a simulated environment when using the newly designed laparoscopic needle holder compared to a conventional market needle holder. Conclusions: Laparoscopic simulator training clearly facilitates laparoscopic skills performance. Improved prerequisites of training opportunities for surgeons could potentiate patient safety, especially since enhanced surgical performance improves patient safety. Subsequently, as depicted in this thesis, there is not one single truth or solution, rather different angles and several factors that affect learning in general and surgical performance in particular. Therefore, considerations of for instance individual differences, gender, and motivation, should all be included when producing laparoscopic skills training curriculum for future surgical trainees

The functional organization of the brain for mental imagery and image rotation: an electroencephalographic investigation

The intent of this dissertation was to reveal (by utilizing a set of cognitive tasks that are visuospatial in nature) how complex mental tasks are performed in the brain. Particular attention was devoted to the functional systems subserving the processes comprising the complex internal generation of mental images and their rotation;Utilizing Electroencephalography (more specifically, alpha power reduction), the functional system subserving the processes of mental rotation and mental image generation was identified. In this functional system, the occipital lobes are bilaterally involved in the initial encoding of visual information into a neural representation. These representations are then shunted to the parietal lobes, with the left parietal lobe specifically involved in generating the three dimensional representation of the stimuli, while actual mental rotation is mediated by left temporal lobe. All of the above subprocesses are completed under the auspices of the right frontal lobe which appears to be involved in mediating comparison and decision subcomponents of the task. In cases where stimuli need to be resampled for further analysis, the right occipital lobe played an important role;The most significant findings of this dissertation are that multiple brain locales are involved in performance of complex visuospatial tasks, and that these locales can be quite remote from one another, with some residing in left hemisphere and some in the right. It is apparent that some of the existing confusion in the literature exploring hemispheric superiority for image generation and mental rotation may be partly attributed to the mistaken expectation that one hemisphere is solely involved in performing a given spatial task. Recent advances in brain imaging technology (like the one employed here) are rapidly changing this manner of thinking

Executive Functioning and its Relationship to Academic and Social - Emotional Outcomes in Children with a History of Arterial Ischemic Stroke

Thirty-two pediatric patients with stroke and 32 demographically equivalent, healthy controls were tested on standardized measures of working memory, arithmetic, and spelling. EF and social-emotional behavioural data were collected via standardized parent questionnaires. Relative to controls, working memory performance of stroke participants was significantly lower across all tasks. Stroke participants demonstrated poorer functioning in both metacognitive and behavioural regulatory EF domains and significantly lower achievement on tests of math and spelling. Untimed pencil and paper arithmetic was an area of particular concern, as math impairment was documented in 40% of the tested stroke participants. Metacognitive EF abilities predicted academic achievement, and behavioural regulatory EF predicted social-emotional functioning. Furthermore, increased time since stroke and larger stroke lesions were associated with poorer academic outcomes, as indicated by retrospective analysis of a large patient database. Findings assist with accurate prognosis and indicate need for early post-stroke cognitive intervention in affected children and youth

Memory Complaint Profiles in Dementia Populations Utilizing the Memory Complaints Inventory

The Memory Complaints Inventory (MCI) is a self-report questionnaire developed by Paul Green to provide further effort-related evidence in neuropsychiatric practice. It is comprised of nine subscale scores, in addition to the imbedded Plausible and Implausible symptom validity scales. The current study utilized archival MCI scores in dementia populations to determine the presence of, and difference between, genuine memory impairment profiles in separate subgroups of cognitive impairment. The study sample consisted of 244 adults presenting to an outpatient neuropsychology practice for evaluation of memory impairment. The diagnostic categories of the sample consisted of Alzheimer’s Disease (n = 21), Vascular Dementia (n = 33), Mild Cognitive Impairment (n = 53), Pseudodementia (n = 88), and Poor Effort (n = 49). Results indicated significant differences in all twelve one-way ANOVAs to represent differences between subgroups on each memory-related subscale of the MCI, the overall MCI score, and the imbedded Plausible and Implausible validity scales. Post-hoc analyses revealed large differences between the dementia categories and the Poor Effort subgroup, providing further evidence for the use of the MCI as a symptom validity measure due to its ability to differentiate between poor effort and genuine neurological impairment. Further support of the study’s findings would result in reliable genuine memory impairment profiles to provide further diagnostic and prognostic specificity in general medical practice settings

Working Memory Deficits and Emotion Dysregulation in Youth with Attention-Deficit/Hyperactivity Disorder: Understanding Relationships and Treatment Implications

Evidence suggests that working memory (WM) impairment is a primary deficit in attention-deficit/hyperactivity disorder (ADHD), underlying core symptoms of the disorder and associated impairments. However, the relationship between deficits in different WM components and emotional problems specifically in ADHD has not yet been studied. Knowledge of the cognitive substrates contributing to emotional deficits in ADHD could inform efforts toward refining cognitive remediation as a treatment for emotion dysregulation in this population. The first aim of this study (Aim 1) investigated whether WM deficits, as a global construct, were related to and mediated the relationship between ADHD and emotion dysregulation. The first sub-aim (Aim 1A) examined whether different components of WM, as defined by the traditional Baddeley Model (i.e., phonological loop, visuospatial sketchpad, central executive), were related to and differentially mediated emotion regulation deficits in ADHD. The second sub-aim (Aim 1B) examined whether WM constructs mediated the relationship of ADHD symptoms severity with degree of emotion dysregulation, after examining mediating effects of, and adjusting for, other factors related to emotional functioning. Other factors included inattention (relative to total ADHD symptoms), hyperactivity/impulsivity (relative to total ADHD symptoms), comorbid ODD symptoms, negative parenting behaviors, parental stress, and social skills deficits. Given a possible relationship between WM deficits and emotion dysregulation, Aim 2 investigated whether improvement in WM skills following cognitive remediation was related to improvement in emotion regulation ability. Participants were youth with ADHD (ages 7 - 11 years) who were recruited for a larger treatment study investigating the augmentative and complementary effects of combined WM training and behavioral parent training. At a baseline visit, objective neuropsychological data measuring Baddeley components of WM ability and parent-ratings of emotion dysregulation, ADHD symptoms, comorbid ODD symptoms, parenting behaviors, and parental stress were collected (Aim 1). Teacher ratings of ADHD symptoms, ODD symptoms, and social skills were also collected at baseline. For Aim 2, participants were randomly assigned to an active or low-level, non-scaffolded ( placebo ) condition of WM training. Upon the completion of WM training, WM deficits and parent-rated emotion dysregulation were again measured. Aim 1 and sub-aims results: Deficits in WM, as a composite measure, were not associated with emotion dysregulation in this sample and, therefore, not included in the mediation model. With regard to the Baddeley components of WM, a deficit in the phonological loop was associated with parent-rated emotion dysregulation in ADHD (but not visuospatial sketchpad and central executive deficits). As such, the phonological loop factor was included in the mediation model. Lastly, a phonological loop deficit, comorbid ODD symptom severity, negative parenting behaviors (e.g., inconsistent use of discipline), parental stress, and social skills deficits together mediated the relationship between ADHD and emotion dysregulation. However, no variables contributed to the mediation above and beyond comorbid ODD symptom severity. Aim 2 Results: Improvement in overall WM functioning was significantly associated with better emotion regulation from pre-to-post WM training in the active group relative to the placebo group. Results suggest that many factors, including a deficit in the phonological loop, contribute to emotional impairment in youth with ADHD, the strongest being severity of comorbid ODD symptoms. Results also suggest that, while comorbid ODD may contribute most strongly to emotion dysregulation in this study, improvements in total WM ability after cognitive remediation were nonetheless associated with improvement in emotion regulation skills. Taken together, cognitive remediation may have effects on emotional functioning in youth with ADHD; developing a more precise understanding of the neurocognitive substrates underlying emotional deficits in ADHD could thus inform treatment strategies

Evaluation of a social skills program for children.

The purpose of this study was to evaluate the effectiveness of a social skills program designed to improve the behavior, social skills, and coping skills of children with learning disabilities. This type of program could also have potential benefits for children without LD who have social skills deficiencies. The current study focused on the impact of the 10-week Better Emotional and Social Times program delivered through the Windsor-Essex chapter of the Learning Disabilities Association of Ontario for 36 children (28 boys, 8 girls), 8 to 12 years of age, from Southwestern Ontario. These children completed pre- and post-treatment the Social Skills Rating System as a measure of social skills and the Piers-Harris Children\u27s Self-Concept Scale as a measure of self-concept. T-tests were conducted comparing pre- and post-treatment scores on the inventories. Results indicated that significant improvements occurred in parent rating of assertion, cooperation, responsibility, internalizing behaviors, and social skills and problem behaviors in general. Improvements were found in the children\u27s rating of intellectual and school status only. When examining subgroups, it was found that items indicating improvements in responsibility, internalizing behavior, hyperactivity, and overall problem behaviors were endorsed by parents of children with ADD/ADHD diagnoses. Parents of children with primary deficits in the verbal domain of cognitive functioning endorsed items indicating an improvement in cooperation, self-control, and social skills in general. For children with primary deficits in the nonverbal domain of intellectual functioning, parents reported a decrease in overall problem behaviors and improvements were found in child rating of cooperation. These results and their relation to previous research are discussed and limitations of the present study as well as suggestions for future research are also presented.Dept. of Psychology. Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis2004 .D78. Source: Masters Abstracts International, Volume: 43-03, page: 1007. Adviser: Joseph E. Casey. Thesis (M.A.)--University of Windsor (Canada), 2004

Quod Erat Demonstrandum: From Herodotus’ ethnographic journeys to cross-cultural research

A peer-reviewed book based on presentations at the XVIII Congress of the International Association for Cross-Cultural Psychology, 2006, Isle of Spetses, Greece. (c) 2009, International Association for Cross-Cultural Psychologyhttps://scholarworks.gvsu.edu/iaccp_proceedings/1004/thumbnail.jp

USE OF POPE ENGAGEMENT INDEX TO MEASURE COGNITIVE LOAD OF PHYSICAL MODELING ACTIVITIES IN ORGANIC CHEMISTRY

Understanding how students learn and process information is critical to developing physical modeling activities that facilitate student learning by decreasing cognitive load in the working memory. Optimizing cognitive load during physical modeling activities in organic chemistry is the key to effective and efficient learning. Using EEG (electroencephalogram) and eye tracking technologies, researchers measured and recorded the cognitive processing of participants while they completed a chiral physical modeling activity. Analysis of the data using the Engagement Index developed by Pope et al provided information necessary to develop curriculum that does not undermine student learning due to excessive cognitive load