Does repetitive task training improve functional activity after stroke? A Cochrane systematic review and meta-analysis.

Repetitive task training resulted in modest improvement across a range of lower limb outcome measures, but not upper limb outcome measures. Training may be sufficient to have a small impact on activities of daily living. Interventions involving elements of repetition and task training are diverse and difficult to classify: the results presented are specific to trials where both elements are clearly present in the intervention, without major confounding by other potential mechanisms of action

Simultaneous bilaternal training for improving arm function after stroke

Background Simultaneous bilateral training, the completion of identical activities with both arms simultaneously, is one intervention to improve arm function and reduce impairment. Objectives To determine the effects of simultaneous bilateral training for improving arm function after stroke. Search strategy We searched the Cochrane Stroke Trials Register (last searched August 2009) and 10 electronic bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2009), MEDLINE, EMBASE, CINAHL and AMED (August 2009). We also searched reference lists and trials registers. Selection criteria Randomised trials in adults after stroke, where the intervention was simultaneous bilateral training compared to placebo or no intervention, usual care or other upper limb (arm) interventions. Primary outcomes were performance in activities of daily living (ADL) and functional movement of the upper limb. Secondary outcomes were performance in extended activities of daily living and motor impairment of the arm. Data collection and analysis Two authors independently screened abstracts, extracted data and appraised trials. Assessment of methodological quality was undertaken for allocation concealment, blinding of outcome assessor, intention-to-treat, baseline similarity and loss to follow up. Main results We included 18 studies involving 549 relevant participants, of which 14 (421 participants) were included in the analysis (one within both comparisons). Four of the 14 studies compared the effects of bilateral training with usual care. Primary outcomes: results were not statistically significant for performance in ADL (standardised mean difference (SMD) 0.25, 95% confidence interval (CI) -0.14 to 0.63); functional movement of the arm (SMD -0.07, 95% CI -0.42 to 0.28) or hand (SMD -0.04, 95% CI -0.50 to 0.42). Secondary outcomes: no statistically significant results. Eleven of the 14 studies compared the effects of bilateral training with other specific upper limb (arm) interventions. Primary outcomes: no statistically significant results for performance of ADL (SMD -0.25, 95% CI -0.57 to 0.08); functional movement of the arm (SMD -0.20, 95% CI -0.49 to 0.09) or hand (SMD -0.21, 95% CI -0.51 to 0.09). Secondary outcomes: one study reported a statistically significant result in favour of another upper limb intervention for performance in extended ADL. No statistically significant differences were found for motor impairment outcomes. Authors' conclusions There is insufficient good quality evidence to make recommendations about the relative effect of simultaneous bilateral training compared to placebo, no intervention or usual care. We identified evidence that suggests that bilateral training may be no more (or less) effective than usual care or other upper limb interventions for performance in ADL, functional movement of the upper limb or motor impairment outcome

Capturing the Essence of Developing Endovascular Expertise for the Construction of a Global Assessment Instrument

AbstractObjectivesTo explore what characterises the development of endovascular expertise and to construct a novel global assessment instrument.DesignLiterature review and an experimental study.Materials and methodsThe literature was searched for information regarding available global rating scales (GRSs); scientific societies’ official statements on endovascular competence; and task analyses of endovascular procedures. In the experimental study, clinicians performed a video-recorded simulated iliac-artery stenting procedure. Subsequently, by using the method of retrospective verbalisation, the clinicians were interviewed while watching their performance on video commenting on key issues of the construct. Data from all sources were analysed, categorised and synthesised into a novel rating scale.ResultsAvailable GRSs primarily included technical aspects of performance, whereas the competence statements, task analyses and clinicians’ perceptions added a range of non-technical aspects. The novel rating scale SAVE (Structured Assessment of endoVascular Expertise) differs from prior scales by including issues of pre-planning; prediction of challenges; preparation of tools; management of imaging presentation; distinction of technical skills into external and internal control according to operator focus of visual attention; adaptation of strategy; clinical decision making; use of assistant; complications; inter-personal skills; and post-procedural planning.ConclusionsThe essence of developing endovascular expertise goes far beyond mere technical aspects

Learning Laparoscopic Skills: Observation or Practice?

OBJECTIVE: The aim of this study was to assess the respective roles of observation and direct practice in the retention of laparoscopic skills. MATERIALS AND METHODS: Eighteen fifth-year medical students were included in a two-session laparoscopic learning course. During the first session, each participant was given four tasks to complete from the "Basic skills" and "Essential tasks" modules of the Simbionix LAP Mentor™, and another four tasks for observation only. During the second session, each participant completed all eight tasks. Performance evaluation was assessed using the objective structured assessment of technical skills (OSATS) global rating scale and LAP Mentor metrics. RESULTS: The mean OSATS score during the first session (S1) was 16.7 ± 3.2. This increased by 34% during the second session (S2), reaching 21.8 ± 2.6 in the group of former observer students (S2O, P < .0001), and by 56% (25.1 ± 1.9) in the group of former practicing students (S2A, P < .0001). The analysis of LAP Mentor metrics showed that 14 of 28 parameters (50%) improved in the S2A group compared to S1, whereas only 25% of the parameters improved in the S2O group, the difference being significant (P = .048). In both groups, the more complex the task, the more the number of improved parameters decreased. CONCLUSIONS: Although simple observation of laparoscopic skills improved further performance, direct practice on the virtual reality trainer ensured more effective training. This work therefore advocates incorporating personal training on simulators into residents\u27 surgical curricula

Effective Lifeguard Scanning: A Review

The purpose of this scientific review was to address the question of what evidence-based visual surveillance/scanning skills exist in the peer-reviewed scholarly literature. It is well known that lifeguards spend a majority of their on-duty time surveying bathers and swimmers in the water. Lifeguards need to quickly distinguish among swimmers in distress and drowning persons from other bathers in order to rapidly come to their aid to prevent drowning. To be able to accomplish this task, Signal Detection Theory reveals that lifeguards need specific and extensive training in identifying the behavioral patterns associated with drowning persons and swimmers in distress. A typical drowning is not what has been popularized in the press and movies that shows a person calling for help and waving his or her arms about. Instead, drowning victims usually demonstrate the instinctive drowning response in which they are in a vertical position in the water, unable to call out because the mouth is underwater and arm and leg movements are ineffective in keeping them near the water’s surface. The literature revealed that expert lifeguard observation, scanning, and surveillance skills need to be acquired through planned systematic practice to identify the presence of the instinctive drowning response among bathers

Versão em português do Iowa Gambling Test: adaptação transcultural e validade discriminate

OBJECTIVE: The Iowa Gambling Task is a neuropsychological task developed in English, most widely used to assess decision-making. The aim of this work was to adapt the Iowa Gambling Task to Brazilian Portuguese, compare it with the original version and assess its validity. METHOD: We assessed 75 Brazilian adults divided into three groups: 1) 25 healthy volunteers holding the Proficiency Certificate in English tested using the English version of the Iowa Gambling Task; 2) 25 healthy volunteers who did not speak or read English tested using the Iowa Gambling Task-Portuguese; 3) 25 Attention Deficit Hyperactivity Disorder subjects tested with the Iowa Gambling Task-Portuguese. RESULTS: No difference between groups 1 and 2 was observed. Nonetheless, we found significant differences between Attention Deficit Hyperactivity Disorder subjects and the other 2 groups on blocks 3, 4, 5, and on net score. CONCLUSION: Our results are similar to those previously described in the literature concerning adults without neuropsychiatric diseases. Since those two versions were equivalent and Attention Deficit Hyperactivity Disorder subjects performed significantly worse than healthy volunteers we can conclude that the adaptation of the Iowa Gambling Task to Brazilian Portuguese is valid and can be used for research purposes in the Brazilian context.OBJETIVO: Iowa Gambling Task é uma tarefa neuropsicológica originalmente desenvolvida em inglês, mais usada no mundo para avaliar o processo de tomada de decisões. Este estudo pretendeu adaptar o Iowa Gambling Task para o português, comparar a versão adaptada com a versão original em inglês e avaliar sua validade discriminante. MÉTODO: Foram investigados 75 adultos brasileiros divididos em três grupos: 1) 25 voluntários sadios proficientes em inglês, avaliados com a versão original em inglês; 2) 25 voluntários sadios não-proficientes em inglês avaliados com o Iowa Gambling Task-português; 3) 25 adultos com Transtorno do Déficit de Atenção e Hiperatividade (avaliados com o Iowa Gambling Task-português. RESULTADOS: Não houve diferenças entre os grupos 1 e 2. No entanto, encontramos diferenças entre os adultos com Transtorno do Déficit de Atenção e Hiperatividade e os outros dois grupos nos blocos 3, 4, 5 e no netscore. CONCLUSÃO: Nossos resultados são semelhantes aos descritos na literatura. Considerando que as duas versões se mostraram equivalentes e os sujeitos com Transtorno do Déficit de Atenção e Hiperatividade desempenharam significativamente pior do que os controles, podemos concluir que a adaptação do Iowa Gambling Task para o português praticado no Brasil é válida e pode ser aplicada no contexto brasileiro

PHYSICAL AND BIOMECHANICAL ASPECTS THAT CAN INFLUENCE THE PREFERENCE FOR THE UCHIMATA TECHNIQUE IN JUDO: A CASE STUDY

The aim of this study was to compare the handgrip strength, flexibility level (sit and reach test), kumikata and biomechanical aspects of the uchimata technique of two national level judokas, one who favors to use the uchimata (tokui-waza), and one who selects another judo technique in combat. We recorded the highest value of three attempts for handgrip strength (handgrip test), and flexibility (sit and reach); we recorded the highest value of three attempts for strength (handgrip test) and flexibility (sit and reach test); we analyzed the uchimata phases (kuzushi, tsukuri, kake and zanshi) in 3D using Vicon® system. We found that non-traditional kumikata during combat (grips with both hands on the same side), greater level of flexibility (45 vs. 36 cm), greater leg opening distance (113 vs. 66 cm) and greater displacement speed of the center of mass performing the technique (75 vs. 49 cm/s) may be indicators for the choice of uchimata technique as tokui-waza

Desempenho da atencao entre motoristas de caminhao brasileiros e sua associacao com uso de anfetaminas: estudo-piloto

The aim of this article was to describe the attention functioning of twenty-two truck drivers and its relationship with amphetamine use. Those drivers who reported using amphetamines in the twelve months previous to the interview had the best performance in a test evaluating sustained attention functioning. Although amphetamine use may initially seem advantageous to the drivers, it may actually impair safe driving. The findings suggest the importance of monitoring the laws regarding amphetamine use in this country.O objetivo deste estudo foi descrever o desempenho de atenção de motoristas de caminhão e sua relação com o uso de anfetaminas. Os motoristas que relataram usar anfetaminas nos doze meses prévios à entrevista tiveram desempenho melhor em um teste de atenção sustentada. Apesar de inicialmente representar uma vantagem para motoristas, o uso de anfetaminas pode dificultar a direção segura. Os resultados sugerem a importância de supervisionar as leis que regulamentam o uso de anfetaminas no País.El objetivo de éste estudio fue describir el desempeño de atención de choferes de camión y su relación con el uso de anfetaminas. Los choferes que informaron usar anfetaminas en los doce meses previos a la entrevista tuvieron mejor desempeño en la prueba de atención sustentada. A pesar de inicialmente representar una ventaja para los choferes, el uso de anfetaminas puede dificultar la dirección segura. Los resultados sugieren la importancia de supervisar las leyes que regularizan el uso de anfetaminas en el País