Application of the Donabedian Quality-of-Care Model to New York State Direct Support Professional Core Competencies: How Structure, Process, and Outcomes Impacts Disability Services

Direct support professionals (DSPs) are responsible for the daily supervision and care of people diagnosed with intellectual and developmental disabilities (IDDs) living in community residential group homes. In New York State, these DSPs are trained within the Office for People With Developmental Disabilities DSPs core competencies; a set of ethical, technical, and cognitive training geared to the individual care of each person as per their specific needs. This qualitative case study was to understand how DSPs perceived the implementation of the core competencies after being trained and under the direction of their supervisors. Using the Donabedian’s quality-of-care conceptual framework, this study explored what DSPs perceived to be necessary in strengthening the effectiveness of the New York State DSP competencies within organizational policies (structure) with the DSPs knowledge, skills, and, attitudes (processes) to the quality-of-life (outcomes). Data were collected through face-to-face interviews with 12 DSPs and supervisors. Data were inductively coded then subject to Braun and Clarke’s thematic analysis procedure. Findings revealed that DSPs and supervisors implemented the core competencies inconsistently because of organizational perceptions and experiences. Implications for social change in this study includes recommendations to the National Alliance of DSPs to add a practicum component to the core competencies training that may benefit people living in community residential group homes diagnosed with IDDs through hands-on-approach training that would allow full implementation of the DSP core competencies in various everyday, real-life situation

Risk Perception and Coping Strategies among Direct Support Professionals in the Age of COVID-19.

The spread of novel coronavirus (COVID-19) across the globe and its associated morbidity and mortality has impacted and challenged society in many ways, which resulted in adapting to a new way of life. One underrecognized and unaddressed area is the mental health of essential employees providing services to people with intellectual and developmental disabilities (IDD). Direct support professionals (DSPs) serve an important function in the daily supervision and care of clients with IDD. It is not clear, however, how these essential workers perceived their own risk of contracting COVID-19 while working during this pandemic. Our research presents results of a national survey of 478 DSPs that focused on perceptions of risk and ways of coping with COVID-19. Using an online survey, we examined DSPs’ perception of risk and on the emotional and problem-solving strategies they used to cope with the global crisis. We found that DSPs engaged in higher problem-focused strategies rather than emotion-focused strategies in coping with the virus. As such, we show that it is critical for IDD provider organizations to assess DSPs’ needs to provide coping supports during the age of COVID

Transcranial magnetic stimulation and action observation: exploring methodological issues

This thesis explored a number of methodological issues present in motor cognition research using transcranial magnetic stimulation (TMS). The facilitatory effect of the corticospinal pathway during observation of simple hand actions was also investigated. TMS was applied to the motor cortex during action observation and the resulting MEP peak-to-peak amplitudes were analysed. A series of four studies were conducted to test whether a motor facilitation effect specific to the muscles involved in the observed actions were obtained, while simultaneously investigating five prominent methodological concerns in TMS research. In Study 1 the issue of choosing the optimal control condition was investigated. The MEP facilitation obtained during action observation (ball pinch) was compared to two commonly used control conditions (fixation cross and static image). Consistent with published literature, the action condition resulted in larger MEP amplitudes than the controls. There was no statistical difference in MEP amplitude between the two resting conditions. It was argued, however, that the static image allows for more accurate comparison with the action condition by providing meaningful visual cues without the associated action. In Study 2, the effect of short-term physical execution on the relationship between observed actions and neural activity was explored. The motor facilitation effect was present during action observation. This was not enhanced following execution of the observed action which is in contrast with the literature that shows the observation-execution matching system tuned to familiarity with an action. In TMS studies, different stimulation timings are included in order to reduce anticipatory effects of the TMS pulse. While the different timings are usually analysed together, in Studies 1 and 2, the two stimulation timings were analysed separately. As a consequence, a motor facilitation effect was only evident for the earlier stimulation timing of 6250ms in Study 1. When participants executed the action prior to observing it in Study 2, there was no effect of stimulation timing, leading to speculation that the prior execution may have had some effect on the attentional demands during the subsequent observation. Studies 3 and 4 explored two general methods concerns regarding the motor hotspot and stimulation intensity. In Study 3, the muscle- vi specificity notion was explored via observation of index finger and little finger movements versus observation of a static hand, with the corresponding muscles tested at their individual hotspots. This was a novel approach as one hotspot is typically used for all muscles under investigation. The choice of motor hotspot, however, did not significantly affect the muscle-specific findings, providing further support for the muscle-specific motor facilitation findings reported in the literature. Finally, Study 4 investigated the concept of stimulation intensity. TMS action observation studies differ in the stimulation intensities used, typically ranging from 110% to 130% of resting motor threshold. Since the motor response obtained through TMS may be affected depending on the stimulation intensity used, two stimulation intensities were employed (high vs. low) during observation of finger movements. A motor facilitation effect was reported in the low intensity stimulation, which was expected given that near threshold intensities are more representative of the ongoing level of cortical excitability. No motor facilitation effect was shown in the high intensity stimulation, possibly due to the nature of high stimulation intensities on the corticospinal pathway, or simply because the low intensity stimulations were always delivered before the high intensity stimulations. In light of the stimulation timing findings of Study 1, this may have resulted in participants getting distracted or fatigued, focussing their attention elsewhere (and therefore lowering MEP amplitudes) during the latter high stimulations. From the results presented in these studies, it is clear that there is a muscle specific motor facilitation during action observation and its characteristics are influenced by many procedural, technical and cognitive and attentional factors. This thesis provides a much needed critical analysis into the methods and methodologies commonly adopted in this area of research. It is essential to continue to explore the methods employed in TMS motor cognition studies, making them accepted universally and scientifically rigorous

Resonances, radiation pressure and optical scattering phenomena of drops and bubbles

Acoustic levitation and the response of fluid spheres to spherical harmonic projections of the radiation pressure are described. Simplified discussions of the projections are given. A relationship between the tangential radiation stress and the Konstantinov effect is introduced and fundamental streaming patterns for drops are predicted. Experiments on the forced shape oscillation of drops are described and photographs of drop fission are displayed. Photographs of critical angle and glory scattering by bubbles and rainbow scattering by drops are displayed

Competency Development and Implementation among Direct Support Professionals in New York State

Direct support professionals (DSPs) serve an important function in the daily supervision and care of clients with intellectual and developmental disabilities (ID/DD) through standardization of technical, cognitive, and ethical competencies for all DSPs. It is not clear, however, how these DSPs and managers perceive the implementation process and utility of these competencies or whether implementation results in meeting the desired outcomes for clients. Using Donabedian\u27s quality of care model as the foundation, the purpose of this qualitative case study in New York State to understand how DSPs perceived the implementation of the DSP core competencies under the direction of front-line managers. Data were collected through face-to-face interviews with 12 DSPs and front-line managers. Data were inductively coded then subject to Braun and Clarke\u27s thematic analysis procedure. Findings revealed that DSPs and front-line managers implemented the core competencies inconsistently because of organizational perceptions and experiences. The implications for social change stemming from this study includes recommendations to the National Alliance of Direct Support Professionals to add a practicum component to the core competencies training which may benefit people living in community residential group homes diagnosed with ID/DD through hands-on approach training that would allow full implementation of the DSP core competencies in various, every day real life situations

Action Observation and Imagery Training Improve the Ease With Which Athletes Can Generate Imagery

Imagery can improve sport performance, although its efficacy is mediated by the ease with which athletes can generate images. Establishing techniques that improve this imagery ability factor is desirable to enhance the effectiveness of imagery interventions. Twenty-seven club-level female golfers were assigned to imagery, action observation, or physical practice training groups (n = 9). Changes in image generation ease were assessed using the Revised Movement Imagery Questionnaire over an 8-week period. Imagery and action observation training were both effective in improving aspects of imagery ability. Action observation can provide sport psychologists with an effective tool for improving visual imagery ability in athletes

Differences in cortical activity related to motor planning between experienced guitarists and non-musicians during guitar playing.

The influence of motor skill learning on movement-related brain activity was investigated using electroencephalography. Previous research has indicated that experienced performers display movement-related cortical potentials (MRCPs) of smaller amplitude and later onset compared to novices participants. Unfortunately, previous studies have lacked ecological validity with experimenters recording the MRCP prior to simple motor tasks and applying the results to more complex motor skills. This study replicated previous research using an ecologically valid motor skill; recording the MRCP from a group of experienced guitarists and a control group of non-musicians while they played a simple scale on the guitar. Results indicated no difference between groups in early motor planning. In contrast, the later, negative slope and motor potential components were of smaller amplitude and the negative slope began later in the experienced guitarists. The data may indicate that, for experienced guitarists, a reduced level of effort is required during the motor preparation phase of the task. These findings have implications for musical instrument learning as well as motor skill acquisition in general

Screen Position Preference Offers a New Direction for Action Observation Research: Preliminary Findings Using TMS

Action observation has been suggested to be an effective adjunct to physical practice in motor (re)learning settings. However, optimal viewing conditions for interventions are yet to be established. Single-pulse transcranial magnetic stimulation (TMS) was used to investigate the effect of two different screen positions and participants’ screen position viewing preference on the amplitude of motor evoked potentials (MEPs) during observation of a ball pinch action. Twenty-four participants observed four blocked conditions that contained either a dynamic index finger-thumb ball pinch or a static hand holding a ball in a similar position on a horizontally or vertically positioned screen. TMS was delivered to the hand representation of the left primary motor cortex and MEPs were recorded from the first dorsal interosseous muscle of the right hand. Initial analysis of the normalized MEP amplitude data showed no significant differences between conditions. In a follow-up procedure, participants engaged in individual semi-structured interviews and completed a questionnaire designed to assess viewing affect and screen position viewing preference. The MEP data were subsequently split by screen position preference and re-analyzed using a 2 × 2 repeated measures ANOVA. Main effects indicated that participants who preferred the horizontal screen position (n = 16) demonstrated significantly greater MEP amplitudes during observation of the ball-pinch action compared to the static hand condition irrespective of screen position, and during the horizontal compared to the vertical screen position irrespective of video type. These results suggest that ensuring anatomical and perceptual congruency with the physical task, alongside consideration of participants’ screen position viewing preferences, may be an important part of optimizing action observation interventions

Reflecting on mirror mechanisms:motor resonance effects during action observation only present with low-intensity transcranial magnetic stimulation

Transcranial magnetic stimulation (TMS) studies indicate that the observation of other people's actions influences the excitability of the observer's motor system. Motor evoked potential (MEP) amplitudes typically increase in muscles which would be active during the execution of the observed action. This 'motor resonance' effect is thought to result from activity in mirror neuron regions, which enhance the excitability of the primary motor cortex (M1) via cortico-cortical pathways. The importance of TMS intensity has not yet been recognised in this area of research. Low-intensity TMS predominately activates corticospinal neurons indirectly, whereas high-intensity TMS can directly activate corticospinal axons. This indicates that motor resonance effects should be more prominent when using low-intensity TMS. A related issue is that TMS is typically applied over a single optimal scalp position (OSP) to simultaneously elicit MEPs from several muscles. Whether this confounds results, due to differences in the manner that TMS activates spatially separate cortical representations, has not yet been explored. In the current study, MEP amplitudes, resulting from single-pulse TMS applied over M1, were recorded from the first dorsal interosseous (FDI) and abductor digiti minimi (ADM) muscles during the observation of simple finger abductions. We tested if the TMS intensity (110% vs. 130% resting motor threshold) or stimulating position (FDI-OSP vs. ADM-OSP) influenced the magnitude of the motor resonance effects. Results showed that the MEP facilitation recorded in the FDI muscle during the observation of index-finger abductions was only detected using low-intensity TMS. In contrast, changes in the OSP had a negligible effect on the presence of motor resonance effects in either the FDI or ADM muscles. These findings support the hypothesis that MN activity enhances M1 excitability via cortico-cortical pathways and highlight a methodological framework by which the neural underpinnings of action observation can be further explored. © 2013 Loporto et al

Combined action observation and imagery facilitates corticospinal excitability.

Observation and imagery of movement both activate similar brain regions to those involved in movement execution. As such, both are recommended as techniques for aiding the recovery of motor function following stroke. Traditionally, action observation and movement imagery (MI) have been considered as independent intervention techniques. Researchers have however begun to consider the possibility of combining the two techniques into a single intervention strategy. This study investigated the effect of combined action observation and MI on corticospinal excitability, in comparison to either observation or imagery alone. Single-pulse transcranial magnetic stimulation (TMS) was delivered to the hand representation of the left motor cortex during combined action observation and MI, passive observation (PO), or MI of right index finger abduction-adduction movements or control conditions. Motor evoked potentials (MEPs) were recorded from the first dorsal interosseous (FDI) and abductor digiti minimi (ADM) muscles of the right hand. The combined action observation and MI condition produced MEPs of larger amplitude than were obtained during PO and control conditions. This effect was only present in the FDI muscle, indicating the facilitation of corticospinal excitability during the combined condition was specific to the muscles involved in the observed/imagined task. These findings have implications for stroke rehabilitation, where combined action observation and MI interventions may prove to be more effective than observation or imagery alone