Pitfalls in QCA's consistency measure

Background. As a consequence of difficulties in movement initiation and execution, people with Parkinson's disease (PD) are typically encouraged to consciously monitor and control the mechanics of their actions. This is described as 'reinvestment' and has been shown to help mediate effective motor output. Paradoxically, in situations where people with PD are particularly motivated to move effectively, reinvestment may exacerbate existing movement deficits. Objective. To examine the propensity for reinvestment in a sample of people with PD. Methods. A volunteer sample of 55 people with PD was asked to complete a previously validated measure, the Reinvestment Scale. A sub-sample (and age matched controls) was asked to complete a recently developed, movement specific, version of the Scale. Data was collected on Mini Mental State Examination and the Hoehn & Yahr Scale. Participant demographics, including age of onset and duration of disease, were also collated. Results. Multiple regression analyses showed that duration of disease was associated with reinvestment score on both the Reinvestment Scale and the Movement Specific Reinvestment Scale. Conclusions. Participants appeared to become more aware of the mechanics of their actions over time. Possible explanations for this finding are discussed with reference to rehabilitation. Copyright © 2007 The American Society of Neurorehabilitation.link_to_subscribed_fulltex

Multitask training promotes automaticity of a fundamental laparoscopic skill without compromising the rate of skill learning.

A defining characteristic of expertise is automated performance of skills, which frees attentional capacity to better cope with some common intraoperative stressors. There is a paucity of research on how best to foster automated performance by surgical trainees. This study examined the use of a multitask training approach to promote automated, robust laparoscopic skills.Eighty-one medical students completed training of a fundamental laparoscopic task in either a traditional single-task training condition or a novel multitask training condition. Following training, participants' laparoscopic performance was tested in a retention test, two stress transfer tests (distraction and time pressure) and a secondary task test, which was included to evaluate automaticity of performance. The laparoscopic task was also performed as part of a formal clinical examination (OSCE).The training groups did not differ in the number of trials required to reach task proficiency (p = .72), retention of skill (ps > .45), or performance in the clinical examination (p = .14); however, the groups did differ with respect to the secondary task (p = .016). The movement efficiency (number of hand movements) of single-task trainees, but not multitask trainees, was negatively affected during the secondary task test. The two stress transfer tests had no discernable impact on the performance of either training group.Multitask training was not detrimental to the rate of learning of a fundamental laparoscopic skill and added value by providing resilience in the face of a secondary task load, indicative of skill automaticity. Further work is needed to determine the extent of the clinical utility afforded by multitask training

The experience of living with chronic heart failure: a narrative review of qualitative studies

<p>Abstract</p> <p>Background</p> <p>Chronic heart failure (CHF) is the leading cause of all hospitalisations and readmissions in older people, accounting for a large proportion of developed countries' national health care expenditure. CHF can severely affect people's quality of life by reducing their independence and ability to undertake certain activities of daily living, as well as affecting their psychosocial and economic capacity. This paper reports the findings of a systematic narrative review of qualitative studies concerning people's experience of living with CHF, aiming to develop a wide-ranging understanding of what is known about the patient experience.</p> <p>Methods</p> <p>We searched eight relevant electronic databases using the terms based on the diagnosis of 'chronic heart failure', 'heart failure' and 'congestive heart failure' and qualitative methods, with restrictions to the years 1990-May 2008. We also used snowballing, hand searching and the expert knowledge of the research team to ensure all relevant papers were included in the review. Of 65 papers collected less than half (n = 30) were found relevant for this review. These papers were subsequently summarised and entered into QSR NVivo7 for data management and analysis.</p> <p>Results</p> <p>The review has identified the most prominent impacts of CHF on a person's everyday life including social isolation, living in fear and losing a sense of control. It has also identified common strategies through which patients with CHF manage their illness such as sharing experiences and burdens with others and being flexible to changing circumstances.</p> <p>Finally, there are multiple factors that commonly impact on patients' self care and self-management in the disease trajectory including knowledge, understanding and health service encounters. These health service encounters encompass access, continuity and quality of care, co-morbid conditions, and personal relationships.</p> <p>Conclusions</p> <p>The core and sub-concepts identified within this study provide health professionals, service providers, policy makers and educators with broad insights into common elements of people's experiences of CHF and potential options for improving their health and wellbeing. Future studies should focus on building a comprehensive picture of CHF through examination of differences between genders, and differences within age groups, socioeconomic groups and cultural groups.</p

The effects of secondary tasks on implicit motor skill performance

Acquiring a skill in an implicit manner is thought to have a number of advantages over acquiring the same skill explicitly. In particular, implicitly learnt skills have been shown to be more durable over time and more robust to the influence of psychological stress. Implicit motor skill learning has been demonstrated on several occasions using a concurrent secondary task to curb explicit rule formation. On each occasion the benefits of learning the skill implicitly have been robustness under psychological stress, with the learners less likely to exhibit skill breakdown. The secondary task employed to curb explicit rule formation has been one that loads on the central executive component of working memory. The primary difficulty with the use of this task has been a consequent decrement in performance as a result of the attentional demands of the central executive task intruding upon execution of the motor skill. This paper examines whether less intrusive, non-central executive, phonological loop secondary tasks prevent explicit knowledge formation whilst not impacting adversely upon performance of the primary skill. Two experiments were performed, the results of which demonstrate that phonological loop tasks do not prevent explicit knowledge acquisition. This suggests that the phonological loop is not an essential component in the development of explicit knowledge regarding a motor task. The problem of finding a secondary task to block explicit knowledge formation whilst not interfering with motor performance remains.link_to_subscribed_fulltex

Implicit motor learning in Parkinson's disease

Objective: This study examined whether disruption of performance is moderated in Parkinson's disease (PD) patients who acquire their motor behaviors in an implicit manner. Method: Twenty-seven patients with PD learned a hammering task in errorless (implicit) or errorful (explicit) conditions and were tested for robustness of motor performance under a secondary task load, which required them to continuously count backward as they performed the hammering task. Results: Patients in the errorless (implicit) motor learning condition exhibited robustness to secondary task loading, whereas patients in the errorful (explicit) motor learning condition did not. Conclusions: Implicit motor learning techniques should be considered by PD rehabilitation specialists in cases in which existing disruption to movements is exacerbated by conscious control.link_to_subscribed_fulltex

The attention-intention-effort pathway in the development of psychophysiologic insomnia: A theoretical review

Psychophysiologic insomnia (PI) is the most common form of persistent primary insomnia. Its 'behavioral phenotype', comprising elements such as conditioned arousal, sleep-incompatible behavior and sleep preoccupation, has not changed markedly across several generations of diagnostic nosology. Moreover, a substantial outcome literature demonstrates that PI can be treated effectively using a range of psychological interventions. It seems evident that behavioral and cognitive factors play a part. What is less clear is exactly how PI develops and what are its crucial maintaining factors. This paper proposes an explanatory model, that we call the attention-intention-effort pathway. The argument is that sleep normalcy is a relatively automatic process. Consequently, it is vulnerable, and may be inhibited, by focused attention and by direct attempts to control its expression. Drawing upon parallels in the literature on adult psychopathology, and upon recent clinical and experimental studies on insomnia, the evidence for this pathway is considered and a research agenda is outlined. In particular, computerized tests of cognitive bias are seen as offering an objective means of appraising mental processes in insomnia. These may be applied concurrently with somatic measurements in future studies to better understand this common psycho-physiologic condition