Plagiocephaly and Associated Head Deformities in the NICU: The PLAY Bundle

MNRS Student Poster Abstract EBP/QI Poster Title: Plagiocephaly and Associated Head Deformities in the NICU: The PLAY Bundle Authors: Ashley Kubik, RN, BSN & Jenna Welton, RN, BSN Description of Students\u27 Role: Two students are conducting this project for their DNP Capstone at the University of Nebraska Medical Center. Both are BSN to DNP students completing the dual Pediatric Acute & Primary Care Nurse Practitioner program. There is equal contribution from both for project development, implementation, data collection, and analysis. Nature and scope of the project: Premature infants in the Neonatal Intensive Care Unit (NICU) have a greater risk of head asymmetry and related complications. No standardized protocol for positional head deformities exists at Children’s Hospital of Omaha. The Electronic Health Record (EHR) doesn’t optimize head measurement documentation or flag concerning head measurements. Our goal is to reduce the progression of head deformities through education, prevention strategies, and earlier identification and treatment. Background: Numerous evidence-based interventions demonstrate successful prevention and treatment for head deformities with maximized success when combined. Authors developed an evidence-based bundle comprised of Positioning and PT/OT involvement, Learning, Assistive Devices, and You (PLAY). The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework is utilized. Project implementation: Data collected during weeks 1-13 (June-September 2022) were under the current standard of care, then the PLAY Bundle was implemented, and data collection will continue through week 26 (December 2022). All NICU patients are eligible for inclusion on a rolling basis. Evaluation Criteria: Paired t-tests will be used for nurse’s knowledge tool, caregiver comfort survey, and nurses’ practice and documentation. PT/OT involvement comparisons pre- and post-bundle will be analyzed using Fisher’s exact test. Descriptive statistics will be utilized for adherence and documentation rates with the addition of PT/OT involvement included. Bundle efficacy will be analyzed using repeated measures ANOVA. Outcomes: Since project inception, 33 infants have been measured for possible plagiocephaly and associated head deformities with 19 occurring after PLAY Bundle implementation. Under previous standard of care, 34% of patients (n=27) had plagiocephaly documentation while just 7% (n=6) received a PT consultation. Of the NICU patients diagnosed with head deformities since PLAY Bundle implementation, biweekly head measurements improved in 58%, worsened in 20%, worsened then improved in 8%, and stayed the same in 20%. Recommendations: Preliminary recommendations include EHR optimization and standardized parental education. There is a vital need for a nurse-driven releasable order set with intervention activation when infants meet criteria

How many motoric body representations can we grasp?

At present there is a debate on the number of body representations in the brain. The most commonly used dichotomy is based on the body image, thought to underlie perception and proven to be susceptible to bodily illusions, versus the body schema, hypothesized to guide actions and so far proven to be robust against bodily illusions. In this rubber hand illusion study we investigated the susceptibility of the body schema by manipulating the amount of stimulation on the rubber hand and the participant’s hand, adjusting the postural configuration of the hand, and investigating a grasping rather than a pointing response. Observed results showed for the first time altered grasping responses as a consequence of the grip aperture of the rubber hand. This illusion-sensitive motor response challenges one of the foundations on which the dichotomy is based, and addresses the importance of illusion induction versus type of response when investigating body representations

Changing the size of a mirror-reflected hand moderates the experience of embodiment but not proprioceptive drift: a repeated measures study on healthy human participants.

Mirror visual feedback is used for reducing pain and visually distorting the size of the reflection may improve efficacy. The findings of studies investigating size distortion are inconsistent. The influence of the size of the reflected hand on embodiment of the mirror reflection is not known. The aim of this study was to compare the effect of magnifying and minifying mirror reflections of the hand on embodiment measured using an eight-item questionnaire and on proprioceptive drift. During the experiment, participants (n = 45) placed their right hand behind a mirror and their left hand in front of a mirror. Participants watched a normal-sized, a magnified and a minified reflection of the left hand while performing synchronised finger movements for 3 min (adaptive phase). Measurements of embodiment were taken before (pre) and after (post) synchronous movements of the fingers of both hands (embodiment adaptive phase). Results revealed larger proprioceptive drift post-adaptive phase (p = 0.001). Participants agreed more strongly with questionnaire items associated with location, ownership and agency of the reflection of the hand post-adaptive phase (p < 0.001) and when looking at the normal-sized reflection (p < 0.001). In conclusion, irrespective of size, watching a reflection of the hand while performing synchronised movements enhances the embodiment of the reflection of the hand. Magnifying and minifying the reflection of the hand has little effect on proprioceptive drift, but it weakens the subjective embodiment experience. Such factors need to be taken into account in future studies using this technique, particularly when assessing mirror visual feedback for pain management

Multiple reassortment events in the evolutionary history of H1N1 influenza A virus since 1918

The H1N1 subtype of influenza A virus has caused substantial morbidity and mortality in humans, first documented in the global pandemic of 1918 and continuing to the present day. Despite this disease burden, the evolutionary history of the A/H1N1 virus is not well understood, particularly whether there is a virological basis for several notable epidemics of unusual severity in the 1940s and 1950s. Using a data set of 71 representative complete genome sequences sampled between 1918 and 2006, we show that segmental reassortment has played an important role in the genomic evolution of A/H1N1 since 1918. Specifically, we demonstrate that an A/H1N1 isolate from the 1947 epidemic acquired novel PB2 and HA genes through intra-subtype reassortment, which may explain the abrupt antigenic evolution of this virus. Similarly, the 1951 influenza epidemic may also have been associated with reassortant A/H1N1 viruses. Intra-subtype reassortment therefore appears to be a more important process in the evolution and epidemiology of H1N1 influenza A virus than previously realized

Manipulable Objects Facilitate Cross-Modal Integration in Peripersonal Space

Previous studies have shown that tool use often modifies one's peripersonal space – i.e. the space directly surrounding our body. Given our profound experience with manipulable objects (e.g. a toothbrush, a comb or a teapot) in the present study we hypothesized that the observation of pictures representing manipulable objects would result in a remapping of peripersonal space as well. Subjects were required to report the location of vibrotactile stimuli delivered to the right hand, while ignoring visual distractors superimposed on pictures representing everyday objects. Pictures could represent objects that were of high manipulability (e.g. a cell phone), medium manipulability (e.g. a soap dispenser) and low manipulability (e.g. a computer screen). In the first experiment, when subjects attended to the action associated with the objects, a strong cross-modal congruency effect (CCE) was observed for pictures representing medium and high manipulability objects, reflected in faster reaction times if the vibrotactile stimulus and the visual distractor were in the same location, whereas no CCE was observed for low manipulability objects. This finding was replicated in a second experiment in which subjects attended to the visual properties of the objects. These findings suggest that the observation of manipulable objects facilitates cross-modal integration in peripersonal space

Integration of visual and joint information to enable linear reaching motions

A new dynamics-driven control law was developed for a robot arm, based on the feedback control law which uses the linear transformation directly from work space to joint space. This was validated using a simulation of a two-joint planar robot arm and an optimisation algorithm was used to find the optimum matrix to generate straight trajectories of the end-effector in the work space. We found that this linear matrix can be decomposed into the rotation matrix representing the orientation of the goal direction and the joint relation matrix (MJRM) representing the joint response to errors in the Cartesian work space. The decomposition of the linear matrix indicates the separation of path planning in terms of the direction of the reaching motion and the synergies of joint coordination. Once the MJRM is numerically obtained, the feedfoward planning of reaching direction allows us to provide asymptotically stable, linear trajectories in the entire work space through rotational transformation, completely avoiding the use of inverse kinematics. Our dynamics-driven control law suggests an interesting framework for interpreting human reaching motion control alternative to the dominant inverse method based explanations, avoiding expensive computation of the inverse kinematics and the point-to-point control along the desired trajectories

Pre-Stressor Interference Control and Intrusive Memories

Although intrusive imagery is a common response in the aftermath of a stressful or traumatic event, only a minority of trauma victims show persistent re-experiencing and related psychopathology. Individual differences in pre-trauma executive control possibly play a critical role. Therefore, this study investigated whether a relatively poor pre-stressor ability to resist proactive interference in working memory might increase risk for experiencing undesirable intrusive memories after being exposed to a stressful event. Non-clinical participants (N = 85) completed a modified version of a widely used test of interference control in working memory (CVLT; Kramer and Delis 1991) and subsequently watched an emotional film fragment. Following presentation of the fragment, intrusive memories were recorded in a 1-week diary and at a follow up session 7 days later. A relatively poor ability to resist proactive interference was related to a relatively high frequency of film-related intrusive memories. This relationship was independent of neuroticism and gender. These findings are consistent with the idea that a pre-morbid deficit in the ability to resist proactive interference reflects a vulnerability factor for experiencing intrusive memories after trauma exposure

Using a Stick Does Not Necessarily Alter Judged Distances or Reachability

Background It has been reported that participants judge an object to be closer after a stick has been used to touch it than after touching it with the hand. In this study we try to find out why this is so. Methodology We showed six participants a cylindrical object on a table. On separate trials (randomly intermixed) participants either estimated verbally how far the object is from their body or they touched a remembered location. Touching was done either with the hand or with a stick (in separate blocks). In three different sessions, participants touched either the object location or the location halfway to the object location. Verbal judgments were given either in centimeters or in terms of whether the object would be reachable with the hand. No differences in verbal distance judgments or touching responses were found between the blocks in which the stick or the hand was used. Conclusion Instead of finding out why the judged distance changes when using a tool, we found that using a stick does not necessarily alter judged distances or judgments about the reachability of objects