Effectiveness of Blended Versus Traditional Refresher Training for Cardiopulmonary Resuscitation: Prospective Observational Study

BACKGROUND

Generally, cardiopulmonary resuscitation (CPR) skills decline substantially over time. By combining web-based self-regulated learning with hands-on practice, blended training can be a time- and resource-efficient approach enabling individuals to acquire or refresh CPR skills at their convenience. However, few studies have evaluated the effectiveness of blended CPR refresher training compared with that of the traditional method.

OBJECTIVE

This study investigated and compared the effectiveness of traditional and blended CPR training through 6-month and 12-month refresher sessions with CPR ability indicators.

METHODS

This study recruited participants aged ≥18 years from the Automated External Defibrillator Donation Project. The participants were divided into 4 groups based on the format of the CPR training and refresher training received: (1) initial traditional training (a 30-minute instructor-led, hands-on session) and 6-month traditional refresher training (Traditional6 group), (2) initial traditional training and 6-month blended refresher training (an 18-minute e-learning module; Mixed6 group), (3) initial traditional training and 12-month blended refresher training (Mixed12 group), and (4) initial blended training and 6-month blended refresher training (Blended6 group). CPR knowledge and performance were evaluated immediately after initial training. For each group, following initial training but before refresher training, a learning effectiveness assessment was conducted at 12 and 24 months. CPR knowledge was assessed using a written test with 15 multiple-choice questions, and CPR performance was assessed through an examiner-rated skill test and objectively through manikin feedback. A generalized estimating equation model was used to analyze changes in CPR ability indicators.

RESULTS

This study recruited 1163 participants (mean age 41.82, SD 11.6 years; n=725, 62.3% female), with 332 (28.5%), 270 (23.2%), 258 (22.2%), and 303 (26.1%) participants in the Mixed6, Traditional6, Mixed12, and Blended6 groups, respectively. No significant between-group difference was observed in knowledge acquisition after initial training (P=.23). All groups met the criteria for high-quality CPR skills (ie, average compression depth: 5-6 cm; average compression rate: 100-120 beats/min; chest recoil rate: >80%); however, a higher proportion (98/303, 32.3%) of participants receiving blended training initially demonstrated high-quality CPR skills. At 12 and 24 months, CPR skills had declined in all the groups, but the decline was significantly higher in the Mixed12 group, whereas the differences were not significant between the other groups. This finding indicates that frequent retraining can maintain high-quality CPR skills and that blended refresher training is as effective as traditional refresher training.

CONCLUSIONS

Our findings indicate that 6-month refresher training sessions for CPR are more effective for maintaining high-quality CPR skills, and that as refreshers, self-learning e-modules are as effective as instructor-led sessions. Although the blended learning approach is cost and resource effective, factors such as participant demographics, training environment, and level of engagement must be considered to maximize the potential of this approach.

TRIAL REGISTRATION

IGOGO NCT05659108; https://www.cgmh-igogo.tw.

Detraining and Retraining Effects from a Multicomponent Training Program on the Functional Capacity and Health Profile of Physically Active Prehypertensive Older Women

BACKGROUND

Resuming a physical exercise program after a period of cessation is common in older women. Monitoring the responses during this detraining (DT) and retraining (RT) may allow us to analyze how the body reacts to an increase and a reduction in physical inactivity. Therefore, we conducted a follow-up training, DT, and RT in prehypertensive older women to analyze the response to these periods.

METHODS

Twenty-three prehypertensive older women (EG; 68.3 ± 2.8 years; 1.61 ± 0.44 m) performed 36 weeks of the multicomponent training program (MTP) followed by twelve weeks of DT plus eight weeks of RT. Fifteen prehypertensive older women (CG; 66.3 ± 3.2 years; 1.59 ± 0.37 m) maintained their normal routine. Functional capacity (FC), lipid, and hemodynamic profile were assessed before, during 24 and 36 weeks of the MTP, after 4 and 12 weeks of DT, and after 8 weeks of RT.

RESULTS

After 24 weeks of the MTP, only SBP did not improve. Four weeks of DT did not affect lower body strength (30-CS), TC, or GL. Eight weeks of RT improved BP (SBP: -2.52%; ES: 0.36; p < 0.00; DBP: -1.45%; ES: 0.44; p < 0.02), handgrip strength (3.77%; ES: 0.51; p < 0.00), and 30-CS (3.17%; ES: 0.38; p < 0.04) compared with 36 weeks of the MTP.

CONCLUSIONS

Eight weeks of RT allowed patients to recover the benefits lost with detraining, which after only four weeks affected them negatively, and the systematic practice of exercise contributed to greater regulation of BP since 24 weeks of the MTP proved not to be enough to promote positive effects of SBP.

Dynamic posturography after computerized vestibular retraining for stable unilateral vestibular deficits

BACKGROUND

Balance deficits increase the risk of falls and compromise quality of life. Current treatment modalities do not resolve symptoms for many patients.

AIMS/OBJECTIVES

To measure changes in objective posturography after a computerized vestibular retraining therapy protocol.

MATERIALS AND METHODS

This was a single-arm interventional study of individuals with a stable unilateral vestibular deficit present for greater than six months. Participants underwent 12 twice-weekly sessions of computerized vestibular retraining therapy. Objective response was measured by the Sensory Organization Test and questionnaires were administered to measure subjective changes.

RESULTS

We enrolled 13 participants (5 females and 8 males) with a median age of 51 years (range 18 to 67). After retraining, the Sensory Organization Test composite score improved by 8.8 (95% CI 0.6 to 19.1) and this correlated with improvement in the Falls Efficacy Scale-International questionnaire (r_s -0.6472; 95% CI -0.8872 to - 0.1316). Participants with moderate-to-severe disability at baseline (n = 7) demonstrated greater improvement in the composite score (14.6; 95% CI 7.0 to 36.9).

CONCLUSIONS AND SIGNIFICANCE

Computerized vestibular retraining therapy for stable unilateral vestibular deficits is associated with improvement in dynamic balance performance. Posturography improvements correlated with a reduction in perceived fall risk.Trial Registration Information Clinicaltrials.gov registration NCT04875013; 04/27/2021.

Determining presentation skills gaps among healthcare professionals

Healthcare professionals frequently communicate complex medical information among colleagues and students. This paper aims to determine gaps in healthcare professionals' presentation skills and identify barriers to improving. Eighty-eight individuals at a Midwest Academic Medical Center completed a survey that consisted of three parts: (1) respondents' current presentation slide deck, (2) respondents' perceptions of their current presentation skills, and (3) barriers to and motivations for improving their presentation skills. A mixed-methods approach was used to collect and analyze data. Respondents used bullet points and text the most (74%), and videos the least in their presentations (51%). When assessing respondents' perceptions of their current presentation skills, they rated themselves the lowest as a storyteller (median = 6/10) and as an overall presenter (median = 6/10). The biggest barrier reported was "lack of training on best practices" (58%). Respondents reported "interested in improving" and "enhance opportunities" as their main motivations for improving presentation skills. Four themes emerged from the open-ended survey items: Practical tips and best practices, Ability to communicate effectively, Professional development, and Practice opportunities. Effective presentation skills should be included in every healthcare professionals faculty development curriculum. This is especially crucial for junior faculty members to ensure their continued success.

"I didn't know you could do that": A Pilot Assessment of EHR Optimization Training

BACKGROUND

Informatics tools within electronic health records (EHRs)-for example, data rosters and clinical reminders-can help disseminate care guidelines into clinical practice. Such tools' adoption varies widely, however, possibly because many primary care providers receive minimal training in even basic EHR functions.

OBJECTIVES

This mixed-methods evaluation of a pilot training program sought to identify factors to consider when providing EHR use optimization training in community health centers (CHCs) as a step toward supporting CHC providers' adoption of EHR tools.

METHODS

In spring 2018, we offered 10 CHCs a 2-day, 16-hour training in EHR use optimization, provided by clinician trainers, and customized to each CHC's needs. We surveyed trainees pre- and immediately post-training and again 3 months later. We conducted post-training interviews with selected clinic staff, and conducted a focus group with the trainers, to assess satisfaction with the training, and perceptions of how it impacted subsequent EHR use.

RESULTS

Six CHCs accepted and received the training; 122 clinic staff members registered to attend, and most who completed the post-training survey reported high satisfaction. Three months post-training, 80% of survey respondents said the training had changed their daily EHR use somewhat or significantly.

CONCLUSION

Factors to consider when planning EHR use optimization training in CHCs include: CHCs may face barriers to taking part in such training; it may be necessary to customize training to a given clinic's needs and to different trainees' clinic roles; identifying trainees' skill level a priori would help but is challenging; in-person training may be preferable; and inclusion of a practice coach may be helpful. Additional research is needed to identify how to provide such training most effectively.

Validity and Reliability of an Instrumented Treadmill with an Accelerometry System for Assessment of Spatio-Temporal Parameters and Impact Transmission

Running retraining programs focused on concurrent feedback of acceleration impacts have been demonstrated to be a good strategy to reduce running-related injuries (RRI), as well as to improve running economy and reduce acceleration impacts and injury running incidence. Traditionally, impacts have been registered by mean of accelerometers attached directly to the athletes, which is inaccessible to the entire population, because it requires laboratory conditions. This study investigated the validity and reliability of a new device integrated directly into the treadmill, compared to a traditional acceleration impact system. Thirty healthy athletes with no history of RRI were tested on two separate days over the instrumented treadmill (AccTrea) and simultaneously with an acceleration impact system attached to the participant (AccAthl). AccTrea was demonstrated to be a valid and reliable tool for measuring spatio-temporal parameters like step length (validity intraclass correlation coefficient (ICC) = 0.94; reliability ICC = 0.92), step time (validity ICC = 0.95; reliability ICC = 0.96), and step frequency (validity ICC = 0.95; reliability ICC = 0.96) during running. Peak acceleration impact variables showed a high reliability for the left (reliability ICC = 0.88) and right leg (reliability ICC = 0.85), and peak impact asymmetry showed a modest validity (ICC = 0.55). These results indicated that the AccTrea system is a valid and reliable way to assess spatio-temporal variables, and a reliable tool for measuring acceleration impacts during running.

Daily self-care practices influence exit-site condition in patients having peritoneal dialysis: A multicenter cross-sectional survey

AIMS

To investigate practice patterns in exit-site care and identify the risk factors for exit-site infection.

DESIGN

A quantitative cross-sectional design.

METHODS

Data were collected in 12 peritoneal dialysis (PD) centres in 2018. Daily exit-site care practice patterns and exit-site status of patients receiving PD were assessed through interviews and questionnaires.

RESULTS/FINDINGS

Most of the 1,204 patients adhered with the protocols about main aspects of exit-site care, such as cleansing agents selection, frequency of cleansing, catheter fixation, and following the catheter protective measures. However, their adherence levels on hand hygiene, mask wearing, observing exit site, examining secretion, and communicating with PD staff were rather low. Eighty-four patients' exit sites were evaluated as problematic exit site (PES). And 186 patients had catheter-related infection (CRI) history. After multivariable logistic regression analysis, diabetes (OR = 1.631), traction bleeding history (OR = 2.697), antibiotic agents use (OR = 2.460), compliance on mask wearing (OR = 0.794), and observing exit site (OR = 0.806) were influencing factors of CRI history. Traction bleeding history (OR = 2.436), CRI history (OR = 10.280), and effective communication (OR = 0.808) with PD staff were influencing factors for PES.

CONCLUSIONS

The adherence levels on different aspects of exit-site care were varied in patients having PD. Their self-care behaviours did correlate with the exit-site status.

IMPACT

The adherence level of patients' exit-site care practice needs attention of medical staff. Further studies about the optimal procedure in exit-site care were warranted.

Changes of knowledge and practical skills before and after retraining for basic life support: Focused on students of Dental School

Background: Considering the increasing possibility of emergency situations in dental clinics over time, we conducted this study to evaluate the changes in the knowledge and practical skills of students of dental school before and after retraining for 2 years after the initial education on basic life support (BLS) of the American Heart Association (AHA). Methods: All third-year students of dental school who had received the same education on BLS provider training of the AHA 2 years earlier were included in this study. Among them, 98 students were asked to answer a questionnaire about BLS knowledge and conduct a practical skills assessment of high-quality cardiopulmonary resuscitation using Little Anne QCPR before and after retraining. Results: After retraining, the level of BLS knowledge increased in all 7 categories, and BLS performance increased in all 19 subcategories. Comparison of the QCPR numerical data items before and after retraining showed that all items after retraining met the criteria recommended by the AHA. Conclusion: Students of dental school had low levels of knowledge and practical skills of BLS before retraining after 2 years from the initial education and had high levels after retraining. Therefore, BLS training must be updated periodically, and more effective education methods are required to maintain BLS knowledge and practical skills.

A follow-up report on the effect of a simplified basic life support training program for non-medical staff working at a university hospital: changes in attitude toward cardiopulmonary resuscitation and automated external defibrillator use through repeat training

Aim

This study aimed to investigate the effect of repeat training and the interval of reattending a simplified basic life support (BLS) training course.

Methods

We administered a questionnaire on the attitude toward cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use (check for response, chest compression, and using an AED) before and immediately after a 45‐min BLS training program provided for non‐medical staff working at a university hospital from September 2010 to November 2018. The main outcome was positive willingness of the participants toward CPR and AED use. The effect of repeat training was assessed with McNemar’s test and multivariable logistic regression analysis. Differences in the interval of reattending the simplified BLS training course were assessed with Fisher’s exact test.

Results

Fifty‐nine training courses were held. Among the total participant count of 1,025, 760 individuals attended, of whom 126 attended the training multiple times. The proportion of participants showing a positive attitude toward chest compression before the course increased as the number of attendances increased (adjusted odds ratio 1.62: 9.8% at first training to 58.8% at sixth training). The positive attitude of participants before the course was significantly greater when the training interval was <1 year (36.1% versus 18.7%). There was no significant difference for a 6‐month interval (40% versus 23.2%).

Conclusions

Repeat training for non‐medical staff in a chest compression‐only CPR training course showed a cumulative effect of repeat attendance. A course interval of <1 year from the previous attendance would be important for maintaining a positive attitude toward CPR and AED use.

Prevention of peritoneal dialysis-related peritonitis by regular patient retraining via technique inspection or oral education: a randomized controlled trial

BACKGROUND

There has been little research on strategies for prevention of peritoneal dialysis (PD)-related peritonitis. We explored whether regular retraining on bag exchanges (via two methods: technique inspection and oral education) every other month could help reduce the risk of peritonitis in PD patients through a randomized controlled trial (RCT).

METHOD

This is an RCT conducted at Peking University First Hospital. A total of 150 incident patients receiving PD at our centre were included between December 2010 and June 2016 and followed up until June 2018. Patients were randomly assigned 1:1:1 to receive retraining on bag exchange via technique inspection, oral education or usual care. The primary outcome was time to the first peritonitis episode. Secondary outcomes were time to organism-specific peritonitis, transfer to haemodialysis and all-cause death.

RESULTS

Patients in the technique inspection group, oral education group and usual care group (n = 50 for each group) were followed up for 47.5 ± 22.9 months. Time to first peritonitis was comparable between the groups. The technique inspection group showed a lower risk of first non-enteric peritonitis than the usual care group, while the oral education group did not show a significant benefit. The incidence of first non-enteric peritonitis in the usual care group (0.07/patient-year) was significantly higher than that in the technique inspection group (0.02/patient-year; P < 0.01) but was comparable with that in the oral education group (0.06/patient-year). Transfer to haemodialysis and all-cause mortality were not significantly different between the groups.

CONCLUSIONS

Neither technique inspection nor oral education significantly altered the risk of all-cause peritonitis compared with usual care, despite technique inspection showing a trend towards reducing the risk of non-enteric PD-related peritonitis.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT01621997).

A Pretraining-Retraining Strategy of Deep Learning Improves Cell-Specific Enhancer Predictions

Deciphering the code of cis-regulatory element (CRE) is one of the core issues of today’s biology. Enhancers are distal CREs and play significant roles in gene transcriptional regulation. Although identifications of enhancer locations across the whole genome [discriminative enhancer predictions (DEP)] is necessary, it is more important to predict in which specific cell or tissue types, they will be activated and functional [tissue-specific enhancer predictions (TSEP)]. Although existing deep learning models achieved great successes in DEP, they cannot be directly employed in TSEP because a specific cell or tissue type only has a limited number of available enhancer samples for training. Here, we first adopted a reported deep learning architecture and then developed a novel training strategy named “pretraining-retraining strategy” (PRS) for TSEP by decomposing the whole training process into two successive stages: a pretraining stage is designed to train with the whole enhancer data for performing DEP, and a retraining strategy is then designed to train with tissue-specific enhancer samples based on the trained pretraining model for making TSEP. As a result, PRS is found to be valid for DEP with an AUC of 0.922 and a GM (geometric mean) of 0.696, when testing on a larger-scale FANTOM5 enhancer dataset via a five-fold cross-validation. Interestingly, based on the trained pretraining model, a new finding is that only additional twenty epochs are needed to complete the retraining process on testing 23 specific tissues or cell lines. For TSEP tasks, PRS achieved a mean GM of 0.806 which is significantly higher than 0.528 of gkm-SVM, an existing mainstream method for CRE predictions. Notably, PRS is further proven superior to other two state-of-the-art methods: DEEP and BiRen. In summary, PRS has employed useful ideas from the domain of transfer learning and is a reliable method for TSEPs.

Are Footedness and Lateral Postures Better Predictors of Hemispheric Dominance Than Handedness: A Cross-sectional Questionnaire-Based Clinical and Pedigree Study

Objective  Approximately 9 out of 10 individuals show right-hand dominance. The remaining 10% include left-hand dominant and mixed handed/ambidextrous individuals. Laterality, lateral postures or lateral preference is defined by various authors as the most comfortable posture that an individual prefers to assume. The current study aims at finding the distribution of these lateral postures and their correlation with handedness/dominant side.

Materials and Methods  The study was done in medical and nursing students in the age group 18 to 22 years. The patients were asked to fill a self-assessment questionnaire to determine handedness and footedness. The laterality traits were observed by asking the patients to do by themselves after an untailored demonstration.

Statistical Analysis  The relationship between study parameters was assessed using Chi-square test. Pearson’s correlation test was done to assess the strength of association between comfort ratings of the various laterality postures.

Results  In our study, 96.5% were right handed and 79.9% of patients were right footed. Also, 50.8% preferred right-hand clasping, 53.9% preferred left-arm folding, and 60.6% preferred right-leg folding. A statistically significant correlation was seen between foot preference and lateral postures and arm folding and hand clasping (p < 0.05). A significant association was also found between handedness and positive history of retraining. Sidedness did not follow any Mendelian pattern of inheritance.

Conclusions  Handedness is affected by genetic and environmental factors. Since cultural and traditional practices can affect the lateral postures and handedness, it is important to know the relationship between laterality postures and sidedness and the impact of retraining on them. These postures are measures of cerebral dominance and are clinically important.

Sensory retraining of the leg after stroke: systematic review and meta-analysis

Objective:

This systematic review aimed to investigate the effects of interventions intended for retraining leg somatosensory function on somatosensory impairment, and secondary outcomes of balance and gait, after stroke.

Data sources:

Databases searched from inception to 16 January 2019 included Cochrane Library, PubMed, MEDLINE, CINAHL, EMBASE, PEDro, PsycINFO, and Scopus. Reference lists of relevant publications were also manually searched.

Review methods:

All types of quantitative studies incorporating interventions that intended to improve somatosensory function in the leg post stroke were retrieved. The Quality Assessment Tool for Quantitative Studies was used for quality appraisal. Standardised mean differences were calculated and meta-analyses were performed using preconstructed Microsoft Excel spreadsheets.

Results:

The search yielded 16 studies, comprising 430 participants, using a diverse range of interventions. In total, 10 of the included studies were rated weak in quality, 6 were rated moderate, and none was rated strong. Study quality was predominantly affected by high risk of selection bias, lack of blinding, and the use of somatosensory measures that have not been psychometrically evaluated. A significant heterogeneous positive summary effect size (SES) was found for somatosensory outcomes (SES: 0.52; 95% confidence interval (CI): 0.04 to 1.01; I² = 74.48%), which included joint position sense, light touch, and two-point discrimination. There was also a significant heterogeneous positive SES for Berg Balance Scale scores (SES: 0.62; 95% CI: 0.10 to 1.14; I² = 59.05%). Gait SES, mainly of gait velocity, was not significant.

Conclusion:

This review suggests that interventions used for retraining leg somatosensory impairment after stroke significantly improved somatosensory function and balance but not gait.

Five-year follow-up of persons with brain injury entering the French vocational and social rehabilitation programme UEROS: Return-to-work, life satisfaction, psychosocial and community integration

BACKGROUND

Social and vocational reintegration of persons with brain injury is an important element in their rehabilitation.

AIMS

To evaluate the 5-year outcome of persons with brain injury included in 2008 in the Aquitaine Unit for Evaluation, Training and Social and Vocational Counselling programme (UEROS).

METHOD

57 persons with brain injury were recruited from those who completed the 2008 UEROS programme. Five years later, an interview was done to assess family and vocational status, autonomy and life satisfaction. These results were compared with those from persons completing the 1997-1999 programme.

RESULTS

The typical person entered the 2008 UEROS programme 6 years after a severe brain injury (42%) and was male, single and 35 years. At the 5-year follow-up, more persons lived with a partner (+23%) and lived in their own home (+21%). 47% were working vs 11% on entering the programme. Approximately half were satisfied or very satisfied with their quality of life. Having a job in 2013 was associated with a high education level, less cognitive sequelae, having a job in 2008 and no health condition.

CONCLUSIONS

The UEROS programme is effective with regard to return-to-work and improvement of autonomy in persons with brain injury, irrespective of length of time from injury.

General scheme to reduce the knee adduction moment by modifying a combination of gait variables

Reducing the knee adduction moment (KAM) is a promising treatment for medial compartment knee osteoarthritis (OA). Although several gait modifications to lower the KAM have been identified, the potential to combine modifications and individual dose-responses remain unknown. This study hypothesized that: (i) there is a general scheme consisting of modifications in trunk sway, step width, walking speed, and foot progression angle that reduces the KAM; (ii) gait modifications can be combined; and (iii) dose-responses differ among individuals. Walking trials with simultaneous modifications in step width, walking speed, progression angle, and trunk sway were analyzed for 10 healthy subjects. Wider step width, slower speed, toeing-in, and increased trunk sway resulted in reduced first KAM peak, whereas wider step width, faster speed, and increased trunk sway reduced the KAM angular impulse. Individual regressions accurately modeled the amplitude of the KAM variables relative to the amplitude of the gait modification variables, while the dose-responses varied strongly among participants. In conclusion, increasing trunk sway, increasing step width, and toeing-in are three gait modifications that could be combined to reduce KAM variables related to knee OA. Results also indicated that some gait modifications reducing the KAM induced changes in the knee flexion moment possibly indicative of an increase in knee loading. Taken together with the different dose-responses among subjects, this study suggested that gait retraining programs should consider this general scheme of modifications with individualization of the modification amplitudes. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1547-1556, 2016.

Occupational skin diseases from 1997 to 2004 at the Department of Dermatology, University Hospital of Northern Norway (UNN): an investigation into the course and treatment of occupational skin disease 10-15 years after first consultations with a dermatologist

Objectives

We investigate the impact of occupational skin disease consultations among outpatients at the Dermatological Department, University Hospital, Northern Norway.

Study design

From 1997 until 2004, 386 patients with occupational skin disease were examined and given advice on skin care, skin disease treatment, skin protection in further work, and on the legal rights of patients with this disease. Ten to fifteen years later, we wanted to look at these patients in terms of their work situation, the current status of their disease, the help they received from the labour offices, and their subjective quality of life.

Material and methods

In the autumn of 2011 until the spring of 2012, a number of the patients examined in the period from 1997 to 2004 were selected and sent a questionnaire, which they were asked to answer and return, regarding their work situation and the progress and current status of their occupational disease.

Results

A total of 153 (77%) patients answered the questionnaire; 71% of these patients were still in work, and further 15% had old-age retired, 13% were working until then; 16% had retired early because of disability; 54% had changed jobs because of their occupational skin disease; 86% of the patients indicated that the skin disease had improved since our previous investigation.

Conclusions

Our investigation into patients with occupational skin disease documented that the majority of patients who had received professional dermatological consultation and intervention offers were still in the labour market and had good control of their skin disease 10–15 years later. We discovered that 71% of the patients were still employed. 13% had remained in work until they became old age pensioners. Only 16% dropped out of work because of disability. These high percentages may indicate that our intervention has contributed positively to patients’ work conditions and the course of their skin disease.

Computer-Based Cognitive Training for Executive Functions after Stroke: A Systematic Review

Background: Stroke commonly results in cognitive impairments in working memory, attention, and executive function, which may be restored with appropriate training programs. Our aim was to systematically review the evidence for computer-based cognitive training of executive dysfunctions.

Methods: Studies were included if they concerned adults who had suffered stroke or other types of acquired brain injury, if the intervention was computer training of executive functions, and if the outcome was related to executive functioning. We searched in MEDLINE, PsycINFO, Web of Science, and The Cochrane Library. Study quality was evaluated based on the CONSORT Statement. Treatment effect was evaluated based on differences compared to pre-treatment and/or to a control group.

Results: Twenty studies were included. Two were randomized controlled trials that used an active control group. The other studies included multiple baselines, a passive control group, or were uncontrolled. Improvements were observed in tasks similar to the training (near transfer) and in tasks dissimilar to the training (far transfer). However, these effects were not larger in trained than in active control groups. Two studies evaluated neural effects and found changes in both functional and structural connectivity. Most studies suffered from methodological limitations (e.g., lack of an active control group and no adjustment for multiple testing) hampering differentiation of training effects from spontaneous recovery, retest effects, and placebo effects.

Conclusions: The positive findings of most studies, including neural changes, warrant continuation of research in this field, but only if its methodological limitations are addressed.

Sensory trick phenomenon improves motor control in pianists with dystonia: prognostic value of glove-effect

Musician’s dystonia (MD) is a task-specific movement disorder that causes loss of voluntary motor control while playing the instrument. A subgroup of patients displays the so-called sensory trick: alteration of somatosensory input, e.g., by wearing a latex glove, may result in short-term improvement of motor control. In this study, the glove-effect in pianists with MD was quantified and its potential association with MD-severity and outcome after treatment was investigated. Thirty affected pianists were included in the study. Music instrument digital interface-based scale analysis was used for assessment of fine motor control. Therapeutic options included botulinum toxin, pedagogical retraining and anticholinergic medication (trihexyphenidyl). 19% of patients showed significant improvement of fine motor control through wearing a glove. After treatment, outcome was significantly better in patients with a significant pre-treatment sensory trick. We conclude that the sensory trick may have a prognostic value for the outcome after treatment in pianists with MD.

Expanding the consumer base for behavior-analytic services: meeting the needs of consumers in the 21st century

A growing workforce of behavior analysts provides services to individuals with autism and intellectual disabilities as legislative initiatives have spurred a growth of funding options to support these services. Though many opportunities currently exist for serving individuals with autism, the growing demand for these services may wane or, at some point, the growth in service providers will meet that demand. Other consumer groups could benefit from behavior analytic services, but typically have limited access to qualified providers. Individuals with dementia and traumatic brain injury are used as example consumer groups to illustrate the necessary tasks for a behavior analyst to expand their scope of practice to a new population. This paper provides strategies for developing competence and creating employment opportunities with new consumer groups.

Improving Functional Performance and Muscle Power 4-to-6 Months After Anterior Cruciate Ligament Reconstruction

The purpose of this study was to examine the effects of 8-week retraining programs, with either two or three training sessions per week, on measures of functional performance and muscular power in athletes with anterior cruciate ligament reconstruction (ACLR). Sixteen male athletes were randomly assigned to two groups after ACLR: a functional training group (FTG, n = 8) training 2 intense sessions per week (4hrs/week), and a control group (CG, n = 8) training 3 sessions per week with moderate intensity (6hrs/week). The two groups were assessed at four and six months post-ACLR and the effects of retraining were measured using the following assessments: the functional and the muscular power tests, and the agility T-test. After retraining, the FTG had improved more than the CG in the operated leg in the single leg hop test (+34.64% vs. +10.92%; large effect), the five jump test (+8.87% vs. +5.03%; medium effect), and single leg triple jump (+32.15% vs. +16.05%; medium effect). For the agility T-test, the FTG had larger improvements (+17.26% vs. +13.03%, medium effect) as compared to the CG. For the bilateral power tests, no significant training effects were shown for the two groups in the squat jump (SJ), the counter movement jump (CMJ) and the free arms CMJ (Arm CMJ). On the other hand, the unilateral CMJ test with the injured and the uninjured legs showed a significant increase for the FTG with respect to CG (p < 0.05). The present study introduces a new training modality in rehabilitation after ACLR that results in good recovery of the operated limb along with the contra-lateral leg. This may allow the athletes to reach good functional and strength performance with only two physical training sessions per week, better preparing them for a return to sport activity at 6 months post- ACLR and eventually sparing time for a possible progressive introduction of the sport specific technical training. Key pointsFunctional training (plyometrics, neuromuscular, proprioceptive and agility exercises) in athletes during 4th to 6th months post-ACLR further improved functional outcomes, compared to a conventional rehabilitation program.The former program was more time-efficient compared to the latter one as indicated by the weekly training duration (4hrs/week vs. 6hrs/week).This study provides evidence of the functional training in knee rehabilitation and provides important information that is highly relevant to clinicians, physiotherapists, coaches and trainers who are in charge of the injured athletes during the later phase of the rehabilitation after ACLR.