Learning functional human anatomy with a new interactive three-dimensional digital tool

Human anatomy requires understanding spatial relationships among anatomical structures and is often perceived as difficult to learn by students. To overcome this concern, several digital tools exist with some strengths and limitations among which the lack of interactivity especially for complex functional anatomy learning. In this way, a new interactive three-dimensional tool called Antepulsio was designed. Antepulsio was assessed by comparing three groups of first year kinesiology students to test whether it is likely to favor functional anatomy learning during three training sessions spread over a week. The experiment was conducted during a real academic course. Laterality judgment, 3D spatial abilities and working memory abilities from all participants were previously collected to create three homogeneous groups: the active group (n = 17, 17.76 ± 0.56 years) interacted with Antepulsio, the passive group (n = 18, 17.89 ± 0.83 years) watched videos of Antepulsio while the control group (n = 15, 18.07 ± 0.80 years) performed a neutral activity unrelated to anatomy. Anatomy knowledge was also assessed during pretest, posttest, and retention test (8 weeks after the posttest). The most significant outcome of this study revealed that in case of better working visual memory, the active group outperformed the passive group between pretest and retention test (p < 0.01). In other words, Antepulsio tool is efficient only for students with high visuospatial working memory. These selective benefits of Antepulsio are discussed in terms of cognitive load, training duration and the necessary period of familiarization with the tool.

Exploring the impact of interactive movement-based anatomy learning in real classroom setting among kinesiology students

Descriptive and functional anatomy is one of the most important sciences for kinesiology students. Anatomy learning requires spatial and motor imagery abilities. Learning anatomy is complex when teaching methods and instructional tools do not appropriately develop spatial and motor imagery abilities. Recent technological developments such as three-dimensional (3D) digital tools allow to overcome those difficulties, especially when 3D tools require strong interactions with the learners. Besides interactive digital tools, embodied learning or learning in motion is an effective method for a wide variety of sciences including anatomy. The aim of this study was to explore the impact of combining movement execution with 3D animation visualization on anatomy learning in a real classroom teaching context. To do so, the results of two groups of kinesiology students during three official assessments were compared. The experimental group (n = 60) learned functional anatomy by combining movement execution with traditional knowledge acquisition (e.g., 3D animations visualization, problem-based learning exercises). The control group (n = 61) had the same material but did not execute the movements during problem-solving exercises. Although no differences were found between both groups on early and mid-semester examinations, significant difference appeared at the end of the semester with an advantage for the experimental group. This exploratory study suggests that embodied learning is beneficial in improving functional anatomy learning. Therefore, it would be interesting to integrate such type of pedagogical approach within the kinesiology curriculum.

A haptic laparoscopic trainer based on affine velocity analysis: engineering and preliminary results

BACKGROUND

There is a general agreement upon the importance of acquiring laparoscopic skills outside the operation room through simulation-based training. However, high-fidelity simulators are cost-prohibitive and elicit a high cognitive load, while low-fidelity simulators lack effective feedback. This paper describes a low-fidelity simulator bridging the existing gaps with affine velocity as a new assessment variable. Primary validation results are also presented.

METHODS

Psycho-motor skills and engineering key features have been considered e.g. haptic feedback and complementary assessment variables. Seventy-seven participants tested the simulator (17 expert surgeons, 12 intermediates, 28 inexperienced interns, and 20 novices). The content validity was tested with a 10-point Likert scale and the discriminative power by comparing the four groups' performance over two sessions.

RESULTS

Participants rated the simulator positively, from 7.25 to 7.72 out of 10 (mean, 7.57). Experts and intermediates performed faster with fewer errors (collisions) than inexperienced interns and novices. The affine velocity brought additional differentiations, especially between interns and novices.

CONCLUSION

This affordable haptic simulator makes it possible to learn and train laparoscopic techniques. Self-assessment of basic skills was easily performed with slight additional cost compared to low-fidelity simulators. It could be a good trade-off among the products currently used for surgeons' training.

Effect of motor imagery and actual practice on learning professional medical skills

BACKGROUND

The peripheral venous catheter is the most frequently used medical device in hospital care to administer intravenous treatment or to take blood samples by introducing a catheter into a vein. The aim of this study was to examine the effect of motor imagery associated with actual training on the learning of peripheral venous catheter insertion into a simulated venous system.

METHOD

This was a prospective monocentre study in 3rd year medical students. Forty medical students were assigned to the experimental group (n = 20) performing both real practice and motor imagery of peripheral venous catheter insertion or to the control group (n = 20) trained through real practice only. We also recruited a reference group of 20 professional nurses defining the benchmark for a target performance.

RESULTS

The experimental group learned the peripheral venous catheter insertion faster than the control group in the beginning of learning phase (p < 0.001), reaching the expected level after 4 sessions (p = .87) whereas the control group needed 5 sessions to reach the same level (p = .88). Both groups were at the same level at the end of the scheduled training.

CONCLUSIONS

Therefore, motor imagery improved professional motor skills learning, and limited the time needed to reach the expected level. Motor imagery may strengthen technical medical skill learning.

The therapeutic role of motor imagery during the chronic phase after total knee arthroplasty: a pilot randomized controlled trial

BACKGROUND

There is now ample evidence that motor imagery contributes to enhance motor learning and promote motor recovery in patients with motor disorders. Whether motor imagery practice is likely to facilitate mobility in patients suffering from knee osteoarthritis, at 6-months after total knee arthroplasty, remains unknown.

AIM

This trial was designed to evaluate the therapeutic effectiveness of implementing motor imagery into the classical course of physical therapy at 6-months after total knee arthroplasty.

DESIGN

Randomized controlled trial.

POPULATION

Twenty-four patients with unilateral total knee arthroplasty were assigned to a motor imagery or control group in a test-retest procedure, following a rehabilitation program as outpatients.

METHODS

During both the pre- and post-test, a set of strength and functional mobility measures were assessed: quadriceps strength, peak knee flexion during the swing phase, performance at the timed up and go test, stair climbing test, and 6-minute walk test, and finally Oxford knee score. In addition to a common physical therapy program, the motor imagery group practiced additional motor imagery exercises, while participants of the control group were subjected to a period of neutral activities for an equivalent amount of time.

RESULTS

Data provided evidence that motor imagery enhanced the quadriceps muscle strength of the operated knee (F (1, 22)=10.36, P=0.003), improved the peak knee flexion during the swing phase (F (1, 22)=31.52, P<0.001), and increased the speed to climb and descend stairs (F (1, 22)=14.28, P=0.001).

CONCLUSIONS

This study demonstrated the effectiveness of motor imagery exercises in gait performance and functional recovery in a small sample of individuals who underwent total knee arthroplasty. However, before drawing final conclusions sample size calculation should be conducted in the future.

CLINICAL REHABILITATION IMPACT

While waiting for further research, our findings encourage incorporating motor imagery exercises into classical physical therapy protocols at 6-months after total knee arthroplasty.

Implementing Cognitive Training Into a Surgical Skill Course: A Pilot Study on Laparoscopic Suturing and Knot Tying

Mini-invasive surgery-for example, laparoscopy-has challenged surgeons' skills by extending their usual haptic space and displaying indirect visual feedback through a screen. This may require new mental abilities, including spatial orientation and mental representation. This study aimed to test the effect of cognitive training based on motor imagery (MI) and action observation (AO) on surgical skills. A total of 28 postgraduate residents in surgery took part in our study and were randomly distributed into 1 of the 3 following groups: (1) the basic surgical skill, which is a short 2-day laparoscopic course + MI + AO group; (2) the basic surgical skill group; and (3) the control group. The MI + AO group underwent additional cognitive training, whereas the basic surgical skill group performed neutral activity during the same time. The laparoscopic suturing and knot tying performance as well as spatial ability and mental workload were assessed before and after the training period. We did not observe an effect of cognitive training on the laparoscopic performance. However, the basic surgical skill group significantly improved spatial orientation performance and rated lower mental workload, whereas the 2 others exhibited lower performance in a mental rotation test. Thus, actual and cognitive training pooled together during a short training period elicited too high a strain, thus limiting potential improvements. Because MI and AO already showed positive outcomes on surgical skills, this issue may, thus, be mitigated according to our specific learning conditions. Distributed learning may possibly better divide and share the strain associated with new surgical skills learning.

The therapeutic role of motor imagery during the acute phase after total knee arthroplasty: a pilot study

PURPOSE

The aim of this study was to measure physical and functional outcomes during the acute postoperative recovery in patients who underwent total knee arthroplasty. Motor imagery has been shown to decrease pain and promote functional recovery after both neurological and peripheral injuries. Yet, whether motor imagery can be included as an adjunct effective method into physical therapy programs following total knee arthroplasty remains a working hypothesis that we aim to test in a pilot study.

METHOD

Twenty volunteers were randomly assigned to either a motor imagery or a control group. Pain, range of motion, knee girth as well as quadriceps strength and Timed Up and Go Test time were the dependent variables during pre-test and post-test.

RESULTS

The motor imagery group exhibited larger decrease of ipsilateral pain and knee girth, a slightly different evolution of range of motion and an increase of ipsilateral quadriceps strength compared to the control group. No effects of motor imagery on Timed Up and Go Test scores were observed.

CONCLUSION

Implementing motor imagery practice into the course of physical therapy enhanced various physical outcomes during acute postoperative recovery after total knee arthroplasty. According to this pilot study, motor imagery might be relevant to promote motor relearning and recovery after total knee arthroplasty.Partial effect-sizes should be conducted in the future. Implications for rehabilitation    Adding motor imagery to physical therapy sessions during the acute period following total knee arthroplasty:    • Enhances quadriceps strength.    • Alleviates pain.    • Enhances range of motion.    • Does not have any effect on basic functional mobility.    • Does not have any effect on knee girth.

How spatial abilities and dynamic visualizations interplay when learning functional anatomy with 3D anatomical models

The emergence of dynamic visualizations of three-dimensional (3D) models in anatomy curricula may be an adequate solution for spatial difficulties encountered with traditional static learning, as they provide direct visualization of change throughout the viewpoints. However, little research has explored the interplay between learning material presentation formats, spatial abilities, and anatomical tasks. First, to understand the cognitive challenges a novice learner would be faced with when first exposed to 3D anatomical content, a six-step cognitive task analysis was developed. Following this, an experimental study was conducted to explore how presentation formats (dynamic vs. static visualizations) support learning of functional anatomy, and affect subsequent anatomical tasks derived from the cognitive task analysis. A second aim was to investigate the interplay between spatial abilities (spatial visualization and spatial relation) and presentation formats when the functional anatomy of a 3D scapula and the associated shoulder flexion movement are learned. Findings showed no main effect of the presentation formats on performances, but revealed the predictive influence of spatial visualization and spatial relation abilities on performance. However, an interesting interaction between presentation formats and spatial relation ability for a specific anatomical task was found. This result highlighted the influence of presentation formats when spatial abilities are involved as well as the differentiated influence of spatial abilities on anatomical tasks.

Effectiveness of three-dimensional digital animation in teaching human anatomy in an authentic classroom context

Three-dimensional (3D) digital animations were used to teach the human musculoskeletal system to first year kinesiology students. The purpose of this study was to assess the effectiveness of this method by comparing two groups from two different academic years during two of their official required anatomy examinations (trunk and upper limb assessments). During the upper limb section, the teacher used two-dimensional (2D) drawings embedded into PowerPoint(®) slides and 3D digital animations for the first group (2D group) and the second (3D group), respectively. The same 3D digital animations were used for both groups during the trunk section. The only difference between the two was the multimedia used to present the information during the upper limb section. The 2D group surprisingly outperformed the 3D group on the trunk assessment. On the upper limb assessment no difference in the scores on the overall anatomy examination was found. However, the 3D group outperformed the 2D group in questions requiring spatial ability. Data supported that 3D digital animations were effective instructional multimedia material tools in teaching human anatomy especially in recalling anatomical knowledge requiring spatial ability. The importance of evaluating the effectiveness of a new instructional material outside laboratory environment (e.g., after a complete semester and on official examinations) was discussed.

Physiological changes in response to apnea impact the timing of motor representations: a preliminary study

Background

Reduced physiological arousal in response to breath-holding affects internal clock processes, leading swimmers to underestimate the time spent under apnea. We investigated whether reduced physiological arousal during static apnea was likely to affect the temporal organization of motor imagery (MI).

Methods

Fourteen inter-regional to national breath-holding athletes mentally and physically performed two 15 m swimming tasks of identical durations. They performed the two sequences in a counterbalanced order, the first while breathing normally using a scuba, the second under apnea. We assessed MI duration immediately after completion of the corresponding task. Athletes performed MI with and without holding breath.

Results

MI durations (26.1 s ± 8.22) were significantly shorter than actual durations (29.7 s ± 7.6) without holding breath. Apnea increased MI durations by 10% (± 5%). Heart rate decrease in response to breath-holding correlated with MI durations increase (p < .01). Under apnea, participants achieved temporal congruence between MI and PP only when performing MI of the apnea swimming task. Self-report data indicated greater ease when MI was performed in a physiological arousal state congruent with that of the corresponding motor task.

Conclusions

Physiological arousal affected the durations of MI through its effects on internal clock processes and by impacting the congruency in physiological body states between overt and covert motor performance. Present findings have potential implications with regards to the possibility of preventing underestimation of durations spent under a state of reduced physiological arousal.

The therapeutic role of motor imagery on the functional rehabilitation of a stage II shoulder impingement syndrome

PURPOSE

Motor imagery (MI) has been used as a complementary therapeutic tool for motor recovery after central nervous system disease and peripheral injuries. However, it has never been used as a preventive tool. We investigated the use of MI in the rehabilitation of stage II shoulder impingement syndrome. For the first time, MI is used before surgery.

METHOD

Sixteen participants were randomly assigned to either a MI or control group. Shoulder functional assessment (Constant score), range of motion and pain were measured before and after intervention.

RESULTS

Higher Constant score was observed in the MI than in the control group (p=0.04). Participants in the MI group further displayed greater movement amplitude (extension (p<0.001); flexion (p=0.025); lateral rotation (p<0.001). Finally, the MI group showed greater pain decrease (p=0.01).

CONCLUSION

MI intervention seems to alleviate pain and enhance mobility, this is probably due to changes in muscle control and consequently in joint amplitude. MI might contribute to postpone or even protect from passing to stage III that may require surgery. Implications for Rehabilitation Adding motor imagery training to classical physical therapy in a stage II impingement syndrome: Helps in alleviating pain Enhances shoulder mobility Motor imagery is a valuable technique that can be used as a preventive tool before the stage III of the impingement syndrome.

Selective effect of physical fatigue on motor imagery accuracy

While the use of motor imagery (the mental representation of an action without overt execution) during actual training sessions is usually recommended, experimental studies examining the effect of physical fatigue on subsequent motor imagery performance are sparse and yielded divergent findings. Here, we investigated whether physical fatigue occurring during an intense sport training session affected motor imagery ability. Twelve swimmers (nine males, mean age 15.5 years) conducted a 45 min physically-fatiguing protocol where they swam from 70% to 100% of their maximal aerobic speed. We tested motor imagery ability immediately before and after fatigue state. Participants randomly imagined performing a swim turn using internal and external visual imagery. Self-reports ratings, imagery times and electrodermal responses, an index of alertness from the autonomic nervous system, were the dependent variables. Self-reports ratings indicated that participants did not encounter difficulty when performing motor imagery after fatigue. However, motor imagery times were significantly shortened during posttest compared to both pretest and actual turn times, thus indicating reduced timing accuracy. Looking at the selective effect of physical fatigue on external visual imagery did not reveal any difference before and after fatigue, whereas significantly shorter imagined times and electrodermal responses (respectively 15% and 48% decrease, p<0.001) were observed during the posttest for internal visual imagery. A significant correlation (r = 0.64; p<0.05) was observed between motor imagery vividness (estimated through imagery questionnaire) and autonomic responses during motor imagery after fatigue. These data support that unlike local muscle fatigue, physical fatigue occurring during intense sport training sessions is likely to affect motor imagery accuracy. These results might be explained by the updating of the internal representation of the motor sequence, due to temporary feedback originating from actual motor practice under fatigue. These findings provide insights to the co-dependent relationship between mental and motor processes.

The Use of the Vandenberg and Kuse Mental Rotation Test in Children

Previous studies found that children are able to perform mental rotation (MR) tasks with a gender difference from the age of 4. More recently, gender differences in MR were also reported in infancy. However, different kinds of paradigms and stimuli were used. The present study investigates whether the Vandenberg and Kuse Mental Rotation Test (VMRT; Vandenberg & Kuse, 1978 ) as well as another similar 2-dimensional stimuli test may be used with elementary and middle-school children, and whether gender differences are evidenced. Results show that boys outperform girls in the middle-school group only. Elementary school children encountered difficulties solving both the VMRT and 2D MR tests. The data confirmed recent results showing that gender differences in the VMRT performance were found at age 10. We further concluded that the VMRT and 2D MR tests may not be well-designed for elementary-school children. Further investigations should focus on gender differences in MR for children younger than 9 years old as well as on the underlying causes of such difference, using other experimental paradigms.

Enhancement of mental rotation abilities and its effect on anatomy learning

BACKGROUND

Mental rotation (MR) is improved through practice and high MR ability is correlated to success in anatomy learning.

PURPOSES

We investigated the effects of improving the MR ability on the Vandenberg and Kuse MR test performance and the consequences on learning functional human anatomy.

METHODS

Forty-eight students were assigned into three groups: MR group (16 students attending functional anatomy course and MR training), anatomy group (16 students attending the same functional anatomy course), and the control group (n = 16). Instead of MR training, the latter 2 groups were engaged in physical activities for an equivalent time, and the control group did not attend anatomy course.

RESULTS

MR group performed better than the two others in the MR test and better than the anatomy group in the anatomy test.

CONCLUSIONS

The MR training sessions were found to improve MR test performance and were further transferred to anatomy learning.