Efficacy of the Fast Track Friendship Group Program for Peer-rejected Children: A Randomized-Controlled Trial.

OBJECTIVE: To evaluate the benefits of the Fast Track Friendship Group program implemented as a stand-alone school-based intervention on the social cognitions, social behavior, peer and teacher relationships of peer-rejected students. METHOD: Over four successive years, 224 peer-rejected elementary students (57% White, 17% Black, 20% Latinx, 5% multiracial; 68% male; grades 1-4; Mage = 8.1 years old) were identified using peer sociometric nominations and randomly assigned to the intervention (n = 110) or a treatment-as-usual control group (n = 114). Four school districts serving economically-disadvantaged urban and rural communities participated. Intervention involved weekly small group social skills training with classmate partners, with sessions tailored to address individual child needs. Consultation meetings held at the start and mid-point of intervention were designed to help teachers and parents support the generalization of targeted skills. RESULTS: Multi-level linear models, with children nested within schools (controlling for demographics and baseline scores) documented improvements in social-cognitive skills (direct assessments of emotion recognition and competent social problem-solving), social behavior (teacher ratings of social skills and externalizing behavior), and interpersonal relationships (peer sociometric nominations of peer acceptance and friendships, teacher-rated student-teacher closeness). Significant effects were generally small (ds = .19-.36) but consistent across child sex, grade level, and behavioral characteristics. CONCLUSIONS: The intervention proved feasible for high-fidelity implementation in school settings and produced significant improvements in the social adjustment of peer-rejected children, validating the approach as a school-based Tier 2 intervention.

The effects of AAC video visual scene display technology on the communicative turns of preschoolers with autism spectrum disorder.

Over 40% of children with autism spectrum disorder (ASD) experience difficulty in using speech to meet their daily communication needs. Although augmentative and alternative communication (AAC) can be of benefit, the AAC intervention must support beginning communicators in the early social interactions that provide the foundation for more sophisticated communication skills. An AAC video visual scene display approach uses an AAC app (provided on a tablet computer), including videos based on the interests of the child and infused with AAC supports, to provide opportunities for social interaction and communication between the child and the communication partner. The purpose of this study was to investigate the impact of video visual scene display technology on the communicative turns taken by three preschoolers with ASD and complex communication needs during a high-interest, shared activity (i.e., watching videos). All three participants demonstrated a large increase in the number of communicative turns taken with their partner (Tau-U of 1.00) following the introduction of the video VSD app. The results provide evidence that a video VSD approach may be a promising intervention to increase participation in communication opportunities for young children with ASD.

Observed finger behaviour during computer mouse use.

Two-button computer mouse users may exhibit sustained, static finger lifting behaviours to prevent inadvertent activations by avoiding finger pressure on the buttons, which leads to prolonged, static finger extensor muscle loading. One hundred graduate students were observed during normal computer work in a university computer facility to qualify and quantify the prevalence of lifted finger behaviours and extended finger postures, as well as wrist/forearm and grip behaviour, during specific mouse activities. The highest prevalences observed were 48% of the students lifted their middle finger during mouse drag activities, and 23% extended their middle finger while moving the mouse. In addition, 98% of the students rested their wrist and forearm (77%) or wrist only (21%) on the workstation surface, and 97% had an extended wrist posture (15 degrees -30 degrees ) when using the mouse. Potential applications of these findings include future computer input device designs to reduce finger lifting behaviour and exposures to risk factors of hand/forearm musculoskeletal pain.

"Every child that is a foster child is marked from the beginning": The home-school communication experiences of foster parents of children with disabilities.

This study investigated the perceptions of foster parents of children with disabilities concerning their interactions with school personnel. We conducted semi-structured interviews with 7 foster parents of 6 children with disabilities (age range=5-16). A qualitative analysis of the interviews resulted in the identification of five thematic areas, including foster parent perceptions of: (a) the role of the foster parent, (b) the efficacy of the foster parent in helping the child learn, (c) invitations to involvement from the school (d) invitations to involvement from the child, and (e) foster child experiences in the school system. Marked differences were found in the perceptions of the perceptions in foster parents of elementary and secondary age students. It is clear that foster parents who take on an active role in their child's education experienced positive relationships with their child's school. Foster parents who take a passive role in their partnerships with the schools experienced increased difficulty maintaining motivation to continue in their efforts to increase collaboration and involvement with the schools. They indicated a sense of anger, distrust, and even hostility towards the schools. Based on the findings, recommendations are provided for improving home-school relationships, and addressing obstacles to successful school partnerships with foster families.

Finger joint coordination during tapping.

We investigated finger joint coordination during tapping by characterizing joint kinematics and torques in terms of muscle activation patterns and energy profiles. Six subjects tapped with their index finger on a computer keyswitch as if they were typing on the middle row of a keyboard. Fingertip force, keyswitch position, kinematics of the metacarpophalangeal (MCP) and the proximal and distal interphalangeal (IP) joints, and intramuscular electromyography of intrinsic and extrinsic finger muscles were measured simultaneously. Finger joint torques were calculated based on a closed-form Newton-Euler inverse dynamic model of the finger. During the keystroke, the MCP joint flexed and the IP joints extended before and throughout the loading phase of the contact period, creating a closing reciprocal motion of the finger joints. As the finger lifted, the MCP joint extended and the interphalangeal (IP) joints flexed, creating an opening reciprocal motion. Intrinsic finger muscle and extrinsic flexor activities both began after the initiation of the downward finger movement. The intrinsic finger muscle activity preceded both the IP joint extension and the onset of extrinsic muscle activity. Only extrinsic extensor activity was present as the finger was lifted. While both potential energy and kinetic energy are present and large enough to overcome the work necessary to press the keyswitch, the motor control strategies utilize the muscle forces and joint torques to ensure a successful keystroke.

The effects of continuous and partial reward on the vigilance task performance of adults with attentional deficits: a pilot investigation.

The effects of reward schedule (100% and 30%) and extinction on attention (reaction time to auditory stimuli) and frustration levels (pressure exerted on a response key) of 15 adults with attentional disorders and 21 normal adults were examined using a continuous performance task. We predicted, that adults with attentional deficits would (a) perform similar to comparisons when rewarded on a continuous schedule, (b) exhibit higher levels of frustration when that continuous schedule was moved to an extinction schedule, and (c) experience more frustration than comparisons when rewarded on a partial schedule. Overall, adults with attentional deficits were slower to respond and their responses were more variable than typical comparisons across trials, similar to what is observed for children. Continuous reward resulted in poorer performance earlier in the reward phase and continued throughout an extinction phase. The frustration levels of adults with attentional deficits did not differ from comparisons across schedule conditions. Results are discussed in terms of the role of arousal in mediating responding to various schedules of reward.

Functional analysis of maladaptive behaviors: Rule as a transitive conditioned motivating operation.

The purpose of this study was to examine the role of a staff-delivered rule on the occurrence of challenging behavior (stereotypic touching) of an adult with severe intellectual disabilities. Four experimental functional analysis conditions were developed: (a) attention, (b) rule+attention, (c) rule only, and (d) control. Results showed that the percentage of intervals in which stereotypic touching responses (STR) occurred was greater within the experimental condition where a rule statement was embedded with contingent attention. Results are discussed in light of the plasticity of functional analysis technology to allow for stimulus variation within the typical social attention condition, and the suggestion that the rule statement, in this study, may function as a Transitive Conditioned Establishing Operation (CEO-T), asserting that the provision of attention is more valued in the presence of the stated rule.

The Design of Hand Gestures for Human-Computer Interaction: Lessons from Sign Language Interpreters.

The design and selection of 3D modeled hand gestures for human-computer interaction should follow principles of natural language combined with the need to optimize gesture contrast and recognition. The selection should also consider the discomfort and fatigue associated with distinct hand postures and motions, especially for common commands. Sign language interpreters have extensive and unique experience forming hand gestures and many suffer from hand pain while gesturing. Professional sign language interpreters (N=24) rated discomfort for hand gestures associated with 47 characters and words and 33 hand postures. Clear associations of discomfort with hand postures were identified. In a nominal logistic regression model, high discomfort was associated with gestures requiring a flexed wrist, discordant adjacent fingers, or extended fingers. These and other findings should be considered in the design of hand gestures to optimize the relationship between human cognitive and physical processes and computer gesture recognition systems for human-computer input.

The effect of keyboard key spacing on typing speed, error, usability, and biomechanics: Part 1.

OBJECTIVE: In this study, we evaluated the effects of key spacing on a conventional computer keyboard on typing speed, percentage error, usability, and forearm muscle activity and wrist posture. BACKGROUND: International standards that specify the spacing between keys on a keyboard have been guided primarily by design convention because few studies have evaluated the effects of key spacing on productivity, usability, and biomechanical factors. METHOD: Experienced male typists (N = 37) with large fingers (middle finger length > or = 8.7 cm or finger breadth of > or = 2.3 cm) typed on five keyboards that differed only in horizontal and vertical key spacing (19 x 19 mm, 18 x 19 mm, 17 x 19 mm, 16 x 19 mm, and 17 x 17 mm) while typing speed, percentage error, fatigue, preference, extensor carpi ulnaris and flexor carpi ulnaris muscle activity, and wrist extension and ulnar deviation were recorded. RESULTS: Productivity and usability ratings were significantly worse for the keyboard with spacing of 16 x 19 mm compared with the other keyboards. Differences on these measures between the other keyboards were not significant. Muscle activity tended to increase in the left forearm and decrease in the right with decreasing horizontal key spacing. There was also a trend for left wrist extension to increase and left ulnar deviation to decrease with decreasing horizontal key spacing. Reducing vertical key spacing from 19 to 17 mm had no significant effect on productivity or usability ratings. CONCLUSIONS: The study findings support key spacing on a computer keyboard between 17 and 19 mm in both vertical and horizontal directions. APPLICATIONS: These findings may influence keyboard standards and the design of keyboards.

The effects of high-preference problems on the completion of nonpreferred mathematics problems.

Failure to initiate and remain engaged in academic tasks can have long-lasting effects for students. In this study, we investigated the effects of high-preference sequences on both digits correct per minute and latency to initiate nonpreferred mathematics problems for 3 students with emotional and behavioral disorders. We found that high-preference sequences had negligible positive effects on rate of problem completion but had larger effects on problem initiation. This study replicates and extends prior work on the effects of high-preference sequences on mathematics problem initiation and completion.

The effects of periodontal curette handle weight and diameter on arm pain: a four-month randomized controlled trial.

BACKGROUND: The design of periodontal curette handles may cause or aggravate arm pain in dental practitioners. The authors conducted a four-month randomized controlled trial to evaluate the effects of curette handle diameter and weight on arm pain among dental hygienists and dentists. METHODS: One hundred ten dental hygienists and dentists who performed scaling, root planing or dental prophylaxis procedures participated in this study. The authors assessed right wrist/hand, elbow/forearm and shoulder pain levels weekly. They randomized participants to receive either a set of light (14 grams) periodontal curettes with a large diameter (11 millimeters) or a set of heavy (34 g) periodontal curettes with a narrow diameter (8 mm). The authors compared changes in mean pain scores across the study period between intervention groups by using general linear models and controlling for covariates. RESULTS: The improvement in pain scores across the three body regions was greater for participants who used the lighter, wider-diameter curettes. In the final adjusted model, the differences were statistically significant only for the shoulder region (P = .02). CONCLUSIONS: The study results show that dental instrument design has an effect on upper-extremity pain in dental practitioners. Using a lighter instrument with a wider diameter may be an easy and cost-effective intervention to reduce or prevent upper-extremity pain associated with dental hygiene procedures. CLINICAL IMPLICATIONS: To prevent or reduce arm pain, practitioners should consider using lightweight instruments with large diameters when performing scaling and root planing procedures.

The effect of two alternative arm supports on shoulder and upper back muscle loading during pipetting.

OBJECTIVE: Pipetting involves static upper arm positions with the pipette held away from the body for sustained periods of time, putting increased musculoskeletal load on the shoulder and upper back. This study explores the effect of using two alternative arm supports while pipetting on muscle loading in the shoulder/neck region. PARTICIPANTS: 15 experienced pipette users participated in this study. METHODS: In a repeated-measures design, participants performed simulated pipetting in a laboratory setting under three arm support conditions: (1) a gel pad on the work surface, (2) a freely-moving counter-balanced forearm support, and (3) no support (control). Surface electromyography (EMG) of the anterior deltoid and upper trapezius muscles were recorded, as well as productivity and subjective usability. RESULTS: Both arm support conditions resulted in significantly lower mean muscle activity of the anterior deltoid and upper trapezius muscles (p<0.001) and significantly higher subjective comfort ratings (p<0.001) compared to the control condition. The freely moving forearm support resulted in significantly lower peak muscle activity in the anterior deltoid compared to the control condition (p<0.001). Productivity was not affected by the arm supports. These findings suggest that arm support may be beneficial in reducing muscle loading and improving comfort in the shoulder and upper back during pipetting. Future studies are needed to measure the impact of these arm supports in the workplace.

Computer keyswitch force-displacement characteristics affect muscle activity patterns during index finger tapping.

This study examined the effect of computer keyboard keyswitch design on muscle activity patterns during finger tapping. In a repeated-measures laboratory experiment, six participants tapped with their index fingers on five isolated keyswitch designs with varying force-displacement characteristics that provided pairwise comparisons for the design factors of (1) activation force (0.31 N vs. 0.59 N; 0.55 N vs. 0.93 N), (2) key travel (2.5mm vs. 3.5mm), and (3) shape of the force-displacement curve as realized through buckling-spring vs. rubber-dome switch designs. A load cell underneath the keyswitch measured vertical fingertip forces, and intramuscular fine wire EMG electrodes measured muscle activity patterns of two intrinsic (first lumbricalis, first dorsal interossei) and three extrinsic (flexor digitorum superficialis, flexor digitorum profundus, and extensor digitorum communis) index finger muscles. The amplitude of muscle activity for the first dorsal interossei increased 25.9% with larger activation forces, but not for the extrinsic muscles. The amplitude of muscle activity for the first lumbricalis and the duration of muscle activities for the first dorsal interossei and both extrinsic flexor muscles decreased up to 40.4% with longer key travel. The amplitude of muscle activity in the first dorsal interossei increased 36.6% and the duration of muscle activity for all muscles, except flexor digitorum profundus, decreased up to 49.1% with the buckling-spring design relative to the rubber-dome design. These findings suggest that simply changing the force-displacement characteristics of a keyswitch changes the dynamic loading of the muscles, especially in the intrinsic muscles, during keyboard work.

Alternative computer mouse design and testing to reduce finger extensor muscle activity during mouse use.

OBJECTIVE: The purpose of this study was to design and test alternative computer mouse designs that attempted to reduce extensor muscle loading of the index and middle fingers by altering the orientation of the button switch direction and the force of the switch. BACKGROUND: Computer users of two-button mouse designs exhibit sustained lifted finger behaviors above the buttons, which may contribute to hand and forearm musculoskeletal pain associated with intensive mouse use. METHODS: In a repeated-measures laboratory experiment, 20 participants completed point-and-click, steering, and drag tasks with four alternative mouse designs and a reference mouse. Intramuscular and surface electromyography (EMG) measured muscle loading, and movement times recorded by software provided a measure of performance. RESULTS: Changing the direction of the switch from a conventional downward to a forward design reduced (up to 2.5% maximum voluntary contraction [MVC]) sustained muscle activity (10th percentile EMG amplitude distribution) in the finger extensors but increased (up to 0.6% MVC) flexor EMG and increased movement times (up to 31%) compared with the reference mouse (p < .001). Implementing a high switch force design also increased flexor EMG but did not differ in movement times compared with the reference mouse (p < .001). CONCLUSION: The alternative mouse designs with altered switch direction reduced sustained extensor muscle loading; however, trade-offs with higher flexor muscle loading and lower performance existed. APPLICATION: Potential applications of this study include ergonomic and human computer interface design strategies in reducing the exposure to risk factors that may lead to upper extremity musculoskeletal disorders.

Transesophageal echocardiography interpretation: a comparative analysis between cardiac anesthesiologists and primary echocardiographers.

UNLABELLED: Diagnostic interpretation of intraoperative transesophageal echocardiography (TEE) examinations may vary, particularly when the echocardiographer is also the anesthesiologist. We therefore evaluated the concordance of TEE interpretation as part of a process of continuous quality improvement (CQI). Ten cardiac anesthesiologists participating in a CQI program conducted 154 comprehensive TEE examinations, each consisting of 16 major fields describing cardiac anatomy and function. These examinations were subsequently interpreted off-line by two primary echocardiographers (a radiologist and a cardiologist). Agreement was assessed using the kappa coefficient and percent agreement. Overall kappa and percent agreement were 0.58 and 83% for anesthesiologists versus radiologist, 0.57 and 80% for anesthesiologists versus cardiologist, and 0.60 and 82% for radiologist versus cardiologist. Anesthesiologists with longer than 5 yr of TEE experience had higher levels of agreement with the radiologist when assessing the aorta, right atrium, pulmonary vein flow, transmitral flow, and fractional area change. Cardiac anesthesiologists supported by a CQI program interpret TEE examinations at a level comparable with physicians whose primary practice is echocardiography. Thus, the anesthesiologist and the intraoperative echocardiographer need not be mutually exclusive. IMPLICATIONS: Interpretation of intraoperative transesophageal echocardiograms can be reliably performed by cardiac anesthesiologists.