Fundamental movement skills and balance of children with Down syndrome.

BACKGROUND: Conclusive evidence supports the importance of fundamental movement skills (FMS) proficiency in promoting physical activity and countering obesity. In children with Down Syndrome (DS), FMS development is delayed, which has been suggested to be associated with balance deficits. This study therefore examined the relationship between FMS proficiency and balance ability in children with DS, with the aim of contributing evidence to programmes that address FMS delay. METHODS: Participants consisted of 20 children with DS (7.1 ± 2.9 years old) and an age-matched control group of children with typical development (7.25 ± 2.5 years). In the first part of the study, FMS (i.e. locomotor and object control) proficiency of the children was tested using the Test of Gross Motor Development-2. Balance ability was assessed using a force platform to measure centre of pressure average velocity (AV; mm/sec), path length (mm), medio-lateral standard deviation (mm) and antero-posterior standard deviation (mm). In the second part of the study, children with DS participated in 5 weeks of FMS training. FMS proficiency and balance ability were tested post-training and compared to pre-training scores. Verbal and visuo-spatial short-term memory capacities were measured at pre-training to verify the role of working memory in skill learning. RESULTS: FMS proficiency was associated with centre of pressure parameters in children with DS but not in children with typical development. After controlling for age, AV was found to predict significant variance in locomotor (R2  = 0.61, P < 0.001) and object control (R2  = 0.69, P < 0.001) scores. FMS proficiency and mastery improved after FMS training, as did AV, path length and antero-posterior standard deviation (all P < 0.05). Verbal and visuo-spatial short-term memory did not interact with the effects of training. CONCLUSIONS: Children with DS who have better balance ability tend to have more proficient FMS. Skill-specific training improved not only FMS sub-skills but static balance stability as well. Working memory did not play a role in the changes caused by skills training. Future research should examine the causal relationship between balance and FMS.

Movement specific reinvestment and allocation of attention by older adults during walking.

Older repeat fallers have previously been shown to have a higher propensity to consciously monitor and control their movements (i.e. reinvestment) than non-fallers, yet to direct their attention equally between their limb movements and the external environment during locomotion (Wong et al. in J Am Geriatr Soc 57: 920-922, 2009). Whether increased attention to their movements is a result of falling or originates from a prior inclination to reinvest remains unclear. In order to better understand the interaction between reinvestment and attention during locomotion, this study examined the allocation of attention by older adults who had not fallen but displayed a high or low inclination for reinvestment. Twenty-eight low and twenty-eight high reinvestors were required to perform 30 walking trials. Their allocation of attention during walking was evaluated by asking tone-related attentional focus questions shortly after finishing each walking trial. High reinvestors were found to be more aware of their limb movements and less aware of the external environment. Low reinvestors, on the contrary, were more aware of the surrounding environment and less aware of their movement mechanics. Given that focusing internally to body movements has been proposed to utilise working memory capacity, the ability of high reinvestors to pick up all the environmental information necessary for successful locomotion might be compromised and requires further examination.

Reduced influence of perceptual context in mild traumatic brain injury is not an illusion.

Perceptual grouping is impaired following mild traumatic brain injury (mTBI). This may affect visual size perception, a process influenced by perceptual grouping abilities. We conducted two experiments to evaluate visual size perception in people with self-reported history of mTBI, using two different size-contrast illusions: the Ebbinghaus Illusion (Experiment 1) and the Müller-Lyer illusion (Experiment 2). In Experiment 1, individuals with mTBI and healthy controls were asked to compare the size of two target circles that were either the same size or different sizes. The target circles appeared by themselves (no-context condition), or were surrounded by smaller or larger circles (context condition). Similar levels of accuracy were evident between the groups in the no-context condition. However, size judgements by mTBI participants were more accurate in the context condition, suggesting that they processed the target circles separately from the surrounding circles. In Experiment 2, individuals with mTBI and healthy controls judged the length of parallel lines that appeared with arrowheads (context condition) or without arrowheads (no context condition). Consistent with Experiment 1, size judgements by mTBI participants were more accurate than size judgements by control participants in the context condition. These findings suggest that mTBI influences size perception by impairing perceptual grouping of visual stimuli in near proximity.

Reducing errors benefits the field-based learning of a fundamental movement skill in children.

Proficient fundamental movement skills (FMS) are believed to form the basis of more complex movement patterns in sports. This study examined the development of the FMS of overhand throwing in children through either an error-reduced (ER) or error-strewn (ES) training program. Students (n = 216), aged 8-12 years (M = 9.16, SD = 0.96), practiced overhand throwing in either a program that reduced errors during practice (ER) or one that was ES. ER program reduced errors by incrementally raising the task difficulty, while the ES program had an incremental lowering of task difficulty. Process-oriented assessment of throwing movement form (Test of Gross Motor Development-2) and product-oriented assessment of throwing accuracy (absolute error) were performed. Changes in performance were examined among children in the upper and lower quartiles of the pretest throwing accuracy scores. ER training participants showed greater gains in movement form and accuracy, and performed throwing more effectively with a concurrent secondary cognitive task. Movement form improved among girls, while throwing accuracy improved among children with low ability. Reduced performance errors in FMS training resulted in greater learning than a program that did not restrict errors. Reduced cognitive processing costs (effective dual-task performance) associated with such approach suggest its potential benefits for children with developmental conditions.

Reduction of errors during practice facilitates fundamental movement skill learning in children with intellectual disabilities.

BACKGROUND: Children with intellectual disabilities (ID) have been found to have inferior motor proficiencies in fundamental movement skills (FMS). This study examined the effects of training the FMS of overhand throwing by manipulating the amount of practice errors. METHODS: Participants included 39 children with ID aged 4-11 years who were allocated into either an error-reduced (ER) training programme or a more typical programme in which errors were frequent (error-strewn, ES). Throwing movement form, throwing accuracy, and throwing frequency during free play were evaluated. RESULTS: The ER programme improved movement form, and increased throwing activity during free play to a greater extent than the ES programme. Furthermore, ER learners were found to be capable of engaging in a secondary cognitive task while manifesting robust throwing accuracy performance. CONCLUSIONS: The findings support the use of movement skills training programmes that constrain practice errors in children with ID, suggesting that such approach results in improved performance and heightened movement engagement in free play.

Reinvestment in one versus one in-field and shoot-out field hockey performance.

The theory of reinvestment suggests that inappropriate use of attention to consciously engage in movements or decisions (movement specific reinvestment or decision specific reinvestment) can result in disrupted performance. We used moderation analysis to investigate the association between these forms of reinvestment and performance during one versus one in-field and shoot-out scenarios during field hockey. We expected that the propensity for reinvestment would be negatively associated with shoot-out performance but not in-field performance, because monitoring many other players during in-field play diverts attention away from conscious engagement in movements or decisions. No association was evident between decision specific reinvestment and in-field or shoot-out performance. However, a higher propensity for movement specific reinvestment (specifically, conscious motor processing) was negatively associated with shoot-out performance, but not in-field performance. We speculate that the necessity to shift between many non-static attentional demands during in-field situations may reduce capacity for movement specific reinvestment during performance.

Proinsulin-to-C-peptide ratio versus proinsulin-to-insulin ratio in the prediction of incident diabetes: the Insulin Resistance Atherosclerosis Study (IRAS).

AIMS: Associations of proinsulin-to-insulin ratios with incident type 2 diabetes have been inconsistent. The use of C-peptide as the denominator in the ratio may allow for better prediction because C-peptide concentration is not affected by hepatic insulin clearance. The objective of this paper was to compare fasting intact and split proinsulin-to-insulin ratios (PI/I, SPI/I) with intact and split proinsulin-to-C-peptide ratios (PI/C-pep, SPI/C-pep) in the prediction of type 2 diabetes. METHODS: Prospective data on 818 multi-ethnic adults without diabetes at baseline from the Insulin Resistance Atherosclerosis Study (IRAS) were used. Insulin sensitivity (S(I)) and acute insulin response (AIR) were determined from frequently sampled intravenous glucose tolerance tests, and fasting intact and split proinsulin were measured using specific two-site monoclonal antibody-based immunoradiometric assays. Associations of proinsulin ratios with type 2 diabetes were determined using logistic regression and differences in prediction were assessed by comparing areas under the receiver operating characteristic curve (AROCs). RESULTS: In logistic regression analyses, PI/C-pep and SPI/C-pep were more strongly associated with incident type 2 diabetes (n = 128) than PI/I and SPI/I, and were significantly better predictors of diabetes in AROC analyses (PI/C-pep = 0.662 vs PI/I = 0.603, p = 0.02; SPI/C-pep = 0.690 vs SPI/I = 0.631, p = 0.01). Both PI/C-pep and SPI/C-pep were associated with type 2 diabetes after adjustment for age, sex, ethnicity, waist circumference, impaired glucose tolerance, lipids and S(I). Both PI/C-pep and SPI/C-pep were significantly associated with incident type 2 diabetes in models that included AIR. CONCLUSIONS: Proinsulin-to-C-peptide ratios were stronger predictors of diabetes in comparison with proinsulin-to-insulin ratios. These findings support the use of C-peptide as the denominator for proinsulin ratios, to more accurately reflect the degree of disproportional hyperproinsulinaemia.

Associations between the intake of caffeinated and decaffeinated coffee and measures of insulin sensitivity and beta cell function.

AIMS/HYPOTHESIS: Although protective relationships between coffee consumption and type 2 diabetes mellitus have consistently been observed, few studies have examined the relationships between coffee consumption and underlying pathophysiological defects that characterise diabetes aetiology. The aim of this study was to explore the associations between caffeinated and decaffeinated coffee consumption and measures of insulin sensitivity and secretion. METHODS: The study population included 954 multi-ethnic non-diabetic adults from the Insulin Resistance Atherosclerosis Study (IRAS). Multiple regression analyses were performed to examine the cross-sectional relationships between caffeinated and decaffeinated coffee intake and insulin sensitivity and acute insulin response, measured by a frequently sampled intravenous glucose tolerance test, 2 h postload glucose measured by OGTT, fasting insulin, and proinsulin to C-peptide ratios. RESULTS: Caffeinated coffee intake was positively associated with insulin sensitivity (ß = 0.054; SE = 0.026; p = 0.04) and inversely related to 2 h postload glucose (ß = -0.37; SE = 0.10; p = 0.0003) in fully adjusted models. Caffeinated coffee intake was not associated with acute insulin response or proinsulin ratios. Decaffeinated coffee intake was inversely related to 2 h postload glucose (ß = -0.47; SE = 0.18; p = 0.0096) and positively related to acute insulin response (ß = 0.191; SE = 0.077; p = 0.0132). Decaffeinated coffee intake was inversely related to the ratios of both intact and split proinsulin to C-peptide (ß = -0.150; SE = 0.061; p = 0.0148; ß = -0.254; SE = 0.068; p = 0.0002, respectively). CONCLUSIONS/INTERPRETATION: In this cross-sectional study, caffeinated coffee was positively related to insulin sensitivity and decaffeinated coffee was favourably related to measures of beta cell function. These results provide pathophysiological insight as to how coffee could impact the risk of type 2 diabetes mellitus.

Probing the allocation of attention in implicit (motor) learning.

We investigated the attention demands associated with implicit and explicit (motor) learning and performance using a probe reaction time paradigm. Two groups of participants learned a golf putting task over eight blocks of 50 trials performed from different distances. One group (errorless learning) began putting from the shortest distance (25 cm) and moved progressively back to the furthest distance (200 cm). A second group (errorful learning) began putting from the furthest distance (200 cm) and moved progressively closer (25 cm). Retention tests were used to assess learning in the two conditions, followed by transfer tests in which participants used either an unusual putter or a very unusual putter. Transfer to the unusual putters had an equivalent effect on the performance of both errorless and errorful learners, but probe reaction times were unaffected in the errorless learners, suggesting that execution of their movements was associated with reduced attention demands. Reducing errors during initial learning trials may encourage an implicit mode of learning and lower the demand for cognitive resources in subsequent performance.

Reinvestment and movement disruption following stroke.

BACKGROUND: Disruption of the automaticity of movement execution is commonly experienced by people with stroke and may result from the person consciously attempting to control the mechanics of his or her movements. This act of turning one's attention in toward the mechanics of an action is referred to as "reinvestment." OBJECTIVES: This study aimed to explore the hypothesis that people with stroke have a greater propensity for reinvestment than the nondisabled population and to examine the relationship between reinvestment, functional impairment from stroke, and aspects of rehabilitation. METHODS: A cross-sectional questionnaire survey was used. A total of 148 people with stroke and 148 nondisabled adults completed the Movement Specific Reinvestment Scale. Correlational and multiple regression analyses were conducted to examine the relationship between functional impairment and various potential predictors. RESULTS: Compared with controls, people with stroke had a greater propensity for reinvestment. Conscious motor processing and time spent in rehabilitation were significant predictors of functional impairment following stroke. CONCLUSIONS: The association between functional impairment, propensity for reinvestment, and time spent in rehabilitation indicates that exclusive reliance on conscious motor processing strategies in the rehabilitation setting may be an impediment to regaining functional independence. There is a need to develop motor learning strategies for rehabilitation that restrain the propensity for reinvestment.

Reinvestment and falls in community-dwelling older adults.

BACKGROUND: Falls are common in older adults and have many adverse consequences. In an attempt to prevent further incidents, elder fallers may consciously monitor and control their movements. Ironically, conscious movement control may be one factor that contributes to disruption of automaticity of walking, increasing the likelihood of subsequent falls. OBJECTIVE: The Movement Specific Reinvestment Scale (MSRS), which aims to measure the propensity for movement-related self-consciousness and for conscious processing of movement, was used to try to discriminate elder fallers from non-fallers. METHODS: Fifty-two volunteer older adults, aged 65 or above, participated. In addition to the 10-item MSRS, participants completed the Mini-Mental State Examination questionnaire, Timed "Up & Go" test, and Four Word Short-Term Memory test. Demographics including age, gender, and history of falling were collected. RESULTS: Elder fallers scored significantly higher than non-fallers on both the movement self-consciousness and conscious motor processing components of the MSRS. Logistic regression revealed a significant association between the MSRS (conscious motor processing component) and "faller or non-faller" status. CONCLUSIONS: Elder fallers may have a higher propensity to consciously control their movements. The MSRS shows potential as a clinical tool with which to predict falls in the elderly, as well as to gain insight into the perception of safety during walking in any impaired patient.

Stable implicit motor processes despite aerobic locomotor fatigue.

Implicit processes almost certainly preceded explicit processes in our evolutionary history, so they are likely to be more resistant to disruption according to the principles of evolutionary biology [Reber, A. S. (1992). The cognitive unconscious: An evolutionary perspective. Consciousness and Cognition, 1, 93-133.]. Previous work (e.g., [Masters, R. S. W. (1992). Knowledge, (k)nerves and know-how: The role of explicit versus implicit knowledge in the breakdown of a complex motor skill under pressure. British Journal of Psychology, 83, 343-358.]) has shown that implicitly learned motor skills remain stable under psychological pressure and concurrent cognitive demands, and recently [Poolton, J. M., Masters, R. S. W., & Maxwell, J. P. (2007). Passing thoughts on the evolutionary stability of implicit motor behaviour: Performance retention under physiological fatigue. Consciousness and Cognition, 16(2), 456-468.] showed that they also remain stable under conditions of anaerobic fatigue that would have significantly challenged the survival skills of our ancestors. Here we examine the stability of an implicitly learned motor skill under fatigue conditions that primarily tax a different physiological system (the aerobic system), but which have equally strong evolutionary connotations. Participants acquired a throwing task by means of an errorless (implicit) learning method or an errorful (explicit) method. Motor performance in the errorless condition, but not the errorful condition, remained stable following an exhaustive VO2 max. running test. Our findings replicate and extend the work of Poolton et al., providing further support for Reber's evolutionary distinction between implicit and explicit processes.

Trunk muscle training, posture fatigue, and performance in laparoscopic surgery.

PURPOSE: To investigate the effect of trunk muscle endurance training on the perception of back postural fatigue and performance of a laparoscopic task. MATERIALS AND METHODS: Thirty-one medical students (28 men and 13 women) with no laparoscopic surgical experience were randomly assigned to either a training group or a control group. Participants in the training group underwent a 6-week, 18-session trunk (abdominal and back muscle) endurance training program, whereas participants in the control group did not. Performance by all participants was assessed on a simulated laparoscopic task under varying conditions of low back postural fatigue, both before and after the training program. RESULTS: Participants in the training group showed significant improvements in trunk endurance after the 6-week, trunk endurance training program (P<0.05), whereas those in the control group did not. The improvements in trunk endurance were accompanied by significantly reduced perceptions of discomfort (P< .001) and fewer errors during performance of the laparoscopic task. (P<0.02), whereas no significant changes occurred for the control group (P>0.05). CONCLUSION: Increasing trunk endurance can increase postural fatigue and discomfort during simulated laparoscopic tasks, which may assist in the management of errors during laparoscopy.

Implicit motor learning and complex decision making in time-constrained environments.

The cost-effectiveness of the implicit (procedural) knowledge that supports motor expertise enables surprisingly efficient performance when a decision and an action must occur in close temporal proximity. The authors argue that if novices learn the motor component of performance implicitly rather than explicitly, then they will also be efficient when they make a decision and execute an action in close temporal proximity. Participants (N = 35) learned a table tennis shot implicitly or explicitly. The authors assessed participants' motor performance and movement kinematics under conditions that required a concurrent low-complexity decision or a concurrent high-complexity decision about where to direct each shot. Performance was disrupted only for participants who learned explicitly when they made high-complexity decisions but not when they made low-complexity decisions. The authors conclude that implicit motor learning encourages cognitively efficient motor control more than does explicit motor learning, which allows performance to remain stable when time constraints call for a complex decision in tandem with a motor action.

Duration of Parkinson disease is associated with an increased propensity for "reinvestment".

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

Assessment of cyclosporine pharmacokinetic parameters to facilitate conversion from C0 to C2 monitoring in heart transplant recipients.

BACKGROUND: Cyclosporine (CsA) 2-hour postdose (C2) monitoring is recommended to assess CsA exposure and predict clinical outcomes among heart transplant recipients. We correlated pharmacokinetic parameters and clinical outcomes in stable long-term heart transplant recipients monitored with C0 to develop an algorithm to convert patients from C0 to C2 monitoring. METHODS: Paired CsA C0-C2 measurements and serum creatinine levels were obtained from 35 heart transplant recipients more than 2 years posttransplantation (mean 8.8+/-4.7 years). RESULTS: The mean CsA dose and C0, C2, and C0/C2 ratio were 85+/-23 mg/12 hours, 123+/-41 ng/mL, 572+/-274 ng/mL and 4.8+/-2.1, respectively. C0 correlated weakly with C2 (r=.42, P=.011). The CsA dose correlated better with C2 (r=.58; P<.001) than with C0 (r=.37; P=.026). A good correlation was noted between C2 and the C2/C0 ratio (r=.73; P<.001), but none between C0 and the C2/C0 ratio. A borderline significant inverse correlation was noted between C0 and the worst endomyocardial biopsy score (r=-.34; P=.045), whereas none was noted with C2. Serum creatinine level did not correlate with either C2 or C0. Among patients with C0 within our target of 100 to 150 ug/L, six had C2 above 300 to 600 ug/L as suggested by the literature. CONCLUSIONS: In long-term heart transplant recipients, we could not identify a single pharmacokinetic parameter that could be used to develop an algorithm to convert from C0 to C2 monitoring; however, C2 may be better than C0 for identifying patients at risk of overexposure to CsA.

Implicit motor learning of a balancing task.

This study examined the implicit learning of a balancing task. Three treatment conditions were constructed using different motor learning strategies. In two of the treatment conditions, explicit learning of the balancing task was impeded by using either an analogy or an errorless learning technique. In the third treatment condition, participants learnt the task by discovery learning, which typically results in explicit knowledge. It was hypothesised that in the analogy and errorless learning conditions, learning of the balancing task would be implicit in character. Three criteria of implicit learning were used to test this hypothesis; the accumulation of few explicit rules, robustness under secondary task loading and durability over time. Although the discovery learners acquired more explicit rules, all groups appear to have acquired the skill implicitly, in that all groups were robust to imposition of a concurrent task load and over time. Indeed, balance performance with a concurrent verbal task was better than balance performance alone. Discussion focuses on the contribution of verbal and non-verbal processes to balancing.

Angle selective backscattered electron contrast in the low-voltage scanning electron microscope: Simulation and experiment for polymers.

Recently developed detectors can deliver high resolution and high contrast images of nanostructured carbon based materials in low voltage scanning electron microscopes (LVSEM) with beam deceleration. Monte Carlo Simulations are also used to predict under which exact imaging conditions purely compositional contrast can be obtained and optimised. This allows the prediction of the electron signal intensity in angle selective conditions for back-scattered electron (BSE) imaging in LVSEM and compares it to experimental signals. Angle selective detection with a concentric back scattered (CBS) detector is considered in the model in the absence and presence of a deceleration field, respectively. The validity of the model prediction for both cases was tested experimentally for amorphous C and Cu and applied to complex nanostructured carbon based materials, namely a Poly(N-isopropylacrylamide)/Poly(ethylene glycol) Diacrylate (PNIPAM/PEGDA) semi-interpenetration network (IPN) and a Poly(3-hexylthiophene-2,5-diyl) (P3HT) film, to map nano-scale composition and crystallinity distribution by avoiding experimental imaging conditions that lead to a mixed topographical and compositional contrast.

Discoordinate modulation of natriuretic peptides during acute cardiac allograft rejection in humans.

BACKGROUND: Increased circulating levels of the cardiac polypeptide hormones atrial natriuretic factor (ANF) and brain natriuretic peptide (BNP) may be observed after orthotopic cardiac transplantation. Both the hypertrophic and inflammatory processes in the allograft may contribute to this increase, but no mechanistic explanation has been suggested for this observation. METHODS AND RESULTS: Plasma immunoreactive ANF and BNP determinations were performed in 10 consecutive transplant patients. These were correlated with degree of rejection as reflected by histopathological findings at serial endomyocardial biopsies. Three patients had associated hemodynamic measurements and blood samples 24 hours before and after transplantation. All rejection episodes that received treatment were accompanied by a marked increase in BNP plasma levels to > approximately 400 pg/mL. Steadily increasing BNP levels preceded overt rejection as assessed by histopathological criteria. The increase in plasma BNP was not always accompanied by an increase in ANF, which suggests the specific upregulation of BNP gene expression during acute rejection episodes. Treatment of the acute rejection episodes led to a substantial decrease of BNP plasma levels. CONCLUSIONS: The significant selective increase in plasma BNP levels found in the present study has not been previously described. This finding provides a new insight into the mechanism of allograft rejection and the modulation of natriuretic peptide synthesis and release. Furthermore, although preliminary, the data suggest that BNP plasma levels could form the basis for a new, noninvasive screening test to predict acute cardiac allograft rejection. Because treatment with the antilymphocyte monoclonal antibody OKT3 (murine monoclonal antibody to the CD3 antigen of the human T-cell) decreased BNP plasma levels, cytokine production by T-cells may mediate the selective increase in circulating BNP.