Extended-Duration Work Shifts in Surgical Specialties: A Systematic Review.

INTRODUCTION: There has been widespread international implementation of duration-hour restrictions to prevent surgical resident burnout and promote patient safety and wellbeing of doctors. A variety of Extended-Duration Work Shifts (EDWS) have been implemented, with a variety of studies examining the effect of shift systems on both surgical performance and the stress response unestablished in the literature. METHODS: This was a systematic review evaluating the impact of extended working hours on surgical performance, cognitive impairment, and physiological stress responses. The review used PubMed, Ovid Medline, Embase, and Google Scholar search engines between September and October 2021 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Filters including studies carried out after 2002 and published in the English language were applied. RESULTS: In total, 30 studies were included for analysis. General surgery was the most commonly studied rotation, with Neurosurgical, Orthopedic, and ear, nose and throat specialties also included. The majority of studies found no difference or a significant improvement in post-EDWS on simulated performance. EDWS appeared to have the greatest impact on physiological stress markers in junior surgical trainees. CONCLUSIONS: Experience appears to confer a protective element in the postcall period, with preservation of skill demonstrated. More experienced clinicians yielded lower levels of physiological markers of stress, although variability in hierarchical workload should be considered. Heterogeneity of findings across physiological, cognitive, and psychomotor assessments highlights the need for robust research on the optimum shift pattern prevents worker burnout and promotes patient safety. Future research to evaluate correlation between stress, on-call workload, and performance in the postcall period is warranted.

Linear growth beyond 24 months and child neurodevelopment in low- and middle-income countries: a systematic review and meta-analysis.

AIM: To synthesize available evidence on the association between change in linear growth (height for age z score, HAZ) beyond the first two years of life with later child neurodevelopment outcomes in Low- and middle-income countries (LMICs). METHODS: We searched PubMed, Web of Science, and EMBASE for cohort studies on the association between change in HAZ after age two and neurodevelopment outcomes in middle or late childhood. Data extraction was done independently by two reviewers. RESULTS: A total of 21 studies, that included 64,562 children from 13 LMICs were identified. Each unit increase in change in HAZ above two years is associated with a + 0.01 increase (N = 8 studies, 27,393 children) in the cognitive scores at 3.5 to 12 years of age and a + 0.05-standard deviation (SD) increase (95% CI 0.02 to 0.08, N = 3 studies, 17,830 children) in the language score at 5 to 15 years of age. No significant association of change in HAZ with motor (standardized mean difference (SMD) 0.04; 95% CI: -0.10, 0.18, N = 1 study, 966 children) or socio-emotional scores (SMD 0.00; 95% CI: -0.02, 0.01, N = 4 studies, 14,616 participants) was observed. CONCLUSION: Changes in HAZ after the first two years of life appear to have a small or no association with child neurodevelopment outcomes in LMICs.

Comparison of the effects of apprenticeship training by sandwich feedback and traditional methods on final-semester operating room technology students' perioperative competence and performance: a randomized, controlled trial.

BACKGROUND: Effective feedback is fundamental in clinical education, as it allows trainers to constantly diagnose the trainees' condition, determine their weaknesses, and intervene at proper times. Recently, different feedback-based approaches have been introduced in clinical training; however, the effectiveness of such interventions still needs to be studied extensively, especially in the perioperative field. Therefore, this study sought to compare the effects of apprenticeship training using sandwich feedback and traditional methods on the perioperative competence and performance of Operating Room (OR) technology students. METHODS: Thirty final-semester undergraduate OR technology students taking the apprenticeship courses were randomly allocated into experimental (n = 15) and control (n = 15) groups through the stratified randomization approach. The students in the experimental group experienced Feedback-Based Learning (FBL) using a sandwich model, and the students in the control group participated in Traditional-Based Training (TBT) in six five-hour sessions weekly for three consecutive weeks. All students completed the Persian version of the Perceived Perioperative Competence Scale-Revised (PPCS-R) on the first and last days of interventions. Also, a blinded rater completed a checklist to evaluate all students' performance via Direct Observation of Procedural Skills (DOPS) on the last intervention day. Besides, the students in the FBL filled out a questionnaire regarding their attitude toward the implemented program. RESULTS: The mean total score of the PPCS-R was significantly higher in the FBL than in the TBT on the last intervention day (P < 0.001). Additionally, the increase in mean change of PPCS-R total score from the first to last days was significantly more in the FBL (P < 0.001). Likewise, the FBL students had higher DOPS scores than the TBT ones (P < 0.001). Most FBL students also had a good attitude toward the implemented program (n = 8; 53.3%). CONCLUSION: Apprenticeship training using a sandwich feedback-based approach was superior to the traditional method for enhancing perioperative competence and performance of final-semester OR technology students. Additional studies are required to identify the sustainability of the findings.

Simultaneous Three-Degrees-of-Freedom Prosthetic Control Based on Linear Regression and Closed-Loop Training Protocol.

Machine learning-based controllers of prostheses using electromyographic signals have become very popular in the last decade. The regression approach allows a simultaneous and proportional control of the intended movement in a more natural way than the classification approach, where the number of movements is discrete by definition. However, it is not common to find regression-based controllers working for more than two degrees of freedom at the same time. In this paper, we present the application of the adaptive linear regressor in a relatively low-dimensional feature space with only eight sensors to the problem of a simultaneous and proportional control of three degrees of freedom (left-right, up-down and open-close hand movements). We show that a key element usually overlooked in the learning process of the regressor is the training paradigm. We propose a closed-loop procedure, where the human learns how to improve the quality of the generated EMG signals, helping also to obtain a better controller. We apply it to 10 healthy and 3 limb-deficient subjects. Results show that the combination of the multidimensional targets and the open-loop training protocol significantly improve the performance, increasing the average completion rate from 53% to 65% for the most complicated case of simultaneously controlling the three degrees of freedom.

Sex differences in change of direction deficit and asymmetries in footballers with cerebral palsy.

The aims of this study were (1) to describe and examine differences in change of direction (COD) performance and the magnitude of asymmetries in para-footballers with cerebral palsy (CP) and controls and (2) to evaluate the association between COD outcomes and linear sprint performance. Twenty-eight international para-footballers with CP and thirty-nine non-impaired football players (control group) participated in this study. All participants completed a 10-m sprint and two attempts of the 505 COD test with the dominant and non-dominant leg. The COD deficit was calculated using the difference between the 505 test and the 10-m sprint time, while the asymmetry index was determined by comparing each leg's completion time and COD deficit. Players across groups showed interlimb asymmetries between the dominant and non-dominant legs in COD outcomes and deficit (p < 0.05, dg = -0.40 to -1.46), although these asymmetries imbalance were not significantly different between the sexes with and without impairment. Males with CP exhibited a faster directional COD speed and a shorter COD deficit than their female counterparts (p < 0.01, dg = -1.68 to -2.53). Similarly, the control group had faster scores than the CP groups of the same sex (p < 0.05, dg = 0.53 to 3.78). Lastly, the female CP group and male control groups showed a significant association between sprint and the COD deficit in the dominant leg (p < 0.05, r = -0.58 to 0.65). Therefore, the use of directional dominance, the COD deficit, and asymmetry outcomes could be helpful for classification purposes to assess the impact of the impairment on sport-specific activity testing according to sex.

Self-reported Measures of Function Compared to Lower Limb Motor Performance in People With and Without Imaging Evidence of Unilateral Lumbar Nerve Root Compression: A Cross-sectional Study.

OBJECTIVE: The primary objective of the present study was to determine if imaging findings of unilateral lumbar nerve root compression (ULNRC) impact performance on a coordinated motor performance task and to determine if there were correlations between motor performance and self-reported clinical measures. METHODS: People with back pain (N = 45) were stratified into 3 groups based on combinations of: lumbar imaging; and clinical presentation for ULNRC. Group 1 included people with imaging of lumbar nerve root compression, who presented with neurological deficit. Group 2 people demonstrated imaging evidence of nerve compression, without motor, sensory or reflex change. Group 3 participants possessed only degenerative changes on lumbar imaging films, and were neurologically intact. Performance measures included behavioral and kinematic variables from an established lower limb Fitts' Task requiring movements to targets of different difficulties. Self-reported measures of disability, function and pain were collected. Analysis of variance for between and within group variables were conducted, and Pearson correlation compared performance with self-reported measures. RESULTS: All groups yielded main effects for movement time with increasing task difficulty as predicted by Fitts' Law. A main effect revealed Group 1 participants performed less accurately than Group 3 participants. Positive correlations were predominantly found between self-report measures and motor performance for Group 2 and Group 3. CONCLUSION: Imaging, and self-reported measures alone did not predict function, however, Fitts' task performance accuracy effectively differentiated groups.

Influence Of Rehacom System Programme On Hand Function In Spastic Hemiplegic Children.

Objectives: To assess the impact of cognitive therapy with the rehacom visual-motor module on the hand function in hemiplegic cerebral palsy children. METHODS: The randomised case-control study was conducted at Kafrelsheikh University, Egypt, from September 2021 to February 2022, and comprised children aged 6-8 years with spastic hemiplegic cerebral palsy. They were randomised into control group A and intervention group B. Subjects in group A received designed physical therapy and hand function training, while those in group B additionally received visual-motor coordination training with the help of rehacom system. The groups were evaluated for both visual-motor coordination and fine motor skills at baseline and after 6-month training. SPSS version 26 was used to analyse the raw data of the current study. RESULTS: Of the 40 subjects, 20(50%) were in each of the two groups. There were 13(65%) boys and 7(35%) girls with mean age 66±4.01 monthsin group A, and 9(45%) boys and 11(55%) girls with mean age 67±4.06 monthsin group B (p>0.05). Both groups showed improvement related to grasping, visual-motor integration and fine motor quotient post-intervention, but improvement in group B was significantly higher on each count(p<0.05). CONCLUSIONS: The addition of visual-motor integration programme by rehacom system wasfound to be more effective than the effect of routine physiotherapy training alone.

Sex Effects on Mirror Overflow during Finger Tapping in Children with ADHD.

OBJECTIVES: The presence of excessive mirror overflow in children with Attention Deficit/Hyperactivity Disorder (ADHD) is discussed in numerous published reports. These reports, however, include a limited age range in their samples. The objective of this study is to examine the effects of diagnosis and sex on mirror overflow and standard deviation (SD) of tap time in children with and without ADHD across a larger age range (5-12 years) of children. METHODS: One-hundred and forty-eight children with ADHD and 112 age- and sex-matched typically developing (TD) children completed a finger sequencing task. Mirror overflow, SD of tap time, and mean tap time were measured using finger twitch transducers. RESULTS: Results reveal a significant diagnostic effect on mirror overflow such that boys and girls with ADHD demonstrate increased overflow compared to same-sex TD children. Boys with ADHD demonstrated more variable tap times compared to TD boys; no diagnostic effect was observed in the girls. CONCLUSIONS: Boys with ADHD exhibit anomalous motor variability; girls with ADHD show similar levels of variability as TD girls. Boys and girls with ADHD exhibit similar levels of excessive mirror overflow. This lack of sex differences on mirror overflow is distinct from reports finding sex effects on overflow and could result from an examination of a broader age range than is included in prior reports. Adolescent data would provide a greater understanding of the trajectory of anomalous mirror overflow across development. Examination of functional and structural connectivity would expand the current understanding of the neurobiological foundation of motor overflow.

Parent-recorded videos of infant spontaneous movement: Comparisons at 3-4 months and relationships with 2-year developmental outcomes in extremely preterm, extremely low birthweight and term-born infants.

BACKGROUND: Infants born extremely preterm (EP, <28-week gestational age) or extremely low birthweight (ELBW, <1000 g) are at risk of developmental delay and cerebral palsy (CP). The General Movements Assessment (GMA) and its extension, the Motor Optimality Score, revised (MOS-R) (assesses movement patterns and posture), may help to identify early delays. OBJECTIVES: To compare differences in the MOS-R scored from parent-recorded videos between infants born EP/ELBW and term-born infants, to determine relationships between the MOS-R and 2-year cognitive, language and motor outcomes and if any relationships differ between birth groups and the association of the GMA (fidgety) with CP. METHODS: A geographical cohort (EP/ELBW and term-control infants) was assessed using the MOS-R inclusive of the GMA at 3- to 4-month corrected age (CA), and the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) at 2-year CA. Differences in mean total MOS-R between groups, relationships between MOS-R and 2-year outcomes and relationships between GMA (fidgety) and CP in infants born EP/ELBW were estimated using linear/logistic regression. RESULTS: Three hundred and twelve infants (147 EP/ELBW; 165 term) had complete MOS-R and Bayley-III assessments. Mean MOS-R was lower in infants born EP/ELBW than controls (mean difference -3.2, 95% confidence interval [CI] -4.2, -2.3). MOS-R was positively related to cognitive (ß [regression coefficient] = 0.71, 95% CI 0.27, 1.15), language (ß = 0.96, 95% CI 0.38, 1.54) and motor outcomes (ß = .89, 95% CI 0.45, 1.34). There was little evidence for interaction effects between birth groups for any outcome. Absent/abnormal fidgety movements were related to CP in children born EP/ELBW (risk ratio 5.91, 95% CI 1.48, 23.7). CONCLUSIONS: Infants born EP/ELBW have lower MOS-R than infants born at term. A higher MOS-R is related to better outcomes for 2-year development, with similar relationships in both birth groups. Absent/abnormal fidgety movements are related to CP in EP/ELBW survivors.

Regional differences regarding the occurrence of falls and associated factors in two populations of Brazilian longevous people.

BACKGROUND: Few studies have explored regional asymmetries and their implications for health policies regarding episodes of falls among the population of ≥80 years old in continental and developing countries like Brazil with deep inequalities and sociocultural differences. OBJECTIVE: To evaluate the occurrence of falls and their association with functional capacity and nutritional status in the longest oldest-old living in two municipalities in the Northeast and Southeast of Brazil. METHODS: This is a cross-sectional study, with primary data collection in which were included in the research seniors aged 80 years or more, of both sexes, belonging to two Brazilian municipalities of discrepant socioeconomic aspects. The dependent variable was the occurrence of falls in the last year. The independent variables were grouped into demographic aspects, functional capacity and nutritional status. To identify variables that contribute to the occurrence of falls, the multiple logistic regression model, adopts a significance level of 5%. RESULTS: The sample was composed of 415 oldest-old adults. From the total, 32.3% reported having fallen in the last year, 24.7% in Brejo dos Santos and 37.8% in São Paulo. Among the former population, the mean value of walking speed for those who had falls was 0.27 m/s and for those who had no occurrence of falls was 0.33 m/s; and, among the seniors from São Paulo, the mean values were 0.51 m/s and 0.58 m/s, respectively. Significant correlations between walking speed and falls were verified for both populations, showing that the lower the walking speed, the higher the predisposition to falls. In the final regression model, the occurrence of falls was associated with moderate balance (OR = 5.28; CI: 1.11-25.18) among the longevous people Brejo dos Santos and with very poor functional performance (OR = 16.09; CI:1.46-177.06) among those from São Paulo. CONCLUSION: The results pointed out a lower prevalence of falls in longevous people from Brejo dos Santos than in those from São Paulo and differences regarding the associated factors, showing heterogeneity between the two populations; indicating the need for public policies and effective programmes aimed at preventing falls based on the maintenance or increase of functional capacity.

Motor competence, physical activity, and perceived motor competence: A relational systems approach.

Being and perceiving oneself as proficient in motor skills seems essential for an active lifestyle; conversely, being active and perceiving oneself as proficient may be associated with greater motor competence. By expanding the causal path view about the relationship between active and healthy developmental system elements, this study tested the mediation hypothesis of perceived motor competence in the relationship between motor competence and physical activity - in both ways - and moderation by developmental phase and sex. This cross-sectional study sampled healthy schoolchildren (n = 379; 8.2 ± 1.7 years; 54.9% boys). Physical activity (questionnaire), motor competence (tests included locomotor and object control skills) and perception of motor competence (a pictorial scale) were assessed. Maximum likelihood structural equation models with fit statistics confirmed the mediation in both ways. Unexpectedly, the relationship between motor competence and physical activity was inverse. Sex was a moderating variable (boys). In a systemic relational paradigm of human development, perceived motor competence, motor competence, and physical activity interact in an active and healthy behavioural system, but the complexities of understanding how these elements relate to one another across childhood point to the need for future longitudinal studies.

Fitts' Tapping Task as a New Test for Cognition and Manual Dexterity in Multiple Sclerosis: Validation Study.

Introduction. Studies suggest that people with multiple sclerosis (pwMS) experience continuous and subclinical physical worsening, even as early as their disease diagnosis. Validating sensitive and reproducible tests that can capture subclinical disease activity early in the disease are clinically useful and highly warranted. We aimed at validating the utility of Fitts' Tapping Task (FTT) as reproducible measure of psychomotor performance in pwMS. Materials and Methods. Thirty newly-diagnosed pwMS (within 2 years of diagnosis and Expanded Disability Status Scale; EDSS ≤ 2.0), 30 people with migraine (pwMig), and 30 healthy controls (HCs) underwent a psychomotor assessment using the FTT, O'Connor hand dexterity test, and Visual Reaction Time Test (VRTT). Hand strength was measured using a hand-grip dynamometer. Subjects also provided patient-reported outcomes (PROs) using the 36-Item Short Form Survey (SF-36). Intrarater and interrater reproducibility was acquired on 5 HCs by two independent operators. Test−retest reproducibility was determined in 5 pwMS over a 1-week follow-up. Eight pwMS returned for the same test procedures 2 years after the baseline assessment. Bland−Altman plots were used to determine the minimally detectable change (MDC) and logistic regression models determined the ability to differentiate between newly-diagnosed pwMS and HCs. Results. FTT exhibited a high intrarater and interrater reproducibility (interclass correlation coefficient of 0.961, p < 0.001). The test−retest demonstrated an MDC of the average FTT at > 15%. PwMS had significantly a slower FTT time and O'Connor dexterity time when compared to pwMig and HCs (p < 0.001 for both). Higher Fitts' difficulty levels (4th and 6th difficulty) and average performance on the O'Connor test were able to differentiate newly-diagnosed pwMS from HCs with 80% accuracy (p < 0.01). Slower FTT performance was correlated with worse PROs due to physical health. Over the 2-year follow-up, and despite being clinically stable (no change in EDSS), 6 out of 8 (75%) pwMS had more than a 15% worsening in their average FTT time. Conclusions. FTT is a highly-reproducible test for measuring psychomotor performance in newly-diagnosed pwMS. FTT can capture insidious worsening in psychomotor performance and cognitive function in early stages of MS.

Nocebo effects on motor performance: A systematic literature review.

Directionally opposite to placebo effects are the nocebo effects that negatively impact people's thoughts, feelings, and actions. An important but scarcely studied aspect of everyday functioning is motor performance, in which nocebo effects might impair athletic skills and the much-needed purposeful daily movements and motor actions. The aim of this literature review is to unveil the nocebo effects on motor performance. Searched databases were PubMed, PsycINFO, and SPORTDiscus. Twenty-one articles, reporting 23 studies, met the eligibility criteria for inclusion in the current review. All reports exhibited "some" risk of bias. Of the 23 studies, 14 found a nocebo effect on motor performance, equivocal results emerged from two studies, and negative findings were reported in seven studies. Most (10/12) studies using a between-subjects design have reported a nocebo effect. The mean effect size was 0.60, suggesting a medium-to-large effect of nocebo intervention on motor performance. Based on this review, we conclude that nocebo effects do influence motor performance and can be evoked with negative verbal information. This effect may be more robust than the placebo effect but also depends on the type of motor performance, on the examined sample, and on the nocebo agent. Hence, nocebo effects should be recognized and controlled in empirical research on motor performance, and they should be prevented or extinguished in practical and therapeutic settings. More extensive examination of the nocebo effect on motor performance is warranted, especially using between-subjects research design and a "no agent" control condition.

A narrative review of psychomotor abilities in medical sciences: Definition, categorization, tests, and training.

Extensive research in the past decades has evidenced differences in the psychomotor ability of individuals resulting from varying levels of experience, age, gender, response precision, compatibility, performance, and ability. Many studies have called for the need to identify psychomotor ability and appropriate tests that can assess it. This review article surveys the definition, categorization, and tests of psychomotor ability as well as training based on psychomotor ability in medical sciences. We searched the literature with no time limit, using the ProQuest, PubMed, and Eric databases, as well as the Google Scholar search engine. The keywords for the search involved psychomotor, psychomotor performance, assessment, psychomotor ability, motor learning, education, training, psychomotor ability testing, and psychomotor skills. Other relevant papers found through hand searching and snowballing were also included in the review. The EndNote X8 was employed as a reference manager tool. Only abstracts of the papers whose full texts were accessible were reviewed after repetitious papers were excluded. The documents were categorized into five groups: definition of psychomotor skills and ability, psychomotor ability components, psychomotor ability tests, identification of psychomotor ability (task analysis), and training. This review article revealed that there is not a single definition for psychomotor ability and its components. However, it can be said that motor abilities are the foundation for the rapid acquisition of skills and according to the neuroplasticity process are learned through training and practice. Given psychomotor abilities vary among individuals, training courses should also provide different levels of psychomotor training for learners. The literature introduces psychomotor tests as a selection tool, a predictor of future professional behavior, and a means to evaluate progress in performance, academic guidance (ability-oriented medical specialty), and curriculum implementation tailored to the needs of learners of varying graduate disciplines. The tests should be profession-specific because each profession entails its peculiar characteristics and abilities. On the other hand, the major problem in studying and analyzing underlying psychomotor skills and abilities is that the components are being investigated by researchers from varying, and usually unrelated, scientific fields. Therefore, it is necessary to have a holistic view through close interaction between the researchers of different sciences to better understand this area.

Performance of discrete, reciprocal, and cyclic movements of the ipsilesional upper limb in individuals after stroke.

Aiming movements of the upper limbs can be classified either as discrete, or reciprocal, or cyclic. The control of these movements after a stroke can be affected. The aim of this experimental, cross-sectional study was to characterize the performance of these movements after the right and left hemisphere chronic stroke. Thirty-six individuals aged between 40 and 70 years, right-handed, were allocated into three groups (control, right stroke, and left stroke). Participants were asked to perform aiming movements on a tablet. Individuals after stroke performed the tasks only with their ipsilesional limb, while the control group performed movements with both limbs. The reaction and movement times, peak velocity, and the variability and error of the endpoint were analyzed. Individuals after stroke presented a worse performance in all movement classes as expected, but differently depending on the damaged hemisphere. Participants with right hemisphere damage showed larger endpoint errors, while those with left hemisphere damage had longer reaction and movement times. Both differences were seen consistently in discrete and reciprocal, but not in cyclic movements. Cyclic movements presented shorter latencies, were faster, and showed greater endpoint errors when compared to discrete and reciprocal movements. These results suggest that stroke affects differently the performance of discrete and reciprocal movements according to the hemisphere lesion side, but not in cyclic movements. Different levels of motor control among the three classes of movements by the nervous system may justify these results.

A Reaching Performance Scale for 2 Wolf Motor Function Test Items.

OBJECTIVE: To adapt the Reaching Performance Scale for Stroke (RPSS) for the Wolf Motor Function Test (WMFT) "Lift Can" (Can) and "Hand to Box" (Box) items. DESIGN: Retrospective analysis of video-recorded WMFT assessment performed by 3 raters on 2 occasions. SETTING: Not applicable. PARTICIPANTS: Participants (N=29) with mild to moderate upper extremity impairment less than 3 months after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Inter- and intra-rater agreement, concurrent validity of WMFT-RPSS. RESULTS: Mean ± SD inter-rater Gwet's agreement coefficient (AC2) was 0.61±0.05 for Can WMFT-RPSS and 0.56 (0.03) for Box. Mean ± SD intra-rater AC2 for Can was 0.63±0.05 and 0.70±0.04 for Box. WMFT-RPSS Can and Box scores correlated with log mean WMFT time (C, -0.73; B, -0.48), Functional Ability Scale (C, 0.87; B, 0.62), Upper Extremity Fugl-Meyer Motor Score (C, 0.69; B, 0.51), and item movement rate (C, 0.74; B, 0.71) (P<.05 for all). Mean ± SD WMFT-RPSS score across the 29 participants was 12.7±3.5 for Can (max score, 19) and 11.4±3.0 for Box (max score, 16). CONCLUSIONS: WMFT-RPSS demonstrated moderate intra-rater and weak-to-moderate inter-rater agreement for individuals with mild-moderate impairment. For construct validity, Can and Box WMFT-RPSS were significantly correlated with 4 standardized measures. Average WMFT-RPSS scores revealed that some participants may have relied on compensatory movements to complete the task, a revelation not discernable from movement rate alone. The WMFT-RPSS is potentially useful as a valid and reliable tool to examine longitudinal changes in movement quality after stroke.

Handwriting skills of children with tic disorders.

INTRODUCTION: Although circumstantial evidence suggests children with tic disorders (TD) experience challenges in handwriting which may be attributed to their tics, few studies have systematically investigated handwriting performance among children with TD. This study examined the relationship between handwriting deficits and TD using a causal comparative research design. METHODS: Thirty-four children with TD completed the Test of Handwriting Skills-Revised (THS-R). The overall percentile ranks of the THS-R were analysed to determine if children with TD have lower scores compared to the test's normative values. Writing speed, letter reversals, touching letters and case errors were also evaluated. RESULTS: Data revealed the median percentile rank of the THS-R for the participants was significantly lower than the median percentile score of the THS-R for the normative sample. Close to 80% (n = 27) of writing samples were scored below 50th percentile. More than one-third (35.3%, n = 12) of the writing samples were scored greater than one standard deviation below the normative mean on the THS-R. Of the four ancillary scores, 82.4% (n = 28) of the participants' writing samples scored below 50th percentile (in the categories of watch or test further) on case errors and 67.6% (n = 23) scored below 50th percentile on writing speed. CONCLUSION: Findings suggested that children with TD took longer to complete the writing task, and committed more case substitution errors than the normative sample of the THS-R and were likely to exhibit handwriting deficits.

Dose of remote limb ischemic conditioning for enhancing learning in healthy young adults.

Remote limb ischemic conditioning (RLIC) is a technique in which tissues distant from the target organ are exposed to brief, sub-lethal bouts of ischemia. The effects of remotely applied ischemic conditioning are systemically transferred to the target organ, and typically manifested as protection from subsequent ischemic injury. Previous studies in our lab have found and confirmed that RLIC enhances learning and retention during motor training on a balance task. The current study tested the effect of RLIC dose (number of cycles) on learning enhancement in young, healthy adults. Forty healthy participants age 18-40 years were randomized to receive 5 cycles of sham conditioning (n = 9), 3 cycles of RLIC (n = 11), 4 cycles of RLIC (n = 10), or 5 cycles of RLIC (n = 10) using a blood pressure cuff around the upper arm once a day for 7 consecutive weekdays (Days 1-7). Participants concurrently trained on a balance task, bimanual cup stacking task, and a discrete sequence production task on Days 3-7. Change in performance on each of the three tasks was compared across groups. Participants in all four groups improved their performance on each of the three tasks over time. However, RLIC at any dose did not enhance learning on any of the three tasks. While RLIC is safe, inexpensive, and clinically feasible, reproducibility may be challenged by unidentified factors, raising critical challenges to the straightforward translation of RLIC for improving rehabilitation outcomes in individuals recovering from neurological injury.

Handgrip strength: An effective screening instrument for anemia in the elderly women.

OBJECTIVE: The objectives of this study were to discover associations between anemia and functional performance indicators, and to identify the best functional performance test to screen for anemia in the elderly. METHODS: A cross-sectional study analyzed data from 109 elderly residents in the community. For statistical analysis, the Logistic Regression and the Receiver Operating Characteristic (ROC) curve was used. RESULTS: The prevalence of anemia in the elderly was 13.9%. There was an inverse association between handgrip strength (HGS) and anemia in women; the HGS test was an effective screening tool for anemia in the elderly. CONCLUSION: The HGS test can be used to screen for anemia in the elderly women.

An innovative educational approach in using instructional videos to teach dental local anaesthetic skills.

OBJECTIVE: Good clinical skills are crucial for all dental practitioners. The transfer of knowledge from didactic lectures to daily clinical application can be challenging for current millennial learners. This study aimed to evaluate the effectiveness of using instructional videos to teach dental local anaesthesia in an undergraduate oral health programme in 2017. METHODS: The philosophical basis of this study relies on the Advanced Trauma Life Support (ATLS) course which has been proven effective in practical education. Video clips were made in 3 different formats, with the addition of a quiz-embedded version to reinforce learning and revision for practical assessments. RESULTS: All the students agreed that their motivation to watch the videos was to refresh their memories before assessments. 90% of students agreed the videos helped them to learn psychomotor skills that required accuracy. There was a statistically significant correlation between the number of views of the videos on the administration of block injections and the marks received for practical assessment (r = 0.36, P = 0.05), and correlation between participating in online quizzes and theory assessment (r = 0.371, P = 0.044). Videos with narration and background music were found to be popular amongst oral health students. CONCLUSION: The use of instructional videos has been found effective in complementing the ATLS approach for teaching psychomotor skills in the administration of local anaesthetics by oral health students. Further studies are required to measure the students' retention of knowledge and application of skills on a patient in clinical settings.