Assessing the quality of chest compressions with a DIY low-cost manikin (LoCoMan) versus a standard manikin: a quasi-experimental study in primary education.

Extending the access to cardiopulmonary resuscitation (CPR) training to a wider public is an important step in increasing survivability of out-of-hospital cardiac arrest. However, often price and maintenance of CPR manikins are barriers that prevent training at schools. This study aims to evaluate the learning of hands-only (HO) CPR by practicing with a low-cost manikin (LoCoMan) with visual qualitative feedback and to compare the results with the skills acquired by practice on a conventional manikin. A quasi-experimental study with 193 schoolchildren (10 to 12 years old) who were allocated to two groups: the LoCoMan group was taught via an integrative approach (science combined with physical education (PE)) and practiced on a handmade manikin, and a control group practiced in a traditional setting with a commercial manikin (Resusci Junior, Laerdal, Norway). All participants practiced for 1 hands-on skill session before performing a post-test on an instrumented CPR manikin. The outcomes including HO-CPR performance variables were compared between groups. The LoCoMan and control groups both achieved acceptable percentage of HO-CPR quality (57% and 71%, p = 0.004). Among 6th-graders, there were no significant differences in HO-CPR quality between LoCoMan 68% and control 71%, p = 0.66. The control group achieved better chest compression depth while the LoCoMan group showed more compressions with adequate chest recoil.     Conclusion: Schoolchildren are able to build and use a low-cost manikin with visual feedback. The integrative learning approach used in this study may be a feasible alternative methodology for training and learning HO-CPR in schools when commercial manikins are not available. What is Known: • Access to CPR training should be universal and independent of age, location, financial means, or access to qualified instructors. • Scientific societies promote the implementation of CPR in schools, so that teachers and schoolchildren can play a multiplier role in their environment, but the gap in CPR learning is related to cultural, economic factors or access to resources and materials. What is New: • LoCoMan may be a useful device for teaching and learning CPR in schoolchildren from the age of 10 and upwards. • LOCOMAN shows that it is feasible and possible to build a low-cost manikin (about €5 in the European Region) and to integrate it into an integrative educational project, and outlines how this could be done. this approach can be an incentive for teachers to attempt teaching CPR, but also for education outside the formal environment.

Energetic and Cognitive Demands of Treading Water: Effects of Technique and Expertise.

Being able to tread water effectively can improve the likelihood of survival following accidental immersion. People tread water in various ways, ranging from rudimentary 'doggy-paddle' to more elaborate techniques like the eggbeater, but little is known about the energetic and cognitive requirements of treading water. We therefore aimed to measure the demands of treading water techniques for people of different experience levels. Three cohorts, comprising 21 adult water treading experts (water polo players), 15 intermediate swimmers and 16 inexperienced swimmers, treaded water for 3 min each using four different techniques while cognitive and energetic economy measures were taken. For inexperienced swimmers, the flutter kick and breaststroke patterns produced the lowest self-reported physical and task load (rating of perceived exertion, NASA task load index), while cognitive (probe reaction time), cardiac (heart rate) and metabolic (oxygen consumption) load did not differ between techniques. In contrast, for expert water treaders, both breaststroke and eggbeater patterns produced lower cognitive, cardiac and metabolic loads. For intermediate swimmers, breaststroke resulted in the lowest cardiac and metabolic loads, as well as self-reported task load. Probe reaction time was highest while performing the eggbeater technique, indicating that this technique was challenging to coordinate and cognitively demanding. While the energetic demands of antiphase kicking patterns (such as eggbeater in experts or flutter kick in beginners) may be similarly low, the symmetric coordination of upright breaststroke may explain why this pattern's cognitive economy was favourable for all groups. As the eggbeater can be challenging to perform for many people, an upright breaststroke technique is an adequate alternative to adopt in survival situations.

Assessment of water safety competencies: Benefits and caveats of testing in open water.

Drowning has been the cause of over 2.5 million preventable deaths in the past decade. Despite the fact that the majority of drownings occur in open water, assessment of water safety competency typically occurs in swimming pools. The assessment of water safety competency in open water environments brings with it a few difficulties, but also promises tremendous benefits. The aim of this position paper is to discuss the benefits and caveats of conducting assessments in open water environments as opposed to closed and controlled environments, and to provide recommendations for evidence-based practice. The first theoretical section discusses the effects of the environment and key variables (such as temperature and water movement) on various factors of assessment. These discussions are linked to the two perspectives of representative learning design (based on ecological dynamics) and information processing theory. The second section presents two pilot studies of relevance and provides practical implications for assessment of water safety competency. It seems that a combination of pool-based practice and open water education may be ideal in assessing aquatic skills competency. Assessment in open water presents clear benefits regarding validity, but often poses seemingly unsurmountable barriers, which providers may have reservations about in the absence of clear evidence. Hence this article provides a robust discussion about competency assessment and signals the practical importance of faithfully reproducing the environment in which skilled behavior is most relevant.

A Multidisciplinary Comparison of Different Techniques Among Skilled Water Treaders.

In an immersion incident, a person may be required to tread water for extended periods of time in order to survive. Treading water, or maintaining a stable head position above the water surface, can be achieved in several different ways. Determining which treading water techniques are economic (energetically and cognitively) is an important first step in approaching evidence-based water safety instruction. The present study investigated the cognitive and metabolic demands associated with four main techniques for treading water in experienced water treaders. Skilled water treaders (n=21) performed four common treading techniques for 3min each: "running" in the water, "flutter kick" with hands sculling, "upright breaststroke," and "egg-beater." Self-reported rate of perceived exertion (RPE) and task load index (TLX) score, as well as objective measures of probe reaction time (PRT; i.e., response to auditory cues while treading), oxygen consumption and heart rate were assessed. The "egg-beater" technique and the "upright breaststroke" technique were linked to significantly lower cognitive and energetic demands compared to the other techniques (VO2: p<0.001 - "Running" M=29.02, SD=7.40/"Flutter kick" M=29.37, SD=8.56, "Breaststroke" M=23.47, SD=7.28, and "Eggbeater" M=23.18, SD=6.31). This study lays the groundwork for future research that may establish the ideal movement behavior in drowning situations and investigate movement instruction to less experienced treaders.

The Influence of Equipment and Environment on Children and Young Adults Learning Aquatic Skills.

Learning aquatic skills is an important component of developing physical literacy in children. Aquatic skills such as floating, swimming and safe entry/exit promote engagement in different water environments and may help preserve lives in an emergency. This scoping review was conducted to evaluate the influence of task constraints (i.e., equipment) and environmental constraints (i.e., physical and social) on how children learn foundational aquatic skills. In developed countries, children are typically taught in swimming pools under direct supervision. It is also not uncommon to see children and infants learning to swim with assistive equipment (e.g., buoyancy aids). However, perhaps surprisingly, the evidence on how and where children learn aquatic skills does not uniformly promote such practices. For example, the use of flotation devices has not been proven to aid skill learning. Some researchers have advocated that children should learn aquatic skills whilst wearing outdoor clothing. One benefit of children wearing clothing is an increased capacity to practice in colder water (such as the ocean, rivers, or lakes). Overall, whilst practitioners often use equipment for various reasons it seems that not all equipment is equally useful in promoting the acquisition of aquatic skills. In less developed countries, with limited access to swimming pools and fewer resources for private instruction, a range of different open water aquatic environments and practices, such as swimming in temporarily flooded areas, have been reported. Such strategies are in urgent demand of further research given that drowning rates in less developed countries around the world exceed those in developed nations. It can be argued that learning in pools does not afford the opportunities to develop the whole range of adaptive skills that may be required in different open water environments such as navigating currents and waves, floating whilst clothed, or making life-saving decisions. Consequently, a shift toward teaching in open water environments has occurred in several countries. This review provides an evidence-base upon which practitioners can design more effective aquatic education programs for children.

Discerning measures of conscious brain processes associated with superior early motor performance: Capacity, coactivation, and character.

This study explored the relationship between working memory (WM) capacity, corticocortical communication (EEG coherence), and propensity for conscious control of movement during the performance of a complex far-aiming task. We were specifically interested in the role of these variables in predicting motor performance by novices. Forty-eight participants completed (a) an assessment of WM capacity (an adapted Rotation Span task), (b) a questionnaire that assessed the propensity to consciously control movement (the Movement Specific Reinvestment Scale), and (c) a hockey push-pass task. The hockey push-pass task was performed in a single task (movement only) condition and a combined task (movement plus decision) condition. Electroencephalography (EEG) was used to examine brain activity during the single task. WM capacity best predicted single task performance. WM capacity in combination with T8-Fz coherence (between the visuospatial and motor regions of the brain) best predicted combined task performance. We discuss the implied roles of visuospatial information processing capacity, neural coactivation, and propensity for conscious processing during performance of complex motor tasks.