Impact of patterns of language use and socio-economic status on a constructed response Situational Judgment Test (SJT).

The study explored the impacts of patterns of language use (PLU) and socio-economic status (SES) on Casper, a constructed-response situational judgment test (SJT). 10,266 applicants from two U.S. medical schools were grouped into self-reported balanced bilinguals, unbalanced bilinguals, English monolinguals, and English as a Second Language (ESL) students. A multicomponent SES composite was used to assess the degree of socioeconomic disadvantage (DSD). Results from a hierarchical regression analysis showed that after accounting for demographic variables, both PLU and DED were significant factors on applicants' Casper performance. Bilingualism was associated with better Casper performance compared to English monolinguals and ESL students. No significant effect of speaking English as a native language was found on applicants' Casper performance. English monolinguals and ESL students performed equivalently on Casper. Finally, high DSD was associated with better Casper performance than low DSD, and the impact of DSD on Casper held the same across all four language groups. These findings provide evidence that socio-cultural factors, such as PLU and DSD have important impacts on SJT performance. Further research is needed to understand the role of differences in language construction across socio-cultural factors on constructed-response SJT performance.

Validity of constructed-response situational judgment tests in training programs for the health professions: A systematic review and meta-analysis protocol.

BACKGROUND: Situational judgments tests have been increasingly used to help training programs for the health professions incorporate professionalism attributes into their admissions process. While such tests have strong psychometric properties for testing professional attributes and are feasible to implement in high-volume, high-stakes selection, little is known about constructed-response situational judgment tests and their validity. METHODS: We will conduct a systematic review of primary published or unpublished studies reporting on the association between scores on constructed-response situational judgment tests and scores on other tests that measure personal, interpersonal, or professional attributes in training programs for the health professions. In addition to searching electronic databases, we will contact academics and researchers and undertake backward and forward searching. Two reviewers will independently screen the papers and decide on their inclusion, first based on the titles and abstracts of all citations, and then according to the full texts. Data extraction will be done independently by two reviewers using a data extraction form to chart study details and key findings. Studies will be assessed for the risk of bias and quality by two reviewers using the "Quality In Prognosis Studies" tool. To synthesize evidence, we will test the statistical heterogeneity and conduct a psychometric meta-analysis using a random-effects model. If adequate data are available, we will explore whether the meta-analytic correlation varies across different subgroups (e.g., race, gender). DISCUSSION: The findings of this study will inform best practices for admission and selection of applicants for training programs for the health professions and encourage further research on constructed-response situational judgment tests, in particular their validity. TRIAL REGISTRATION: The protocol for this systematic review has been registered in PROSPERO [CRD42022314561]. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022314561.

Health professions school applicant experiences of discrimination during interviews.

BACKGROUND: Bias pervades every aspect of healthcare including admissions, perpetuating the lack of diversity in the healthcare workforce. Admissions interviews may be a time when applicants to health profession education programs experience discrimination. METHODS: Between January and June 2021 we invited US and Canadian applicants to health profession education programs to complete a survey including the Everyday Discrimination Scale, adapted to ascertain experiences of discrimination during admissions interviews. We used chi-square tests and multivariable logistic regression to determine associations between identity factors and positive responses. RESULTS: Of 1115 respondents, 281 (25.2%) reported discrimination in the interview process. Individuals with lower socioeconomic status (OR: 1.78, 95% CI [1.26, 2.52], p = 0.001) and non-native English speakers (OR: 1.76, 95% CI [1.08, 2.87], p = 0.02) were significantly more likely to experience discrimination. Half of those experiencing discrimination (139, or 49.6%) did nothing in response, though 44 (15.7%) reported the incident anonymously and 10 (3.6%) reported directly to the institution where it happened. CONCLUSIONS: Reports of discrimination are common among HPE applicants. Reforms at the interviewer- (e.g. avoiding questions about family planning) and institution-level (e.g. presenting institutional efforts to promote health equity) are needed to decrease the incidence and mitigate the impact of such events.

A Classification and Calibration Procedure for Gesture Specific Home-Based Therapy Exercise in Young People With Cerebral Palsy.

Movement-based video games can provide engaging practice for repetitive therapeutic gestures towards improving manual ability in youth with cerebral palsy (CP). However, home-based gesture calibration and classification is needed to personalize therapy and ensure an optimal challenge point. Nineteen youth with CP controlled a video game during a 4-week home-based intervention using therapeutic hand gestures detected via electromyography and inertial sensors. The in-game calibration and classification procedure selects the most discriminating, person-specific features using random forest classification. Then, a support vector machine is trained with this feature subset for in-game interaction. The procedure uses features intended to be sensitive to signs of CP and leverages directional statistics to characterize muscle activity around the forearm. Home-based calibration showed good agreement with video verified ground truths (0.86 ± 0.11, 95%CI = 0.93-0.97). Across participants, classifier performance (F1-score) for the primary therapeutic gesture was 0.90 ± 0.05 (95%CI = 0.87-0.92) and, for the secondary gesture, 0.82 ± 0.09 (95%CI = 0.77-0.86). Features sensitive to signs of CP were significant contributors to classification and correlated to wrist extension improvement and increased practice time. This study contributes insights for classifying gestures in people with CP and demonstrates a new gesture controller to facilitate home-based therapy gaming.

A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: A randomized single-case experimental design feasibility study.

IMPORTANCE/BACKGROUND: Movement-controlled video games have potential to promote home-based practice of therapy activities. The success of therapy gaming interventions depends on the quality of the technology used and the presence of effective support structures. AIM: This study assesses the feasibility of a novel intervention that combines a co-created gaming technology integrating evidence-based biofeedback and solution-focused coaching (SFC) strategies to support therapy engagement and efficacy at home. METHODS: Following feasibility and single-case reporting standards (CONSORT and SCRIBE), this was a non-blind, randomized, multiple-baseline, AB, design. Nineteen (19) young people with cerebral palsy (8-18 years old) completed the 4-week home-based intervention in France and Canada. Participant motivations, personalized practice goals, and relevance of the intervention to daily activities were discussed in a Solution Focused Coaching-style conversation pre-, post-intervention and during weekly check-ins. Participants controlled a video game by completing therapeutic gestures (wrist extension, pinching) detected via electromyography and inertial sensors on the forearm (Myo Armband and custom software). Process feasibility success criteria for recruitment response, completion and adherence rates, and frequency of technical issues were established a priori. Scientific feasibility, effect size estimates and variance were determined for Body Function outcome measures: active wrist extension, grip strength and Box and Blocks Test; and for Activities and Participation measures: Assisting Hand Assessment (AHA), Canadian Occupational Performance Measure (COPM) and Self-Reported Experiences of Activity Settings (SEAS). RESULTS: Recruitment response (31%) and assessment completion (84%) rates were good and 74% of participants reached self-identified practice goals. As 17% of technical issues required external support to resolve, the intervention was graded as feasible with modifications. No adverse events were reported. Moderate effects were observed in Body Function measures (active wrist extension: SMD = 1.82, 95%CI = 0.85-2.78; Grip Strength: SMD = 0.63, 95%CI = 0.65-1.91; Box and Blocks: Hedge's g = 0.58, 95%CI = -0.11-1.27) and small-moderate effects in Activities and Participation measures (AHA: Hedge's g = 0.29, 95%CI = -0.39-0.97, COPM: r = 0.60, 95%CI = 0.13-0.82, SEAS: r = 0.24, 95%CI = -0.25-0.61). CONCLUSION: A definitive RCT to investigate the effectiveness of this novel intervention is warranted. Combining SFC-style coaching with high-quality biofeedback may positively engage youth in home rehabilitation to complement traditional therapy. TRIAL REGISTRATION: ClinicalTrials.gov, U.S. National Library of Medicine: NCT03677193.

Biofeedback interventions for individuals with cerebral palsy: a systematic review.

Purpose: The purpose of this study is to evaluate the quality of evidence of biofeedback interventions aimed at improving motor activities in people with Cerebral Palsy (CP). Second, to describe the relationship between intervention outcomes and biofeedback characteristics. Methods: Eight databases were searched for rehabilitation interventions that provided external feedback and addressed motor activities. Two reviewers independently assessed and extracted data. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to evaluate quality of evidence for outcome measures related to two International Classification of Functioning, Disability and Health (ICF) chapters. Results: Fifty-seven studies were included. There were 53 measures related Activities and Participation and 39 measures related to Body Functions. Strength of evidence was "Positive, Very-Low" due to the high proportion of non-controlled studies and heterogeneity of measures. Overall, 79% of studies and 63% of measures showed improvement post-intervention. Counter to motor learning theory recommendations, most studies provided feedback consistently and concurrently throughout the intervention regardless of the individual's desire or progress. Conclusion: Heterogeneous interventions and poor study design limit the strength of biofeedback evidence. A thoughtful biofeedback paradigm and standardized outcome toolbox can strengthen the confidence in the effect of biofeedback interventions for improving motor rehabilitation for people with CP. Implications for Rehabilitation Biofeedback can improve motor outcomes for people with Cerebral Palsy. If given too frequently, biofeedback may prevent the client from learning autonomously. Use consistent and concurrent feedback to improve simple/specific motor activities. Use terminal feedback and client-directed feedback to improve more complex/general motor activities.

Police Officer performance and perception using light, medium and heavy weight tactical batons.

OBJECTIVE: Compare the effectiveness of light, medium and heavy weight Police expandable batons from a performance and a user perception perspective. RATIONALE: Police Officers are required to control combative individuals using less lethal tactics in proportion to the threat they face. Officers need to deliver sufficient force quickly and accurately. As such, it is important to select batons that are optimal for both performance and user experience. METHODS: Eleven active-duty New York Police Department Officers completed static and dynamic strike testing followed by a questionnaire. Six baton types were tested using different weights and lengths. RESULTS: Peak force, dynamic task speed and accuracy were similar between baton types. Peak impulse, forearm muscle activity, and discomfort were higher with the heaviest baton. CONCLUSIONS: Lighter batons can deliver sufficient force to control assailants while imposing lower ergonomic costs and being preferable to the user with no impact on speed or accuracy.

Pharmacological and neurosurgical interventions for managing dystonia in cerebral palsy: a systematic review.

AIM: To systematically review evidence for pharmacological/neurosurgical interventions for managing dystonia in individuals with cerebral palsy (CP) to inform a care pathway. METHOD: Searches included studies with a minimum of five participants with dystonia in CP receiving oral baclofen, benzodiazepines (clonazepam, diazepam, lorazepam), clonidine, gabapentin, levodopa, trihexyphenidyl, botulinum toxin, intrathecal baclofen (ITB), or deep brain stimulation (DBS). Evidence was classified according to American Academy of Neurology guidelines. RESULTS: Twenty-eight articles underwent data extraction: one levodopa, five trihexyphenidyl, three botulinum toxin, six ITB, and 13 DBS studies. No articles for oral baclofen, benzodiazepines, clonidine, or gabapentin met the inclusion criteria. Evidence for reducing dystonia was level C (possibly effective) for ITB and DBS; level C (possibly ineffective) for trihexyphenidyl; and level U (inadequate data) for botulinum toxin. INTERPRETATION: For dystonia reduction, ITB and DBS are possibly effective, whereas trihexyphenidyl was possibly ineffective. There is insufficient evidence to support oral medications or botulinum toxin to reduce dystonia. There is insufficient evidence for pharmacological and neurosurgical interventions to improve motor function, decrease pain, and ease caregiving. The majority of the pharmacological and neurosurgical management of dystonia in CP is based on clinical expert opinion. WHAT THIS PAPER ADDS: Intrathecal baclofen and deep brain stimulation are possibly effective in reducing dystonia. Current evidence does not support effectiveness of oral medications or botulinum toxin to reduce dystonia. Evidence is inadequate for pharmacological/neurosurgical interventions impact on improving motor function, pain/comfort, and easing caregiving. The majority of the care pathway rests on expert opinion.

Ability-Based Balancing Using the Gross Motor Function Measure in Exergaming for Youth with Cerebral Palsy.

OBJECTIVE: To test if the gross motor function measure (GMFM) could be used to improve game balancing allowing youth with cerebral palsy (CP) with different physical abilities to play a cycling-based exercise videogame together. Our secondary objective determined if exergaming with the GMFM Ability-Based algorithm was enjoyable. MATERIALS AND METHODS: Eight youth with CP, 8-14 years of age, GMFM scores between 25.2% and 87.4% (evenly distributed between Gross Motor Function Classification System levels II and III), competed against each other in head-to-head races, totaling 28 unique race dyads. Dyads raced three times, each with a different method of minimizing the distance between participants (three balancing algorithms). This was a prospective repeated measures intervention trial with randomized and blinded algorithm assignment. The GMFM Ability-Based algorithm was developed using a least squares linear regression between the players' GMFM score and cycling cadence. Our primary outcome was dyad spread or average distance between players. The GMFM Ability-based algorithm was compared with a control algorithm (No-Balancing), and an idealized algorithm (one-speed-for-all [OSFA]). After each race, participants were asked "Was that game fun?" and "Was that game fair?" using a five-point Likert scale. RESULTS: Participants pedaled quickly enough to elevate their heart rate to an average of 120 ± 8 beats per minute while playing. Dyad spread was lower when using GMFM Ability-Based balancing (4.6 ± 4.2) compared with No-Balancing (11.9 ± 6.8) (P < 0.001). When using OSFA balancing, dyad spread was (1.6 ± 0.9), lower than both GMFM Ability-Based (P = 0.006) and No-Balancing (P < 0.001). Cycling cadence positively correlated to GMFM, equal to 0.58 (GMFM) +33.29 (R2adj= 0.662, P = 0.004). Participants rated the games a median score 4/5 for both questions: "was that game fun?" and "was that game fair?." CONCLUSION: The GMFM Ability-Based balancing decreased dyad spread while requiring participants to pedal quickly, facilitating interaction and physical activity.

An open-source model and solution method to predict co-contraction in the finger.

A novel open-source biomechanical model of the index finger with an electromyography (EMG)-constrained static optimization solution method are developed with the goal of improving co-contraction estimates and providing means to assess tendon tension distribution through the finger. The Intrinsic model has four degrees of freedom and seven muscles (with a 14 component extensor mechanism). A novel plugin developed for the OpenSim modelling software applied the EMG-constrained static optimization solution method. Ten participants performed static pressing in three finger postures and five dynamic free motion tasks. Index finger 3D kinematics, force (5, 15, 30 N), and EMG (4 extrinsic muscles and first dorsal interosseous) were used in the analysis. The Intrinsic model predicted co-contraction increased by 29% during static pressing over the existing model. Further, tendon tension distribution patterns and forces, known to be essential to produce finger action, were determined by the model across all postures. The Intrinsic model and custom solution method improved co-contraction estimates to facilitate force propagation through the finger. These tools improve our interpretation of loads in the finger to develop better rehabilitation and workplace injury risk reduction strategies.

Balancing for Gross Motor Ability in Exergaming Between Youth with Cerebral Palsy at Gross Motor Function Classification System Levels II and III.

OBJECTIVE: To test how three custom-built balancing algorithms minimize differences in game success, time above 40% heart rate reserve (HRR), and enjoyment between youth with cerebral palsy (CP) who have different gross motor function capabilities. Youth at Gross Motor Function Classification System (GMFCS) level II (unassisted walking) and level III (mobility aids needed for walking) competed in a cycling-based exercise video game that tested three balancing algorithms. MATERIALS AND METHODS: Three algorithms: a control (generic-balancing [GB]), a constant non-person specific (One-Speed-For-All [OSFA]), and a person-specific (Target-Cadence [TC]) algorithms were built. In this prospective repeated measures intervention trial with randomized and blinded algorithm assignment, 10 youth with CP aged 10-16 years (X ± standard deviation = 12.4 ± 1.8 years; GMFCS level II n = 4, III n = 6) played six exergaming sessions using each of the three algorithms. Outcomes included game success as measured by a normalized game score, time above 40% HRR, and enjoyment. RESULTS: The TC algorithm balanced game success between GMFCS levels similarly to GB (P = 0.11) and OSFA (P = 0.41). TC showed poorer balancing in time above 40% HRR compared to GB (P = 0.02) and OSFA (P = 0.02). Enjoyment ratings were high (6.4 ± 0.7/7) and consistent between all algorithms (TC vs. GB: P = 0.80 and TC vs. OSFA: P = 0.19). CONCLUSION: TC shows promise in balancing game success and enjoyment but improvements are needed to balance between GMFCS levels for cardiovascular exercise.

Biofeedback interventions for people with cerebral palsy: a systematic review protocol.

BACKGROUND: Cerebral palsy is a life-long disability that affects motor control and activities of daily living. Depending on the type of cerebral palsy, some individuals may have trouble performing tasks with one or both of their arms and/or legs. Different strategies exist to help develop motor capacity. Biofeedback therapy is a commonly applied rehabilitation strategy. In biofeedback therapy, information about the motor behavior while completing a task is given back to the individual to help improve their performance. This can provide valuable information that would otherwise be unknown to the individual. Biofeedback may also have a unique method of operation in clinical populations, such as people with cerebral palsy. Therefore, it is important to identify the most effective mechanisms for specific populations. This review aims to evaluate the effects of biofeedback interventions that have been used towards improving motor performance and motor learning in people with cerebral palsy. METHODS: Using a customized strategy, MEDLINE, CINAHL, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, SCOPUS, SPORTDiscus, and PEDro databases will be searched. Two independent reviewers will screen titles and abstracts, review full texts for inclusion criteria, and extract data from relevant articles using a standardized template. Quality of evidence and risk of bias will be assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. DISCUSSION: Several studies have investigated biofeedback-based interventions for people with cerebral palsy. However, there is a great variety and limited consensus regarding how to implement biofeedback mechanisms. This systematic review will consolidate the current evidence to direct future study and develop effective biofeedback rehabilitation strategies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID: CRD42016047612.

Change in pain status in children with cerebral palsy.

AIM: To identify factors associated with a change in pain over time in children with cerebral palsy (CP). METHOD: Pain was assessed at two time-points by physicians and caregiver-rated Health Utilities Index 3 (HUI3) pain scores. RESULTS: One hundred and forty-eight children out of 179 approached from outpatient clinics (83% response; 104 males, 44 females mean age 8y 8mo, range 3y-16y) across all Gross Motor Function Classification System (GMFCS) levels were included. Fifty-five percent had changes in caregiver-reported HUI3 pain. A backward stepwise multiple linear regression retained HUI3 pain score at visit 1 and GMFCS level (F[2,144] =23.40, R2 =0.35; p<0.001) as variables associated with a change in pain status (HUI3 pain at visit 1: ß=0.61, p<0.001; GMFCS level: ß=-0.17, p<0.015). The association between HUI3 pain at visit 1 and GMFCS level was significant (ß=-0.15, p<0.036). There was an association between pain etiology and pain trajectory (F[3,144] =5.39, p=0.002). Post-hoc testing revealed musculoskeletal pain had the greatest improvements compared with the no pain group (p=0.006). INTERPRETATION: Children with CP with more severe initial pain and higher gross motor function have lower pain at follow-up indicating an improvement in pain status over time.