Simulated versus traditional occupational therapy placements: A randomised controlled trial.

BACKGROUND/AIM: Professional practise placements in occupational therapy education are critical to ensuring graduate competence. Australian occupational therapy accreditation standards allow up to 200 of a mandated 1000 placement hours to include simulation-based learning. There is, however, minimal evidence about the effectiveness of simulation-based placements compared to traditional placements in occupational therapy. We evaluated whether occupational therapy students completing a 40 hour (one week block) Simulated Clinical Placement (SCP) attained non-inferior learning outcomes to students attending a 40 hour Traditional Clinical Placement (TCP). METHODS: A pragmatic, non-inferiority, assessor-blinded, multicentre, randomised controlled trial involving students from six Australian universities was conducted. Statistical power analysis estimated a required sample of 425. Concealed random allocation was undertaken with a 1:1 ratio within each university. Students were assigned to SCP or TCP in one of three settings: vocational rehabilitation, mental health or physical rehabilitation. SCP materials were developed, manualised and staff training provided. TCPs were in equivalent practice areas. Outcomes were assessed using a standardised examination, unit grades, the Student Practice Evaluation Form-Revised and student confidence survey. A generalised estimating equation approach was used to assess non-inferiority of the SCP to the TCP. RESULTS: Of 570 randomised students (84% female), 275 attended the SCP and 265 the TCP (n = 540, 94.7% retention). There were no significant differences between the TCP and SCP on (i) examination results (marginal mean difference 1.85, 95% CI: 0.46-3.24; P = 0.087); (ii) unit score (mean (SD) SCP: 71.9 (8.8), TCP: 70.34 (9.1); P = 0.066); or (iii) placement fail rate, assessed using the Student Practice Evaluation Form-Revised (100% passed both groups). CONCLUSION: Students can achieve equivalent learning outcomes in a 40 hour simulated placement to those achieved in a 40 hour traditional placement. These findings provide assurance to students, educators and professional accreditation bodies that simulation can be embedded in occupational therapy education with good effect.

Touch can be as accurate as passively-guided kinaesthesis in length perception.

Two experiments were designed to investigate the contribution of touch and kinaesthesis to haptic perception of the length of raised lines. Experiment 1 showed that judgements based on kinaesthetic information were not more accurate than those based on cutaneous information. Instead, kinaesthetic and cutaneous inputs appear to be weighted almost equally in the haptic percept, with haptic performance more closely approximated by cutaneous performance than by kinaesthetic. In Experiment 2 it was shown that effects attributed to condition (modality) were not due to the speed with which the stimulus or exploring finger moved. Our results challenge the view that kinaesthesis is more important than touch for identification of raised line drawings.

Capture of kinesthesis by a competing cutaneous input.

In four experiments, blindfolded participants were presented with pairs of stimuli simultaneously, one to each index finger. Participants moved one index finger, which was presented with cutaneous and/or kinesthetic stimuli, and this movement caused a raised line to move underneath the other, stationary index finger in a yoked manner. The stimuli were 180º rotations of each other (e.g., < and >), and thus when a < was traced with the moving finger, it caused a > to be felt at the stationary finger. When asked to report the experience, participants predominantly reported the cutaneous stimulus, seemingly being ignorant of the kinesthetic stimulus. This appears to be an intrahaptic capture phenomenon, which is of interest because it suggests that conflict between intrahaptic sensory stimuli can go unnoticed; sometimes we are unaware of how we moved, and sometimes we do not know what we touched. The results are interpreted in light of optimal integration, perceptual suppression, reafference suppression, and inattentional blindness.

Visual and haptic influence on perception of stimulus size.

In six experiments, subjects judged the sizes of squares that were presented visually and/or haptically, in unimodal or bimodal conditions. We were interested in which mode most affected size judgments in the bimodal condition when the squares presented to each mode actually differed in size. Three factors varied: whether haptic exploration was passive or active, whether the choice set from which the subjects selected their responses was visual or haptic, and whether cutaneous information was provided in addition to kinesthetic information. To match the task for each mode, visual presentations consisted of a cursor that moved along a square pathway to correspond to the haptic experience of successive segments revealed during exploration. We found that the visual influence on size judgments was greater than the influence of haptics when the haptic experience involved only kinesthesis, passive movement, and a visual choice set. However, when cutaneous input was added to kinesthetic information, size judgments were most influenced by the haptic mode. The results support hypotheses of sensory integration, rather than capture of one sense by the other.

Components of haptic information: skin rivals kinaesthesis.

Four components of the haptic system were investigated, in isolation and in various combinations, during passive-guided exploration of raised-line drawings. The components were kinaesthesis, cutaneous input from the presence of a raised line, shear forces from relative movement between the skin and a textured surface, and attenuated distortions at the fingertip resulting from relative movement between the fingertip and a surface. Although the presence of kinaesthetic information was found to be positively correlated with performance in a task of identifying raised-line letters, conditions involving touch alone yielded performance equivalent to that when kinaesthesis was involved. Together, these results suggest that tactile information could be as effective as kinaesthetic information. The results are discussed in terms of applications to the design of human-machine interfaces.

Intrasensory attention: kinaesthetic versus cutaneous inputs.

Blindfolded participants felt pairs of raised-line drawings simultaneously, one with each index finger. The stimuli presented at each fingertip were 180 degrees rotations of each other (eg 6 and 9). One finger moved (either actively or passively), and this in turn caused movement of a matched raised line underneath the stationary finger on the other hand, in a yoked manner. Thus, a 6 at the moving finger would be felt as a 9 on the stationary finger. On all trials there was a raised line moving underneath the stationary fully passive finger. For the moving finger, a raised line was present on only half of the trials. When a raised line could be felt at the moving fingertip, the shape followed by this finger was more often reported than was the shape present at the other (stationary) fingertip. However, when no line was present under the moving finger (ie when movement became the major cue for shape), subjects reported experiencing the shape moved under the stationary fingertip. Results are interpreted as an indication that cutaneous information can be more 'attention-getting' than kinaesthetic information, and are considered to support the modality-appropriateness theory.

Active and passive movements give rise to different judgments of coldness.

When the right index fingertip of twelve subjects was moved across a cold (15 degrees C) tile by a machine (passive-guided condition), the subjects rated the temperature of the tile as being colder than when they moved the finger across the stimulus themselves (active condition). Results confirmed that active movements were associated with an attenuation of 'coldness'. When these findings are considered alongside those of earlier experiments (see VanDoorn et al, 2005 Perception 34 231 236), it may be concluded that intentionality of movement plays some role in this attenuation.

Modification of magnitude estimations in thermotactile perception during self-generated and externally generated movements.

Fourteen participants felt a 'cold' stimulus move across a fingertip. When movement was self-controlled, the stimulus was reported as feeling less 'cold' than when movement was externally generated.