The self-reported driving and pedestrian behaviour of adults with developmental coordination disorder.

BACKGROUND: Developmental coordination disorder (DCD) affects movement coordination, but little is known about how the condition impacts the behaviours of car drivers and pedestrians. AIMS: This study examined the self-reported driving and pedestrian behaviours of adults with Developmental Coordination Disorder (DCD). METHODS AND PROCEDURES: One hundred and twenty-eight participants (62 adults with DCD vs. 66 TD adults) responded to an online survey asking them about their perceptions of confidence and self-reported driving and pedestrian behaviours in the real-world. OUTCOMES AND RESULTS: Results suggested that adults with DCD felt less confident and reported more lapses in attention (e.g., forgetting where their car was parked) and errors (e.g., failing to check their mirrors prior to a manoeuvre) when driving compared to typically developed (TD) adults. Adults with DCD also reported feeling less confident and reported less adherence to road traffic laws (e.g., not waiting for a green crossing signal before crossing the road) when walking as pedestrians. CONCLUSIONS AND IMPLICATIONS: These results offer some much-needed insight into the behaviours of those with DCD outside of the laboratory environment and underline the need for research investigating the driving and pedestrian behaviours of individuals with DCD in 'real-world' contexts.

Children with developmental coordination disorder have less variable motor unit firing rate characteristics across contractions compared to typically developing children.

Introduction: Understanding the nuances of neuromuscular control is crucial in unravelling the complexities of developmental coordination disorder (DCD), which has been associated with differences in skeletal muscle activity, implying that children with DCD employ distinct strategies for muscle control. However, force generation and control are dependent on both recruitment of motor units and their firing rates and these fine details of motor function have yet to be studied in DCD. The purpose of this study was therefore to compare motor unit characteristics in a small muscle of the hand during low level, handgrip contractions in typically developing (TD) children and children with DCD. Methods: Eighteen children (9 TD vs. 9 DCD) completed a series of manual handgrip contractions at 10 ± 5% of their maximum voluntary contraction. High density surface electromyography was used to record excitation of the first dorsal interosseus muscle. Recorded signals were subsequently decomposed into individual motor unit action potential trains. Motor unit characteristics (firing rate, inter-pulse interval, and action potential amplitude) were analysed for contractions that had a coefficient variation of <10%. Results and Discussion: This study found few differences in average motor unit characteristics (number of motor units: TD 20.24 ± 9.73, DCD 27.32 ± 14.00; firing rate: TD 7.74 ± 2.16 p.p.s., DCD 7.86 ± 2.39 p.p.s.; inter-pulse interval: TD 199.72 ± 84.24 ms, DCD 207.12 ± 103 ms) when force steadiness was controlled for, despite the DCD group being significantly older (10.89 ± 0.78 years) than the TD group (9.44 ± 1.67 years). However, differences were found in the variability of motor unit firing statistics, with the children with DCD surprisingly showing less variability across contractions (standard deviation of coefficient of variation of inter-pulse interval: TD 0.38 ± 0.12, DCD 0.28 ± 0.11). This may suggest a more fixed strategy to stabilise force between contractions used by children with DCD. However, as variability of motor unit firing has not been considered in previous studies of children further work is required to better understand the role of variability in motor unit firing during manual grasping tasks, in all children.

Children with developmental coordination disorder are less able to fine-tune muscle activity in anticipation of postural perturbations than typically developing counterparts.

The majority of children with developmental coordination disorder (DCD) struggle with static and dynamic balance, yet there is limited understanding of the underlying neuromechanical mechanisms that underpin poor balance control in these children. Eighteen children with DCD and seven typically developing (TD) children aged 7-10 years stood with eyes open on a moveable platform progressively translated antero-posteriorly through three frequencies (0.1, 0.25 and 0.5 Hz). Myoelectric activity of eight leg muscles, whole-body 3D kinematics and centre of pressure were recorded. At each frequency, postural data were divided into transition-state and steady-state cycles. Data were analyzed using a linear mixed model with follow-up Tukey's pairwise comparisons. At the slowest frequency, children with DCD behaved like age-matched TD controls. At the fastest frequency, children with DCD took a greater number of steps, had a greater centre of mass variability, had a greater centre of pressure area, and tended to activate their muscles earlier and for longer than TD children. Children with DCD did not alter their postural response following prolonged exposure to platform movement, however they made more, non-structured postural adjustments in the medio-lateral direction as task difficulty increased. At the faster oscillation frequencies, children with DCD adopted a different muscle recruitment strategy to TD children. Activating their muscles earlier and for longer may suggest that children with DCD attempt to predict and react to postural disturbances, however the resulting anticipatory muscle excitation patterns do not seem as finely tuned to the perturbation as those demonstrated by TD children. Future work should examine the impact of balance training interventions on the muscle recruitment strategies of children with DCD, to ensure optimal interventions can be prescribed.

Investigating how prior knowledge influences perception and action in developmental coordination disorder.

Developmental coordination disorder (DCD) is characterised by a broad spectrum of difficulties in performing motor tasks. It has recently been proposed that a specific deficit in sensorimotor prediction and feedforward planning might underpin these motoric impairments. The purpose of this study was to use a naturalistic object lifting paradigm to examine whether deficits in sensorimotor prediction might underpin the broad spectrum of difficulties individuals with DCD face when interacting with objects in their environment. We recruited 60 children with probable DCD and 61 children without DCD and measured perceptions of heaviness and fingertip force rate application when interacting with objects which varied in their apparent weight. If deficits in sensorimotor prediction do underpin the broad-ranging motor difficulties seen in DCD, we would expect to see a reduced effect of visual size cues on fingertip force rates and illusory misperceptions of object heaviness. We found no evidence of differences in any metrics of sensorimotor prediction between children with (n = 46) and without DCD (n = 61). Furthermore, there was no correlation between any metrics of sensorimotor prediction and motor performance (as assessed by the standard diagnostic movement assessment battery). Illusory misperceptions of object weight also did not appear to differ between groups. These findings suggest that issues with sensorimotor prediction are unlikely to affect the performance of simple real-world movements in those with DCD.

Strengths and weaknesses of the MABC-2 as a diagnostic tool for developmental coordination disorder: An online survey of occupational therapists and physiotherapists.

The Movement Assessment Battery for Children-2 (MABC-2) is the most widely used instrument for aiding the diagnosis of developmental coordination disorder (DCD). Despite being shown to have strong validity and reliability, it has received criticism for aspects of its scoring system, the lack of formal training, and its susceptibility to overlook higher functioning DCD children. To aid the development of future diagnostic tools and/or iterations of the MABC-2, the present study attempted to draw upon the experience of key stakeholders and determine the strengths and weaknesses of the MABC-2. Using a short online questionnaire, occupational therapists (n = 14) and physiotherapists (n = 3) with experience using the MABC-2 for DCD diagnosis completed a series of Likert scale and free-text questions. Braun and Clarke's six-phase process to thematic analyses was used to identify main themes obtained across quantitative and qualitative data. Results indicate that whilst the MABC-2 is easy to administer and interpret, the scores can misrepresent true motor difficulties due to (a) daily variations in mental and physical state, (b) the reliance on non-functional tasks, (c) negative interference from parents, (d) changes in motor competency due to practice, and (e) a lack of formal examiner training to ensure the test is effectively lead. Further work is needed to more reliably determine how perceptions of the MABC-2 might vary across levels of expertise, profession, and cultural differences.

Soccer heading immediately alters brain function and brain-muscle communication.

Introduction: There is growing evidence of a link between repetitive soccer heading and the increased incidence of neurodegenerative disease. Even a short bout of soccer heading has been shown to impair cognitive performance and disrupt movement control. However, a greater understanding of the mechanisms behind these immediate impairments is needed. The current study attempted to identify how a short bout of soccer heading alters brain function and brain-muscle communication during a movement task. Methods: Sixty soccer players were exposed to either an acute bout (i.e., 20 balls thrown underarm) of soccer heading (n = 30) or a control condition where participants (n = 30) headed soccer balls in virtual reality (VR). Before and after heading, we measured cognitive performance on the King-Devick test, as well as electromyography (EMG), electroencephalography (EEG) and brain-muscle communication (i.e., corticomuscular coherence; CMC) during a force precision task. Results: Following the heading protocol, the VR group improved their cognitive performance whereas the Heading group showed no change. Both groups displayed more precise force contractions at post-test. However, the VR group displayed elevated frontal theta activity and global increases in alpha and beta activity during the contraction task, whereas the Heading group did not. Contrary to our expectations, the Heading group displayed elevated CMC, whereas the VR group showed no change. Discussion: Our findings indicate a short bout of soccer heading may impair cognitive function and disrupt the organization of efficient neural processes that typically accompany motor skill proficiency. Soccer heading also induced corticomuscular hyperconnectivity, which could represent compensatory brain-muscle communication and an inefficient allocation of increased task-related neuromuscular resources. These initial findings offer insights to the mechanisms behind the impairments experienced after a short bout of repetitive soccer heading.

A tool for measuring mental workload during prosthesis use: The Prosthesis Task Load Index (PROS-TLX).

When using a upper-limb prosthesis, mental, emotional, and physical effort is often experienced. These have been linked to high rates of device dissatisfaction and rejection. Therefore, understanding and quantifying the complex nature of workload experienced when using, or learning to use, a upper-limb prosthesis has practical and clinical importance for researchers and applied professionals. The aim of this paper was to design and validate a self-report measure of mental workload specific to prosthesis use (The Prosthesis Task Load Index; PROS-TLX) that encapsulates the array of mental, physical, and emotional demands often experienced by users of these devices. We first surveyed upper-limb prosthetic limb users who confirmed the importance of eight workload constructs taken from published literature and previous workload measures. These constructs were mental demands, physical demands, visual demands, conscious processing, frustration, situational stress, time pressure and device uncertainty. To validate the importance of these constructs during initial prosthesis learning, we then asked able-bodied participants to complete a coin-placement task using their anatomical hand and then using a myoelectric prosthesis simulator under low and high mental workload. As expected, using a prosthetic hand resulted in slower movements, more errors, and a greater tendency to visually fixate the hand (indexed using eye-tracking equipment). These changes in performance were accompanied by significant increases in PROS-TLX workload subscales. The scale was also found to have good convergent and divergent validity. Further work is required to validate whether the PROS-TLX can provide meaningful clinical insights to the workload experienced by clinical users of prosthetic devices.

Combined action observation and motor imagery improves learning of activities of daily living in children with Developmental Coordination Disorder.

Developmental coordination disorder (DCD) is characterised by poor motor coordination, which interferes with the ability to execute activities of daily living (ADLs). Combined action observation and motor imagery (AOMI) involves observing movement videos whilst imagining simultaneously the sensations of executing the same movement. Laboratory-based research indicates that AOMI can help improve movement coordination in children with DCD, but no previous research had investigated the efficacy of AOMI interventions for learning ADLs. This study investigated the efficacy of a home-based, parent-led, AOMI intervention for learning ADLs in children with DCD. Children with confirmed (n = 23) or suspected (n = 5) DCD (total sample n = 28), aged 7-12 years, were assigned to either an AOMI intervention or a control intervention (both n = 14). Participants attempted the following ADLs at pre-test (week 1), post-test (week 4), and retention test (week 6): shoelace tying, cutlery use, shirt buttoning, and cup stacking. Task completion times and movement techniques were recorded. The AOMI intervention produced significantly faster task completion times than the control intervention at post-test for shoelace tying, and significantly improved movement techniques for shoelace tying and cup stacking. Importantly, for children who could not tie shoelaces at pre-test (n = 9 per group), 89% of those following the AOMI intervention learnt the skill successfully by the end of the study, compared to only 44% of those following the control intervention. The findings indicate that home-based, parent-led, AOMI interventions can aid the learning of complex ADLs in children with DCD, and may be particularly effective for facilitating the learning of motor skills that do not currently exist within these children's motor repertoire.

Cortical, muscular, and kinetic activity underpinning attentional focus strategies during visuomotor control.

Focusing internally on movement control or bodily sensations is frequently shown to disrupt the effectiveness and efficiency of motor control when compared to focusing externally on the outcome of movement. Whilst the behavioral consequences of these attentional strategies are well-documented, it is unclear how they are explained at the corticomuscular level. The aim of the present study was to investigate how attentional focus strategies affect kinetic, cortical, muscular, and corticomuscular activity during an isometric force precision task. In a repeated measures design, we measured force, EEG and EMG activity from twenty-seven participants who performed isometric contractions of the right hand whilst encouraged to adopt either an internal or external focus through a combination of instructions, secondary tasks, and self-report evaluations. Results indicated that focusing internally led to poorer force accuracy and steadiness compared to an external focus. An internal focus also increased muscle activity of the forearm flexor, increased EEG alpha activity across the parieto-occipital cortex, lowered frontal midline EEG theta activity, and lowered beta corticomuscular coherence between the forearm flexor and contralateral motor cortex. The results of this study provide a holistic understanding of how attentional focus strategies alter corticomuscular control during an isometric force precision task, paving the way for exploring how the behavioral consequences of attentional strategies can be explained at the corticomuscular levels across a wide range of motor tasks and contexts.

A collaborative approach to adopting/adapting guidelines. The Australian 24-hour movement guidelines for children (5-12 years) and young people (13-17 years): An integration of physical activity, sedentary behaviour, and sleep.

BACKGROUND: In 2018, the Australian Government updated the Australian Physical Activity and Sedentary Behaviour Guidelines for Children and Young People. A requirement of this update was the incorporation of a 24-hour approach to movement, recognising the importance of adequate sleep. The purpose of this paper was to describe how the updated Australian 24-Hour Movement Guidelines for Children and Young People (5 to 17 years): an integration of physical activity, sedentary behaviour and sleep were developed and the outcomes from this process. METHODS: The GRADE-ADOLOPMENT approach was used to develop the guidelines. A Leadership Group was formed, who identified existing credible guidelines. The Canadian 24-Hour Movement Guidelines for Children and Youth best met the criteria established by the Leadership Group. These guidelines were evaluated based on the evidence in the GRADE tables, summaries of findings tables and recommendations from the Canadian Guidelines. We conducted updates to each of the Canadian systematic reviews. A Guideline Development Group reviewed, separately and in combination, the evidence for each behaviour. A choice was then made to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. We then conducted an online survey (n=237) along with three focus groups (n=11 in total) and 13 key informant interviews. Stakeholders used these to provide feedback on the draft guidelines. RESULTS: Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Guideline Development Group agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, maintain the wording of the guidelines, preamble, and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-hours), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for children (5-12 years) and young people (13-17 years). CONCLUSIONS: To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used to develop movement behaviour guidelines. The judgments of the Australian Guideline Development Group did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian Guidelines were adopted with only very minor alterations. This allowed the Australian Guidelines to be developed in a shorter time frame and at a lower cost. We recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines that was developed using the GRADE approach is available with all supporting materials. Other countries may consider this approach when developing and/or revising national movement guidelines.

A scoping review of the application of motor learning principles to optimize myoelectric prosthetic hand control.

Although prosthetic hand rejection rates remain high, evidence suggests that effective training plays a major role in device acceptance. Receiving training early in the rehabilitation process also enhances functional prosthetic use, decreases the likelihood of developing an overreliance on the intact limb, and reduces amputation-related pain. Despite these obvious benefits, there is a current lack of evidence regarding the most effective training techniques to facilitate myoelectric prosthetic hand control, and it remains unknown whether training is effective in facilitating the acquisition and transfer of prosthetic skill. In this scoping review, we introduced and summarized key motor learning principles related to attentional focus, implicit motor learning, training eye-hand coordination, practice variability, motor imagery, and action observation, and virtual training and biofeedback. We then reviewed the existing literature that has applied these principles for training prosthetic hand control before outlining future avenues for further research. The importance of optimizing early and appropriate training cannot be overlooked. While the intuition and experience of clinicians holds enormous value, evidence-based guidelines based on well-established motor learning principles will also be crucial for training effective prosthetic hand control. While it is clear that more research is needed to form the basis of such guidelines, it is hoped that this review highlights the potential avenues for this work.

Combined action observation and motor imagery: An intervention to combat the neural and behavioural deficits associated with developmental coordination disorder.

Action observation (AO) and motor imagery (MI) have been used separately across different populations to alleviate movement impairment. Recently these two forms of covert motor simulation have been combined (combined action observation and motor imagery; AOMI), resulting in greater neurophysiological activity in the motor system, and more favourable behavioural outcomes when compared to independent AO and MI. This review aims to outline how some of the neural deficits associated with developmental coordination disorder (DCD) are evident during AO and MI, and highlight how these motor simulation techniques have been used independently to improve motor skill learning in children in this population. The growing body of evidence indicating that AOMI is superior to the independent use of either AO and MI is then synthesised and discussed in the context of children with DCD. To conclude, recommendations to optimise the delivery of AOMI for children with DCD are provided and future avenues for research are highlighted.

Visuo-motor attention during object interaction in children with developmental coordination disorder.

Developmental coordination disorder (DCD) describes a condition of poor motor performance in the absence of intellectual impairment. Despite being one of the most prevalent developmental disorders, little is known about how fundamental visuomotor processes might function in this group. One prevalent idea is children with DCD interact with their environment in a less predictive fashion than typically developing children. A metric of prediction which has not been examined in this group is the degree to which the hands and eyes are coordinated when performing manual tasks. To this end, we examined hand and eye movements during an object lifting task in a group of children with DCD (n = 19) and an age-matched group of children without DCD (n = 39). We observed no differences between the groups in terms of how well they coordinated their hands and eyes when lifting objects, nor in terms of the degree by which the eye led the hand. We thus find no evidence to support the proposition that children with DCD coordinate their hands and eyes in a non-predictive fashion. In a follow-up exploratory analysis we did, however, note differences in fundamental patterns of eye movements between the groups, with children in the DCD group showing some evidence of atypical visual sampling strategies and gaze anchoring behaviours during the task.

Children With Developmental Coordination Disorder Show Altered Visuomotor Control During Stair Negotiation Associated With Heightened State Anxiety.

Safe stair negotiation is an everyday task that children with developmental coordination disorder (DCD) are commonly thought to struggle with. Yet, there is currently a paucity of research supporting these claims. We investigated the visuomotor control strategies underpinning stair negotiation in children with (N = 18, age = 10.50 ± 2.04 years) and without (N = 16, age = 10.94 ± 2.08 years) DCD by measuring kinematics, gaze behavior and state anxiety as they ascended and descended a staircase. A questionnaire was administered to determine parents' confidence in their child's ability to safely navigate stairs and their child's fall history (within the last year). Kinematics were measured using three-dimensional motion capture (Vicon), whilst gaze was measured using mobile eye-tracking equipment (Pupil labs). The parents of DCD children reported significantly lower confidence in their child's ability to maintain balance on the stairs and significantly more stair-related falls in the previous year compared to the parents of typically developing (TD) children. During both stair ascent and stair descent, the children with DCD took longer to ascend/descend the staircase and displayed greater handrail use, reflecting a more cautious stair negotiation strategy. No differences were observed between groups in their margin of stability, but the DCD children exhibited significantly greater variability in their foot-clearances over the step edge, which may increase the risk of a fall. For stair descent only, the DCD children reported significantly higher levels of state anxiety than the TD children and looked significantly further along the staircase during the initial entry phase, suggesting an anxiety-related response that may bias gaze toward the planning of future stepping actions over the accurate execution of an ongoing step. Taken together, our findings provide the first quantifiable evidence that (a) safe stair negotiation is a significant challenge for children with DCD, and that (b) this challenge is reflected by marked differences in their visuomotor control strategies and state anxiety levels. Whilst it is currently unclear whether these differences are contributing to the frequency of stair-related falls in children with DCD, our findings pave the way for future research to answer these important questions.

Examining the equivalence between imagery and execution within the spatial domain - Does motor imagery account for signal-dependent noise?

Motor imagery is suggested to be functionally equivalent to physical execution as they each utilise a common neural representation. The present study examined whether motor imagery correspondingly reflects the spatial characteristics of physically executed movements, including the signal-dependent noise that typically manifests in more variable end locations (as indicated by effective target width; We). Participants executed or imagined a single, upper-limb target-directed aim in the horizontal medio-lateral direction. The start and end of the imagined movements were indexed by the lifting and lowering of the limb over the home position, respectively. Following each imagined movement, participants had to additionally estimate their imagined end location relative to the target. All the movements had to be completed at a pre-specified criterion time (400 ms, 600 ms, 800 ms). The results indicated that the We increased following a decrease in movement time for execution, but not imagery. Moreover, the total error of imagined movements was greater than the actual error of executed movements. While motor imagery may comprise a neural representation that also contributes to the execution of movements, it is unable to closely reflect the random sources of variability. This limitation of motor imagery may be attributed to the comparatively limited efferent motor signals.

Assessing corporate planning of future sustainability initiatives in private healthcare organizations.

PURPOSE: The research objective is to assess the corporate planning of future sustainability initiatives in private healthcare organizations. DESIGN/METHODOLOGY/APPROACH: Private hospital organizations have been selected using a judgmental sampling. A qualitative case study was followed in this research. FINDINGS: The findings shed light on corporate planning of future sustainability initiatives in private healthcare organizations. RESEARCH LIMITATIONS/IMPLICATIONS: The diversity of similarities and differences that has been uncovered between private healthcare organizations on corporate planning, reveals the complexity faced in trying to achieve sector-wide and or industry-wide uniformity of sustainability initiatives. MANAGERIAL IMPLICATIONS: These findings offer opportunities to examine criteria to examine the corporate planning of future efforts and priorities in private healthcare sectors across countries and continents. ORIGINALITY/VALUE: This paper distinguishes between corporate planning approaches in relation to the assessment criteria to examine future sustainability initiatives in private hospitals.

Children With Developmental Coordination Disorder Exhibit Greater Stepping Error Despite Similar Gaze Patterns and State Anxiety Levels to Their Typically Developing Peers.

This study examined stepping accuracy, gaze behavior, and state-anxiety in children with (N = 21, age M = 10.81, SD = 1.89) and without (N = 18, age M = 11.39, SD = 2.06) developmental coordination disorder (DCD) during an adaptive locomotion task. Participants walked at a self-selected pace along a pathway, placing their foot into a raised rectangular floor-based target box followed by either no obstacles, one obstacle, or two obstacles. Stepping kinematics and accuracy were determined using three-dimensional motion capture, whilst gaze was determined using mobile eye-tracking equipment. The children with DCD displayed greater foot placement error and variability when placing their foot within the target box and were more likely to make contact with its edges than their typically developing (TD) peers. The DCD group also displayed greater variability in the length and width of their steps in the approach to the target box. No differences were observed between groups in any of the gaze variables measured, in mediolateral velocity of the center of mass during the swing phase into the target box, or in the levels of self-reported state-anxiety experienced prior to facing each task. We therefore provide the first quantifiable evidence that deficits to foot placement accuracy and precision may be partially responsible for the increased incidence of trips and falls in DCD, and that these deficits are likely to occur independently from gaze behavior and state-anxiety.

All talk? Challenging the use of left-temporal EEG alpha oscillations as valid measures of verbal processing and conscious motor control.

This study tested the validity of EEG left-temporal alpha power and upper-alpha T7-Fz connectivity as indices of verbal activity and conscious motor control. Participants (n = 20) reached for, and transported, a jar under three conditions: a control condition and two self-talk conditions aimed at eliciting either task-unrelated verbal processing or task-related conscious control, while EEG and hand kinematics were recorded. Compared to the control condition, both self-talk conditions increased self-reported verbal processing, but only the task-related self-talk condition increased left-temporal activity (i.e., alpha power decreased). However, as cortical activity increased across the entire scalp topography, conscious control likely elicits a multitude of processes that may not be explained by left-temporal activity or verbal processing alone, but by a widespread decrease in neural efficiency. No significant effects for T7-Fz connectivity were detected. Results suggest that left-temporal EEG alpha oscillations are unlikely to uniquely reflect verbal processing during conscious motor control.

Combining Action Observation and Motor Imagery Improves Eye-Hand Coordination during Novel Visuomotor Task Performance.

In this study, we compared the effectiveness of concurrent action observation and motor imagery (AO + MI), observing with the intent to imitate (active observation; AO), and passive observation (PO) training interventions for improving eye-hand coordination. Fifty participants were assigned to five groups [AO + MI, AO, PO, physical practice (PP); control] and performed a visuomotor rotation task, whilst eye movements were recorded. Each participant then performed 20 task trials in a training intervention before repeating the visuomotor rotation task in a post-test. As expected, PP produced the greatest improvement in task performance and eye-hand coordination. However, in comparison to the control group, AO + MI training produced a statistically significant increase in both task performance and eye-hand coordination, but no such improvements were found following AO or PO.

Sustainability trends in public hospitals: Efforts and priorities.

PURPOSE: The purpose of this study is to examine the previous and the current efforts and the priorities of sustainability initiatives in the public sector. DESIGN/METHODOLOGY/APPROACH: This study has been conducted in one industry, overcoming contextual bias as a judgmental sampling was used to select the public hospitals that were studied. Only knowledgeable key informants were approached and used. FINDINGS: The examination of the previous and the current efforts and the priorities of the sustainability initiatives revealed in this study indicate the existence of different trends in the public hospitals studied. RESEARCH LIMITATIONS/IMPLICATIONS: The results report the key trends that were disclosed in the public hospitals studied in their efforts towards sustainability. In particular, the results show that there appears to be a lack of guidelines and homogeneity in sustainability planning in public hospitals in Spain, accompanied by the near universal absence of the evaluation phase in respect to the outcomes of the sustainability initiatives that have been put in place in these organizations. MANAGERIAL IMPLICATIONS: The multi-dimensional factors of sustainability initiatives provide managerial guidance to assess the previous and the current efforts and priorities. These factors also provide organizational guidance to assess the trends of an organization through time. ORIGINALITY/VALUE: This study contributes to a selection of factors regarding the previous and the current efforts and the priorities of sustainability initiatives applicable in public hospitals. It provides a multi-dimensional framework of factors that can be used in order to describe sustainability trends.