Skilled Hands Research Articles

Pathogenic Variants in STXBP1 and in Genes for GABAa Receptor Subunities Cause Atypical Rett/Rett-like Phenotypes.

Rett syndrome (RTT) is a neurodevelopmental disorder, affecting 1 in 10,000 girls. Intellectual disability, loss of speech and hand skills with stereotypies, seizures and ataxia are recurrent features. Stringent diagnostic criteria distinguish classical Rett, caused by a MECP2 pathogenic variant in 95% of cases, from atypical girls, 40–73% carrying MECP2 variants, and rarely CDKL5 and FOXG1 alterations. A large fraction of atypical and RTT-like patients remain without genetic cause. Next Generation Sequencing (NGS) targeted to multigene panels/Whole Exome Sequencing (WES) in 137 girls suspected for RTT led to the identification of a de novo variant in STXBP1 gene in four atypical RTT and two RTT-like girls. De novo pathogenic variants—one in GABRB2 and, for first time, one in GABRG2—were disclosed in classic and atypical RTT patients. Interestingly, the GABRG2 variant occurred at low rate percentage in blood and buccal swabs, reinforcing the relevance of mosaicism in neurological disorders. We confirm the role of STXBP1 in atypical RTT/RTT-like patients if early psychomotor delay and epilepsy before 2 years of age are observed, indicating its inclusion in the RTT diagnostic panel. Lastly, we report pathogenic variants in Gamma-aminobutyric acid-A (GABAa) receptors as a cause of atypical/classic RTT phenotype, in accordance with the deregulation of GABAergic pathway observed in MECP2 defective in vitro and in vivo models.

Surgical Outcome of Spinal Tumour: Our Experience in Dhaka Medical College & Hospital

Introduction: Surgical outcome of spinal tumour varies depending on a number of factors such as: site of tumour, compression within the spinal canal, the histological characteristics of tumour, the neurological progression and initial response to corticosteroid therapy, patient’s age, comorbidity, tumour extension, involvement of neighboring structures and organs etc.
 Materials & Methods: The 86 patients with spinal tumour underwent surgery by our team in 7 years (2011-2018) were reviewed retrospectively.
 Discussion: Analysis of the surgical outcome of our spinal tumour patients was done on different variables like age, sex, presenting symptoms, neuroimaging, comorbidities etc. The aim of surgery was decompression of the spinal cord, total removal of the tumour when possible and spinal stabilization when needed. Out of our 86 patients with spinal tumour, extradural tumour comprises 18, intradural tumour 56 and intramedullary tumour 12.
 Conclusion: The aim of this study is to analyze the data to made conclusion for more effective strategy as per site, size, type, resectibility and histological variety to establish and effective treatment protocol and prevention of per-operative and post-operative complications. Intradural extramedullary tumour can be radically resected with no mortality and minimal peri-operative morbidity. But resection of intramedullary spinal tumour is difficult, hazardous and usually incomplete, so needs much more skilled and meticulous surgical hands.
 Bang. J Neurosurgery 2019; 8(2): 63-67

Sekizinci Sınıf Öğrencilerinin Uzamsal Görselleştirme, Zihinsel Döndürme ve Zihinde Canlandırma Becerilerinin Matematik Odaklı Epistemolojik İnançlar ve Bazı Değişkenlerle İlişkisi

Bu çalışmada sekizinci sınıf öğrencilerinin, i) uzamsal görselleştirme, zihinsel döndürme ve zihinde canlandırma becerilerinin matematik odaklı epistemolojik inançlar bağlamında, ii) uzamsal görselleştirme, zihinsel döndürme ve zihinde canlandırma becerilerinin cinsiyet ve matematik başarısı değişkenlerine göre incelenmesi amaçlanmıştır. Araştırma İzmir şehir merkezindeki bir devlet ortaokulunun sekizinci sınıf düzeyinde öğrenim gören 200 öğrenci ile yürütülmüştür. Veri toplama araçları olarak; uzamsal görselleştirme, zihinsel döndürme ve Santa Barbara Solids testlerinin yanı sıra matematik odaklı epistemolojik inanç ölçeği kullanılmıştır. Öğrencilerin matematik başarısını belirlemek için dönem sonu matematik ders notlarından faydalanılmıştır. Veri setinin analizinde, betimsel istatistiksel tekniklerin yanı sıra korelasyon katsayısı, Mann-Whitney U testi ve çoklu doğrusal regresyon analizleri yapılmıştır. Analiz sonuçlarına göre, öğrenmenin çabaya bağlı olduğu inanç ile uzamsal görselleştirme ve zihinsel döndürme arasında pozitif yönlü ve anlamlı bir ilişki olduğu belirlenmiştir. Cinsiyet değişkenine göre, öğrencilerin uzamsal görselleştirme, zihinsel döndürme ve zihinde canlandırma testlerinden aldıkları puanlar arasında anlamlı bir fark belirlenmemiştir. Diğer yandan uzamsal görselleştirme, zihinsel döndürme ve zihinde canlandırma becerileri matematik başarısının %15’ini açıklamıştır. Elde edilen bulgulara göre birtakım önerilerde bulunulmuştur.

Development and Evaluation of a Customized Wrist-Hand Orthosis using 3D Technology for a Child with Cerebral Palsy - A Case Study.

Cerebral Palsy (CP) is a disability that affects more than 100 million children. More than 60% of these children have significant difficulties within their hand abilities, affected by involuntary movements and spasticity. So, to overcome this issue, orthoses are being employed as therapeutic intervention and can allow children with CP to have an opportunity to better use their hands. Three-dimensional (3D) technologies provide the generation of high-quality orthopedic products. Although, there are limited studies related to the evaluation of such assistive devices, especially for children. Therefore, the purpose of this research was to design, develop and evaluate a customized wrist-hand orthosis using 3D technologies for a child with CP. So, it was used a high-level 3D scanning to acquire the wrist-hand anatomy, a free software for 3D modelling and a low-cost 3D printer for manufacturing the orthosis. The Jebsen-Taylor Test of Hand Function (JTTHF) was used to evaluate unilateral hand abilities. We noticed improvements while wearing the orthosis at the affected hand, in the following subtests: writing (13 s), lifting small objects (0.9 s) and simulated feeding (69.3 s). The customized orthosis was able not only to improve some functional hand skills, but also to provide comfort, better fitting and with an appealing aesthetic design.

Psycho-adaptive changes and psychological growth after childbirth in primiparous women.

To explore the psycho-adaptive changes and the level of psychological growth after childbirth among first-time mothers. This study used a descriptive qualitative approach. Using the purposeful sampling method, 18 primiparous women who received postnatal care between August and September 2017 were interviewed. The women's experiences about psycho-adaptive changes were collected under eight main themes. These themes were change in values, change in personality, change in hand skills and time management, change in priorities, change in problem-solving skills, increase in self-esteem, change in social life, and change in relations, respectively. Nurses should assume important responsibilities, such as childbirth education needs, psycho-adaptive features of the mothering process, culturally-sensitive antenatal visits, and childcare.

Influence of Biofeedback and Task Oriented Training on Hand Skills in Children with Spastic Cerebral Palsy

Influence of Biofeedback and Task Oriented Training on Hand Skills in Children with Spastic Cerebral Palsy

Graduates’ skills and employability: the view of students from different European countries

Purpose In the last decade, graduates’ employability has assumed a central role in scholars’ concerns. This was mainly due the high rate of recent graduates’ unemployment in some European countries, as well as the Bologna Process reform of the European higher education system and the new Europe Strategy 2020. The purpose of this paper, driven by the increasing need to improve graduates’ skills and employability, is to identify a set of skills that students consider important to achieve success in their own field of study and another set of skills, which they perceive to lack the most. Design/methodology/approach To achieve the main goal of this study, based on the methodology supported by literature review, a questionnaire was applied to students from five different European universities. Findings The main results allowed the authors to infer that, on the one hand, the European students of the universities included in the study consider communication, thinking and interpersonal skills as the most important skills to get a job in their own field of study; and on the other hand, personal, interpersonal and entrepreneurial skills are the skills lacked by students. These set of skills are quite similar and even overlapping, which makes this a significant inference that needs to be accounted by higher education institutions (HEIs). Originality/value In the research carried out in this study, with the students of five different European universities affected by the economic crisis of 2007/2008, the needed skills perceived by students to obtain employment in their own field of study were identified, along with the skills which they perceived to lack the most. The obtained findings contribute to shed light on the important issue of supporting HEIs regarding the skills that should be imparted in the curricula of their courses and workshops, in order to help the students to succeed in the current and potential competitive labour market.

Does hand skill asymmetry relate to creativity, developmental and health issues and aggression as markers of fitness?

ABSTRACTA remarkable feature of human handedness at the population level is specialization of the hands, the right hand performing usually better than the left. This specialization might have an evolutionary advantage, because it provides the individual and population with a wider range of skill. We therefore investigated the relationships between hand skill asymmetry and potential markers of Darwinian fitness that have been hypothesized to explain the bias in hand preference: creativity, aggression and developmental and health problems. Over twenty thousand participants (56% left-handers) completed an online survey, including a finger-tapping task to measure hand skill asymmetry. Left-skilled individuals were overall more aggressive than right-skilled individuals and rated themselves as more artistically creative. However, when assessed with a questionnaire, they were less creative on problem solving and equally artistically creative compared to right-skilled individuals, who reported more health problems. Conclusion: we found some evidence for current selection on the direction of lateralization of hand skill although the effect sizes were rather low. Strength of lateralization of hand skill showed only a few associations with fitness proxies. We suggest that Darwinian selection on hand preference (Zickert, Feen, van der, Geuze, & Groothuis, 2018. Fitness costs and benefits associated with hand preference in humans: A large internet study in a Dutch sample. Evolution and Human Behavior, 39, 235–248) and hand skill asymmetry (present study) may be attenuated in modern society.

Putting the "Sensory" Into Sensorimotor Control: The Role of Sensorimotor Integration in Goal-Directed Hand Movements After Stroke.

Integration of sensory and motor information is one-step, among others, that underlies the successful production of goal-directed hand movements necessary for interacting with our environment. Disruption of sensorimotor integration is prevalent in many neurologic disorders, including stroke. In most stroke survivors, persistent paresis of the hand reduces function and overall quality of life. Current rehabilitative methods are based on neuroplastic principles to promote motor learning that focuses on regaining motor function lost due to paresis, but the sensory contributions to motor control and learning are often overlooked and currently understudied. There is a need to evaluate and understand the contribution of both sensory and motor function in the rehabilitation of skilled hand movements after stroke. Here, we will highlight the importance of integration of sensory and motor information to produce skilled hand movements in healthy individuals and individuals after stroke. We will then discuss how compromised sensorimotor integration influences relearning of skilled hand movements after stroke. Finally, we will propose an approach to target sensorimotor integration through manipulation of sensory input and motor output that may have therapeutic implications.

Prep-Along Facilitated Posterior Crown Preparation in the Preclinical Dental Setting: A Multimedia Approach.

Dental students often seek visual aids and demonstrations when attempting to perform new procedures. This video resource provides an adjunctive teaching tool for a crown preparation on an ivorine molar using the "prep-along" method. This method teaches crown preparation in a uniform, step-by-step manner while providing feedback to students after each step. Prior to the daily simulation clinic session, a calibration session was held for faculty. Following didactic instruction-including principles, criteria, and grading rubric-students participated in the laboratory portion of the course. During this laboratory portion, students viewed a segment of the video, the video was paused, and students attempted that portion of the preparation. The project continued in stages until it was completed. Upon completion, using an electronic grading system, each student performed a self-evaluation, the instructor then performed a blind evaluation, and both student and instructor compared assessments. To obtain feedback, an electronic survey was sent to 285 third- and fourth-year dental students. Ninety-four students completed the survey; 94% responded favorably to this method of instruction. Individual comments were also predominantly positive. Preclinical faculty at the Midwestern University College of Dental Medicine-Arizona use this prep-along for instruction of direct and indirect tooth preparations and restorations. Students participate in this step-by-step process while receiving feedback. Faculty are allowed a structured environment in which to give feedback and instruction at each segment of the preparation. The faculty found that this method of instruction created efficiency and excellence in training surgical hand skills.

Clinically Significant Gains in Skillful Grasp Coordination by an Individual With Tetraplegia Using an Implanted Brain-Computer Interface With Forearm Transcutaneous Muscle Stimulation

ObjectiveTo demonstrate naturalistic motor control speed, coordinated grasp, and carryover from trained to novel objects by an individual with tetraplegia using a brain-computer interface (BCI)-controlled neuroprosthetic. DesignPhase I trial for an intracortical BCI integrated with forearm functional electrical stimulation (FES). Data reported span postimplant days 137 to 1478. SettingTertiary care outpatient rehabilitation center. ParticipantA 27-year-old man with C5 class A (on the American Spinal Injury Association Impairment Scale) traumatic spinal cord injury InterventionsAfter array implantation in his left (dominant) motor cortex, the participant trained with BCI-FES to control dynamic, coordinated forearm, wrist, and hand movements. Main Outcome MeasuresPerformance on standardized tests of arm motor ability (Graded Redefined Assessment of Strength, Sensibility, and Prehension [GRASSP], Action Research Arm Test [ARAT], Grasp and Release Test [GRT], Box and Block Test), grip myometry, and functional activity measures (Capabilities of Upper Extremity Test [CUE-T], Quadriplegia Index of Function-Short Form [QIF-SF], Spinal Cord Independence Measure–Self-Report [SCIM-SR]) with and without the BCI-FES. ResultsWith BCI-FES, scores improved from baseline on the following: Grip force (2.9 kg); ARAT cup, cylinders, ball, bar, and blocks; GRT can, fork, peg, weight, and tape; GRASSP strength and prehension (unscrewing lids, pouring from a bottle, transferring pegs); and CUE-T wrist and hand skills. QIF-SF and SCIM-SR eating, grooming, and toileting activities were expected to improve with home use of BCI-FES. Pincer grips and mobility were unaffected. BCI-FES grip skills enabled the participant to play an adapted “Battleship” game and manipulate household objects. ConclusionsUsing BCI-FES, the participant performed skillful and coordinated grasps and made clinically significant gains in tests of upper limb function. Practice generalized from training objects to household items and leisure activities. Motor ability improved for palmar, lateral, and tip-to-tip grips. The expects eventual home use to confer greater independence for activities of daily living, consistent with observed neurologic level gains from C5-6 to C7-T1. This marks a critical translational step toward clinical viability for BCI neuroprosthetics.

씨름 경기에서 신장 차이에 따른 선수들의 경기력과 기술 구사 분석

This study aimed to identify how relative players’height differences in Ssireum matches affect players’performance, skill pattern and skill effectiveness. For this purpose, we selected 103 Kumkang class competitions in which the height difference between two players is 5.0 cm or more. With the selected matches, the frequency of the win, used skills, succeeded skills and failed skills of the short and tall players were analyzed. Results showed that there were statistically significant differences between short and tall players in terms of the frequency of used skills, succeeded skills, and failed skills. Among 5 skill types, short players used skills in the order of waist skill, leg skill, and hand skill, whereas tall players frequently used waist skill and leg skill. Also, Short players had higher success rates of the waist skill and the hand skill, whereas tall players had higher success rates of waist skill and lower success rates of leg skill. Results indicate that the height difference between two players in the Ssireum match can be an important factor influencing skill patterns and skill effectiveness of short and tall players.

Unplugged Craftivism: A Story of Humans and Environmental Education

This is a written account of a keynote presentation given at the Council of Outdoor Educators of Ontario, annual conference in Canada. The conference themes included revival of the hand-made and Folk Schools. This article outlines the dramatic effects and hand-made props used to present an “unplugged” presentation that was simultaneously humourous and educational. The presentation began by drawing upon research from the field of anthropology that links the historical development of the brain with early flint-knapping skills. Following the introduction a rationale for understanding the importance of fibre and edge technology was conveyed. An exploration of hand skills was further explored by examining some materials and the design aspects involved in making clothing. The later part of the article describes the child developmental ideas that correspond with Waldorf Handwork programs and outlines the origin of two of North America’s largest Folk Schools. Short narrations occur throughout the paper and are used to emphasize the way making things with our hands link human’s environmental survival to human development and education. The paper concludes with three short stories that emphasize the importance of using our hands in conjunction with our minds to make the stuff of life we need to live.

"I am a lefty in a right-handed world": Qualitative analysis of clinical learning experience of left-handed undergraduate dental students.

Left-handedness is the preferential use of the left hand in single-handed activities such as writing. There are many studies in the literature on left-handedness in relation to professional sports, medicine and surgery. Although dentistry largely depends on manual dexterity and hand skills, there has been little research to investigate the effect of left-handedness on clinical dentistry, particularly in Australasia. To gain an insight into the clinical learning experience of left-handed undergraduate dental students at the Faculty of Dentistry, University of Otago, New Zealand. Purposive sampling of left-handed students was done within the final-year class of undergraduate dental students, and they were invited to participate in a semi-structured group interview to discuss their clinical learning experience at the Faculty. Six participants agreed to participate, and the interview was recorded and transcribed verbatim. Collected data were analysed using a thematic inductive/interpretive analysis approach according to the constructivist grounded theory. All participants reported having clinical difficulties being left-handed students learning using right-handed equipment. There was a common theme of experiencing hand and wrist musculoskeletal problems as well as feeling of guilt causing patient discomfort during treatment. The majority of participants reported incidents where they were told by their supervisors to learn practising dentistry with their right hand and they felt that little guidance was given on how to operate as a left-handed clinician. All participants perceived that being a left-handed operator affected their efficiency and confidence level in their early clinical years. Left-handed students have a strong sense of adaptability. However, in order to improve the learning experience regardless of the difference in the operator's preference of dominant hand, students should be provided with appropriate equipment such as ambidextrous dental chairs and professional guidance, especially during their early career.

Food properties influence grasping strategies in strepsirrhines

Although hand grasping is ubiquitous in primate species, its origins remain uncertain. This is in part because uncertainty about hand skills and grasping strategies persists in strepsirrhines, a monophyletic group of primates located near the base of the primate tree. In this study, we report and discuss our observations of the different grasping strategies adopted by 85 captive individuals belonging to 22 species of strepsirrhines during the grasping of food items of different sizes and consistencies. Our results indicate that although strepsirrhines do not present variability in their hand-grip types (sole whole-hand power grip), they are able to adjust their grasping strategy depending on the properties of the food. Notably, they use the mouth when more precision is needed (i.e. to grasp small items). Moreover, grasping strategies adopted for big items differ depending on food consistency, revealing a new and potentially essential factor to consider in future research on grasping abilities. We believe that by looking across this important set of species in unconstrained standardized conditions, this study provides valuable insight for further comparative research on the potential selective pressures involved in the evolution of hand grasping.

Early prediction of long-term tactile object recognition performance after sensorimotor stroke

Until now tactile agnosia has been reported only in small, but detailed cross-sectional case studies. Here we show that multi-voxel pattern analysis (MVPA) of early diffusion-weighted lesion maps can be used to accurately predict long-term recovery of tactile object recognition (TOR) in 35 subjects with varying hand skill impairment and associated specific daily activity limitation after cortical sensori-motor stroke. Multiple regression analysis revealed the essentially dysfunctional subprocesses for object recognition in the specifically impaired subjects, i.e., grasping as determined by a subtest of Jebsen Taylor hand function test, and perception of macrogeometrical object properties. The Gaussian process regression of MVPA represents a function that relates a selection of lesioned voxels as input variables to TOR performance scores as target variables. On the behavioural level, patients fell into three recovery subgroups, depending on TOR performance over the observation period. Only baseline motor hand skill and shape discrimination were significantly correlated with the TOR trajectories. To define functionally meaningful voxels, we combined information from MVPA of lesion maps and a priori knowledge of regions of interest derived from a data bank for shape recognition. A high significance for the predicted TOR performances over nine months could be verified by permutation tests, leading us to expect that the model generalises to larger patient cohorts with first cortical ischemic stroke. The lesion sites of the persistently impaired subjects exhibited an overlap with critical areas related to the MVPA prediction map in the cytoarchitectonic areas PFt of inferior parietal lobule and OP1 of parietal operculum which are associated with higher order sensory processing. This ultimate check corroborated the significance of the MVPA map for the prediction of tactile object recognition. The clinical implication of our study is that neuroimaging data acquired immediately after first stroke could facilitate individual forecasting of post-stroke recovery.

Surface- and voxel-based brain morphologic study in Rett and Rett-like syndrome with MECP2 mutation

Rett syndrome (RTT) is a rare congenital disorder which in most cases (95%) is caused by methyl-CpG binding protein 2 (MECP2) mutations. RTT is characterized by regression in global development, epilepsy, autistic features, acquired microcephaly, habitual hand clapping, loss of purposeful hand skills, and autonomic dysfunctions. Although the literature has demonstrated decreased volumes of the cerebrum, cerebellum, and the caudate nucleus in RTT patients, surface-based brain morphology including cortical thickness and cortical gyrification analyses are lacking in RTT. We present quantitative surface- and voxel-based morphological measurements in young children with RTT and Rett-like syndrome (RTT-l) with MECP2 mutations. The 8 structural T1-weighted MR images were obtained from 7 female patients with MECP2 mutations (3 classic RTT, 2 variant RTT, and 2 RTT-l) (mean age 5.2 [standard deviation 3.3] years old). Our analyses demonstrated decreased total volumes of the cerebellum in RTT/RTT-l compared to gender- and age-matched controls (t (22)=-2.93, p = .008, Cohen’s d = 1.27). In contrast, global cerebral cortical surface areas, global/regional cortical thicknesses, the degree of global gyrification, and global/regional gray and white matter volumes were not statistically significantly different between the two groups. Our findings, as well as literature findings, suggest that early brain abnormalities associated with RTT/RTT-l (with MECP2 mutations) can be detected as regionally decreased cerebellar volumes. Decreased cerebellar volume may be helpful for understanding the etiology of RTT/RTT-l.

The effectiveness of music therapy for individuals with Rett syndrome and their families

Patients with Rett syndrome (RTT) present characteristic regression in communication and hand skills, which eventually leads to intellectual and physical disability. Moreover, caregivers of patients with RTT face stressors related to patients' medical and developmental concerns. Given the indications from case reports, this pilot study investigated the effectiveness of music therapy on RTT patients, as well as on parental stress for families of children with RTT. Families in the study group were enrolled in a twice-weekly 120-minute music therapy program for 24 weeks (n=11), whereas families in the control group did not receive music therapy (n=12). Participants were administered the Vineland Adaptive Behavior Scales, Rett Syndrome Clinical Severity Scale, Rett Syndrome Motor Behavioral Assessment, and Parenting Stress Index for caregivers of RTT children before and after the music therapy program. Music therapy improved receptive language, verbal and non-verbal communication skills, and social interaction for RTT patients. In addition, purposeful hand function, breathing patterns, and eye contact were significantly improved. Of note, music therapy also decreased the frequency of epileptic seizures. Lastly, caregivers in the study group exhibited significantly lower stress following the program. The 24-week music therapy program was effective in improving social interaction, communication skills, eye contact, hand function, and reducing seizure frequency among RTT patients. Additionally, music therapy was effective in relieving parenting stress, which may help healthcare providers initiate early intervention strategies that can prevent parenting stress and reduce the risk of depression.

A Proposed Modular Work Integrated Learning Framework for South Africa

The skills’ crisis in South Africa is a growing problem, exacerbated by the lack of adequate structures to study and assess the gap between the skills offered by young graduates and those required in the labor market. The purpose of this paper is to verify whether the achieved competencies of graduates are comparable with the expectation from the employers. This raises the awareness of the need for training institutions to train students on new areas of knowledge, skills, and attitudes capable of responding to the specifications of the contemporary workplace in the competitive economic environment of South Africa. In order to address the skills’ gap, work integrated learning (WIL) and other internship programs can be deployed in a partnership between the training institutions and the industry. To accommodate working students in finding a willing industrial company to fulfill their WIL requirement, the introduction of a modular WIL program is aimed at providing a space to groom more skilled hands in a flexible mechanism allowing students to complete their qualification on a part-time basis, made of compulsory and optional practical combined subjects. This paper proposes a framework for modular WIL. In such a context, the focus is on the processes of monitoring, evaluation, and progression of students within the framework.

Visual loss following cosmetic facial filler injection

Facial filler injection for soft-tissue augmentation, wrinkle reduction, and rejuvenation has recently become increasingly popular. This procedure is well accepted and widely performed because of its safety and excellent outcomes. However, complications may occur even in the most skilled hands. A 36-year-old female presented with immediate loss of vision in her right eye following the periocular injection of cosmetic hyaluronic acid facial filler into the glabellar region. The visual loss was accompanied by weakness of her left arm. Blindness may complicate cosmetic facial filler injection. The treating physician should have a firm knowledge of the facial vascular anatomy, and the patient should be aware of the potential blinding complications associated with facial filler injection.