Manual Skills Research Articles

Assessment of the effectiveness of physiotherapy in children with cerebral palsy in the opinion of the parents

Abstract
 Many specialists have studied cerebral palsy. Currently, the most accurate definition is that proposed by Bax, who defines cerebral palsy as a disorder of posture and movement caused by damage to the brain. The factors that predispose to the development of this disorder include: pre-contraceptive, prenatal, perinatal and postnatal. Symptoms indicating the possibility of cerebral palsy can be observed already in the neonatal period, therefore it is important to follow pediatric visits, and in case of alarming symptoms, consult a neurologist. Early diagnosis of the disorder will allow the introduction of quick, individualized child physiotherapy, which may strengthen the child's psychomotor development.
 Aim of the research: to assess the effectiveness of physiotherapy in children with cerebral palsy in the opinion of the parents. Material and methods: the proprietary questionnaire and two certified scales were used: Gross Motor Classification System to determine the degree of motor disorders and Manual Ability Classification System to check the degree of manual skills. Results: 67% of parents support the high effectiveness of physiotherapy. Therapeutic sessions most often take place 3-5 times a week (51%); moreover, 97% of children perform rehabilitation exercises at home. Conclusions: Physiotherapy is an effective form of exercise therapy for children with cerebral palsy. The most popular of the methods used in working with children is NDT-Bobath. The desirability of early diagnosis of cerebral palsy is associated with the possibility of quick therapeutic sessions, which translates into benefits in psychomotor development and significantly improves the quality of life.

Frugal entrepreneurship: Resource mobilization in resource‐constrained environments

Frugal entrepreneurship (FE) is a recent pursuit that has evolved from the frugal innovation (FI) concept. How frugal entrepreneurs mobilize resources is both interesting and novel, yet it remains an underresearched area. The objective of this study is to explore how frugal entrepreneurs mobilize resources at the grassroots level of emerging markets to realize their innovation and entrepreneurial aspiration. Based on six cases of frugal enterprise, this study contributes to the FE literature in particular and FI more generally. We reveal the various resources that frugal entrepreneurs mobilize and how they mobilize them in three broad categories, namely, human, social and financial. Unlike other entrepreneurs, frugal entrepreneurs usually possess manual work skills, and they help each other with their technical, financial and other knowhow. They understand their context and culture and consider them deeply when developing frugal solutions. Indeed, frugal entrepreneurs integrate the culture and context into their innovation process, because they themselves are embedded in the same society. Patents do not help entrepreneurs to protect their innovations, however, and they need to rely more on informal rather than formal finance.

Advanced Technology or Manual Skills: Evidence That The Accuracy of Corticospinal Responsiveness Is Not Ameliorated by Neuronavigation

PurposeTranscranial magnetic stimulation (TMS) is a noninvasive technique to assess corticospinal excitability and inhibition. TMS over the motor cortex during a voluntary contraction elicits short‐latency excitatory (motor‐evoked potential, MEP) and inhibitory (silent period, SP) responses in the target muscle. However, the technique for searching and determining the optimal site to elicit MEPs (“hotspot”), an essential component in order to correctly place the TMS coil, is not unanimously standardized. This can be a problem since changes in coil position and/or orientation may influence the magnitude of MEP and SP responses. Usually, the “hotspot” is marked either on a swim cap or on the scalp and the investigator holds the coil manually during the entire testing session. However, the capacity to maintain the coil placement within and between sessions may be limited. To reduce variability in coil position and orientation in space and over time, neuronavigated TMS (nTMS) is used. However, no studies investigated the accuracy of the assessment of corticospinal excitability and inhibition using nTMS versus a traditional manual approach for the maintenance of coil positioning.Methods18 healthy participants (10W/8M) volunteered in two identical and randomized sessions ~30 days apart. Maximal and submaximal neuromuscular evaluations were performed with TMS six times before (PRE), and at the end (POST) of a 2‐min sustained maximal voluntary isometric contraction (MVIC) (100%, 75%, 50% MVIC and 25%isoEMG). The “hotspot” was maintained either with a grid demarcated on the participants’ scalp or with visual feedback provided by nTMS on a computer screen. In both sessions, “hotspot” was considered as the site where the largest MEPs in the rectus femoris were elicited.ResultsThere were not a “hotspot” technique × contraction intensities × time points interactions for both MEP (P = 0.217) and SP (P = 0.627). Bland‐Altman plots display adequate agreements between the difference in the two “hotspot” techniques and the means of the two “hotspot” techniques. The slopes of the resulting regression lines were not significantly different from zero (horizontal to x‐axis) for both MEP (all r ≤ 0.335, all P ≥ 0.162) and SP (all r ≤ 0.382, all P ≥ 0.131), indicating a uniformity of systematic error at all contraction intensities and time points.ConclusionsSpatial stability of the TMS coil position over the motor cortex did not influence corticospinal excitability and inhibition responses in unfatigued and fatigued knee extensors. This is because the variability in MEP and SP responses is due to spontaneous fluctuations in corticospinal and motoneuron excitability and inhibition; and this variability is not affected by spatial accuracy. Therefore, nTMS or a traditional manual approach could be interchangeably use in order to maintain the TMS coil position in the exact “hotspot”.

A Low-fidelity Simulator for the Development of Vascular Ligation Skills.

Training simulators can facilitate the acquisition and development of basic surgical skills, and they constitute a safe and humane method that does not harm animals in the process. The objective of this work was to create and evaluate a low-cost simulator to help undergraduate students of veterinary medicine acquire and practise vascular ligation skills. A training model was made by using easily accessible and inexpensive materials. Fifteen students, without prior surgical experience, each performed the orchiectomy technique on the simulator seven times. The emphasis was on performing vascular ligatures in both testicles of the simulator (n = 14), in two different scenarios: firstly, with the contents of the blood vessels not under pressure; and secondly, with the syringe plunger depressed by 1 ml to pressurise the blood vessels. The outcomes of the procedure in the simulator were based on three qualitative criteria: Correct (no 'bleeding'), Sufficient (light 'bleeding') and Incorrect (heavy 'bleeding'). After the seventh attempt, all participants were able to perform vascular ligatures with at least a score of Sufficient in both scenarios. By the 10th ligature attempt, they were all able to perform the procedure with a score of Correct (p < 0.05). There was a trend toward a decrease in the time taken to carry out the procedure as learning progress was made during training, with this being significant from the 12th attempt (p < 0.05). The use of this low-cost simulator represents a useful didactic tool, which supports the acquisition and practise of manual skills by using methods that do not involve the use of animals. In addition, this training simulator could be useful in distance learning, in view of the ready accessibility of the materials required for its construction.

Research on the Mining of Intangible Cultural Heritage Digital Resources in the Manual Online Teaching System of Preschool Education.

Our country's international status as a cultural power has been further enhanced, and the protection of intangible cultural heritage containing the essence of traditional culture is also gradually being carried out. In addition, with the rapid development of the digital environment, the public's cultural needs continue to grow, and the contradiction between the supply and demand of public digital cultural services continues to intensify. Converting intangible cultural heritage into digital form for protection and providing resource services for the public has become an important trend in the protection and inheritance of intangible cultural heritage at home and abroad, and it is also an inevitable requirement to solve the contradiction between supply and demand. Improving public cultural services is one of the key projects. At present, our country's research and practice of intangible cultural heritage digitization and services are also in progress, but there is no research on intangible cultural heritage digital resource services and system construction from the perspective of information service elements. Based on the digital resource service of intangible cultural heritage, the manual course is one of the main skill courses for preschool education majors. At this stage, the short class hours of manual courses, the lack of class hours, the low utilization rate of teaching materials, and the disconnection between the content and the needs of the kindergarten are all problems that need to be solved at present. Just relying on cross-references between schools, the manual knowledge and skills mastered by graduates are not comprehensive enough to complete the manual tasks assigned by the kindergarten. This paper implements the concept of intangible cultural heritage and hopes that by studying the manual knowledge and skills that today's kindergarten teachers need to possess, the content of existing manual courses can be adjusted in a targeted manner, so that the electronic culture dissemination of manual curriculum resources for preschool education is more reasonable, meeting the requirements of kindergarten teachers in terms of manual knowledge and skills.

Investigating the effect of background music on cognitive and skill performance: A cross-sectional study.

Existing studies on the impact of background music in the workplace have reported varying results, from improving production and performance to being known as an annoying factor. Given the lack of evidence of the background music influence on the cognitive factors in the work place in previous studies and the lack of study on the effect of background music on skill performance when gender and personality type is considered, research in this area seems necessary. The purpose of the present study is to investigate the influence of background music on cognitive and skill performance in the work place with regard to gender and personality type. This study was conducted with the participation of 52 students (26 males and 26 females) aged between 18-30 years old. Sustained attention, working memory, fine finger and gross manual dexterity skills and personality type were assessed. Participants were randomly tested once when being exposed to classical instrumental music and once again when faced with complete silenceRESULTS:Playing background music improved students working memory but had no significant effect on sustained attention. Music also improved skill performance.Overall, memory performance and fine finger dexterity were found significantly better in extroverts when compared to introverts during playing background music. Background music improves working memory and speeds up performance in skill tasks, however the role of personality type in influencing background music on cognitive and skill performance needs further investigation.

Specialist program training for dentists: an analysis of the teachers’ opinions

BACKGROUND: In the context of public health, high-quality training of dental professionals is essential for improvement of the provision of dental care in the cities and rural areas of Russia. Therefore, adequate training should become a cornerstone of the conceptual solution to inadequate organization and poor quality of primary health care.&#x0D; AIM: The aim of this study was to assess the opinion of teachers at medical universities regarding the level of preparation among dental students in specialty programs in order to identify and address problematic areas requiring improvement.&#x0D; MATERIAL AND METHODS: A survey was conducted among 115 teachers who were responsible for training dental students in specialty programs in 17 medical universities in Russia.&#x0D; RESULTS: The majority of teachers rated the theoretical training of dental students in specialty programs as either good or excellent, although this was not replicated when considering practical training. Instead, the overwhelming majority of teachers rated the practical training as good (36.52%), satisfactory (44.35%), or unsatisfactory (19.13%). The most difficult dental topics to teach were gnathology (67.83%), maxillofacial prosthetics (53.04%), oncostomatology (45.22%), gerontostomatology (36.52%), salivalogy (20.87%), dental arthrology (13.04%), and neurostomatology (13.04%). The overwhelming majority of teachers (71.3%) reported spending a lot of time on methodological work.&#x0D; CONCLUSION: The current questionnaire-based study analyzed trends in teachers opinions regarding the quality of theoretical and practical training provided to dental students in specialty programs as well as the manual skills of students in various fields of dentistry. The most difficult topics to teach were identified, and information on what teachers considered necessary for the improvement of dental training was collected.

Impact of Guidance and Multitasking on Manual Dexterity Skills in Dentistry.

This study investigated the effect of learning by observation on the development of fine motor skills related to endodontic manual instrumentation. We evaluated if learning by observation with guidance had any influence upon operator performance under tense or taxing conditions. Dental students prepared standardized simulated root canals of varying morphology. Learning involved silent video with hand guidance (n = 23), audiovisual combined with oral instructions (n = 23), or silent video (n = 13). Undergraduates who previously completed conventional preclinical endodontics provided comparative data as a control group (n = 16). During investigations, a root canal of a lower molar plastic tooth was shaped, beginning with a primary task, and followed by multitasking conditions. The performance of the students was assessed by evaluating the accuracy of dental canal shaping and time taken to complete the task. Differences were analyzed using ANOVA (p < 0.05). Performance was similar during learning between the three experimental groups. Accuracy of the performance did not differ within each group for the two tests nor between the groups at each test (p > 0.05). These findings demonstrated that performance subsequent to learning by observation without instructions was comparable to learning with instructed observation. The results also identified that the performance of the experimental group (1.5- to 2-hour practice) was comparable with the conventional control group (15- to 20-hour practice). Alternative approaches to learning dexterity skills in dentistry may provide improved outcomes, especially in demanding situations.

Evaluation des bénéfices d’un dispositif d’entraînement à l’usage des doigts en mathématiques

Numerous studies have shown a significant positive relationship between the mental representation of hands in young children and their calculation performance. The literature indicates that certain components of manual motor skills may be critical to the quality of this relationship. The main objective of this study is to measure the benefit of an explicit training and teaching device for finger use in mathematics by measuring the initial motor imitation abilities of young children. A protocol of pretest, training, and post-test type was proposed to 101 children with an average age of 5 years and 3 months. Measurements focused on manual motor skills and arithmetical skills. The 12-week classroom-based device was designed to develop manual motor skills and explicitly teach finger use in mathematics. The results indicate that significant progress was made in arithmetic for the students who benefited from the training. Interestingly this progress is modulated by the children’s initial motor imitation skills. This contribution opens up new research and application perspectives on the relationships between mental motor imagery, fine motor skills, and arithmetic ability.

Differences in training among prehospital emergency physicians in Germany.

BackgroundGermany has an interdisciplinary physician-based emergency medical service. Differences in training likely lead to different levels of expertise.ObjectivesWe assessed the number of manual procedures performed at the completion of training to determine level of experience of prehospital emergency physicians of different primary specialties.Materials and methodsImmediately after passing the board examination each examinee was asked to estimate the number of performed procedures for 26 manual skills. We compared the results with recommendations and data on learning manual skills. Results are presented as mean (standard deviation).ResultsEndotracheal intubation via direct laryngoscopy was performed 1032 (739) times by anesthesiologists. Surgeons and internists performed 89 (89) and 77 (65) intubations, respectively. Intubation via video laryngoscopy was performed 79 (81) times by anesthesiologists, 11 (17) times by surgeons and 6 (11) times by internists. Surgeons had little experience in non-invasive ventilation, with 9 (19) performed procedures and had rarely used external pacemaker therapy or electrical cardioversion. In comparison, among all participants non-invasive ventilation was performed 152 (197) times, electrical cardioversion was performed 41 (103) times and an external pacemaker was used 6 (15) times. For other procedures the numbers did not markedly differ between the different specialties.ConclusionThe number of performed procedures markedly differed for some skills between different primary specialties. Recommendations regarding a procedural volume were not always met, suggesting missing expertise for some skills. A defined number of procedures should therefore be a formal requirement to be eligible for board certification in prehospital emergency medicine.

Cognitive status is associated with performance of manual wheelchair skills in hospitalized older adults

Purpose To examine the relationship between manual wheelchair skills and cognitive function in hospitalized older adults. Methods The observational study included older adults who used a manual wheelchair following hip/knee surgery. Participants underwent a series of tests to evaluate manual wheelchair skills and cognitive performance. Four items appearing on the Wheelchair Skills Test: brake handling (locking/unlocking), a 10-metre forward roll, a 2-metre backward roll and rotating in place, were used to evaluate manual wheelchair skills. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), the Clock Drawing Test, and the Loewenstein Occupational Therapy Cognitive Assessment. The relationship between wheelchair skills and cognitive scores was assessed by a series of univariate linear regression analyses. Results Fifty older adults, aged 65–85, participated in the study. The MoCA-7 (orientation) explained 19.3% of the variance related to the turn in place wheelchair skill, 18.8% of the variance related to the two-metre backwards roll and 31.9% of the variance related to the 10-metre forward roll. The addition of gender (to the MoCA-7) increased the explained variance related to the 10-metre forward roll and turn in place skills to 38.5% and 28.5%, respectively. As for the brakes handling skill test, gender explained 18.3% of the variance. The addition of the CDT (to gender) increased the explained variance for the brakes handling skill to 31.4%. Conclusions Because cognitive impairments negatively affect the performance of wheelchair skills, rehabilitation therapists may need to adjust wheelchair mobility training methods for cognitively impaired older adults. Implication for rehabilitation Given the prevalence of older adults with cognitive impairments who use manual wheelchairs, it is critical to better understand the relationship between cognition and wheelchair skills. Poor results reported on the cognitive tests, specifically, visual attention and orientation, were found to be associated with poor performance of four manual wheelchair skills. Rehabilitation therapists should consider the cognitive status of older adults when teaching manual wheelchair skills, specifically in new users. Future studies should examine whether a customized preparation program, enhancing visuospatial orientation, can benefit manual wheelchair control in older adults.

Polish Lace Makers: Gender, Heritage, and Identity

Polish Lace Makers: Gender, Heritage, and Identity

Despairing of Despair, Living for Today and the Day after Tomorrow: Reflections on Naoko Saito'sAmerican Philosophy in Translation

Despairing of Despair, Living for Today and the Day after Tomorrow: Reflections on Naoko Saito's<i>American Philosophy in Translation</i>

INFERIOR TURBINOPLASTY: COMPARISON BETWEEN THE DIRECT VISION AND NASAL ENDOSCOPIC TECHNIQUES

The hypertrophy of inferior turbinates is considered one of the main causes of nasal obstruction. There are clinical and surgical options for treatment. If clinical control fails, the volumetric reduction of those structures is usually recommended. Theendoscopic approach is considered safe, as it enables a comprehensive assessment of the extent of the turbinate anatomy and effective hemostasis. Turbinoplasty is a procedure that requires manual skill and has the advantages of non-exposure of raw area, less chance of bleeding and less crusting. This study aimed to compare the postoperative outcome of patients who underwent inferior turbinoplasty under direct vision and via nasal endoscopy, through a prospective randomized study conducted at the IPO hospital (Instituto Paranaense de Otorrinolaringologia, Curitiba/PR, Brazil). In this study, 17 patients were evaluated and divided into two groups according to the surgical technique used. Both groups underwent flexible nasofibroscopy on the 15th and 30th day postoperatively, were asked if they experienced cacosmia, and if there was any need for nasal packing during the period. Although the video technique offers a broad view of the nasal anatomy and of the inferior turbinates, it demands more adequate material and more experience from the surgeon, and its surgical time is longer. By considering these results, we can conclude that there are no statistical differences between the postoperative results of the two turbinoplasty techniques.

Development of a mannequin lab for clinical training in a chiropractic program.

Faced with COVID-19 safety protocols that severely limited the ability to conduct chiropractic technique instruction in the usual manner, our university invested the resources to develop a new mannequin lab for hands-on training, which would help supplement the loss of person-to-person contact. Training mannequins could enable student learning of palpation and adjustment skills while avoiding close human-human contact. The university had developed a mannequin over the previous 4 years consisting of a full-sized human torso with individually movable and palpable vertebrae, pelvis, and thighs. In the mannequin, 64 pressure sensors are attached to particular vertebral and skeletal landmarks and provide feedback on palpation location and level of force applied. We assembled 3 teams to produce 20 copies of that mannequin for student use. Mannequins were produced in 7 weeks, and space was built out for a special lab. Faculty members are developing classroom procedures to introduce the mannequin to students, phase in the skills from static and motion palpation, and practice thrust performance. The production run was successful, and the resulting equipment, well-received by students and faculty. In addition to helping teach manual skills, the lab serves as a platform for educational research to test the efficacy of mannequin-based training protocols. With the pressure sensors on known locations along the spine, future research may be able to test the ability of students to identify and contact specific target locations for adjustive thrusts.

The Value of Artificial Intelligence-Assisted Imaging in Identifying Diagnostic Markers of Sarcopenia in Patients with Cancer.

Sarcopenia is defined as the loss of skeletal muscle mass and muscle function. It is common in patients with malignancies and often associated with adverse clinical outcomes. The presence of sarcopenia in patients with cancer is determined by body composition, and recently, radiologic technology for the accurate estimation of body composition is under development. Artificial intelligence- (AI-) assisted image measurement facilitates the detection of sarcopenia in clinical practice. Sarcopenia is a prognostic factor for patients with cancer, and confirming its presence helps to recognize those patients at the greatest risk, which provides a guide for designing individualized cancer treatments. In this review, we examine the recent literature (2017-2021) on AI-assisted image assessment of body composition and sarcopenia, seeking to synthesize current information on the mechanism and the importance of sarcopenia, its diagnostic image markers, and the interventions for sarcopenia in the medical care of patients with cancer. We concluded that AI-assisted image analysis is a reliable automatic technique for segmentation of abdominal adipose tissue. It has the potential to improve diagnosis of sarcopenia and facilitates identification of oncology patients at the greatest risk, supporting individualized prevention planning and treatment evaluation. The capability of AI approaches in analyzing series of big data and extracting features beyond manual skills would no doubt progressively provide impactful information and greatly refine the standard for assessing sarcopenia risk in patients with cancer.

Viewpoint: Virtual and Augmented Reality in Basic and Advanced Life Support Training.

The use of augmented reality (AR) and virtual reality (VR) for life support training is increasing. These technologies provide an immersive experience that supports learning in a safe and controlled environment. This review focuses on the use of AR and VR for emergency care training for health care providers, medical students, and nonprofessionals. In particular, we analyzed (1) serious games, nonimmersive games, both single-player and multiplayer; (2) VR tools ranging from semi-immersive to immersive virtual and mixed reality; and (3) AR applications. All the toolkits have been investigated in terms of application goals (training, assessment, or both), simulated procedures, and skills. The main goal of this work is to summarize and organize the findings of studies coming from multiple research areas in order to make them accessible to all the professionals involved in medical simulation. The analysis of the state-of-the-art technologies reveals that tools and studies related to the multiplayer experience, haptic feedback, and evaluation of user’s manual skills in the foregoing health care-related environments are still limited and require further investigation. Also, there is an additional need to conduct studies aimed at assessing whether AR/VR-based systems are superior or, at the minimum, comparable to traditional training methods.

Hand-developed creative prototyping. Methodological proposal and experimentation

The generation of original and innovative ideas is a challenge for any professional. There are several studies that demonstrate how the capacity to explore creativity is reduced until reaching educational levels where it is hardly experienced, and for this reason it is necessary to introduce it in the classroom to complement their academic training before their incorporation into the labour market. The use of new technologies implies in turn an abandonment of manual or craft skills, losing in this area a very relevant possibility of creative development. Most of the methods that are usually used to generate ideas are related to oral and written conceptualization, but manual ideation is practically not contemplated. This study proposes a methodology for generating ideas based on traditional ideation from the physical creation of models as part of the creative process. This methodology has been used with satisfactory results in 38 courses at the Industrial Organisation School (Spain), with 382 people between 18 and 30 years of age participating in the study, demonstrating that the development of creative skills obtained through this new approach can have a very significant impact on students' later career development.

Digitising prosthetics: Clinical series

Loss of any part of the body is seen mostly due to trauma, diseases or congenital malformations which causes psychological trauma along with functional, and esthetic impairment. Amputed finger can be surgically reconstructed but when not feasible the patient reports to a prosthetist for replacement of the lost part. The patient’s expectations must be met by the prosthetist by mimicking the opposite digit as closely as possible which helps regains the patient’s lost confidence. This article proposes a technique for rehabilitation of an amputated finger using Rapid prototyping technique as compared to the conventional technique which is time consuming, requires manual skills, lacks precision and finesse making digitally fabricated prosthetic digit a reality.

Democratizing Flexible Endoscopy Training: Noninferiority Randomized Trial Comparing a Box-Trainer vs a Virtual Reality Simulator to Prepare for the Fundamental of Endoscopic Surgery Exam.

A considerable number of surgical residents fail the mandated endoscopy exam despite having completed the required clinical cases. Low-cost endoscopy box trainers (BTs) could democratize training; however, their effectiveness has never been compared with higher-cost virtual reality simulators (VRSs). In this randomized noninferiority trial, endoscopy novices trained either on the VRS used in the Fundamental of Endoscopic Surgery manual skills (FESms) exam or a validated BT-the Basic Endoscopic Skills Training (BEST) box. Trainees were tested at fixed timepoints on the FESms and on standardized ex vivo models. The primary endpoint was FESms improvement at 1 week. Secondary endpoints were FESms improvement at 2 weeks, FESms pass rates, ex vivo tests performance, and trainees' feedback. Seventy-seven trainees completed the study. VRS and BT trainees showed comparable FESms improvements (25.16 ± 14.29 vs 25.58 ± 11.75 FESms points, respectively; p = 0.89), FESms pass rates (76.32% vs 61.54%, respectively; p = 0.16) and total ex vivo tasks completion times (365.76 ± 237.56 vs 322.68 ± 186.04 seconds, respectively; p = 0.55) after 1 week. Performances were comparable also after 2 weeks of training, but FESms pass rates increased significantly only in the first week. Trainees were significantly more satisfied with the BT platform (3.97 ± 1.20 vs 4.81 ± 0.40 points on a 5-point Likert scale for the VRS and the BT, respectively; p < 0.001). Simulation-based training is an effective means to develop competency in endoscopy, especially at the beginning of the learning curve. Low-cost BTs like the BEST box compare well with high-tech VRSs and could help democratize endoscopy training.