Multiple Training Sessions Research Articles

How effective is fine motor training in children with ADHD? A scoping review

BackgroundMotor deficiencies are observed in a large number of children with ADHD. Especially fine motor impairments can lead to academic underachievement, low self-esteem and frustration in affected children. Despite these far-reaching consequences, fine motor deficiencies have remained widely undertreated in the ADHD population. The aim of this review was to systematically map the evidence on existing training programs for remediating fine motor impairments in children with ADHD and to assess their effectiveness.MethodsThe scoping review followed the PRISMA-ScR guidelines. In March 2020, PsycINFO, MEDLINE (PubMed), Web of Science, Google Scholar and The Cochrane Database of Systematic Reviews were searched for evidence. The eligibility criteria and the data charting process followed the PICO framework, complemented by study design. The investigated population included children with a formal ADHD diagnosis (either subtype) or elevated ADHD symptoms aged between 4 and 12 years, both on and off medication. All training interventions aiming at improving fine motor skills, having a fine motor component or fine motor improvements as a secondary outcome were assessed for eligibility; no comparators were specified.ResultsTwelve articles were included in the final report, comprising observational and experimental studies as well as a review. Both offline and online or virtual training interventions were reported, often accompanied by physical activity and supplemented by training sessions at home. The training programs varied in length and intensity, but generally comprised several weeks and single or multiple training sessions per week. All interventions including more than one session were effective in the treatment of fine motor deficiencies in children with ADHD and had a wide range of additional positive outcomes. The effects could be maintained at follow-up.ConclusionsFine motor training in children with ADHD can be very effective and multiple approaches including specific fine motor and cognitive training components, some kind of physical activity, feedback mechanisms, or multimodal treatments can be successful. Training programs need to be tailored to the specific characteristics of the ADHD population. A mHealth approach using serious games could be promising in this context due to its strong motivational components.

Fostering Apprentice Beauticians’ Visual Expertise Through Annotations: A Design Experiment Using the Platform Realto

Professional beauticians regularly perform skin analyses and should be skilled at observing small skin anomalies and skin damages. However, little is done directly for improving their observation skills at school, during their training. In order to foster apprentices’ observation skills of skin anomalies, a new training scheme exploiting annotations and attention-guiding methods through the use of the platform Realto was developed and tested.A second year class of apprentice beauticians (N=9) was given a pre-test on the visual expertise of skin anomalies. Then, for a semester they attended multiple training sessions where firstly teachers explained skin anomaly images with the help of annotations (attention-guiding) and secondly, students were asked to observe other images of the same anomalies, annotate them, and then provide a textual description of the identified anomaly.At the end of the semester, the trained class completed a post-test and a questionnaire, and group interview have been collected. Another group of apprentices (N=19) of the third year who already completed the skin anomaly course was used as baseline. Results showed that the group who participated in the treatment mentioned almost double the amount of details noticed by the baseline group in the post-test; being trained using annotations and the Realto platform proved effective in developing observation skills, compared to normal lessons. Furthermore, apprentices confirmed, both through the questionnaire and the interviews, that they considered annotations useful for improving their observation skills and that using Realto and its annotation facilities was a good way to achieve this result.

Evaluation of Sensitization Program on Occupational Health Hazards for Nursing and Allied Health Care Workers in a Tertiary Health Care Setting.

Background: Occupational health hazard pertaining to health care providers is one of the neglected areas that need serious attention. Any compromise in their safety would result in reduction in workforce, which may affect patient care, keeping in mind the wide gap between the required number and actual health care workers (HCWs) available in the world over.Aim: This study was undertaken to evaluate the change in knowledge through a sensitization training program on occupational health hazards and vaccination for HCWs.Materials and Methods: Participants of the study included nursing and allied HCWs of a tertiary care health institute in Uttarakhand, India. Multiple training sessions, each of around 180 min, were held periodically in small groups with 20–40 participants over 2 years. Participants were assessed with pretest and posttest questionnaires, and feedback was taken. Questionnaires comprised three categories: general safety and ergonomics, biological hazards, and chemical and radiation hazards. Data of incident reporting for needlestick injury from 2017 to 2019 were retrieved. All data were compiled in Excel sheet and analyzed.Results: A total of 352 participants were included in the study. Mean ± SD for pretest and posttest scores were 5.3 ± 2.13 and 11.22 ± 2.15, respectively. There was considerable improvement in knowledge, which was found to be statistically significant with p-value of 0.001 for all categories. Participants in their feedback suggested for inclusion of psychosocial aspect in further training programs.Conclusion: Low baseline knowledge prior to attending the course highlights a need for an intervention through such structured sensitization program to create awareness and educate HCWs on common occupational health hazards and vaccination. Statistically significant improvement in posttest knowledge highlights effectiveness of the training program. A drastic rise in incident reporting for needlestick injury reflects fairly good impact of training program. Regular and appropriate form of training can reduce injuries resulting from occupational hazards and ensure healthy workforce contributing toward a positive impact on national economy.

Nurse Practitioner Student Perceptions of a Multimodal Telemedicine Clinical Course.

Telemedicine facilitates access to care that is both efficacious and highly satisfactory to patients. As primary health care providers, nurse practitioners (NPs) need to be educated to deliver health care within various settings. With the rapid expansion of telemedicine, NP educational authorities have charged educators to address essential telemedicine-based competencies. Innovative approaches to integrating telemedicine competencies into NP curricula have yet to be established in nursing education. Multifocal curricular changes were integrated into an NP clinical course. Students engaged in self-directed learning modules and multiple simulation training sessions and rotated through telemedicine clinical practicums. Experiences were perceived as realistic and complementary, learning meaningful, and applicability broad and far-reaching. Telemedicine-focused simulation training sessions were viewed as highly satisfactory, and students were confident in simulation-derived learning. Nursing educators should integrate multimodal telemedicine experiences into curricula, addressing multiple learning phases through experientially designed simulation trainings.

Assessing the efficacy of investigative interviewing training courses: A systematic review

Substantial resources have been dedicated to designing and implementing training courses that focus on enhancing the interviewing skills of police officers. Laboratory research studies and real-world assessments of the effectiveness of interview training courses, however, have found notably mixed results. In this article, empirical studies ( N = 30) that have assessed the effectiveness of police interview and interrogation training courses were systematically reviewed. We found a wide variation in terms of the type, length, and content of the training courses, the performance criteria used to assess the training effectiveness, and the impact of the training courses on interviewing performance. Overall, the studies found that basic interviewing skills can be developed to a certain level through even short evidence-based training courses. More cognitively demanding skills, such as question selection and meaningful rapport-building, showed less of an improvement post training. The courses that included multiple training sessions showed the most consistent impact on interviewing behavior. This review also indicated a need for more systematic research on training effectiveness with more uniform and longer-term measures of effectiveness. Our findings should help guide future research on this specific topic and inform the training strategies of law enforcement and other investigatory organizations.

Comparisons of Daily Energy Intake vs. Expenditure Using the GeneActiv Accelerometer in Elite Australian Football Athletes.

Salagaras, BS, Mackenzie-Shalders, KL, Nelson, MJ, Fraysse, F, Wycherley, TP, Slater, GJ, McLellan, C, Kumar, K, and Coffey, VG. Comparisons of daily energy intake vs. expenditure using the GeneActiv accelerometer in elite Australian Football athletes. J Strength Cond Res 35(5): 1273-1278, 2021-To assess validity of the GeneActiv accelerometer for use within an athlete population and compare energy expenditure (EE) with energy and macronutrient intake of elite Australian Football athletes during a competition week. The GeneActiv was first assessed for utility during high-intensity exercise with indirect calorimetry. Thereafter, 14 professional Australian Football athletes (age, 24 ± 4 [SD] y; height, 1.87 ± 0.08 m; body mass, 86 ± 10 kg) wore the accelerometer and had dietary intake assessed via dietitian-led 24-hour recalls throughout a continuous 7 days of competition period (including match day). There was a significant relationship between metabolic equivalents and GeneActiv g·min-1 (SEE 1.77 METs; r2 = 0.64; p < 0.0001). Across the in-season week a significant difference only occurred on days 3 and 4 (day 3: energy intake [EI] EI 137 ± 31 kJ·kg-1·d-1; 11,763 ± 2,646 kJ·d-1 and EE: 186 ± 14 kJ·kg-1·d-1; 16,018 ± 1973 kJ·d-1; p < 0.05; d = -1.4; day 4: EI: 179 ± 44 kJ·kg-1·d-1, 15,413 ± 3,960 kJ·d-1 and EE: 225 ± 42 kJ·kg-1·d-1; 19,313 ± 3,072 kJ·d-1; d = -0.7). Carbohydrate intake (CI) was substantially below current sports nutrition recommendations on 6 of 7 days with deficits ranging from -1 to -7.2 g·kg-1·d-1 (p < 0.05), whereas daily protein and fat intake was adequate. In conclusion, the GeneActiv provides effective estimation of EE during weekly preparation for a professional team sport competition. Australian Footballers attempt to periodize dietary EI to varying daily training loads but fail to match expenditure on higher-training load days. Specific dietary strategies to increase CI may be beneficial to achieve appropriate energy balance and macronutrient distribution, particularly on days where athletes undertake multiple training sessions.

Combat Casualty Care Training: Implementation of a Simulation-Based Program in a Cross-Cultural Setting: Experience of the French Military Health Service in West Africa

In the French army, combat casualty care (CCC) training involves the use of simulation. The application of this pedagogic method in a cross-cultural environment has not previously been described. In this report, we explore the challenges highlighted by multiple training sessions for foreign medical providers in West Africa.We collected the data from six 2-week courses held in Libreville, Gabon. Our main objective was to describe the course; our secondary objective was to assess our trainees' progress in their knowledge of CCC.The first week involved lectures, technical workshops, and single-patient simulations. The second part emphasized multiple-victim simulations and interactions with combatants and was held in the Gabonese rainforest. Sixty- two trainees undertook the six sessions. Their knowledge improved during the course, from a median score of 4 (of a maximum of 40) before to 9.5 after (p < .05).Our study is the first to describe medical-level CCC training in a cross-cultural environment. Challenges are numerous, notably differences in the expected roles of instructors and trainees. Mitigating those difficulties is possible through cultural awareness and self-awareness. Our results are limited by the absence of evaluation of improvement in the actual management of patients.CCC training using medical simulation is feasible in a cross-cultural environment.

Training Surgical Residents to Communicate with Their Patients: A Scoping Review of the Literature

Effective communication is critical in surgical practice and the Accreditation Council on Graduate Medical Education requires a focus on interpersonal and communication skills. Absent a national communication skills curriculum for surgical residents, individual programs have designed and implemented their own curricula. This scoping review explores communication training in North American surgical residency programs. The review was conducted according to PRISMA guidelines, and included articles identified through searches of 6 publication databases conducted on June 25, 2019 and updated on April 2, 2020. Eligible studies described patient or family communication skills education for surgical residents in North America. Published abstracts were excluded. Article abstracts were screened by 2 reviewers. For articles meeting criteria, data on study setting, participants, curriculum design, educational techniques, and skills focus were extracted and analyzed. A total of 2724 articles were identified after removing duplicates; 84 articles were reviewed in full text. Thirty-three met study criteria including 4 from 2006 to 2009 and 29 after 2010. The most common skills education focused on breaking bad news, followed by a range of topics, such as empathy, end of life and/or palliative care discussions, medical error disclosure, shared decision making, and informed consent. Some of the training was part of larger curriculum including team training or professionalism. Over half of the studies involved general surgery learners. The most common form of education included didactics followed by practice with peers or simulated patients. Only half of the programs described curricula involving multiple training sessions which is important for ongoing development and skill reinforcement. Effective communication skills are important, necessary, and increasingly incorporated into surgical training programs. While the literature is expanding, few surgical residency programs have described communication curricula. This review serves as a guide for programs interested in developing their own communication curricula for surgical residents.

Swipe up to smoke less cigarettes! Introducing a mobile Approach-Avoidance Task Application to fight Smoking

Abstract Automatic tendencies to approach addictionrelated stimuli have been linked to the development and maintenance of harmful drug use behavior. Recent studies have shown that these automatic approaches can be directly addressed and modified by cognitive bias modification (CBM). However, the training and treatment effects are rather small and compliance could be impaired by time-consuming, multiple laboratory training sessions. Here we present a mobile variant of the Approach-Avoidance Task (app-AAT), which is evaluated by a feasibility study. The app-AAT is designed to improve the efficiency of CBM training by allowing smokers to access the training at any time, and by offering the option to track consumed cigarettes. Our first run with eight participants showed that the app was rated very positively with 4.2 out of 5 points (engagement: 3.7, functionality: 4.5, aesthetics: 4.4) by using the german Mobile App Rating Scale (MARS-G).

The Effect of Ingesting Carbohydrate and Proteins on Athletic Performance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Endurance athletes participating in sporting events may be required to complete multiple training sessions a day or on successive days with a limited recovery time. Nutritional interventions that enhance the restoration of endogenous fuel stores (e.g., liver and muscle glycogen) and improve muscle damage repair have received a lot of attention. The purpose of this review is to investigate the effect of ingesting carbohydrate (CHO) and protein (PRO) on athletic performance. Studies were identified by searching the electronic databases PubMed and EMBASE. Random-effects meta-analyses were conducted to examine the intervention efficacy. A total of 30 randomized controlled trials (RCT), comprising 43 trials and 326 participants in total, were included in this review. The meta-analysis showed an overall significant effect in Time-To-Exhaustion (TTE) and Time-Trial (TT) performance, when ingesting carbohydrates and proteins (CHO-PRO) compared to CHO-only (p = 0.03 and p = 0.0007, respectively). A subgroup analysis demonstrated a significant effect in TTE by ingesting CHO-PRO compared to CHO, when supplements were provided during and/or following an exercise bout. CHO-PRO significantly improved TTE compared to CHO-only, when a long-term recovery (i.e., ≥8 h) was implemented (p = 0.001). However, no effect was found when the recovery time was short-term (i.e., ≤8 h). No significant effect was observed when CHO-PRO and CHO-only supplements were isocaloric. However, a significant improved TTE was evident with CHO-PRO compared to CHO-only, when the supplements were matched for carbohydrate content (p < 0.00001). In conclusion, co-ingesting carbohydrates and proteins appears to enhance TTE and TT performance compared to CHO-only and presents a compelling alternate feeding strategy for athletes.

Investigating the influence of paired-associative stimulation on multi-session skill acquisition and retention in older adults

ObjectivePriming non-invasive brain stimulation (NIBS) can improve motor learning in the elderly, but it remains unclear how benefits observed in a single training session translate to multiple training sessions. The current study therefore examined the influence of priming NIBS on acquisition and retention of a novel motor skill over sequential training days in older adults. MethodsIn 30 older adults (68.2 ± 5.3 years, 14 females), paired-associative stimulation (PAS) was applied prior to visuomotor training on 3 consecutive days. The interstimulus interval used for PAS was either 10 ms (PASLTD) or 100 ms (PASControl) and long-term retention was assessed by quantifying motor performance 7 days after the final training session. ResultsDuring training, skill progressively increased across sessions (P < 0.0001), but this was not different between PASLTD and PASControl (P > 0.1). In contrast, the magnitude of skill retained 7 days after training was significantly greater in the PASLTD group (P = 0.02), suggesting significantly greater long-term retention of the trained skill. ConclusionsPASLTD over multiple sessions may represent an effective tool to help maintain newly learned motor skills in older adults. SignificanceWhile multisession priming with PAS can influence long-term skill retention, improving skill acquisition requires investigation of alternative protocols.

The effects of single versus multiple training sessions on the motor learning of two Krav Maga strike techniques, in women.

BackgroundExperts of the Krav Maga (KM) self-defense system propose that KM techniques are based on simple body movements which are suggested to be learned rapidly and retained. This study investigated the acquisition, retention, and further improvement with additional training of two KM strike techniques among novice female practitioners: straight punch and defensive kick.MethodsSixteen healthy females (age: 23 ± 3.7 years) without any previous martial arts/self-defense experience volunteered to participate. All participants received an initial 30-min instruction session (AQ), taught by a certified KM instructor, where each technique was deconstructed into three checkpoints (defined as a component of the entire movement) for learning. Participants were divided into two groups, one of which received additional training. Several kinematic and kinetic measures were recorded at four timepoints: immediately before AQ, immediately after AQ, 5 days after AQ, and 12 days after AQ.ResultsResults suggest that both techniques were learned rapidly, as checkpoint performance was significantly improved after AQ. Kick velocity and impact force also increased significantly after AQ; however, these measures did not change after AQ for the punch technique. Additional training did not improve either punch or kick performance beyond that learned during AQ.ConclusionThe findings from this study suggest that a single training session may be sufficient to learn and retain KM strike techniques relatively permanently; and the acquisition of the kick technique may lead to concomitant improvements in kick velocity and impact force.

A Novel Application of Digital Microscope for Microsurgery Training

Abstract Background Time spent under the microscope is often a limiting factor as plastic surgery residents work toward proficiency in microsurgery. This study describes and assesses a novel application of a digital microscope compatible with smart devices which can consistently and reliably magnify microsurgical fields. Methods A digital microscope was used to display an “operating” field on a tablet device. Two junior plastic surgery residents participated in multiple training sessions. During each session, residents completed two sessions of a knot-tying task and a chicken vessel anastomosis task. The sessions were recorded on the tablet, photographed, and graded by an experienced microsurgeon utilizing three standardized microsurgery training scales (OWOMSA, OSATS, and Global scale) for evaluation. Between sessions, the residents received feedback from the experienced microsurgeon. Results Statistically significant improvements (p &lt; 0.05) in microsurgical technique were observed across 16 areas assessed by the standardized evaluation scales. Additionally, the residents' surveys suggest favorable attitudes toward the digital microscope and its value as a training device. Conclusion Traditional operating microscopes present considerable barriers for effective microsurgical training. The digital microscope analyzed in the present study provides solutions to several of these barriers: it is economical, lightweight, portable, and can be set up by the trainee on any flat surface; photographing and recording capabilities via the connected tablet device make the digital microscope setup optimized for education. Our study demonstrates measurable improvements in trainee's skills with use of—as well as favorable trainee attitudes toward—the digital microscope, which could present a valuable addition to plastic surgery education.

CREB in Mushroom Body Gates &lt;i&gt;Drosophila&lt;/i&gt; Long-Term Memory

Long-term memory (LTM) requires learning-induced synthesis of new proteins allocated in specific neurons and synapses in a neural circuit. Not all learned information, however, becomes permanent memory. How the brain gates relevant information into LTM remains unclear. In Drosophila adults, a single training session in an olfactory aversive learning task is not sufficient to induce protein synthesis-dependent LTM. Instead, multiple spaced training sessions are required. Here, we report the surprising finding that a single training session induces the synthesis of new proteins in early α/β Kenyon cells of the mushroom body (MB), and output from these neurons inhibits LTM formation. CREBB expression, induced by spaced training, then appears to suppress this inhibitory effect. One training session can induce LTM formation when this inhibitory effect is relieved. We propose that learning-induced proteins and spaced training-induced CREBB protein act antagonistically to modulate neuron activity from early α/β MB neurons during LTM formation.

Multiple brief training sessions to improve nurses' knowledge, attitudes, and confidence regarding nursing care of older adults with depression in long-term care facilities.

In long-term care facilities (LTCFs), nurses are key healthcare providers for older residents who have depressive symptoms or depression; therefore, they need accurate knowledge of late-life depression, positive attitudes towards depression, and confidence in providing depression care. This cluster-randomized trial was designed to examine the effectiveness of multiple, face-to-face, brief training sessions in improving nurses' knowledge, attitudes, and confidence in providing late-life depression care in LTCFs. Nine LTCFs were included in the study. In total, 30 nurses from the four LTCFs assigned to the intervention group received three 30-min training sessions and 36 nurses in the five comparison group LTCFs did not. A self-report questionnaire was administered before and after the intervention. There were significant differences between groups concerning improvement in nurses' knowledge of late-life depression, attitudes towards depression, and confidence in providing depression care. The effect size (Cohen's d) was 1.55 for knowledge, 1.38 for attitudes, and 0.89 for confidence. This training program was effective in improving LTCF nurses' knowledge, attitudes, and confidence in providing depression care. On the basis of these findings, we recommend that nurse managers and directors implement similar training programs for nurses in LTCFs to enhance the care quality for older residents.

Retraining automatic action tendencies for smoking using mobile phone-based approach-avoidance bias training: A study protocol for a randomized controlled study

BackgroundAutomatic tendencies to approach drug-related cues have been linked to the development and maintainance of harmful drug-taking behavior. Recent studies have demonstrated that these automatic approach tendencies can be targeted directly by means of cognitive bias modification (CBM). Moreover, changing those approach tendencies may enhance treatment outcomes. However, training and therapy effects tend to be rather small and adherence to the training might be impaired by time-consuming multiple laboratory training sessions. Here, we present a protocol for a randomized controlled design to improve CBM training efficiency and facilitate access to the training by providing mobile-phone-based training sessions at home to current smokers motivated to quit smoking.MethodsParticipants (n = 100) are current smokers who smoke at least six cigarettes per day for at least 6 months and are willing to quit smoking. All participants attend a brief behavioral smoking cessation intervention (TAU) and are randomly assigned either to an experimental (TAU + training) or a control group. Participants in the experimental condition are given access to a training application (app) aimed at retraining automatic approach biases for smoking cues. Participants are instructed to perform the app training outside the laboratory context on a daily basis for 14 consecutive days. Participants in the control group do not receive the training. Primary outcome measures are changes in smoking-related approach biases and reductions in daily nicotine consumption as assessed at baseline, post-training and at 6-week follow up. Secondary outcome measures include approach biases for alternative stimuli or smoking stimuli to which participants were not exposed during training, attentional and association biases, biochemical outcomes, and self-reported smoking behavior, also measured at three different time points (baseline, post-training, and follow up). After completion of the study, smokers in the control condition will receive access to the training app.DiscussionThis randomized controlled trial is the first to test the effectiveness of an app-based CBM intervention as an adjunct to a brief smoking cessation intervention in smokers motivated to quit smoking. The results of this study can inform future research in the optimization and advancement of CBM treatment for addiction.Trial registrationCurrent Controlled Trials, ISRCTN15690771. Registered on 20 November 2018.

Cultural Humility: A Way to Reduce LGBTQ Health Disparities at the End of Life.

Sexual and gender minorities experience disparities throughout the life course. These are especially detrimental at the end-of-life and can include disenfranchised grief, homophobia and transphobia from medical staff, and forced outing. The best healthcare training approach to ameliorate health disparities is debated. Cultural competency trainings for clinicians have been commonly proposed by major medical institutions and certifying bodies to ameliorate lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) health disparities. However, cultural competency trainings have limitations, including (1) false competence, (2) measurement issues, and (3) ecological fallacy (i.e., assuming individuals conform to the norms of their cultural group). The purpose of this commentary is to describe the limitations of cultural competency training and argue for healthcare systems to implement cultural humility trainings as a way to reduce LGBTQ health disparities at the end-of-life. The strengths of cultural humility training include focus on (1) individuals instead of their cultural groups, (2) self-reflection, and (3) active listening. While there are challenges to implementing cultural humility trainings in the health-care system, we assert that these trainings align with the aims of healthcare systems and can be an essential tool in reducing LGBTQ health disparities. We suggest practical components of successful cultural humility trainings including leadership buy-in, appropriate outcome measurements, multiple training sessions, and fostering a safe reflection space.

Does interleaved practice enhance foreign language learning? The effects of training schedule on Spanish verb conjugation skills.

Do the cognitive benefits of interleaving—the method of alternating between two or more skills or concepts during training—extend to foreign language learning? In four experiments, we investigated the efficacy of interleaved versus conventional blocked practice for teaching adult learners to conjugate Spanish verbs in the preterite and imperfect past tenses. In the first two experiments, training occurred during a single session and interleaving between tenses began during the presentation of introductory content (Experiment 1) or during randomly ordered verb conjugation practice trials at the end of the training session (Experiment 2). This yielded, respectively, numerically higher performance in the blocked group and equivalent performance in the interleaved and blocked groups on a 2-day delayed test. In Experiments 3 and 4, the amount of training was increased across 2 weekly sessions in which the blocked group trained on 1 tense per session and the interleaved group trained on both tenses per session, with random interleaving occurring during verb conjugation practice trials. Interleaving yielded substantially better performance on a 1-week delayed test. Thus, although interleaving did not confer an advantage over blocking under 2 different single-session training schedules, it improved learning when used to practice conjugating verbs across multiple training sessions. These results constitute the first demonstration of an interleaving effect for foreign language learning. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Functional Connectivity of Language Regions of Stroke Patients with Expressive Aphasia During Real-Time Functional Magnetic Resonance Imaging Based Neurofeedback.

Stroke lesions in the language centers of the brain impair the language areas and their connectivity. This article describes the dynamics of functional connectivity (FC) of language areas (FCL) during real-time functional magnetic resonance imaging (RT-fMRI)-based neurofeedback training for poststroke patients with expressive aphasia. The hypothesis is that FCL increases during the upregulation of language areas during neurofeedback training and that the training improves FCL with an increasing number of sessions and restores it toward normalcy. Four test and four control patients with expressive aphasia were recruited for the study along with four healthy volunteers termed as the normal group. The test and normal groups were administered four neurofeedback training sessions in between two test sessions, whereas the control group underwent only the two test sessions. The training session requires the subject to exercise language activity covertly so that it upregulates the feedback signal obtained from the Broca's area (in left inferior frontal gyrus) and amplifies the feedback when it is correlated with the Wernicke's area (in left superior temporal gyrus) using RT-fMRI. FC was measured by Pearson's correlation coefficient. The results indicate that the FC of the test group was weaker in the left hemisphere than that of the normal group, and post-training the connections have strengthened (correlation coefficient increases) in the left hemisphere when compared with the control group. The connections of language areas strengthened in both hemispheres during neurofeedback-based upregulation, and multiple training sessions strengthened new pathways and restored left hemispheric connections toward normalcy.

Deficits in Explicit Language Problem Solving Rather Than in Implicit Learning in Specific Language Impairment: Evidence From Learning an Artificial Morphological Rule.

Purpose The purpose of this study was to delineate differences between children with specific language impairment (SLI), typical age-matched (TAM) children, and typical younger (TY) children in learning and mastering an undisclosed artificial morphological rule (AMR) through exposure and usage. Method Twenty-six participants (eight 10-year-old children with SLI, 8 TAM children, and ten 8-year-old TY children) were trained to master an AMR across multiple training sessions. The AMR required a phonological transformation of verbs depending on a semantic distinction: whether the preceding noun was animate or inanimate. All participants practiced the application of the AMR to repeated and new (generalization) items, via judgment and production tasks. Results The children with SLI derived significantly less benefit from practice than their peers in learning most aspects of the AMR, even exhibiting smaller gains compared to the TY group in some aspects. Children with SLI benefited less than TAM and even TY children from training to judge and produce repeated items of the AMR. Nevertheless, despite a significant disadvantage in baseline performance, the rate at which they mastered the task-specific phonological regularities was as robust as that of their peers. On the other hand, like 8-year-olds, only half of the SLI group succeeded in uncovering the nature of the AMR and, consequently, in generalizing it to new items. Conclusions Children with SLI were able to learn language aspects that rely on implicit, procedural learning, but experienced difficulties in learning aspects that relied on the explicit uncovering of the semantic principle of the AMR. The results suggest that some of the difficulties experienced by children with SLI when learning a complex language regularity cannot be accounted for by a broad, language-related, procedural memory disability. Rather, a deficit-perhaps a developmental delay in the ability to recruit and solve language problems and establish explicit knowledge regarding a language task-can better explain their difficulties in language learning.