Tactile Skills Research Articles

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Musical instruments are great for developing audio, visual, tactile and motor skills. This month Asco are offering three lucky readers the chance to win a 14 piece music set worth £36.50. The instruments have been specially selected for younger children aged from 12 months and upwards.

Extended neocortical maturation time encompasses speciation, fatty acid and lateralization theories of the evolution of schizophrenia and creativity

I suggest that the extended maturation time of some regions of the human neocortex is the uniquely human factor which allows the development of language, creativity and madness. The genetic event or events which contribute to the long delay to final maturation occurred at or after the speciation of Homo sapiens sapiens. Neocortical growth may follow the previously detailed "balloon model", which suggests that intra- and subcortical myelin production during development physically stretches each local area of the cortex tangentially to the pial surface, thereby causing neuronal columns to become more disjoint and more functionally independent, thereby increasing the functional capacity of the area [Seldon HL. Does brain white matter growth expand the cortex like a balloon? Hypothesis and consequences. Laterality 2005;10(1):81-95]. This occurs in addition to Hebbian synaptic modeling. Therefore, the size and functional capacity of each cytoarchitectonic area of each individual adult neocortex are the outcomes of partly deterministic (e.g., genetic) and partly statistical growth processes with numerous factors including environmental stimuli and fatty acid content in diets. The possible functional capacity and variation among growth outcomes increase with the length of time allowed to "finalize" synaptic weights, myelination and other plastic processes. For example, acquisition of quite differing linguistic skills becomes possible only in Homo sapiens because of the extended, decades-long plasticity of temporal lobe areas; in contrast, tactile skills vary little among human races and cultures, or even among higher primates, because of the faster maturation of the somatomotor areas. Some of the statistically extreme variations of the neocortical growth processes lead to abnormal cognition and behavior called "madness" or "genius". This maturation hypothesis overcomes some problems with those based purely on fatty acid metabolism or on functional asymmetry (non-human species show functional asymmetry, but no language. Neanderthals had brains comparable in size and shape to ours, but failed to develop language or creativity). This hypothesis implies that the search for genetic factors should include those which influence the temporal regulation of neuronal and myelin growth, but it also allows the development of unusual creativity or madness as a statistical extreme in the absence of any deterministic factors. It has implications about our attitudes toward mental "disorders" and about potential approaches to treating some of them - for example, attempting communication and conditioning via those senses and cortical areas which show less variation and are less affected.

Augmented, Pulsating Tactile Feedback Facilitates Simulator Training of Clinical Breast Examinations

Haptic training devices can facilitate tactile skill development by providing repeatable exposures to rare stimuli. Extant haptic training simulator research primarily emphasizes realistic stimuli representation; however, the experiments reported herein suggest that providing augmented feedback can improve training effectiveness, even when the feedback is not natural. A novel clinical breast examination training device uses inflated balloons embedded in silicone to simulate breast lumps. Oscillating the balloon water pressure makes the lumps pulsate. The pulsating lumps are easier to detect than the static lumps used in current simulators, and this manipulation seems to effectively introduce trainees to small, deep lumps that are initially difficult to perceive. A study of 48 medical students indicates that training with the dynamic breast model increased the number of lumps detected, F(1, 47) = 9.34, p = .004, decreased the number of false positives, F(1, 47) = 5.78, p = .020, and improved intersimulator skill transfer, F(1, 47) = 26.56, p < .001. The results suggest that at least in this case, augmented, tactile feedback increases training effectiveness, despite the fact that the feedback does not attempt to mimic any physical phenomenon present in the natural stimulus. Applications of this research include training techniques and tools for improved detection of palpable cancers.

An 8‐Year Retrospective Study: 1,100 Patients Receiving 1,557 Implants Using the Minimally Invasive Hydraulic Sinus Condensing Technique

For many clinicians, inadequate alveolar bone height and anatomical features of the maxillary sinus complicate sinus lift procedures and placement of endosseous implants. We present a new internal crestal approach that addresses these issues. Sinus burs and condensers of increasing width are used in conjunction with pliable atraumatic bone grafting mixture and hydraulic pressure from a surgical handpiece. The risk of a membrane perforation is minimized when the surgeon's tactile skill is administered in a two-stage process to first loosen and then graft bone particulate under the Schneiderian membrane. Threaded implants can then be placed in the same visit and secured via primary closure. A retrospective investigation of 1,100 cases showed that eight implants failed and 14 required longer healing periods in patients with alveolar ridge heights varying between <1 to 5 mm. Our experience suggests that hydraulic sinus condensing is a predictable and minimally invasive alternative for prosthetic rehabilitation of maxillary anterior and posterior regions in the presence of anatomical restrictions to implant placement.

Comparison of blind and sighted participants' performance in a letter recognition working memory task

The performance in letter recognition of 21 blind participants was compared with that of 16 age-matched sighted participants in an n-back working memory task. Blind participants were tested tactually with series of raised letters and Braille characters, and sighted participants tactually with series of raised letters and visually with series of letters presented on a computer screen. With this approach, we wanted to compare the tactual performances by trained (blind) and non-trained (sighted) participants, and tactual and visual performances by trained (blind and sighted, respectively) participants. Increments of mnemonic load increased the number of incorrect responses significantly in all n-back tasks. As expected, the blind participants outperformed the sighted ones statistically significantly in the tactile raised letters n-back task. The sighted participants produced significantly fewer incorrect responses in the visual task than the blind participants in the raised letters task, whereas there was no such difference between sighted subjects' visual performance and blind subjects' tactile performance in the Braille task. These results demonstrate the degree and limits to which everyday practice develops perceptual skills either in persons without sensory deficits (vision and visual environment), or persons with severe sensory loss (blindness and tactile environment). The performance level of blind persons relying on their tactile skills is just about the same as that of sighted subjects relying on their visual skills.

Effectiveness of a dynamic breast examination training model to improve clinical breast examination (CBE) skills

Despite the potential utility of clinical breast examination (CBE), doctors’ palpation skills are often inadequate and difficult to train. CBE sensitivity ranges from 39–59%, in part because current training does not effectively teach tactile skills. To address CBE training limitations, we developed a breast examination training model with 15 dynamically controlled lumps, set to desired hardness within underlying rib and muscle structures, in a silicone breast. In an experiment of 48 medical students, training with the dynamic model increased lump detection by 1.35 lumps compared to 0.60 lumps for a traditional breast model ( P=0.008), reduced false positives by −0.70 lumps compared to +0.42 lumps ( P=0.0277), and demonstrated skill transfer with a 1.17 lump detection improvement on the traditional device compared to only a 0.17 lump detection improvement by traditional device trainees on the dynamic device ( P<0.001). Findings demonstrate the advantage of the dynamic model over conventional models in training CBE tactile skills.

Enhanced tactile encoding and memory recognition in congenital blindness.

Several behavioural studies have shown that early-blind persons possess superior tactile skills. Since neurophysiological data show that early-blind persons recruit visual as well as somatosensory cortex to carry out tactile processing (cross-modal plasticity), blind persons' sharper tactile skills may be related to cortical re-organisation resulting from loss of vision early in their life. To examine the nature of blind individuals' tactile superiority and its implications for cross-modal plasticity, we compared the tactile performance of congenitally totally blind, low-vision and sighted children on raised-line picture identification test and re-test, assessing effects of task familiarity, exploratory strategy and memory recognition. What distinguished the blind from the other children was higher memory recognition and higher tactile encoding associated with efficient exploration. These results suggest that enhanced perceptual encoding and recognition memory may be two cognitive correlates of cross-modal plasticity in congenital blindness.

Efficacy of a Virtual Reality Simulator for Evaluating the Aptitude of Medical Students

OBJECTIVE Our goal was to develop a system using virtual reality (VR) technology to test the haptic skills of medical students. Currently, surgical skills are learned on live patients in a clinical environment in which the student practices under the close supervision of an experienced surgeon. We are interested in using haptic feedback devices to enhance surgical skills, because simulated touch in a virtual world improves the performance of trainee surgeons. In this study, we evaluated the efficacy of a test that evaluates the surgical skill of medical students by using a VR simulator. METHODS We used a microsurgical simulator with a force-feedback system. Its effectiveness in helping 36 medical students to acquire the tactile skills used in microscopic surgery was evaluated experimentally. Operating time and the number of sites of hemorrhage were measured to evaluate surgical aptitude. We also evaluated system performance with respect to reality, immersiveness, and operability as secondary measures. Data were analyzed using descriptive methods. RESULTS The operating time and number of hemorrhagic sites were positively correlated. Subject students were clustered into three groups: dexterous, awkward, or clumsy. The relation between the number of hemorrhages in the retina and immersion and operability differed between the group of would-be surgeons and those of would-be internists and pediatricians. All the students commented that the simulator was a useful tool for medical education. CONCLUSIONS The VR simulator can be used not only to teach and evaluate subtle tactile and surgical skills relevant to the surgical profession, but also to test the aptitude of medical students. The training transfer from a haptic simulator to actual practice methodology should be quantifiable in the near future. This work has steered medical informatics research into a new type of medical education.

An initial evaluation of the Iowa Dental Surgical Simulator

The University of Iowa colleges of dentistry and engineering are collaborating to build an effective but low-cost surgical simulator that uses force feedback to teach and assess the tactile skills of dentistry. A prototype simulator was built, and a formative evaluation examined the realism of the haptics and identified directions for future work. Using a cross-over design, twelve experienced practitioners probed two virtual teeth using two instruments attached to the force feedback device. The session was videotaped, the forces recorded, and a standardized questionnaire completed. Two analyses were conducted: an ANOVA examined practitioners' questionnaire responses, and a t-test analyzed the probing forces. Significant tooth order by instrument order interaction and instrument effects were found. Practitioners were generally satisfied. They preferred a standard joystick to an explorer, felt that two-dimensional graphics were sufficient, and emphasized that the existing vibration be eliminated. Random placement of caries should help teach generalized skills.

A clinical comparison of pain perception to the Wand and a traditional syringe

This study compared the pain response of a group of 40 volunteers to the Wand with the response to syringe injections. Of 240 total injections given, 120 were with the Wand system, and 120 were with the traditional aspirating syringe. Three injections were evaluated: injections to the middle superior alveolar (MSA) of the maxillary right first premolar and the maxillary left first premolar; palatal injections of the maxillary right first premolar and the maxillary left first premolar; and inferior alveolar nerve injection (IAN) of both the right and the left sides. Each volunteer received 6 injections, 3 on one side with the Wand and 3 on the opposite side with the syringe (control). All injections were given by the primary investigator without the use of a topical anesthetic. Pain perception levels were recorded with a 4-point visual analog scale: no pain, mild pain, moderate pain, and severe pain. The results were evaluated statistically by using an unpaired t test. The results showed injections with the syringe were statistically more painful than injections with the Wand in 4 of 18 evaluations: MSA of the maxillary left first premolar, female volunteers responses to MSA of the maxillary left first premolar, IAN left side injections, and male responses to IAN left injections (P =.01, P =.05, P =.05 and P =.05, respectively). The Wand generally seemed to provide less painful injections; however, the mean ratings of pain were mostly mild pain for both injections. Therefore, the clinical significance of the results should be interpreted with caution. The operator technique and tactile skill in syringe injections and site of injection (right or left) could be important factors that were not evaluated in this study.

Do clinical breast examination skills improve during medical school?

To assess the effects of stage of training, gender, and specialty interest on medical students' breast cancer knowledge, attitudes, and clinical breast examination (CBE) skills as a case study of the progression of physical examination skills during medical education. In 1996, questionnaires assessing breast cancer knowledge and attitudes were administered to 493 premedical and first-, second-, and third-year medical students at Northwestern University Medical School. Silicone breast models were used to evaluate the CBE proficiency of a subset of 151 students. Breast cancer knowledge was positively correlated with stage of training (r = .62), with significant differences between all levels (p < .001). In contrast, first-year medical students attained the highest mean lump-detection sensitivity (61.5%), followed by second-year (53.9%) and third-year (43.5%) students (p < .001, first- vs third-year students; p < .10, second- vs third-year students). There was no significant difference in specificity among the four stages. The results suggest that breast cancer knowledge and attitudes are not related to CBE proficiency, which is a practiced tactile skill. The decline in lump-detection sensitivity with increased stage of training may demonstrate the need for increased attention to palpation skills during the clinical years. These findings are consistent with those of earlier reports that suggest the need for the reinforcement of physical examination skills during clinical education.

Development of Adaptive Behavioral Robot Using Tactile Skills.

In order to utilize autonomous robots in the service fields such as in offices and hospitals, the robots should be equipped with functions for co-existing with humans. In this paper, initially, we discuss the functions which service robots require, such as (1) safety for humans, (2) adaptability to unknown environments and (3) maintenance of appropriate function. We propose the architec-ture based on SSA (Subsumption Architecture) to realize the above functions. We have developed a prototype system using a 5-axes robot and touch sensors. We have confirmed the efficiency of our system by experimentation.

Cost-Effectiveness of Two Nurse-Led Programs to Teach Breast Self-examination

The cost-effectiveness of breast cancer screening that includes breast self-examination (BSE) has not been investigated, in part because the costs and effects of programs to teach BSE are not well known. I used data from a randomized, controlled trial and national surveys to compare the benefit, cost, and cost-effectiveness of two one-year, nurse-led programs to teach BSE in a medical practice setting. One program (Mammacare, or MAM) used manufactured silicone models to develop tactile skills; the other program (Traditional, or TRAD) stressed knowledge and examination techniques. I defined benefit as the marginal one-year increase in the number of women in an "average" adult primary care office practice who performed competent and frequent BSE. I defined cost as the marginal increase in the resources used to teach BSE and in the resources used as a result of performing BSE. Cost-effectiveness equaled the cost per competent, frequent BSE examiner added. The "average" practice was derived based on estimates from national surveys of physicians and medical practices. The MAM program's benefit was fivefold greater than the TRAD program's; its total cost was more than threefold greater; and its cost per competent, frequent examiner added was 32% lower. Yet, regardless of the program, one year following teaching only 15%-28% of women were competent, frequent performers. Cost-effectiveness was sensitive to the definition of benefit. Cost-effectiveness was also sensitive to some costs, but generally these sensitivities did not alter the relative cost-effectiveness of the two programs. The cost of teaching BSE was substantial. Benefit, cost, and cost-effectiveness varied by program.(ABSTRACT TRUNCATED AT 250 WORDS)

Subjective Assessment of Wet-raised Woollen Fabric

An investigation is reported in which a panel of judges, using visual and tactile skills, assessed a series of milled and wet-raised fabrics for smoothness, softness, and stiffness. It was found that fabric smoothness and softness were clearly related to the amount or raise given to the fabrics.

Improving Physicians’ and Nurses’ Clinical Breast Examination: A Randomized Controlled Trial

Health professionals' clinical breast examination accuracy and skills are not optimal. We conducted a randomized trial to evaluate changes in physicians' and nurses' lump detection accuracy and examination skills after a training program emphasizing development of tactile skills and using silicone breast models containing lumps of varying sizes, degrees of hardness, and depth of placement. Sensitivity, specificity, and examination technique were measured before and four months after training in 43 experimental group and 46 control group participants. Mean sensitivity increased from 57% to 63% in the experimental group but decreased from 57% to 56% in the control group (P less than or equal to .05). The experimental group's posttest sensitivity was better for each lump characteristic, with statistically significant improvement for the very small (0.3 cm) and medium hard lumps. Duration of examination independently predicted sensitivity. Specificity decreased from 56% to 41% in the experimental group while it increased from 56% to 68% in the control group (P less than or equal to .05). Physicians had significantly higher mean sensitivity than nurses overall, as well as for the larger (1.0 cm), very small (0.3 cm), and softer lumps, but significantly lower mean specificity (33% versus 57%, P = .03). The experimental group improved significantly in five of six technique components while the control group improved in only one. To determine the effect of training on specificity in the clinical setting, we examined medical records of women seen by a subset of experimental and control physicians during the six months following training. There were no significant differences in the proportion of abnormal breast examinations reported or the number of mammograms ordered by experimental and control physicians. Our results show health professionals can be taught successfully to improve their clinical breast examination accuracy and skills.

How Best to Teach Women Breast Self-Examination

To compare three methods for teaching breast self-examination. Randomized controlled trial with factorial design. A general medicine group practice in a university hospital. Continuing-care patients from 40 to 68 years of age. Of 456 eligible women, 156 refused participation, 300 were randomly assigned, 269 completed assigned interventions, and 260 completed the post-test 1 year later. One third of patients received nurse instruction stressing tactile skills (Mammacare group) (Mammatech Corporation, Gainesville, Florida); one third, traditional nurse instruction emphasizing technique (traditional group); and one third, no nurse instruction (control group). Half of each group received physician encouragement. One year later, women in the Mammacare group found more lumps (mean, 57%; 95% CI, 54% to 60%) in manufactured breast models than did those in the traditional (mean, 47%; CI, 44% to 51%) and control (mean, 45%; CI, 42% to 48%) groups. Lump detection specificity was unaffected. Self-reported examination frequency rose in all groups, to 5.1 times per 6 months in the traditional group, 4.2 in the Mammacare group, and 3.9 in the control group. Physician encouragement did not improve sensitivity, specificity, or overall frequency. Women in the Mammacare group used more of seven examination techniques (4.9) than did those in the traditional (3.9) or control (3.2) groups (P less than 0.001). No group increased health care use or reported more overall worry about breast cancer. Mammacare instruction resulted in more long-term improved lump detection and examination technique use than did traditional instruction or physician encouragement. Breast self-examination instruction should emphasize lump detection skills.

Individual Variation in Tactile Map Reading Skills: Some Guidelines for Research

A framework for studying individual variation in tactile map reading is offered and a set of research guidelines suggested. It is argued that the reading may be viewed as a many-leveled skill or set of skills, and that differences are best understood from an information processing rather than a psychometric perspective. Possible kinds of individual variation are distinguished, corresponding to differences in basic tactile abilities, amount of knowledge of the problem domain, different cognitive styles, and differences in affective factors. It is argued that the divergences must be related to a full task analysis.

Comparison of Three Methods of Teaching Women How to Perform Breast Self-Examination

This paper presents results from an experimental study designed to evaluate the relative effectiveness of three methods of teaching women how to do breast self-examination (BSE). Frequency of BSE, confidence in examination performance, proficiency of BSE technique, and lump detection performance were the main outcome variables assessed. The three training methods compared in this study were provision of a pamphlet describing how to do BSE, having women view a videotape depicting proper performance of BSE, and having women practice doing BSE on a life-like breast model. Results showed that passive methods of BSE instruction such as the use of pamphlets or films were of little value in helping women develop the tactile skills necessary for proficient BSE. Three months after training, it was found that lump detection performance, as measured on silicone breast models, was significantly higher among those women who had been given an opportunity to practice doing the breast examination on a breast model with corrective feedback given by a BSE instructor. The opportunity to practice doing the examination with corrective feedback on performance appears to be a critical variable in the acquisition of BSE skill.

Tactile-perceptual functioning and academic performance in brain-impaired and unimpaired children.

The purpose of this study was to determine whether tactile perception is a useful predictor of academic performance. 50 control and 42 brain-impaired (epileptic) children were examined. Both groups showed a strong relationship between tactile perceptual integrity and academic achievement. Analyses of extreme groups indicated that academic performance is clearly ordered by tactile perceptual skill not only for children with documented brain impairment but also for a normal control group as well. The implications for additions to the traditional cognitively oriented psychological test battery were discussed.

Articulation improvement and oral tactile changes in children.

To determine whether oral tactile changes accompany improvement in articulation, 16 children were administered two tests of oral tactile perception and two tests of articulation competency at three time periods: before, during, and at the end of speech therapy. A positive relationship between articulation proficiency and oral tactile perception was established. Both articulation tests reflected a progressive improvement for the group across the three testing periods. One of the tests of oral tactile perception reflected the same progressive trend and the second test, while not exhibiting the identical trend, did reflect a general improvement from the first to the third testing period. These findings indicate that oral tactile skills appear to be important factors in speech production and that such skills should be assessed in cases of functional articulation disorders,