Videotaped Sessions Research Articles

The resources and obstacles of creative collaboration in a long-term learning community

In the framework of a subject-centred socio-cultural approach, this study investigates creative collaboration and the resources for and obstacles to it in a long-term learning community of ten teacher students. The study focuses on five different learning situations over a 2-year period. The data were taken from teacher students’ evaluations and accounts (on given criteria) of their videotaped group-learning sessions, and their reports of the obstacles to creative collaboration. Using the students’ evaluations of the five videotaped group learning situations, the sessions they assessed as the least and most creative were compared, the aim being to discover the most important situation-specific contextual resources for collaborative creativity in the learning settings addressed. The findings showed that creative collaboration was manifested by the presentation of alternative views, and in most situations also by the production of new ideas. However, it was less evident that group discussion would in every session reveal contradictions or lead to the disclosure of opposing views concerning different meanings; nor would it necessarily create an elaborated understanding of the learning topic. The main obstacles to creative collaboration were related to the emotional atmosphere and power relations of the group. A comparison of the contextual conditions of the least and most creative evaluated situation illustrates that the least creative situation was characterised by participants’ disputational talk, aimed at invalidating opposing opinions. Here, the group atmosphere was emotionally charged in a negative sense, and mutual care taking was lacking. The unsafe atmosphere made group members afraid of being emotionally bruised by other members. The most creative situation was characterised by complementarity in participants’ talk and by inclusive utilisation of each other's views. The shared history of the group was an extremely important resource for group dialogue, allowing alternative future scenarios to be constructed reflectively. The emotional scaffolding between students was rich, and the tutor's resources were utilised. Results are discussed in terms of complementarity, emotions and power relations.

Assessment of the Content and Process of Genetic Counseling: A Critical Review of Empirical Studies

This article reviews studies that assessed the process and content of genetic counseling communication. A systematic search of the literature was undertaken of studies that audio- or videotaped genetic counseling sessions conducted by genetics health care providers and subjected them to communication analyses. A total of 18 studies (published in 34 articles) were identified that met the eligibility criteria. Studies show that providers speak more than clients, that a large proportion of communication is biomedical rather than psychosocial and that the teaching model of genetic counseling is widely implemented. Higher levels of counselor facilitation of understanding and empathic responses, lower levels of verbal dominance (ratio of counselor to client talk) and the provision of a summary letter of the consultation are associated with more positive client outcomes. Findings from these studies should be used as an evidence base for teaching and continuing education of genetic counseling providers.

Perceived Locus of Control and Academic Performance: Broadening the Construct's Applicability

Perceived Locus of Control and Academic Performance:Broadening the Construct's Applicability Michael A. Kirkpatrick (bio), Kathryn Stant (bio), Shonta Downes (bio), and Leatah Gaither (bio) Locus of control (LOC) is a dimensional construct representing the degree to which individuals perceive reinforcing events in their lives to be the result of their own actions (an "internal" LOC) or fate (an "external" LOC; Bandura, 1986; Rotter, 1966). LOC is meaningfully related to several variables associated with academic achievement (Bernstein, Stephan, & Davis, 1979; Dollinger, 2000; Forsyth, 1986; Forsyth & McMillan, 1981; Kovenklioglu & Greenhaus, 1978; Noel, Forsyth, & Kelly, 1987; Perry & Penner, 1990). Specifically, high scoring students identify effort and ability as causes of their success, whereas those performing poorly are more likely to cite test difficulty and bad luck as causes (Bernstein et al., 1979; Kovenklioglu & Greenhaus,1978). Internals appear to have more incidental knowledge of their environments and make better use of it (Lefcourt, 1976), which allows them to identify important cues and benefit from incidental learning situations (Dollinger & Taub, 1977; Wolk & DuCette, 1974). Thus, although other factors can mediate or qualify the impact of LOC, internal LOC generally predicts higher levels of academic success (Keith, Pottebaum, & Eberhardt, 1986). Unlike some other influences on student academic achievement (e.g., study skills), LOC reflects a student's implicit response to fundamental philosophical and scientific questions about the nature of human life and experiential reality. For this reason, LOC offers a bridge between academic and student development concerns. Although skeptical faculty may be reluctant to devote class time to or provide academic credit for development activities more ambiguously tied to curriculum (e.g., Myers-Briggs personality assessments), the question of causality is central to most disciplines. How students perceive the causes of events in their own lives may influence how they respond to the characters in Oedipus Rex or how readily they understand scientific determinism. LOC addresses fundamental questions germane to philosophy, mythology, and literature, as well as the behavioral, social, and physical sciences. Therefore, it has a natural place in the classroom. Making a connection between basic beliefs about causality and pragmatic, short-term objectives like helping students succeed academically and socially is a legitimate challenge for faculty and an added educational value already established empirically. Dollinger (2000) and Noel et al. (1987) replicated the positive correlation between academic success and students' LOC found by previous researchers, then constructed practical classroom interventions to help students learn. Dollinger had students complete an abbreviated LOC assessment, then quizzed them on course-relevant "trivia" such as their instructor's office location, exam schedule, and other facts not explicitly part of the instructional content but relevant to success. Final course grades were higher for internals. Internals also [End Page 486] displayed higher scores on the trivia tests, suggesting greater attention to course relevant material and higher incidental learning as shown previously (Dollinger & Taub, 1977; Wolk & DuCette, 1974). Because the assessments were easily and naturally integrated into the course content (personality psychology), Dollinger also showed that trivia can be used to help students focus their attention on cues that foster success. The value of LOC as an adjunct to instruction and a vehicle for promoting student success was further demonstrated in studies implementing an "internalizing" influence to improve failing externals' academic performance (Noel et al., 1987; Perry & Penner, 1990). Noel et al. selected students showing substandard performance on early exams in general psychology. Half were shown videotaped testimonials of a confederate who emphasized taking control of academic outcomes in order to succeed. Controls watched a video whose model attributed success to a more general adjustment to college without internalizing control. At the end of the term, those students influenced to adopt an internal LOC raised their mean grade to C or better, whereas the controls' average remained unsatisfactory (Noel et al., 1987). Perry and Penner (1990) exposed internals and externals to a videotaped lecture in a simulated college classroom. Prior to the lecture, some of the students were exposed to a videotaped LOC retraining session in which an instructor described the importance of effort and persistence in attaining academic success. Controls saw no video before proceeding to the simulated classroom. One week later, they all took a test on...

The Use of Videotape Self-Monitoring to Facilitate Interactive Intervention in Speech-Language Therapy with Preschool Children with Autism

ABSTRACT This article describes the outcomes of a videotape self-monitoring project involving two graduate student clinicians enrolled in a clinical practicum in a speech-language pathology program. The goal of the project was to increase the clinicians' use of child-centered, interaction-promoting, and language-promoting strategies while interacting with preschool children with autism. The graduate student clinicians viewed videotapes of their weekly therapy sessions to identify and self-monitor their use of the interactive strategies with the children. The supervisees' and supervisor's ratings of the videotaped sessions were compared to each other and to the videotaped observational data. The outcomes are discussed from a developmental perspective for both supervisor and supervisees.

Supportive expressive therapy--Parent child version: An exploratory study.

Currently, there are no empirically supported psychodynamic treatments for disruptive behavior in young children. Supportive Expressive Therapy--Parent Child (SET-PC) is a newly developed brief psychodynamic psychotherapy that focuses on a parent's internal representations of self and others, particularly as they manifest in problematic parent-child relationships. It is a manualized dyadic therapy that uses videotaped parent-child play sessions followed by parent-therapist discussions. This exploratory study is the first randomized controlled study of SETPC. SET-PC was compared with the Incredible Years Parenting Program (IYPP; Webster-Stratton, 2001), an empirically supported group parent training intervention for child disruptive behavior. Treatment completers were 37 consecutive referrals of parent- child dyads (children ages 30-72 months) to an outpatient psychiatry clinic. SET-PC produced treatment outcomes that were equivalent to IYPP. Both treatments were associated with large effect sizes for decreases in externalizing behavior and for the positive quality of observed parent- child interactions and small effect sizes for improvements in parents' psychological functioning. Treatment gains were maintained at 1-year follow-up regardless of treatment condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

How Collaborative Is Structural Family Therapy?

In response to the charge by “collaborative” therapies, such as solution focused and narrative, that structural family therapy is an aggressive, confrontational, and impositional approach, this investigation examines the role of therapist empathy in creating a collaborative partnership in structural family therapy. Twenty-four videotaped therapy sessions were used to correlate therapists' empathic response to family members and in-session change in the family's core problem dynamic. Findings suggest that empathy is not only evident in structural family therapy, but may be an essential ingredient in establishing a collaborative relationship and facilitating within-session change.

Optimizing selective cerebral perfusion: Deleterious effects of high perfusion pressures

Selective cerebral perfusion is a proven adjunct to hypothermia for neuroprotection in complex aortic surgery. The ideal conditions for the provision of selective cerebral perfusion, however, including optimal perfusion pressure, remain unknown. We investigated the effects of various perfusion pressures during selective cerebral perfusion on cerebral physiology and outcome in a long-term porcine model. Thirty piglets (26.3 +/- 1.4 kg), cooled to 20 degrees C on cardiopulmonary bypass with alpha-stat pH management (mean hematocrit 23.6%), were randomly assigned to 90 minutes of selective cerebral perfusion at a pressure of 50 (group A), 70 (group B), or 90 (group C) mm Hg. With fluorescent microspheres and sagittal sinus sampling, cerebral blood flow and cerebral oxygen metabolism were assessed at baseline, after cooling, at two points during selective cerebral perfusion, and for 2 hours after cardiopulmonary bypass. Visual evoked potentials were monitored during recovery. Neurobehavioral scores were assessed blindly from standardized videotaped sessions for 7 postoperative days. Cerebral blood flow during selective cerebral perfusion was significantly increased by higher-pressure perfusion (P = .04), although all groups sustained similar levels of cerebral oxygen metabolism during selective cerebral perfusion (P = .88). After the end of cardiopulmonary bypass, the cerebral oxygen metabolism increased to above baseline in all groups, with the highest levels seen in group C (P = .06). Intracranial pressure was significantly higher during selective cerebral perfusion in group C (P = .0002); visual evoked potentials did not differ among groups. Neurobehavioral scores were significantly better in group A (P = .0002). Selective cerebral perfusion at 50 mm Hg provides neuroprotection superior to that at higher pressures. The increased cerebral blood flow with higher-pressure selective cerebral perfusion is associated with cerebral injury, reflected by high post-cardiopulmonary bypass cerebral oxygen metabolism and poorer neurobehavioral recovery.

Coming of Age: Online Continuing Education for the Journal and the Society for Simulation in Healthcare

Coming of Age: Online Continuing Education for the Journal and the Society for Simulation in Healthcare

In-home parent training of functional analysis skills.

Functional analysis (FA) is recognized as an effective method for determining social and nonsocial influences maintaining problem behavior and subsequently, formulating an effective intervention plan (Hanley, Iwata, & McCord, 2003). Although early FA studies were implemented by experienced research personnel (Iwata, Dorsey, Slifer, Bauman, & Richman, 1994), more recent inquiry has focused on paraprofessional staff and non-behavioral practitioners. For example, Moore, Edwards, Sterling-Turner, Riley, DuBard, & McGeorge (2002) taught classroom teachers to implement FA conditions through modeling, behavior rehearsal, and performance feedback. Similarly, Wallace, Doney, Mintz-Resudek, & Tarbox (2004) showed that educators could learn FA skills using scripts, role playing, and video demonstration. More recently, Phillips and Mudford (2008) combined lecture, written information, modeling, rehearsal, and feedback to train FA methodology with inexperienced residential-care staff. The importance of these studies is that when compared to assessment that is performed under simulated conditions, having natural care-providers conduct FA may capture more precisely the operating contingencies responsible for problem behavior. Parents of children who have problem behavior have participated in FA sessions under professional supervision (Wacker, Berg, & Harding, 2006) but research has not addressed actual skills training with family members. That is, can parents acquire the skills necessary to conduct FA and within their homes? The present study considered this question by evaluating an in-home training program with two families unfamiliar with FA methods and no prior implementation history METHOD Participants and Setting The participants were two sets of parents who had a child with autism. Family A included mother (32 years old), father (38 years old), and their 10-year old son. Family B included mother (36 years old), father (40 years old), and their 12-year old son. The families agreed to participate in the study as a component of consultation they were receiving from a board certified behavior analyst (BCBA). All FA sessions (described below) were conducted in a small area set aside in each family's home. Measurement The participants conducted FA sessions in which a graduate student played the role of a child. Each simulated session lasted 5 minutes and consisted of either the social disapproval, demand, or play condition described by Iwata et al (1994). During sessions, one parent from each family interacted with the student. There were 3 sessions per day (social disapproval, demand, play), implemented in random order, and scheduled over a one-week period. Note that the alone condition of the Iwata et al (1994) methodology was omitted from the study because the child behavior could not occur if the participants were not present. Because the children in each family occasionally hit their parents, the student playing the role of a child displayed aggression as the behavior during FA sessions. The student followed a written script that specified when aggression should occur within each FA condition. The scripts were introduced to the student during two training meetings conducted by the senior author preceding the study. The senior author videotaped each FA session and subsequently, recorded data by viewing the recorded sessions. Using a 30s partial interval recording method, each occurrence of the behavior was scored and whether the participant implemented the appropriate consequence in each FA condition. Implementation accuracy was calculated as a percentage measure by dividing the number of intervals in which the appropriate consequence was demonstrated by the total intervals in which the target behavior occurred and multiplied by 100. Interobserver Agreement Interobserver agreement (IOA) was assessed by having a second observer score data independently with the senior author for 75% of videotaped FA sessions. …

Using Typical Infant Development to Inform Music Therapy with Children with Disabilities

This article illustrates some ways in which observations of typically-developing infants can inform music therapy and other work with children with disabilities. The research project that is described examines typical infant development with special attention to musical relatedness and communication. Videotapes of sessions centering on musical play with typically-developing infants and of music therapy sessions of children with multiple severe disabilities are examined in light of developmental issues, conceptual frameworks, and relationships between typical development and developmental issues of children with disabilities. Greenspan’s model of psychosocial development is used as a basis for analyzing observations.

The rapid estimate of adult literacy in genetics (REAL‐G): A means to assess literacy deficits in the context of genetics

Genetic information presents challenges to all patients, but particularly those with low and marginal literacy. The goal of the study was to create a rapid estimate of adult literacy in genetics (REAL-G) tool, with established validity, for use with patients receiving genetics services. Patterned after the widely used rapid estimate of adult literacy in medicine (REALM), a three-stage method was used in tool development. This included derivation of terms from transcripts of visits conducted by over 150 prenatal and cancer genetic counselors. Concurrent validity was estimated by administration of both the REAL-G and the REALM to 203 participants. Predictive validity was estimated by relating participants' REAL-G scores to scores on a learning task that involved viewing a videotaped genetic counseling session and answering related questions. The REAL-G measure was strongly correlated with the REALM (Pearson correlation = 0.83; P < 0.0001), indicating substantial concurrent validity in a population of potential genetic counseling patients. Using the REALM as the gold standard, REAL-G scores identified readers at the sixth grade level or below (95.4% sensitivity and 88.5% specificity). Further analysis identified an eight-item subset of words that has strong concurrent validity when compared to longer instruments and even greater predictive power in relation to information recall. Subjects scoring below the sixth grade level on the eight-item REAL-G scored significantly lower than others on knowledge tests after viewing genetic counseling visits. The REAL-G represents a screening tool that can be used to quickly identify low literate patients in the clinical genetics context or to quantify context-specific literacy within a research setting.

Reflections on Shared Practices in a Supervisory Lineage

Three members of a supervisory lineage (i.e., faculty supervisor, doctoral student supervisor/supervisee, and master's student counselor trainee) reflect on their practice during 15 weeks of counseling supervision. Supervisory collaboration and reciprocal learning were made possible by engaging in five shared activities: (1) utilizing a written supervision contract, (2) reviewing videotaped counseling and supervision sessions, (3) participating in live supervision, (4) maintaining written documentation, and (5) attending to here-and-now reflective conversations. Recommendations are provided for utilizing the supervisory relationship as the medium for mutual learning and professional development.

Perfusing the Cold Brain: Optimal Neuroprotection for Aortic Surgery

Selective cerebral perfusion (SCP) may enhance the neuroprotective benefits of hypothermia during aortic surgery. However, despite its widespread adoption, there is no consensus regarding optimal implementation of SCP. We used a survival porcine model to explore the physiologic characteristics and behavioral benefits of various protocols involving hypothermic circulatory arrest (HCA) and SCP. Thirty pigs (26.3 +/- 1.4 kg), cooled to 15 degrees C on cardiopulmonary bypass, using alpha-stat pH management (mean hematocrit 30%), were randomly allocated to differing brain protection strategies: 90 minutes of HCA (group A); 30 minutes of HCA, then 60 minutes of SCP (group B); or 90 minutes of SCP (group C). Using fluorescent microspheres and sagittal sinus sampling, cerebral blood flow (CBF [mL x 100g(-1) x min(-1)]) and cerebral metabolic rate for oxygen (CMRO2 [mL x 100g(-1) x min(-1)]) were assessed at baseline, after cooling, during SCP (where applicable), and for 2 hours after cardiopulmonary bypass. Neurobehavioral scores were assessed blindly from standardized videotaped sessions for 7 days postoperatively. Cerebral blood flow was significantly higher (p = 0.0001) during SCP (60 and 90 minutes) if preceded by HCA. The CMRO2 was also significantly higher in group B versus group C (p = 0.016) at 60 minutes. The CMRO2 in all three groups rebounded promptly toward baseline after weaning from cardiopulmonary bypass. Postoperative neurobehavioral scores were significantly worse in group A. Continuous SCP provides the best brain protection overall. However, an initial period of HCA does not seem to impair late outcome; perhaps the elevated CBF and CMRO2 observed reflect a beneficial cerebral response to a recoverable insult. Clearly, 90 minutes of HCA induces permanent brain injury, even in this carefully controlled setting.

Effects of pulse width variations in pallidal stimulation for primary generalized dystonia

Various pulse widths (from 60-450 mus) have been used for bilateral pallidal stimulation in generalized dystonia but, to date, no comparison of this parameter's effects is available. To provide an analysis of the differential effects of bilateral short, medium and long stimulus pulse width (PW) on clinical improvement in primary generalized dystonia. The most effective therapeutic stimulation parameters were recorded in 22 patients using bilateral pallidal stimulation. Six months after surgery, the effects of bilateral pallidal short (60-90 micros), medium (120-150 micros) and long (450 micros) PWs were studied in 20 of those patients. The effect of the stimulation was assessed by reviewing videotaped sessions by an observer blinded to treatment status (Burke-Fahn-Marsden movement score). Patients were tested on separate days, in random order, for the stimulation conditions (acute effect with the stimulation condition lasting 10 hours). The same contact was used for each stimulation condition. All the electrodes were set at 130 Hz (monopolar stimulation) and the intensity was set individually 10% below the side effect threshold. Median PWs of 60 (short), 120 (medium) and 450 micros (long) were compared,with a mean intensity of 4.46, 3.45 and 2.47 V, respectively. This study failed to demonstrate any significant difference in the movement scale dystonia mean scores depending on PW. According to our findings, short duration stimulus PWs are as effective as longer ones during a 10 hour period of observation. Confirmation of this finding for chronic use could be of importance in saving stimulator energy. Moreover, the use of smaller stimulus pulse widths are said to reduce charge injection and increase the therapeutic window between therapeutic effects and side effects.

Integration of role-playing into technical skills training: a randomized controlled trial

Introduction: Recently, efforts have been undertaken to enhance the face validity of technical skills training by introducing role-plays and standardised patients. Since little is known about the effects of role-playing with respect to the realism of a training situation and students’ objective performance, we performed a randomized controlled trial.Methods: 36 medical students participated in videotaped small group skills-lab sessions on the topics of Doppler sonography and gastric tube insertion. One half of the students participated in role-plays and the other half practised without role-playing. Realism of the training situation was analysed by means of post-intervention self-selected student survey evaluations. Technical performance and patient-physician communication were assessed by independent ratings of the videotaped sessions.Results: The physician's role was regarded to be significantly more realistic when performing role-plays. Assessment of videotaped sessions showed that practising technical skills by performing role-plays resulted in significantly better patient-physician communication whereas students’ technical performance did not differ between groups.Conclusion: Introducing role-plays enhances the realism of technical skills training and leads to better patient-physician communication. Students do not seem to be overstrained by practising clinical technical skills using role-plays. We conclude that role-playing is a valuable method in practising technical skills.

Correlation of Physician Performance in a Simulator-Based Environment to Actual Error Rates in the Intensive Care Unit (ICU).

INTRODUCTION: Despite the inherent appeal of simulator-based training for critical medical events, the correlation between simulator-based performance and real-world behavior remains unclear. PURPOSE: To explore whether directly observed error rates among interns can be independently correlated with performance in a simulator-based testing environment. METHODS: Volunteers participating in the Intern Sleep and Patient Safety Study (Landrigan, NEJM 2004;351:1838) each reported to the simulator lab in an initially rested, and then sleep-deprived state (24+ hours on-call; cohort 1 [n=17]). A subset also subsequently presented after a modified overnight shift (≤16 hours on-call, cohort 2 [n=8]). During each lab visit, subjects were asked to manage two critically ill patients (1 medical case; 1 cardiac arrest). Each case was scored by an on-site physician using a validated performance assessment tool (case score=1[worst]-8[best], accounting for major errors; average of both case scores=session score). Session videotapes were also reviewed by a blinded, independent rater. RESULTS: We conducted 50 simulator sessions (25 rested, 25 sleep-deprived) comprising 100 cases (2 per session). Among all subjects (cohort 1), the simulator session score averaged 6.0 (95% CI: 5.4–6.7) in the fully-rested state, and declined to 5.0 (95% CI: 4.4–5.6) after the traditional overnight shift (p=.008). Among those who progressed to a shortened overnight shift (cohort 2), the simulator session score averaged 5.8 (95% CI: 4.4–7.2; p=.002 compared to their traditional overnight score of 4.3 [95%CI: 3.4–5.3]). The inter-rater correlation coefficient (ICC) for the blinded (versus on-site) ratings was .80. CONCLUSIONS: In a simulator lab, fully rested interns performed better than traditionally sleep-deprived interns in the management of critical patient scenarios; interns also performed better after a shorter overnight shift compared to a longer overnight shift. These findings are consistent with real-time hospital studies documenting fewer serious medical errors among more rested interns. Such a correlation supports the validity of simulation as a clinical performance assessment tool. ACKNOWLEDGEMENTS: Supported by a grant from the Agency for Healthcare Quality and Research (AHRQ). Special thanks to Suresh Venkatan, MBBS, for his assistance as an independent rater.

Quantifying Instructional Interventions in Pediatric Physical therapy with the Motor Teaching Strategies Coding Instrument (MTSCI-1): A Pilot Study

Purpose: This paper presents the development and preliminary psychomotor testing of a new instrument, the Motor Teaching Strategies Coding Instrument (MTSCI-1), designed to quantitatively assess motor-teaching strategies used by physical therapists during therapeutic interventions with children. Method: The MTSCI-1 was developed to evaluate the use of strategies grounded in motor learning theories and concepts. The items were generated from a review of the literature. To evaluate reliability, two physical therapists used the MTSCI-1 to code videotaped treatment sessions of pediatric physical therapists. Kappa was calculated. Validation was examined by comparing scores of physical therapists with different years of experience. Results: The resulting instrument had two main sections: (a) task/movement characteristics, and (b) before-, during- and after-task strategies. Each activity trial was analyzed and frequency of strategies used was determined. Percentage of agreement and preliminary inter- and intra-rater reliability (κ=.66-.94) as well as content and construct validation were established. The instrument differentiated the use of some strategies among groups of physical therapists with varied years of experience. Conclusions: The MTSCI-1 may be considered in research studies to document the motor-teaching strategies of physical therapists. The MTSCI-1 may also facilitate the learning and training of therapists from various fields in the application of motor learning to maximize clients’ outcomes from their motor-teaching activities.

Análise das funções comunicativas expressas por terapeutas e pacientes do espectro autístico

communicative functions used by language therapists and patients. to analyze the communicative functions used by language therapists and patients of the autistic spectrum. the communicative functions expressed by six therapists in interaction with six patients each were analyzed, constituting 36 profiles of communicative functions expressed by the dyad therapist-patient. All therapists were part of a Training Program in Childhood Psychiatric Disorders and the patients were diagnosed within the autistic spectrum. Data were gathered using the transcriptions of a videotaped therapy session and these were analyzed according to the criteria suggested by Fernandes (2000). The communicative functions were divided in two different ways: interpersonal and non-interpersonal, and instrumental, regulatory, interactive, personal, heuristic and imaginative. the comparison between the functions used by the language therapists and the patients indicated a statistically significant difference in use of the following functions: request of social routine, request of information, request of action, comment, recognition of other, exclamation, non-focused, exploratory, exhibition, play and reactive. There was also a statistically significant difference between the use of interpersonal, non-interpersonal, regulatory, interactive, personal and heuristic communicative functions. the functional communicative profile of language therapists is different from the one presented by their patients when comparing each communicative function and when the communicative functions are grouped (interpersonal and non-interpersonal, and instrumental, regulatory, interactive, personal, heuristic and imaginative). Therapists use communicative functions to fill in the communicative space and to make requests. This finding agrees with the findings of previous studies.

Pallidal Deep-Brain Stimulation in Primary Generalized or Segmental Dystonia

Neurostimulation of the internal globus pallidus has been shown to be effective in reducing symptoms of primary dystonia. We compared this surgical treatment with sham stimulation in a randomized, controlled clinical trial. Forty patients with primary segmental or generalized dystonia received an implanted device for deep-brain stimulation and were randomly assigned to receive either neurostimulation or sham stimulation for 3 months. The primary end point was the change from baseline to 3 months in the severity of symptoms, according to the movement subscore on the Burke-Fahn-Marsden Dystonia Rating Scale (range, 0 to 120, with higher scores indicating greater impairment). Two investigators who were unaware of treatment status assessed the severity of dystonia by reviewing videotaped sessions. Subsequently, all patients received open-label neurostimulation; blinded assessment was repeated after 6 months of active treatment. Three months after randomization, the change from baseline in the mean (+/-SD) movement score was significantly greater in the neurostimulation group (-15.8+/-14.1 points) than in the sham-stimulation group (-1.4+/-3.8 points, P<0.001). During the open-label extension period, this improvement was sustained among patients originally assigned to the neurostimulation group, and patients in the sham-stimulation group had a similar benefit when they switched to active treatment. The combined analysis of the entire cohort after 6 months of neurostimulation revealed substantial improvement in all movement symptoms (except speech and swallowing), the level of disability, and quality of life, as compared with baseline scores. A total of 22 adverse events occurred in 19 patients, including 4 infections at the stimulator site and 1 lead dislodgment. The most frequent adverse event was dysarthria. Bilateral pallidal neurostimulation for 3 months was more effective than sham stimulation in patients with primary generalized or segmental dystonia. (ClinicalTrials.gov number, NCT00142259 [ClinicalTrials.gov].).

Objective Assessment of Manual Skills and Proficiency in Performing Epidural Anesthesia—Video-Assisted Validation

Demand is growing for objective assessment of manual skills and competencies of invasive procedures. The aim of this study was to validate an objective tool for assessing residents' skill in performing epidural anesthesia by use of a global assessment scale and a 3-scale, 27-stage checklist. We wish to demonstrate that this tool can differentiate operators with different levels of training. Second-year anesthesia residents were recruited. Their previous experience was assessed by questionnaire. They were repeatedly videotaped performing epidural anesthesia over a 6-month period. Videotaping was done in a blinded manner that masked the identity and level of training of the residents. Three blinded, independent examiners evaluated each session by use of a specifically devised assessment tool that consisted of a global rating scale and a 3-scale, 27-stage checklist to judge the skill level and grade the videotaped sessions. Twenty-one sessions by 6 residents were videotaped over 6 months. Interrater reliability for the different checklist and global-rating form items shows moderate to high degree of agreement for most stages. Total scores demonstrate almost perfect agreement (kappa/ICC +/- SE = 0.90 +/- 0.03 and 0.83 +/- 0.13, respectively; P < .0001) between examiners. To test whether higher total scores are associated with greater experience, a series of repeated-measures ANCOVAs were performed. In both the global-rating form and the checklist, a significant relation between total scores and epidurals done was found to exist (checklist: P < .0001; global rating: P < .0001). The results of our study show that scores on a system that consists of a global-rating form and a task-specific checklist had a significant relation to the number of epidural insertions performed (i.e., experience). The interrater reliability of these assessment tools was very strong. Evaluation of technical skills by an objective tool under direct observation, as opposed to laboratory setting, may create a more reliable standard of assessment. Furthermore, residency programs could use these evaluations to identify deficiencies in teaching programs and trainees who require extra instruction.