Compulsory medical rural placements: senior student opinions of early-year experiential learning

Objective: The aim of this study was to determine senior medical student (year 3–5) opinions of their early‐year (year 1–2) rural placement. Design: We assessed the impact of MBBS early‐year rural placements through a follow up of this cohort in their later years using a cross‐sectional questionnaire. Setting: The questionnaire was administered to year 3–5 medical students at their clinical school. Participants: There were 97 participants (49% response rate) in the study. Twenty‐nine per cent were male and 71% were female; 44% were from a rural background and 56% were from a metropolitan background; 48% were year 3 students, 32% were year 4 students and 20% were year 5 students; and 59% of the students were, at the time, situated at a rural clinical school and 41% were at a metropolitan clinical school. Main outcome measure: Closed‐ended questions were quantified and statistically analysed. Open‐ended responses were thematically analysed to determine what their experience of early‐year rural placements were like. Results: Seventy‐nine per cent of students considered the year 1 placement length as ‘about right’. Overall, most students found year 1 rural placements positive and grasped the placement aims and objectives. Most students were also pleased with year 2 rural placements, mainly due to the clinical aspects. Conclusions: Medical students appear to prefer shorter early‐year rural placements and understand the benefits and importance of such placements. They also have a desire for greater clinical exposure during these early‐year placements.     

Toddlers actively reorganize their whole body coordination to maintain walking stability while carrying an object

Balanced walking involves freely swinging the limbs like pendula. However, children immediately begin to carry objects as soon as they can walk. One possibility for this early skill development is that whole body coordination during walking may be re-organized into loosely coupled collections of body parts, allowing children to use their arms to perform one function, while the legs perform another. Therefore, this study examines: 1) how carrying an object affects the coordination of the arms and legs during walking, and 2) if carrying an object influences stride length and width. Ten healthy toddlers with 3–12 months of walking experience were recruited to walk barefoot while carrying or not carrying a small toy. Stride length, width, speed, and continuous relative phase (CRP) of the hips and of the shoulders were compared between carrying conditions. While both arms and legs demonstrated destabilization and stabilization throughout the gait cycle, the arms showed a reduction in intra-subject coordination variability in response to carrying an object. Carrying an object may modify the function of the arms from swinging for balance to maintaining hold of an object. The observed period-dependent changes of the inter-limb coordination of the hips and of the shoulders also support this interpretation. Overall, these findings support the view that whole-body coordination patterns may become partitioned in particular ways as a function of task requirements.     

The effects of predictability on inter-limb postural synchronization prior to bouts of postural instability

Anticipatory balance control optimizes balance reactions to postural perturbations. Predictive control is dependent on the ability of the central nervous system to modulate gain in accordance with specific task demands. Inter-limb synchronization is a sensitive measure of individual limb contributions to balance control and may reflect the coordination of gain modulation in preparation for instability. The purpose of the study was to determine whether gain modulation in advance of predictable bouts of instability was reflected in the extent of inter-limb synchronization. Two adjacent force plates were used to collect center of pressure (COP) data from 12 healthy young adults (27.5 ± 3.4 years). Participants prepared for internal and external balance perturbations using a cueing paradigm with three auditory warning tones followed by an imperative tone. Perturbations were delivered in blocked and randomized conditions with two perturbation magnitudes (small and large). Inter-limb synchrony was calculated using the cross-correlation function of the COP excursions from the left and right foot for three seconds prior to perturbation onset in the anteroposterior (AP) and mediolateral (ML) direction. Inter-limb synchrony decreased in the AP and ML directions as perturbation magnitude became more unpredictable. The need to take a step or not knowing whether a step was required prior to postural instability reduced ML inter-limb synchrony. No differences were found between internal and external perturbations. Modulation of postural set was evident in the extent of inter-limb synchrony.     

Finger coordination in persons with Down syndrome: atypical patterns of coordination and the effects of practice

The study addresses an issue of possible relations between the apparent "clumsiness" of persons with Down syndrome (DS) and changes in indices of finger coordination. We hypothesized that persons with DS would prefer less challenging, safer motor strategies reflected in finger coordination patterns. Maximal single- and multi-finger force production (MVC) tasks and multi-finger tasks that required the production of a controlled time pattern (ramp) of total force were studied. As compared to typical persons, persons with DS showed lower peak forces, lower force deficit (loss of finger force in multi-finger tasks as compared to single-finger tasks), and higher enslaving (involuntary force production by fingers that are not required to produce force). They showed higher variance of total force computed across several trials for ramp tasks. Their total force variance was higher than the sum of the variances of individual finger forces over the ramp duration, while in control participants the relation was opposite during the middle and late thirds of the ramp. Persons with DS practiced force production tasks over 3 days, one group practicing only one of the tasks (the ramp task with all four fingers acting together) while the other group practiced MVC and ramp tasks (variable practice). Practice led to an increase in MVC, force deficit, and enslaving. The relation between the total force variance and the sum of the variances of individual finger forces became closer to the one observed in typical persons. The effects of practice were more pronounced in the variable practice group. We conclude that persons with DS have a deficit in control of both single fingers and multi-finger groups. They use a less challenging, suboptimal strategy of multi-finger coordination which does not take advantage of the possibility of error compensation among the fingers. Practice is an effective way of improving finger coordination in DS, particularly when using variable tasks.     

Oculo-manual coordination control: respective role of visual and non-visual information in ocular tracking of self-moved targets

We evaluated the role of visual and non-visual information in the control of smooth pursuit movements during tracking of a self-moved target. Previous works have shown that self-moved target tracking is characterised by shorter smooth pursuit latency and higher maximal velocity than eye-alone tracking. In fact, when a subject tracks a visual target controlled by his own arm, eye movement and arm movement are closely synchronised. In the present study, we showed that, in a condition where the direction of motion of a self-moved visual target was opposite to that of the arm (same amplitude, same velocity, but opposite direction of movement), the resulting smooth pursuit eye movements occurred with low latency, and continued for about 140 ms in the direction of the arm movement rather than in the direction of the actual visual target movement. After 140 ms, the eye movement direction reversed through a combination of smooth pursuit and saccades. Subsequently, while arm and visual target still moved in opposite directions, smooth pursuit occurred in pace with the visual target motion. Subjects were also submitted to a series of 60 tracking trials, for which the arm-to-target motion relationship was systematically reversed. Under these conditions subjects were able to initiate early smooth pursuit in the actual direction of the visual target. Overall, these results confirm that non-visual information produced by the arm motor system can trigger and control smooth pursuit. They also demonstrate the plasticity of the neuronal network handling eye-arm coordination control.     

The coordination between trunk and arm motion during pointing movements

The coordination between the trunk and arm of six subjects was examined during unrestrained pointing movements to five target locations. Two targets were within arm's length, three were beyond. The trunk participated in reaching primarily when the target could not be attained by arm and scapular motion. When the trunk did contribute to hand transport, its motion started simultaneously with arm movement and continued until target contact. Redundancy in the degrees of freedom used to execute the movement had no effect on the configuration of joints and segments used to attain a specified target; no difference in variability was noted regardless of whether redundancy existed. However, different configurations were used to achieve the same wrist coordinates along a common endpoint path, depending on the final position of the hand. The addition of trunk flexion, rotation and scapular motion did not alter the coupling between the elbow and shoulder joints and had no effect on the path of the hand or the smoothness of its velocity profile. Thus, trunk motion was integrated smoothly into the transport phase of the hand. As the trunk's contribution to hand transport increased, it played a progressively greater role in positioning the hand close to the target during the terminal stage of the reach. Of the movement components measured, trunk flexion was the last component to complete its motion when target reaches were made beyond arm's length. Hence, the trunk not only acts as a postural stabilizer during reaching, but becomes an integral component in positioning the hand close to the target.     

Ingredients and change processes in occupational therapy for children: a grounded theory study

Background: There is limited evidence about the effectiveness of occupational therapy interventions for participation outcomes in children with coordination difficulties. Developing theory about the interventions, i.e. their ingredients and change processes, is the first step to advance the evidence base.

Aim: To develop theory about the key ingredients of occupational therapy interventions for children with coordination difficulties and the processes through which change in participation might happen.

Material and methods: Grounded theory methodology, as described by Kathy Charmaz, was used to develop the theory. Children and parents participated in semi-structured interviews to share their experiences of occupational therapy and processes of change. Data collection and analysis were completed concurrently using constant comparison methods.

Results: Five key ingredients of interventions were described: performing activities and tasks; achieving; carer support; helping and supporting the child; and labelling. Ingredients related to participation by changing children’s mastery experience, increasing capability beliefs and sense of control. Parents’ knowledge, skills, positive emotions, sense of empowerment and capability beliefs also related to children’s participation.

Conclusion and significance: The results identify intervention ingredients and change pathways within occupational therapy to increase participation. It is unclear how explicitly and often therapists consider and make use of these ingredients and pathway.     

Quantifying intra-limb coordination in walking of healthy children aged three to six

The aim of this study was first to quantify intra-limb coordination and then to explore the gender differences of 180 healthy children aged 3–6. The children's joint Euler angles and angular velocities were measured and were used to calculate the phase angle (PA) and continuous relative phase (CRP). Firstly, a portrait of the mean and standard deviation (SD) of PA and CRP was applied to quantify coordination in the knees and ankles; then five key events in walking were selected and their inter-age differences were assessed by One-way ANOVA. Finally, gender differences were evaluated by GLM-Univariate. The significance level was 0.05 and confidence interval was 95%. Our results show that similar portraits of PA and CRP were found for knees and ankles from age 3–6; SD demonstrated that the PA and CRP in the knees and ankles were consistent with the increase in age. Moreover, θ_CRP(K-A) demonstrated that the direction reversal in heels off of those two joints in children aged 5 and 6 was earlier than those of age 3 and 4 and no inter-age significant differences were recorded for PA and CRP in either gait event. Finally, gender differences exist before the age of six, particularly in the transition period such as heel contact, toe off and during the mid swing. Overall, although further development such as gait control or balance is still improving, basic principle of intra-limb coordination has formed by the age of 3 and gender differences already existed before age of 6.     

Acquisition of anticipatory postural adjustments in a bimanual load-lifting task: normal and pathological aspects

Anticipatory adjustments of forearm posture are associated with a voluntary load-lifting movement in bimanual load-lifting tasks. Three aspects of these adjustments are analyzed: their goal, their central organization, and their acquisition. The goal of the anticipatory adjustment in this task is to minimize the perturbation of forearm posture that occurs during unloading. The central organization is based on two parallel controls responsible, respectively, for the lifting movement of the moving forearm and the anticipatory postural adjustment of the postural forearm, their coordination depending on a central timing signal. The acquisition of the anticipatory postural adjustment was tested using a paradigm where the voluntary movement performed by one hand triggered, via an electronic switch, the load release of the postural forearm. It was achieved after 40–60 trials and was not graded as a function of the voluntary movement parameters, but of the disturbance of the postural arm about to occur. The learned anticipation was not transferred when, after a first acquisition session with one forearm as the postural forearm, a second learning session was performed with the other forearm as the postural forearm. The acquisition was tested in Parkinsonian and in hemiparetic patients with capsular lesion. The highest acquisition deficit was observed in hemiparetic patients, when the contralateral forearm was the postural forearm; the deficit was less important when the ipsilateral arm was postural. Surprisingly, the anticipatory postural adjustments in hemiparetic patients were rather well preserved when the natural load-lifting task was tested. These results suggest that the basal-ganglia SMA circuit and M1 premotor areas are important in the acquisition process. Received: 20 October 1998 / Accepted: 24 March 1999