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PubMed1998

Neural dynamics of short and medium-term motor control effects of levodopa therapy in Parkinson's disease.

A neural network model of movement control in normal and Parkinson's disease (PD) conditions is proposed to simulate the time-varying dose-response relationship underlying the effects of levodopa on movement amplitude and movement duration in PD patients. Short and long-term dynamics of cell activations and neurotransmitter mechanisms underlying the differential expression of neuropeptide messenger RNA within the basal ganglia striatum are modeled to provide a mechanistic account for the effects of levodopa medication on motor performance (e.g. the pharmacodynamics). Experimental and neural network simulation data suggest that levodopa therapy in Parkinson's disease has differential effects on cell activities, striatal neuropeptides, and motor behavior. In particular, it is shown how dopamine depletion in the striatum may modulate differentially the level of substance P and enkephalin messenger RNA in the direct and indirect basal ganglia pathways. This dissociation in the magnitude and timing of peptide expression causes an imbalance in the opponently organized basal ganglia pathways which results in Parkinsonian motor deficits. The model is validated with experimental data obtained from handwriting movements performed by PD subjects before and after medication intake. The results suggest that fine motor control analysis and network modeling of the effects of dopamine in motor control are useful tools in drug development and in the optimization of pharmacological therapy in PD patients.

Aged↗
PubMed2000

What's in a name? Lessening the confusion over drug names.

Confusion over the similarity of drug names, either written or spoken, accounts for approximately one-quarter of all reports to the U.S. Pharmacopeia (USP) Medication Errors Reporting (MER) program. This issue involves confusion between similar brand names, similar generic names, and similar brand and generic names. Such confusion is compounded by illegible handwriting, incomplete knowledge of drug names, newly available products, similar packaging or labeling, and incorrect selection of a similar name from a computerized product list.

Drug Therapy↗
PubMed2005

Medication errors and professional practice of registered nurses.

This Australian study identified and described the incidence of medication errors among registered nurses, the type and causes of these errors and the impact that administration of medications has on the professional practice of registered nurses. Mostly, medication errors were attributed to documentation issues, including: illegible handwriting, misunderstanding abbreviations, misplaced decimal point, misreading and misinterpreting written orders. Several human factors were attributed to potential causes of medication errors, including: stress, fatigue, knowledge and skill deficits. Environmental factors, namely, interruptions and distractions during the administration of medications, were also attributed to potential errors. The study found professional nursing practice involving administration of medications had a strong education, patient and ethical focus. Over a quarter of the respondents indicated that further training in medication administration would positively impact on their nursing practice. The registered nurses also highlighted they would appreciate more time to spend with patients when administering medications. Medication errors are not the sole responsibility of any single professional group, therefore, collaboration with other health professionals is central to establishing processes, policies, strategies and systems that will reduce their occurrence. The organisation and those nurses employed within it share an accountability to ensure safe administration of medications to patients. Based on study results, several recommendations are directed towards preventing or reducing medication errors and supporting nurses in providing best practice.

Attitude of Health Personnel↗
PubMedDate not supplied

Forensic hair morphology comparison--a dying art or junk science?

There has been debate in both the judicial and forensic fields concerning the admissibility and reliability of the so-called forensic comparison sciences such as handwriting, tool mark analyses, and hair analysis. In particular, there has been increasing controversy over the use and interpretation of hair comparison evidence and it has been held partly responsible for miscarriages of justice. There has also been a perceived devaluation of the worth of microscopic human hair analysis particularly since the advent of DNA profiling. This article will attempt to initiate discussion on the past, current and future role of forensic human hair analysis and comparison.

Attitude↗
PubMed2006

Terminology used in research reports of developmental coordination disorder.

A systematic search was performed of all articles from January 1995 to December 2005 published in peer-reviewed journals on children with developmental coordination disorder (DCD). Criteria were applied to ensure that articles included DCD so 319 articles were included in the analysis. Since the publication of a systematic search conducted in 1994, the number of publications in this field has greatly increased across countries and disciplines. The term DCD was used in 52.7% of the articles. Other terms were used less frequently: clumsy children (7.2%), developmental dyspraxia (3.5%), handwriting problems (3.1%), hand-eye coordination problems (2.8%), sensory integration dysfunction (2.5%), deficits in attention, motor control, and perception (2.5%), minor neurological dysfunction (2.2%), and several other scattered terms (23.5%). The data indicated that progress has been made in the usage of the term DCD, but a standardized approach has not yet been achieved. Without consistent use of the term DCD, there is limited communication of research results internationally, slowed progress in understanding the condition, and limited development of intervention and management programmes for children with DCD.

Child↗
PubMed1999

Specific muscle EMG biofeedback for hand dystonia.

Currently available therapies have only limited success in patients having hand dystonia (writer's cramp). We employed specific muscle EMG biofeedback (audio feedback of the EMG from proximal large muscles of the limb that show abnormally high activity during writing) in 10 of 13 consecutive patients (age, 19-62 years; all males) with a duration of illness from 6 months to 8 years. In three patients, biofeedback was not applicable due to lack of abnormal EMG values. Nine patients showed dystonic posture during writing and had hypertrophy of one or more large muscles of the dominant hand. The remaining four patients showed either involvement of small muscles or muscle wasting. Ten patients were given four or more sessions of EMG audio biofeedback from the proximal large limb muscles, which showed maximum EMG activity. They also practiced writing daily with the relaxed limb for 5 to 10 min. Nine patients showed improvement from 37 to 93% in handwriting, alleviation of discomfort, and pain (assessed on a visual analogue scale). One patient did not show any improvement. Thus EMG biofeedback improved the clinical and electromyographic picture in those patients with hand dystonia who showed EMG overactivity of proximal limb muscles during writing. This specific type of EMG biofeedback appears to be a promising tool for hand dystonia and might also be applied to other types of dystonias.

Adult↗
PubMed1980

A computer-based therapy for the treatment of aphasic subjects with writing disorders.

A computer-controlled rehabilitation for aphasics with writing impairments is presented. Subjects were asked to type words under dictation. Each time a letter was typed in its correct position, it was displayed on a screen. If the contrary, the error was not displayed, thus avoiding visual reinforcement of false choices. This method of rehabilitation has proved efficient as concerns typewriting. More importantly, some learning transfer to handwriting was observed at the completion of experimental training. The results showed a significant reduction in the number of misspelled words as well as in the erroneous choice and serial ordering of letters. The stability of the observed improvement is discussed in relationship to variables such as the time elapsed since brain damage and the type of writing difficulty.

Adult↗
PubMed2003

Sequencing, co-ordination and rhythm ability in young children.

BACKGROUND: Sequencing ability is recognized as a fundamental component in motor co-ordination, language and reading performance. METHODS: Sequencing relationships are studied in a sample of 1013 children selected from an existing data set of 3750. Associations are analysed between scores for motor co-ordination tasks and a rhythm repetition task performed in the routine school beginners' medical examination by 4-, 5- and 6-year-old children, and class teachers' assessment of their co-ordination activities and language performance when 6, 7 and 8 years old, together with scores for a routine reading test. RESULTS: Associations are reported between motor tasks and language and reading, and between rhythm repetition and co-ordination activities, language and reading. Associations between successive motor tasks and language and reading are found to be stronger in boys, and those between hopping and reading stronger in girls. Associations between the rhythm repetition task and co-ordination activities, language and reading are also all found to be stronger in girls. DISCUSSION: Discussion finds a place for ball-catching as a sequencing task, and for sequencing ability as a component of handwriting skills. Discussion also attributes the findings of gender differences to an experiential difference in play activity, and advances a variant of the rhythm repetition task for use in further exploration of sequencing ability in young children.

Child↗
PubMed1999

Pharmacist's attitudes towards dispensing errors: their causes and prevention.

OBJECTIVE: To assess the attitudes of pharmacists towards the issue of dispensing errors. METHOD: A postal survey was undertaken among all Tasmanian-registered pharmacists residing in Australia. The anonymous questionnaire sought opinions on whether the risk of dispensing errors and the actual numbers of errors are increasing, the major factors contributing to the occurrence of dispensing errors, factors that can best minimize the risk of dispensing errors, the number of prescription items that one pharmacist can safely dispense in a day and whether Australia should have a regulatory maximum dispensing load, and an estimation of the number of recent errors at the pharmacist's workplace. RESULTS: Completed questionnaires were received from 209 pharmacists (50% response rate). Most pharmacists (82%) believed that the risk of dispensing errors is increasing. The principal contributing factors nominated were: high prescription volumes, pharmacist fatigue, pharmacist overwork, interruptions to dispensing, and similar or confusing drug names. The main factors identified as being important in reducing the risk of dispensing errors were: having mechanisms for checking dispensing procedures, having a systematic dispensing workflow, checking the original prescription (duplicate) when dispensing repeats, improving the packaging and labelling of drug products, having drug names that are distinctive, counselling patients at the time of supply, keeping one's knowledge of drugs up-to-date, avoiding interruptions, reducing workloads on pharmacists, improving doctors' handwriting, and privacy when counselling patients. Most pharmacists (72%) stated that they were aware of dispensing errors that had left the pharmacy undetected, in their place of practice during the past 6 months. The median number of such dispensing errors that they were aware of was three. A median of 150 was nominated as the maximum number of prescription items that can be safely dispensed per 9-h day (i.e. 17 items per hour) by or in the presence of one pharmacist. Most pharmacists (58%) stated that there should be a regulatory guideline for the safe dispensing load in Australia. CONCLUSION: Dispensing errors are occurring in numbers well above reports to regulatory authorities or professional indemnity insurance companies, and seem to be accepted as part of practice. High prescription volumes, pharmacist fatigue and overwork appear to be important factors. The profession needs to be proactive and standards must be set appropriately high (i.e. zero error tolerance).

Adult↗
PubMed2001

Upper-limb function in Australian children with traumatic brain injury: A controlled, prospective study.

OBJECTIVE: To describe upper-limb function in children with mild and severe traumatic brain injury (TBI), by using both quantitative and qualitative measures. DESIGN: Controlled, prospective cohort study with assessment points initially, at 6 months, and at 2 years after TBI. SETTING: A tertiary pediatric trauma center in Australia. PATIENTS: Fifty-one children, ranging in age up to 14 years, who were consecutive admissions with TBI. On the basis of initial and persisting abnormal coma score and persistence of posttraumatic amnesia, they were assigned to either a mild (n = 26) or a severely injured (n = 25) group. Thirty children admitted with non-TBI trauma were recruited as a control group. MAIN OUTCOME MEASURES: Quantitative measures included Bruininks-Oseretsky Test of Motor Proficiency and Peabody Developmental Motor Scales. Qualitative measures included Brunnstrom Recovery Stages (adapted), categoric scales of muscle tone, grasp used when handwriting, quality of writing product, bilateral activity, and splint use. RESULTS: There was little difference between the groups on the standardized assessments for subjects who could complete the tests. Qualitative measures showed the severe TBI group to have more difficulties with gross arm control, hand control, and hand function. CONCLUSION: Children with severe TBI experience more and persisting difficulties with upper-limb function. It is essential to include both quantitative and qualitative measures in this type of research.

Adolescent↗
PubMed1975

[Psychometric effects of perphenacine below the "neuroleptic threshold" (author's transl)].

The extrapyramidal-motorical side effects of neuroleptic drugs are preceded by subtle symptoms, the assessment of which is dependent on the methods used. For the evaluation of several such methods of assessment we compared the results of the handwriting test (Haase, 1969) with EMG-measurements of the silent period and psychometric measurement of aiming-, tapping-, and reaction-time-tests. Twenty normal subjects were tested four times in a double blind study in order to control the short- and long-term effects of a low dosage of perphenacine. Slight but significant drug-dependent changes were found, such as decreases of steadiness and of the speed of arm-hand-movements. From the theoretical point of view these results support a dimensional approach rather than an explanation in terms of a categorial approach as it is suggested by the commonly used notion "neuroleptic threshold".

Adult↗
PubMed1990

The use of hypnosis in a deaf patient with multiple personality disorder: a case report.

We present the first report of multiple personality disorder (MPD) in a prelingually deaf patient and the first description of alter personalities as the source of auditory hallucinations in a nonpsychotic deaf person. This young woman's history and clinical symptoms of MPD did not differ from those of hearing patients. A hypnotic trance was induced by instructing the patient in muscle relaxation, modeling relaxation with exhalation, and having the patient focus her gaze on the hypnotist repeatedly fingerspelling R-E-L-A-X. Hypnosis facilitated automatic handwriting, allowed the first meeting with an alter personality, and speeded the diagnostic process. Fingerspelling has not previously been reported in hypnosis of the deaf. It is a practical means of induction for a therapist who lacks fluent signing skills. It provides a narrow fix of gaze and avoids induction by physical stimulation, a process that some abused patients find upsetting.

Adult↗
PubMed2000

Text entry on handheld computers by older users.

Small pocket computers offer great potential in workplaces where mobility is needed to collect data or access reference information while carrying out tasks such as maintenance or customer support. This paper reports on three studies examining the hypothesis that data entry by older workers is easier when the pocket computer has a physical keyboard, albeit a small one, rather than a touch-screen keyboard. Using a counter-balanced, within-subjects design the accuracy and speed with which adults over 55 years of age could make or modify short text entries was measured for both kinds of pocket computer. The keyboard computer was the Hewlett Packard 360LX (HP), but the touch-screen computers varied across studies (experiment 1: Apple Newton and PalmPilot; experiment 2: Philips Nino; experiment 3: Casio E10). All studies showed significant decrements in accuracy and speed when entering text via the touch-screen. Across studies, most participants preferred using the HP's small physical keyboard. Even after additional practice with the touch screen (experiments 2 and 3) many entries still contained errors. Experiment 3 showed that younger people were faster but not more accurate than older people at using the touch-screen keyboard. It is concluded that satisfactory text entry on palm-size computers awaits improvements to the touch-screen keyboard or alternative input methods such as handwriting or voice. Interface developments that assist older people typically benefit younger users too.

Aged↗
PubMed1982

Explorations of individual differences relevant to high level skill.

Past research has uncovered few broad abilities that underlie high skill. In this paper, attempts to isolate three different abilities of potential relevance to skill are described. No evidence was found for a general time-sharing ability in common to different kinds of tasks. Modest evidence was found for a trait of attentional flexibility. That trait could potentially be of use in predicting success for skills that require rapid shifts of attention because of rapidly changing task demands. Finally, the rate of repetitive activity is correlated across different muscle groups. For example, finger tapping speed is correlated with foot tapping speed, suggesting a common rate limiting factor. In turn, those rates predict handwriting speed and, according to Book (1924), championship typing.

Journal Article↗
PubMed1987

Quantitative assessment of infant reaching movements.

We have identified a fundamental property of human motor behavior as a tight coupling of the curvature-speed relationship in the reaching movements of 5- to 9-month-old infants. This relationship termed a movement unit, occurs regardless of the distance of duration of the reach and in spite of the developmental change that occurs in grasping during this period. Movement unit durations are tightly clustered around 200 ms regardless of overall duration or distance or the position of the unit in the reach. The curvature-speed coupling has been identified by others in adult reaching and handwriting. Models of biological motor control must account for this invariant relationship.

Journal Article↗
PubMed2001

Hand-arm vibration exposure influences performance of daily activities.

PURPOSE: Although much research has been performed on the effects of vibration on nerves, muscles and vascular structures, little is known of the effects that vibration exposure to handheld tools can give on the ability to perform activities of daily living. The objective of the present study was to analyse the consequences of vibration exposure on performance of daily activities. METHOD: In a total group of 105 exposed male workers, a standardized self-administered ADL questionnaire, the EDAQ including 102 activity items plus 22 diagnosis-specific activity items, was filled out. RESULTS: Forty-four workers (42%) expressed one or more difficulties in performing daily activities in the total study group. The data demonstrated that pain and reduced grip force showed a strong correlation with difficulties in performing daily activities. CONCLUSION: Working in a cold environment, using vibrating machines. handwriting, picking up small objects, opening lids, lifting and carrying were activities perceived as most difficult to accomplish.

Activities of Daily Living↗
PubMed2001

Lateral preference patterns as possible correlates of successfully switched left hand writing: data and a theory.

Left-handers often have had to contend with pressure to switch their preferred writing hand and shift attempt reports are common, especially among older adult left-handers. Three groups of left-handers can be defined by combining two variables, writing hand side and the report of a rightward hand preference shift attempt. The three groups are, first, right hand writers who report a rightward shift (successfully shifted left-handers); second, left hand writers who report a rightward shift attempt (unsuccessfully shifted left-handers); and, finally, left hand writers who do not report a rightward shift attempt. The underlying mechanisms that determine the success or failure of a handwriting shift attempt remain unclear. The present study examined the history of attempts to switch the preferred writing hand in a sample of 1277 adults aged 65 to 100 years of age. Older adults are well suited to participate in such a study because pressure to switch hand preference was especially severe for those who grew up in the early part of the 20th century; reports of rightward shift attempts are more common in this age group than among younger adults. Our results suggest that the three groups of left-handers, distinguished by the presence or absence of a shift history report and writing hand side, can also be distinguished from each other on the basis of their overall lateral preference profiles (the sides of hand, foot, eye, and ear preferences). Left hand writers, with and without reports of a rightward shift history, showed stronger left side lateralisation patterns when compared to right hand writers who reported a rightward switch (the successfully shifted left-handers).

Journal Article↗
PubMed2003

In vitro training program to improve ambidextrous skill and reduce physical fatigue during laparoscopic surgery: preliminary experience.

PURPOSE: We illustrate the preliminary experience with our planned intensive in vitro training program focused on the nondominant hand and reducing physical fatigue. Apart from this, we tried to calculate how much training is required for a novice urologist to master laparoscopic freehand suturing with the dominant and nondominant hands. MATERIALS AND METHODS: Between December 2001 and May 2002, one trainee worked on a Pelvi-trainer, first with the dominant (right) hand and then with the left hand, practicing intracorporeal suturing and cutting and improving physical endurance by gradually increasing the duration of each training session. Along with the Pelvi-trainer, he worked on left-handed writing to improve wrist movements. Before starting this training, he did not have any laparoscopic experience as assistant or primary surgeon. The progress was stored in the computer prospectively to compare the results with those obtained at the end of the training. RESULTS: For the dominant hand, 30 hours over 2 months was required to master laparoscopic suturing skills. After training of the right hand, the nondominant hand required 40 hours of Pelvi-trainer work and 20 hours of handwriting during 2 months. Physical endurance for suturing in the Pelvi-trainer increased from 15 minutes to 150 minutes over 3 months. The main improvement was in the degree of pain over the right shoulder (because of the abducted position) and backache. CONCLUSION: Incorporation of sufficient in vitro training to improve nondominant hand functioning and reduce physical fatigue can make adaptation to laparoscopic surgery easier.

Clinical Competence↗