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PubMed1970

The effects of token procedures on a teacher's social contacts with her students.

The effects of a token system on a teacher's rate of social contacts with her students were investigated in a public school kindergarten. A group of six children were observed daily during a 20-min handwriting lesson. The children were divided into two groups (A and B) of three children each. Five conditions were imposed sequentially: (1) baseline without tokens, (2) contingent tokens for Group A, noncontingent tokens for Group B, (3) contingent tokens for Group B, noncontingent tokens for Group A, (4) reinstatement of condition 2, and (5) contingent tokens for both groups. It was consistently observed that the teacher's rate of social contact was higher with the children receiving the contingent tokens than with those who received noncontingent tokens.

Journal Article↗

PubMed1972

The use of programmed materials in the analysis of academic contingencies.

Programmed handwriting materials were used to examine the effects of different reinforcement contingencies on the academic performance of six public school kindergarten children. The children's responses to these materials provided an educationally relevant dependent variable for the analysis of factors that affected the accuracy of their responses and the attainment of criterion performances. Variations in the complexity of most academic materials, which confound the analysis of contingencies, were eliminated by the programmed sequence so that the differential effects of three reinforcement conditions were observed. The three conditions were: baseline without tokens, tokens contingent on correct writing responses, and noncontingent tokens. It was consistently observed that the children were more accurate when their correct responses produced tokens, and that noncontingent tokens reduced accuracy below baseline levels.

Journal Article↗

PubMed1972

Intrinsic reinforcers in a classroom token economy.

An inexpensive, easily managed token economy was used in a normal classroom for one academic year, and data were collected for the entire academic performance in spelling, language, handwriting, and math for that year. During a baseline period, assignment completion was variable. The introduction of a token economy with a point exchange every five days increased assignment completion and decreased variability of performance. An application of a token economy that had a point exchange averaging four days was accompanied by an assignment completion rate that approximated 100%. A reinforcement contingency for which quiet behavior rather than for assignment completion was eased quiet behavior was accompanied by a marked diminution of assignment completion. A reintroduction of the token reinforcement for assignment completion system increased assignment completion again.

Journal Article↗

PubMed2003

Medication errors caused by confusion of drug names.

Many drug names can look or sound like other drug names, which leads to confusion and potentially harmful medication errors. While various types of drug names exist, brand (proprietary) names are most commonly confused. Examples of the numerous drug names that have been confused because they look and/or sound similar include Celebrex (celecoxib), Cerebyx (fosphenytoin), and Celexa (citalopram). Factors such as poor handwriting and clinical similarity may exacerbate the problem. This problem can be alleviated through actions by regulatory agencies, pharmaceutical manufacturers, healthcare professionals, and patients. To address the problem, significant changes in the pharmaceutical regulatory process have occurred in the US and Europe.

Clinical Pharmacy Information Systems↗

PubMed2000

Early Parkinson's disease: what is the best approach to treatment.

Early and correct diagnosis and treatment of Parkinson's disease (PD) are crucial for the patient's well being. At the first visit, it is important to deal with the patient's misconceptions of the disease and its course, to offer sources of information and to suggest exercises. To make a correct initial diagnosis of PD we need to assess the course of the initial levodopa responsiveness. The most frequent challenges in diagnosing PD are the conditions of essential tremor and multiple system atrophy. PD has 3 stages of development: (i) early--from the onset of symptoms to the appearance of motor fluctuations; (ii) middle--from motor fluctuations to the appearance of moderate-to-severe disability; and (iii) advanced--when moderate-to-severe disability is present. The medical treatment of early PD should be started when functional disability appears, which is a different threshold for each patient. For patients below 65 years old, or above 65 years old but with preserved mental function and with no severe comorbidity, initial monotherapy with a dopamine agonist is advisable. This approach appears to delay the appearance and reduce the amount of late motor complications with subsequent levodopa treatment. All dopamine agonists have similar efficacy, which is less than that of levodopa. It is important to consider the adverse effect profile when a choice for initial or adjunctive therapy is made. When levodopa therapy is started as an adjunct in younger patients or as initial monotherapy in older patients, sustained-release levodopa preparations are preferred. They have a longer half-life and possibly stimulate the dopamine receptors more continuously. Anticholinergic drugs are appropriate for younger patients with tremor-dominant PD. Amantadine is mainly used for dyskinesia control. Catechol-O-methyl-transferase inhibitors and neurosurgery are not treatments of choice for early PD but can be very effective for more advanced disease. The presence of presymptomatic markers of PD, such as changes in odour detection, handwriting, speech, movement time of self-initiated motor acts, personality traits, presence of antibodies against dopaminergic neurons, pattern of positron emission tomography results, appearance of mitochondrial DNA mutation profiles, etc., appear to be very important in the light of the emerging neuroprotective therapies. Neuroprotection is aimed at slowing the rate of disease progression. Selegiline has been shown to cause a mild delay in the need for levodopa, possibly suggesting some protection. However, this initial benefit was not sustained in long term studies. Currently, there is no neuroprotective drug for PD.

Animals↗

PubMedDate not supplied

[A rapid detection of motor block in patients with Parkinson disease during volitional movements of the hand].

INTRODUCTION: An algorithm to study hand movements in patients with Parkinson's disease (PD) who experience temporary, involuntary inability to move a hand have been developed. In literature, this rather engimatic phenomenon has been described in gait, speech, handwriting and tapping, and noted as motor blocks (MB) or freezing episodes. Freezing refers to transient periods in which the voluntary motor activity being attempted by an individual is paused. It is a sudden, unplanned state of immobility that appears to arise from deficits in initiating or simultaneously and sequentially executing movements, in correcting inappropriate movements or in planning movements. The clinical evaluation of motor blocks is difficult because of a variability both within and between individuals and relationship of blocks to time of drug ingestion. In literature the terms freezing, motor block or motor freezing are used in parallel. AIM: In clinical settings classical manifestations of Parkinson's Disease (akinesia, bradykinesia, rigidity, tremor, axial motor performance and postural instability) are typically evaluated. Recently, in literature, new computerized methods are suggested for their objective assessment. We propose monitoring of motor blocks during hand movements to be integrated. For this purpose we have developed a simple method that comprises PC computer, digitizing board and custom made software. Movement analysis is "off line", and the result is the data that describe the number, duration and onset of motor blocks. METHOD: Hand trajectories are assessed during simple volitional self paced point-to-point planar hand movement by cordless magnetic mouse on a digitizing board (Drawing board III, 305 x 457 mm, GTCO Cal Comp Inc), Fig. 1. Testing included 8 Parkinsonian patients and 8 normal healthy controls, age matched, with unknown neurologic motor or sensory disorders, Table 1. Three kinematic indicators of motor blocks: 1) duration (MBT%); 2) onset (t%); and 3) number (N) of MB episodes, allow identification and quantification of motor blocks. Duration of motor blocks (MBT) is defined as the time sequence when (x,y) coordinates do not change their values and is expressed in percentage from the whole movement duration MBT% = MBT/T (%). If during some movements more than one motor block occurs (N > 1) then this movement is decomposed. The whole movement motor block (mbt) is the sum of all motor blocks MBT; during the same movement and expressed in percentage from the whole movement duration mbt% = mbt/T (%). The onset of motor block (t) is determined with the beginning of motor block and expressed in percentage from the whole movement duration: t% = t/T (%). After the determination of kinematic indicators of motor blocks (MBT, N, t) for healthy controls, their mean values are calculated. Statistical package ANOVA is applied to determine statistical significance of the difference between PD patients and mean values from age matched control healthy group. PD patients are then classified into two groups: one group consisting of PD patients with motor blocks and the other without motor blocks, similar to healthy controls. RESULTS: Acquired movements are processed and analyzed. Fig. 2 is an example of hand trajectories. Time course of (x, y) coordinates indicates motor block appearance, Fig. 3. Detailed presentation of kinematic indicators of motor block (MBT, N, t) is in Fig. 4. Intra-subject variability of these parameters is presented in Figs 5, 6 and 7 for patient #3. The results for N show that 45% of all patients #3 movements had none motor blocks (N = 0); 20% had N = 1; 15% had N = 2; 11.5% had N = 3; 5.7% had N = 4; 0.3% had N = 5; 0.7% had N = 6; 0.3% had N = 7 and 1% had N = 8 motor blocks. The results for t% show that 3% of all patients' #3 blocks started at first quarter, 17% started in the second, 36% in the third, and 44% in the last quarter of movement. The results for MBT% show that 14.5% of all movements had MBT% in the range 0-5%; 56% had MBT% 5-10%; 22% had MBT% 10-15%; 5.5% had MBT% 15-20% and 2% had MBT% 20-25%. No block lasted more than 25% from the whole movement duration. Table 2 is the summary of mean variability for kinematic indicators of motor block (N, mbt%, t%) and for the movement duration T during a 7 day-testing of patients #3. The analysis of calculated data for eight tested PD patients revealed a significant difference (p < 0.01) between healthy controls and three PD patients; data on five PD patients were not significantly different (ns). This method clustered 3 PD patients in the group that experience motor blocks, while the rest were in the group without their significant occurrence. DISCUSSION: This algorithm is an additional instrument in classical evaluation of PD patients during their clinical evaluation and treatment. It provides to clinician a rapid feedback on the changes of voluntary hand movements in everyday progress of illness. Furthermore, this method could be of assistance for developing strategies to overcome motor blocks in arm movements at their beginning, as well as for the feedback of the success of drug therapy.

Adult↗

PubMed1998

Pressure, velocity, and time in speeded drawing of basic graphic patterns by young children.

Bender Gestalt cards of Pascal and Suttel, simplified by the author, and basic graphic patterns used in neuropsychological assessment by Mai and Marquardt were used in a speeded copying task. Children between 4 and 6 years were drawing with a wireless pen on a pressure-sensitive graphic tablet linked to a computer. Hand pressure, velocity of hand movements, drawing time and penlifts were measured by a CS handwriting analyses software package. Planned comparisons were carried out between developmentally earlier emerging graphic forms and patterns that are mastered later in development. It was shown that for 6-yr.-olds pressure was increased which might indicate a generally higher tension when drawing. Specifically, angular forms were copied with more pressure, but needed less drawing time than round forms. Moreover, children needed more time for penlifts to adjust for a starting point that changed from left to right when drawing vertical lines than horizontal ones. Reduced speed of drawing was more important when copying open forms than closed shapes. In denotation of spatial position no differences were found. It is concluded that the analysis of psychophysical measures of drawing gives important clues about the specific problems produced by relatively basic graphic patterns.

Child↗

PubMed1999

Visuomotor perception in children with attention deficit hyperactivity disorder--combined type.

Children with Attention Deficit Hyperactivity Disorder--Combined Type (ADHD-CT) defined by behavioral characteristics of inattention, impulsivity, and hyperactivity including weaknesses in fine motor coordination and poor motor inhibition frequently exhibit poor handwriting and penmanship. Performance of children on visuomotor tasks is further complicated, as most studies have not excluded children with specific learning disabilities who are known to do poorly on these tests. This study was designed to examine the performance of children diagnosed with this disorder, without learning disabilities on visuomotor tasks. 26 preadolescent patients were administered a battery of tests that included the Bender-Gestalt, Conners' Parent Rating Scale, Continuous Performance Task, and Wide Range Achievement Test-Third Edition Scores on the Bender-Gestalt test averaged significantly lower than Koppitz normative data. This study lends support to the hypothesis that ADHD-CT children without learning disabilities exhibit deficits on tasks requiring visuomotor perception.

Achievement↗

PubMed2002

Long-term predictive validity of the Miller assessment for preschoolers.

The purpose of this study was to examine the predictive validity of the Miller Assessment for Preschoolers in a sample of children in Israel. 30 children (M age 7 yr., 8 mo.) were selected from a group of typical children registered in 4 Mother and Child Health Care Centers in central Israel; they were originally tested as preschoolers (M age 3 yr., 10 mo.) on this procedure. They were retested after an interval of 5 to 7 yr. on academically related tests. Correlations between the Total scores and most of the follow-up test scores indicate significant correspondence (.41-.70). Regression analysis indicated that visuomotor integration and handwriting accounted for 58% of the variance. These results contribute to the empirical evidence regarding the predictive abilities of this procedure and indicate its validity cross-culturally over an extended follow-up interval of 5 to 7 yr.

Aptitude Tests↗

PubMed2003

Predicting performance in primary school subjects.

Correlations among letter naming, word reading, letter writing, and visual-motor integration scores at school start in Grade 1 and reading, spelling, and handwriting scores at the end of Grades 2 and 5 obtained in a longitudinal design for 217 boys and 190 girls entering Grade 1 at the age of 7 years are reported. The correlations between letter naming, word reading, and letter writing and reading and spelling in Grades 2 and 5 fall in the ranges .51 < or = r < or = .62 and .43 < or = r < or = .50, respectively (alpha = .01). For all other correlations (r < .40) alpha = .01.

Child↗

PubMed1987

Neuroelectric correlates of a neuropsychological model of word decoding and semantic processing in normal children.

The use of event-related potentials (ERPS) as a technique in the study of word decoding and semantic processing in the cerebral cortex was investigated. Ten right-handed boys, aged between nine and eleven, with adequate school performance were studied. Visual ERPS were obtained using four derivations: occipital (O1-O2) and parietal (P3-P4). Four stimuli were presented: a frequently used noun written in capitals; the same noun in handwriting; the pictorial representation of this noun (drawing); and a pattern consisting of a checkerboard (25 squares). The data were analyzed using multivariate procedures. A Principal Component Analysis with varimax rotation of the solution was applied. Concepts about reading contributed by cognitive psychology, neuropsychology and neurophysiological research are reviewed, and a hypothetical model of the neuronal bases underlying the act of reading is presented. This model emphasizes the complex, dynamic interplay of the neural structures involved and points to the differences which probably exist between beginning and fluent readers. The results are discussed in accordance with the proposed model.

Brain↗

PubMed1996

Freezing of gait in Parkinson's disease is improved by treatment with weak electromagnetic fields.

Freezing, a symptom characterized by difficulty in the initiation and smooth pursuit of repetitive movements, is a unique and well known clinical feature of Parkinson's disease (PD). It usually occurs in patients with long duration and advanced stage of the disease and is a major cause of disability often resulting in falling. In PD patients freezing manifests most commonly as a sudden attack of immobility usually experienced during walking, attempts to turn while walking, or while approaching a destination. Less commonly it is expressed as arrest of speech or handwriting. The pathophysiology of Parkinsonian freezing, which is considered a distinct clinical feature independent of akinesia, is poorly understood and is believed to involve abnormalities in dopamine and norepinephrine neurotransmission in critical motor control areas including the frontal lobe, basal ganglia, locus coeruleus and spinal cord. In general, freezing is resistant to pharmacological therapy although in some patients reduction or increase in levodopa dose may improve this symptom. Three medicated PD patients exhibiting disabling episodes of freezing of gait are presented in whom brief, extracerebral applications of pulsed electromagnetic fields (EMFs) in the picotesla range improved freezing. Two patients had freezing both during "on" and "off" periods while the third patient experienced random episodes of freezing throughout the course of the day. The effect of each EMFs treatment lasted several days after which time freezing gradually reappeared, initially in association with "off" periods. These findings suggest that the neurochemical mechanisms underlying the development of freezing are sensitive to the effects of EMFs, which are believed to improve freezing primarily through the facilitation of serotonin (5-HT) neurotransmission at both junctional (synaptic) and nonjunctional neuronal target sites.

Aged↗

PubMed1997

Immediate recovery of cognitive functions and resolution of fatigue by treatment with weak electromagnetic fields in a patient with multiple sclerosis.

Cognitive deficits are common among patients with multiple sclerosis (MS). The pathogenetic mechanisms underlying the cognitive impairment in MS are unknown and there is presently no effective therapeutic modality which has shown efficacy in improving cognitive deficits in MS. A 53 year old college professor with a long history of secondary progressive MS experienced, over the preceding year, noticeable deterioration in cognitive functions with difficulties in short and long term memory, word finding in spontaneous speech, attention and concentration span. Unable to pursue his academic activities, he was considering early retirement. Mental examination disclosed features of subcortical and cortical dementia involving frontal lobe, left hemispheric and right hemispheric dysfunction. Almost immediately following the extracerebral application of AC pulsed electromagnetic fields (EMFs) of 7.5 picotesla intensity and a 4-Hz sinusoidal wave, the patient experienced a heightend sense of well being, which he defined as enhancement of cognitive functions with a feeling "like a cloud lifted off my head." He reported heightend clarity of thinking and during the application of EMFs he felt that words were formed faster and he experienced no difficulty finding the appropriate words. His speech was stronger and well modulated and he felt "energized" with resolution of his fatigue. There was improvement in manual dexterity and handwriting and testing of constructional praxis demonstrated improvement in visuospatial, visuoperceptive and visuomotor functions. It is suggested that some of the cognitive deficits associated with MS, which are caused by synaptic disruption of neurotransmitter functions, may be reversed through pulsed applications of picotesla range EMFs.

Cognition Disorders↗

PubMed1984

Record keeping in Norwegian general practice.

Routines of medical record keeping were studied in a random sample of 50 out of 228 general practitioners in two counties, Möre & Romsdal and Sör-Tröndelag. One doctor refused to participate and one had retired. The 48 physicians were interviewed and a questionnaire was completed with details about their record keeping. The standard of the records was assessed according to legibility, quality of notes, past history and tidiness using a score system. All general practitioners had records for every patient, but the quality of the records varied considerably. More than 50 per cent used handwriting in progress notes, which varied from diagnostic labels to extended reports. Few records contained accessible background information about the patient concerned, and many records contained large amounts of old and irrelevant papers. The record-scores varied from 3 to maximum 10 with an average of 6.7. Higher Standards of recording in general practice are called for, since the quality of records does not only affect the individual patient, but, in the end, the quality of medical care in general.

Adult↗

PubMed2005

Tablet computers in the veterinary curriculum.

Tablet computers offer a new method of information management in veterinary medical education. With the tablet computer, students can annotate class notes using electronic ink, search for keywords, and convert handwriting to text as needed. Additional electronic learning resources, such as medical dictionaries and electronic textbooks, can be readily available. Eleven first-year veterinary students purchased tablet computers and participated in an investigation of their working methods and perceptions of the tablet computer as an educational tool. Most students found the technology useful. The small size and portability of the tablet allowed easy transport and use in a variety of environments. Most students adapted to electronic notetaking by the second week of classes; negative experiences with the tablet centered on a failure to become comfortable with taking notes and navigating on the computer as opposed to writing and searching on paper. A few performance-related problems, including short battery life, were reported. Tablet software allowed conversion of faculty course notes from a variety of original formats, meaning that instructors could maintain their original methods of note preparation. Adopting a consistent naming convention for files helped students to locate the files on their computers, and smaller file sizes helped with computer performance. Collaboration between students was fostered by tablet use, which offers possibilities for future development of collaborative learning environments.

Attitude to Computers↗

PubMed2003

A waitlist control-group study of cognitive, mood, and quality of life outcome after posteroventral pallidotomy in Parkinson disease.

OBJECT: The aim of this study was to examine neuropsychological outcome from unilateral posteroventral pallidotomy (PVP) in Parkinson disease while controlling for confounding factors such as test practice and disease progression. METHODS: Participants underwent baseline and 2-month follow-up assessments of cognition, quality of life, mood, and motor functioning. The surgery group (22 patients) underwent PVP (15 left, seven right) after baseline assessment. The waitlist group (14 patients) underwent PVP after follow up. At follow up, the left PVP group exhibited a decline on verbal measures of learning, fluency, working memory, and speeded color naming. The incidence of significant decline on these measures after left PVP ranged from 50 to 86%. The right PVP group did not exhibit a significant cognitive decline, but fluency did decline in 71% of patients who underwent right PVP. Participants who underwent PVP reported better bodily pain and social functioning at follow up than participants in the waitlist group. Improved bodily pain was evident for 62% of the surgery group, and social functioning improved for 19%. Surgery did not alter reported physical functioning or mood. Dyskinesia improved after surgery, but there were no improvements in "on-state" manual dexterity or handwriting. CONCLUSIONS: Most patients who underwent left PVP exhibited declines in learning, fluency, working memory, and speeded color naming. Accounting for retesting effects altered the magnitude of these declines by up to one quarter of a standard deviation, but did not increase the breadth of postsurgical neuropsychological decline beyond that typically reported in the literature. It was found that PVP improved dyskinesia, bodily pain, and social functioning, but did not lead to improvement on other objective and self-reported measures of motor functioning.

Aged↗

PubMed2004

Stimulation of the subthalamic region for essential tremor.

OBJECT: The goal of this study was to determine the safety and efficacy of bilateral subthalamic region stimulation in the treatment of essential tremor (ET). METHODS: Following induction of general anesthesia, four patients with disabling tremor that had proved to be refractory to pharmacotherapy underwent magnetic resonance imaging-guided deep brain stimulation (DBS) of the bilateral subthalamic region. Tremor was assessed by applying the Fahn-Tolosa-Marń Tremor Rating Scale at baseline and again at the 12-month follow-up examination. Following surgery the total tremor score improved by 80.1% (from a baseline mean score of 63 +/- 15.1 to a score of 11.8 +/- 3.9 at 12 months postoperatively). There was a significant improvement (p < 0.0001) in the mean tremor score of the upper limb (postural and action component) from a baseline score of 3 +/- 0.9 to a score of 0.5 +/- 0.5 at 12 months postoperatively. In two patients with Score 4 head tremor complete arrest of the tremor was observed at 12 months. Motor function scores of the upper limb for drawing spirals, pouring water, and drawing lines improved significantly (p < 0.05) by 66.7, 76.9, and 58.3%, respectively. Handwriting improved by 68%, but this gain was not significant. The mean activities of daily living score at baseline was 20 +/- 3.2; there was an 88.8% improvement in this score to 2.3 +/- 1.5 at the 12-month evaluation. The voltage required for effective tremor control was low (mean 1.8 +/- 0.2 V) and, along with the other parameters of DBS (frequency and pulse width), did not change significantly over the 12-month period. Tolerance to the action component of tremor was not seen. There was no procedural or stimulation-related complication. CONCLUSIONS: Bilateral subthalamic region stimulation is effective in arresting tremor and head titubation, as well as functional disability in ET. Complications like dysarthria and disequilibrium were not seen. These patients required low voltages of stimulation and did not develop a tolerance to the treatment.

Activities of Daily Living↗

PubMed2006

Eye and pen: A new device for studying reading during writing.

We present a new method for studying reading during writing and the relationships between these two activities. The Eye and Pen device makes a synchronous recording of handwriting and eye movements during written composition. It complements existing online methods by providing a fine-grained description of the visual information fixated during pauses as well as during the actual writing act. This device can contribute to the exploration of several research issues, since it can be used to investigate the role of the text produced so far and the documentary sources displayed in the task environment. The study of the engagement of reading during writing should provide important information about the dynamics of writing processes based on visual information.

Eye Movements↗