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Hypnotherapy for writers' cramp.
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Uninsured pharmacists and illegible prescriptions.
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Treatment of writers' dystonia.
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Increased writing activity in neurological disease.
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Legibility and completeness of physicians' handwritten medication orders.
OBJECTIVE: To assess handwritten medication orders for legibility and completeness, legibility of physician signatures, and presence of date and time the orders were written. DESIGN: Descriptive. SETTING: Three patient care units in one hospital in Texas. SAMPLE: One hundred seventy-six medication orders and 55 signatures by 36 different physicians for 39 patients. METHODS: Six experienced nurses evaluated medication orders and signatures for legibility using a rating scale developed for the study. Completeness of medication orders and presence of date and time were determined. RESULTS: Twenty percent [corrected] of the medication orders and 78% of the signatures were illegible or legible with effort. Twenty-four percent of the medication orders were incomplete. Date was omitted on 18% of the medication orders, and time was missing on 58%. CONCLUSION: Difficult-to-read and incomplete medication orders continue to be an important system problem that can increase risk for medication errors and patient harm. Good penmanship and complete orders are unrealistic goals without system support.
Dispensing the wrong medication.
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Measurement of ataxic symptoms with a graphic tablet: standard values in controls and validity in Multiple Sclerosis patients.
Aim of our study was to find a specific measure for the intensity of upper limb tremor and other ataxic symptoms in Multiple Sclerosis (MS) patients, and to establish standard values and test quality parameters. Three hundred and forty-two consecutive patients with different symptoms in the upper limbs (upper motor neuron symptoms, cerebellar upper limb ataxia, and/or sensory deficits in the upper limbs) and 140 healthy controls took part in the study. All patients and controls had to trace over a 25 cm high figure '8' on a graphic tablet, to tap with the stylus on the tablet and to perform the nine-hole-peg test (9HPT). Patients were additionally examined using clinical standard scales to classify motor dysfunctions of the upper limbs. One hundred and eighty-nine patients and 27 controls were tested twice to investigate the test reliability. Kinematic analysis of the tablet data was performed by kernel estimators, oscillatory activity by spectral analysis. Total power in the 2--10 Hz band was very specific for ataxia versus other motor symptoms. Tapping and 9HPT could well distinguish patients from controls, and patients with predominant motor neuron or cerebellar symptoms from patients with predominant sensory dysfunctions. Mean drawing error did not differ between motor and sensory dysfunctions. The test--retest reliability was similarly high for both spectral analysis and 9HPT.
Differential contributions of the two hemispheres in intra-modal proprioceptive sensory matching in 7-10-year-old boys.
This study explores putative differential contributions of the two hemispheres when 7-10-year-old right-hand and left-hand preferent boys are required to carry out a 'foot-hand' target location and matching task. The task required subjects to locate a target pin with the big-toe (felt target), and match the located target position with the hand, without vision. Right-handed (n=25) and left-handed (n=22) boys were tested in a four-condition design. Two intra-hemispheric conditions (right foot locating-right hand matching, left foot locating-left hand matching), and two inter-hemispheric conditions (right foot locating-left hand matching, left foot locating-right hand matching) were used. When the criterion for handedness was writing hand only the results were found to be confounded by the large number of subjects with indeterminate handedness (isolated by use of the Edinburgh Handedness Inventory) originally assigned to the left-handed group. Reclassification of the handedness groups, on the basis of this inventory, showed the pure-left handers to be as good on those conditions mediated by the right hemisphere as pure right handers were with those conditions mediated by the left. These findings are discussed with respect to the contention that left handers are not just 'reversed' right handers.
Does order and timing in performance of imagined and actual movements affect the motor imagery process? The duration of walking and writing task.
The purpose of the present study was to investigate the effects on the duration of imagined movements of changes in timing and order of performance of actual and imagined movement. Two groups of subjects had to actually execute and imagine a walking and a writing task. The first group first executed 10 trials of the actual movements (block A) and then imagined the same movements at different intervals: immediately after actual movements (block I-1) and after 25 min (I-2), 50 min (I-3) and 75 min (I-4) interval. The second group first imagined and then actually executed the tasks. The duration of actual and imagined movements, recorded by means of an electronic stopwatch operated by the subjects, was analysed. The duration of imagined movements was very similar to those of actual movements, for both tasks, regardless of either the interval elapsed from the actual movements (first group) or the order of performance (second group). However, the variability of imagined movement duration was significantly increased compared to variability of the actual movements, for both motor tasks and groups. The findings give evidence of similar cognitive processes underlying both imagination and actual performance of movement.
A follow-up study of EEG coherences in children with different pedagogical evaluations.
A follow-up study on EEG coherence values was carried out with 46 school-age children divided into three pedagogical groups considering their reading and writing abilities (normal subject and children with mild and with serious reading-writing problems). EEGs were recorded at rest, with eyes closed in 15 referential derivations that gave 105 possible coherence values. Coherence was calculated after the elimination of the average reference. Repeated Measure ANOVAs were calculated to evaluate the effects of time, sex, reading-writing problems and their interactions. The second EEG recordings were taken 2-3 years after the first. The results revealed significant increase of coherence values during the time lapse studied, consisting of an increase of frontal coherences in all bands, with the exception of the theta band. The most numerous changes occurred in the alpha band. Very few differences in coherence values were observed between the two EEG recordings by pedagogical groups and by sex suggesting a similar but not igual maturation of coherences of boys and girls and of the three pedagogical groups, in this age range studied. These findings suggests an abnormal coherence development for the reading disabled group, as well as different coherence maturation for boys and girls in this time lapse studied.
Comparison of transcribed and handwritten emergency department charts in the evaluation of chest pain.
STUDY OBJECTIVE: To compare transcribed and handwritten emergency department charts for completeness of documentation. DESIGN: Convenience sample, retrospective chart review. SETTING: Level I tertiary-care referral center and primary training site for a fully accredited postgraduate year 2 through postgraduate year 4 emergency medicine residency program. PARTICIPANTS: Two hundred two patients admitted to telemetry or CCU/ICU with a final diagnosis of myocardial infarction, unstable angina, rule out myocardial infarction, or evaluation of chest pain from July 15, 1990, through June 30, 1991. INTERVENTIONS: Each chart, unknown to the faculty and residents, was reviewed for documentation of the presence or absence of 28 critical items. Equal weight was given to each item. Two-tailed testing for independent proportions was used to determine the presence of a statistically significant difference between the transcribed and handwritten charts. In addition, the mean and SD for the number of critical items documented were determined for both the transcribed and handwritten charts. A two-tailed Student t test was used to determine the presence of a statistically significant difference. Significance was set at a P value of less than .05. RESULTS: Ninety-four transcribed and 108 handwritten charts were reviewed. Transcribed charts contained a greater proportion of the 28 critical items than did the handwritten charts (P < .05). The mean number (19.6 +/- 4.0) of critical items present in the dictated charts was significantly greater than the mean number (15.8 +/- 4.0) of items present in the handwritten charts (P < .0001). CONCLUSION: Transcribed ED charts contain more complete documentation than handwritten charts in the evaluation of patients who present with chest pain of suspected ischemic origin.
The use of response deprivation to increase the academic performance of EMR students.
This research was designed to evaluate the proposed advantages of response deprivation as the basis for establishing reinforcement schedules in applied settings. In Experiment 1, response deprivation was used to improve the cursive writing of six EMR children, using math as the contingent response. The results suggested that writing improved in schedules that produced response deprivation and when the children were given corrective feedback on their performances. In Experiment 2, reversibility of reinforcement was investigated in four EMR children working on math and writing tasks. The students were sequentially presented two reinforcement schedules that produced response deprivation; however, the instrumental and contingent responses were reversed from the first to the second. Consistent with the response deprivation view, the results indicated an increase in instrumental responding in both schedules, which suggests that reversibility of reinforcement can be achieved simply by changes in schedule requirements. In summary, the results of both experiments offered support for response deprivation as an alternative method of producing reinforcement in educational settings.
Learning to write letters: transfer in automated movements indicates modularity of motor programs in human subjects.
Many automatic movements are open-loop, feed-forward motor programs (MP) that are kinematically well characterized by smooth speed and acceleration curves. However, it is unclear whether their internal representation consists of monolithic blocks or subroutines. This question was investigated using a learning paradigm of a writing task. Fifty-nine normal subjects were presented with two similar, but different new letters. Every subject practiced each letter in a series of 60 trials, with the order of letter series randomized. Every session was continuously recorded by a digitizing tablet. Using kinematic analysis, we measured the number of vertical acceleration peaks as an indication of the number of corrective movements (COM). Since COM declined as automatization was approached, we could quantitatively infer progress in motor learning under natural learning conditions. In the case of modular storage of MP, transfer in-between letters was expected due to the re-use of pre-learned motor subroutines. Statistical analysis showed that the exponential model described the data much better than the linear model (residual error: P<0.88 and P<0.00001, respectively), as expected for a learning paradigm. There was no difference between letters per se (P<0.77). Motor improvement differed significantly (P<0.02) between the first and the second series; there was a much greater reduction of COM in the second series (50.1 vs. 41.1%). This difference can be logically ascribed to transfer, indicating that automated movements are stored in motor subroutines.
Human motor development and hand laterality: a kinematic analysis of drawing movements.
This study examines the developmental profiles of basic 'open-loop' drawing movements on the non-dominant hand (ND) in comparison with the dominant hand (D). Fifty-three right-handed children aged 7-14 years and 15 adults aged 27-43 years were examined. Each subject drew lines and circles of different sizes at maximum velocity with a pressure-sensitive pen on a computer graphics tablet. Small lines were drawn at 90 degrees to the axis of the forearm (lines using wrist movements (LWM)) and along the axis of the forearm (lines using elbow movements (LEM)). Larger lines were drawn at 90 degrees to the axis of the forearm (LEM). At both extremities, the movement frequencies of the proximally generated drawing movements increased in a parallel fashion at different levels. In LWM, the right-left-differences (RLD) were high in 7- to 8-year-old children; until puberty, the ND hand reached almost the performance of the D hand. In contrast, the RLD of the LFM increased at the same time. As adulthood approaches, frequencies of all drawings increased further while the LWM on the ND side remained stable. In adults, there were similar RLD for all line drawings involving predominantly flexion and extension movements. When drawing circles, the RLD were highest, though stable in all age groups. Hand laterality of pen use changes over time; these changes are dependent on complexity (combined/sequential cf. flexion-extension muscle activation) and on topography (proximal cf. distal movements). Distinct developmental profiles of motoneuronal populations of the cortex may be responsible for the distinct hand laterality effects and the decreasing variability of motor patterns. The drawing abilities and developmental changes on the untrained ND hand indicate that effector-specific practice plays a minor role.
Abnormal increase in the corticomotor output to the affected hand during repetitive transcranial magnetic stimulation of the primary motor cortex in patients with writer's cramp.
In fourteen right-handed patients with writer's cramp and 10 right-handed controls, 10 trains of suprathreshold 1 Hz repetitive transcranial magnetic stimulation (rTMS) were applied over the left primary motor hand area. Each rTMS train lasted for a minute with an intertrain interval of 10 s. The motor evoked potentials (MEPs) were recorded from the relaxed contralateral first dorsal interosseus muscle. The mean MEP area of each rTMS train was taken as a measure of the corticospinal motor output to the affected hand. While the mean MEP area decreased significantly in controls, patients showed a significant increase in mean MEP area during rTMS. The differential effect on MEP size was highly significant. The abnormal rTMS-associated facilitation of the corticomotor output to the affected hand demonstrates an increased excitability of the corticospinal motor system in writer's cramp.
Acquisition of oral and written language in children with severely impaired hearing.
The effect of the use of written language (WL) for the training of children with severely impaired hearing was compared with that of oral language (OL). WL training was given by means of a WL card method from the age of 1 (group 1; 6 cases) of 2 (group 2; 2 cases). The children in group 1 acquired 3.8 words in OL and 50.5 words in WL as an average number of receptive vocabulary, while 4.5 words in OL and 50.5 words in WL as that of expressive vocabulary by the age of 1 year and 11 months. In group 2, one case acquired 641 words and six-word sentences in OL and 1,066 words and nine-word sentences in WL for reception, while 401 words and five-word sentences in OL and 1,066 words and six-word sentences in WL for expression by the age of 3 years and 6 months. The other case acquired no word in OL but 676 words and nine-word sentences in WL for reception, while 131 words and four-word sentences in OL and 676 words and six-word sentences in WL for expression by the age of 4. The results would indicate that the training of children with poor hearing using WL from an early period of life is effective for the promotion of the language development.
Ictal increased writing preceded by dysphasic seizures.
Ictal increased writing has never been concretely demonstrated to be an epileptic symptom. We reported the evolution of seizures, from the beginning of reading-writing dysphasia through increased writing to secondary generalization, in a schoolchild with benign partial seizures. The lateralizing value of inter- or non-ictal hypergraphia has been stressed for the right hemisphere, while ictal increased writing most likely originated from the language area in the dominant (left) cerebral hemisphere in our patient.