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Carrico C, Skrjanc L, Kanduti D, Deeb G, Deeb JG. Effect of guided implant placement learning experiences on freehand skills: A pilot study. Clin Exp Dent Res 2024; 10:e878. [PMID: 38506282 PMCID: PMC10952114 DOI: 10.1002/cre2.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Guided implant systems can be used as a training approach for placing implants. This in vitro prospective randomized pilot study evaluated the learning progression and skill development in freehand placement of two implants supporting a three-unit fixed prosthesis on a simulation model among novice operators. MATERIAL AND METHODS Four senior dental students with no prior implant placement experience participated in the study. As a baseline, each student placed two mandibular and two maxillary implants by freehand technique on a simulation model. Sixteen consecutive guided placements using a static guide, dynamic navigation, and template-based guide followed totaling 32 guided implant placements into maxillary and mandibular models. Freehand implant placements before and after the various guided navigation attempts were compared to assess their impact on freehand skill. Metrics compared included surgical time, horizontal, vertical, and angulation discrepancies between the planned and placed implant positions measured on superimposed CBCT scans and analyzed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = .05). RESULTS Before training with guided techniques, the average baseline freehand implant placement took 10.2 min and decreased to 8.2 after training but this difference was not statistically significant (p = .1670) There was marginal evidence of a significant difference in the 3D apex deviation with an average improvement of 0.89 mm (95% CI: -0.38, 2.16, p = .1120); and marginal evidence of a significant improvement in the overall angle with an average improvement of 3.74° (95% CI: -1.00, 8.48, p = .0869) between baseline and final freehand placement attempts. CONCLUSIONS Within the limitations of this pilot study, guided implant placement experiences did not significantly benefit or hinder freehand placement skills. Dental students should be exposed to various placement techniques to prepare them for clinical practice and allow them to make informed decisions on the best technique based on their skills and a given clinical scenario.
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Affiliation(s)
- Caroline Carrico
- Dental Public Health and Policy, School of DentistryVirginia Commonwealth UniversityRichmondVirginiaUSA
| | | | - Domen Kanduti
- Department for Oral Diseases and Periodontology, Division for Dental Medicine, Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - George Deeb
- Department of Oral and Maxillofacial Surgery, School of DentistryVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Janina Golob Deeb
- Department of Periodontics, School of DentistryVirginia Commonwealth UniversityRichmondVirginiaUSA
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Larkins K, Downie E, Mohan H, Warrier S, Heriot A. How to watch: a guide to structured operative observation and cognitive simulation for trainees. ANZ J Surg 2024; 94:8-10. [PMID: 37872825 DOI: 10.1111/ans.18745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Kirsten Larkins
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of General Surgery, Austin Health, Melbourne, Victoria, Australia
- Department of Surgery, Melbourne University, Melbourne, Victoria, Australia
| | - Emma Downie
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Helen Mohan
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of General Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Satish Warrier
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, Melbourne University, Melbourne, Victoria, Australia
- Department of General Surgery, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Alexander Heriot
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, Melbourne University, Melbourne, Victoria, Australia
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Ghai S, Ghai I, Narciss S. Influence of taping on force sense accuracy: a systematic review with between and within group meta-analysis. BMC Sports Sci Med Rehabil 2023; 15:138. [PMID: 37864268 PMCID: PMC10588111 DOI: 10.1186/s13102-023-00740-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/20/2023] [Indexed: 10/22/2023]
Abstract
Taping is a common technique used to address proprioceptive deficits in both healthy and patient population groups. Although there is increasing interest in taping to address proprioceptive deficits, little is known about its effects on the kinetic aspects of proprioception as measured by force sense accuracy. To address this gap in the literature, the present systematic review and meta-analysis was conducted to evaluate the impact of taping on force sense accuracy. A search for relevant literature was conducted following PRISMA guidelines across seven databases and one register. Eleven studies with 279 participants were included in the review out of 7362 records. In the between-group analyses, we found a significant improvement in absolute (p < 0.01) and relative (p = 0.01) force sense accuracy with taping compared to no comparator. Likewise, a significant improvement in absolute (p = 0.01) force sense accuracy was also observed with taping compared to placebo tape. In the within group analysis, this reduction in the absolute (p = 0.11) force sense accuracy was not significant. Additional exploratory subgroup analyses revealed between group improvement in force sense accuracy in both healthy individuals and individuals affected by medial epicondylitis. The findings of this meta-analysis should be interpreted with caution due to the limited number of studies and a lack of blinded randomized controlled trials, which may impact the generalizability of the results. More high-quality research is needed to confirm the overall effect of taping on force sense accuracy.
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Affiliation(s)
- Shashank Ghai
- Department of Political, Historical, Religious and Cultural Studies, Karlstad University, Karlstad, Sweden.
- Centre for Societal Risk Research, Karlstad University, Karlstad, Sweden.
- Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany.
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany.
| | - Ishan Ghai
- School of Life Sciences, Jacobs University Bremen, Bremen, Germany
| | - Susanne Narciss
- Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
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Larkins K, Khan M, Mohan H, Warrier S, Heriot A. A systematic review of video-based educational interventions in robotic surgical training. J Robot Surg 2023:10.1007/s11701-023-01605-y. [PMID: 37097494 DOI: 10.1007/s11701-023-01605-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
As robotic surgical procedures become more prevalent in practice, there is a demand for effective and efficient educational strategies in robotic surgery. Video has been used in open and laparoscopic surgery to instruct trainees in the acquisition of operative knowledge and surgical skill. Robotic surgery is an ideal application of video-based technology given the access of video recording directly from the console. This review will present the evidence base for video-based educational tools in robotic surgery to guide the development of future educational interventions using this technology. A systematic review of the literature was performed using the key words "video" "robotic surgery" and "education". From a total of 538 results, 15 full text articles were screened. Inclusion criteria were the presentation of an educational intervention using video and the application of this intervention to robotic surgery. The results of 10 publications are presented in this review. Analysis of the key concepts presented in these publications revealed three themes: video as technology, video as instruction, video as feedback. All studies showed a video-based learning had a positive effect on educational outcomes. There are limited published studies looking specifically at the use of video as an educational intervention in robotic surgical training. Existing studies primarily focus on the use of video as a review tool for skill development. There is scope to expand the use of robotic video as a teaching tool through adaptation of novel technology such as 3D headsets and concepts of cognitive simulation including guided mental imagery and verbalisation.
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Affiliation(s)
- Kirsten Larkins
- Peter MacCallum Cancer Centre, 300 Grattan Street, Melbourne, VIC, 3000, Australia.
| | | | - Helen Mohan
- Department of Colorectal Surgery, Austin Health, Heidelberg, VIC, Australia
| | - Satish Warrier
- Peter MacCallum Cancer Centre, 300 Grattan Street, Melbourne, VIC, 3000, Australia
- International Medical Robotics Academy, North Melbourne, VIC, Australia
| | - Alexander Heriot
- Peter MacCallum Cancer Centre, 300 Grattan Street, Melbourne, VIC, 3000, Australia
- International Medical Robotics Academy, North Melbourne, VIC, Australia
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Eaves DL, Hodges NJ, Buckingham G, Buccino G, Vogt S. Enhancing motor imagery practice using synchronous action observation. PSYCHOLOGICAL RESEARCH 2022:10.1007/s00426-022-01768-7. [PMID: 36574019 DOI: 10.1007/s00426-022-01768-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 11/07/2022] [Indexed: 12/28/2022]
Abstract
In this paper, we discuss a variety of ways in which practising motor actions by means of motor imagery (MI) can be enhanced via synchronous action observation (AO), that is, by AO + MI. We review the available research on the (mostly facilitatory) behavioural effects of AO + MI practice in the early stages of skill acquisition, discuss possible theoretical explanations, and consider several issues related to the choice and presentation schedules of suitable models. We then discuss considerations related to AO + MI practice at advanced skill levels, including expertise effects, practical recommendations such as focussing attention on specific aspects of the observed action, using just-ahead models, and possible effects of the perspective in which the observed action is presented. In section "Coordinative AO + MI", we consider scenarios where the observer imagines performing an action that complements or responds to the observed action, as a promising and yet under-researched application of AO + MI training. In section "The dual action simulation hypothesis of AO + MI", we review the neurocognitive hypothesis that AO + MI practice involves two parallel action simulations, and we consider opportunities for future research based on recent neuroimaging work on parallel motor representations. In section "AO + MI training in motor rehabilitation", we review applications of AO, MI, and AO + MI training in the field of neurorehabilitation. Taken together, this evidence-based, exploratory review opens a variety of avenues for future research and applications of AO + MI practice, highlighting several clear advantages over the approaches of purely AO- or MI-based practice.
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Affiliation(s)
- Daniel L Eaves
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Nicola J Hodges
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Gavin Buckingham
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Giovanni Buccino
- Division of Neuroscience, IRCCS San Raffaele and Vita Salute San Raffaele University, Milan, Italy
| | - Stefan Vogt
- Department of Psychology, Lancaster University, Lancaster, UK.
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The application of the spot the difference teaching method in clinical skills training for residents. BMC MEDICAL EDUCATION 2022; 22:542. [PMID: 35836172 PMCID: PMC9281025 DOI: 10.1186/s12909-022-03612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/08/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Clinical skill training (CST) is indispensable for first-year surgical residents. It can usually be carried out through video-based flipped learning (FL) within a web-based learning environment. However, we found that residents lack the process of reflection, blindly imitating results in losing interest and passion for learning in the traditional teaching pattern. The teaching method of "spot the difference" (SDTM), which is based on the fundamentals of the popular game of "spot the difference," is designed to improve students' participation and reflective learning during skill training. This study aimed to evaluate this novel educational model's short-term and long-term effectiveness for surgical residents in China. METHODS First-year residents who required a three-month rotation in the head and neck surgery department were recruited to participate in a series of CSTs. They were randomized into SDTM and traditional FL (control) groups. Clinical skill performance was assessed with validated clinical skill scoring criteria. Evaluations were conducted by comparing the scores that contain departmental rotation skill examinations and the first China medical licensing examination (CMLE) performance on practical skills. In addition, two-way subjective evaluations were also implemented as a reference for the training results. Training effects were assessed using t tests, Mann-Whitney-Wilcoxon tests, chi-square tests, and Cohen' s effect size (d). The Cohen' s d value was considered to be small (<0.2), medium (0.2-0.8), or large (>0.8). RESULTS The SDTM group was significantly superior to the control group in terms of after-department skill examination (t=2.179, p<0.05, d=0.5), taking medical history (t=2.665, p<0.05, d=0.59), and CMLE performance on practical skill (t=2.103, p<0.05, d=0.47). The SDTM members rated the curriculum more highly than the control on the items relating to interestingness and participation (p < 0.05) with large effect sizes (d >0.8). There were no significant differences between the two groups on clinical competence (t=0.819, p=0.415, d=0.18), the first-time pass rate for CMLE (χ2 =1.663, p=0.197, d=0.29), and short-term operational skills improvement (t=1.747, p=0.084, d=0.39). CONCLUSIONS SDTM may be an effective method for enhancing residents' clinical skills, and the effect is significant both short- and long-term. The improvement effect seemed to be more significant in the peer-involved SDTM than training alone. However, despite positive objective results, SDTM still risks student learning burnout. TRIAL REGISTRATION ISRCTN registry, ISRCTN10598469 , 02/04/2022,retrospectively registered.
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Video Learning of Surgical Procedures: A Randomized Comparison of Microscopic, 2- and 3-Dimensional Endoscopic Ear Surgery Techniques. Otol Neurotol 2022; 43:e746-e752. [PMID: 35763494 DOI: 10.1097/mao.0000000000003550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Video learning of surgical procedures helps trainees gain an initial understanding of the complex anatomy and the surgical procedure. Because no comparative studies have yet examined which microsurgical approach to the middle ear is most suitable for video learning, the authors investigated objective and subjective outcomes for medical trainees observing microscopic, 2-dimensional (2D) endoscopic, and 3- dimensional (3D) endoscopic ear surgeries. METHODS Sixty-two medical students (min. 3rd year) from the University Hospital of Bern watched three standardized videos of a type I tympanoplasty surgery recording, conducted with a microscope, a 2D endoscope, and a 3D endoscope, respectively. The authors measured participants' learning outcome, eye movements, cognitive load, and subjective preferences. RESULTS Of the 62 participants included in the study, 14 were male (22.58%), and mean age was 24.44 years (range: 21-29). Learning outcome was highest after watching the 3D endoscopic video (mean [SD], 59.48% [20.57%]). Differences in score were statistically significant: 2D endoscopic video (mean difference: -6.56%, 95% CI: -13.02 to -0.10%), microscopic video (mean difference: -13.82%, 95% CI: -20.27 to -7.36%). Participants showed lowest average eye fixation duration when watching the 3D endoscopic video (mean [SD], 307 ms [109 ms]), with statistically significant differences to the 2D endoscopic video (mean difference: -139 ms, 95% CI: -185 to -93 ms), and the microscopic video (mean difference: -264 ms, 95% CI: -310 to -218 ms). Participants reported lowest cognitive load for the 2D and 3D endoscopic videos. Ratings on discomfort, usability, naturalness, depth perception, and image quality were in favor of the 3D endoscopic video. CONCLUSION The 3D endoscopic technique offers many advantages for video learning in terms of knowledge gain, visual field exploration, and subjective evaluation. To optimize learning effects in trainees, the authors recommend the use of endoscopes in middle ear surgery and, if available, using 3D technology.
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Lee T, Yoon SW, Fernando S, Willey S, Kumar A. Blended (online and in-person) Women's Health Interprofessional Learning by Simulation (WHIPLS) for medical and midwifery students. Aust N Z J Obstet Gynaecol 2022; 62:596-604. [PMID: 35435241 PMCID: PMC9544949 DOI: 10.1111/ajo.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Blended teaching combines traditional in-person components (simulation-based training and clinical-based placement) with online resources. Due to the COVID-19 pandemic, we modified our Women's Health Interprofessional Learning through Simulation (WHIPLS) program - to develop core obstetric and gynaecological skills - into a blended teaching program. There is limited literature reporting the observations of blended teaching on learning. AIMS To qualitatively evaluate the blended teaching program and explore how it contributes to learning. MATERIALS AND METHODS This study was performed at Monash University in Melbourne, Australia. A total of 98 medical students and 39 midwifery students participated. Data were collected by written survey and analysed by authors using a thematic analysis framework. RESULTS Students reported that in-person teaching remains a vital aspect of their curriculum, contributing an averaged 63.2% toward an individual's learning, compared with online. Five substantial themes demonstrate how students learnt and maximised education opportunities using a blended teaching program: 'low-pressure simulation environments', 'peer-assisted learning', 'haptic learning', 'scaffolded learning' and 'the impact of online discourse'. DISCUSSION In-person teaching remains a cornerstone of obstetric and gynaecological clinical skills education, of which interprofessional simulation and clinical-based placement are key components. Teaching via online discourse alone, is not sufficient to completely replace and provide comparable learning outcomes, but certainly plays an important role to prime students' learning and to maximise in-person opportunities and resources. Our study reveals key pedagogies of a blended (online and in-person) learning program, providing further evidence to support its ongoing utility as a feasible and warranted approach to learning.
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Affiliation(s)
- Timothy Lee
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Si Woo Yoon
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Shavi Fernando
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Suzanne Willey
- Monash Nursing and Midwifery, Monash University, Frankston, Victoria, Australia
| | - Arunaz Kumar
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Ioannucci S, Boutin A, Michelet T, Zenon A, Badets A. Conscious awareness of motor fluidity improves performance and decreases cognitive effort in sequence learning. Conscious Cogn 2021; 95:103220. [PMID: 34655968 DOI: 10.1016/j.concog.2021.103220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 09/14/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
Motor skill learning is improved when participants are instructed to judge after each trial whether their performed movements have reached maximal fluidity. Consequently, the conscious awareness of this maximal fluidity can be classified as a genuine learning factor for motor sequences. However, it is unknown whether this effect of conscious awareness on motor learning could be mediated by the increased cognitive effort that may accompany such judgment making. The main aim of this study was to test this hypothesis in comparing two groups with, and without, the conscious awareness of the maximal fluidity. To assess the possible involvement of cognitive effort, we have recorded the pupillary dilation to the task, which is well-known to increase in proportion to cognitive effort. Results confirmed that conscious awareness indeed improved motor sequence learning of the trained sequence specifically. Pupil dilation was smaller during trained than during novel sequence performance, indicating that sequence learning decreased the cognitive cost of sequence execution. However, we found that in the group that had to judge on their maximal fluidity, pupil dilation during sequence production was smaller than in the control group, indicating that the motor improvement induced by the fluidity judgment does not involve additional cognitive effort. We discuss these results in the context of motor learning and cognitive effort theories.
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Affiliation(s)
- Stefano Ioannucci
- CNRS, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (UMR 5287), Université de Bordeaux, France
| | - Arnaud Boutin
- Université Paris-Saclay, CIAMS, 91405, Orsay, France; Université d'Orléans, CIAMS, 45067, Orléans, France
| | - Thomas Michelet
- CNRS, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (UMR 5287), Université de Bordeaux, France
| | - Alexandre Zenon
- CNRS, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (UMR 5287), Université de Bordeaux, France
| | - Arnaud Badets
- CNRS, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (UMR 5287), Université de Bordeaux, France.
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Rizzolatti G, Fabbri-Destro M, Nuara A, Gatti R, Avanzini P. The role of mirror mechanism in the recovery, maintenance, and acquisition of motor abilities. Neurosci Biobehav Rev 2021; 127:404-423. [PMID: 33910057 DOI: 10.1016/j.neubiorev.2021.04.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/12/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
While it is well documented that the motor system is more than a mere implementer of motor actions, the possible applications of its cognitive side are still under-exploited, often remaining as poorly organized evidence. Here, we will collect evidence showing the value of action observation treatment (AOT) in the recovery of impaired motor abilities for a vast number of clinical conditions, spanning from traumatological patients to brain injuries and neurodegenerative diseases. Alongside, we will discuss the use of AOT in the maintenance of appropriate motor behavior in subjects at risk for events with dramatic physical consequences, like fall prevention in elderly people or injury prevention in sports. Finally, we will report that AOT can help to tune existing motor competencies in fields requiring precise motor control. We will connect all these diverse dots into the neurophysiological scenario offered by decades of research on the human mirror mechanism, discussing the potentialities for individualization. Empowered by modern technologies, AOT can impact individuals' safety and quality of life across the whole lifespan.
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Affiliation(s)
- Giacomo Rizzolatti
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy
| | | | - Arturo Nuara
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy; Università di Modena e Reggio Emilia, Dipartimento di Scienze Biomediche, Metaboliche, e Neuroscienze, Modena, Italy
| | - Roberto Gatti
- Istituto Clinico Humanitas, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Pietro Avanzini
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy; Istituto Clinico Humanitas, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
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Hnin HH, Bovonsunthonchai S, Witthiwej T, Vachalathiti R, Ariyaudomkit R. Feasibility of action observation effect on gait and mobility in idiopathic normal pressure hydrocephalus patients. Dement Neuropsychol 2021; 15:79-87. [PMID: 33907600 PMCID: PMC8049582 DOI: 10.1590/1980-57642021dn15-010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Action observation (AO) has been proved to be of benefit in several neurological
conditions, but no study has previously been conducted in idiopathic normal
pressure hydrocephalus (iNPH).
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Affiliation(s)
- Htet Htet Hnin
- Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand.,Gait and Balance Group, Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand
| | - Sunee Bovonsunthonchai
- Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand.,Gait and Balance Group, Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand
| | - Theerapol Witthiwej
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University - Bangkok, Thailand
| | | | - Rattapha Ariyaudomkit
- Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand.,Gait and Balance Group, Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand
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Safely Implementing the Direct Anterior Total Hip Arthroplasty: A Methodological Approach to Minimizing the Learning Curve. J Am Acad Orthop Surg 2020; 28:930-936. [PMID: 32015249 DOI: 10.5435/jaaos-d-19-00752] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Orthopaedic surgeons often cite concern for a learning curve as a barrier to adopting the direct anterior approach (DAA) for total hip arthroplasty (THA) while transitioning from other approaches. Studies both assessing and describing a practical approach and strategy to safely accomplish this transition, as well as the effect on clinical outcomes, are not well described. METHODS This prospective study compares a single surgeon's operative results and complications for the first consecutive 100 direct anterior THA to the last 100 consecutive posterior THA after 7 years in practice. The regimented and disciplined learning strategy used to implement the DAA is detailed in this study. The data were analyzed using univariate and multivariate regression models. RESULTS Univariate analyses identified significant differences in sex, age, Asian race, and diagnostic cause for THA between the two cohorts. Multivariate analyses controlled for these differences and showed that relative to posterior THA, direct anterior THA cases were associated with 7-minute longer procedures (P = 0.002) and lengths of stay that were 0.7 days fewer (P = 0.013). No significant differences were present in the estimated blood loss, and importantly, no significant differences in death or surgical complication rates between cohorts. DISCUSSION This study suggests that the DAA for THA can be safely implemented without the increased and adverse risk to the patient when a structured learning process is maintained and meticulously performed.
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Pelizzo G, Cardinali L, Bonanno L, Marino S, Cavaliere C, Aiello M, Bramanti P, Mazzon E, Soddu A, Calcaterra V. Training Skills in Minimally Invasive, Robotic and Open Surgery: Brain Activation as an Opportunity for Learning. Eur Surg Res 2020; 61:34-50. [PMID: 32585673 DOI: 10.1159/000507766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The advantages of the robotic approach in surgery are undisputed. However, during surgical training, how this technique influences the learning curve has not been described. We provide a tentative model for analyzing the learning curves associated with observation and active participation in learning different surgical techniques, using functional imaging. METHODS Forty medical students were enrolled and assigned to 4 groups who underwent training in robotic (ROB), laparoscopic (LAP), or open (OPEN) surgery, and a control group that performed motor training without surgical instruments. Surgical/motor training included six 1-h sessions completed over 6 days of the same week. All subjects underwent functional magnetic resonance imaging (fMRI) scanning sessions, before and after surgical training during. RESULTS Twenty-three participants completed the study. The 3 surgical groups exhibited different learning curves during training. The main effects of the day of training (p < 0.01) and the group (p < 0.01) as well as a significant interaction of day of training group (p < 0.01) were observed. The performance increased in the first 4 days, reaching a peak at day 4, when all groups were considered together. The OPEN group showed the best performance compared to all other groups (p < 0.04). The OPEN group showed a rapid improvement in performance, which peaked at day 4 and decreased on the last day. Similarly, the LAP group showed a steady increase in the number of exercises they completed, which continued for the entire training period and reached a peak on the last day. However, the participants training in ROB surgery, after a performance initially indistinguishable from that of the LAP group, had a dip in their performance, quickly followed by an improvement and reaching a plateau on day 4. fMRI analysis documented the different involvement of the cortical and subcortical areas based on the type of training. Surgical training modified the activation of some brain regions during both observation and the execution of tasks. CONCLUSIONS Differences in the learning curves of the 3 surgical groups were noted. Functional brain activity represents an interesting starting point to guide training programs.
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Affiliation(s)
- Gloria Pelizzo
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy, .,Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, University of Milano, Milan, Italy,
| | - Lucilla Cardinali
- CMoN, Cognition, Motion and Neuroscience Unit, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy
| | - Lilla Bonanno
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Carlo Cavaliere
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - Marco Aiello
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | | | | | - Andrea Soddu
- Brain and Mind Institute, Department of Physics and Astronomy, Western University, London, Ontario, Canada
| | - Valeria Calcaterra
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.,Pediatric Unit, "Vittore Buzzi" Children's Hospital, Milan, Milan, Italy
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