The postgraduate medical educational climate assessed by the Danish Residency Educational Climate Test (DK-RECT): a validation and cross-sectional observational study

BACKGROUND

A good educational climate is essential for delivering high-quality training for medical trainees, professional development, and patient care. The aim of this study was to (1) validate the Dutch Residency Educational Climate Test (D-RECT) in a Danish setting and (2) describe and evaluate the educational climate among medical trainees.

METHODS

D-RECT was adopted in a three-step process: translation of D-RECT into Danish (DK-RECT), psychometric validation, and evaluation of educational climate. Trainees from 31 medical specialties at Copenhagen University Hospital - Rigshospitalet, Denmark were asked to complete an online survey in a cross-sectional study.

RESULTS

We performed a forward-backward translation from Dutch to Danish. Confirmatory factor analysis showed that DK-RECT was robust and valid. The reliability analysis showed that only seven trainees from one specialty were needed for a reliable result. With 304 trainees completing DK-RECT, the response rate was 68%. The subsequent analysis indicated a positive overall educational climate, with a median score of 4.0 (interquartile range (IQR): 3.0-5.0) on a five-point Likert scale. Analysis of the subscales showed that the subscale Feedback received the lowest ratings, while Supervision and Peer collaboration were evaluated highest.

CONCLUSIONS

Psychometric validation of D-RECT in a Danish context demonstrated valid results on the educational climate in specialist training. DK-RECT can be used to evaluate the effectiveness of interventions in the future and can facilitate the conversation on the educational climate.

Efficacy of surgical treatment in patients with trigeminal neuralgia secondary to multiple sclerosis: A prospective study of 18 cases with evaluation of outcome and complications by independent evaluators

INTRODUCTION

Medical treatments for trigeminal neuralgia secondary to multiple sclerosis have low efficacy and tolerability and scientific evidence regarding efficacy of neurosurgery is scarce. We aimed to assess neurosurgical outcome and complications in trigeminal neuralgia secondary to multiple sclerosis.

METHODS

Patients with trigeminal neuralgia secondary to multiple sclerosis who underwent microvascular decompression, glycerol rhizolysis or balloon compression were prospectively and consecutively included from 2012 to 2019. Preoperatively, we systematically obtained clinical characteristics and performed a 3.0 Tesla MRI. Follow-up at three, six and 12 months was performed by independent assessors.

RESULTS

We included 18 patients. Of the seven patients treated with microvascular decompression, two patients (29%) had an excellent outcome (both had neurovascular contact with morphological changes), three patients (43%) had a good outcome, one patient (14%) had treatment failure and one patient (14%) had a fatal outcome. Three patients (43%) had major complications. Of 11 patients treated with percutaneous procedures, seven patients (64%) had an excellent or good outcome with major complications in three patients (27%).

CONCLUSION

Percutaneous procedures provided acceptable outcome and complication rates and should be offered to the majority of patients with trigeminal neuralgia secondary to multiple sclerosis who need surgery. Microvascular decompression is less effective and has a higher complication rate in trigeminal neuralgia secondary to multiple sclerosis compared to microvascular decompression in classical and idiopathic trigeminal neuralgia. Microvascular decompression should only be considered in patients with trigeminal neuralgia secondary to multiple sclerosis when they have neurovascular contact with morphological changes.

Microvascular decompression in trigeminal neuralgia - a prospective study of 115 patients

Background

Trigeminal neuralgia is a severe facial pain disorder. Microvascular decompression is first choice surgical treatment of patients with classical TN. There exist few prospective studies with an independent evaluation of efficacy and complications after MVD.

Objectives

We aimed to assess outcome and complications after microvascular decompression from our center.

Methods

We prospectively recorded clinical characteristics, outcome, and complications from consecutive patients with either classical or idiopathic (only patients with a neurovascular contact) trigeminal neuralgia undergoing microvascular decompression. Neurovascular contact was evaluated by 3.0 Tesla MRI. Patients were assessed before and 3, 6, 12, and 24 months after surgery by independent assessors.

Results

Of 115 included patients, 86% had a clinically significant outcome (i.e., BNI I – BNI IIIb). There was a significant association between an excellent surgical outcome and the male sex (OR 4.9 (CI 1.9–12.8), p = 0.001) and neurovascular contact with morphological changes (OR 2.5 (CI 1.1–6.0), p = 0.036). Significantly more women (12/62 = 19%) than men (2/53 = 4%) had a failed outcome, p = 0.019. The most frequent major complications were permanent hearing impairment (10%), permanent severe hypoesthesia (7%), permanent ataxia (7%), and stroke (6%). Most patients (94%) recommend surgery to others.

Conclusion

Microvascular decompression is an effective treatment for classical and idiopathic (only patients with a neurovascular contact) trigeminal neuralgia with a high chance of a long-lasting effect. The chance of an excellent outcome was highest in men and in patients with classical trigeminal neuralgia. Complications are relatively frequent warranting thorough patient evaluation and information preoperatively.

Trial registration

Clinical.trials.gov registration no. NCT04445766.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-022-01520-x.

Mortality among patients treated for aneurysmal subarachnoid hemorrhage in Eastern Denmark 2017-2019

OBJECTIVE

The aim of the study was to investigate (1) the 30-day, 3-month, and 12-month cumulative mortalities for patients who underwent aneurysm occlusion, and (2) the causes of death, and (3) the potential risk factors for death.

METHODS

All patients who underwent surgical clipping or endovascular treatment of a ruptured aneurysm at Copenhagen University Hospital, during the period of January 1, 2017-December 31, 2019, were included and followed up for 12 months. Data regarding vital status, causes of death, comorbidities, treatment, and clinical presentations on admission was collected. The absolute mortality risk was estimated as a function of time with a 95% confidence interval. The associations between potential risk factors and death were estimated as odds ratios with 95% confidence intervals using logistic regression models.

RESULTS

A total of 317 patients were included. The overall cumulative mortalities after 30 days, 3 months, and 12 months were 10.7%, 12.9%, and 16.1%, respectively. The most common cause of death was severe primary hemorrhage (52.9%), followed by infections (15.7%) and rebleeding (11.8%). WFNS score > 3 and Fisher score > 3 on admission, preprocedural hydrocephalus, and preprocedural rebleeding were found significantly associated with higher risk of death.

CONCLUSIONS

Considerable mortality was seen. Possible preventable causes accounted for approximately 22% of the deaths. The occurrence of both pre- and postprocedural rebleeding's indicates an opportunity of further improvement of the mortality by (1) further reduction of time from aSAH to aneurysm occlusion and (2) continuous efforts in improving methods of aneurysm occlusion.

[Screening for intracranial aneurysms]

This review states the reasons for considering screening for intracranial aneurysms in Denmark: if patients have two first-degree relatives with intracranial aneurysms, are 30-70 years old, do not have competing disorders, which could significantly shorten life expectancy, and subsequently in patients with autosomal dominant kidney disease and a family history of subarachnoid haemorrhage. MR angiography should be the imaging study of choice, unless contraindicated. Generally, the ethical consequences ought to be considered before carrying out screening.

Prognostic factors for outcome of microvascular decompression in trigeminal neuralgia: A prospective systematic study using independent assessors

Introduction

There is a lack of high-quality prospective, systematic studies using independent assessors of outcome of microvascular decompression as treatment for trigeminal neuralgia.

Methods

Clinical characteristics and outcome data were recorded prospectively from consecutive classical trigeminal neuralgia patients, using standardized interviews. Degree of neurovascular contact was evaluated by a 3.0 Tesla MRI blinded to symptomatic side. Patients were assessed before and 12 months after surgery by a neurologist.

Results

Twenty-six men and 33 women completed 12 months follow-up. Forty-one patients (69%) had an excellent outcome (no pain, no medication). Ten (18%) patients had a good outcome. Eight (12%) patients had no improvement or had worsening of pain. MRI showed neurovascular contact with morphological changes in 34 patients (58%). Odds ratio between neurovascular contact with morphological changes and excellent outcome was 4.4 (Cl 1.16–16.26), p = 0.029. Odds ratio between male sex and excellent outcome was 11.38 (Cl 2.12–59.52), p = 0.004. No significant association was found between excellent outcome and concomitant persistent pain, current age or disease duration.

Conclusion

Neurovascular contact with morphological changes and male sex are positive predictive factors for outcome of microvascular decompression. The findings enable clinicians to better inform patients before surgery.

Cerebellar Mutism Syndrome and Other Complications After Surgery in the Posterior Fossa in Adults: A Prospective Study

BACKGROUND

Cerebellar mutism syndrome (CMS) is rarely described in adults; however, data on self-assessed linguistic complications after posterior fossa surgery do not exist.

METHODS

Through a prospective single-center study, data on 59 tumor operations in the posterior fossa were collected preoperatively as well as 1 week and 1 month postoperatively. Data on self-assessed problems in 5 CMS-related domains, CMS scores, and neurology as well as surgical procedure and complications were obtained.

RESULTS

Data on CMS-related complications were obtained on 56 of the 59 operations. None was found to have CMS according to the CMS score. Within each of the 5 domains, at least 9 operations (16%) were followed by development or worsening of self-assessed CMS-related complications. Self-assessed complications were found to be most frequent after primary tumor surgeries, although they were significant only for speech and motor complications (P value = 0.01 and 0.02). Speech and language complications occurred more frequently in midline tumors compared with lateral tumors (40% vs. 7%; P = 0.004). Surgical complications were similar to other studies.

CONCLUSIONS

We propose that speech and language problems in adults undergoing surgery in the posterior fossa occur more frequently than previously assumed. Some of the self-assessed complications might reflect components of the cerebellar cognitive affective syndrome. Our findings are consistent with the fact that midline location of the tumor is one of the few known risk factors for CMS in children. Thus, the cerebellar midline seems to be a vulnerable region for speech and language complications also in adults.

Persistent idiopathic facial pain – a prospective systematic study of clinical characteristics and neuroanatomical findings at 3.0 Tesla MRI

Introduction

Persistent idiopathic facial pain (PIFP) is a poorly understood chronic orofacial pain disorder and a differential diagnosis to trigeminal neuralgia. To address the lack of systematic studies in PIFP we here report clinical characteristics and neuroimaging findings in PIFP.

Methods

Data collection was prospective and standardized in consecutive PIFP patients. All patients underwent 3.0 MRI.

Results

In a cohort of 53 PIFP patients, the average age of onset was 44.1 years. PIFP was found in more women 40 (75%) than men 13 (25%), p < 0.001. There was a high prevalence of bilateral pain 7 (13%), hypoesthesia 23 (48%), depression 16 (30%) and other chronic pain conditions 17 (32%) and a low prevalence of stabbing pain 21 (40%), touch-evoked pain 14 (26%) and remission periods 10 (19%). The odds ratio between neurovascular contact and the painful side was 1.4 (95% Cl 0.4–4.4, p = 0.565) and the odds ratio between neurovascular contact with displacement of the trigeminal nerve and the painful side was 0.2 (95% Cl 0.0–2.1, p = 0.195).

Conclusion

PIFP is separated from trigeminal neuralgia both with respect to the clinical characteristics and neuroimaging findings, as NVC was not associated to PIFP.

[Diagnostics and treatment of trigeminal neuralgia]

Trigeminal neuralgia (TN) is characterized by unilateral evoked short-lasting intense pain paroxysms in the face. A concomitant persistent background pain is frequently present. Neurovascular contact causing displacement or atrophy of the trigeminal nerve is important to TN aetiology. TN can also be secondary to a space-occupying lesion or multiple sclerosis. Early high-quality magnetic resonance imaging is mandatory as a part of the work-up. First-choice treatment is medical. Medically refractory patients are referred to neurosurgery. Nationwide in Denmark, there is a need for structured and uniform treatment of TN.

Fairness and Distributive Justice by 3- to 5-Year-Old Tibetan Children

We asked whether young children raised in an environment strongly promoting compassion for others, as in the case of Tibetan Buddhism, would show less proclivity toward self-maximizing in sharing. We replicated the procedure of Rochat et al. with a group of 3- and 5-year-old Tibetan children living in exile and attending a traditional Buddhist school where the Dalai Lama resides. We report that Tibetan children, like children of seven other cultures, start from a marked self-maximizing propensity at 3 years of age, becoming significantly more fair by 5 years. These data confirm that the developing sense of equity by young children is comparable in the context of a compassion-based culture.

Trigeminal neuralgia--a coherent cross-specialty management program

BACKGROUND

Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatment programs and close collaboration between medical, radiological and surgical specialties. Organization of such treatment programs has never been described before. With this paper we aim to describe the implementation and feasibility of an accelerated cross-speciality management program, to describe the collaboration between the involved specialties and to report the patient flow during the first 2 years after implementation. Finally, we aim to stimulate discussions about optimal management of TN.

METHODS

Based on collaboration between neurologists, neuroradiologists and neurosurgeons a standardized program for TN was implemented in May 2012 at the Danish Headache Center (DHC). First out-patient visit and subsequent 3.0 Tesla MRI scan was booked in an accelerated manner. The MRI scan was performed according to a special TN protocol developed for this program. Patients initially referred to neurosurgery were re-directed to DHC for pre-surgical evaluation of diagnosis and optimization of medical treatment. Follow-up was 2 years with fixed visits where medical treatment and indication for neurosurgery was continuously evaluated. Scientific data was collected in a structured and prospective manner.

RESULTS

From May 2012 to April 2014, 130 patients entered the accelerated program. Waiting time for the first out-patient visit was 42 days. Ninety-four percent of the patients had a MRI performed according to the special protocol after a mean of 37 days. Within 2 years follow-up 35% of the patients were referred to neurosurgery after a median time of 65 days. Five scientific papers describing demographics, clinical characteristics and neuroanatomical abnormalities were published.

CONCLUSION

The described cross-speciality management program proved to be feasible and to have acceptable waiting times for referral and highly specialized work-up of TN patients in a public tertiary referral centre for headache and facial pain. Early high quality MRI ensured correct diagnosis and that the neurosurgeons had a standardized basis before decision-making on impending surgery. The program ensured that referral of the subgroup of patients in need for surgery was standardized, ensured continuous evaluation of the need for adjustments in pharmacological management and formed the basis for scientific research.

The temporal evolution of a facial pain syndrome associated with neurovascular contact: a case report

BACKGROUND

Trigeminal autonomic cephalalgias are primary headaches characterized by unilateral pain and cranial autonomic symptoms. However, associated autonomic symptoms have also been reported in other headaches and facial pains, e.g. trigeminal neuralgia, with the clinical differentiation proving a complex task.

CASE

A 54-year-old man presented with right-sided, sharp, intense facial pain in the distribution area of the trigeminal nerve. Pain duration was from seconds to a few minutes, and trigger factors included ipsilateral touching of the skin and hair. Over the next ten years, symptoms progressed and changed presentation, also displaying as right-sided, severe, orbital pain, lasting 60 to 90 minutes, with conjunctival injection and rhinorrhea. Neurological examination was normal. Numerous medications were tried with limited or no effect. In 2010, magnetic resonance imaging revealed a right-sided deviation of the basilar artery at the level of pons, creating neurovascular contact with the trigeminal nerve. Microvascular decompression was performed, and symptoms resolved within days.

CONCLUSION

Differentiating between trigeminal autonomic cephalalgias and trigeminal neuralgia with autonomic symptoms can be challenging. The distinct change and evolution over time in the clinical presentation of the patient's head pain suggests a temporal plasticity of the pain in head and facial syndromes, irrespective of underlying pathoanatomic features.

[Vagoglossopharyngeal neuralgia treated with vascular decompression]

This case report describes a 63-year-old man referred with right-sided glossopharyngeal neuralgia. Magnetic resonance imaging (MRI) demonstrated asymmetry of the PICA vessels. A microvascular decompression was performed and complete remission of symptoms followed. After 14 months the neuralgia recurred, this time accompanied by sinus bradycardia/sinus arrest during attacks causing discomfort and syncopes. An MRI now demonstrated an arterial loop at the site of the vagoglossopharyngeal complex leaving the brainstem. After another microvascular decompression, complete remission of symptoms was observed.

Long-term follow up of children with meningiomas in Denmark: 1935 to 1984

OBJECT

Meningiomas in children are rare, infrequently described in the literature, and often associated with neurofibromatosis Type 2 (NF2). The authors report a series of 22 children treated for an intracranial meningioma in Denmark between 1935 and 1984.

METHODS

Of 1542 cases of pediatric intracranial tumors in children younger than 15 years of age, 22 harbored meningiomas. Three children suffered from NF. The male/female ratio was 8:14. The mean age at the time of diagnosis was 5 years for boys and 11.5 years for girls. At the time of diagnosis all tumors were large. All patients underwent surgery. In 20 cases, the final histological diagnoses were low-grade and in two cases high-grade tumors. The follow-up period ranged from I to 45 years (mean 16 years). Two patients were lost to follow up. Four of seven boys and three of 13 girls survived. Five of 13 children in whom the tumor was completely removed survived, whereas two of seven in whom the lesion was partially removed survived. The mean survival time in children who died during follow up was 10 years. Two children with anaplastic meningioma remain alive.

CONCLUSIONS

The long-term prognosis for surgically treated children with intracranial meningiomas was worse than expected. Some reasons for this may have been the late diagnosis and related large size of the tumor during a period of limited diagnostic capacity prior to the computerized tomography and magnetic resonance imaging eras, and the association of NF2 with multiple tumors of the central nervous system. Complete resection is not always possible and should be performed as an image-guided operation.

Sequentially evolved bilateral epidural haematomas

Sequentially evolved bilateral epidural haematomas, where the second haematoma evolves after surgical removal of the first haematoma, are rarely reported. We report two cases of this entity. One patient was involved in a road traffic accident and the other was suffering from a head injury after an assault. CT scans showed that both patients had an unilateral epidural haematoma with a thin presumably epidural haemorrhage on the opposite side. Both patients were operated for their epidural haematomas, but did not improve after surgical treatment, and postoperative CT scans revealed evolving of an epidural haematoma on the opposite side. After evacuation of the second epidural haematoma both patients recovered quickly. Sequentially evolved bilateral epidural haematomas are rare, but must be considered in the postoperative intensive care treatment in patients with epidural haematomas. Both cases emphasize the need for intensive care monitoring after an operation for an epidural haematoma and the need for CT scans if the patient does not improve quickly after removal of the haematoma. This is especially important if a small contralateral haematoma is seen on the initial CT scan.

A single subcutaneous bolus of erythropoietin normalizes cerebral blood flow autoregulation after subarachnoid haemorrhage in rats

Systemic administration of recombinant erythropoietin (EPO) has been demonstrated to mediate neuroprotection. This effect of EPO may in part rely on a beneficial effect on cerebrovascular dysfunction leading to ischaemic neuronal damage. We investigated the in vivo effects of subcutaneously administered recombinant EPO on impaired cerebral blood flow (CBF) autoregulation after experimental subarachnoid haemorrhage (SAH). Four groups of male Sprague-Dawley rats were studied: group A, sham operation plus vehicle; group B, sham operation plus EPO; group C, SAH plus vehicle; group D, SAH plus EPO. SAH was induced by injection of 0.07 ml of autologous blood into the cisterna magna. EPO (400 iu kg(-1) s.c.) or vehicle was given immediately after the subarachnoid injection of blood or saline. Forty-eight hours after the induction of SAH, CBF autoregulatory function was evaluated using the intracarotid (133)Xe method. CBF autoregulation was preserved in both sham-operated groups (lower limits of mean arterial blood pressure: 91+/-3 and 98+/-3 mmHg in groups A and B, respectively). In the vehicle treated SAH-group, autoregulation was abolished and the relationship between CBF and blood pressure was best described by a single linear regression line. A subcutaneous injection of EPO given immediately after the induction of SAH normalized autoregulation of CBF (lower limit in group D: 93+/-4 mmHg, NS compared with groups A and B). Early activation of endothelial EPO receptors may represent a potential therapeutic strategy in the treatment of cerebrovascular perturbations after SAH.

Sinusitis and ischemic stroke

Acute sinusitis is a prevalent and generally uncomplicated infection that is normally resolved by medical therapy. However, severe neurological complications are known, and comprise of cerebral abscess, cavernous sinus thrombosis, meningitis, and epidural or subdural empyema. We report a case about a 10-year-old girl with a severe acute pansinusitis and ischemic stroke in the right lentiform nucleus and the anterior part of the right internal capsule. Possible explanations for this rare combination are discussed.

Effects of alterations in arterial CO2 tension on cerebral blood flow during acute intracranial hypertension in rats

Cerebrovascular reactivity to CO2 in clinical and experimental studies has been found to be impaired during increased intracranial pressure (ICP). However, from previous study results it has not been possible to estimate whether the impairment was caused by elevated ICP, or caused by decreased cerebral perfusion pressure (CPP). The current study was carried out in a group of unmanipulated control rats and in six investigation groups of six rats each: two groups with elevated ICP (30 and 50 mm Hg) and spontaneous arterial blood pressure (MABP), two groups with spontaneous ICP and arterial hypotension (77 and 64 mm Hg), and two groups with elevated ICP (30 and 50 mm Hg) and arterial hypertension (124 mm Hg). Intracranial hypertension was induced by continuous infusion of lactated Ringer's solution into the cisterna magna, arterial hypotension by controlled bleeding, and arterial hypertension by continuous administration of norepinephrine intravenously. Cerebral blood flow (CBF) was measured repetitively by the intraarterial 133Xe method at different levels of arterial PCO2. In each individual animal, CO2 reactivity was calculated from an exponential regression line obtained from the corresponding CBF/PaCO2 values. By plotting each individual value of CO2 reactivity against the corresponding CPP value from the seven investigation groups, CPP was significantly and directly related to CO2 reactivity of CBF (P < .001). No correlation was found by plotting CO2 reactivity values against the corresponding MABP values or the corresponding ICP values. Thus, the results show that CO2 reactivity is at least partially determined by CPP and that the impaired CO2 reactivity observed at intracranial hypertension and arterial hypotension may be caused by reduced CPP.

Antiepileptic drug utilization: a Danish prescription database analysis

OBJECTIVES

The purpose of the study was to use prescription data from a Danish database to analyse and evaluate antiepileptic drug (AED) utilization, and compare with other prevalence studies.

METHODS

A Danish research database covering outpatient prescription data from a population of 471,873 persons was used. Prescription records on all patients prescribed AEDs during 1998 were retrieved. A cohort was extracted from the group of AED users.

RESULTS

We identified 5426 AED users. A total of 3756 of the 5426 AED users were included in our cohort. Of the subjects in the cohort 74% were on monotherapy, 19% used two AEDs and only 7% used three or more AEDs. The eight most frequent regimens were all monotherapy: carbamazepine, oxcarbazepine, phenobarbital, valproic acid, lamotrigine, clonazepam, phenytoin and primidon in that order. The estimated crude 1-year prevalence of AED use was 0.77% for women and 0.83% for men (P<0.001), and it increased with age for both genders.

CONCLUSIONS

The prescription pattern reported here is in accordance with the general guidelines for the treatment of epilepsy in Denmark, except for a surprisingly extensive use of phenobarbital. With specific reservations the figures appear to be reasonable estimates of the prevalence of epilepsy.

Emerging sensitivity to the timing and structure of protoconversation in early infancy

Thirty-six 2-, 4-, and 6-month-old infants were videotaped while interacting with a female adult stranger engaging in either organized or disorganized 1-min peekaboo games. Two-month-old infants gazed and smiled equally at the stranger, regardless of the relative organization of the peekaboo game. In contrast, 4- and 6-month-old infants smiled significantly more and gazed significantly less in the organized peekaboo condition than in the disorganized peekaboo condition. These results suggest that from a diffuse sensitivity to the presence of a social partner, infants by 4 months develop a new sensitivity to the narrative envelope of protoconversation, in particular the timing and the structure of social exchanges scaffolded by adults. These observations are interpreted as evidence of developing social expectations in the first 6 months of life. This early development is viewed as announcing and preparing the communicative competence that blossoms by the end of the 1st year.

Emerging sensitivity to the timing and structure of protoconversation in early infancy

Thirty-six 2-, 4-, and 6-month-old infants were videotaped while interacting with a female adult stranger engaging in either organized or disorganized 1-min peekaboo games. Two-month-old infants gazed and smiled equally at the stranger, regardless of the relative organization of the peekaboo game. In contrast, 4- and 6-month-old infants smiled significantly more and gazed significantly less in the organized peekaboo condition than in the disorganized peekaboo condition. These results suggest that from a diffuse sensitivity to the presence of a social partner, infants by 4 months develop a new sensitivity to the narrative envelope of protoconversation, in particular the timing and the structure of social exchanges scaffolded by adults. These observations are interpreted as evidence of developing social expectations in the first 6 months of life. This early development is viewed as announcing and preparing the communicative competence that blossoms by the end of the 1st year.

Self-perception and action in infancy

By 2-3 months, infants engage in exploration of their own body as it moves and acts in the environment. They babble and touch their own body, attracted and actively involved in investigating the rich intermodal redundancies, temporal contingencies, and spatial congruence of self-perception. Recent research is presented, which investigates the spatial and temporal determinants of self-perception and action infancy. This research shows that, in the course of the first weeks of life, infants develop an ability to detect intermodal invariants and regularities in their sensorimotor experience, which specify themselves as separate entities agent in the environment. Recent observations on the detection of intermodal invariants regarding self-produced leg movements and auditory feedback of sucking by young infants are reported. These observations demonstrate that, early in development and long before mirror self-recognition, infants develop a perceptual ability to specify themselves. It is tentatively proposed that young infants' propensity to engage in self-perception and systematic exploration of the perceptual consequences of their own action plays an important role in the intermodal calibration of the body and is probably at the origin of an early sense of self: the ecological self.

Perceptual strategies in the estimation of physical quantities by orangutans (Pongo pygmaeus)

The perceptual strategies used by 4 orangutans (2 subadults, 2 adults) when choosing the larger of 2 volumes in a Piagetian conservation task were investigated. Three possible perceptual strategies were investigated: (a) direct perceptual estimation of the container's content independent of its shape, (b) use of the spatial and temporal cues provided by the pouring of liquid from one container to another, and (c) ability to initially identify the larger volume and track it across transformations disregarding misleading perceptual cues. Results indicated that the direct perceptual estimation strategy was the best candidate to explain the orangutan's systematic choice of the larger of 2 quantities.

Dynamic mental representation in infancy

Recent research indicates that 4- to 8-month-old infants can track and anticipate the final orientation of an object following different invisible spatial transformations (Rochat, P., Hespos, S.J. (1996). Cognitive Development, 11, 3-17). Six experiments were designed to specify further the nature and development of early expectation for a set of dynamic events. A violation of expectation method was used to assess infants' reactions to probable and improbable outcomes of an objects' orientation following an invisible transformation. The availability of orientation cues, the path of motion, and the amount of invisible spatial transformation was systematically varied. The studies indicate that infants as young as 4 months of age detect orientation-specific cues for objects undergoing invisible spatial transformations. Developmental differences in this ability between 4 and 6 months of age lend insight to the nature and limitations of this early representational ability. These findings provide evidence for dynamic mental representation in infancy.

An account of the systematic error in judging what is reachable

An account of the postural determinants of perceived reachability is proposed to explain systematic overestimations of the distance at which an object is perceived to be reachable. In this account, these errors are due to a mapping of the limits of prehensile space onto a person's perceived region of maximum stretchability, in the context of a whole-body engagement. In support of this account, 6 experiments on the judged reachability of both static and dynamic objects are reported. We tentatively conclude that the mental imagery of action is grounded and calibrated in reference to multiple skeletal degrees of behavioral freedom. Accordingly, this calibration is a source of systematic error in reachability judgments.

An account of the systematic error in judging what is reachable

An account of the postural determinants of perceived reachability is proposed to explain systematic overestimations of the distance at which an object is perceived to be reachable. In this account, these errors are due to a mapping of the limits of prehensile space onto a person's perceived region of maximum stretchability, in the context of a whole-body engagement. In support of this account, 6 experiments on the judged reachability of both static and dynamic objects are reported. We tentatively conclude that the mental imagery of action is grounded and calibrated in reference to multiple skeletal degrees of behavioral freedom. Accordingly, this calibration is a source of systematic error in reachability judgments.

Enhanced sucking engagement by preterm infants during intermittent gavage feedings

Non-nutritive sucking (NNS) activities were recorded in preterm infants born at gestational age 32 weeks or less during nasogastric feedings. Six infants on intermittent nasogastric feeding schedules were tested with a pacifier in their mouth for three 5-minute periods (before, during, and after gavage feeding). Analysis of the recordings revealed that NNS activities increased markedly during the intermittent nasogastric feeding schedule. The overall proportions of sucking engagement, the mean duration of sucking burst, the mean number of sucks per burst, and the mean duration of individual sucks within a burst increased markedly during gavage feeding compared with both pre-test and post-test periods. NNS by a group of five infants on continuous nasogastric feedings was similar to the pre-test and post-test of the infants on the intermittent nasogastric feeding schedule. These results indicate that in the context of intermittent nasogastric feedings, NNS engagement in tube-fed infants depends on stomach cues and/or temperature changes associated with tube feedings.

Liquid conservation in orangutans (Pongo pygmaeus) and humans (Homo sapiens): individual differences and perceptual strategies

Four orangutans (1 juvenile, 2 subadults, and 1 adult) and ten 6-8-year-old children were tested in 4 liquid conservation tasks of increasing levels of difficulty. Task difficulty depended on the type of transformation (continuous vs. discontinuous quantities) and the relative contrast between the shapes of the containers. Results indicate that orangutans did not display conservation in the strict sense; instead they showed "partial" conservation (intermediate reactions according to J. Piaget & B. Inhelder, 1941). In contrast, some of the children provided evidence of conservation in all 4 tasks, showing "true" or logically necessary conservation in the original sense proposed by J. Piaget and B. Inhelder (1941). Although orangutans did not show conservation in the strict sense, as J. Piaget (1955) and others have generally agreed it should be defined, orangutans behaved as individual and creative problem solvers, adopting different perceptual strategies depending on the task.

Perceived reachability for self and for others by 3- to 5-year-old children and adults

Ability to perceive the distance at which an object is within reach was assessed in 3-, 4-, and 5-year-old children and adults. In different situations, subjects had to judge whether an object placed in the vertical or horizontal plane was reachable for themselves or for someone else (the experimenter). Adults as well as children differentiated between the limits of their own prehensile space and those of another person. At all ages, children tend to attribute systematically more reachability to the adult experimenter. Furthermore, both children and adults systematically underestimate reachability for others in a horizontal presentation of the object. For all age groups, judgments of reachability for self are bodily scaled and based on perceived degrees of behavioral freedom for self and for others. From 3 years of age, children are shown to resemble adults in their ability to perceive what objects afford for action, either for self or for others. These results are interpreted as further evidence of early allocentrism (i.e., spatial decentration and perspective taking) in the context of a practical task.

Multimodal perception in the control of infant reaching

Six-month-old infants were presented with sounding objects under 3 conditions of illumination: in full vision, in the dark with target location specified by a glowing and sounding object, and in the dark with location specified by sound alone. Reaching behavior was videotaped with an infrared camera, and hand movement was measured by infrared-emitting diodes on the hand that were tracked by a motion analysis system. No differences were found in reaching behavior for objects in the light and glowing objects in the dark. Reaches for sounding objects in the dark had higher speeds, shorter durations, and more errors compared to the other 2 conditions. These findings indicate that vision of the hand did not appear to affect infants' reaching in this situation, whereas vision of the target did.

Multimodal perception in the control of infant reaching

Six-month-old infants were presented with sounding objects under 3 conditions of illumination: in full vision, in the dark with target location specified by a glowing and sounding object, and in the dark with location specified by sound alone. Reaching behavior was videotaped with an infrared camera, and hand movement was measured by infrared-emitting diodes on the hand that were tracked by a motion analysis system. No differences were found in reaching behavior for objects in the light and glowing objects in the dark. Reaches for sounding objects in the dark had higher speeds, shorter durations, and more errors compared to the other 2 conditions. These findings indicate that vision of the hand did not appear to affect infants' reaching in this situation, whereas vision of the target did.

Self-Sitting and Reaching in 5- to 8-Month-Old Infants: The Impact of Posture and Its Development on Early Eye-Hand Coordination

The relation between progress in the control of posture (i.e., the achievement of self-sitting posture) and the developmental transition from two-handed to one-handed engagement in infant reaching was investigated. Two groups of 5- to 8-month-old infants, who were either able or yet unable to sit on their own, were videotaped while they reached for objects in four different posture conditions that provided varying amounts of body support. Videotapes of infant reaches were microanalyzed to determine the relative engagement of both hands during reaches. Results demonstrate the interaction between postural development and the morphology of infant reaching. Nonsitting infants displayed symmetrical and synergistic engagement of both arms and hands while reaching in all but the seated posture condition. Sitting infants, by contrast, showed asymmetrical and lateralized (one-handed) reaches in all posture conditions. Results also show that, aside from posture, the perceived spatial arrangement of the object display is a determinant of infant reaching. Combined, these results are discussed as evidence for the interaction between postural and perceptual development in the control of early eye-hand coordination.

Object representation guides infants' reaching in the dark

Infants were presented with two sounding objects of different sizes in light and dark, in which sound cued the object's identity. Reaching behavior was assessed to determine if object size influenced preparation for grasping the object. In both light and dark, infants aligned their hands when contacting the large object compared with the small object, which resulted in a reach with both hands extended for the large object and reach with one hand more extended for the small object. Infants contacted the large object more frequently on the bottom and sides rather than the top, where the sound source was located. Reaching in the dark by 6 1/2-month-olds is not merely directed toward a sound source but rather shows preparation in relation to the object's size. These findings were interpreted as evidence that mental representation of previously seen objects can guide subsequent motor action by 6 1/2-month-old infants.

Object representation guides infants' reaching in the dark

Infants were presented with two sounding objects of different sizes in light and dark, in which sound cued the object's identity. Reaching behavior was assessed to determine if object size influenced preparation for grasping the object. In both light and dark, infants aligned their hands when contacting the large object compared with the small object, which resulted in a reach with both hands extended for the large object and reach with one hand more extended for the small object. Infants contacted the large object more frequently on the bottom and sides rather than the top, where the sound source was located. Reaching in the dark by 6 1/2-month-olds is not merely directed toward a sound source but rather shows preparation in relation to the object's size. These findings were interpreted as evidence that mental representation of previously seen objects can guide subsequent motor action by 6 1/2-month-old infants.