An investigation of the impact of regular use of the Wii Fit to improve motor and psychosocial outcomes in children with movement difficulties: a pilot study.

BACKGROUND: Children with Developmental Co-ordination Disorder (DCD) experience poor motor and psychosocial outcomes. Interventions are often limited within the healthcare system, and little is known about how technology might be used within schools or homes to promote the motor skills and/or psychosocial development of these children. This study aimed to evaluate whether short, regular school-based sessions of movement experience using a commercially available home video game console (Nintendo's Wii Fit) would lead to benefits in both motor and psychosocial domains in children with DCD. METHODS: A randomized crossover controlled trial of children with movement difficulties/DCD was conducted. Children were randomly assigned to an intervention (n = 10) or comparison (n = 8) group. The intervention group spent 10 min thrice weekly for 1 month using Wii Fit during the lunch break, while the comparison group took part in their regular Jump Ahead programme. Pre- and post-intervention assessments considered motor proficiency, self-perceived ability and satisfaction and parental assessment of emotional and behavioural problems. RESULTS: Significant gains were seen in motor proficiency, the child's perception of his/her motor ability and reported emotional well-being for many, but not all children. CONCLUSIONS: This study provides preliminary evidence to support the use of the Wii Fit within therapeutic programmes for children with movement difficulties. This simple, popular intervention represents a plausible method to support children's motor and psychosocial development. It is not possible from our data to say which children are most likely to benefit from such a programme and particularly what the dose and duration should be. Further research is required to inform across these and other questions regarding the implementation of virtual reality technologies in therapeutic services for children with movement difficulties.

Paying attention to emotional images with impact.

Emotional stimuli receive high processing priority in attention and memory. This processing "advantage" is generally thought to be predominantly mediated by arousal. However, recent data suggest that ratings of an image's affective "impact" may be a better predictor of recollection than arousal or valence. One interpretation of these findings is that high-impact images may draw an individual's attention, thus facilitating subsequent processing. We investigated the allocation of visual attention to negative emotional images that differed in impact but were matched for valence, arousal, and other characteristics. Participants viewed a central image flanked by 2 neutral indoor or outdoor scenes and made speeded judgments about whether the neutral scenes matched. In Experiment 1, responses were slower on high-impact relative to low-impact or neutral trials. In Experiment 2, responses on high-arousal relative to low-arousal trials did not differ significantly. These data provide evidence for differential allocation of attention to distinct sets of negative, equally arousing images, and argue against the prevailing view that heightened attention to and processing of emotional stimuli relate simply to arousal or valence.

Energy balance during backpacking.

Energy expenditure and energy intake were determined in three subjects during a 160-kilometer backpacking trip. Prior to the trip, heart rate and oxygen consumption during treadmill walking while carrying a backpack were measured. Subjects recorded heart rate during hiking. Heart rate was used to estimate energy expenditure based on the heart rate : oxygen consumption relationship (Heart Rate Method). Expenditure was also estimated from distance walked and elevation gained (Terrain Method). Subjects recorded food consumption, and were weighed upon finishing the hike. Mean heart rate during hiking was 105 +/- 12 beats per minute. According to the Heart Rate Method, net expenditure averaged 3410 +/- 955 kilocalories on days 1 - 4, and 2586 +/- 974 kilocalories on day 5. Net expenditure from the Terrain Method was approximately 28 % lower. Gross expenditure, using the Heart Rate Method, averaged 4928 +/- 1050 kilocalories on days 1 - 4, and 3550 +/- 1052 kilocalories on day 5. Energy intake averaged 2134 +/- 625 kilocalories on days 1 - 4, and 1117 +/- 320 kilocalories on day 5. Expected weight loss due to the caloric deficit was 1.8 +/- 0.4 kilograms, and actual weight loss was 1.7 +/- 0.6 kilograms. Subjects expended nearly 5000 kilocalories per day and did not consume sufficient food to maintain body mass.

Animals and spaceflight: from survival to understanding.

Animals have been a critical component of the spaceflight program since its inception. The Russians orbited a dog one month after the Sputnik satellite was launched. The dog mission spurred U.S. interest in animal flights. The animal missions proved that individuals aboard a spacecraft not only could survive, but also could carry out tasks during launch, near-weightlessness, and re-entry; humans were launched into space only after the early animal flights demonstrated that spaceflight was safe and survivable. After these humble beginnings when animals preceded humans in space as pioneers, a dynamic research program was begun using animals as human surrogates aboard manned and unmanned space platforms to understand how the unique environment of space alters life. In this review article, the following questions have been addressed: How did animal research in space evolve? What happened to animal development when gravity decreased? How have animal experiments in space contributed to our understanding of musculoskeletal changes and fracture repair during exposure to reduced gravity?

Non-specific nature of specific language impairment: a review of the literature with regard to concomitant motor impairments.

In the light of emerging suggestions that language and motor deficits may co-occur, the literature on specific language impairment (SLI) was reviewed to investigate the prevalence of co-morbidity between SLI and poor limb motor skill in children diagnosed with language impairments. An extensive literature search was undertaken and the subsequent findings evaluated with particular reference to issues surrounding symptom co-occurrence, as well as to theoretical and aetiological accounts of SLI. Clearly substantial co-morbidity exists between SLI and poor motor skill, suggesting that SLI is not a specific disorder of language, but rather that children with SLI experience a broader range of difficulties, of which motor incoordination is one. Current theoretical explanations of SLI do not account fully for such wide-ranging difficulties and it may be useful in the future to focus on a more detailed explanation in terms of shared cognitive processes or neuromaturational delay to understand further the nature of the disorder, to explain it theoretically and to deal with it practically.

Action-monitoring and intention reporting in children with autism.

The " mindblindness" theory of core cognitive impairment in autism and at least one of the executive theories of the core cognitive deficit both predict that children with autism should find it difficult to report what their intention was when it diverged from an outcome. The former predicts this because it takes intention reporting to require a " theory of mind " and the latter predicts it because the theory posits an impairment in the monitoring of goal-directed actions. The latter also predicts impairments in the ability to monitor basic actions. Our three studies failed to support either of these views. Experiment 1 demonstrated intact abilities in the monitoring of basic actions (detecting which stimulus of a number of stimuli one is controlling). Experiment 2 demonstrated intact abilities in reporting an intention, both for self and for another agent, when the outcome was unintended but desired. In Experiment 3, using the novel "transparent intentions task", we found (with a minor qualification) intact ability in reporting on nonballistic intended actions when the result that the action achieved was unexpected. The implications of these results for views of the relation between theory of mind and executive difficulties in autism are discussed.

Costing child protective services staff turnover.

This article details the process used in one state to determine the financial costs to the child welfare agency accrued over the course of one year that were directly attributable to CPS staff turnover. The formulas and process for calculating specific cost elements due to separation, replacement and training are provided. The practical considerations inherent in this type of analysis are highlighted, as well as the use of this type of data to inform agency human resource strategies.

A dyspraxic deficit in specific language impairment and developmental coordination disorder? Evidence from hand and arm movements.

The extent to which children with either specific language impairment (SLI) or developmental coordination disorder (DCD) could be considered dyspraxic was examined using three tasks involving either familiar, or unfamiliar actions. SLI is diagnosed in children who fail to develop language in the normal fashion for no apparent reason, while the DCD diagnosis is applied to a child who experiences problems with movement in the absence of other difficulties. Seventy-two children aged between 5 and 13 years participated, falling into one of four groups: (1) children with specific language impairment (SLI), (2) children with developmental coordination disorder (DCD), (3) age-matched control children, and (4) younger control children. The performance of the clinical groups resembled that of younger normally developing children. Children with SLI, DCD, and the younger controls showed significant difficulty on the task requiring the production of familiar, but not unfamiliar postures. The deficit observed in the SLI group is particularly striking because it was seen both in those with and those without recognized motor difficulties.

Chronic vulvar ulceration in an immunocompetent woman due to acyclovir-resistant, thymidine kinase-deficient herpes simplex virus.

A 34-year-old healthy woman presented with a 15-month history of persistent, nonhealing vulvar ulcerations due to herpes simplex virus (HSV) type 2. Extensive dermatologic workup and serial skin biopsies failed to reveal an underlying vulvar dermatosis or autoimmune bullous disorder. Virologic studies revealed resistance to acyclovir in vitro due to deficiency in thymidine kinase activity. Serum antibody to human immunodeficiency virus was negative on two occasions, separated by 1 year. Immunologic evaluation showed normal HSV-specific proliferative and CD8 cytotoxic T lymphocyte responses as well as normal NK cell function. Vulvar lesions failed to heal in association with trials of topical trifluorothymidine and oral valacyclovir but resolved completely with the application of 1% foscarnet cream. No recurrence of HSV has been observed in 24 months of follow-up to date.

A reaching test reveals weak hand preference in specific language impairment and developmental co-ordination disorder.

A reaching test for quantifying hand preference (QHP task) was given to 7- to 11- year-old children with specific language impairment (SLI) or developmental coordination disorder (DCD). The performance of these clinical children was compared to both an age-matched and younger control group. The four groups did not differ in terms of preferred writing hand or preference on a handedness questionnaire. The QHP measure discriminated the clinical and younger control groups from the age-matched controls, but not from each other. Right-handed children with SLI, DCD, and the younger controls reached predominantly with the right hand to spatial positions located to the right of their body's midline and with the left hand to positions situated to its left. Right-handers in the age-matched control group showed a significantly greater tendency to use their right hand to reach to all spatial positions. The increased tendency of the children with SLI to use the non-preferred hand was particularly striking because it was seen both in those with and without recognised motor difficulties. The QHP task appears to be a sensitive, but non-specific, indicator of developmental disorders.

Variability in post-operative fluid and electrolyte prescription.

A four-week retrospective survey of intravenous fluid and electrolyte prescriptions on post-operative surgical patients revealed wide variability in fluid and electrolyte prescription by medical staff. Median volume of intravenous fluid prescribed was 3000 ml (range 1667-5000). Total sodium prescribed varied from 0 to 770, median 242 mmol/day), with potassium infrequently added (range 0-81, median 0 mmol/day). Patients undergoing emergency surgery were prescribed more sodium than those undergoing routine procedures (p = 0.0403); 0.9% saline was the most common fluid prescribed overall. There was poor correlation between serum electrolyte values and the amounts of electrolytes prescribed. Intravenous fluid prescription should take into account the post-operative stress response which reduces sodium requirements (unless there are other concomitant losses) and increases urinary potassium losses. A suitable post-operative 'maintenance' fluid is 4% dextrose/0.18% saline with 1-2 g potassium chloride, particularly if serum electrolyte levels are not known. Other fluid losses should be replaced with equivalent fluids.

Activity, passivity, self-denigration, and self-promotion: toward an interactionist model of interpersonal dependency.

Although dependency in adults is inextricably linked with passivity and submissiveness in the minds of many theoreticians, clinicians, and researchers, evidence has accumulated which suggests that in certain situations, dependency is actually associated with high levels of activity and assertiveness. Three experiments were conducted to test the hypothesis that when a dependent person is concerned primarily with getting along with a peer, he or she will "self-denigrate" (i.e., will utilize strategies that ensure that a peer will be evaluated more positively than he or she is on a laboratory task), but when a dependent person is concerned primarily with pleasing an authority figure, he or she will "self-promote" (i.e., will adopt strategies that increase the likelihood that he or she will be evaluated more positively than a peer on a laboratory task). This hypothesis was supported in all three experiments. Theoretical implications of these findings are discussed, and an interactionist model of interpersonal dependency is briefly described.

The effect of systemically administered PDGF-BB on the rodent skeleton.

Platelet-derived growth factor (PDGF), an osteoblast mitogen, has been demonstrated to accelerate fracture healing and periodontal bone repair when applied locally in vivo. To explore whether PDGF could stimulate bone formation in intact bone, we administered it systemically to rats rendered acutely estrogen-deficient. Because PDGF may stimulate bone resorption in vitro, PDGF was administered with and without an antiresorptive agent (alendronate). All treatments were given by intravenous injection 3 times a week for 6 weeks. Spinal bone mineral density (BMD) decreased by 5% in the vehicle-treated ovariectomized (OVX) rats by the end of the study as determined by DXA. Treatment with PDGF prevented this bone loss and significantly (p < 0.05) increased the bone density in the spine (9%) and whole skeleton (5.8%). Combined treatment with PDGF and alendronate resulted in a greater increase at the spine (18%) and whole skeleton (12.8%) than either agent alone. Histomorphometric analysis demonstrated that treatment with PDGF increased the osteoblast number and osteoblast perimeter without consistent changes in osteoclast estimates. Biomechanical testing demonstrated that PDGF administration increased the vertebral body compressive strength and femoral shaft torsional stiffness and resulted in a trend for enhanced femoral head shearing strength. Coadministration of alendronate further increased these indices of bone strength. PDGF administration also caused premature closure of the growth plate, decreased body fat, and resulted in extraskeletal collagen deposition. We therefore demonstrate, for the first time, that systemic administration of PDGF can increase bone density and strength throughout the skeleton.

Calcitonin gene-related peptide (CGRP) in the developing mouse limb.

The mitogenic effects of neuropeptides and their localization to developing tissues suggest an important role for these peptides during gestation. We examined the expression and action of the neuropeptide calcitonin gene-related peptide (CGRP) in the developing mouse limb bud, an excellent model system for studying musculoskeletal development. CGRP immunoreactivity (CGRP-ir) was detected in the developing limb at day 16.5 of gestation (E 16.5) and was limited to nerve fibers surrounding blood vessels, within the developing muscle or in close proximity to the developing cartilaginous skeleton. Although CGRP-ir was not observed until E 16.5, limb buds were responsive to CGRP as early as E 11.5. Within 5 min of exposure to CGRP (10(-8) to 10(-7) M) a 2--3-fold increase in cyclic AMP (cAMP) levels was observed. This CGRP-induced increase in cAMP was abolished by the addition of human CGRP8-37, a CGRP receptor antagonist. This result suggests that the effect on cAMP was mediated by the interaction of CGRP with CGRP receptors. Our findings indicate that mouse limbs are responsive to CGRP when they are composed of primarily undifferentiated mesenchyme and that CGRP-ir appears at a later stage of development in association with cartilage and muscle differentiation.

Retest reliability of scores on objective and projective measures of dependency: relationship to life events and interest interval.

The retest reliabilities of widely used objective and projective measures of dependency were assessed in a mixed-sex sample of undergraduates (54 women and 34 men). Subjects completed Hirschfeld and colleagues' (1977) Interpersonal Dependency Inventory (IDI) and Masling, Rabie, and Blondheim's (1967) Rorschach Oral Dependency (ROD) scale on two occasions separated by 16, 28, or 60 weeks. The IDI and ROD scale showed good retest reliability over 16 weeks in both men and women. However, the ROD scale did not show adequate retest reliability over longer periods in subjects of either sex. IDI scores showed excellent long-term retest reliability in women, but poor long-term retest reliability in men. Subjects' self-reports and impact ratings of life events experienced during the intertest period were unrelated to changes in subjects' IDI and ROD scale scores from Time 1 to Time 2, regardless of the intertest interval used.

Recurrence and resistance patterns of herpes simplex virus following cessation of > or = 6 years of chronic suppression with acyclovir. Acyclovir Study Group.

Questions have arisen regarding the clinical outcome and the possible selection of resistant virus when patients with genital herpes discontinue prolonged chronic acyclovir; 239 immunocompetent patients with a history of frequently recurring genital herpes who stopped successful suppressive therapy after 6 years were studied. Of the patients, 85.8% had at least one recurrence and 75% had at least two recurrences in the subsequent year (median time to first and second recurrence, 68 and 180 days, respectively). Herpes simplex virus isolates recovered from these patients had a median acyclovir sensitivity of 0.79 micrograms/mL and 4 (3.5%) were resistant (> or = 3 micrograms/mL). These values are comparable to those of pretherapy isolates and to reported values of isolates from acyclovir-naive patients. Also, paired pre- and posttherapy isolates from 13 patients showed no trend toward development of resistance. Thus, even after 6 years of acyclovir suppression, most patients continue to have recurrences, but the selection of resistant virus has not been observed.

Changes in bone in a model of spinal cord injury.

Bone calcium, histomorphometry, and mechanical strength were evaluated in a model of spinal cord injury. Cortical bone area and rates of formation and apposition at the tibiofibular junction (TFJ) and midshaft of the humerus were measured at 35-42, 42-77, and 77-94 days after transection of the spinal cord. All comparisons were between the animals with a spinal lesion and control animals. A 0.34% difference in the length of the tibia of the two groups of animals was observed, the dry weight of the tibia was 28.4% less in rats with a lesion, and there was no significant difference in the amount of calcium per milligram of bone. At 35 days after surgery, the cortical area in the midshaft of the humerus was slightly less (11%) in rats with a lesion, but by 94 days there was no difference in cortical or medullary area. The final (day 94) cortical area at the TFJ in rats with a lesion was less than that in the controls. Bone formation at the TFJ was similar in both groups in the period of 35-42 days and was similar at 77-94 days in the animals with a lesion, and rates of formation and apposition were greater in the humerus of rats with a lesion; the rates did not differ significantly between groups at either site. At 94 days, trabecular bone area in the tibial metaphysis was 41% less in rats with a lesion. Mechanical parameters were significantly less in the femora, but not the humeri, of rats with a lesion.

In vitro and in vivo characterization of herpes simplex virus clinical isolates recovered from patients infected with human immunodeficiency virus.

A total of 100 herpes simplex viruses isolated from lesions not responding to acyclovir (ACV) therapy were recovered from 51 patients infected with human immunodeficiency virus. In vitro analysis of these isolates included testing their susceptibility to ACV and determining their thymidine kinase (TK) phenotypes. Of the 100 isolates evaluated, 23 were ACV sensitive and 77 were ACV resistant. Seventy-four of these ACV-resistant isolates were of the TK-deficient or low-TK-producer phenotype and three were of the TK-altered phenotype. The TKs isolates that represented each of the different autoradiographic phenotypes were further characterized by enzyme kinetics. The ability of selected isolates to cause disease in vivo was evaluated by using several mouse virulence models. Cutaneous virulence in normal and immunocompromised mice was evaluated, and neurovirulence in normal mice was determined. Latent infections were assayed by the cocultivation of trigeminal ganglia recovered from mice that had survived acute infection. These reactivated viruses were evaluated in vitro and compared with the original infecting isolate. The mechanisms of resistance and pathogenicity of these herpes simplex virus isolates recovered from patients positive for human immunodeficiency virus are similar to those reported for isolates recovered from normal and immunocompromised patients without AIDS.