Motor Performance, Mental Workload and Self-Efficacy Dynamics during Learning of Reaching Movements throughout Multiple Practice Sessions.

The human capability to learn new motor skills depends on the efficient engagement of cognitive-motor resources, as reflected by mental workload, and psychological mechanisms (e.g., self-efficacy). While numerous investigations have examined the relationship between motor behavior and mental workload or self-efficacy in a performance context, a fairly limited effort focused on the combined examination of these notions during learning. Thus, this study aimed to examine their concomitant dynamics during the learning of a novel reaching skill practiced throughout multiple sessions. Individuals had to learn to control a virtual robotic arm via a human-machine interface by using limited head motion throughout eight practice sessions while motor performance, mental workload, and self-efficacy were assessed. The results revealed that as individuals learned to control the robotic arm, performance improved at the fastest rate, followed by a more gradual reduction of mental workload and finally an increase in self-efficacy. These results suggest that once the performance improved, less cognitive-motor resources were recruited, leading to an attenuated mental workload. Considering that attention is a primary cognitive resource driving mental workload, it is suggested that during early learning, attentional resources are primarily allocated to address task demands and not enough are available to assess self-efficacy. However, as the performance becomes more automatic, a lower level of mental workload is attained driven by decreased recruitment of attentional resources. These available resources allow for a reliable assessment of self-efficacy resulting in a subsequent observable change. These results are also discussed in terms of the application to the training and design of assistive technologies.

Evaluation of the Experience of Spoke Hospitals in an Academic Telestroke Network.

Background/Introduction:Implementation of telestroke has been associated with improved thrombolysis rates and clinical outcomes in remote or neurologically underserved spoke hospitals. Yet, the experience of spoke hospitals using telestroke has not been well described. We sought to characterize spoke hospitals' perceptions of telestroke to understand perceived advantages, challenges, and barriers to use.Design/Methods:Within our northeastern US telestroke network, we conducted scripted interviews with representatives (stroke coordinators, nurse managers, and emergency physicians) from each of the 15 spoke hospitals connected to a single academic hub hospital. Interview questions included both open-ended and Likert scale responses. We used descriptive and nonparametric analyses (e.g., logit) to present the results.Results:Of the 15 spoke hospitals interviewed, the majority felt that telestroke enabled them to treat more patients with the tissue plasminogen activator (tPA; 93.3%, n = 14) and to achieve faster door-to-needle times for tPA treatment (80%, n = 12). Higher Likert scores were not correlated with hospitals' consult volume or tPA volume. The most commonly reported barriers to using telestroke were providers who were not familiar or comfortable using the technology (66%, n = 10). Few hospitals had concerns that telestroke led to overtreatment with tPA (13.3%, n = 2) or led to unnecessary transfers (20%, n = 3). None of the hospitals felt that the physician-patient relationship was compromised, nor was there a concern that patients would have a negative perception of the spoke hospital with utilization of services.Conclusions:Within this single hub-spoke telestroke system in the northeast, we found that spoke hospitals perceive the advantages of telestroke to be in enabling improved rates and efficiency of tPA administration. Barriers to use were most often related to technological challenges rather than concerns about patient care or patients' perceptions. Future work should further explore how to better meet the needs of spoke hospitals in caring for stroke patients.

Frequent Hub-Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network.

BACKGROUND: For acute ischemic stroke patients, shorter time to thrombolytic (tissue plasminogen activator [tPA]) is associated with improved outcomes. INTRODUCTION: Telestroke increases tPA use at spoke hospitals, yet its effect on door-to-needle (DTN) times for tPA administration is unknown. We hypothesize that spoke hospitals with more frequent contact to a hub hospital will have shorter DTN times than those with less frequent contact. MATERIALS AND METHODS: We identified 375 patients treated with tPA by conventional or telestroke methods in an academic hub-and-spoke telestroke network for whom date and time data were available. Strength of the spoke-hub connection was the primary predictor variable, defined as the number of all telestroke consults (tPA and non-tPA) done at each spoke hospital during the year of the patient's presentation. Patient-level regression analyses examined the relationship between DTN time and spoke-hub connection during the year of the patient's presentation, controlling for temporal trends and clustering within hospitals. RESULTS: Sixteen spoke hospitals contributed data on 375 tPA-treated patients from 2006-2015. Hospitals treated a median of 13.5 patients with tPA per year; median hospital-level DTN was 78.8 min (interquartile range [IQR] 71.3-85). Median number of telestroke consults per year was 34 (range 3-137). Among all 375 patients, median DTN was 76 min (IQR 60-97). Strength of spoke-hub connection was significantly associated with faster DTN time for patients (1.3 min gain per 10 additional consults, p = 0.048). CONCLUSIONS: More frequent contact between a telestroke spoke and its hub was associated with faster tPA delivery for patients, even after accounting for secular trends in DTN improvements.