Guidance hypothesis with verbal feedback in learning a palpation skill.

OBJECTIVE: To investigate whether a force application of a novel motor skill was simple or complex and to determine the appropriate level of feedback during training. The objective was to determine the effects of various amounts of knowledge of results (KR) on learning a novel skill that is frequently taught in chiropractic for the assessment of vertebral motor unit dysfunction. METHODS: Thirty-five active subjects were taught the novel skill of spring testing to a particular force range through 9 or 10 teaching sessions over a 2-week period (a school holiday limited some to only 9 sessions). To determine the particular force range, an initial phase of the study involved a licensed and practicing clinician performing motion palpation spring testing of the thoracic spine of a prone subject. The data from a total of 47 pushes throughout the thoracic spine were recorded, and the mean force and standard deviation were calculated. The second phase of the study used the obtained mean and standard deviation for teaching the force of prone thoracic spine motion palpation to 35 active subjects by administering spring testing to 35 passive subjects. The active subjects were randomly divided into 4 groups, with each receiving a varying amount of verbal feedback to move toward the target force of their learned skill. Each passive subject was laid prone on an instrumented adjusting table. Group 1 received the least amount of feedback while learning the novel skill. Groups 2 and 3 received more frequent, intermittent feedback while learning the skill, and group 4 received constant, frequent feedback during each of the 10 teaching sessions. All subjects returned within 2 weeks for 2 retention trials to determine the efficacy of the learned skill. RESULTS: The mean force determined was 143 N with a standard deviation of 14 N. Each subject was taught spring testing within this target range. The 2 final retention trials showed group 3 to have demonstrated the most targeted retention of the learned motor skill. These subjects exhibited the closest force range to the target for the motor skill learned and fewer changes in standard deviation compared with their acquisition trials and thus the highest retention. Group 4, receiving 100% feedback, demonstrated the most accurate spring testing during the acquisition trials, but the subjects did not effectively demonstrate when compared on acquisition and retention trials. CONCLUSION: The results of this study show data to be consistent with the guidance hypothesis in learning a novel motor skill. The constant KR feedback is beneficial for learning when used to reduce error during practice but detrimental when relied upon for retention and learning. These data suggest the necessity of using motor skill development learning theory in the teaching of chiropractic.

Case report: Myofascial pain syndrome: a double crush-like appearance.

OBJECTIVE: To discuss the case of a patient with myofascial pain syndrome that appeared similar to double crush syndrome. CLINICAL FEATURES: This is a case report of a 45-year old female who presents to the private practice clinic with the same signs and symptoms of carpal tunnel syndrome, 1 year post-carpaltunnel surgery. The history is consistent with injuries that result in double crush syndrome and thoracic outlet syndrome. The patient history includes a motor vehicle accident (MVA) in 1963 that resulted in a prolonged hospital stay and fracture of a cervical vertebral (C4) body. She fractured the olecranon process of the right elbow during a fall in 1970's. She has smoked approximately 1 pack a day for 20 years. Her job involves long periods of sitting at a keyboard and in a car. All of these portions of the patient history are possible factors in the clinical signs and symptoms of double crush syndrome. INTERVENTION AND OUTCOME: Treatment involved chiropractic manipulation and physical therapy modalities for the elimination of pain and returning the patient's full range of motion in the wrist, elbow, shoulder and cervical spine. After range of motion was restored, a home exercise program was initiated. The home exercise program included a return to past sporting activity and active, resistive (Theraciser band) activities for the elbow and cervical spine. Also a reduction in smoking was initiated as part of the patient's treatment plan. CONCLUSION: It is our contention that patients who have electromyographic (EMG) demonstrable carpal tunnel syndrome need a cervical spine workup and a period of conservative care to include skilled manipulation, physical therapy and home exercises before surgery is recommended.

Intra-instrument reliability of 4 goniometers.

BACKGROUND: Cervical spine ROM movements taken accurately with reliable measuring devices are important in outcome measures as well as in measuring disability. OBJECTIVE: To compare the active cervical spine ROM in healthy young adult population using 4 different goniometers. METHODS: Subjects were tested during active cervical spine ROM. The devices were a single hinge inclinometer, single bubble carpenter's inclinometer, dual bubble goniometers and Cybex EDI 320 electrical inclinometer. All subjects were tested for rotational limits along each of the orthogonal axes of movement. There are 3 trials for each movement direction, except rotation was not measured with the Cybex as per manual suggestions. The subjects were randomly assigned to the sequence of devices. SUBJECTS: Twenty-seven student volunteers (19 men and 8 women) were tested. Ages ranged from 21 to 41, mean age of 27.6 years of age. DATA: Active cervical spine ROM trials for each measurement was used to calculate mean and standard deviation. An overall analysis of variance (ANOVA) and Bonferroni adjusted T-test were determined in order to calculate reliability and significance. DISCUSSION: The cost of the instruments were not used in determining reliability or significance. The single hinge inclinometer was found to be a reliable measure but not likely valid. The Cybex EDI 320 was found to be the best measuring device; however, the 2 instruments whose cost were in-between the single hinge inclinometer and the electrical goniometer were just as reliable as the more expensive device. The AMA Guides of Impairment were used as the normative data to compare these devices. CONCLUSION: Since the devices could measure reliably, whether expensive or more cost effective for students they would likely make adequate devices for training students on the methods for measuring ROM. There is previous data to suggest that older populations have gender differences and age differences with ROM. This study could not measure that and would make a useful follow-up study.