Visuospatial ability and novice brachial plexus sonography performance.

BACKGROUND: The knowledge on the type and influence of visuospatial ability on sonography performance relevant for ultrasound-guided regional anaesthesia remains incomplete. The aim of this study was to determine whether four different factors of visuospatial ability are important in determining proficiency and procedure time of novices performing brachial plexus sonography. These factors were spatial visualisation, flexibility of closure, spatial relations and speed of closure. METHODS: Thirty-three ultrasound novices were recruited in this prospective, observational trial. Five cognitive tests, from a standardised battery that assesses all four visuospatial factors, were administered to each participant at the start of the study. Each novice then performed brachial plexus sonography on a human model at baseline and final exams, separated by a discovery learning session. Novices were examined in their sonography performance by blinded assessors who scored proficiency, technique, image quality, and time taken to perform at both baseline and final scans. RESULTS: Novices with intermediate and high visuospatial ability in spatial visualisation, spatial relations and speed of closure were significantly more proficient and efficient compared with their peers stratified into low-ability cohorts (P < 0.02). The Matrix Reasoning and the Mental Rotations Test-A were both correlated with sonography final exam scores (Spearman rank correlation ρ = 0.38 and 0.36, P = 0.03 and 0.04, respectively). CONCLUSIONS: Spatial visualisation, spatial relations and speed of closure, but not flexibility of closure, influence sonography performance. Visuospatial ability testing can identify novices who will require extra assistance in learning ultrasound relevant for regional anaesthesia. ( TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry 12614000819628).

Efficacy of electronic portable assistive devices for people with acquired brain injury: a systematic review.

A systematic review was conducted to evaluate the efficacy of electronic portable assistive devices (EPADs) for people with acquired brain injury. A systematic database search (OVID, CINAHL) found 541 citations published between 1989 and the end of 2012. A total of 23 reports met the inclusion/exclusion criteria, namely intervention studies (group, n-of-1) testing the efficacy of EPADs as compensatory devices for cognitive impairment for people with acquired brain injury aged 16-65 years. Study quality was rated by the PEDro (Physiotherapy Evidence Database) scale, (randomised controlled trials), the Downes and Black tool (other group intervention studies), and the Single Case Experimental Design tool (single participant studies). Levels of evidence were determined using five levels of classification based on the Spinal Cord Injury Rehabilitation Evidence table. Results found no Level 1 studies (RCTs with PEDro score ≥ 6), four Level 2 studies and 10 Level 3 studies. There was insufficient evidence to recommend any practice standards, but sufficient evidence to recommend the use of electronic reminder systems in supporting the everyday functioning of people with acquired brain injury as a practice guideline. Higher quality studies are required to support a broader range of compensatory roles that EPADs have the potential to play in neurorehabilitation and the long-term support of people with acquired brain injury.

Bone dysplasia sclerosteosis results from loss of the SOST gene product, a novel cystine knot-containing protein.

Sclerosteosis is an autosomal recessive sclerosing bone dysplasia characterized by progressive skeletal overgrowth. The majority of affected individuals have been reported in the Afrikaner population of South Africa, where a high incidence of the disorder occurs as a result of a founder effect. Homozygosity mapping in Afrikaner families along with analysis of historical recombinants localized sclerosteosis to an interval of approximately 2 cM between the loci D17S1787 and D17S930 on chromosome 17q12-q21. Here we report two independent mutations in a novel gene, termed "SOST." Affected Afrikaners carry a nonsense mutation near the amino terminus of the encoded protein, whereas an unrelated affected person of Senegalese origin carries a splicing mutation within the single intron of the gene. The SOST gene encodes a protein that shares similarity with a class of cystine knot-containing factors including dan, cerberus, gremlin, prdc, and caronte. The specific and progressive effect on bone formation observed in individuals affected with sclerosteosis, along with the data presented in this study, together suggest that the SOST gene encodes an important new regulator of bone homeostasis.