Learning functional human anatomy with a new interactive three-dimensional digital tool.

Human anatomy requires understanding spatial relationships among anatomical structures and is often perceived as difficult to learn by students. To overcome this concern, several digital tools exist with some strengths and limitations among which the lack of interactivity especially for complex functional anatomy learning. In this way, a new interactive three-dimensional tool called Antepulsio was designed. Antepulsio was assessed by comparing three groups of first year kinesiology students to test whether it is likely to favor functional anatomy learning during three training sessions spread over a week. The experiment was conducted during a real academic course. Laterality judgment, 3D spatial abilities and working memory abilities from all participants were previously collected to create three homogeneous groups: the active group (n = 17, 17.76 ± 0.56 years) interacted with Antepulsio, the passive group (n = 18, 17.89 ± 0.83 years) watched videos of Antepulsio while the control group (n = 15, 18.07 ± 0.80 years) performed a neutral activity unrelated to anatomy. Anatomy knowledge was also assessed during pretest, posttest, and retention test (8 weeks after the posttest). The most significant outcome of this study revealed that in case of better working visual memory, the active group outperformed the passive group between pretest and retention test (p < 0.01). In other words, Antepulsio tool is efficient only for students with high visuospatial working memory. These selective benefits of Antepulsio are discussed in terms of cognitive load, training duration and the necessary period of familiarization with the tool.

Exploring the impact of interactive movement-based anatomy learning in real classroom setting among kinesiology students.

Descriptive and functional anatomy is one of the most important sciences for kinesiology students. Anatomy learning requires spatial and motor imagery abilities. Learning anatomy is complex when teaching methods and instructional tools do not appropriately develop spatial and motor imagery abilities. Recent technological developments such as three-dimensional (3D) digital tools allow to overcome those difficulties, especially when 3D tools require strong interactions with the learners. Besides interactive digital tools, embodied learning or learning in motion is an effective method for a wide variety of sciences including anatomy. The aim of this study was to explore the impact of combining movement execution with 3D animation visualization on anatomy learning in a real classroom teaching context. To do so, the results of two groups of kinesiology students during three official assessments were compared. The experimental group (n = 60) learned functional anatomy by combining movement execution with traditional knowledge acquisition (e.g., 3D animations visualization, problem-based learning exercises). The control group (n = 61) had the same material but did not execute the movements during problem-solving exercises. Although no differences were found between both groups on early and mid-semester examinations, significant difference appeared at the end of the semester with an advantage for the experimental group. This exploratory study suggests that embodied learning is beneficial in improving functional anatomy learning. Therefore, it would be interesting to integrate such type of pedagogical approach within the kinesiology curriculum.

Modelling response time in a mental rotation task by gender, physical activity, and task features.

Mental rotation (MR) is a spatial skill considered to be a key-component of intellectual ability. Studies have suggested that the response time (RT) in a MR task (MRt) might be influenced, with possible gender differences, by the practice of a physical activity (PA) and depending on the plane, direction, degrees of the MR and the frame of reference to perform it. The present study aimed at examining the respective influences of all these variables on the RT by developing a linear mixed-effect model from the RTs varying according to the MR plane, direction, degrees and frame of reference. The MRt was performed by 96 males and females, all undergraduate students, distributed in three groups (sedentary subjects, artistic gymnasts, and futsal players). The results showed that only gender had a main effect (faster log RT in males), probably task-dependent. The other variables interacted among them showing that: (a) the log RT may be influenced by rotations experienced during PA, in particular during the locomotion on a horizontal ground and (b) such influence mainly depends on the compatibility of the physical rotations experienced with the plane and the degrees of the MRt.

A haptic laparoscopic trainer based on affine velocity analysis: engineering and preliminary results.

BACKGROUND: There is a general agreement upon the importance of acquiring laparoscopic skills outside the operation room through simulation-based training. However, high-fidelity simulators are cost-prohibitive and elicit a high cognitive load, while low-fidelity simulators lack effective feedback. This paper describes a low-fidelity simulator bridging the existing gaps with affine velocity as a new assessment variable. Primary validation results are also presented. METHODS: Psycho-motor skills and engineering key features have been considered e.g. haptic feedback and complementary assessment variables. Seventy-seven participants tested the simulator (17 expert surgeons, 12 intermediates, 28 inexperienced interns, and 20 novices). The content validity was tested with a 10-point Likert scale and the discriminative power by comparing the four groups' performance over two sessions. RESULTS: Participants rated the simulator positively, from 7.25 to 7.72 out of 10 (mean, 7.57). Experts and intermediates performed faster with fewer errors (collisions) than inexperienced interns and novices. The affine velocity brought additional differentiations, especially between interns and novices. CONCLUSION: This affordable haptic simulator makes it possible to learn and train laparoscopic techniques. Self-assessment of basic skills was easily performed with slight additional cost compared to low-fidelity simulators. It could be a good trade-off among the products currently used for surgeons' training.

Effect of motor imagery and actual practice on learning professional medical skills.

BACKGROUND: The peripheral venous catheter is the most frequently used medical device in hospital care to administer intravenous treatment or to take blood samples by introducing a catheter into a vein. The aim of this study was to examine the effect of motor imagery associated with actual training on the learning of peripheral venous catheter insertion into a simulated venous system. METHOD: This was a prospective monocentre study in 3rd year medical students. Forty medical students were assigned to the experimental group (n = 20) performing both real practice and motor imagery of peripheral venous catheter insertion or to the control group (n = 20) trained through real practice only. We also recruited a reference group of 20 professional nurses defining the benchmark for a target performance. RESULTS: The experimental group learned the peripheral venous catheter insertion faster than the control group in the beginning of learning phase (p < 0.001), reaching the expected level after 4 sessions (p = .87) whereas the control group needed 5 sessions to reach the same level (p = .88). Both groups were at the same level at the end of the scheduled training. CONCLUSIONS: Therefore, motor imagery improved professional motor skills learning, and limited the time needed to reach the expected level. Motor imagery may strengthen technical medical skill learning.

The therapeutic role of motor imagery during the chronic phase after total knee arthroplasty: a pilot randomized controlled trial.

BACKGROUND: There is now ample evidence that motor imagery contributes to enhance motor learning and promote motor recovery in patients with motor disorders. Whether motor imagery practice is likely to facilitate mobility in patients suffering from knee osteoarthritis, at 6-months after total knee arthroplasty, remains unknown. AIM: This trial was designed to evaluate the therapeutic effectiveness of implementing motor imagery into the classical course of physical therapy at 6-months after total knee arthroplasty. DESIGN: Randomized controlled trial. POPULATION: Twenty-four patients with unilateral total knee arthroplasty were assigned to a motor imagery or control group in a test-retest procedure, following a rehabilitation program as outpatients. METHODS: During both the pre- and post-test, a set of strength and functional mobility measures were assessed: quadriceps strength, peak knee flexion during the swing phase, performance at the timed up and go test, stair climbing test, and 6-minute walk test, and finally Oxford knee score. In addition to a common physical therapy program, the motor imagery group practiced additional motor imagery exercises, while participants of the control group were subjected to a period of neutral activities for an equivalent amount of time. RESULTS: Data provided evidence that motor imagery enhanced the quadriceps muscle strength of the operated knee (F (1, 22)=10.36, P=0.003), improved the peak knee flexion during the swing phase (F (1, 22)=31.52, P<0.001), and increased the speed to climb and descend stairs (F (1, 22)=14.28, P=0.001). CONCLUSIONS: This study demonstrated the effectiveness of motor imagery exercises in gait performance and functional recovery in a small sample of individuals who underwent total knee arthroplasty. However, before drawing final conclusions sample size calculation should be conducted in the future. CLINICAL REHABILITATION IMPACT: While waiting for further research, our findings encourage incorporating motor imagery exercises into classical physical therapy protocols at 6-months after total knee arthroplasty.

The therapeutic role of motor imagery during the acute phase after total knee arthroplasty: a pilot study.

PURPOSE: The aim of this study was to measure physical and functional outcomes during the acute postoperative recovery in patients who underwent total knee arthroplasty. Motor imagery has been shown to decrease pain and promote functional recovery after both neurological and peripheral injuries. Yet, whether motor imagery can be included as an adjunct effective method into physical therapy programs following total knee arthroplasty remains a working hypothesis that we aim to test in a pilot study. METHOD: Twenty volunteers were randomly assigned to either a motor imagery or a control group. Pain, range of motion, knee girth as well as quadriceps strength and Timed Up and Go Test time were the dependent variables during pre-test and post-test. RESULTS: The motor imagery group exhibited larger decrease of ipsilateral pain and knee girth, a slightly different evolution of range of motion and an increase of ipsilateral quadriceps strength compared to the control group. No effects of motor imagery on Timed Up and Go Test scores were observed. CONCLUSION: Implementing motor imagery practice into the course of physical therapy enhanced various physical outcomes during acute postoperative recovery after total knee arthroplasty. According to this pilot study, motor imagery might be relevant to promote motor relearning and recovery after total knee arthroplasty.Partial effect-sizes should be conducted in the future. Implications for rehabilitation   Adding motor imagery to physical therapy sessions during the acute period following total knee arthroplasty: • Enhances quadriceps strength. • Alleviates pain. • Enhances range of motion. • Does not have any effect on basic functional mobility. • Does not have any effect on knee girth.

Implementing Cognitive Training Into a Surgical Skill Course: A Pilot Study on Laparoscopic Suturing and Knot Tying.

Mini-invasive surgery-for example, laparoscopy-has challenged surgeons' skills by extending their usual haptic space and displaying indirect visual feedback through a screen. This may require new mental abilities, including spatial orientation and mental representation. This study aimed to test the effect of cognitive training based on motor imagery (MI) and action observation (AO) on surgical skills. A total of 28 postgraduate residents in surgery took part in our study and were randomly distributed into 1 of the 3 following groups: (1) the basic surgical skill, which is a short 2-day laparoscopic course + MI + AO group; (2) the basic surgical skill group; and (3) the control group. The MI + AO group underwent additional cognitive training, whereas the basic surgical skill group performed neutral activity during the same time. The laparoscopic suturing and knot tying performance as well as spatial ability and mental workload were assessed before and after the training period. We did not observe an effect of cognitive training on the laparoscopic performance. However, the basic surgical skill group significantly improved spatial orientation performance and rated lower mental workload, whereas the 2 others exhibited lower performance in a mental rotation test. Thus, actual and cognitive training pooled together during a short training period elicited too high a strain, thus limiting potential improvements. Because MI and AO already showed positive outcomes on surgical skills, this issue may, thus, be mitigated according to our specific learning conditions. Distributed learning may possibly better divide and share the strain associated with new surgical skills learning.

How spatial abilities and dynamic visualizations interplay when learning functional anatomy with 3D anatomical models.

The emergence of dynamic visualizations of three-dimensional (3D) models in anatomy curricula may be an adequate solution for spatial difficulties encountered with traditional static learning, as they provide direct visualization of change throughout the viewpoints. However, little research has explored the interplay between learning material presentation formats, spatial abilities, and anatomical tasks. First, to understand the cognitive challenges a novice learner would be faced with when first exposed to 3D anatomical content, a six-step cognitive task analysis was developed. Following this, an experimental study was conducted to explore how presentation formats (dynamic vs. static visualizations) support learning of functional anatomy, and affect subsequent anatomical tasks derived from the cognitive task analysis. A second aim was to investigate the interplay between spatial abilities (spatial visualization and spatial relation) and presentation formats when the functional anatomy of a 3D scapula and the associated shoulder flexion movement are learned. Findings showed no main effect of the presentation formats on performances, but revealed the predictive influence of spatial visualization and spatial relation abilities on performance. However, an interesting interaction between presentation formats and spatial relation ability for a specific anatomical task was found. This result highlighted the influence of presentation formats when spatial abilities are involved as well as the differentiated influence of spatial abilities on anatomical tasks.

Impact of neurologic deficits on motor imagery: a systematic review of clinical evaluations.

Motor imagery (MI, the mental representation of an action without engaging in its actual execution) is a therapeutically relevant technique to promote motor recovery after neurologic disorders. MI shares common neural and psychological bases with physical practice. Interestingly, both acute and progressive neurologic disorders impact brain motor networks, hence potentially eliciting changes in MI capacities. How experimental neuroscientists and medical practitioners should assess and take into account these changes in order to design fruitful interventions is largely unresolved. Understanding how the psychometric, behavioral and neurophysiological correlates of MI are impacted by neurologic disorders is required. To address this brain-behavior issue, we conducted a systematic review of MI data in stroke, Parkinson's disease, spinal cord injury, and amputee participants. MI evaluation methods are presented. Redundant MI profiles, primarily based on psychometric and behavioral evaluations, emerged in each clinical population. When present, changes in the psychometric and behavioral correlates of MI were highly congruent with the corresponding motor impairments. Neurophysiological recordings yielded specific changes in cerebral activations during MI, which mirrored structural and functional reorganizations due to neuroplasticity. In this view, MI capacities may not be deteriorated per se by neurologic diseases resulting in chronic motor incapacities, but adjusted to the current state of the motor system. Literature-driven orientations for future clinical research are provided.

Physiological changes in response to apnea impact the timing of motor representations: a preliminary study.

BACKGROUND: Reduced physiological arousal in response to breath-holding affects internal clock processes, leading swimmers to underestimate the time spent under apnea. We investigated whether reduced physiological arousal during static apnea was likely to affect the temporal organization of motor imagery (MI). METHODS: Fourteen inter-regional to national breath-holding athletes mentally and physically performed two 15 m swimming tasks of identical durations. They performed the two sequences in a counterbalanced order, the first while breathing normally using a scuba, the second under apnea. We assessed MI duration immediately after completion of the corresponding task. Athletes performed MI with and without holding breath. RESULTS: MI durations (26.1 s ± 8.22) were significantly shorter than actual durations (29.7 s ± 7.6) without holding breath. Apnea increased MI durations by 10% (± 5%). Heart rate decrease in response to breath-holding correlated with MI durations increase (p < .01). Under apnea, participants achieved temporal congruence between MI and PP only when performing MI of the apnea swimming task. Self-report data indicated greater ease when MI was performed in a physiological arousal state congruent with that of the corresponding motor task. CONCLUSIONS: Physiological arousal affected the durations of MI through its effects on internal clock processes and by impacting the congruency in physiological body states between overt and covert motor performance. Present findings have potential implications with regards to the possibility of preventing underestimation of durations spent under a state of reduced physiological arousal.

The therapeutic role of motor imagery on the functional rehabilitation of a stage II shoulder impingement syndrome.

PURPOSE: Motor imagery (MI) has been used as a complementary therapeutic tool for motor recovery after central nervous system disease and peripheral injuries. However, it has never been used as a preventive tool. We investigated the use of MI in the rehabilitation of stage II shoulder impingement syndrome. For the first time, MI is used before surgery. METHOD: Sixteen participants were randomly assigned to either a MI or control group. Shoulder functional assessment (Constant score), range of motion and pain were measured before and after intervention. RESULTS: Higher Constant score was observed in the MI than in the control group (p=0.04). Participants in the MI group further displayed greater movement amplitude (extension (p<0.001); flexion (p=0.025); lateral rotation (p<0.001). Finally, the MI group showed greater pain decrease (p=0.01). CONCLUSION: MI intervention seems to alleviate pain and enhance mobility, this is probably due to changes in muscle control and consequently in joint amplitude. MI might contribute to postpone or even protect from passing to stage III that may require surgery. Implications for Rehabilitation Adding motor imagery training to classical physical therapy in a stage II impingement syndrome: Helps in alleviating pain Enhances shoulder mobility Motor imagery is a valuable technique that can be used as a preventive tool before the stage III of the impingement syndrome.

Effectiveness of three-dimensional digital animation in teaching human anatomy in an authentic classroom context.

Three-dimensional (3D) digital animations were used to teach the human musculoskeletal system to first year kinesiology students. The purpose of this study was to assess the effectiveness of this method by comparing two groups from two different academic years during two of their official required anatomy examinations (trunk and upper limb assessments). During the upper limb section, the teacher used two-dimensional (2D) drawings embedded into PowerPoint(®) slides and 3D digital animations for the first group (2D group) and the second (3D group), respectively. The same 3D digital animations were used for both groups during the trunk section. The only difference between the two was the multimedia used to present the information during the upper limb section. The 2D group surprisingly outperformed the 3D group on the trunk assessment. On the upper limb assessment no difference in the scores on the overall anatomy examination was found. However, the 3D group outperformed the 2D group in questions requiring spatial ability. Data supported that 3D digital animations were effective instructional multimedia material tools in teaching human anatomy especially in recalling anatomical knowledge requiring spatial ability. The importance of evaluating the effectiveness of a new instructional material outside laboratory environment (e.g., after a complete semester and on official examinations) was discussed.

Hand mental rotation is not systematically altered by actual body position: Laterality judgment versus same-different comparison tasks.

It is commonly believed that during mental rotation of body parts, participants tend to imagine their own body part moving toward the stimulus, thus using an egocentric strategy. Several studies have also shown that the mental rotation of hands is affected by the actual hand position, especially if the hand is kept in an awkward position. However, this hand posture effect, as well as the use of an egocentric strategy during mental rotation of body parts, is not systematic. Several experiments have demonstrated that manipulating the stimulus features or the paradigm could induce a shift to visual and allocentric strategies. Here, we studied the effects of hand posture and biomechanical constraints on one-hand mental rotation (laterality judgment task), two-hand mental rotation (same-different judgment task), and mental rotation of one or two alphanumeric symbols (control tasks). Effects of posture and biomechanical constraints were observed solely for the laterality judgment task. Response times in the same-different hand mental rotation items were influenced by the angular disparity between the stimuli. We interpreted our result as evidence of the use of different strategies for each task. Future research should focus on disentangling the exact subprocesses in which an egocentric strategy is used, in order to propose better tests for participants with motor impairments.

Selective effect of physical fatigue on motor imagery accuracy.

While the use of motor imagery (the mental representation of an action without overt execution) during actual training sessions is usually recommended, experimental studies examining the effect of physical fatigue on subsequent motor imagery performance are sparse and yielded divergent findings. Here, we investigated whether physical fatigue occurring during an intense sport training session affected motor imagery ability. Twelve swimmers (nine males, mean age 15.5 years) conducted a 45 min physically-fatiguing protocol where they swam from 70% to 100% of their maximal aerobic speed. We tested motor imagery ability immediately before and after fatigue state. Participants randomly imagined performing a swim turn using internal and external visual imagery. Self-reports ratings, imagery times and electrodermal responses, an index of alertness from the autonomic nervous system, were the dependent variables. Self-reports ratings indicated that participants did not encounter difficulty when performing motor imagery after fatigue. However, motor imagery times were significantly shortened during posttest compared to both pretest and actual turn times, thus indicating reduced timing accuracy. Looking at the selective effect of physical fatigue on external visual imagery did not reveal any difference before and after fatigue, whereas significantly shorter imagined times and electrodermal responses (respectively 15% and 48% decrease, p<0.001) were observed during the posttest for internal visual imagery. A significant correlation (r=0.64; p<0.05) was observed between motor imagery vividness (estimated through imagery questionnaire) and autonomic responses during motor imagery after fatigue. These data support that unlike local muscle fatigue, physical fatigue occurring during intense sport training sessions is likely to affect motor imagery accuracy. These results might be explained by the updating of the internal representation of the motor sequence, due to temporary feedback originating from actual motor practice under fatigue. These findings provide insights to the co-dependent relationship between mental and motor processes.

Enhancement of mental rotation abilities and its effect on anatomy learning.

BACKGROUND: Mental rotation (MR) is improved through practice and high MR ability is correlated to success in anatomy learning. PURPOSES: We investigated the effects of improving the MR ability on the Vandenberg and Kuse MR test performance and the consequences on learning functional human anatomy. METHODS: Forty-eight students were assigned into three groups: MR group (16 students attending functional anatomy course and MR training), anatomy group (16 students attending the same functional anatomy course), and the control group (n = 16). Instead of MR training, the latter 2 groups were engaged in physical activities for an equivalent time, and the control group did not attend anatomy course. RESULTS: MR group performed better than the two others in the MR test and better than the anatomy group in the anatomy test. CONCLUSIONS: The MR training sessions were found to improve MR test performance and were further transferred to anatomy learning.