Using a divided-attention stepping accuracy task to improve balance and functional outcomes in an individual with incomplete spinal cord injury: A case report.

A spinal cord injury (SCI) frequently results in impaired balance, endurance, and strength with subsequent limitations in functional mobility and community participation. The purpose of this case report was to implement a training program for an individual with a chronic incomplete SCI using a novel divided-attention stepping accuracy task (DASAT) to determine if improvements could be made in impairments, activities, and participation. The client was a 51-year-old male with a motor incomplete C4 SCI sustained 4 years prior. He presented with decreased quality of life (QOL) and functional independence, and deficits in balance, endurance, and strength consistent with central cord syndrome. The client completed the DASAT intervention 3 times per week for 6 weeks. Each session incorporated 96 multi-directional steps to randomly-assigned targets in response to 3-step verbal commands. QOL, measured using the SF-36, was generally enhanced but fluctuated. Community mobility progressed from close supervision to independence. Significant improvement was achieved in all balance scores: Berg Balance Scale by 9 points [Minimal Detectable Change (MDC) = 4.9 in elderly]; Functional Reach Test by 7.62 cm (MDC = 5.16 in C5/C6 SCI); and Timed Up-and-Go by 0.53 s (MDC not established). Endurance increased on the 6-Minute Walk Test, with the client achieving an additional 47 m (MDC = 45.8 m). Lower extremity isokinetic peak torque strength measures were mostly unchanged. Six minutes of DASAT training per session provided an efficient, low-cost intervention utilizing multiple trials of variable practice, and resulted in better performance in activities, balance, and endurance in this client.

Environmental context affects outcome and kinematic changes at different rates during skill learning.

Based on Gentile's learning model, this study used a dart-throwing task to investigate the influence of environmental context. Novice participants (N = 32) were trained in one of four conditions, while measuring outcomes and kinematics. The interaction of regulatory conditions (stationary/in motion) and intertrial variability (present/absent) created four target conditions: (1) stationary with one location, (2) stationary with five locations, (3) moving with one movement pattern, (4) moving with five starting locations. Performance outcome (radial error) and movement coordination (displacement of shoulder, elbow, and wrist) changes were investigated during three days of practice (480 trials). Radial error scores were analyzed using a 3 x 8 x 4 (Day x Trial Block x Condition) analysis of variance, repeated measures design. The transformed cross-correlation values of the kinematic trials were analyzed using a 3 x 3 x 4 (Joint x Day x Condition) analysis of variance, repeated measures design. Reducing the environmental context complexity of the skill (closed regulatory conditions and no inter-trial variability), decreased outcome errors and changed kinematics at different times in the learning. The environmental context influence was observed by a day x condition interaction on joint coordination. Inter-trial variability had its greatest influence on coordination. The environmental context should be taken into consideration when evaluating and assessing skill performance during learning.

Allowing learners to choose: self-controlled practice schedules for learning multiple movement patterns.

For this study, we investigated the effects of self-controlled practice on learning multiple motor skills. Thirty participants were randomly assigned to self-control or yoked conditions. Participants learned a three-keystroke pattern with three different relative time structures. Those in the self-control group chose one of three relative time structures before each of 90 practice trials; yoked participants were not allowed to choose but were yoked to a self-control participant and followed that individual's sequence of practice trials. Results of the 24-hr serial transfer test revealed the self-control group exhibited significantly lower relative timing error, absolute error, and total error than the yoked group. Findings further support the efficacy of self-controlled learning

Systematically increasing contextual interference is beneficial for learning sport skills.

To better understand the contextual interference effect, in two experiments we investigated a form of practice schedule that provided novices with systematic increases in contextual interference. This new type of practice schedule was compared with traditional blocked and random scheduling for two types of sports skills. In Experiment 1, we tested the hypothesis that practising variations of the same task with systematic increases in contextual interference would lead to superior performance compared with blocked or random scheduling. Participants practised golf putting tasks following a blocked, random or increasing schedule, which involved initial blocked trials, followed by serial practice trials, and ended with random scheduling. Participants who followed the increasing schedule had superior retention test performance. In Experiment 2, we tested if these learning benefits were observed when learning tasks controlled by different generalized motor programs. Participants practised three different basketball passes (chest, overhead, single arm) in a blocked, random or increasing schedule. Participants practising with gradual increases in contextual interference performed better on retention and transfer tests than participants practising with blocked or random scheduling. The results of these two expe

A comparison of tyrosine against placebo, phentermine, caffeine, and D-amphetamine during sleep deprivation.

Sleep deprivation can impair alertness and cognitive and motor performance. We hypothesized that the amino acid tyrosine might reduce deleterious effects of sleep deprivation. Seventy-six healthy males, age 18-35 years, participated in a four-day protocol that included a habituation night, a baseline night, a 40.5 h period without sleep, and a recovery night. Tyrosine 150 mg/kg, caffeine 300 mg/70 kg, phentermine 37.5 mg, D-amphetamine 20 mg and placebo were administered in a double-blind, randomized fashion to compare their effects on the time it took to fall asleep, on endocrine responses during sleep deprivation, and on sleep quantity, quality and architecture as measured by polysomnography during recovery sleep. When given after 36 h without sleep, tyrosine had no significant effect on any parameter of sleep. D-amphetamine produced marked decrease in sleep drive but caused deleterious effects on many aspects of recovery sleep. Still, D-amphetamine was associated with increased alertness on the first recovery day. Phentermine and caffeine both decreased sleep drive during sleep deprivation, but phentermine impaired rapid-eye-movement (REM) recovery sleep. Tyrosine (when compared to placebo) had no effect on any sleep related measure, but it did stimulate prolactin release.

Effects of tyrosine, phentermine, caffeine D-amphetamine, and placebo on cognitive and motor performance deficits during sleep deprivation.

Cognitive and motor performance are critical in many circumstances and are impaired by sleep deprivation. We administered placebo, tyrosine 150 mg/kg, caffeine 300 mg/70 kg, phentermine 37.5 mg and D-amphetamine 20 mg at 15.30 h following overnight sleep deprivation and compare their effects on cognitive and motor performance in healthy young men. Tests of visual scanning, running memory, logical reasoning, mathematical processing, the Stroop task, four-choice serial reaction time, time wall take, pursuit tracking, visual vigilance, Trails (B) task and long-term memory were evaluated at standardized intervals before, during and after sleep deprivation and drugs. Performance decrements with sleep deprivation occurred in visual scanning, running memory, logical reasoning, mathematical processing, the Stroop test, the time wall test, tracking and visual vigilance. Interestingly, with sleep deprivation some tests improved and others did not deteriorate. Improvements with medication following sleep deprivation were seen in running memory, logical reasoning, mathematical processing, tracking and visual vigilance. Although less effective than D-amphetamine, tyrosine improved performance on several tests. We conclude that all drugs tested improved at least some aspects of cognitive and motor performance after sleep deprivation. As a naturally occurring amino acid, and thus amenable to nutritional strategies, tyrosine may deserve further testing.