In-Person and Virtual World Mindfulness Training: Trust, Satisfaction, and Learning.

Virtual worlds (VWs) present a viable, low-cost delivery mechanism for telehealth services. Although preliminary reports support the effectiveness of VWs in terms of health metrics, few studies have examined the perceived benefits and learning potential for military service members and veterans. Trust is integral to any interaction and may be even more important, and problematic to establish, during virtual interactions than in-person (IP) communications. The purpose of this study was to compare active duty and veteran U.S. Military service members' (n = 92) self-reported trust, class satisfaction, and didactic learning after completing either an 8-week training course in mindfulness-based stress reduction (MBSR) delivered IP or an 8-week mindfulness meditation class based on MBSR via the VW of Second Life. Results showed that learning performance was not significantly different between the IP and VW groups (p > 0.05). Although overall trust was high for both groups, participants in the IP group reported greater trust and class satisfaction compared with the VW group (p < 0.05). Trust, satisfaction, and learning were significantly correlated with one another, and trust in the instructor significantly predicted trust-in-classmates, trust-in-self, and class satisfaction for both groups (p < 0.05). In this study, IP group training was superior to VW training in terms of self-reported greater trust in the instructor, classmates, and self, and higher satisfaction with the training. Trust in the instructor is particularly important for group training, whether IP or in a VW. This study reiterates the arduous task of establishing trust in a VW setting and suggests that creating trust between the instructor and participants is high priority as a leading objective for VW communications. Suggestions for building trust are tight collaboration and clear communication, along with supporting and advocating for one another.

Effects of Neurocognitive Temporal Training on Weapon Firing Performance.

While marksmanship is a critical skill for military personnel, some service members experience difficulty in attaining and maintaining marksmanship qualifications. Temporal training may improve marksmanship performance, since rhythm and timing are critical for coordinated movement. In this study, we examined the effect of neurocognitive temporal training (NTT) on military personnel's marksmanship performance. We randomly assigned 41 active duty U.S. Army service members with prior marksmanship training into an NTT group that received 12 NTT training sessions (N = 18) and a Control group (N = 23) that received no NTT training. We measured marksmanship at baseline (pretest) and following either NTT (posttest) or, for the Control group, a comparable time period. We quantified marksmanship during 2 tasks of firing 5 self-paced shots at stationary 175 m and 300 m targets (Task 1) and firing at 50 moving and stationary targets of varying distances (Task 2). We recorded three measures of accuracy and three measures of precision (including Total Path Length, a unique measure quantifying shot-to-shot variability) for the first task, and we recorded one accuracy measure for the second task. To determine group differences for pretest versus posttest, we used multivariate analysis of variances for Task 1 and a mixed-model analysis of variance for Task 2. Results revealed significantly reduced variability and improved precision when firing at the 175 m target for the NTT group compared with the Control group (p < .05), but there were no significant group differences on other measures. While these results suggest the utility of neurocognitive timing and rhythm training for marksmanship precision, additional research is needed and should include varied training regimens, comparisons of expert versus novice shooters, additional outcome measures, and a larger participant sample.

The Effect of Traumatic Brain Injury (TBI) on Cognitive Performance in a Sample of Active Duty U.S. Military Service Members.

INTRODUCTION: Traumatic brain injury (TBI) is considered a signature injury from the fighting in Iraq and Afghanistan. Since the year 2000, over 370,000 U.S. active duty service members have been diagnosed with TBI. Although prior research has shown that even mild forms of TBI are associated with impaired cognitive performance, it is not clear which facets of cognition (computation, memory, reasoning, etc.) are impacted by injury. METHOD: In the present study, we compared active duty military volunteers (n = 88) with and without TBI on six measures of cognition using the Automated Neuropsychological Assessment Metric software. RESULTS: Healthy volunteers exhibited significantly faster response times on the matching-to-sample, mathematical processing, and second round of simple reaction time tasks and had higher throughput scores on the mathematical processing and the second round of the simple reaction time tasks (P < 0.05). CONCLUSION: In this population, cognitive impairments associated with TBI influenced performance requiring working memory and basic neural processing (speed/efficiency).

A pilot study investigating preferred background sounds during mindfulness meditation: What would you like to hear?

BACKGROUND: Music and meditation have affirmative effects on the parasympathetic nervous system. OBJECTIVE: To investigate individual preferences for background sounds during meditation, using a series of paired, forced-choice comparisons. METHOD: Interventions included music with a distinct melody (one sample) and without a distinct melody (MWDM) (three samples), nature sounds with embedded alpha brainwave pulses (one sample), alpha brainwave pulses alone (one sample), and silence. Participants rated how much they liked hearing a sample during meditation and whether they felt they could meditate deeply while listening to it. Heart rhythm coherence scores were recorded using HeartMath emWavePro software and hardware. Participants were ranked as novice or adept meditators (NM vs AM) based on coherence scores. Rankings were based on preference selections, rating scales, and coherence scores. RESULTS: Rankings were highest for silence and MWDM. AMs preferred silence, followed by MWDM. NMs preferred listening to MWDM during meditation. DISCUSSION: Those with greater experience preferred meditating in silence. A preference was also seen for a composition style that incorporated altering arrhythmic and rhythmic patterns, and alternating asynchronous and synchronous patterns. CONCLUSION: These results indicate a compelling case for further research investigating meditation, music, and the potential interactive effect of the two on mind, body, and personal performance.

Self-Reported Sleep, Anxiety, and Cognitive Performance in a Sample of U.S. Military Active Duty and Veterans.

Unhealthy sleep can interfere with U.S. military service members affective and cognitive functioning, and increase accident and injury risks. This study examined the relationship between U.S. active duty and veterans' (n = 233) self-reported sleep (Pittsburgh Sleep Quality Index), anxiety (Zung Self-Rating Anxiety Scale), and cognitive performance (Automated Neuropsychological Assessment Metric). Statistical analyses included Pearson product moment correlations and multivariate analysis of variance, with Tukey-b post-hoc tests, with a p < 0.05 significance level. Higher education, abstinence from sleep aids, longer time in active duty service, and being on active duty were correlated with better sleep and lower anxiety. Greater sleep disturbance, poor sleep quality, and sleepiness-related daytime dysfunction were associated with greater anxiety and slower response times, and lower response accuracy. Statistically controlling for anxiety diminished the magnitude and significance of the correlations between sleep and cognitive performance, suggesting that reducing anxiety will improve sleep and diminish cognitive performance effects. These findings suggest the need for addressing both sleep and anxiety for those with diagnosed sleep disorders, as well as using a procedural systems approach to decrease anxiety during missions that demand outstanding cognitive performance.

Impact of In-Person and Virtual World Mindfulness Training on Symptoms of Post-Traumatic Stress Disorder and Attention Deficit and Hyperactivity Disorder.

Mindfulness meditation training has been shown to reduce stress and improve short-term memory for military personnel. However, no studies have investigated the effects of in-person and virtual world (VW) mindfulness training on Post-Traumatic Stress Disorder (PTSD) or Attention Deficit Hyperactivity Disorder (ADHD) symptoms. In this study, U.S. military active duty service members and veterans were pseudo-randomized into two mindfulness training groups: in-person (IP) and online via a VW, and a wait-list control group. Volunteers answered a demographic questionnaire, and completed the PTSD Checklist-Military Version (PCL-M) and ADHD Current Symptoms Scale before and after training. The results showed practical and clinically relevant reductions in PTSD symptoms, particular for the IP group, but did not show statistical relevance with hypothesis testing. Results also showed post-training reductions in ADHD symptoms for both IP and VW groups, but no change for the control group. To investigate the effects of initial ADHD symptoms, IP and VW groups were combined into a single Mindfulness Training group. Those with high-initial ADHD symptoms attending training showed improvements, but the control group did not. These results expand research on the mindfulness training, and suggest that IP mindfulness training, rather than VW training, may be of greater benefit for those with PTSD symptoms, while either delivery system appears adequate for reducing attentional symptoms.

Warnings for children.

OBJECTIVE: The purpose of this paper is to provide information to the reader on warnings and the use of warnings with children, to prevent accidental injuries. METHODS: A literature review was used to present research findings related to child warnings. RESULTS: This paper provides a basic introduction to accidental injuries, susceptibility of children, warnings, the effectiveness of warnings, and guidelines for designing effective warnings. CONCLUSION: While most warnings concerning children focus on adult caregivers, there are warnings for children that appear effective, especially when combined with other methods of hazard control and injury prevention. Additional research on warnings geared toward children is needed.

The relationship between symptoms of attention deficit and hyperactivity disorder and oppositional defiant disorder with soldier performance during training.

OBJECTIVE: During interviews with Health Care Specialist military cadre, instructors voiced concern that symptoms associated with attention deficit and hyperactivity disorder (SoADHD) and oppositional defiant disorder (SoODD) were interfering with soldiers' ability to complete training. The purpose of this research was to examine the relationship between SoADHD and SoODD with soldiers' grade point average (GPA), Army Physical Fitness Test (APFT) scores, and musculoskeletal injuries during Health Care Specialist (HCS) Advanced Individual Training (AIT). METHOD: Participants included 122 soldiers attending HCS training. Participants completed a demographic survey and Barkley and Murphy's ADHD and ODD self-report symptom surveys. Their ADHD and ODD self-report scores were correlated with course performance metrics at the conclusion of their 16 weeks of training. RESULTS: Pearson Correlation Coefficients revealed a significant negative relationship between ratings on the Oppositional Defiant Disorder scale with soldiers' GPA (p < 0.05), however the relationship was weak - accounting for 4% of the variance. No significant findings were noted between SoADHD and GPA, nor were significant relationships found between SoADHD or SoODD with APFT scores or musculoskeletal injuries. CONCLUSION: Symptoms associated with ADHD and ODD had little impact on the academic and physical performance of soldiers attending HCS training. Implications and future research are explored, in this article.

If you want to know why students fail, just ask them.

One method to discover possible reasons why individuals fail academic training is to ask them. However, self-report information can be difficult to trust, especially if students are perceived as having something to lose if they are honest. The purpose of this study was to identify potential reasons students fail (or do well) in their training as reported by 4 groups: those who failed the program (F) (n=28) and a peer (F-P) (n=28); and those who passed with a grade of B or above (P) (n=101) and one of their peers (P-P) (n=32). Statistical analysis included chi-square test statistics and t tests with a P < .05. Only findings considered "external" to students are included here, including class structure and schedule, instructors and teaching, support systems, and sleep. Few differences were found between peer reports and self reports by students who passed or students who failed their program. On the positive side, both P and F students indicated they could get individual attention even with large classes, having good support systems, and bonding well with their unit. On the negative side, P and F students reported difficulty staying focused during long class hours, and F students felt teaching methods made it difficult to succeed and struggled with the fast pace of the course (P < .05). More than half of all students reported sleeping between 5 and 6 hours per night, but those who failed more often reported sleeping only 3 to 4 hours per night (P < .05). These findings highlight areas of organizational strength, as well as areas of difficulty for students, which will permit administrators to set goals and perhaps tailor their programs to reduce attrition.

Self-reported health status of students in-processing into military medical advanced individual training.

It is important to be aware of the health and injury status of students in military training settings in order to adequately plan for their progression through required physical training and provision of health care to meet their needs. This paper describes the self-reported health status of students arriving in two medical training Battalions at Ft. Sam Houston. The results revealed that 43% of arriving soldiers had musculoskeletal symptoms and 35% had symptoms that interfered with their ability to accomplish the normal daily activities required as students. The most common sites of symptoms were knee (17 and 18%), foot/toe (16 and 13%), ankle (9 and 10%), and lower leg (9 and 12%) for the 232nd and 187th Medical Battalions respectively. Risk factors for those with musculoskeletal injury (MSI) symptoms that interfere with their abilities to do their jobs include gender, past history of injury, and self-reported stress and fitness levels. Other risk factors for medical specialties other than combat medic include being older (over 24 yrs of age), active duty status, being overweight, and use of smokeless tobacco. This information can help identify soldiers considered at risk of incurring a MSI during AIT. With this knowledge, physical training can be designed to help soldiers achieve fitness without additional injury and health care facilities can be designed to provide appropriate staffing of the health care professionals needed for evaluation and treatment.

Fear of failure: implications for military health care specialist student training.

During scholastic or physical performance testing, individuals who fear failure tend to focus on their fears instead of the task and often perform poorly. This study examined the relationship between fear-of-failure (FoF) and performance among 200~students (male=140, female =60) attending Health Care Specialist Advanced Individual Training (AIT) at Ft. Sam Houston. Performance measures included grade point average, pass/fail status, Army Physical Fitness Test scores, and number of musculoskeletal injuries. Pearson Product Moment Correlations revealed that Soldiers who scored higher on a FoF scale also had higher final grades (r=0.16, p=0.02, r;{2}=0.026). No significant correlations were found between FoF and other performance measures. While the variation in GPA accounted for by FoF was small (2.6%), this finding demonstrates a positive relationship that differs from previous studies. This finding may be explained by the concepts of failure avoidance and success orientation (self confidence and motivation), as well as the unique military setting. Suggestions for designing military educational interventions during AIT and throughout one's military career are offered.

Effectiveness of a screening tool to detect injuries during Army Health Care Specialist training.

The purpose of this project was to evaluate the effectiveness of an initial screening and referral process in reducing the impact of musculosketetal injuries among soldiers attending Health Care Specialist training. Musculoskeletal injury among Army Health Care Specialist students have been reported to be approximately 24% for men and 24-30% for women. The highest student visit rate to the troop medical clinic for musculoskeletal injuries, for men and women, occurs during the first week of training. Anecdotal reports indicate that many students arrive for training with existing injuries or symptoms. This project was designed to assess whether formalized early screening, referral, and intervention could 1) identify arriving students who need musculoskeletal injury-related medical attention, 2) reduce the number of students receiving limited duty status during their 10-week training, 3) decrease the total number of limited duty days for students, and 4) decrease the number of students who cannot graduate due to musculoskeletal injury. Students (N=291) from one company were divided into three groups of 97 students. Three methods were used to screen and refer students for medical intervention: 1) traditional (T), 2) by health care providers (HCP), or 3) by Drill Sergeants (DS). Screening by HCP and DSs involved using a new screening tool to identify and consequently refer students with symptoms to a troop medical clinic (TMC) for early evaluation and intervention. Using the screening tool, HCPs identified 92% of students with injuries, while DSs accurately identified 80%. The screening did not reduce the number of students receiving limited duty status, total limited duty days, or the number of students that could not graduate due to musculoskeletal injury ("holdovers") (p>0.05). The screening tool demonstrated good sensitivity and specificity whether conducted by HCPs or DSs. It failed to demonstrate efficacy in reducing the impact of musculoskeletal injuries among Combat Medic soldiers, as measured by limited duty days and holdovers.

Participatory ergonomics: determining injury control "buy-in" of US Army cadre.

Overuse injuries account for the majority of lost duty time profiles for soldiers attending Advanced Individual Training (AIT) to become a Combat Medic at Ft. Sam Houston (63% for men and 74% for women). An intervention program was initiated with two AIT Battalions (BN) in an effort to reduce overuse injuries. The purpose of this paper is to describe methods of tracking the participation of supervisors during the intervention program. Methods used to monitor participation included recording the number of coordinating meetings, keeping minutes of advisory committee meetings, and conducting perception surveys. Over an 18-month period, the number of coordinating meetings decreased. Surveys identified the opinions, values, and self-identified roles of supervisors (drill sergeants and cadre) in regard to injury prevention with their assigned student-soldiers before and after an intervention program. At the initiation of the injury control program, 103 individuals completed a 27 question, anonymous survey to assist planners with developing a strategy that would encourage participation of cadre and drill sergeants in preventing injuries. One year later, 191 individuals from the same battalion completed the same survey. Results revealed a slight, statistically insignificant, decrease in supervisors' perception of the presence of overuse injuries in their BN (31.4% vs. 27.4%, p>0.05), and the level of acceptable injuries moved from the 16-30% range to the 1-10% range (chi2=4.65, p<0.05). Post-intervention, more supervisors believed their physical training programs could impact overuse injuries (pre 20.4% vs. post 31.6%, Chi2=6.7, p<0.01). The results reveal several methods to track the involvement of participants, to develop intervention strategies, and to monitor cultural shifts necessary to the injury control process.

Part II. Work hardening for warriors: Training military Occupational Therapy professionals in the management of combat stress casualties.

The purpose of this article is to describe the training of military occupational therapy personnel in a unique application of their professional skills. Ergonomic principles of training for stressful environments were implemented to ensure training effectiveness and transfer of skills to combat situations. Training schedules, casualty role-play scenarios, critical incident stress debriefing principles and scenarios, unit survey guidelines, and premises for training persons to function under stressful conditions are provided. Comparisons with civilian applications are drawn, and suggestions for future roles and training for Occupational Therapy professionals are given.

Dental Workers, Musculoskeletal CumulativeTrauma, and Carpal Tunnel Syndrome: Who is at Risk? A Pilot Study.

A pilot study was conducted at a dental clinic to identify (a) the prevalence of musculoskeletal cumulative trauma disorders (MCTD), (b) associated symptoms (with special attention paid to carpal tunnel syndrome [CTS]), and (c) practitioners at risk. Videotapes, two questionnaires, a medical record review, and interviews were used. Forty-five dental workers participated and were classified into three categories: (a) dentists, (b) dental assistants and special assistants (DA/SA), and (c) dental hygienists and dental assistant-expanded function (DH/DAEF). Categorical data were analyzed using the chi- square statistic and risk ratios. The Fisher exact probability test was used for categorical data with a small cell. One or more symptoms associated with CTS were noted by 75.6% of the dental workers, 11% reported diagnosed CTS, and 53% reported back and shoulder pain. Both psychosocial factors and job demands appear to be associated with MCTD. All three categories of dental workers reported MCTD symptoms, and the DH/DAEF group was found to be at greatest risk for developing upper extremity symptoms, CTS, and back pain.