脑外伤患者内隐记忆康复护理可行性研究

探讨脑外伤患者在高强度练习和准确反馈条件下,内隐学习知识效应和底层规则迁移易化能力。结果发现：①脑外伤患者在汉字整体偏好深加工的非显著特征学习与对照组一样有效;在笔划浅加工的显著特征学习,明显低于对照组;在自由回忆和再认的重复测验中,患者组与对照组存在显著性差异。②脑外伤患者学习记忆具有整体性、直观性、模糊抽象性、无意识性等特点。③脑外伤患者存在着内隐学习知识效应和内隐知识学习效应,且随着训练强化和训练方法的改进,有增强和外显记忆转化的趋势。     

Evidence of the origin of specific spontaneous head turns during intertrial intervals

Direction and the frequency of spontaneous head movements during the ITIs following forward and backward paired trials were compared to an acquisition of a conditioned orienting (alpha) response directed to the side of the tone source. The head movements were analyzed from video recordings using classification of head turns to preferred and to nonpreferred directions. The results showed a significant increase in the alpha responses during the forward paired conditioning to the preferred direction and rapid extinction during the subsequent backward conditioning sessions. Spontaneous head movements during the ITIs increased to the same preferred direction as the conditioned alpha responses. The results of this experiment suggest that the response initially elicited by the CS can later appear as “spontaneous,” instrumental behavior, the form and the nature of which is determined by the characteristics of the conditioned alpha response developing as a result of classical conditioning.     

EFFECT OF SUPPORTED EMPLOYMENT ON THE VOCATIONAL OUTCOMES OF PERSONS WITH TRAUMATIC BRAIN INJURY

This paper reports the job placement of 5 males with severe traumatic brain injury. An individual placement model of supported employment was used. All individuals were placed in competitive employment and received staggered intervention over time by trained employment specialists. A multiple baseline design across persons was used to evaluate results. All individuals had been unable to work consistently or at all in competitive work environments. The range of wages was $4.25 to $5.00 per hour with an average of 339 hours of employment specialist intervention time required per case. The major problems experienced by employment specialists were insubordinate and disruptive behaviors as well as other inappropriate social behaviors displayed at the job site.     

Simulation-based research to improve infant health outcomes: Using the infant simulator to prevent infant shaking

Simulation is a technique that creates a situation or environment to allow persons to experience a representation of a real event for the purpose of practice, learning, evaluation, testing, or to gain understanding of systems or human actions. We will first provide an introduction to simulation in healthcare and describe the two types of simulation-based research (SBR) in the pediatric population. We will then provide an overview of the use of SBR to improve health outcomes for infants in health care settings and to improve parent-child interactions using the infant simulator. Finally, we will discuss previous and future research using simulation to reduce morbidity and mortality from abusive head trauma, the most common cause of traumatic death in infancy.     

Social support,coping, and psychological adjustment among caregivers of head-injured patients

Abstract

The purpose of this study was to test a mediational model of risk and protective factors associated with the psychological adjustment of caregivers of head-injured patients. Forty-three caregivers of patients who had suffered a head injury participated in the study. Findings strongly supported hypotheses. Caregiver burden was associated with poorer psychological adjustment. Social support and a higher percentage of approach coping strategies relative to overall coping strategies were associated with better psychological adjustment. As predicted, caregiver burden showed a direct relationship to psychological adjustment, while social support showed an indirect relationship to adjustment mediated by percentage approach coping.     

Another look at “tummy time” for primary plagiocephaly prevention and motor development

It is three decades since it was recommended that infants sleep on the back to reduce risk of sudden unexpected infant death (SUID). The SUID prevention program is known as “back to sleep” or “safe sleeping”, and this initiative is not questioned. Sleeping on the back is associated with, but not the cause of, the development of infant positional plagiocephaly, also known as deformational or a non-synostotic misshapen head when the skull sutures are open, not fused. This paper provides a synthesis of the history and impact of positional plagiocephaly. It includes a scoping review of plagiocephaly prevention facilitating motor development and reveals few articles on primary prevention which aims to prevent it developing in the first place. It is concerning that preschool-aged children with a history of infant plagiocephaly continued to receive lower developmental scores, particularly in motor development, than unaffected controls, and this may be a marker of developmental delay. Tummy-time (prone) for play is the mainstay of plagiocephaly prevention advice to minimize development of plagiocephaly and to facilitate infant motor development, particularly head control. While tummy-time has shown benefit for infant development, there is limited evidence of its effectiveness in preventing plagiocephaly and some evidence that it promotes only prone-specific motor skills. Most of the published literature is concerned with treatment post-diagnosis, in the form of reviews, or clinical notes. There is a plethora of opinion articles reinforcing tummy-time from birth for plagiocephaly prevention. The review shows that there are gaps in advice for early infant development of head control. An accepted test of head control in infants is “pull to sit” from supine which demonstrates antigravity strength of the neck flexors and coordination of the head and neck when the infant is drawn to sit from supine. This motor skill was cited as achievable by 4 months in the earliest paper on plagiocephaly in 1996. Physical therapists and others should revisit the mechanism of early infant head control development against gravity, particularly antigravity head, neck and trunk coordinated flexion movement in supine, as there has been little attention to early facilitation of this motor skill as a plagiocephaly prevention strategy. This may be achieved by considering “face time” as well as tummy time for primary prevention of plagiocephaly.     

Autoshaped head poking in the mouse: a quantitative analysis of the learning curve

In autoshaping experiments, we quantified the acquisition of anticipatory head poking in individual mice, using an algorithm that finds changes in the slope of a cumulative record. In most mice, upward changes in the amount of anticipatory poking per trial were abrupt, and tended to occur at session boundaries, suggesting that the session is as significant a unit of experience as the trial. There were large individual differences in the latency to the onset of vigorous responding. "Asymptotic" performance was unstable; large, bidirectional, and relatively enduring changes were common. Given the characteristics of the individual learning curves, it is unlikely that physiologically meaningful estimates of rate of learning can be extracted from group-average learning curves.     

The generality of selective observing

Four rats obtained food pellets by poking a key and 5-s presentations of the discriminative stimuli by pressing a lever. Every 1 or 2 min, the prevailing schedule of reinforcement for key poking alternated between rich (either variable-interval [VI] 30 s or VI 60 s) and lean (either VI 240 s, VI 480 s, or extinction) components. While the key was dark (mixed-schedule stimulus), no exteroceptive stimulus indicated the prevailing schedule. A lever press (i.e., an observing response), however, illuminated the key for 5 s with either a steady light (S+), signaling the rich reinforcement schedule, or a blinking light (S-), signaling the lean reinforcement schedule. One goal was to determine whether rats would engage in selective observing (i.e., a pattern of responding that maintains contact with S+ and decreases contact with S-). Such a pattern was found, in that a 5-s presentation of S+ was followed relatively quickly by another observing response (which likely produced another 5-s period of S+), whereas exposure to S- resulted in extended breaks from observing. Additional conditions demonstrated that the rate of observing remained high when lever presses were effective only when the rich reinforcement schedule was in effect (S+ only condition), but decreased to a low level when lever presses were effective only during the lean reinforcement component (S- only condition) or when lever presses had no effect (in removing the mixed stimulus or presenting the multiple-schedule stimuli). These findings are consistent with relativistic conceptualizations of conditioned reinforcement and extend the generality of selective observing to procedures in which the experimenter controls the duration of stimulus presentations, the schedule components both offer intermittent food reinforcement, and rats serve as subjects.     

Response rate viewed as engagement bouts: resistance to extinction

Rats obtained food pellets by nose poking a lighted key, the illumination of which alternated every 50 s during a session between blinking and steady, signaling either a relatively rich (60 per hour) or relatively lean (15 per hour) rate of reinforcement. During one training condition, all the reinforcers in the presence of the rich-reinforcement signal were response dependent (i.e., a variable-interval schedule); during another condition only 25% were response dependent (i.e., a variable-time schedule operated concurrently with a variable-interval schedule). An extinction session followed each training block. For both kinds of training schedule, and consistent with prior results, response rate was more resistant to extinction in the presence of the rich-reinforcement signal than in the presence of the lean-reinforcement signal. Analysis of interresponse-time distributions from baseline showed that differential resistance to extinction was not related to baseline differences in the rate of initiating response bouts or in the length of bouts. Also, bout-initiation rate (like response rate) was most resistant to extinction in the presence of the rich-reinforcement signal. These results support the proposal of behavioral momentum theory (e.g., Nevin & Grace, 2000) that resistance to extinction in the presence of a discriminative stimulus is determined more by the stimulus-reinforcer (Pavlovian) than by the stimulus-response-reinforcer (operant) contingency.