Paul Yielder

Introduction: Identifying the most effective simulation training approach for maintaining critical skills among staff physicians is essential, as this can affect patient safety and healthcare costs. While competency-based and mastery-based interventions have been studied independently, their effects on skill retention and transfer have not been directly compared. This prospective cohort study compared mastery-based and competency-based training for video laryngoscopy (VL) skill maintenance among staff physicians. Methods: Each intervention included a presimulation online module and a simulation-based training session differing only in performance standards. The competency group (n=8) followed an instructor-determined standard, while the mastery group (n=8) adhered to a higher Mastery Angoff-established standard. VL skills were assessed pre-, post-, and 6 months later (follow-up) in the mastery group; the competency group was assessed only at follow-up. Follow-up included a retention test (pediatric mannequin) and a transfer test (neonatal task trainer). Performance was evaluated using an 18-item checklist (max score: 36) and procedural time (seconds). Results: The mastery group significantly increased mean VL scores and decreased mean VL time from pretest (score=22.13; time=162.00 s) to post-test (34.38; 71.50 s) [( P P P 0.05, 95% CI: −70.02,8.78)] and transfer [(score=34.38 vs. 26.13; P 0.05,95% CI: −53.50, 4.75)]. Conclusions: Simulation-based mastery learning may enhance staff physicians’ maintenance of VL skills and procedural efficiency. However, given the absence of baseline data for the competency group, definitive conclusions regarding superiority cannot be drawn.

(1) Background: Subclinical neck pain is mild-to-moderate neck pain that has not yet been treated, and where individuals experience pain-free days. Alterations in sensorimotor integration, motor control, proprioception, and cerebellar inhibition have been observed in individuals with subclinical neck pain. Upregulation of the cervico-ocular reflex is documented in subclinical neck pain, with no difference in the gain of the vestibulo-ocular reflex. Vestibulo-ocular reflex gain adaptation and associated differences in visuo-motor control have not been successfully measured in this population. This study aims to investigate the vestibulo-ocular reflex gain adaptation and visuo-motor control in individuals with subclinical neck pain. (2) Methods: 30 right-hand-dominant participants (19 healthy controls: 10 male and 9 female; 16 subclinical neck pain: 6 male and 10 female) aged 18 to 35 performed an eye tracking task. Participants were seated 90cm away from a monitor and instructed to hold their gaze on a stationary or moving target projected onto a screen while performing active head rotations. Trials were divided into 12 blocks (pre-adaptation, 10 adaptation, and post-adaptation) for a total of 192 trials. During adaptation, the target would move at increasing speeds during each block, increasing by 10% of active head velocity up to a maximum of 100%. (3) Results: The subclinical neck pain group demonstrated significantly higher total saccades (p = 0.006, ƞ² = 0.240) and overt catch-up saccades (p = 0.041, ƞ² = 0.141) than the healthy control group. (4) Conclusion: Subclinical neck pain alters the visual–vestibular interaction.

Background/Objectives: Neck muscle vibration alters neural processing, sensorimotor integration, and proprioception in healthy adults. Significant differential changes in the N18 and N24 somatosensory evoked potential (SEP) peak amplitudes, coupled with altered motor learning, occurred when completion of a force-matching task took place following neck muscle vibration. It is currently unknown if neck muscle vibration also impacts acquisition of skills from visuomotor tracking tasks, a gap this research addresses. Methods: A total of 25 right-handed, healthy participants were divided into vibration (age: 21.7 ± 1.89, n = 13; 8 females) (V) and no-vibration (NV) control (age: 21.2 ± 3.03, n = 12; 6 females) groups. The vibration was device applied over the right sternocleidomastoid and left cervical extensor muscles. The participants underwent right-median-nerve stimulation at 2.47 Hz and 4.98 Hz to elicit SEPs. A total of 1000 sweeps were recorded and averaged using an ANT Neuro Waveguard 64-lead EEG cap (ANT Neuro, the Netherlands, Manufactured by Eemagine, Berlin, Germany)pre- and post-completion of a novel visuomotor tracing task (MTT). Post-acquisition, the NV group had a 10 min rest, and the V group received 10 min of vibration at 60 Hz before motor task completion, followed immediately by post-acquisition and retention 24 h after. Results: N18 peak: The V group exhibited a proportional amplitude increase of 19%, while the NV group exhibited a 36% decrease. There was a trend toward decreased retention in the V group. P25 showed a significant effect of time, with increases of 11% for V and 9% for NV. Conclusions: V resulted in N18 SEP changes post-MTT-skill-acquisition. Both groups appeared to learn, with the V trending towards less retention.

Artificial Intelligence (AI), computer simulations, and virtual reality (VR) are increasingly becoming accessible tools that can be leveraged to implement training protocols and educational resources. Typical assessment tools related to sensory and neural processing associated with task performance in virtual environments often rely on self-reported surveys, unlike electroencephalography (EEG), which is often used to compare the effects of different types of sensory feedback (e.g., auditory, visual, and haptic) in simulation environments in an objective manner. However, it can be challenging to know which aspects of the EEG signal represent the impact of different types of sensory feedback on neural processing. Machine learning approaches offer a promising direction for identifying EEG signal features that differentiate the impact of different types of sensory feedback during simulation training. For the current study, machine learning techniques were applied to differentiate neural circuitry associated with haptic and non-haptic feedback in a simulated drilling task. Nine EEG channels were selected and analyzed, extracting different time-domain, frequency-domain, and nonlinear features, where 360 features were tested (40 features per channel). A feature selection stage identified the most relevant features, including the Hurst exponent of 13–21 Hz, kurtosis of 21–30 Hz, power spectral density of 21–30 Hz, variance of 21–30 Hz, and spectral entropy of 13–21 Hz. Using those five features, trials with haptic feedback were correctly identified from those without haptic feedback with an accuracy exceeding 90%, increasing to 99% when using 10 features. These results show promise for the future application of machine learning approaches to predict the impact of haptic feedback on neural processing during VR protocols involving drilling tasks, which can inform future applications of VR and simulation for occupational skill acquisition.

Alterations in neck sensory input from recurrent neck pain (known as subclinical neck pain (SCNP)) result in disordered sensorimotor integration (SMI). The cervico-ocular (COR) and vestibulo-ocular (VOR) reflexes involve various neural substrates but are coordinated by the cerebellum and reliant upon proprioceptive feedback. Given that proprioception and cerebellar processing are impaired in SCNP, we sought to determine if COR or VOR gain is also altered. COR and VOR were assessed using an eye-tracking device in 20 SCNP (9 M and 11 F; 21.8 (SD = 2.35) years) and 17 control (7 M and 10 F; 22.40 (SD = 3.66) years) participants. COR gain (10 trials): A motorized chair rotated the trunk at a frequency of 0.04 Hz and an amplitude of 5° while participants gazed at a circular target that disappeared after three seconds. VOR gain (30 trials): Rapid bilateral head movements away from a disappearing circular target while eyes fixated on the last observed target. Independent t-tests on COR and VOR gain were performed. SCNP had a significantly larger COR gain (p = 0.006) and smaller VOR gain (p = 0.487) compared to healthy controls. The COR group differences suggest an association between proprioceptive feedback and SMI, indicating COR may be a sensitive marker of altered cerebellar processing.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, where differences are often present relating to the performance of motor skills. Our previous work elucidated unique event-related potential patterns of neural activity in those with ADHD when performing visuomotor and force-matching motor paradigms. The purpose of the current study was to identify whether there were unique neural sources related to somatosensory function and motor performance in those with ADHD. Source localization (sLORETA) software identified areas where neural activity differed between those with ADHD and neurotypical controls when performing a visuomotor tracing task and force-matching task. Median nerve somatosensory evoked potentials (SEPs) were elicited, while whole-head electroencephalography (EEG) was performed. sLORETA localized greater neural activity post-FMT in those with ADHD, when compared with their baseline activity (p < 0.05). Specifically, greater activity was exhibited in BA 31, precuneus, parietal lobe (MNI coordinates: X = −5, Y = −75, and Z = 20) at 156 ms post stimulation. No significant differences were found for any other comparisons. Increased activity within BA 31 in those with ADHD at post-FMT measures may reflect increased activation within the default mode network (DMN) or attentional changes, suggesting a unique neural response to the sensory processing of force and proprioceptive afferent input in those with ADHD when performing motor skills. This may have important functional implications for motor tasks dependent on similar proprioceptive afferent input.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that exhibits unique neurological and behavioural characteristics. Our previous work using event-related potentials demonstrated that adults with ADHD process audiovisual multisensory stimuli somewhat differently than neurotypical controls. This study utilised an audiovisual multisensory two-alternative forced-choice discrimination task. Continuous whole-head electroencephalography (EEG) was recorded. Source localization (sLORETA) software was utilised to determine differences in the contribution made by sources of neural generators pertinent to audiovisual multisensory processing in those with ADHD versus neurotypical controls. Source localization techniques elucidated that the controls had greater neural activity 164 ms post-stimulus onset when compared to the ADHD group, but only when responding to audiovisual stimuli. The source of the increased activity was found to be Brodmann Area 2, postcentral gyrus, right-hemispheric parietal lobe referenced to Montreal Neurological Institute (MNI) coordinates of X = 35, Y = −40, and Z = 70 (p < 0.05). No group differences were present during either of the unisensory conditions. Differences in the integration areas, particularly in the right-hemispheric parietal brain regions, were found in those with ADHD. These alterations may correspond to impaired attentional capabilities when presented with multiple simultaneous sensory inputs, as is the case during a multisensory condition.

Even on pain free days, recurrent neck pain alters sensorimotor integration (SMI) measured via somatosensory evoked potentials (SEPs). Neck muscle fatigue decreases upper limb proprioception, and thus may interfere with upper limb motor task acquisition and SMI. This study aimed to determine the effect of cervical extensor muscle (CEM) fatigue on upper limb motor acquisition and retention; and SMI, measured via early SEPs. Twenty-four healthy right-handed individuals were randomly assigned to control or CEM fatigue. Baseline SEPs were elicited via median nerve stimulation at the wrist. Participants then lay prone on a padded table. The fatigue group supported a 2 kg weight until they could no longer maintain the position. The control group rested their neck in neutral for 5 min. Participants completed pre- and post-motor skill acquisition while seated, SEPs were again collected. Task retention was measured 24 h later. Accuracy improved post acquisition and at retention for both groups (p < 0.001), with controls outperforming the fatigue group (p < 0.05). The fatigue group had significantly greater increases in the N24 (p = 0.017) and N30 (p = 0.007) SEP peaks. CEM fatigue impaired upper limb motor learning outcomes in conjunction with differential changes in SEP peak amplitudes related to SMI.

Previous studies have shown significant changes in cortical and subcortical evoked potential activity levels in response to motor training with the distal upper-limb muscles. However, no studies to date have assessed the neurological processing changes in somatosensory evoked potentials (SEPs) associated with motor training whole-arm movements utilizing proximal upper-limb muscles. The proximal upper-limb muscles are a common source of work-related injuries, due to repetitive glenohumeral movements. Measuring neurophysiological changes following performance of a proximal motor task provide insight into potential neurophysiological changes associated with occupational postures and movements involving proximal upper limb muscles. This study sought to assess the impact of a novel motor skill acquisition task on neural processing of the proximal upper-limb muscle groups, through the measurement of short-latency median nerve SEPs. One group of 12 participants completed a novel motor training task, consisting of tracing a sinusoidal waveform varying in amplitude and frequency. Baseline SEP measurements were recorded from each participant, followed by a mental recitation control task. Pre-test SEP measurements were then recorded, followed by the motor training task, and post-test SEP recordings. The participants completed the tracing with their right thumb, using glenohumeral rotation only to move their hand. Significant improvements in task accuracy were demonstrated, indicating that motor acquisition had occurred. Significant changes were also seen in the N11, N13, N20, N24, P25, and the N30 SEP peaks were seen following the motor training task. Conclusion: Early SEPs appear to be a sensitive measure of changes in sensorimotor integration in response to novel motor skill acquisition within the proximal upper-limb muscles.

During training in a novel dynamic environment, the non-dominant upper limb favors feedback control, whereas the dominant limb favors feedforward mechanisms. Early somatosensory evoked potentials (SEPs) offer a means to explore differences in cortical regions involved in sensorimotor integration (SMI). This study sought to compare differences in SMI between the right (Dom) and left (Non-Dom) hand in healthy right-handed participants. SEPs were recorded in response to median nerve stimulation, at baseline and post, a motor skill acquisition-tracing task. One group (n = 12) trained with their Dom hand and the other group (n = 12), with their Non-Dom hand. The Non-Dom hand was significantly more accurate at baseline (p < 0.0001) and both groups improved with time (p < 0.0001), for task accuracy, with no significant interaction effect between groups for both post-acquisition and retention. There were significant group interactions for the N24 (p < 0.001) and the N30 (p < 0.0001) SEP peaks. Post motor acquisition, the Dom hand had a 28.9% decrease in the N24 and a 23.8% increase in the N30, with opposite directional changes for the Non-Dom hand; 22.04% increase in N24 and 24% decrease in the N30. These SEP changes reveal differences in early SMI between Dom and Non-Dom hands in response to motor acquisition, providing objective, temporally sensitive measures of differences in neural mechanisms between the limbs.