Objective. Clinicians may use implicit or explicit motor learning approaches to facilitatemotor learning of patients with stroke. Implicit motor learning approaches have shown promising results in healthy populations. The purpose of this study was to assess whether an implicit motor learning walking intervention is more effective compared with an explicit motor learning walking intervention delivered at home regarding walking speed in people after stroke in the chronic phase of recovery. Methods. This randomized, controlled, single-blind trial was conducted in the home environment. The 79 participants, who were in the chronic phase after stroke (age = 66.4 [SD = 11.0] years; time poststroke = 70.1 [SD = 64.3] months; walking speed = 0.7 [SD = 0.3] m/s; Berg Balance Scale score = 44.5 [SD = 9.5]), were randomly assigned to an implicit (n = 38) or explicit (n = 41) group. Analogy learning was used as the implicit motor learning walking intervention, whereas the explicit motor learning walking intervention consisted of detailed verbal instructions. Both groups received 9 training sessions (30 minutes each), for a period of 3 weeks, targeted at improving quality of walking. The primary outcome was walking speed measured by the 10-MeterWalk Test at a comfortable walking pace. Outcomes were assessed at baseline, immediately after intervention, and 1 month postintervention. Results. No statistically or clinically relevant differences between groups were obtained postintervention (between-group difference was estimated at 0.02 m/s [95% CI = −0.04 to 0.08] and at follow-up (between-group difference estimated at −0.02 m/s [95% CI = −0.09 to 0.05]). Conclusion. Implicit motor learning was not superior to explicit motor learning to improve walking speed in people after stroke in the chronic phase of recovery. Impact. To our knowledge, this is the first study to examine the effects of implicit compared with explicit motor learning on a functional task in people after stroke. Results indicate that physical therapists can use (tailored) implicit and explicit motor learning strategies to improve walking speed in people after stroke who are in the chronic phase of recovery.
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Background: A significant part of neurological rehabilitation focuses on facilitating the learning of motor skills. Training can adopt either (more) explicit or (more) implicit forms of motor learning. Gait is one of the most practiced motor skills within rehabilitation in people after stroke because it is an important criterion for discharge and requirement for functioning at home. Objective: The aim of this study was to describe the design of a randomized controlled study assessing the effects of implicit motor learning compared with the explicit motor learning in gait rehabilitation of people suffering from stroke. Methods: The study adopts a randomized, controlled, single-blinded study design. People after stroke will be eligible for participation when they are in the chronic stage of recovery (>6 months after stroke), would like to improve walking performance, have a slow walking speed (<1 m/s), can communicate in Dutch, and complete a 3-stage command. People will be excluded if they cannot walk a minimum of 10 m or have other additional impairments that (severely) influence gait. Participants will receive 9 gait-training sessions over a 3-week period and will be randomly allocated to an implicit or explicit group. Therapists are aware of the intervention they provide, and the assessors are blind to the intervention participants receive. Outcome will be assessed at baseline (T0), directly after the intervention (T1), and after 1 month (T2). The primary outcome parameter is walking velocity. Walking performance will be assessed with the 10-meter walking test, Dynamic Gait Index, and while performing a secondary task (dual task). Self-reported measures are the Movement Specific Reinvestment Scale, verbal protocol, Stroke and Aphasia Quality of Life Scale, and the Global Perceived Effect scale. A process evaluation will take place to identify how the therapy was perceived and identify factors that may have influenced the effectiveness of the intervention. Repeated measures analyses will be conducted to determine significant and clinical relevant differences between groups and over time. Results: Data collection is currently ongoing and results are expected in 2019. Conclusions: The relevance of the study as well as the advantages and disadvantages of several aspects of the chosen design are discussed, for example, the personalized approach and choice of measurements.
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This paper presents a mixed methods study in which 21 first-year student teachers took part that investigated learning outcomes of a modified learning by design task. The study is part of a series of studies that aims to improve student learning, teaching skills and teacher training. Design-based science challenges are reasonably successful project-based approaches for breaking down the boundaries between traditional school subjects. Previous learning outcomes of the extensively studied Learning by Design (LBD) approach demonstrated a strong positive effect on students’ skills. However, compared to traditional classroom settings, LBD provided little or no profit on (scientific) concept learning. For this, according to two preliminary studies, a lack of explicit teaching and scaffolding strategies, both strongly teacher-dependent, bears a share of responsibility. The results of this third study indicate that more emphasis on these strategies indeed strengthens concept learning without reducing positive effects on skill performance.
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Inzet van serious games als scholingsinstrument voor zorgprofessionals of als patiëntinterventie neemt sterk toe. Serious games kunnen kosten besparen en zorgkwaliteit verbeteren. (Potentiële) afnemers vragen, in lijn met het medische onderzoeksparadigma, vaak naar de klinische effectiviteit (internal validity) van deze games. Het gros van de Nederlandse game-ontwikkelaars bestaat echter uit kleine ondernemingen die het aan middelen en expertise ontbreekt om de hiervoor benodigde longitudinale onderzoekstrajecten uit te voeren. Tegelijkertijd tonen mkb’ers, meestal zonder ervan bewust te zijn, tijdens het game-ontwikkelproces al verschillende validiteitsvormen aan volgens het design-onderzoeksparadigma (face validity, construct validity, e.d.). Door dit niet bij hun afnemers kenbaar te maken, komt een constructieve dialoog over validiteit moeilijk op gang en lopen mkb’ers opdrachten mis. Het ontbreekt hen aan een begrippenkader en praktische handvatten. Bestaande raamwerken zijn nog te theorie-gedreven. Om mkb’ers te helpen de 'clash' te overbruggen tussen het medische en het design-onderzoeksparadigma, ontwikkelen lectoraten ICT-innovaties in de Zorg (Hogeschool Windesheim, penvoerder) en Serious Gaming (NHL Stenden Hogeschool) samen met elf mkb’ers, afnemers, studenten en experts in een learning community drie hulpmiddelen: •Checklist: praktische mkb-richtlijnen voor het vaststellen van validiteit; •Beslisboom: op basis waarvan mkb’ers onderbouwd de juiste validatiemethode kunnenselecteren; •Serious game: om samen met (potentiële) afnemers te spelen, zodat verschillende soortenvaliditeit expliciet benoemd worden. De hulpmiddelen worden inhoudelijk gevoed door casestudies waarin mkb’ers gevolgd worden in hoe validiteit momenteel wordt vastgesteld en geëxpliciteerd in het ontwikkelproces. Vervolgens brengen we de ontworpen hulpmiddelen in de mkb-praktijk voor evaluatie. Opgeleverde hulpmiddelen stellen mkb’ers in staat werkbare validatiemethoden toe te passen gedurende het game-ontwikkelproces om acceptabele bewijslast op te leveren voor potentiële afnemers, waardoor hun marktpositie versterkt. Ook draagt het project bij aan operationalisering van bestaande raamwerken en kunnen de hulpmiddelen in game design-curricula worden geïncorporeerd.
-Chatbots are being used at an increasing rate, for instance, for simple Q&A conversations, flight reservations, online shopping and news aggregation. However, users expect to be served as effective and reliable as they were with human-based systems and are unforgiving once the system fails to understand them, engage them or show them human empathy. This problem is more prominent when the technology is used in domains such as health care, where empathy and the ability to give emotional support are most essential during interaction with the person. Empathy, however, is a unique human skill, and conversational agents such as chatbots cannot yet express empathy in nuanced ways to account for its complex nature and quality. This project focuses on designing emotionally supportive conversational agents within the mental health domain. We take a user-centered co-creation approach to focus on the mental health problems of sexual assault victims. This group is chosen specifically, because of the high rate of the sexual assault incidents and its lifetime destructive effects on the victim and the fact that although early intervention and treatment is necessary to prevent future mental health problems, these incidents largely go unreported due to the stigma attached to sexual assault. On the other hand, research shows that people feel more comfortable talking to chatbots about intimate topics since they feel no fear of judgment. We think an emotionally supportive and empathic chatbot specifically designed to encourage self-disclosure among sexual assault victims could help those who remain silent in fear of negative evaluation and empower them to process their experience better and take the necessary steps towards treatment early on.
mechanism for fostering innovation competenceThis dissertation focuses on fostering students’ innovation competence in higher education. The research is aimed at developing instructional strategies based on theoretical design principles to aid teachers in higher education foster innovation competence in their classrooms and assess students’ innovation competence. The research was implemented within the existing curriculum of three Netherlands universities of applied sciences in which developing students’ innovation competence was the target learning goal. To aid innovation competence learning, an innovation competence teaching mechanism was developed following education design research steps. The research includes four independents sub-studies which used different research methods. This thesis shows that students’ innovation competence can be positively influenced by instruction. The findings of this study suggested that development of students’ innovation competence takes place through explicitly coordinated teaching and learning activities, design, assessment, and reflection. It was found that this innovation-supportive learning environment influenced the actual innovation competence of students and that the way of teaching (especially a better structured, balanced and more student-centred constructivist approach to teaching) had a positive influence on students’ development of innovation competence. This dissertation has shown that every student has the potential to be innovative, and that teachers can fulfil their role in recognizing the innovation potential of students by creating a teaching and learning environment that promotes and encourages innovation competence.
