This paper conducted a preliminary study of reviewing and exploring bias strategies using a framework of a different discipline: change management. The hypothesis here is: If the major problem of implicit bias strategies is that they do not translate into actual changes in behaviors, then it could be helpful to learn from studies that have contributed to successful change interventions such as reward management, social neuroscience, health behavioral change, and cognitive behavioral therapy. The result of this integrated approach is: (1) current bias strategies can be improved and new ones can be developed with insight from adjunct study fields in change management; (2) it could be more sustainable to invest in a holistic and proactive bias strategy approach that targets the social environment, eliminating the very condition under which biases arise; and (3) while implicit biases are automatic, future studies should invest more on strategies that empower people as “change agents” who can act proactively to regulate the very environment that gives rise to their biased thoughts and behaviors.
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Objectives: To investigate immediate changes in walking performance associated with three implicit motor learning strategies and to explore patient experiences of each strategy. Design: Participants were randomly allocated to one of three implicit motor learning strategies. Within-group comparisons of spatiotemporal parameters at baseline and post strategy were performed. Setting: Laboratory setting. Subjects: A total of 56 community-dwelling post-stroke individuals. Interventions: Implicit learning strategies were analogy instructions, environmental constraints and action observation. Different analogy instructions and environmental constraints were used to facilitate specific gait parameters. Within action observation, only videotaped gait was shown. Main measures: Spatiotemporal measures (speed, step length, step width, step height) were recorded using Vicon 3D motion analysis. Patient experiences were assessed by questionnaire. Results: At a group level, three of the four analogy instructions (n=19) led to small but significant changes in speed (d=0.088m/s), step height (affected side d=0.006m) and step width (d=–0.019m), and one environmental constraint (n=17) led to significant changes in step width (d=–0.040m). At an individual level, results showed wide variation in the magnitude of changes. Within action observation (n=20), no significant changes were found. Overall, participants found it easy to use the different strategies and experienced some changes in their walking performance. Conclusion: Analogy instructions and environmental constraints can lead to specific, immediate changes in the walking performance and were in general experienced as feasible by the participants. However, the response of an individual patient may vary quite considerably.
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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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DOEL: Deze studie onderzoekt de mogelijke invloed van gender op de historische dynamiek rond verpleegkundig leiderschap. METHODE: Gebruikmakend van een historische onderzoeksbenadering voert deze studie een bronnenanalyse uit met gender als analytische lens, gericht op de ontwikkeling van het verpleegkundig directeurschap in het Sint Radboudziekenhuis vanaf de oprichting van de medische kliniek (1956) tot de uitsluiting van de verpleegkundig directrice uit de directie (1971). RESULTATEN: Er worden zes gendergaps geïdentificeerd, namelijk verschillen in vermeende capaciteiten en kwaliteiten, werk-privébalans, opleiding, salarisstructuur, ondersteuning en gebruik van retoriek. Dit wijst op betrokkenheid van stereotype denkbeelden bij het vormen van de genderasymmetrie binnen het verpleegkundig beroep en de perceptie ervan op de werkplek en daarbuiten. DISCUSSIE: Een geleidelijke uitsluiting van verpleegkundigen op basis van geslacht op strategisch niveau in directies wordt benadrukt. Deze asymmetrie en vooroordelen creëerden een onevenwichtig speelveld, wat de onderhandelingen over de status van het verpleegkundig beroep bemoeilijkte en belemmeringen opwierp voor verpleegkundig leiderschap. CONCLUSIE: Het zichtbaar en bespreekbaar maken van deze vooroordelen kan het bewustzijn vergroten over de wijze waarop historisch gegroeide ideeën en overtuigingen hedendaags verpleegkundig leiderschap beïnvloeden.
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Movement is an essential part of our lives. Throughout our lifetime, we acquire many different motor skills that are necessary to take care of ourselves (e.g., eating, dressing), to work (e.g., typing, using tools, care for others) and to pursue our hobbies (e.g., running, dancing, painting). However, as a consequence of aging, trauma or chronic disease, motor skills may deteriorate or become “lost”. Learning, relearning, and improving motor skills may then be essential to maintain or regain independence. There are many different ways in which the process of learning a motor skill can be shaped in practice. The conceptual basis for this thesis was the broad distinction between implicit and explicit forms of motor learning. Physiotherapists and occupational therapists are specialized to provide therapy that is tailored to facilitate the process of motor learning of patients with a wide range of pathologies. In addition to motor impairments, patients suffering from neurological disorders often also experience problems with cognition and communication. These problems may hinder the process of learning at a didactic level, and make motor learning especially challenging for those with neurological disorders. This thesis focused on the theory and application of motor learning during rehabilitation of patients with neurological disorders. The overall aim of this thesis was to provide therapists in neurological rehabilitation with knowledge and tools to support the justified and tailored use of motor learning in daily clinical practice. The thesis is divided into two parts. The aim of the first part (Chapters 2‐5) was to develop a theoretical basis to apply motor learning in clinical practice, using the implicit‐explicit distinction as a conceptual basis. Results of this first part were used to develop a framework for the application of motor learning within neurological rehabilitation (Chapter 6). Afterwards, in the second part, strategies identified in first part were tested for feasibility and potential effects in people with stroke (Chapters 7 and 8). Chapters 5-8 are non-final versions of an article published in final form in: Chapter 5: Kleynen M, Moser A, Haarsma FA, Beurskens AJ, Braun SM. Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study. Disabil Rehabil. 2017 Aug;39(17):1729-1737. doi: 10.1080/09638288.2016.1207111. Chapter 6: Kleynen M, Beurskens A, Olijve H, Kamphuis J, Braun S. Application of motor learning in neurorehabilitation: a framework for health-care professionals. Physiother Theory Pract. 2018 Jun 19:1-20. doi: 10.1080/09593985.2018.1483987 Chapter 7: Kleynen M, Wilson MR, Jie LJ, te Lintel Hekkert F, Goodwin VA, Braun SM. Exploring the utility of analogies in motor learning after stroke: a feasibility study. Int J Rehabil Res. 2014 Sep;37(3):277-80. doi: 10.1097/MRR.0000000000000058. Chapter 8: Kleynen M, Jie LJ, Theunissen K, Rasquin SM, Masters RS, Meijer K, Beurskens AJ, Braun SM. The immediate influence of implicit motor learning strategies on spatiotemporal gait parameters in stroke patients: a randomized within-subjects design. Clin Rehabil. 2019 Apr;33(4):619-630. doi: 10.1177/0269215518816359.
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Background: Motor learning is central to domains such as sports and rehabilitation; however, often terminologies are insufficiently uniform to allow effective sharing of experience or translation of knowledge. A study using a Delphi technique was conducted to ascertain level of agreement between experts from different motor learning domains (i.e., therapists, coaches, researchers) with respect to definitions and descriptions of a fundamental conceptual distinction within motor learning, namely implicit and explicit motor learning. Methods: A Delphi technique was embedded in multiple rounds of a survey designed to collect and aggregate informed opinions of 49 international respondents with expertise related to motor learning. The survey was administered via an online survey program and accompanied by feedback after each round. Consensus was considered to be reached if $70% of the experts agreed on a topic. Results: Consensus was reached with respect to definitions of implicit and explicit motor learning, and seven common primary intervention strategies were identified in the context of implicit and explicit motor learning. Consensus was not reached with respect to whether the strategies promote implicit or explicit forms of learning. Discussion: The definitions and descriptions agreed upon may aid translation and transfer of knowledge between domains in the field of motor learning. Empirical and clinical research is required to confirm the accuracy of the definitions and to explore the feasibility of the strategies that were identified in research, everyday practice and education.
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Purpose – Information verification is an important factor in commercial valuation practice.Valuers use their professional autonomy to decide on the level of verification required, thereby creating an opportunity for client-related judgement bias in valuation. The purpose of this paper is to assess the manifestation of client attachment risks in information verification. Design/methodology/approach – A case-based questionnaire was used to retrieve data from 290 commercial valuation professionals in the Netherlands, providing a 15 per cent response rate of the Dutch commercial valuation population. Descriptive and inferential statistics have been used to test research hypotheses involving relations between information verification and professional features that may indicate client attachment such as an executive job level and brokerage experience. Findings – The results reveal that valuers acting at partner level within their organisation obtain lower scores on information verification compared to lower-ranked valuers. Also, brokerage experience correlates negatively to information verification of valuation professionals. Both findings have statistical significance. Research limitations/implications – The results reflect valuers’ reasoning behaviour rather than actual behaviour. Replication of findings through experimental design will contribute to research validity. Practical implications – Maintaining close client contact in a competitive environment is important for business continuity yet may foster client attachment.The associated downside risks in valuation practice call for higher awareness of (subconscious) client influence and the development of attitudinal scepticism in valuer training programmes. Originality/value – This paper is one of the few that explore possible sources of valuer judgement bias by relating client-friendly valuer features to a key area of valuation i.e. information verification.
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This thesis provides an examination of judgement autonomy of Dutch commercial real estate valuers in relation to client orientation. The valuation of commercial real estate such as offices or retail properties requires in-depth analysis due to its uniqueness by location, building type and usage details. Essentially, a register-valuer is qualified and instructed to assess a property value to one’s best cognitive effort and inform others of this outcome by means of a valuation report. In the Netherlands, concerns over independence risks and client-related judgement risks of valuers have been raised by regulative authorities as the Dutch Central Bank (DNB) and the Dutch Authority for the Financial Markets (AFM). A significant part of these concerns followed the 2008 financial crisis, which appeared to be at least partially driven by unreliable and incomparable valuations of Dutch commercial real estate (AFM, 2014; DNB, 2012; 2015). Among other things, these concerns led to the instigation of the Nederlands Register Vastgoed Taxateurs (NRVT) in 2015. NRVT is a new Dutch central register of valuation practitioners set up in order to improve self-regulation, quality control and compliance of valuation practitioners. Currently, the chamber for commercial real estate valuation holds about 2,000 commercial valuation registrations (NRVT, 2020). The introduction of NRVT, and other measures taken, reflect an instrumental view towards enhancing professionalism of Dutch valuers. This view is based on a systematic orientation to professional conduct in which good practice is primarily objectively determined (Van Ewijk, 2019). However, Wassink and Bakker (2016) point out that individuals make personal choices in order to deal with work complexity. Insight into and reflection on individual choices is part of what is referred to as normative aspects of professionalisation: what norms prevail in individual judgement and decision-making and why (Van Ewijk, 2019). In this regard, insight into judgement reasoning of valuation practitioners may contribute to normative levels of professional development of valuers. The need for such is expressed through community concerns over how individual judgement autonomy may become subdued due to instrumental-driven developments taking place in the sector. The combination of authoritative concerns over professional quality in the Netherlands and lack of (scientific) insight on how client influence affects judgement in valuation practice poses a problem: How may practitioners address client-related judgement bias risks and improve valuation accuracy from this viewpoint, if little is known on how such risks may occur in daily practice? The seemingly scarce scientific insights available in this regard in the Netherlands may also prevent educational programs to adequately address valuer independence and objectivity risks in relevant training programs. In order to address this knowledge gap, the present PhD research examines the following research problem: 169 Summary “How does client orientation affect professional judgement autonomy of commercial real estate valuers in the Netherlands?” The term ‘client orientation’ should be broadly interpreted and may refer to valuers’ perception, understanding and meaning given to alleged, actual or anticipated client-related aspects. Information on such client aspects is not required for the performance of valuation instructions. It should also be noted that this research examines the context of how client orientation may affect valuer judgement reasoning patterns during work practice, yet not its effect in terms of decision on final value opinion.
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Deze studie kent de volgende opbouw. Voordat er concrete stappen gezet kunnen worden om onderwijs meer inclusief te maken, is het van belang om te weten waarom juist deze stappen gezet dienen te worden. Daarom gaan wij in hoofdstuk 2 eerst in op inzichten die een licht werpen op mechanismen die ten grondslag liggen aan interacties tussen studenten en docenten. Wij proberen hiermee wellicht onbewuste, en daarmee nauwelijks zichtbare processen die zich afspelen tussen docenten en studenten, in de schijnwerpers te plaatsen. Deze mechanismen uiten zich in zowel docent- als studentgedrag, die onderling ook weer op elkaar inwerken. In hoofdstuk 3 kijken we naar in onderzoek genoemde handelingsperspectieven voor docenten om een inclusieve leeromgeving tot stand te brengen en te bevorderen. En ten slotte in hoofdstuk 4 zullen we de theoretische bevindingen in een samenvattend hoofdstuk proberen in te bedden in de dagelijkse onderwijspraktijk.
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Safety is monitored by various proactive and reactive methods, including the investigation of adverse accidents and incidents, which are collectively known as safety investigations. In this study we demonstrate how accident and incident investigation reports can be useful to identify implicit safety views and accident investigation approaches. An analysis framework was developed based on contemporary safety literature. The framework incorporates aspects such as hindsight bias, judgemental approach, proximal or distal focus, and the application of systemic versus sequential accident causation models. The framework was piloted through the analysis of sixteen (16) accident investigation reports published by a Nuclear Power Plant (NPP). The comments of independent researchers lead to framework refinements that increased the inter-rater reliability substantially. The initial results were validated through interviews with the staff of the NPP. Afterwards, the framework was applied to 52 air accident reports published by the Dutch Safety Board (DSB) from 1999 to 2013. Frequency calculations revealed the extent of new safety thinking embracement from the DSB, and Fisher’s Exact Test showed that none of the modern safety aspects has changed over time. The framework can be used to analyse accident investigation reports published by various organisations as means to identify implicit safety views and evolution of accident investigation practices over time. Further research will explore the reasons for potential gaps between theory and practice and contribute to minimizing such distance. Safety is monitored by various proactive and reactive methods, including the investigation of adverse accidents and incidents, which are collectively known as safety investigations. In this study we demonstrate how accident and incident investigation reports can be useful to identify implicit safety views and accident investigation approaches. An analysis framework was developed based on contemporary safety literature. The framework incorporates aspects such as hindsight bias, judgemental approach, proximal or distal focus, and the application of systemic versus sequential accident causation models. The framework was piloted through the analysis of sixteen (16) accident investigation reports published by a Nuclear Power Plant (NPP). The comments of independent researchers lead to framework refinements that increased the inter-rater reliability substantially. The initial results were validated through interviews with the staff of the NPP. Afterwards, the framework was applied to 52 air accident reports published by the Dutch Safety Board (DSB) from 1999 to 2013. Frequency calculations revealed the extent of new safety thinking embracement from the DSB, and Fisher’s Exact Test showed that none of the modern safety aspects has changed over time. The framework can be used to analyse accident investigation reports published by various organisations as means to identify implicit safety views and evolution of accident investigation practices over time. Further research will explore the reasons for potential gaps between theory and practice and contribute to minimizing such distance.
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