Cervical spinal manipulation (CSM) and cervical mobilization are frequently used in patients with neck pain and headache. Pre-manipulative cervical instability and arterial integrity tests appear to be unreliable in identifying patients at risk at risk for adverse events. It would be valuable if patients at risk could be identified by specific characteristics during the preliminary screening.
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Er is behoefte aan mensen die bijdragen leveren aan de ontwikkeling van technische producten en processen. Onderwijs heeft de opdracht de technische geletterdheid van leerlingen te ontwikkelen en te zorgen dat ze zich prettig voelen bij het hanteren van techniek. Deze studie focust op de bijdrage die Mindtools hieraan leveren. Mindtools zijn op ICT gebaseerde leermiddelen die samenwerkend constructivistisch leren en hoger-orde (kritisch en creatief) denken stimuleren. Het begrip Direct Manipulation Environments (DME's), een subklasse van Mindtools, kenmerkt concrete leermiddelen zoals de microwerelden "Lego Mindstorms" en "Techno Logica". Deze microwerelden functioneren op basis van een materieel technisch model dat direct via een computer¬programma bestuurd wordt en taken kan uitvoeren (robots). De leertaak voor de leerling kan zich bewegen op het continuüm van het zelf programmeren van een kant-en-klaar materieel model dat bepaalde taken moet uitvoeren tot en met het zelf bedenken, bouwen en programmeren van een dergelijk model dat een of meer taken kan uitvoeren. Op grond van eerder literatuuronderzoek en een casestudie veronderstellen we dat het educatief toepassen van DME's bijdraagt aan de ontwikkeling van de technische geletterdheid van leerlingen. Hoewel definiëring van technische geletterdheid meer aandacht vraagt, zijn de volgende drie dimensies voor onze analyses bruikbaar gebleken: inhoud (zoals feiten, concepten, voorschriften), praktijk (het handelen, het materiële, doen en realiseren) en de cognitieve dimensie (denkvaardigheden en denkhoudingen). Het is aannemelijk dat door het toepassen van DME's domeinspecifieke concepten en kennis ontwikkeld wordt. Het denken van leerlingen is gekoppeld aan contexten en taken en moet niet geïsoleerd worden bestudeerd. We concentreren ons in deze studie vooral op onderzoek naar de dimensie van de denkvaardigheden en denkhoudingen (het denken van leerlingenduo's bij het oplossen van een probleemtaak) door het analyseren van de verbale interactie op kenmerken van kritisch - en creatief denken. Er is gebruik gemaakt van een Techno Logica leeromgeving bestaande uit een computer met software, een interface, bestuurbare materialen zoals lampjes en motors, en een zelfinstructie handleiding. Twee in complexiteit toenemende probleemtaken, ieder gebaseerd op een kant-en-klaar materieel model (Verkeerslicht en Reuzenrad), zijn gebruikt om de leerlingen besturingen te laten ontwerpen en testen. Dit proces werd op video opgenomen. We veronderstellen dat Techno Logica een bruikbare Mindtool is wanneer werken ermee bijdraagt aan technologische geletterdheid, in de zin dat er sprake is van probleemoplossen en hoger orde denken. Om dit te operationaliseren ontwierpen we een gestructureerd observatie-instrument op basis van het IOWA Integrated Thinking Model en de theorie over denkhoudingen (Costa, 2000). Hiermee werd het voorkomen en de diversiteit van denkvaardigheden en denkhoudingen in de verbale acties en interactie gescoord. Op basis van onze waarnemingen concluderen we dat veel interactie en handelen eerder geduid kan worden als uitingen van denken dan trial and error. Er zijn indicaties dat de leeromgeving en probleemtaken leiden tot ontwikkeling van expertise waardoor een nieuwe (moeilijkere) probleemtaak efficiënter en effectiever opgelost wordt. We vragen we aandacht voor de rol van de docent. We ervaren immers dat nieuwe leermiddelen niet gemakkelijk geadopteerd worden door leerkrachten.
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This study investigates what pupils aged 10-12 can learn from working with robots, assuming that understanding robotics is a sign of technological literacy. We conducted cognitive and conceptual analysis to develop a frame of reference for determining pupils' understanding of robotics. Four perspectives were distinguished with increasing sophistication; psychological, technological, function, and controlled system. Using Lego Mindstorms NXT robots, as an example of a Direct Manipulation Environment, we developed and conducted a lesson plan to investigate pupils' reasoning patterns. There is ample evidence that pupils have little difficulty in understanding that robots are man-made technological and functional artifacts. Pupils' understanding of the controlled system concept, more specifically the complex sense-reason-act loop that is characteristic of robotics, can be fostered by means of problem solving tasks. The results are discussed with respect to pupils' developing technological literacy and the possibilities for teaching and learning in primary education.
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Cervical spinal manipulation (CSM) and cervical mobilization are frequently used in patients with neck pain and headache. Pre-manipulative cervical instability and arterial integrity tests appear to be unreliable in identifying patients at risk for adverse events. It would be valuable if patients at risk could be identified by specific characteristics during the preliminary screening.Objective was to identify characteristics of 1) patients, 2) practitioners, 3) treatment process and 4) adverse events (AE) occurring after CSM or cervical mobilization.A systematic search was performed in PubMed, Embase, CINAHL, Web-of-science, AMED, and ICL (Index Chiropractic Literature) up to December 2014.Of the initial 1043 studies, 144 studies were included, containing 227 cases. 117 cases described male patients with a mean age of 45 (SD 12) and a mean age of 39 (SD 11) for females. Most patients were treated by chiropractors (66%). Manipulation was reported in 95% of the cases, and neck pain was the most frequent indication. Cervical arterial dissection (CAD) was reported in 57% (P = 0.21) of the cases and 45.8% had immediate onset symptoms. The overall distribution of gender for CAD is 55% (n = 71) for female and therefore opposite of the total AE.Patient characteristics were described poorly. No clear patient profile, related to the risk of AE after CSM, could be extracted. However, women seem more at risk for CAD. There seems to be under-reporting of cases. Further research should focus on a more uniform and complete registration of AE using standardized terminology.
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Study design: A secondary analysis of a systematic review. Background: Manipulations or mobilizations are commonly used interventions in patients with mechanical neck pain. The treatment effects have often been studied in randomized controlled trials (RCT) which are generally considered the gold standard in evaluating the treatment effects, mainly due to its high internal validity. External validity is defined as the extent to which the effects can be generalised to clinical practice. An important prerequisite for this is that interventions used in clinical trials can be replicated in clinical practice. It can be questioned if interventions utilized in randomized controlled trials can be translated into clinical practice. Objectives: The overall aim of this study is to examine whether the quality of the description of manipulation and mobilization interventions is sufficient for to replication of these interventions in clinical practice. Methods: A comprehensive literature search was performed. Two independent researchers used the Template for Intervention Description and Replication (TIDieR) which is a 12-item checklist for describing the completeness of the interventions. Results: Sixty-seven articles were included that used manipulation and/or mobilization interventions for patients with mechanical neck pain. None of the articles describe the intervention e.g. all the items on the TIDieR list. Considering item 8 (a-f) of the TIDieR checklist only one article described the used techniques completely. Conclusion: Manipulation or a mobilization interventions are poorly reported in RCTs, which jeopardize the external validity of RCTs, making it difficult for clinicians and researchers to replicate these interventions.
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The authors regret that during a recent review of this work, an erroneous calculation was uncovered. In our discussion we estimated the number of VAD patients annually with recent manipulation in the U.S. If the annual rate of VAD patients in the U.S. population was approximately (318,857,056 × 1.0/100.000) 3188, and of those patients 6.9% received a cervical manipulation, the correct number should be (3188 × 0.069) 220. This had been accidentally calculated as 220,011 instead of 220. Although it does not change the overall conclusions or discussion of the paper, the authors would like to thank dr. Clum for his attentiveness and apologize for any inconvenience caused.
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BACKGROUND AND OBJECTIVE: High-velocity low-amplitude thrust spinal manipulation (SM) is a recommended and commonly used manual therapy intervention in physiotherapy. Beliefs surrounding the safety and effectiveness of SM have challenged its use, and even advocated for its abandonment. Our study aimed to investigate the knowledge and beliefs surrounding SM by Italian physiotherapists compared with similar practitioners in other countries.METHODS: An online survey with 41 questions was adapted from previous surveys and was distributed via a mailing list of the Italian Physiotherapists Association (March 22-26, 2020). The questionnaire was divided into 4 sections to capture information on participant demographics, utilization, potential barriers, and knowledge about SM. Questions were differentiated between spinal regions. Attitudes towards different spinal regions, attributes associated with beliefs, and the influence of previous educational background were each evaluated.RESULTS: Of the 7398 registered physiotherapists, 575 (7.8%) completed the survey and were included for analysis. The majority of respondents perceived SM as safe and effective when applied to the thoracic (74.1%) and lumbar (72.2%) spines; whereas, a smaller proportion viewed SM to the upper cervical spine (56.8%) as safe and effective. Respondents reported they were less likely to provide and feel comfortable with upper cervical SM (respectively, 27.5% and 48.5%) compared to the thoracic (respectively, 52.2% and 74.8%) and lumbar spines (respectively, 46.3% and 74.3%). Most physiotherapists (70.4%) agreed they would perform additional screening prior to upper cervical SM compared to other spinal regions. Respondents who were aware of clinical prediction rules were more likely to report being comfortable with SM (OR 2.38-3.69) and to perceive it as safe (OR 1.75-3.12). Finally, physiotherapists without musculoskeletal specialization, especially those with a traditional manual therapy background, were more likely to perform additional screening prior to SM, use SM less frequently, report being less comfortable performing SM, and report upper cervical SM as less safe (p < 0.001).DISCUSSION: The beliefs and attitudes of physiotherapists surrounding the use of SM are significantly different when comparing the upper cervical spine to other spinal regions. An educational background in traditional manual therapy significantly influences beliefs and attitudes. We propose an updated framework on evidence-based SM.
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A previous review concluded that postural sway is increased in patients with low back pain (LBP). However, more detailed analysis of the literature shows that postural deficit may be dependent on experimental conditions in which patients with LBP have been assessed. The research question to be answered in this review was: " Is there any difference in postural sway between subjects with and without LBP across several sensory manipulation conditions?" A literature search in Pubmed, Scopus, Embase and PsychInfo was performed followed by hand search and contact with authors. Studies investigating postural sway during bipedal stance without applying external forces in patients with specific and non-specific LBP compared to healthy controls were included. Twenty three articles fulfilled the eligibility criteria. Most studies reported an increased postural sway in LBP, or no effect of LBP on postural sway. In a minority of studies, a decreased sway was found in LBP patients. There were no systematic differences between studies finding an effect and those reporting no effect of LBP. The proportion of studies finding between-group differences did not increase with increased complexity of sensory manipulations. Potential factors that may have caused inconsistencies in the literature are discussed in this systematic review.
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Voor hun ontwikkeling is het belangrijk dat kinderen greep krijgen op de moderne digitale leefwereld. Deze wereld heeft veel kenmerken van een black box. Mindtools zijn computertoepassingen die kunnen helpen de black box te openen. Ze stimuleren kinderen actief reflecterend te leren met en over digitale technologie. Een Robotic Direct Manipulation Environment (DME) is een mindtool waarmee leerlingen een werkende robot maken en al doende denkvaardigheden activeren om conceptuele kennis te ontwikkelen. De leerlingen krijgen en realistischer beeld van de plaats en mogelijkheden van moderne technologie. Terwijl ze probleemtaken oplossen activeren ze allerlei denkvaardigheden en ontwikkelen conceptuele kennis.
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Although there seems to be no causality between cervical spine (CS) manipulation and major adverse events (MAE), it remains important that manual therapists try to prevent every potential MAE. Although the validity of positional testing for vertebrobasilar insufficiency (VBI) has been questioned, recently, the use of these tests was recommended. However, based on the low sensitivity of the VBI tests, which may result in too many false-negative results, the VBI tests seem to be less valuable in pre-manipulative screening. Moreover, because the VBI tests are unable to consistently produce a decreased blood flow in the contralateral vertebral artery in (healthy people), the underlying mechanism of the test may not be a valid construct. There are numerous cases reporting MAE after a negative VBI test, indicating that the VBI tests do not have a role in assessing the risk of serious neurovascular pathology, such as cervical arterial dissection, the most frequently described MAE after CS manipulation. Symptoms of VBI can be identified in the patient interview and should be considered as red flags or warning signs and require further medical investigation. VBI tests are not able to predict MAE and seem not to have any added value to the patient interview with regard to detecting VBI or another vascular pathology. Furthermore, a negative VBI test can be wrongly interpreted as 'safe to manipulate'. Therefore, the use of VBI tests cannot be recommended and should be abandoned.
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