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ABSTRACT: A teaching tool that facilitates student understanding of a three-dimensional (3D) integration of dermatomes with peripheral cutaneous nerve field distributions is described. This model is inspired by the confusion in novice learners between dermatome maps and nerve field distribution maps. This confusion leads to the misconception that these two distribution maps fully overlap, and may stem from three sources: (1) the differences in dermatome maps in anatomical textbooks, (2) the limited views in the figures of dermatome maps and cutaneous nerve field maps, hampering the acquisition of a 3D picture, and (3) the lack of figures showing both maps together. To clarify this concept, the learning process can be facilitated by transforming the 2D drawings in textbooks to a 3D hands-on model and by merging the information from the separate maps. Commercially available models were covered with white cotton pantyhose, and borders between dermatomes were marked using the drawings from the students' required study material. Distribution maps of selected peripheral nerves were cut out from color transparencies. Both the model and the cut-out nerve fields were then at the students' disposal during a laboratory exercise. The students were instructed to affix the transparencies in the right place according to the textbook's figures. This model facilitates integrating the spatial relationships of the two types of nerve distributions. By highlighting the spatial relationship and aiming to provoke student enthusiasm, this model follows the advantages of other low-fidelity models. Anat Sci Educ. © 2013 American Association of Anatomists.
Anatomical Sciences Education 03/2013; · 2.98 Impact Factor
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ABSTRACT: Spatial ability is an important factor in learning anatomy. Students with high scores on a mental rotation test (MRT) systematically score higher on anatomy examinations. This study aims to investigate if learning anatomy also oppositely improves the MRT-score. Five hundred first year students of medicine (n = 242, intervention) and educational sciences (n = 258, control) participated in a pretest and posttest MRT, 1 month apart. During this month, the intervention group studied anatomy and the control group studied research methods for the social sciences. In the pretest, the intervention group scored 14.40 (SD: ± 3.37) and the control group 13.17 (SD: ± 3.36) on a scale of 20, which is a significant difference (t-test, t = 4.07, df = 498, P < 0.001). Both groups show an improvement on the posttest compared to the pretest (paired samples t-test, t = 12.21/14.71, df = 257/241, P < 0.001). The improvement in the intervention group is significantly higher (ANCOVA, F = 16.59, df = 1;497, P < 0.001). It is concluded that (1) medical students studying anatomy show greater improvement between two consecutive MRTs than educational science students; (2) medical students have a higher spatial ability than educational sciences students; and (3) if a MRT is repeated there seems to be a test effect. It is concluded that spatial ability may be trained by studying anatomy. The overarching message for anatomy teachers is that a good spatial ability is beneficial for learning anatomy and learning anatomy may be beneficial for students' spatial ability. This reciprocal advantage implies that challenging students on spatial aspects of anatomical knowledge could have a twofold effect on their learning. Anat Sci Educ. © 2013 American Association of Anatomists.
Anatomical Sciences Education 01/2013; · 2.98 Impact Factor
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ABSTRACT: Anatomists often use images in assessments and examinations. This study aims to investigate the influence of different types of images on item difficulty and item discrimination in written assessments. A total of 210 of 460 students volunteered for an extra assessment in a gross anatomy course. This assessment contained 39 test items grouped in seven themes. The answer format alternated per theme and was either a labeled image or an answer list, resulting in two versions containing both images and answer lists. Subjects were randomly assigned to one version. Answer formats were compared through item scores. Both examinations had similar overall difficulty and reliability. Two cross-sectional images resulted in greater item difficulty and item discrimination, compared to an answer list. A schematic image of fetal circulation led to decreased item difficulty and item discrimination. Three images showed variable effects. These results show that effects on assessment scores are dependent on the type of image used. Results from the two cross-sectional images suggest an extra ability is being tested. Data from a scheme of fetal circulation suggest a cueing effect. Variable effects from other images indicate that a context-dependent interaction takes place with the content of questions. The conclusion is that item difficulty and item discrimination can be affected when images are used instead of answer lists; thus, the use of images as a response format has potential implications for the validity of test items. Anat Sci Educ © 2012 American Association of Anatomists.
Anatomical Sciences Education 06/2012; · 2.98 Impact Factor
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ABSTRACT: Anatomy students studying dissected anatomical specimens were subjected to either a loosely-guided, self-directed learning environment or a strictly-guided, preformatted gross anatomy laboratory session. The current study's guiding questions were: (1) do strictly-guided gross anatomy laboratory sessions lead to higher learning gains than loosely-guided experiences? and (2) are there differences in the recall of anatomical knowledge between students who undergo the two types of laboratory sessions after weeks and months? The design was a randomized controlled trial. The participants were 360 second-year medical students attending a gross anatomy laboratory course on the anatomy of the hand. Half of the students, the experimental group, were subjected without prior warning to station-based laboratory sessions; the other half, the control group, to loosely-guided laboratory sessions, which was the course's prevailing educational method at the time. The recall of anatomical knowledge was measured by written reproduction of 12 anatomical names at four points in time: immediately after the laboratory experience, then one week, five weeks, and eight months later. The strictly-guided group scored higher than the loosely-guided group at all time-points. Repeated ANOVA showed no interaction between the results of the two types of laboratory sessions (P = 0.121) and a significant between-subject effect (P ≤ 0.001). Therefore, levels of anatomical knowledge retrieved were significantly higher for the strictly-guided group than for the loosely-guided group at all times. It was concluded that gross anatomy laboratory sessions with strict instructions resulted in the recall of a larger amount of anatomical knowledge, even after eight months. Anat Sci Educ. © 2012 American Association of Anatomists.
Anatomical Sciences Education 05/2012; · 2.98 Impact Factor
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ABSTRACT: Until now, research on flaps in the anteromedial thigh region has focused on flaps in specific regions. To elucidate the complete pattern of suitable anteromedial thigh perforators, an anatomical study was performed by dissecting nine thighs from different cadavers. The ideal perforator has maximum length and diameter and runs through a septum. According to the data found in our study, these perforators can predominantly be found in the middle third of the anteromedial thigh region. All of the three main thigh vessels supply perforators which can be used for flaps. Pertaining to length and diameter the most suitable perforators originate from the deep femoral artery, which can be found in the proximal and middle third of the anteromedial thigh. Musculocutaneous perforators are found to be longer than septocutaneous perforators. Because of their position, the proximal and distal third perforators should preferentially be used for local pedicled flaps. Defects in the pelvic area and around the knee can be closed with perforator flaps from the proximal and distal anteromedial thigh, respectively. Because of their diameter, length, and number, the middle third perforators should be the first choice for harvesting free flaps. Skin closure is easily achieved in the anteromedial thigh region even when larger flaps are used.
Microsurgery 09/2009; 30(1):43-9. · 1.61 Impact Factor
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ABSTRACT: The anterior cruciate ligament (ACL) consists of an anteromedial bundle (AMB) and a posterolateral bundle (PLB). A reconstruction restoring the functional two-bundled nature should be able to approximate normal ACL function better than the most commonly used single-bundle reconstructions. Accurate tunnel positioning is important, but difficult. The purpose of this study was to provide a geometric description of the centre of the attachments relative to arthroscopically visible landmarks. The AMB and PLB attachment sites in 35 dissected cadaver knees were measured with a 3D system, as were anatomical landmarks of femur and tibia. At the femur, the mean ACL centre is positioned 7.9 +/- 1.4 mm (mean +/- 1 SD) shallow, along the notch roof, from the most lateral over-the-top position at the posterior edge of the intercondylar notch and from that point 4.0 +/- 1.3 mm from the notch roof, low on the surface of the lateral condyle wall. The mean AMB centre is at 7.2 +/- 1.8 and 1.4 +/- 1.7 mm, and the mean PLB centre at 8.8 +/- 1.6 and 6.7 +/- 2.0 mm. At the tibia, the mean ACL centre is positioned 5.1 +/- 1.7 mm lateral of the medial tibial spine and from that point 9.8 +/- 2.1 mm anterior. The mean AMB centre is at 3.0 +/- 1.6 and 9.4 +/- 2.2 mm, and the mean PLB centre at 7.2 +/- 1.8 and 10.1 +/- 2.1 mm. The ACL attachment geometry is well defined relative to arthroscopically visible landmarks with respect to the AMB and PLB. With simple guidelines for the surgeon, the attachments centres can be found during arthroscopic single-bundle or double-bundle reconstructions.
Knee Surgery Sports Traumatology Arthroscopy 01/2008; 15(12):1422-31. · 2.21 Impact Factor
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ABSTRACT: Semiexperimental study.
To investigate the effect of an external wrist extension force on extensor muscle activity during hand gripping in patients with lateral epicondylalgia.
Lateral epicondylalgia or "tennis elbow" is a common, often disabling ailment affecting millions of people. An optimal treatment strategy remains to be identified. The use of an external wrist extension force may reduce the extensor muscle activity during gripping in these patients.
Muscle activity of the extensor carpi radialis brevis (ECRB), extensor digitorum communis (EDC), and extensor carpi radialis longus (ECRL) was measured using surface EMG. Subjects gripped at an intensity of 10%, 20%, and 30% of the maximum voluntary contraction (MVC) force with and without the dynamic extensor brace and with and without an applied external wrist extension force of 1%, 2%, and 3% of MVC.
At all levels of MVC gripping, the EMG signal of the ECRB and EDC were significantly lower for gripping with than without brace. An extension force of 3% of the MVC force significantly reduced the EMG signal of all muscles in almost all measurement conditions.
The results of this study indicate that the dynamic extensor brace as well as the external extension force significantly reduced the EMG signal of the wrist extensor muscles during gripping in patients with lateral epicondylalgia. Based on these results, the dynamic extensor brace could be a promising new intervention for lateral epicondylalgia.
Journal of Orthopaedic and Sports Physical Therapy 04/2006; 36(3):170-8. · 3.00 Impact Factor
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ABSTRACT: Lateral epicondylitis (tennis elbow) is a common, often disabling ailment. Based on the failure of current therapies, a new dynamic extensor brace has been developed. In this study, the effects of application of this brace for 3 months on the most important and disabling symptoms of patients with lateral epicondylitis were assessed. After prestratification for the duration of complaints (ie, < or = 3 months and > or = 3 months), 63 patients initially were assigned randomly to 12 weeks of brace treatment (Group 1; n = 30) or no brace treatment (Group 2; n = 33). Outcome measures included pain (VAS), pain-free grip strength, maximum grip strength, and functionality of the arm. All outcomes were assessed at 6, 12, 18, and 24 weeks. Brace treatment resulted in significant pain reduction, improved functionality of the arm, and improvement in pain-free grip strength. The beneficial effects of the dynamic extensor brace observed after 12 weeks were significantly different from the treatment group that received no brace. The beneficial effects were sustained for another 12 weeks. No correlation between duration of symptoms and treatment effects of the brace was revealed. The dynamic extensor brace is an effective therapeutic tool for treating lateral epicondylitis. Level of Evidence: Therapeutic study. Level I (randomized controlled trial with statistically significant difference). See the Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 01/2006; 442:149-57. · 2.53 Impact Factor
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ABSTRACT: In clinical practice, visual gait observation is often used to determine gait disorders and to evaluate treatment. Several reliability studies on observational gait analysis have been described in the literature and generally showed moderate reliability. However, patients with orthopedic disorders have received little attention. The objective of this study is to determine the reliability levels of visual observation of gait in patients with orthopedic disorders.
The gait of thirty patients referred to a physical therapist for gait treatment was videotaped. Ten raters, 4 experienced, 4 inexperienced and 2 experts, individually evaluated these videotaped gait patterns of the patients twice, by using a structured gait analysis form. Reliability levels were established by calculating the Intraclass Correlation Coefficient (ICC), using a two-way random design and based on absolute agreement.
The inter-rater reliability among experienced raters (ICC = 0.42; 95%CI: 0.38-0.46) was comparable to that of the inexperienced raters (ICC = 0.40; 95%CI: 0.36-0.44). The expert raters reached a higher inter-rater reliability level (ICC = 0.54; 95%CI: 0.48-0.60). The average intra-rater reliability of the experienced raters was 0.63 (ICCs ranging from 0.57 to 0.70). The inexperienced raters reached an average intra-rater reliability of 0.57 (ICCs ranging from 0.52 to 0.62). The two expert raters attained ICC values of 0.70 and 0.74 respectively.
Structured visual gait observation by use of a gait analysis form as described in this study was found to be moderately reliable. Clinical experience appears to increase the reliability of visual gait analysis.
BMC Musculoskeletal Disorders 02/2005; 6:17. · 1.58 Impact Factor
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ABSTRACT: Experimental repeated-measures study.
To investigate the effect of different extension forces applied to the palm of the hand on electromyographic (EMG) activity of the wrist extensor muscles during hand gripping.
Lateral epicondylitis is usually caused by repetitive wrist extension that leads to an overuse injury. The current theory is that the process of lateral epicondylitis begins with an overuse injury that leads to microtearing of the extensor carpi radialis brevis muscle and occasionally the extensor digitorum communis muscle. Use of an external wrist extension force might reduce muscle activity during gripping.
Muscle activity was measured using surface EMG while subjects gripped at an intensity of 10%, 20%, and 30% of the maximum voluntary contraction force without, and with, an applied external wrist extension force of 1%, 2%, and 3% of maximum voluntary contraction.
Applying an extension force to the palm of the hand reduced EMG activity of the extensor muscles at the same strength generation during hand gripping. The muscles with the most significant reduction in EMG level, the extensor carpi radialis brevis and extensor digitorum communis, are those muscles that are most often involved with lateral epicondylitis.
This study shows that an external extension force reduces EMG activity of the wrist extensor muscles during gripping in healthy volunteers. As the extension force increased, a greater reduction in muscle activity was noted.
Journal of Orthopaedic and Sports Physical Therapy 06/2004; 34(5):228-34. · 3.00 Impact Factor
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ABSTRACT: The knee joints of mice can serve as a model for studying knee ligament properties. The goal of our study was to measure the structural stiffness of the medial collateral ligament (MCL) of the murine knee. A tensile test was developed for this purpose. First 84 femur-MCL-tibia complexes of 11-week-old C57Black6 mice were tested. Of four groups (n = 14 per group) the right MCL was ruptured. The mice were sacrificed at 1.5, 3, 6, and 9 weeks after the operation. The other two groups served as controls at 0 and 9 weeks after the operation. Absolute values of the structural stiffness of the healed MCLs at 1.5 weeks were initially significantly lower than their unoperated controls, but were not different from normal values at three, six, and nine weeks of healing. The structural stiffness of the unoperated controls increased by 11% at 20 weeks compared to 11 weeks of age.
Connective Tissue Research 01/2004; 45(3):190-5. · 1.20 Impact Factor
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ABSTRACT: On All Saints Day 2009 a monument for body donors was unveiled by the Department of Anatomy, at the Radboud University Nijmegen Medical Centre (RUNMC). Although body donation to medical science contributes substantially to the quality of medical education, the ceremony was only the first time that the RUNMC publicly reciprocated the anatomical gift. By means of the monument the department of Anatomy endeavors to express gratitude for the gift of body donors and raise awareness among students to value the gift and treat donor bodies with the proper respect. Furthermore, the large attendance of bereaved at the unveiling ceremony, revealed another equally important meaning of the monument, which is the significance of the monument to the donor kin. The wish of a body donor has large implications for the way bereaved can take leave of the donor; there is limited time to bade the deceased farewell, the body will not be available for a funeral, and the donor kin stay behind empty handed without even a grave or ashes. Therefore the monument can be meaningful by facilitating the bereaved with a place of commemoration. The design of the monument anticipates on these multiple meanings and symbolisms by placing an old marble dissection table in the shape of an altar and fixing a bronze sculpture of a phoenix as symbol of imperishableness.
Anatomical Sciences Education 3(6):323-5. · 2.98 Impact Factor
