How are Canadian universities training and supporting undergraduate medical, physiotherapy and occupational students for global health experiences in international low-resource settings?

Abstract : OBJECTIVES : Canadian medical (MD), physiotherapy (PT) and occupational therapy (OT) students increasingly show an interest in global health experiences (GHEs). As certain moral hazards can occur as a result of student GHEs, a growing consensus exists that universities must have an established selection process, in-depth pre-departure training (PDT), adequate onsite supervision and formal debriefing for their students. This study aimed at identifying current practices in Canadian MD, PT and OT programs and discussing areas for improvement by comparing them with recommendations found in the literature. METHODS : Canadian MD, PT and OT programs (n = 45) were invited to answer an online survey about their current practices for GHE support and training. The survey included 24 close-ended questions and 18 open-ended questions. Descriptive statistics and a thematic analysis were performed on the data and results were discussed with recommendations found in the literature. RESULTS : Twenty-three programs responded to the survey. Student selection processes varied across universities; examples included using academic performance, interviews and motivation letters. All but 1 MD program had mandatory PDT; content and teaching formats varied, as did training duration (2-38 hours). All but 1 MD program had onsite supervision; local clinicians were frequently involved. Debriefing, although not systematic, covered similar content; debriefing was variable in duration (1-8 hours). CONCLUSIONS : Many current practices are encouraging but areas for improvement exist. Integrating global health content into the regular curriculum with advanced study option in global health for students participating in GHEs could help universities standardize support and training.

Effect of haptic guidance and error amplification robotic training interventions on the immediate improvement of timing among individuals that had a stroke

Abstract : Many individuals that had a stroke have motor impairments such as timing deficits that hinder their ability to complete daily activities like getting dressed. Robotic rehabilitation is an increasingly popular therapeutic avenue in order to improve motor recovery among this population. Yet, most studies have focused on improving the spatial aspect of movement (e.g. reaching), and not the temporal one (e.g. timing). Hence, the main aim of this study was to compare two types of robotic rehabilitation on the immediate improvement of timing accuracy: haptic guidance (HG), which consists of guiding the person to make the correct movement, and thus decreasing his or her movement errors, and error amplification (EA), which consists of increasing the person’s movement errors. The secondary objective consisted of exploring whether the side of the stroke lesion had an effect on timing accuracy following HG and EA training. Thirty-four persons that had a stroke (average age 67 ± 7 years) participated in a single training session of a timing-based task (simulated pinball-like task), where they had to activate a robot at the correct moment to successfully hit targets that were presented a random on a computer screen. Participants were randomly divided into two groups, receiving either HG or EA. During the same session, a baseline phase and a retention phase were given before and after each training, and these phases were compared in order to evaluate and compare the immediate impact of HG and EA on movement timing accuracy. The results showed that HG helped improve the immediate timing accuracy (p=0.03), but not EA (p=0.45). After comparing both trainings, HG was revealed to be superior to EA at improving timing (p=0.04). Furthermore, a significant correlation was found between the side of stroke lesion and the change in timing accuracy following EA (r[subscript pb]=0.7, p=0.001), but not HG (r[subscript pb]=0.18, p=0.24). In other words, a deterioration in timing accuracy was found for participants with a lesion in the left hemisphere that had trained with EA. On the other hand, for the participants having a right-sided stroke lesion, an improvement in timing accuracy was noted following EA. In sum, it seems that HG helps improve the immediate timing accuracy for individuals that had a stroke. Still, the side of the stroke lesion seems to play a part in the participants’ response to training. This remains to be further explored, in addition to the impact of providing more training sessions in order to assess any long-term benefits of HG or EA.