Development and evaluation of a program to improve clinician and patient communication during a telehealth consultation : C.R.I.S.P. Telehealth

Introduction: The delivery of health care in the 21st century will look like no other in the past. The fast paced technological advances that are being made will need to transition from the information age into clinical practice. The phenomenon of e-Health is the over-arching form of information technology and telehealth is one arm of that phenomenon. The uptake of telehealth both in Australia and overseas, has changed the face of health service delivery to many rural and remote communities for the better, removing what is known as the tyranny of distance. Many studies have evaluated the satisfaction and cost-benefit analysis of telehealth across the organisational aspects as well as the various adaptations of clinical pathways and this is the predominant focus of most studies published to date. However, whilst comments have been made by many researchers about the need to improve and attend to the communication and relationship building aspects of telehealth no studies have examined this further. The aim of this study was to identify the patient and clinician experiences, concerns, behaviours and perceptions of the telehealth interaction and develop a training tool to assist these clinicians to improve their interaction skills. Methods: A mixed methods design combining quantitative (survey analysis and data coding) and qualitative (interview analysis) approaches was adopted. This study utilised four phases to firstly qualitatively explore the needs of clients (patients) and clinicians within a telehealth consultation then designed, developed, piloted and quantitatively and qualitatively evaluated the telehealth communication training program. Qualitative data was collected and analysed during Phase 1 of this study to describe and define the missing 'communication and rapport building' aspects within telehealth. This data was then utilised to develop a self-paced communication training program that enhanced clinicians existing skills, which comprised of Phase 2 of this study to develop the interactive program. Phase 3 included evaluating the training program with 26 clinicians and results were recorded pre and post training, whilst phase 4 was the pilot for future recommendations of this training program using a patient group within a Queensland Health setting at two rural hospitals. Results: Comparisons of pre and post training data on 1) Effective communication styles, 2) Involvement in communication training package, 3) satisfaction pre and post training, and 4) health outcomes pre and post training indicated that there were differences between pre and post training in relation to effective communication style, increased satisfaction and no difference in health outcomes between pre and post training for this patient group. The post training results revealed over half of the participants (N= 17, 65%) were more responsive to non-verbal cues and were better able to reflect and respond to looks of anxiousness and confusion from a 'patient' within a telehealth consultation. It was also found that during post training evaluations, clinicians had enhanced their therapeutic communication with greater detail to their own body postures, eye contact and presentation. There was greater time spent looking at the 'patient' with an increase of 35 second intervals of direct eye contact and less time spent looking down at paperwork which decreased by 20 seconds. Overall 73% of the clinicians were satisfied with the training program and 61% strongly agreed that they recognised areas of their communication that needed improving during a telehealth consultation. For the patient group there was significant difference post training in rapport with a mean score from 42 (SD = 28, n = 27) to 48 (SD = 5.9, n = 24). For communication comfort of the patient group there was a significant difference between the pre and post training scores t(10) = 27.9, p = .002, which meant that overall the patients felt less inhibited whilst talking to the clinicians and more understood. Conclusion: The aim of this study was to explore the characteristics of good patient-clinician communication and unmet training needs for telehealth consultations. The study developed a training program that was specific for telehealth consultations and not dependent on a 'trainer' to deliver the content. In light of the existing literature this is a first of its kind and a valuable contribution to the research on this topic. It was found that the training program was effective in improving the clinician's communication style and increased the satisfaction of patient's within an e-health environment. This study has identified some historical myths that telehealth cannot be part of empathic patient centred care due to its technology tag.

A standing vehicle occupant is likely to sustain a more severe injury than one who has flexed knees in an under‐vehicle explosion : a cadaveric study

The lower limb of military vehicle occupants has been the most injured body part due to undervehicle explosions in recent conflicts. Understanding the injury mechanism and causality of injury severity could aid in developing better protection. Therefore, we tested 4 different occupant postures (seated, brace, standing, standing with knee locked in hyper‐extension) in a simulated under‐vehicle explosion (solid blast) using our traumatic injury simulator in the laboratory; we hypothesised that occupant posture would affect injury severity. No skeletal injury was observed in the specimens in seated and braced postures. Severe, impairing injuries were observed in the foot of standing and hyper‐extended specimens. These results demonstrate that a vehicle occupant whose posture at the time of the attack incorporates knee flexion is more likely to be protected against severe skeletal injury to the lower leg.

Description of body posture during Static load bearing exercises for individuals with transfemoral amputation fitted with bone-anchored prosthesis

The rehabilitation programs of bone-anchorage prostheses relying either on the OPRA (Integrum, Sweden) or the ILP (Orthodynamics, Germany) fixation involve some forms of static load bearing exercises (LBE). So far, most of biomechanical studies of these static LBEs focused on the direct measurements of the actual forces and moments applied on the OPRA fixation of individuals with transfemoral amputation (TFA). To date, the proof-of-concept of an apparatus to conduct these kinetic measurements has been presented, along with some preliminary data. The understanding of the kinetic data is essential to improve rehabilitation programs as well as the design of upcoming loading frames. However, kinetic information alone is difficult to interpret without concomitant kinematic data. The purpose of this preliminary study was to introduce a qualitative analysis describing the different body postures during LBE for a group of TFAs.

Influence of posture and frequency modes in total body water estimation using bioelectrical impedance spectroscopy in boys and adult males

The aim of the study was to examine differences in total body water (TBW) measured using single-frequency (SF) and multi-frequency (MF) modes of bioelectrical impedance spectroscopy (BIS) in children and adults measured in different postures using the deuterium (2H) dilution technique as the reference. Twenty-three boys and 26 adult males underwent assessment of TBW using the dilution technique and BIS measured in supine and standing positions using two frequencies of the SF mode (50 kHz and 100 kHz) and the MF mode. While TBW estimated from the MF mode was comparable, extra-cellular fluid (ECF) and intra-cellular fluid (ICF) values differed significantly (p < 0.01) between the different postures in both groups. In addition, while estimated TBW in adult males using the MF mode was significantly (p < 0.01) greater than the result from the dilution technique, TBW estimated using the SF mode and prediction equation was significantly (p < 0.01) lower in boys. Measurement posture may not affect estimation of TBW in boys and adult males, however, body fluid shifts may still occur. In addition, technical factors, including selection of prediction equation, may be important when TBW is estimated from measured impedance.

Focus on Form : J. J. Tikkanen, Giotto and Art Research in the 19th Century

My doctoral dissertation is on Johan Jakob Tikkanen (1857 1930), the first professor of art history in Finland, and his significance and methods in the context of late 19th and early 20th-century European art history. Tikkanen was one of the pioneering scholars in the field of medieval art research, and, along with Anton Springer, Heinrich Wölfflin, Aloïs Riegl, Adolfo Venturi, Franz Wickhoff, Julius von Schlosser, Aby Warburg, Emile Mâle and others, one of the scholars who defined art history as an independent academic discipline. Tikkanen s scholarly interests and his methods resemble those of many formalistically oriented German and Austrian art historians of his time. He became well known throughout Europe, mainly for his studies on illustrated medieval manuscripts. Tikkanen s dissertation, Der Malerische Styl Giotto s Versuch zu einer Characteristik Desselben, from 1884 was regarded in its day as the best form-analytical study on the painter. It has a central position in the present thesis, as it already included nearly all the methods that Tikkanen used and elaborated upon throughout his career. Giotto also gives a good perspective for comparing Tikkanen s ideas with a long art-historical tradition. Tikkanen was profoundly interested in artistic creativity. In his own words, he wanted to study das künstlerische Können , artistic ability, instead of das künstlerische Wollen or artistic will, which was an important theoretical issue in art history in the late 19th century. This starting point led him to the history of style and iconographical research. Along with the Danish art historian, Julius Lange, he was one of the first scholars who began to study the meaning of gestures and postures in art. In my dissertation I have emphasized the importance of Tikkanen s personal art education. I regard it as having influenced both his scholarly argumentation and his working methods. I have also written a short overview of the situation of art history in Finland and in Northern Countries before Tikkanen s time in order to give an idea of his scientific background. My thesis is a critical and historiographical study on J. J. Tikkanen s role in the development of art history and its methodology.

Vilijonkka ikkunassa - Tove Janssonin muumiteosten kuva, sana ja liike

Tove Jansson (1914--2001) was a Finnish illustrator, author, artist, caricaturist and comic artist. She is best known for her Moomin Books, written in Swedish, which she illustrated herself, and published between 1945 and 1977. My study focuses on the interweaving of images and words in Jansson s picturebooks, novels and short stories situated in the fantasy world of Moomin Valley. In particular, it concentrates on Jansson s development of a special kind of aesthetics of movement and stasis, based upon both illustration and text. The conventions of picturebook art and illustration are significant to both Jansson s visual art and her writing, and she was acutely conscious of them. My analysis of Jansson s work begins by discussing her first published picturebooks and less familiar illustrations (before she began her Moomin books) and I then proceed to discuss her three Moomin picturebooks, The Book about Moomin, Mymble and Little My; Who Will Comfort Toffle?, and The Dangerous Journey. The discussion moves from images to words and from words to images: Barthes s (1982) concept of anchoring and, in particular, what he calls relaying , form a point of reading and viewing Moomin texts and illustrations in a complementary relation, in which the message s unity occurs on a higher level: that of the story, the anecdote, the diegesis . The eight illustrated Moomin novels and one collection of short stories are analysed in a similar manner, taking into account the academic discourse about picturebooks which was developed in the last decade of the 20th century and beginning of the 21st century by, among others, scholars such as Nodelman, Rhedin, Doonan, Thiele, Stephens, Lewis, Nikolajeva and Scott. In her Moomin books, Jansson uses a wide variety of narrative and illustrative styles which are complementary to each other. Each book is different and unique in its own way, but a certain development or progression of mood and representation can be seen when assessing the series as a whole. Jansson s early stories are happy and adventurous but her later Moomin novels, beginning from Moominland Midwinter, focus more on the interiority of the characters, placing them in difficult situations which approximate social reality. This orientation is also reflected in the representation of movement and space. The books which were published first include more obviously descriptive passages, exemplifying the tradition of literary pictorialism. Whereas in Jansson s later work, the space develops into something that is alive which can have an enduring effect on the characters personalities and behaviour. This study shows how the idea of an image a dynamic image -- forms a holistic foundation for Jansson s imagination and work. The idea of central perspective, or frame, for instance, provided inspiration for whole stories or in the way that she developed her characters, as in the case of the Fillyjonk, who is a complex female figure, simultaneously frantic and prim. The idea of movement is central to the narrative art of picturebooks and illustrated texts, particularly in relation to the way that action is depicted. Jansson, however, also develops a specific choreography of characters in which poses and postures signify action, feelings and relationships. Here, I use two ideas from modern dance, contraction and release (Graham), to characterise the language of movement which is evident in Jansson s words and images. In Jansson s final Moomin novels and short stories, the idea of space becomes more and more dynamic and closely linked with characterisation. My study also examines a number of Jansson s early sketches for her Moomin novels, in which movement is performed much more dramatically than in those illustrations which appeared in the last novels to be published.

Haptiisit ja hapteemit : tapaustutkimus kuurosokean henkilön kosketukseen perustuvan kommunikaation kehityksestä

Haptices and haptemes: A case study of developmental process in touch-based communication of acquired deafblind people This research is the first systematic, longitudinal process and development description of communication using touch and body with an acquired deafblind person. The research consists of observational and analysed written and video materials mainly from two informants´ experiences during period of 14 years. The research describes the adaptation of Social-Haptic methods between a couple, and other informants´ experiences, which have been collated from biographies and through giving national and international courses. When the hearing and sight deteriorates due to having an acquired deafblind condition, communication consists of multi-systematic and adaptive methods. A person`s expressive language, spoken or Sign Language, usually remains unchanged, but the methods of receiving information could change many times during a person s lifetime. Haptices are made from haptemes that determines which regulations are analysed. When defining haptemes the definition, classification and varied meanings of touch were discovered. Haptices include sharing a personal body space, meaning of touch-contact, context and using different communication channels. Communication distances are classified as exact distance, estimated distance and touch distance. Physical distance can be termed as very long, long, medium or very close. Social body space includes the body areas involved in sending and receiving haptices and applying different types of contacts. One or two hands can produce messages by using different hand shapes and orientations. This research classifies how the body can be identified into different areas such as body orientation, varied body postures, body position levels, social actions and which side of the body is used. Spatial body space includes environmental and situational elements. Haptemes of movements are recognised as the direction of movements, change of directions on the body, directions between people, pressure, speed, frequency, size, length, duration, pause, change of rhythm, shape, macro and micro movements. Haptices share multidimensional meanings and emotions. Research describes haptices in different situations enhancing sensory information and functioning also as an independent language. Haptices includes social-haptic confirmation system, social quick messages, body drawing, contact to the people and the environment, guiding and sharing art experiences through movements. Five stages of emotional differentiation were identified as very light, light, medium, heavy and very heavy touch. Haptices give the possibility to share different art, hobby and game experiences. A new communication system development based on the analysis of the research data is classified into different phases. These are experimental initiation, social deconstruction, developing the description of Social-Haptic communication and generalisation of the theory as well as finding and conceptualising the haptices and haptemes. The use and description of haptices is a social innovation, which illustrates the adaptive function of the body and perceptual senses that can be taught to a third party. Keywords: deafblindness, hapteme, haptic, haptices, movement, social-haptic communication, social-haptic confirmation system, tactile, touch

The relationship between forward head posture and cervical muscle performance in healthy individuals

Background Forward head postures (FHP) are proposed to adversely load cervical spine structures. Neck muscles provide support for the neck, and thus an imbalance in neck muscle performance could potentially contribute to the development of FHP. Previous studies have not considered the interaction of multiple muscle groups with regard to postural orientation. Given the interdependence of muscles along the cervical spine for optimal orientation and physical support of the vertebral column, the performance of a single muscle group may not accurately reflect the coordinated ability of the muscles to maintain a neutral neck posture. Purpose The purpose of this study was to investigate the relationship between FHP and the balance between the cervical extensor and flexor muscle groups in healthy individuals. We hypothesised that the magnitude of FHP would be associated with the strength and endurance performance ratios between the cervical extensor and flexor muscle groups. Methods Twenty male and 24 female volunteers were photographed in the sagittal plane wearing surface markers. The FHP of each participant was measured via the tragus-sternum marker distance over two conditions: (1)in relaxed standing and (2)during a sustained sitting task. Maximal strength (Nm) and endurance (s) performance of the extensor and flexor muscle groups were recorded at the upper (craniocervical flexion/extension (CCF/CCE)) and lower (cervicothoracic flexion/extension (CTF/CTE)) cervical regions. Muscle performance measures were expressed as extension:flexion ratios and their relation to FHP evaluated. A stepwise multiple regression analysis using backward elimination was utilised to examine the relationship between the postural measures and the muscle performance ratio measures. Separate models were used for the two different postural conditions (standing, sustained sitting). Gender was included as a constant correction factor in all regression models. Where gender was a significant variable in the model, analyses were repeated separately for males and females. Results Greater FHP in standing was significantly associated with reduced proportional CTE to CCF strength in females (R2 = 0.21, P = 0.03) and greater proportional CTE to CTF strength in males (R2 = 0.23, P = 0.03). A greater drift into FHP during sustained sitting was associated with a relative reduction in CCE endurance proportional to CTF endurance in females only (R2 = 0.27, P = 0.017). Conclusion(s) This initial study indicates that the balance in performance between the cervical flexor and extensor muscle groups may impact FHP in healthy individuals. However, the findings were inconsistent across different muscle performance ratios and gender. Larger scale studies are therefore now needed to further clarify the relationship between FHP and muscle performance. Implications The findings suggest that relative performance of the various cervical muscle groups needs to be accounted for when considering postural correction strategies in the clinical setting, as is often recommended.

An analysis of sun salutation

Sun salutation is a part of yoga. It consists of a sequence of postures done with synchronized breathing. The practice of few cycles of sun salutation is known to help in maintaining good health and vigor. The practice of sun salutation does not need any extra gadgets. Also it is very much aerobic and invigorates the body and the mind.

Water in Action : Encounters among 2- to 3-Year-Old Children, Adults, and Water in Day Care

In line with cultural psychology and developmental theory, a single case approach is applied to construct knowledge on how children s interaction emerge interlinked to historical, social, cultural, and material context. The study focuses on the negotiation of constraints and meaning construction among 2-to 3-year-old children, a preschool teacher, and the researcher in settings with water. Water as an element offers a special case of cultural canalization: adults selectively monitor and guide children s access to it. The work follows the socio-cultural tradition in psychology, particularly the co-constructivist theory of human development and the Network of Meanings perspective developed at the University of São Paulo. Valsiner s concepts of Zone of Free Movement and Zone of Promoted Action are applied together with studies where interactions are seen as spaces of construction where negotiation of constraints for actions, emotions, and conceptions occur. The corpus was derived at a Finnish municipal day care centre. During a seven months period, children s actions were video recorded in small groups twice a month. The teacher and the researcher were present. Four sessions with two children were chosen for qualitative microanalysis; the analysis also addressed the transformations during the months covered by the study. Moreover, the data derivation was analyzed reflectively. The narrowed down arenas for actions were continuously negotiated among the participants both nonverbally and verbally. The adults expectations and intentions were materialized in the arrangements of the setting canalizing the possibilities for actions. Children s co-regulated actions emerged in relation to the adults presence, re-structuring attempts, and the constraints of the setting. Children co-constructed novel movements and meanings in relation to the initiatives and objects offered. Gestures, postures, and verbalizations emerged from the initially random movements and became constructed to have specific meanings and functions; meaning construction became abbreviated. The participants attempted to make sense of the ambiguous (explicit and implicit) intentions and fuzzy boundaries of promoted and possible actions: individualized yet overlapping features were continuously negotiated by all the participants. Throughout the months, children s actions increasingly corresponded adults (re-defined) conceptions of water researchers as an emerging group culture. Water became an instrument and a context for co-regulations. The study contributes to discussions on children as participants in cultural canalization and emphasizes the need for analysis in early childhood education practices on the implicit and explicit constraint structures for actions.

Nonlinear measures of heart rate time series: influence of posture and controlled breathing

In this study, we investigated measures of nonlinear dynamics and chaos theory in regards to heart rate variability in 27 normal control subjects in supine and standing postures, and 14 subjects in spontaneous and controlled breathing conditions. We examined minimum embedding dimension (MED), largest Lyapunov exponent (LLE) and measures of nonlinearity (NL) of heart rate time series. MED quantifies the system's complexity, LLE predictability and NL, a measure of deviation from linear processes. There was a significant decrease in complexity (P<0.00001), a decrease in predictability (P<0.00001) and an increase in nonlinearity (P=0.00001) during the change from supine to standing posture. Decrease in MED, and increases in NL score and LLE in standing posture appear to be partly due to an increase in sympathetic activity of the autonomous nervous system in standing posture. An improvement in predictability during controlled breathing appears to be due to the introduction of a periodic component. (C) 2000 published by Elsevier Science B.V.

Diminished chaos of heart rate time series in patients with major depression

Background: Depression and anxiety have been linked to serious cardiovascular events in patients with preexisting cardiac illness. A decrease in cardiac vagal function as suggested by a decrease in heart rate (HR) variability has been linked to sudden death. Methods: We compared LLE and nonlinearity scores of the unfiltered (UF) and filtered time series (very low, low, and high frequency; VLF, LF and HF) of HR between patients with depression (n = 14) and healthy control subjects (n = 18). Results: We found significantly lower LLE of the unfiltered series in either posture, and HF series in patients with major depression in supine posture (p < .002). LLE (LF/UF), which may indicate relative sympathetic activity was also significantly higher in supine and standing postures in patients (p < .05); LF/HF (LLE) was also higher in patients (p < .05) in either posture. Conclusions: These findings suggest that major depression is associated with decreased cardiac vagal function and a relative increase in sympathetic function, which may be related to the higher risk of cardiovascular mortality, in this group and illustrates the usefulness of nonlinear measures of chaos such as LLE in addition to the commonly used spectral measures.

Nonlinear measures of respiration: Respiratory irregularity and increased chaos of respiration in patients with panic disorder

Background. Respiratory irregularity has been previously reported in patients with panic disorder using time domain measures. However, the respiratory signal is not entirely linear and a few previous studies used approximate entropy (APEN), a measure of regularity of time series. We have been studying APEN and other nonlinear measures including a measure of chaos, the largest Lyapunov exponent (LLE) of heart rate time series, in some detail. In this study, we used these measures of respiration to compare normal controls (n = 18) and patients with panic disorder (n = 22) in addition to the traditional time domain measures of respiratory rate and tidal volume. Methods: Respiratory signal was obtained by the Respitrace system using a thoracic and an abdominal belt, which was digitized at 500 Hz. Later, the time series were constructed at 4 Hz, as the highest frequency in this signal is limited to 0.5 Hz. We used 256 s of data (1,024 points) during supine and standing postures under normal breathing and controlled breathing at 12 breaths/min. Results: APEN was significantly higher in patients in standing posture during normal as well as controlled breathing (p = 0.002 and 0.02, respectively). LLE was also significantly higher in standing posture during normal breathing (p = 0.009). Similarly, the time domain measures of standard deviations and the coefficient of variation (COV) of tidal volume (TV) were significantly higher in the patient group (p = 0.02 and 0.004, respectively). The frequency of sighs was also higher in the patient group in standing posture (p = 0.02). In standing posture, LLE (p < 0.05) as well as APEN (p < 0.01) contributed significantly toward the separation of the two groups over and beyond the linear measure, i.e. the COV of TV. Conclusion: These findings support the previously described respiratory irregularity in patients with panic disorder and also illustrate the utility of nonlinear measures such as APEN and LLE as additional measures toward a better understanding of the abnormalities of respiratory physiology in similar patient populations as the correlation between LLE, APEN and some of the time domain measures only explained up to 50-60% of the variation. Copyright (C) 2002 S. Karger AG, Basel.

Nonlinear measures of QT interval series: novel indices of cardiac repolarization lability: MEDqthr and LLEqthr

In this study, we investigated nonlinear measures of chaos of QT interval time series in 28 normal control subjects, 36 patients with panic disorder and 18 patients with major depression in supine and standing postures. We obtained the minimum embedding dimension (MED) and the largest Lyapunov exponent (LLE) of instantaneous heart rate (HR) and QT interval series. MED quantifies the system's complexity and LLE predictability. There was a significantly lower MED and a significantly increased LLE of QT interval time series in patients. Most importantly, nonlinear indices of QT/HR time series, MEDqthr (MED of QT/HR) and LLEqthr (LLE of QT/HR), were highly significantly different between controls and both patient groups in either posture. Results remained the same even after adjusting for age. The increased LLE of QT interval time, series in patients with anxiety and depression is in line with our previous findings of higher QTvi (QT variability index, a log ratio of QT variability corrected for mean QT squared divided by heart rate variability corrected for mean heart rate squared) in these patients, using linear techniques. Increased LLEqthr (LLE of QT/HR) may be a more sensitive tool to study cardiac repolarization and a valuable addition to the time domain measures such as QTvi. This is especially important in light of the finding that LLEqthr correlated poorly and nonsignificantly with QTvi. These findings suggest an increase in relative cardiac sympathetic activity and a decrease in certain aspects of cardiac vagal function in patients with anxiety as well as depression. The lack of correlation between QTvi and LLEqthr suggests that this nonlinear index is a valuable addition to the linear measures. These findings may also help to explain the higher incidence of cardiovascular mortality in patients with anxiety and depressive disorders. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

A Comparative Assessment of Hand Preference in Captive Red Howler Monkeys, Alouatta seniculus and Yellow-Breasted Capuchin Monkeys, Sapajus xanthosternos

There are two major theories that attempt to explain hand preference in non-human primates-the `task complexity' theory and the `postural origins' theory. In the present study, we proposed a third hypothesis to explain the evolutionary origin of hand preference in non-human primates, stating that it could have evolved owing to structural and functional adaptations to feeding, which we refer to as the `niche structure' hypothesis. We attempted to explore this hypothesis by comparing hand preference across species that differ in the feeding ecology and niche structure: red howler monkeys, Alouatta seniculus and yellow-breasted capuchin monkeys, Sapajus xanthosternos. The red howler monkeys used the mouth to obtain food more frequently than the yellow-breasted capuchin monkeys. The red howler monkeys almost never reached for food presented on the opposite side of a wire mesh or inside a portable container, whereas the yellow-breasted capuchin monkeys reached for food presented in all four spatial arrangements (scattered, on the opposite side of a wire mesh, inside a suspended container, and inside a portable container). In contrast to the red howler monkeys that almost never acquired bipedal and clinging posture, the yellow-breasted capuchin monkeys acquired all five body postures (sitting, bipedal, tripedal, clinging, and hanging). Although there was no difference between the proportion of the red howler monkeys and the yellow-breasted capuchin monkeys that preferentially used one hand, the yellow-breasted capuchin monkeys exhibited an overall weaker hand preference than the red howler monkeys. Differences in hand preference diminished with the increasing complexity of the reaching-for-food tasks, i.e., the relatively more complex tasks were perceived as equally complex by both the red howler monkeys and the yellow-breasted capuchin monkeys. These findings suggest that species-specific differences in feeding ecology and niche structure can influence the perception of the complexity of the task and, consequently, hand preference.