ItemCognitive Assessment Using the KINARM Exoskeleton Robot in Patients with Transient Ischemic Attack(2015-07-09) Parker, NadineBackground: Transient ischemic attack (TIA) is a condition causing focal neurological deficits lasting less than 24hrs. TIA patients present similarly to other conditions with rapid onset of neurological symptoms such as migraine. The accurate diagnosis of TIA is critical because it serves as a warning for subsequent stroke. Furthermore, cognitive deficit associated with TIA may predict the development of dementia. Therefore, characterizing the cognitive symptoms of TIA patients and discriminating these patients from those with similar symptoms is important for proper diagnosis and treatment. Currently the diagnosis of TIA is made on clinical and radiographic evidence. Robotic assessment, with instruments such as the KINARM, may improve the identification of cognitive impairment in TIA patients. Methods: In this prospective cohort study, two KINARM tests, trail making task (TMT) and spatial span task (SST), were used to detect cognitive deficits. Two study groups were made. The TIA group was tested at 5 time points over the span of a year. The migraine active control group had one initial visit and another a year later. Both of these groups were compared to a normative database of approximately 400 healthy volunteers. From this database age and sex matched normative data was used to calculate Z-scores for the TMT. The Montreal Cognitive Assessment (MoCA) was also administered to both groups. Results: 31 participants were recruited, 20 TIA group and 11 active controls (mean ± SD age= 66 ± 11.3 and 62 ± 14.5). There was no significant difference in TIA and active control group MoCA scores. The TMT was able to detect cognitive impairment in TIA and migraine group. Also, both KINARM tasks could detect significant differences in performance between TIA and migraine patients while the MoCA could not. Changes in TIA and migraine performance on the MoCA, TMT, and SST were observed. Conclusions: The robotic KINARM exoskeleton can be used to assess cognitive deficits in TIA patients. ItemBlood and Cerebrospinal Fluid Circulations in the Brain and Spinal Cord: An Internet-Based Learning Module(2013-02-18) Elkheir, ShirazThe amount of knowledge and skills that an average university student should learn in any given course is increasing each year. On the other hand, the time dedicated for formal teaching is decreasing for various reasons. New and emerging topics need more time to cover. Newer approaches to learning place more emphasis on self-directed and interactive learning as opposed to didactic methods. Online learning is becoming a very popular method of delivering course materials, with institutions and students alike, that could very well restore the balance between time and content to be learnt. For institutions, it can free up time slots of busy lecture halls and seminar rooms, and valuable faculty time that could be utilized in research. For the learners, it means convenience in terms of when and where to study and at what pace. The topic of "Blood and Cerebrospinal fluid Circulations in the Brain and Spinal Cord" is a good example of anatomical content that can be presented as an online learning module. The idea stemmed from the movement of the medical school at Queen's University to revamp its curriculum with an expected reduction of the hours dedicated to Anatomy. Another initiative came from the clinical residents at the Kingston General Hospital, who expressed the interest of having learning materials made available online for quick reference and refreshment of knowledge. To address those needs and requests of the clinical residents, and to serve students in the Life Sciences, Medicine, and MSc Anatomy programs, an online learning module on the blood and cerebrospinal fluid circulations in the brain and spinal cord was created. Unique to the design of this online module is a virtual dialogue that covers the content of the topic and its appeal to a wide readership. For some it represents most of what they need to know, while for the others it would be an introduction or a quick refresher. It is designed in a way to mimic the interaction between the student and a professor with questions that stimulate and engage the learner. Finally, the basic knowledge presented was fortified with clinical scenarios that describe their application and utility in a clinical setting. ItemThe Development of an Introductory E-Learning Module on Echocardiography(2012-04-30) Abdullah, HaninEchocardiography, or cardiac ultrasound, is an imaging technique that has been increasingly used by multiple clinicians due to its ease of use and the valuable information that can be obtained from it. As a result, echocardiography training has been incorporated into multiple postgraduate medical programs. In addition, there have been increasing attempts to incorporate this imaging modality into the undergraduate medical curriculum. Due to the importance of this technique and its increased use, there have been multiple online resources on echocardiography developed. However, there is not a single freely accessible resource that is directed at first-time “naïve” learners. The goal of this study was to create an easy-to-access online learning module on echocardiography that can be used by first-time learners. The online resource was designed to provide an overview of the skills to be acquired during introductory level training in echocardiography. The module was developed through the Medical Education Technology unit at Queen’s University to allow access by all medical faculty and students associated with this institution. The content and images of the module were evaluated by a group of twelve first year medical students who had no prior experience with echocardiography. This group found that the content coverage was sufficient for their limited knowledge in echocardiography and that the images used were sufficiently-labelled to enhance their learning. Also, the plastinated sectional heart images, which were included, were well-accepted and the students found them helpful for interpreting echocardiographic images. In addition, the module was assessed by a group of cardiologists who are involved in echocardiography training and research at Kingston General Hospital. There was consensus from this group about the usefulness and effectiveness of this introductory echocardiography learning module. ItemThe Flexible Cadaver Knee Model as a Training Model for the Development of Basic Arthroscopic Skills(2012-04-26) Scribbans, Trisha DawnGoal: Develop an effective high-fidelity model for the purpose of training orthopaedic surgeons. Objectives: This study had two objectives; I) the development of a flexible cadaver model for training orthopaedic surgery residents in basic arthroscopic skills and; II) the evaluation of the educational utility of the flexible cadaver model in comparison to the fresh-frozen cadaver model. Hypothesis: The flexible cadaver model is equivalent to the fresh-frozen cadaver model as a training resource for the development of arthroscopic skills. Materials and Methods: A human body was embalmed with a phenol-based embalming solution to create a flexible cadaver. A knee model was then developed and introduced to orthopaedic surgery residents and faculty at an arthroscopic skills training workshop. SurveyMonkey® was utilized to create and administer an online survey asking participants to rate a variety of statements regarding the educational utility of the flexible cadaver model and fresh-frozen cadaver models on Likert-type scales. Mean response values between the two models were calculated and compared. Results: The phenol-embalmed cadaver produced a high-fidelity knee model that workshop participants were unable to differentiate from the fresh-frozen cadaver model, except for some differences in colour. Survey responses supported our hypothesis that the flexible cadaver model is equivalent to the fresh-frozen cadaver model as a training resource for the development of basic arthroscopic skills. Conclusions: Two conclusions can be drawn from this study; I) the flexible cadaver model is at least equivalent in educational utility compared to the fresh-frozen cadaver model for the development of basic arthroscopic skills and; II) the flexible cadaver model is a promising resource for the development of arthroscopic skills. ItemAccuracy of Producing 3D Printed Models From CT Segmentation Renderings of Cadaveric Ankle and Foot Bones and the Kinematics of Loaded Joints in the Ankle and Foot(2012-02-08) Lee, Bonnie Sze PuiIntroduction: Total ankle arthroplasty is a relatively new and underdeveloped treatment for ankle arthritis that has disappointing results due to complications from malpositioning and improper sizing of the prosthesis during surgery as well as a lack of knowledge on the kinematics of the ankle and foot. The purpose of this study was two-fold: Part 1 analyzed the accuracy of producing three-dimensional (3D) printed models from computed tomography (CT) segmentation renderings and Part 2 examined the kinematics of the loaded joints in the ankle and foot. Part 1: Methods: CT images were taken from four cadaveric lower limbs and the ankle and foot bones were segmented into 3D virtual models and printed plastic models. A three-way analysis was performed between the CT segmentations, printed models and cadaveric bones. Results: Sub-millimetre accuracy was achieved for the analyses although the CT segmentations were consistently slightly larger than the printed models or cadaveric bones. Part 2: Methods: 3D fluoroscopic images were taken of four loaded cadaveric lower limbs in the plantarflexed, neutral and dorsiflexed positions. The images were segmented to produce 3D virtual models and the translation as well as rotation of the ankle, subtalar and talonavicular joints were analyzed. Results: The ankle joint had little translation (0.4mm-2.5mm) but rotation of the tibiofibular mortise was great in the anterior/posterior (7.2°-51.9°), internal/external (2.1°-24.8°) and medial/lateral (2.2°-31.9°) directions. The talonavicular joint displayed the most translation (0.2mm-7.4mm) and had moderate rotation. The subtalar and talonavicular joints translated and rotated the most during loading of a foot in neutral position indicating that loading induces a significant amount of movement between bones. Conclusions: This study found that 3D models of the ankle and foot bones could be successfully produced from their CT images with sub-millimetre accuracy and should be used for pre-operative planning and during surgeries. This study also reported more translation and rotation in the ankle and foot joints than allowed in current total ankle arthroplasties. As well, the simple action of loading a foot induces a lot of movement in the joints. This kinematic data is valuable to future revisions and designs of total ankle arthroplasty implants.