The diagnostic and prognostic utility of the dual-task tandem gait test for pediatric concussion

Background:The tandem gait test has gained interest recently for assessment of concussion recovery.The purpose of our study was to determine the prognostic and diagnostic use of the single-and dual-task tandem gait test,alongside other clinical measures,within 10 days of pediatric concussion.Methods:We assessed 126 patients post-concussion(6.3§2.3 days post-injury,mean§SD)at a pediatric sports medicine clinic and compared them to 58 healthy controls(age:15.6§1.3 years;43%female).We also compared the 31 patients with concussion who developed persistent post-concussion symptoms(PPCS)(age=14.9§2.0 years;48%female)to the 81 patients with concussion who did not develop PPCS following the initial assessment(age:14.1§3.0 years;41%female).All subjects completed a test battery,and concussion patients were monitored until they experienced concussion-symptom resolution.The test battery included tandem gait(single-task,dual-task(performing tandem gait while concurrently completing a cognitive test)conditions),modified Balance Error Scoring System(mBESS),and concussion symptom assessment(Health and Behavior Inventory).We defined PPCS as symptom resolution time>28 days post-concussion for the concussion group.Measurement outcomes included tandem gait time(single-and dual-task),dual-task cognitive accuracy,mBESS errors(single/double/tandem stances),and symptom severity.Results:The concussion group completed the single-task(mean difference=9.1 s,95%confidential interval(95%CI):6.1-12.1)and dual-task(mean difference=12.7 s,95%CI:8.7
16.8)tandem gait test more slowly than the control group.Compared to those who recovered within 28 days of concussion,the PPCS group had slower dual-task tandem gait test times(mean difference=7.9 s,95%CI:2.0-13.9),made more tandem-stance mBESS errors(mean difference=1.3 errors,95%CI:0.2-2.3),and reported more severe symptoms(mean difference=26.6 Health and Behavior Inventory rating,95%CI:21.1-32.6).Conclusion:Worse dual-task tandem gait test time and mBESS tandem stance performance predicted PPCS in pediatric patients evaluated within 10 days of concussion.Tandem gait assessments may provide valuable information augmenting common clinical practices for concussion management.     

An instrument for measuring short intervals of time

This paper describes a meter for measuring short intervals of time. Full scale deflections of 0.001, 0.1 and 1.0 second can be obtained by the use of a selector switch. This meter will indicate the length of time a contact remains closed, or the interval of time between the closing of one circuit and the opening of another. The device has a linear acale for any chosem range. It measures time by the charge which flows to a condenser during the interval. The charge is found by reading the potential difference 0n the condenser with a sensitive vacuum-tube voltmeter.The theory of the circuit and its advantage over other devices for the same purpose are discussed.     

Fāṭimid Alexandria as an Entrepôt in the East–West Exchange of Islamic Scholarship

Abstract

The arrival in Alexandria of al-?ur?ūshī from Spain and al-Silafī from Iran and the settling there of both early in the sixth/twelfth century created a nucleus of Sunni learning that grew into a full-blown renaissance. Many additional scholars participated, either as students and colleagues of these two, or on their own. As one result, the city itself became, over the first half of that century, a noted entrepôt for the east–west exchange of scholarship in the Muslim world, and all this despite the core Shi‘ism of the Fā?imid dynasty that controlled Egypt, including Alexandria. This renaissance in fact continued to flourish until the Fā?imids were finally supplanted in 567/1171 by the Ayyūbids, a full two decades into the second half of the same century, at which time Cairo became once again a major centre of Sunnism.     

CLASS–Infant: An Observational Measure for Assessing Teacher–Infant Interactions in Center-Based Child Care

Research Findings: The growing body of literature demonstrating the importance of quality interactions with caregivers to infant development coupled with the increasing number of infants spending time in classroom settings highlights the need for a measure of interpersonal relationships between infants and caregivers. This article introduces a new measure of quality in infant classrooms based on the Classroom Assessment Scoring System (CLASS) framework. This measure focuses on teacher–infant interactions with the goal of understanding how these proximal process features can be assessed in this environment. Results from a small pilot study of 30 infant classrooms indicated that the CLASS–Infant demonstrated adequate variability as well as expected convergent and divergent validity with the most commonly used infant child care quality measure. The dimensions of the measure composed a single construct of classroom quality based on teacher–infant interactions. Practice or Policy: Implications of using this measure as an assessment of center-based infant classroom quality and improving professional development are discussed.     

Assessing children's collaborative skills by paired observation

Summary

In some ways it now becomes too easy to compare — boys with girls, Jonathan with Michael (and other leaders), older with younger. My colleague's girls were more egalitarian than her boys; my least successful group, however, consisted entirely of 3rd year girls. Jonathan's leadership was of a notably selfish kind, but there were no other boy leaders of his age to compare with. There was certainly a feeling of development, younger to older, in terms of ability to plan, to sustain an investigation over time and draw conclusions when working together. Nevertheless one older group (3rd years) spent all its time trying to arrive at a workable social structure. The older often chose to co-operate in pairs with friends and showed considerable respect for each other's observations and ideas and care over their modification. At the same time, throughout both classes, children worked intensely in all their appointed groups on set tasks, even when no direct collaboration or conversation took place at all.

These facts in themselves make the evaluation of process and outcomes difficult. How, in effect, did we first recognise and second assess group success? Was joint completion of a task the only criterion or could social interaction be considered too? How important, indeed, was interaction to the final result?

If we say that achievement of a result of some kind through talk and mutual help was the main aim, then most of the older children actually brought that about. All but two groups came to a point of conclusion which they were able to discuss and summarise and those groups most closely monitored, either by tape-recording or adult eavesdropping, showed an ability to work very closely together and move forward through contributive conversation which seemed to exclude no-one. If I had the space to quote more copiously from tapes and notes the intensity of some of these sessions would become more apparent — the best of the 4th year girls' groups sometimes approaching an hour during which the quality of listening and concentration is clearly as important as the round of contribution. The boys' groups and some of the pairs were often more laconic, sometimes lapsing into silence for pondering or writing or moving around, but their overall persistence and their ability to plan and co-ordinate their efforts were notable.

My colleague claims less in terms of planning and outcome. Interactions did take place in her groups, sometimes with a tangible result, like a piece of floating plasticine, but children often worked alongside rather than together — in the group rather than with the group — with the marked exception of the girls' water experiments, where they were not only contributing in close canon, but narrating for the tape at the same time.

If one includes a social value in group work it is possible that even the group in my class which most obviously failed even to set up a single agreed investigation went through some kind of social learning. They tempt one to believe that smaller groups must have been better than larger and they certainly did help some of the shyer to participate more fully. On the other hand, large groups which had good cohesion actually seemed to be able to refine ideas better, more effectively eliminate less workable ones and arrive at more practicable and communicable solutions.

Children self-monitoring through taping seems to have been immensely successful; with the older as an aid to continuity and a means of reflection; with all ages in providing an awareness of audience, — the need to shape and present the whole process and its outcome. It seems not to have affected spontaneity of contribution, even where children imposed structures for taping (such as members reporting in turn), and the whole thing was handled in a very matter-of-fact way.

For the teachers the tapes were revelatory and entertaining — providing a means of study more complete and far reaching than any other devised. Adult intervention by the visiting teacher could be equally thorough, but rarely equally unobtrusive. However, children who knew each other well and seemed to be working perhaps too intuitively together were actually forced to define things more precisely for themselves in the process of reporting to an adult. The shortcomings of groups, older or younger, may ultimately return to this fact — an inability to see the need to share surmises, either with each other or with the community beyond the group. This leads me to believe that independent learning needs, nonetheless, to be carried out with eventual accountability in mind.

The benefits accruing to the two teachers are an echo of these thoughts. The very presence of another adult, planning, observing and discussing, raised the level of interest for both of us. We each had an audience and a means of sharing current problems, discussion on a number of occasions bringing about developments like my colleague's use of music to encourage greater mutual awareness and team-work in her younger children. Our perceptions of each other's children at work were often more objective and useful because they were less involved and, as my colleague pointed out, we tended to look at each other's groups much more as groups and much less as familiar individuals in groups. In practical terms it was also much easier for a visitor to a room to give entire attention to one group for a long period than it was for the class teacher who had overall responsibility for the activity of every group and individual in the room.

Some of the tasks performed by the visiting teacher — listening, talking, guiding — could equally have been (and often were) performed by the class teacher, but the greater value came in the later sharing of impressions — a sharing which led to modification, to a better assessment of success and failure, to useful comparison between age groups and to a wider broadcasting of these awarenesses to other teachers.

In our opinion, group tasks can be made more effective by careful setting up, the provision of awareness-raising frameworks, supporting collaborative exercises, questions to be considered (‘What do you think you have found out so far?’) and precise aims laid down for each session. But these do not preclude failure or actually deliver interactive skills. They are aids to learning — learning which may continue given the opportunity (a) to go on working together and (b) to reflect on the positives and negatives of each piece of work through writing and/or open class discussion.

All that one can say of the children applies equally to the teachers.

Finally, it is now clear that under the national curriculum we shall be dealing directly with matters such as how children cope with group tasks and whether or not they can talk and listen effectively in groups. Consequently teachers will be called on to increase their awareness of various aspects of collaboration, so that they can foster and then assess them. We hope this article goes some way towards raising the level of that awareness.     

Notes on Contributors

In this paper, one policy response to the problem of classed school choice experiences in England is examined. ‘Choice Advisers’ are employed by government to provide advice and information to working class and disadvantaged parents with the aim of ‘empowering’ them to exercise school choice and aspire to ‘better’ schools for their children. However, Advisers have been subjectified by contradictions inherent in policy, expected to solve the problems of school choice in a context of significant structural limits to choice for working-class parents. Interviews with choice Advisers show that difficulties of the job in addition to insecure working conditions within local authorities have led to depoliticised, contradictory advice and Advisers bearing the brunt of policy both in terms of overwork and the venting of parental frustrations. Agency, both for parents and for Advisers themselves, is described as being something possessed by individuals rather than collectives, so there is little sense overall that underlying inequalities within the education system might be challenged.     

The Use of Individual Growth and Developmental Indicators for Progress Monitoring and Intervention Decision Making in Early Education

Progress monitoring tools have been shown to be essential elements in current approaches to intervention problem-solving models. Such tools have been valuable not only in marking individual children's level of performance relative to peers but also in measuring change in skill level in a way that can be attributed to intervention and development. As such, progress monitoring measures have been central to Response to Intervention (RtI) approaches. In early childhood, progress monitoring measures have only recently been applied to the process of intervention decision-making. The purpose of this article is to describe Individual Growth and Developmental Indicators, contrast them with existing approaches to assessment in early childhood, and illustrate how they can be used within a larger problem-solving model to guide intervention decisions for infants and toddlers.