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Abstract Functional electrical stimulation (FES) can support functional restoration of a paretic limb post-stroke. Hebbian plasticity depends on temporally coinciding pre- and post-synaptic activity. A tight temporal relationship between motor cortical (MC) activity associated with attempted movement and FES-generated visuo-proprioceptive feedback is hypothesized to enhance motor recovery. Using a brain–computer interface (BCI) to classify MC spectral power in electroencephalographic (EEG) signals to trigger FES-delivery with detection of movement attempts improved motor outcomes in chronic stroke patients. We hypothesized that heightened neural plasticity earlier post-stroke would further enhance corticomuscular functional connectivity and motor recovery. We compared subcortical non-dominant hemisphere stroke patients in BCI-FES and Random-FES (FES temporally independent of MC movement attempt detection) groups. The primary outcome measure was the Fugl-Meyer Assessment, Upper Extremity (FMA-UE). We recorded high-density EEG and transcranial magnetic stimulation-induced motor evoked potentials before and after treatment. The BCI group showed greater: FMA-UE improvement; motor evoked potential amplitude; beta oscillatory power and long-range temporal correlation reduction over contralateral MC; and corticomuscular coherence with contralateral MC. These changes are consistent with enhanced post-stroke motor improvement when movement is synchronized with MC activity reflecting attempted movement.

Introduction: Non-adherence to recommended secondary preventive anticoagulation in stroke patients with atrial fibrillation (AF) is a common phenomenon, although the introduction of direct oral anticoagulants (DOACs) has simplified anticoagulation management for physicians as well as for patients. Methods: We examined the adherence of secondary preventive anticoagulation in AF patients after re-integration in their social environment 6–12 weeks after stroke unit and rehabilitation clinic treatment and analyzed for predictors for adherence and non-adherence. We conducted a telephone survey in consecutive patients treated between January 2013 and December 2021 at our institutional stroke unit with an acute cerebrovascular ischemic event, and we analyzed discharge letters of rehabilitation clinics of those patients not anticoagulated at follow-up. All patients had known or newly diagnosed AF, and in all, we had recommended secondary preventive anticoagulation. Results: Follow-up information about anticoagulant intake could be obtained in 1,348 of 1,685 patients (80.0%) treated within the study period. Anticoagulation rate was 91.5%, with 83.6% of patients receiving DOACs and 7.9% receiving vitamin K antagonists (VKAs). Adherence to recommended anticoagulation was associated with intake of the recommended anticoagulant already at discharge (adjusted odds ratio [OR], 18.357; confidence interval [CI], 9.637–34.969), recommendation of a specific DOAC and dose (in contrast to “DOAC” as drug category) (adjusted OR, 2.971; CI, 1.173–7.255), a lower modified Rankin Scale at discharge (per point; adjusted OR, 0.813; CI, 0.663–0.996), younger age (per year; OR, 0.951; CI, 0.926–0.976), and the absence of peripheral vascular disease (adjusted OR, 0.359; CI, 0.173–0.746). In patients already anticoagulated at discharge, adherence was 98.5%, irrespective of a patient’s age, functional deficit at discharge, and peripheral vascular disease. Avoidable obstacles for non-adherence in patients not on anticoagulants at stroke unit discharge were (1) non-implementation of recommended anticoagulation by rehabilitation physicians predominantly in patients with moderate-severe or severe stroke disability (2.1%), (2) delegation of anticoagulation start from rehabilitation physicians to general practitioners/resident radiologists (1.3%), and (3) rejection of recommended anticoagulation because of patients’ severe stroke disability (0.5%). Non-avoidable obstacles were contraindications to anticoagulation (2.1%) and patients’ refusal (0.7%). Conclusions: Commencing drug administration already during stroke unit hospitalization and providing an explanation for the selection of the recommended anticoagulant in discharge letters ensures high adherence at patients’ re-integration in their social environment after acute stroke treatment. If drug administration cannot be commenced before discharge, education of rehabilitation physicians by stroke physicians and the involvement of stroke physicians into the post-stroke decision process might hinder avoidable obstacles.

Medienbezogene Kompetenzen von Lehrkräften sind unabdingbar, um Schüler:innen auf Teilhabe, Partizipation und eine verantwortliche Mitgestaltung in einer Kultur der Digitalität vorzubereiten. Konkret benötigen Lehrkräfte hierzu medienbezogene Basis- und Lehrkompetenzen. Für die zielgerichtete und erfolgreiche Förderung dieser Kompetenzen im Rahmen der Lehrkräftebildung sind Instrumente zur Messung dieser Medienkompetenzen hilfreich. Bestehende Instrumente greifen allerdings zumeist auf einfache, nicht selten sehr allgemein formulierte Selbsteinschätzungen zurück. Dies erschwert eine valide Messung von Kompetenzen. In diesem Beitrag wird ein alternativer Messansatz vorgestellt, der Selbsteinschätzungen von Medienkompetenzen mittels Szenarien kontextualisiert und damit präzisiert. Die Szenarien-Basierung führt zu einem validen Messergebnis, hat aber für den Einsatz im Feld den Nachteil, dass die Messung deutlich umfangreicher ausfällt. Dem begegnen wir im vorliegenden Beitrag durch die Entwicklung einer Kurzskala in einem mehrstufigen Verfahren. Auf Basis eines Datensatzes von N = 552 (angehenden) Lehrkräften wird eine szenarienbasierte Kurzskala zur Messung instrumenteller und kritisch-reflexiver Medienkompetenzen sowie medienbezogener Lehrkompetenzen entwickelt. Diese Kurzskala wird in einer weiteren Studie mit N = 204 Lehrkräften nochmals validiert. Die Ergebnisse beider Studien unterstützen die Validität der Kurzskala. Für die Lehrkräftebildung und Forschung wird somit ein akzeptanzförderndes und ressourcenschonendes Instrument bereitgestellt, das eine reliable und valide Messung instrumenteller und kritisch-reflexiver Medienkompetenzen sowie medienbezogener Lehrkompetenzen erlaubt.

Teachers routinely observe and interpret student behavior to make judgements about whether and how to support their students' learning. Simulated cases can help pre-service teachers to gain this skill of diagnostic reasoning. With 118 pre-service teachers, we tested whether participants rate simulated cases presented in a serial-cue case format as more authentic and become more involved with the materials compared to cases presented in a whole case format. We further investigated whether participants with varying prior conceptual knowledge (what are symptoms of ADHD and dyslexia) gain more strategic knowledge (how to detect ADHD and dyslexia) with a serial-cue versus whole case format. We found that the case format did not impact authenticity ratings but that learners reported higher involvement in the serial-cue case format condition. Bayes factors provide moderate evidence for the absence of a case format effect on strategic knowledge and strong evidence for the absence of an interaction of case format and prior knowledge. We recommend using serial-cue case formats in simulations as they are a more authentic representation of the diagnostic reasoning process and cognitively involve learners. We call for replications to gather more evidence for the impact of case format on knowledge acquisition. We suggest a further inquiry into the relationship of case format, involvement, and authenticity but think that a productive way forward for designing authentic simulations is attention to aspects that make serial-cue cases effective for diverse learners. For example, adaptive feedback or targeted practice of specific parts of diagnostic reasoning such as weighing evidence.

This perspective piece explores the transformative potential and associated challenges of large language models (LLMs) in education and how those challenges might be addressed utilizing playful and game-based learning. While providing many opportunities, the stochastic elements incorporated in how present LLMs process text, requires domain expertise for a critical evaluation and responsible use of the generated output. Yet, due to their low opportunity cost, LLMs in education may pose some risk of over-reliance, potentially and unintendedly limiting the development of such expertise. Education is thus faced with the challenge of preserving reliable expertise development while not losing out on emergent opportunities. To address this challenge, we first propose a playful approach focusing on skill practice and human judgment. Drawing from game-based learning research, we then go beyond this playful account by reflecting on the potential of well-designed games to foster a willingness to practice, and thus nurturing domain-specific expertise. We finally give some perspective on how a new pedagogy of learning with AI might utilize LLMs for learning by generating games and gamifying learning materials, leveraging the full potential of human-AI interaction in education.