[The clumsy child]. / Das motorisch ungeschickte Kind.

This article describes the motor development of normal healthy children from school-age through adolescence and summarizes the recently published interdisciplinary clinical practice guidelines for the definition, origin, diagnosis, assessment and intervention of developmental coordination disorder (DCD).

Improvement in gross motor performance between 3 and 5 years of age.

This study examined gross motor performance of 101 typically developing children between 3 and 5 years of age (48 boys, 53 girls, M age = 3.9 yr., SD = 0.5). All children performed 7 different gross motor tasks which were rated on a 5-point scale. Age and sex were assessed by an ordinal-logistic model, and odds ratios were calculated for each task using age and sex as covariates. For standing on one leg, walking on a beam, hopping on one leg, running, and taking stairs, statistically significant age differences were found, while for rising and jumping down, none were apparent. Mean motor performance did not differ between boys and girls on the tasks. The older the children were, the better they performed on the tasks.

Correlations between motor performance and cognitive functions in children born < 1250 g at school age.

Very low birth weight born children manifest a higher prevalence of motor and cognitive impairments than term children. Seventy-four prospectively enrolled children born < 1250 g underwent testing of motor (Zurich neuromotor assessment ZNA: timed motor performances and associated movements) and cognitive functions (Kaufman-ABC) at age six years. Children with cerebral palsy or mental retardation were excluded. Adaptive motor tasks (pegboard and dynamic balance) and visuomotor cognitive functions were specifically impaired, and a distinct correlation pattern between motor and cognitive abilities was detected. The adaptive fine motor task (pegboard) correlated with visuomotor functions of the Kaufman-ABC ("triangles", r = 0.35; "matrix analogies", r = 0.39), while pure motor tasks of the ZNA (repetitive, alternating, and sequential movements) did not in spite of impaired motor performance. Timed motor performance below the 10th percentile correlated strongly with cognitive delay (IQ < 85: adaptive fine motor: OR 6.0 [95% CI] 4.7-7.3; adaptive gross motor: OR 7.0 [CI 5.6-8.4]; static balance: OR 9.6 [CI 8.2-11.0]). In conclusion, motor deficits in children born < 1250 g without severe disabilities correlate with specific cognitive impairments, in particular of the visuomotor domain. The correlation pattern may indicate specific dysfunction in visuomotor transformation, the intermediate process between visual-perceptual input and motor output. Early assessment of both motor and cognitive functions using standardized assessment tools is important to determine the extent and combination of specific developmental disturbances and to tailor therapeutic intervention.

Neuromotor development from 5 to 18 years. Part 1: timed performance.

Timed performance in specific motor tasks is an essential component of a neurological examination applied to children with motor dysfunctions. This article provides centile curves describing normal developmental course and interindividual variation of timed performances of non-disabled children from 5 to 18 years. In a cross-sectional study (n=662) the following motor tasks were investigated: repetitive finger movements, hand and foot movements, alternating hand and foot movements, sequential finger movements, pegboard, and dynamic and static balance. Intraobserver, interobserver, and test-retest reliability for timed measurements were moderate to high. Timed performances improved throughout the entire prepubertal period, but differed among various motor tasks with respect to increase in speed and when the 'adolescent plateau' was reached. Centile curves of timed performance displayed large interindividual variation for all motor tasks. At no age were clinically relevant sex differences noted, nor did socioeconomic status significantly correlate with timed performance. Our results demonstrate that timed motor performances between 5 and 18 years are characterized by a long-lasting developmental change and a large interindividual variation. Therefore, a well standardized test instrument, and age-specific standards for motor performances are necessary preconditions for a reliable assessment of motor competence in school-age children.

Neuromotor development from 5 to 18 years. Part 2: associated movements.

Associated movements (AMs) are the most frequently assessed parameters of movement quality in children with motor dysfunctions. In this article, reference curves of duration and degree of AMs from 5 to 18 years are provided. In a cross-sectional study of non-disabled children (n=662) duration and degree of AMs were estimated at six specific ages while children performed repetitive finger, hand, and foot movements, alternating hand and foot movements, diadochokinesis, sequential finger movements, pegboard, stress gaits, and dynamic balance. Moderate-to-high intraobserver and interobserver reliability for the assessment of AMs were noted. Duration and degree of AMs displayed a non-linear developmental course that was a function of the motor task's complexity. AMs decreased most with age in repetitive movements, less in alternating and sequential movements, and least in the pegboard and dynamic balance. Reference curves demonstrated large interindividual variations for duration and degree of AMs. Both the variable developmental course and large interindividual variation need to be taken into account in the assessment of movement quality of school-age children. In contrast to timed performance, considerable sex differences for AMs were observed.