Effectiveness of a self-regulated remedial program for handwriting difficulties.

BACKGROUND: Handwriting difficulties may have pervasive effects on a child's school performance. I Can! is a remedial handwriting program with a focus on self-regulated learning and applying motor learning principles combined with a behavioural approach. It is developed for typically developing children with handwriting problems. OBJECTIVE: The study aim was to evaluate the program's effectiveness. MATERIALS AND METHODS: Thirty-one children aged 7-8 year participated in a cross-over study. Handwriting quality and speed were repeatedly assessed by means of the Systematic Screening of Handwriting Difficulties test. Difficulties addressed were fluency in letter formation, fluency in letter connections, letter height, regularity of letter height, space between words, and line path. RESULTS: Mixed model analysis revealed improved quality of writing and speed for all children but significantly more improvement in handwriting quality for the children participating in the program. Although writing speed improved over time, no additional effects of the program occurred. CONCLUSIONS AND SIGNIFICANCE: 'I Can!' is found to be an effective instructive program to ameliorate handwriting quality in typically developing children with handwriting difficulties. The program's success was by a therapy burst of only 7 weeks focusing on the child's self-regulated learning capacities, within an individualized education plan according to their needs and goals.

Brain Connectomics of Visual-Motor Deficits in Children with Developmental Coordination Disorder.

OBJECTIVE: To extend preliminary findings on associated white matter deficits and structural connectivity in children with developmental coordination disorder (DCD). STUDY DESIGN: Diffusion magnetic resonance imaging-based tractography was used to identify abnormal microstructural properties of specific sensorimotor white matter tracts in 21 children with DCD between 8 and 10 years of age and 20 age- and sex-matched typically developing controls. Graph theoretical analyses were applied to evaluate whole brain connectomics. Associations were also calculated between the tractography/connectome results and visual-motor performance, as measured with the Beery-Buktenica Developmental Test of Visual Motor Integration. RESULTS: Significant positive correlations were obtained between visual-motor trace scores and fractional anisotropy (FA) in the retrolenticular limb of the internal capsule within the group with DCD. Moreover, lower FA in sensorimotor tracts and altered structural connectivity were observed for children with DCD. Compared with controls, subjects with DCD showed decreases in clustering coefficient, and global and local efficiency, suggesting weaker structural network segregation and integration. The degree of decreased global efficiency was significantly associated with poor visual-motor tracing outcomes, above and beyond FA reductions. Specifically, nodal efficiency at the cerebellar lobule VI and right parietal superior gyrus were found significant predictors to discriminate between children with DCD and those with typical development. CONCLUSIONS: Specific white matter alterations and network topology features associate with visual-motor deficits and DCD diagnosis indicating the clinical potential of diffusion magnetic resonance imaging-based metrics for diagnosing DCD.

Deficient motor timing in children with neurofibromatosis type 1.

Neurofibromatosis type 1 (NF1) is one of the most common single-gene disorders affecting fine and visual-motor skills. This case-control study investigated motor timing as a possible related performance deficit in children with NF1. A visual-motor reaction time (VRT) test was administered in 20 NF1 children (mean age 9 years 7 months) and 20 age- and gender-matched typically developing (TD) children. Copying and tracing performance were evaluated using the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI). Children with NF1 responded with an increased reaction time (RT) to temporally predictive stimuli compared to TD children, whereas RT at unpredictive stimuli did not differ between groups. Motor timing indexed by the RT decrease at predictive stimuli significantly associated with the Beery VMI copy and tracing outcomes. Deficient motor timing as an actual symptom may add to further research on the pathogenesis of NF1-associated motor impairment and the development of more effective treatment.

Neural underpinnings of impaired predictive motor timing in children with Developmental Coordination Disorder.

A dysfunction in predictive motor timing is put forward to underlie DCD-related motor problems. Predictive timing allows for the pre-selection of motor programmes (except 'program' in computers) in order to decrease processing load and facilitate reactions. Using functional magnetic resonance imaging (fMRI), this study investigated the neural correlates of motor timing in DCD (n=17) and typically developing children (n=17). The task involved motor responses to sequences of visual stimuli with predictive or unpredictive interstimulus intervals (ISIs). DCD children responded with a smaller reaction time (RT) advantage to predictive ISIs compared to typically developing children. Typically developing children exhibited higher activation in the right dorsolateral prefrontal cortex (DLPFC) and right inferior frontal gyrus (IFG) for responses at unpredictive as opposed to predictive ISIs, whereas activations in DCD children were non-differentiable. Moreover, DCD children showed less activation than typically developing children in the right DLPFC, the left posterior cerebellum (crus I) and the right temporo-parietal junction (TPJ) for this contrast. Notably, activation in the right temporo-parietal junction (TPJ) positively correlated with RT as an indicator of processing load in both groups. These data indicate that motor performance in DCD children requires extra processing demands due to impaired predictive encoding.

Age-related differences in predictive response timing in children: evidence from regularly relative to irregularly paced reaction time performance.

Predictive timing refers to the anticipation and precise timing of planned motor responses. This study was performed to investigate children's predictive response timing abilities while accounting for confounding age-related effects of motor speed. Indices of predictive timing were evaluated for their contributions in motor skill proficiency as well. Eighty typically developing children in 4 age groups (5-6, 7-8, 9-10 and 11-12 years) performed a visuomotor reaction time (RT) test. Differences in speed and anticipatory responding at regularly relative to irregularly paced stimuli were evaluated as indices of predictive timing. Also, explicit timing and motor tests (M-ABC-2, VMI tracing, and KTK jumping) were administered. Significant faster responding for regularly versus irregularly paced stimuli was found from the ages of 9-10 years on. Better anticipatory responding behavior for regular in contrast with irregular stimuli was found to be present already at 7-8 years. Overall, predictive timing abilities increased across the 4 age groups. Also, inter-individual differences in the speed indices of predictive timing contributed to predicting VMI tracing and KTK jumping outcomes when controlling for age and overall motor response speed. In conclusion, predictive motor timing abilities increase during age 5 to 12 and correlate with motor skill performance.