Effect of dual tasking on a dynamic balance task in children with and without DCD.

The purpose of this study was to compare performance of children with Developmental Coordination Disorder (DCD) and typically developing (TD) children in a dual task paradigm with a dynamic balance task on the Wii Fit as primary task and a concurrent cognitive (counting) or a concurrent bimanual fine motor task as secondary tasks. Using a cross-sectional design, 25 children with DCD and 38 TD children were assessed with the Movement Assessment Battery for Children, 2nd edition (MABC-2) and Divided Attention (DA) task of the KiTAP. Next, the single- and dual-tasks were performed and the level of interference or facilitation of the dual tasks was calculated. Regression analysis determined the predictive value of the DA and MABC-2 component balance outcomes on the dual task performance. On the motor and attentional tasks, the group of children with DCD scored significantly below the level of the TD children. The dual task effect showed similar interference and facilitation of tasks in the different dual-task conditions in both groups. In the dual task-cognitive condition, the divided attention abilities and the MABC-2 balance score predicted 25% of the Wii Fit dynamic balance task performance, whereas in the dual task-motor condition this was higher (31.6%). In both conditions, DA was a stronger predictor than MABC balance score and appears to be an important factor to consider when developing motor task training for children with DCD.

Movement Control Strategies in a Dynamic Balance Task in Children With and Without Developmental Coordination Disorder.

Our study aimed to analyze movement control strategies using predefined criteria for amplitude and differences in these strategies between children with and without DCD. Children with (n = 28) and without DCD (n = 15) were included. A video-observation-tool was used to score the moving body parts during a Wii Fit slalom task over multiple time points. Two-step cluster analysis was used to extract distinct movement strategies. Two different movement strategies were identified that were independently validated by a measure of task performance and a subjective mark of quality of the movement. Initial differences between groups and changes over time toward the more successful strategy were found in both groups, albeit in a different percentage. This study shows that the more efficient movement strategy is seen in the majority of the TD children and only in a small number of children with DCD, even after practice.

Testosterone effects on functional amygdala lateralization: A study in adolescent transgender boys and cisgender boys and girls.

The influence of testosterone on the development of human brain lateralization has been subject of debate for a long time, partly because studies investigating this are necessarily mostly correlational. In the present study we used a quasi-experimental approach by assessing functional brain lateralization in trans boys (female sex assigned at birth, diagnosed with Gender Dysphoria, n = 21) before and after testosterone treatment, and compared these results to the functional lateralization of age-matched control groups of cisgender boys (n = 20) and girls (n = 21) around 16 years of age. The lateralization index of the amygdala was determined with functional magnetic resonance imaging (fMRI) during an emotional face matching task with angry and fearful faces, as the literature indicates that boys show more activation in the right amygdala than girls during the perception of emotional faces. As expected, the lateralization index in trans boys shifted towards the right amygdala after testosterone treatment, and the cumulative dose of testosterone treatment correlated significantly with amygdala lateralization after treatment. However, we did not find any significant group differences in lateralization and endogenous testosterone concentrations predicted rightward amygdala lateralization only in the cis boys, but not in cis girls or trans boys. These inconsistencies may be due to sex differences in sensitivity to testosterone or its metabolites, which would be a worthwhile course for future studies.

Prenatal and pubertal testosterone affect brain lateralization.

After decades of research, the influence of prenatal testosterone on brain lateralization is still elusive, whereas the influence of pubertal testosterone on functional brain lateralization has not been investigated, although there is increasing evidence that testosterone affects the brain in puberty. We performed a longitudinal study, investigating the relationship between prenatal testosterone concentrations in amniotic fluid, pubertal testosterone concentrations in saliva, and brain lateralization (measured with functional Transcranial Doppler ultrasonography (fTCD)) of the Mental Rotation, Chimeric Faces and Word Generation tasks. Thirty boys and 30 girls participated in this study at the age of 15 years. For boys, we found a significant interaction effect between prenatal and pubertal testosterone on lateralization of Mental Rotation and Chimeric Faces. In the boys with low prenatal testosterone levels, pubertal testosterone was positively related to the strength of lateralization in the right hemisphere, while in the boys with high prenatal testosterone levels, pubertal testosterone was negatively related to the strength of lateralization. For Word Generation, pubertal testosterone was negatively related to the strength of lateralization in the left hemisphere in boys. For girls, we did not find any significant effects, possibly because their pubertal testosterone levels were in many cases below quantification limit. To conclude, prenatal and pubertal testosterone affect lateralization in a task-specific way. Our findings cannot be explained by simple models of prenatal testosterone affecting brain lateralization in a similar way for all tasks. We discuss alternative models involving age dependent effects of testosterone, with a role for androgen receptor distribution and efficiency.

Changes in dynamic balance control over time in children with and without Developmental Coordination Disorder.

The aim of this study was to examine differences in underlying adaptations of dynamic balance in children with and without Developmental Coordination Disorder (DCD) during a Wii Fit game and to measure changes over time and after intervention. Twenty-eight children with DCD and 21 typically developing (TD) children participated in the study. Analyses of force plate variables showed that the TD group initially used a longer path length for the ski slope descent and tended toward more variation in Center of Pressure (CoP) displacement in lateral direction than the children with DCD. In contrast, the TD group showed a trend of fewer reversals per cm in both AP and lateral direction. After the nonintervention period, the TD group improved performance by decreasing the path length, while the DCD group improved by increasing the path length and by decreasing the number of reversals. After intervention, no changes were found in sway characteristics. Individual analyses within the DCD group showed that the path length per run fell more often within the 95% confidence Interval of the faultless runs. In conclusion both TD and DCD children modify the underlying kinetics of dynamic balance control, but in different ways and both lead to better performance.

What is the evidence of impaired motor skills and motor control among children with attention deficit hyperactivity disorder (ADHD)? Systematic review of the literature.

This article presents a review of the studies that have analysed the motor skills of ADHD children without medication and the influence of medication on their motor skills. The following two questions guided the study: What is the evidence of impairment of motor skills and aspects of motor control among children with ADHD aged between 6 and 16 years? What are the effects of ADHD medication on motor skills and motor control? The following keywords were introduced in the main databases: attention disorder and/or ADHD, motor skills and/or handwriting, children, medication. Of the 45 articles retrieved, 30 described motor skills of children with ADHD and 15 articles analysed the influence of ADHD medication on motor skills and motor control. More than half of the children with ADHD have difficulties with gross and fine motor skills. The children with ADHD inattentive subtype seem to present more impairment of fine motor skills, slow reaction time, and online motor control during complex tasks. The proportion of children with ADHD who improved their motor skills to the normal range by using medication varied from 28% to 67% between studies. The children who still show motor deficit while on medication might meet the diagnostic criteria of developmental coordination disorder (DCD). It is important to assess motor skills among children with ADHD because of the risk of reduced participation in activities of daily living that require motor coordination and attention.

A systematic review of instruments for assessment of capacity in activities of daily living in children with developmental co-ordination disorder.

Children with developmental co-ordination disorder (DCD) face evident motor difficulties in activities of daily living (ADL). Assessment of their capacity in ADL is essential for diagnosis and intervention, in order to limit the daily consequences of the disorder. The aim of this study is to systematically review potential instruments for standardized and objective assessment of children's capacity in ADL, suited for children with DCD. As a first step, databases of MEDLINE, EMBASE, CINAHL and PsycINFO were searched to identify studies that described instruments with potential for assessment of capacity in ADL. Second, instruments were included for review when two independent reviewers agreed that the instruments (1) are standardized and objective; (2) assess at activity level and comprise items that reflect ADL; and (3) are applicable to school-aged children that can move independently. Out of 1507 publications, 66 publications were selected, describing 39 instruments. Seven of these instruments were found to fulfil the criteria and were included for review: the Bruininks-Oseretsky Test of Motor Performance-2 (BOT2); the Do-Eat (Do-Eat); the Movement Assessment Battery for Children-2 (MABC2); the school-Assessment of Motor and Process Skills (schoolAMPS); the Tuffts Assessment of Motor Performance (TAMP); the Test of Gross Motor Development (TGMD); and the Functional Independence Measure for Children (WeeFIM). As a third step, for the included instruments, suitability for children with DCD was discussed based on the ADL comprised, ecological validity and other psychometric properties. We concluded that current instruments do not provide comprehensive and ecologically valid assessment of capacity in ADL as required for children with DCD.

Driving performance during word generation--testing the function of human brain lateralization using fTCD in an ecologically relevant context.

It has been hypothesized that cerebral lateralization of function enhances cognitive performance. Evidence was found in birds and fish. However, recent research in humans did not support this hypothesis. We aimed to replicate and extend these findings for single- and dual-task performance in an ecologically relevant task. We combined a word generation task which is assumed to be primarily processed in the left hemisphere with a driving task which is assumed to be primarily processed in the right hemisphere. For each task the individual strength and direction of hemispheric lateralization was assessed by using functional transcranial Doppler sonography (fTCD). For each subject (36 right-handed, 35 nonright-handed) performance was measured in the two single-tasks and in the dual-task condition. On average, subjects showed a left hemisphere bias for the word generation task, a right hemisphere bias for the driving task and dual-task interference. Within subjects, lateralization of language and driving were statistically independent. In accordance with earlier studies, the results show no indication of a positive effect of strength of lateralization on performance in single-tasks or dual-task efficiency. We also found no advantage of a typical compared to an atypical or a contralateral compared to an ipsilateral lateralization pattern. In right-handers, but not in nonright-handers, we even found a negative relationship between strength of lateralization and dual-task efficiency for atypically lateralized subjects. This further supports the suggestion that lateralization does not enhance cognitive performance in humans.

Functional cerebral lateralization and dual-task efficiency-testing the function of human brain lateralization using fTCD.

It has been hypothesized that functional cerebral lateralization enhances cognitive performance. Evidence was found in birds and fish. Our study aimed to test this hypothesis by analyzing the relationship between cerebral lateralization and both single-task performance and dual-task efficiency in humans. We combined a dynamic Landmark task which is assumed to be primarily processed in the right hemisphere and a frequently used word generation task which is assumed to be primarily processed in the left hemisphere. For each task individual strength and direction of hemispheric lateralization was assessed using functional transcranial Doppler sonography (fTCD). For each subject (15 women, 11 men), performance was measured in the two single-tasks and in the dual-task condition. Performance was not related to strength or direction of lateralization in single-tasks. With regard to dual-task efficiency, we found the expected advantage of having a typical lateralization pattern. Moreover, the results showed a slight negative, rather than a positive, relationship between strength of lateralization and dual-task efficiency. Further analysis showed that this negative relationship may only be present in subjects showing non-significant lateralization for one or both tasks. Therefore, the hypothesis that cerebral lateralization enhances human cognitive performance is too general: having two functions significantly lateralized to different hemispheres enhances dual-task efficiency, in this group strength of lateralized does not matter. However, if one or both functions are not significantly lateralized overall performance is worse and in this group, performance is negatively related to increased strength of lateralization.

Quadriceps strength and executive functions in older women.

OBJECTIVE: The aim of this study is to answer the question whether the strength of the knee extensor musculus quadriceps (m. quadriceps), in particular, is related to specific executive functions and whether this relationship is independent of aerobic fitness. The clinical relevance of this question is that the m. quadriceps can still be trained in older people and executive functions are the most vulnerable to processes of aging. DESIGN: In 41 cognitively intact older women, cognitive functioning was assessed by neuropsychological tests; isometric and isotonic quadriceps strength by the Quadrisotester and the 30-sec chair-stand test, respectively; and aerobic fitness by the 6-min walk test. RESULTS: A significant proportion of the total variance of the executive functions, attention/working memory and inhibition, were explained by isometric/isotonic knee extensor strength and aerobic fitness, respectively. Extensor muscle strength, aerobic fitness, or one or more interactions did not explain a significant proportion of the total variance of other cognitive functions. CONCLUSIONS: These data suggest that in older women, quadriceps strength is associated with the executive function, attention/working memory, and that this effect is independent of aerobic fitness, which seems to be associated more strongly with inhibition, another executive function.

Sex specific effect of prenatal testosterone on language lateralization in children.

Brain lateralization refers to the division of labour between the two hemispheres in controlling a wide array of functions and is remarkably well developed in humans. Based on sex differences in lateralization of handedness and language, several hypotheses have postulated an effect of prenatal exposure to testosterone on human lateralization development, the topic of a long-standing and unresolved debate. Here we demonstrate a clear relationship between prenatal levels of testosterone as assessed from amniotic fluid of healthy pregnant mothers and language lateralization of their offspring at the age of 6 years. Using focused attention conditions in the dichotic listening task, in which the child is instructed to report information from the left ear or the right ear, we were able to differentiate between potential effects of early testosterone on the left hemisphere and effects on inter-hemispheric connectivity. This provides a new method to distinguish between the claims of the different hypotheses. The results suggest that in girls higher prenatal testosterone exposure facilitates left hemisphere language processing, whereas in boys it reduces the information transfer via the corpus callosum.

Stability of bimanual coordination in Parkinson's disease and cognitive modulation of intention.

The functional integrity of the bimanual neuro-motor system of Parkinson's disease (PD) subjects (stageII) compared to controls (2 x n = 16) was evaluated by measures of coordination stability of tapping in in-phase, anti-phase, and 90 degrees-phase. Recently, intentional influence was modeled as an additive attractor function on the intrinsic dynamics, resulting in predictions tested by Scholz and Kelso (1990). In this study, the intentional influence was modulated by attaching cognitive meaning to the rhythmical pattern, which was expected to enhance the stability of coordination and, if effective, might be profitable to PD patients. Half of the PD subjects significantly lacked stability. They were less stable than controls, lost coordination at lower frequencies, and needed more time to switch between phase patterns. The reduction of stability was reflected in the progression of the disease. Cognitive meaning reduced variability of the single-hands but not of relative phase, and no effect on switching time was found. The results suggest a weaker coupling strength between the limbs in PD patients lacking stability.

Perceptual skills of children with developmental coordination disorder.

The aim of this study was to investigate whether children with a Developmental Coordination Disorder (DCD) experience problems in the processing of visual, proprioceptive or tactile information. Different aspects of visual perception were tested with the Developmental Test of Visual Perception (DTVP-2), tactile perception was assessed with the Tactual Performance Test (TPT), and a manual pointing task was employed to measure the ability to use visual and proprioceptive information in goal-directed movements. Nineteen children with DCD and nineteen age and sex-matched controls participated in this study. Differences between groups were most pronounced in the subtests measuring visual-motor integration of the DTVP-2, and in two subtests measuring visual perception (visual closure and position in space). On average the children with DCD performed slightly below the norm for tactile perception, with only three children failing the norm. On the manual pointing task, children with DCD made inconsistent responses towards the targets in all three conditions (visual, visual-proprioceptive and proprioceptive condition). No significant differences between groups were found for absolute error. Inspection of the individual data revealed that only two children failed on the majority of perceptual tasks in the three modalities. Across tasks, no consistent pattern of deficits appeared, illustrating the heterogeneity of the problems of children with DCD.

Temporal stability of rhythmic tapping "on" and "off the beat": a developmental study.

This study, following a dynamic pattern approach, examines age-related differences in the stability of unimanual rhythmic perception-action patterns. Thirty-six children, aged 7, 9, and 11 years, attempted to synchronize their finger tapping to the beats of an auditory metronome, either "on the beat" (i.e., in-phase coordination), or "off the beat" (i.e., antiphase coordination). The temporal stability of these perception-action patterns was measured by the variability of the relative phase between taps and auditory events and by the critical frequency, that is, the frequency at which a loss of stability was observed when the metronome frequency was increased. Age-related differences in stability were found for both relative phase variability and critical frequency. These findings suggest that the relative phase dynamics underlying perception-action coordination patterns change with age in the direction of an increased temporal stability.

Kinaesthetic acuity in adolescent boys: a longitudinal study.

The Kinaesthetic Sensitivity Test (KST) was used to measure the development of kinaesthetic acuity in adolescent boys. Thirty boys were tested longitudinally, at intervals of 6 months, between the ages of 11 1/2 and 14 years. A second group of 20 boys was tested at the ages of 14 and 16 1/2 years. The findings were compared with existing normative data on 5- to 12-year-old children and young adults, and they indicated improvement in kinaesthetic acuity with age. Although the age effect is statistically significant only in the older group, confidence intervals show that the rate of improvement in both groups is comparable to improvement between the ages of 5 and 12 years. The reliability of the test is rather poor. The conclusion is that kinaesthetic development continues throughout adolescence. Further, development is quite robust and detectable even with a fairly unreliable measurement instrument. However, individual assessments should be interpreted with caution.

Stability of rhythmic finger movement in children with a developmental coordination disorder.

The stability of single and bimanual (i.e., in-phase and antiphase) rhythmic finger movements was studied in 24 children with a developmental coordination disorder (DCD) and 24 matched controls from a dynamic pattern perspective. Stability was assessed by applying perturbations and measuring the time the system needed to return to its initial stability (i.e., the relaxation time). In addition, fluctuations of the patterns were measured. For antiphase coordination patterns, the frequency at which loss of stability occurred was also determined. Children with DCD displayed less stable single and bimanual rhythmic coordination patterns than control children. Further, within the DCD group, 9 children were identified as having particularly poor bimanual coordination stability. Individual differences suggested that variability of individual limb oscillations might have contributed to this poorer interlimb coordination stability. Findings were discussed in relation to a previous study on DCD in which the Wing-Kristofferson timekeeper model was applied.

Timing variability in children with early-treated congenital hypothyroidism.

This study reports on central and peripheral determinants of timing variability in self-paced tapping by children with early-treated congenital hypothyroidism (CH). A theoretical model of the timing of repetitive movements developed by Wing and Kristofferson was applied to estimate the central timekeeper (clock) and peripheral implementation (motor delay) variances from the variability in the response intervals. Before it is diagnosed and treated, CH is known to affect proper development of the cerebellum. If this would affect the time-keeper function of the cerebellum, it should be reflected by an increased central clock variability rather than by an increased peripheral motor-delay variability in terms of the Wing and Kristofferson model. Results of 46 children with early-treated CH, differing in severity (21 severe, 25 mild), and 34 normal controls are reported. A refinement of the Wing and Kristofferson model is applied to estimate central clock and peripheral motor delay timing variability more precisely than has been done before. Results show that for children with early-treated CH the estimate of the motor delay variance is four times higher than for the controls, while the estimate of the clock variance does not differ between the groups. It is concluded that motor problems in early-treated CH are associated with peripheral rather than with central timing deficiencies.

Motor response processing in clumsy children.

Twelve clumsy children and 12 controls executed a four choice reaction time task in two compatibility conditions and three precue conditions. The experimental results indicated that the cognitive decision process of response selection contributed to the slow but not to the inaccurate performance of clumsy children. Clumsy children, compared with controls, had more problems with the translation of the stimulus code (s) to the response code (r) when this translation required more transformations. Response selection is a cognitive process that is likely to be important for deficits in perceptual-motor skills.