Self-perceptions in children with probable developmental coordination disorder with and without overweight.

BACKGROUND: Children with probable developmental coordination disorder (pDCD) experience motor problems that negatively influence their self-perceptions and increase the risk to develop overweight due to physical inactivity. Whether overweight in children with pDCD has an additional impact on their self-perceptions is unclear. Insight in this impact would provide vital information for diagnostics and interventions to enhance physical activity in children with pDCD and overweight. AIMS: Investigate differences in self-perceptions between children with pDCD and overweight (pDCD-O), children with pDCD without overweight (pDCD-NO), and typically developing children (TD). METHODS AND PROCEDURES: A total of 366 children (188 boys/178 girls), aged between 7 and 13 years, participated in this study. Thirteen children were categorized as pDCD-O, 51 children as pDCD-NO, and 302 children as TD. Self-perceptions were assessed with the Self-Perception Profile for Children. OUTCOMES AND RESULTS: Children with pDCD-O perceived themselves lower in social acceptance than children with pDCD-NO and TD children. Children with pDCD-NO perceived themselves lower in athletic competence than TD children, but not than children with pDCD-O. No differences were found for perceived physical appearance and global self-esteem. CONCLUSIONS AND IMPLICATIONS: Overweight has an additional negative impact on perceived social acceptance in children with pDCD.

A home-video method to assess infant gross motor development: parent perspectives on feasibility.

BACKGROUND: Current use of smartphone cameras by parents create opportunities for longitudinal home-video-assessments to monitor infant development. We developed and validated a home-video method for parents, enabling Pediatric Physical Therapists to assess infants' gross motor development with the Alberta Infant Motor Scale (AIMS). The objective of the present study was to investigate the feasibility of this home-video method from the parents' perspective. METHODS: Parents of 59 typically developing infants (0-19 months) were recruited, 45 parents participated in the study. Information about dropout was collected. A sequential mixed methods design was used to examine feasibility, including questionnaires and semi-structured interviews. While the questionnaires inquired after the practical feasibility of the home-video method, the interviews also allowed parents to comment on their feelings and thoughts using the home-video method. RESULTS: Of 45 participating parents, 34 parents returned both questionnaires and eight parents agreed to an interview. Parent reported effort by the infants was very low: the home-video method is perceived as similar to the normal routine of playing. The parental effort level was acceptable. The main constraint parents reported was time planning. Parents noted it was sometimes difficult to find the right moment to record the infant's motor behavior, that is, when parents were both at home and their baby was in the appropriate state. Technical problems with the web portal, reported by 28% of the parents were also experienced as a constraint. Positive factors mentioned by parents were: the belief that the home videos are valuable for family use, receiving feedback from a professional, the moments of one-on-one attention and interaction with their babies. Moreover, the process of recording the home videos resulted in an increased parental awareness of, and insight into, the gross motor development of their infant. CONCLUSION: The AIMS home-video method is feasible for parents of typically developing children. Most constraints are of a practical nature that can be addressed in future applications. Future research is needed to show whether the home-video method is also applicable for parents with an infant at risk of motor development problems.

The Use of Local and Global Ordering Strategies in Number Line Estimation in Early Childhood.

A lot of research has been devoted to number line estimation in primary school. However, less is known about the early onset of number line estimation before children enter formal education. We propose that ordering strategies are building blocks of number line estimation in early childhood. In a longitudinal study, children completed a non-symbolic number line estimation task at age 3.5 and 5 years. Two ordering strategies were identified based on the children's estimation patterns: local and global ordering. Local ordering refers to the correct ordering of successive quantities, whereas global ordering refers to the correct ordering of all quantities across the number line. Results indicated a developmental trend for both strategies. The percentage of children applying local and global ordering strategies increased steeply from 3.5 to 5 years of age. Moreover, children used more advanced local and global ordering strategies at 5 years of age. Importantly, level of strategy use was related to more traditional number line estimation outcome measures, such as estimation accuracy and regression fit scores. These results provide evidence that children use dynamic ordering strategies when solving the number line estimation task in early stages of numerical development.

Responsiveness of the Test of Basic Motor Skills of Children with Down Syndrome.

The aim of this study was to examine the responsiveness of the Test of Basic Motor Skills for Children with Down Syndrome (BMS). Forty-one children with Down Syndrome, 3 to 36 months of age, participated in the study. Gross motor skills were assessed three times using the BMS and the Gross Motor Function Measure (GMFM) before and after a baseline period of 2 weeks (T1-T2) and after a period of 16 weeks (T2-T3). Internal and external responsiveness of the BMS was analyzed using Guyatt's Responsiveness Index (GRI) and 2 x 2 repeated measures. Change in BMS scores was compared to change in GMFM scores and parent and physiotherapist ratings of change. The responsiveness of the BMS was large (GRI = 2.55). A significant Time x Age interaction [F(1,37) = 8.87, p < .01] indicated that BMS scores increased more for children

Stress in parents of children with cerebral palsy: what sources of stress are we talking about?

BACKGROUND: Parents of children with cerebral palsy (CP) often experience high levels of stress. Little is known however on the different sources of stress parents experience. The purpose of the present study was to explore the relation between aspects of parental distress in the parenting role and the child's limitations in functional skills and the child's behavioural difficulties, in parents of children with CP. METHODS: A cross-sectional study among 42 parents of ambulatory children with CP (age 3-8 years; GMFCS levels I-III) was performed, using the Parenting Stress Index (PSI), the Paediatric Evaluation of Disability Inventory (PEDI) and the Vineland Adaptive Behaviour Scales (VABS). RESULTS: Regression analysis revealed that the PEDI Functional Skills and VABS Maladaptive behaviour scores explained 27% of the total variance in the PSI Parent domain total stress score. Maladaptive behaviour did significantly contribute to parental stress scores for the Parent domain subscales Attachment, Relationship with spouse, Depression, and, in particular, Sense of competence. CONCLUSIONS: Parents' functioning can be affected by behavioural aspects of the child with CP, and sense of competence could be an important variable in this relation. This emphasizes the importance of the development of specific interventions that support the family as a whole.

Rhythmic coordination of hand and foot in children with Developmental Coordination Disorder.

BACKGROUND: Children with Developmental Coordination Disorder (DCD) have difficulties producing stable rhythmic bimanual coordination patterns in comparison with age-related peers. Rhythmic coordination of non-homologous limbs (e.g. hand and foot) is even more difficult to perform because of mechanical differences between the limbs. The aim of the present study is to investigate the stability of hand-foot coordination patterns of children with DCD. METHODS: Ten children with DCD (mean age 7.0 years, SD 1.1 years) and 16 control children (mean age 7.4 years, SD 1.3 years) participated in the study. They were asked to perform in-phase or anti-phase tapping movements in three different interlimb coordination combinations: (1) hand-hand (homologous), (2) hand-foot same body side (ipsilateral), and (3) hand-foot different body side (contralateral). Coordination stability was measured by the variability of the relative phase between the limbs under a 'steady state' (preferred) frequency condition, and by the critical frequency (i.e. the point at which loss of pattern stability was observed) in a condition in which the movement frequency was 'scaled' up (only anti-phase tapping). RESULTS: Coordination patterns of children in the DCD group were less stable in all three limb combinations compared with controls. Further, hand-foot coordination patterns were less stable than hand-hand coordination patterns. With regard to hand-foot coordination, ipsilateral patterns were equally stable compared with contralateral patterns in the in-phase task, but less stable in the anti-phase task. No differential effects were found between the DCD and control groups across the different limb combinations, except for steady-state anti-phase coordination in the ipsilateral limb condition. This effect was due to a relatively good performance of the control children in this condition in comparison with the other limb combination conditions. CONCLUSIONS: Children with DCD have difficulties producing stable rhythmic hand-foot coordination patterns compared with control children.

Handwriting difficulties in primary school children: a search for underlying mechanisms.

OBJECTIVE: This study investigated the contribution of perceptual-motor dysfunction and cognitive planning problems to the quality or speed of handwriting in children with handwriting problems (HWP). METHOD: Twenty-nine children with HWP and 20 classroom peers attending regular schools (grade 2 and grade 3) were tested with regard to visual perception, visual-motor integration, fine motor coordination, and cognitive planning abilities. RESULTS: The HWP group scored significantly lower on visual perception, visual-motor integration, fine motor coordination, and cognitive planning in comparison with classroom controls. Regression analyses showed that visual-motor integration was the only significant predictor for quality of handwriting in the HWP group, whereas fine motor coordination (i.e., unimanual dexterity) was the only significant predictor of quality of handwriting in the control group. CONCLUSIONS: Results suggest that two different mechanisms underlie the quality of handwriting in children with and without handwriting problems. Poor quality of handwriting of children with HWP seems particularly related to a deficiency in visual-motor integration.

Spatial coupling in children with hemiplegic cerebral palsy during bimanual circle and line drawing.

The effect of amplitude incongruence (small circles-large circles) and form incongruence (circles-lines) on the performance of the affected and non-affected arm was examined in 12 children with hemiplegic cerebral palsy in bimanual rhythmic drawing tasks. Amplitude and form incongruence are assumed to be associated with aspects of movement execution and movement planning, respectively. The following questions were addressed: Does amplitude or form incongruence in bimanual coordination result in: (a) accommodation of the affected or non-affected arm, or both, (b) an increase of temporal variability of drawing movements of the affected or non-affected arm, and (c) a decrease of bimanual coordination stability? Form incongruence resulted in accommodation of both affected and non-affected arm in a similar way found in non-disabled participants. Despite this accommodation, the temporal variability of both affected and non-affected arm was increased, and coordination stability decreased, because the spatial trajectories of affected and non-affected arm were still rather dissimilar. Amplitude incongruence resulted in accommodation of either the affected arm (large circles required) or non-affected arm (small circles required), and in an increase or decrease of temporal variability of the affected arm, depending on the degree of spatial similarity of the trajectories of affected and non-affected arm. These findings suggest that in children with hemiplegic cerebral palsy aspects of movement execution, but not aspects of movement planning are affected by the "hemiplegic"

Epilepsy surgery does not harm motor performance of children and adolescents.

The impact of epilepsy surgery on motor performance, activities of daily life (ADL) and caregiver assistance was assessed in 37 children (age range 0.1-15.4 years) with pharmacologically untreatable epilepsy, 17 of whom were also diagnosed as having spasticity of cerebral origin. All patients underwent epilepsy surgery between 1996 and 2001 at the Wilhelmina University Children's Hospital and were assessed using a standard protocol at fixed intervals: before surgery and 6 months, 1 year and 2 years after surgery. The type of surgery was hemispherectomy (n = 14) and temporal (n = 14), frontal (n = 4), parietal (n = 2) and central (n = 2) resection. One child underwent callosotomy. Engel's classification was used to determine seizure outcome. Impairments were measured in terms of muscle strength, range of motion and muscle tone. Motor performance of infants and children without spasticity was measured using the Movement Assessment Battery for Children (M-ABC). The Gross Motor Function Measure (GMFM-88) was used in children with spasticity, the severity of motor disability in this group being determined by means of the Gross Motor Function Classification System (GMFCS). Daily activities and caregiver's assistance were measured in all children using the Pediatric Evaluation of Disability Inventory (PEDI). Twenty-four months after surgery 74% of the children could be classified as Engel class 1, indicating a significant seizure reduction. Impairments revealed some decrease in muscle strength and range of motion in the group with spasticity. Scores improved statistically significantly at group level on M-ABC and GMFM (P < 0.05). Improvement in activities of daily life and caregiver's assistance could not be measured in children without spasticity because of the ceiling effect of the PEDI, but children with spasticity improved significantly with respect to these parameters (PEDI) (P < 0.05). Hence, epilepsy surgery does not harm motor performance in children with or without spasticity.

Effect of task context on reaching performance in children with spastic hemiparesis.

OBJECTIVE: To investigate the effect of task context on the quality of reaching movements in children with spastic hemiparesis. DESIGN: Randomized controlled experimental trial. SETTING: Institute for the Study of Education and Human Development (ISED). SUBJECTS: Twelve children (8-14 years of age) with spastic hemiplegic cerebral palsy. INTERVENTIONS: Subjects made fast reaching movements with the affected or nonaffected arm on a digitizer in three context conditions: (a) reach to press a light switch to turn on a red light (functional), (b) reach to press the light switch; no light (semi-functional), and (c) reach to a marker (nonfunctional). MAIN OUTCOME MEASURES: Kinematics of reaching movements of affected and nonaffected arms: movement time (MT), peak velocity (PV), time to PV, percentage of MT where peak velocity occurred (PPV), and smoothness (i.e. number of movement units (MU)). RESULTS: The functional condition elicited better quality of reaching for the nonaffected, but particularly the affected arm. Reaching of the affected arm was faster (larger MT; F = 10.21, p < 0.01), smoother (fewer MU; F = 19.95, p < 0.001), and better-controlled (right shift of PPV; F = 16.03, p < 0.001) compared with the semi- and nonfunctional condition. Reaching of the nonaffected arm was also faster (longer MT, F = 4.81, p < 0.05), and more smooth (fewer MU, F = 7.23, p < 0.05). CONCLUSIONS: These findings suggest that providing a functional context to perform a task may enhance the quality of reaching movements of the affected arm in children with spastic hemiparesis.

Bimanual circle drawing in children with spastic hemiparesis: effect of coupling modes on the performance of the impaired and unimpaired arms.

The present study examined the effect of interlimb coupling on the performance of the impaired and unimpaired arm in children with spastic hemiparesis during bimanual circle drawing. The following questions were addressed: (1) does coupling positively influence the performance of the impaired arm compared to single-hand performance and (2) is such an effect dependent on mode of coordination (i.e., symmetric versus asymmetric). Twelve children with spastic hemiparesis produced circle drawings on a digitizer under different task conditions. Spatiotemporal characteristics and quality of movement of pen trajectories of the individual limbs as well as interlimb relative phase were analysed. Coupling in a symmetric coordination mode resulted in a decrease of temporal variability and an increase of smoothness of circle drawing movements in the impaired arm compared to single-handed performance. Coupling in an asymmetric coordination mode resulted in an increase of spatial and temporal variability in the unimpaired arm. It is concluded that coupling may enhance the performance of the impaired arm in children with spastic hemiparesis, but only during symmetric bimanual coordination. A possible underlying neural mechanism that might explain these findings is discussed.

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.

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.