NCS Assessments of the Motor, Sensory, and Physical Health Domains.

As part of the National Children's Study (NCS) comprehensive and longitudinal assessment of the health status of the whole child, scientific teams were convened to recommend assessment measures for the NCS. This manuscript documents the work of three scientific teams who focused on the motor, sensory, or the physical health aspects of this assessment. Each domain team offered a value proposition for the importance of their domain to the health outcomes of the developing infant and child. Constructs within each domain were identified and measures of these constructs proposed. Where available extant assessments were identified. Those constructs that were in need of revised or new assessment instruments were identified and described. Recommendations also were made for the age when the assessments should take place.

Beyond the mean reaction time: Trial-by-trial reaction time reveals the distraction effect on perceptual-motor sequence learning.

Perceptual-motor sequences can be learned quickly under distraction, often demonstrated by the mean reaction time (RT) change in a serial reaction time (SRT) task. However, any arbitrary mean RT can arise from one of many distinct trial-by-trial RT patterns. It is surprising that previous sequence learning studies have hinged only on the mean RT metrics while little is known about the distraction effect on its trial-by-trial processes. In an SRT task with or without distraction, we found that initially learning a fixed repeating sequence without distraction was expressed by a micro-online learning process where reaction time (RT) progressively improved within learning blocks as adults continuously performed the SRT task. Such online RT improvements, however, vanished when the SRT task was performed under distraction. Despite the detrimental effect of distraction on micro-online RT improvements, we observed offline enhancements in RT following rest intervals of 3 min that emerged to secure sequence learning under distraction. We reasoned that distraction may exert influence on the micro-online and offline learning by mediating the engagement of explicit and implicit memory. Given the offline RT change under distraction, a short rest between learning blocks may be a key player in early perceptual-motor sequence learning under distraction. We thus suggest that future studies investigating the distraction effect on sequence learning need to control the length of rest between learning blocks, while previous research with equivocal interpretations of the distraction effect failed to do so.

A Perception-Action Approach to Understanding Typical and Atypical Motor Development.

In this chapter, we ask two questions. First, can the study of the perception-action system across time offer a useful model for understanding motor development? Second, can the study of the perception-action system in children with developmental coordination disorder (DCD) inform our understanding of atypical as well as typical motor development? We begin by describing the dynamical systems perspective and a control-theoretic approach that together provide the conceptual framework for our paradigms, methodology, and interpretation of our experiments. Our experimental strategy has been to perturb one or more sensory systems and observe the effect on the motor system. The majority of the chapter explains how we employed two principal perturbation strategies: (1) removing or adding a static source of sensory information believed to be salient to the task at hand and (2) enhancing a dynamic source of sensory information either implicitly or explicitly. These strategies were employed in three different action systems: posture; rhythmic interlimb coordination, and goal-directed reaching and drawing. After synthesizing our findings, we conclude by addressing the original questions and offering future directions. In brief, we consider that perception-action coupling is an underlying mechanism/foundation/constraint of motor development in the sense that the ongoing processing of sensations and the planning and execution of movements are how the brain produces goal-directed movements. Therefore, a better understanding of how this coupling changes or adapts over time has much to offer as to how motor behavior develops across the lifespan, both typically and atypically.

The "Motor" in Implicit Motor Sequence Learning: A Foot-stepping Serial Reaction Time Task.

This protocol describes a modified serial reaction time (SRT) task used to study implicit motor sequence learning. Unlike the classic SRT task that involves finger-pressing movements while sitting, the modified SRT task requires participants to step with both feet while maintaining a standing posture. This stepping task necessitates whole body actions that impose postural challenges. The foot-stepping task complements the classic SRT task in several ways. The foot-stepping SRT task is a better proxy for the daily activities that require ongoing postural control, and thus may help us better understand sequence learning in real-life situations. In addition, response time serves as an indicator of sequence learning in the classic SRT task, but it is unclear whether response time, reaction time (RT) representing mental process, or movement time (MT) reflecting the movement itself, is a key player in motor sequence learning. The foot-stepping SRT task allows researchers to disentangle response time into RT and MT, which may clarify how motor planning and movement execution are involved in sequence learning. Lastly, postural control and cognition are interactively related, but little is known about how postural control interacts with learning motor sequences. With a motion capture system, the movement of the whole body (e.g., the center of mass (COM)) can be recorded. Such measures allow us to reveal the dynamic processes underlying discrete responses measured by RT and MT, and may aid in elucidating the relationship between postural control and the explicit and implicit processes involved in sequence learning. Details of the experimental set-up, procedure, and data processing are described. The representative data are adopted from one of our previous studies. Results are related to response time, RT, and MT, as well as the relationship between the anticipatory postural response and the explicit processes involved in implicit motor sequence learning.

Timing at peak force may be the hidden target controlled in continuation and synchronization tapping.

Timing control, such as producing movements at a given rate or synchronizing movements to an external event, has been studied through a finger-tapping task where timing is measured at the initial contact between finger and tapping surface or the point when a key is pressed. However, the point of peak force is after the time registered at the tapping surface and thus is a less obvious but still an important event during finger tapping. Here, we compared the time at initial contact with the time at peak force as participants tapped their finger on a force sensor at a given rate after the metronome was turned off (continuation task) or in synchrony with the metronome (sensorimotor synchronization task). We found that, in the continuation task, timing was comparably accurate between initial contact and peak force. These two timing events also exhibited similar trial-by-trial statistical dependence (i.e., lag-one autocorrelation). However, the central clock variability was lower at the peak force than the initial contact. In the synchronization task, timing control at peak force appeared to be less variable and more accurate than that at initial contact. In addition to lower central clock variability, the mean SE magnitude at peak force (SEP) was around zero while SE at initial contact (SEC) was negative. Although SEC and SEP demonstrated the same trial-by-trial statistical dependence, we found that participants adjusted the time of tapping to correct SEP, but not SEC, toward zero. These results suggest that timing at peak force is a meaningful target of timing control, particularly in synchronization tapping. This result may explain the fact that SE at initial contact is typically negative as widely observed in the preexisting literature.

Children and Adults Both Learn Motor Sequences Quickly, But Do So Differently.

Both children and adults can learn motor sequences quickly in one learning session, yet little is known about potential age-related processes that underlie this fast sequence acquisition. Here, we examined the progressive performance changes in a one-session modified serial reaction time task in 6- and 10-year-old children and adults. We found that rapid sequence learning, as reflected by reaction time (RT), was comparable between groups. The learning was expressed through two behavioral processes: online progressive changes in RT while the task was performed in a continuous manner and offline changes in RT that emerged following a short rest. These offline and online RT changes were age-related; learning in 6-year-olds was primarily reflected through the offline process. In contrast, learning in adults was reflected through the online process; and both online and offline processes occurred concurrently in 10-year-olds. Our results suggest that early rapid sequence learning has a developmental profile. Although the unifying mechanism underlying these two age-related processes is unclear, we discuss possible explanations that need to be systematically elucidated in future studies.

New insights into statistical learning and chunk learning in implicit sequence acquisition.

Implicit sequence learning is ubiquitous in our daily life. However, it is unclear whether the initial acquisition of sequences results from learning to chunk items (i.e., chunk learning) or learning the underlying statistical regularities (i.e., statistical learning). By grouping responses with or without a distinct chunk or statistical structure into segments and comparing these responses, previous studies have demonstrated both chunk and statistical learning. However, few studies have considered the response sequence as a whole and examined the temporal dependency of the entire sequence, where the temporal dependencies could disclose the internal representations of chunk and statistical learning. Participants performed a serial reaction time (SRT) task under different stimulus interval conditions. We found that sequence learning reflected by reaction time (RT) rather than motor improvements represented by movement time (MT). The temporal dependency of RT and MT revealed that both RT and MT displayed recursive patterns caused by biomechanical effects of response locations and foot transitions. Chunking was noticeable only in the presence of the recurring RT or MT but vanished after the recursive component was removed, implying that chunk formation may result from biomechanical constraints rather than learning itself. In addition, we observed notable first-order autocorrelations in RT. This trial-to-trial association enhanced as learning progressed regardless of stimulus intervals, reflecting the internal cognitive representation of the first-order stimulus contingencies. Our results suggest that initial acquisition of implicit sequences may arise from first-order statistical learning rather than chunk learning.

Children with developmental coordination disorder (DCD) can adapt to perceptible and subliminal rhythm changes but are more variable.

Children with DCD demonstrate impairments in bimanual finger tapping during self-paced tapping and tapping in synchrony to different frequencies. In this study, we investigated the ability of children with DCD to adapt motorically to perceptible or subliminal changes of the auditory stimuli without a change in frequency, and compared their performance to typically developing controls (TDC). Nineteen children with DCD between ages 6-11years (mean age±SD=114±21months) and 17 TDC (mean age±SD=113±21months) participated in this study. Auditory perceptual threshold was established. Children initially tapped bimanually to an antiphase beat and then to either a perceptible change in rhythm or to gradual subliminal changes in rhythm. Children with DCD were able to perceive changes in rhythm similar to TDC. They were also able to adapt to both perceptible and subliminal changes in rhythms similar to their age- and gender- matched TDC. However, these children were significantly more variable compared with TDC in all phasing conditions. The results suggest that the performance impairments in bilateral tapping are not a result of poor conscious or sub-conscious perception of the auditory cue. The increased motor variability may be associated with cerebellar dysfunction but further behavioral and neurophysiological studies are needed.

Probabilistic Motor Sequence Yields Greater Offline and Less Online Learning than Fixed Sequence.

It is well acknowledged that motor sequences can be learned quickly through online learning. Subsequently, the initial acquisition of a motor sequence is boosted or consolidated by offline learning. However, little is known whether offline learning can drive the fast learning of motor sequences (i.e., initial sequence learning in the first training session). To examine offline learning in the fast learning stage, we asked four groups of young adults to perform the serial reaction time (SRT) task with either a fixed or probabilistic sequence and with or without preliminary knowledge (PK) of the presence of a sequence. The sequence and PK were manipulated to emphasize either procedural (probabilistic sequence; no preliminary knowledge (NPK)) or declarative (fixed sequence; with PK) memory that were found to either facilitate or inhibit offline learning. In the SRT task, there were six learning blocks with a 2 min break between each consecutive block. Throughout the session, stimuli followed the same fixed or probabilistic pattern except in Block 5, in which stimuli appeared in a random order. We found that PK facilitated the learning of a fixed sequence, but not a probabilistic sequence. In addition to overall learning measured by the mean reaction time (RT), we examined the progressive changes in RT within and between blocks (i.e., online and offline learning, respectively). It was found that the two groups who performed the fixed sequence, regardless of PK, showed greater online learning than the other two groups who performed the probabilistic sequence. The groups who performed the probabilistic sequence, regardless of PK, did not display online learning, as indicated by a decline in performance within the learning blocks. However, they did demonstrate remarkably greater offline improvement in RT, which suggests that they are learning the probabilistic sequence offline. These results suggest that in the SRT task, the fast acquisition of a motor sequence is driven by concurrent online and offline learning. In addition, as the acquisition of a probabilistic sequence requires greater procedural memory compared to the acquisition of a fixed sequence, our results suggest that offline learning is more likely to take place in a procedural sequence learning task.

Development of adaptive sensorimotor control in infant sitting posture.

A reliable and adaptive relationship between action and perception is necessary for postural control. Our understanding of how this adaptive sensorimotor control develops during infancy is very limited. This study examines the dynamic visual-postural relationship during early development. Twenty healthy infants were divided into 4 developmental groups (each n=5): sitting onset, standing alone, walking onset, and 1-year post-walking. During the experiment, the infant sat independently in a virtual moving-room in which anterior-posterior oscillations of visual motion were presented using a sum-of-sines technique with five input frequencies (from 0.12 to 1.24 Hz). Infants were tested in five conditions that varied in the amplitude of visual motion (from 0 to 8.64 cm). Gain and phase responses of infants' postural sway were analyzed. Our results showed that infants, from a few months post-sitting to 1 year post-walking, were able to control their sitting posture in response to various frequency and amplitude properties of the visual motion. Infants showed an adult-like inverted-U pattern for the frequency response to visual inputs with the highest gain at 0.52 and 0.76 Hz. As the visual motion amplitude increased, the gain response decreased. For the phase response, an adult-like frequency-dependent pattern was observed in all amplitude conditions for the experienced walkers. Newly sitting infants, however, showed variable postural behavior and did not systemically respond to the visual stimulus. Our results suggest that visual-postural entrainment and sensory re-weighting are fundamental processes that are present after a few months post sitting. Sensorimotor refinement during early postural development may result from the interactions of improved self-motion control and enhanced perceptual abilities.

Development of kinesthetic-motor and auditory-motor representations in school-aged children.

In two experiments using a center-out task, we investigated kinesthetic-motor and auditory-motor integrations in 5- to 12-year-old children and young adults. In experiment 1, participants moved a pen on a digitizing tablet from a starting position to one of three targets (visuo-motor condition), and then to one of four targets without visual feedback of the movement. In both conditions, we found that with increasing age, the children moved faster and straighter, and became less variable in their feedforward control. Higher control demands for movements toward the contralateral side were reflected in longer movement times and decreased spatial accuracy across all age groups. When feedforward control relies predominantly on kinesthesia, 7- to 10-year-old children were more variable, indicating difficulties in switching between feedforward and feedback control efficiently during that age. An inverse age progression was found for directional endpoint error; larger errors increasing with age likely reflect stronger functional lateralization for the dominant hand. In experiment 2, the same visuo-motor condition was followed by an auditory-motor condition in which participants had to move to acoustic targets (either white band or one-third octave noise). Since in the latter directional cues come exclusively from transcallosally mediated interaural time differences, we hypothesized that auditory-motor representations would show age effects. The results did not show a clear age effect, suggesting that corpus callosum functionality is sufficient in children to allow them to form accurate auditory-motor maps already at a young age.

Preparing future faculty and professionals for public health careers.

Recent years have brought rapid growth in schools of public health and an increasing demand for public health practitioners. These trends highlight the need for innovative approaches to prepare doctoral graduates for academic and high-level practice positions. The University of Maryland's School of Public Health developed a "Preparing Future Faculty and Professionals" program to enrich the graduate education and professional development of its doctoral students. We describe the program's key elements, including foundational seminars to enhance students' knowledge and skills related to teaching, research, and service; activities designed to foster career exploration and increase competitiveness in the job market; and independent, faculty-mentored teaching and research experiences. We present a model for replicating the program and share student outcomes of participation.

Training oncology and palliative care clinical nurse specialists in psychological skills: evaluation of a pilot study.

OBJECTIVE: National guidelines in the United Kingdom recommend training Clinical Nurse Specialists in psychological skills to improve the assessment and intervention with psychological problems experienced by people with a cancer diagnosis (National Institute for Health and Clinical Excellence, 2004). This pilot study evaluated a three-day training program combined with supervision sessions from Clinical Psychologists that focused on developing skills in psychological assessment and intervention for common problems experienced by people with cancer. METHODS: Questionnaires were developed to measure participants' levels of confidence in 15 competencies of psychological skills. Participants completed these prior to the program and on completion of the program. Summative evaluation was undertaken and results were compared. In addition, a focus group interview provided qualitative data of participants' experiences of the structure, process, and outcomes of the program. RESULTS: Following the program, participants rated their confidence in psychological assessment and skills associated with providing psychological support as having increased in all areas. This included improved knowledge of psychological theories, skills in assessment and intervention and accessing and using supervision appropriately. The largest increase was in providing psycho-education to support the coping strategies of patients and carers. Thematic analysis of interview data identified two main themes including learning experiences and program enhancements. The significance of the clinical supervision sessions as key learning opportunities, achieved through the development of a community of practice, emerged. SIGNIFICANCE OF RESULTS: Although this pilot study has limitations, the results suggest that a combined teaching and supervision program is effective in improving Clinical Nurse Specialists' confidence level in specific psychological skills. Participants' experiences highlighted suggestions for refinement and development of the program. Opportunities for further research and developments in this area are discussed.

Validity and reliability of the TGMD-2 for South Korean children.

The purpose of this study was to investigate the reliability and validity of the Test of Gross Motor Development-2 (TGMD-2) for South Korean children. Three professionals assessed all children. Appropriate internal consistency (Cronbach's alpha values from 0.73 to 0.87), concordance among evaluators (≥ .92), and test-retest reliability (locomotor = .91; object control = .85) were found. Appropriate fit indexes were found for the 1-factor nested model and the 2-factor model (goodness-of-fit index = 0.91, normed fit index = 0.87, comparative fit index = 0.94, Tucker-Lewis index = 0.93, incremental fit index = 0.95, root mean square error of approximation = 0.07). The 2-factor results from South Korean sample were similar to the results reported in the American sample. The TGMD-2 is an appropriate tool for assessing the motor skills of children in South Korea.

Development of interactions between sensorimotor representations in school-aged children.

Reliable sensory-motor integration is a pre-requisite for optimal movement control; the functionality of this integration changes during development. Previous research has shown that motor performance of school-age children is characterized by higher variability, particularly under conditions where vision is not available, and movement planning and control is largely based on kinesthetic input. The purpose of the current study was to determine the characteristics of how kinesthetic-motor internal representations interact with visuo-motor representations during development. To this end, we induced a visuo-motor adaptation in 59 children, ranging from 5 to 12years of age, as well as in a group of adults, and measured initial directional error (IDE) and endpoint error (EPE) during a subsequent condition where visual feedback was not available, and participants had to rely on kinesthetic input. Our results show that older children (age range 9-12years) de-adapted significantly more than younger children (age range 5-8years) over the course of 36 trials in the absence of vision, suggesting that the kinesthetic-motor internal representation in the older children was utilized more efficiently to guide hand movements, and was comparable to the performance of the adults.

Differences in movement-related cortical activation patterns underlying motor performance in children with and without developmental coordination disorder.

Behavioral deficits in visuomotor planning and control exhibited by children with developmental coordination disorder (DCD) have been extensively reported. Although these functional impairments are thought to result from "atypical brain development," very few studies to date have identified potential neurological mechanisms. To address this knowledge gap, electroencephalography (EEG) was recorded from 6- to 12-yr-old children with and without DCD (n = 14 and 20, respectively) during the performance of a visuomotor drawing task. With respect to motor performance, typically developing (TD) children exhibited age-related improvements in key aspects of motor planning and control. Although some children with DCD performed outside this TD landscape (i.e., age-related changes within the TD group), the group developmental trajectory of the children with DCD was similar to that of the TD children. Despite overall similarities in performance, engagement of cortical resources in the children with DCD was markedly different from that in their TD counterparts. While the patterns of activation are stable in TD children across the age range, the young children with DCD exhibited less engagement of motor cortical brain areas and the older children with DCD exhibited greater engagement of motor cortical brain areas than their TD peers. These results suggest that older children with DCD may employ a compensatory strategy in which increased engagement of relevant motor resources allows these children to perform comparably to their TD peers. Moreover, the magnitude of activation was related to several kinematic measures, particularly in children with DCD, suggesting that greater engagement in motor resources may underlie better behavioral performance.

Development of multisensory reweighting is impaired for quiet stance control in children with developmental coordination disorder (DCD).

BACKGROUND: Developmental Coordination Disorder (DCD) is a leading movement disorder in children that commonly involves poor postural control. Multisensory integration deficit, especially the inability to adaptively reweight to changing sensory conditions, has been proposed as a possible mechanism but with insufficient characterization. Empirical quantification of reweighting significantly advances our understanding of its developmental onset and improves the characterization of its difference in children with DCD compared to their typically developing (TD) peers. METHODOLOGY/PRINCIPAL FINDINGS: Twenty children with DCD (6.6 to 11.8 years) were tested with a protocol in which visual scene and touch bar simultaneously oscillateded medio-laterally at different frequencies and various amplitudes. Their data were compared to data on TD children (4.2 to 10.8 years) from a previous study. Gains and phases were calculated for medio-lateral responses of the head and center of mass to both sensory stimuli. Gains and phases were simultaneously fitted by linear functions of age for each amplitude condition, segment, modality and group. Fitted gains and phases at two comparison ages (6.6 and 10.8 years) were tested for reweighting within each group and for group differences. Children with DCD reweight touch and vision at a later age (10.8 years) than their TD peers (4.2 years). Children with DCD demonstrate a weak visual reweighting, no advanced multisensory fusion and phase lags larger than those of TD children in response to both touch and vision. CONCLUSIONS/SIGNIFICANCE: Two developmental perspectives, postural body scheme and dorsal stream development, are provided to explain the weak vision reweighting. The lack of multisensory fusion supports the notion that optimal multisensory integration is a slow developmental process and is vulnerable in children with DCD.

Developmental delay of finger torque control in children with developmental coordination disorder.

AIM: We examined whether the behavioral impairments in finger torque control evident in children with developmental coordination disorder (DCD) follow a delayed or different developmental trajectory compared with their typically developing peers. METHOD: Children with DCD (n=36; 18 males, 18 females; mean age 9y 7mo, SD 1y 8mo) and 36 typically developing children (15 males, 21 females; mean age 9y 7mo, SD 2y), between 6 years 10 months and 12 years 7 months of age were recruited from schools in Porto Alegre, Brazil. Particpants completed finger torque control and maximum finger torque production tasks. The inclusion criterion for children with DCD was a Movement Assessment Battery for Children score below the fifth centile. Group means and cross-sectional age-related landscapes of the two groups were compared. RESULTS: Children with DCD were more variable (p<0.001), less accurate (p=0.007), and less irregular (p<0.001), on average, in their finger torque control than their typically developing peers, despite producing nearly equivalent levels of maximum torque (p=0.49). Despite these mean differences, the cross-sectional age-related changes in torque control were similar in the two groups (all p>0.05). INTERPRETATION: The developmental trajectory of finger torque control in children with DCD, compared with typically developing children, is delayed. This suggests the behavioral deficits in finger torque control in children with DCD persist as a function of age, rather than progressing or resolving.

Development of state estimation explains improvements in sensorimotor performance across childhood.

Previous developmental research examining sensorimotor control of the arm in school-age children has demonstrated age-related improvements in movement kinematics. However, the mechanisms that underlie these age-related improvements are still unclear. This study hypothesized that changes in sensorimotor performance across childhood can be attributed, in part, to the development of state estimation, defined as estimates computed by the central nervous system, which specify both current and future hand positions and velocities (i.e., hand "state"). Two behavioral experiments were conducted, in which 6- to 12-year-old children and young adults executed goal-directed arm movements. Results from Experiment 1 revealed that young children (i.e., ∼6-8 years) have less precise proprioceptive feedback for static (i.e., stationary) hand state estimation compared with older children (i.e., ∼10-12 years), resulting in increased variability of target-directed reaching movements. Experiment 2 demonstrated that young children rely on delayed and unreliable state estimates during the execution of goal-directed hand movements (i.e., dynamic state estimation), resulting in both increased movement errors and directional variability. Collectively, these results suggest that improvements in sensorimotor behavior across childhood can be attributed, at least partially, to the development of both static and dynamic state estimation.