Quantifying Coloring Skills Among Preschoolers.

IMPORTANCE: Coloring is popular with preschool children and reveals their developmental state. However, interpreting coloring performances is challenging because descriptive and subjective evaluations are commonly used with large variations. OBJECTIVE: To develop a scoring method to objectively quantify children's coloring skills. DESIGN: Colored blank train templates were analyzed using four indicators (entropy, complexity, coloring outside the lines, and unexpected blank areas) to form a summed score. SETTING: Kindergarten in a urban city (Tainan, Taiwan). PARTICIPANTS: Two hundred thirty-nine typically developing children ages 3 to 6 yr. OUTCOME AND MEASURES: A newly developed method to assess coloring skill on the basis of a colored picture of a train. RESULTS: The summed score exhibited good internal consistency (Cronbach's α = .80), discriminative validity (p = .04), convergent validity (rs = .66 and .59 with age and visual-motor integration), and acceptable factorial validity (comparative fit index = .99, standardized root-mean-square residual = .04, and root-mean-square error of approximation = .13). Moreover, three coloring patterns (mature, transitional, and immature) were identified. CONCLUSIONS AND RELEVANCE: The new method provides objective, reliable, and valid scores representing coloring skills in typically developing children. In addition, the coloring patterns can be recognized. This method can be used to facilitate comparisons of children's coloring skills with peers and provide valuable insight into children's development. Plain-Language Summary: This study proposes a new method to objectively quantify children's coloring skills with sound reliability and validity in typically developing children. The method can be used to evaluate children's coloring skills and patterns to shed light on their developmental stages.

Motor Control Adherence to the Two-thirds Power Law Differs in Autistic Development.

Autistic individuals often exhibit motor atypicalities, which may relate to difficulties in social communication. This study utilized a smart tablet activity to computationally characterize motor control by testing adherence to the two-thirds power law (2/3 PL), which captures a systematic covariation between velocity and curvature in motor execution and governs many forms of human movement. Children aged 4-8 years old participated in this study, including 24 autistic children and 33 typically developing children. Participants drew and traced ellipses on an iPad. We extracted data from finger movements on the screen, and computed adherence to the 2/3 PL and other kinematic metrics. Measures of cognitive and motor functioning were also collected. In comparison to the typically developing group, the autistic group demonstrated greater velocity modulation between curved and straight sections of movement, increased levels of acceleration and jerk, and greater intra- and inter-individual variability across several kinematic variables. Further, significant motor control development was observed in typically developing children, but not in those with autism. This study is the first to examine motor control adherence to the 2/3 PL in autistic children, revealing overall diminished motor control. Less smooth, more varied movement and an indication of developmental stasis in autistic children were observed. This study offers a novel tool for computational characterization of the autism motor signature in children's development, demonstrating how smart tablet technology enables accessible assessment of children's motor performance in an objective, quantifiable and scalable manner.

Motor Signature Differences Between Autism Spectrum Disorder and Developmental Coordination Disorder, and Their Neural Mechanisms.

Autism spectrum disorder (ASD) and Developmental Coordination Disorder (DCD) are distinct clinical groups with overlapping motor features. We attempted to (1) differentiate children with ASD from those with DCD, and from those typically developing (TD) (ages 8-17; 18 ASD, 16 DCD, 20 TD) using a 5-min coloring game on a smart tablet and (2) identify neural correlates of these differences. We utilized standardized behavioral motor assessments (e.g. fine motor, gross motor, and balance skills) and video recordings of a smart tablet task to capture any visible motor, behavioral, posture, or engagement differences. We employed machine learning analytics of motor kinematics during a 5-min coloring game on a smart tablet. Imaging data was captured using functional magnetic resonance imaging (fMRI) during action production tasks. While subject-rated motor assessments could not differentiate the two clinical groups, machine learning computational analysis provided good predictive discrimination: between TD and ASD (76% accuracy), TD and DCD (78% accuracy), and ASD and DCD (71% accuracy). Two kinematic markers which strongly drove categorization were significantly correlated with cerebellar activity. Findings demonstrate unique neuromotor patterns between ASD and DCD relate to cerebellar function and present a promising route for computational techniques in early identification. These are promising preliminary results that warrant replication with larger samples.

Developmental differences in the prospective organisation of goal-directed movement between children with autism and typically developing children: A smart tablet serious game study.

Movement is prospective. It structures self-generated engagement with objects and social partners and is fundamental to children's learning and development. In autistic children, previous reports of differences in movement kinematics compared to neurotypical peers suggest that its prospective organisation might be disrupted. Here, we employed a smart tablet serious game paradigm to assess differences in the feedforward and feedback mechanisms of prospective action organisation, between autistic and neurotypical preschool children. We analysed 3926 goal-directed finger movements made during smart-tablet ecological gameplay, from 28 children with Childhood Autism (ICD-10; ASD) and 43 neurotypical children (TD), aged 3-6 years old. Using linear and generalised linear mixed-effect models, we found the ASD group executed movements with longer movement time (MT) and time to peak velocity (TTPV), lower peak velocity (PV), with PV less likely to occur in the first movement unit (MU) and with a greater number of movement units after peak velocity (MU-APV). Interestingly, compared to the TD group, the ASD group showed smaller increases in PV, TTPV and MT with an increase in age (ASD × age interaction), together with a smaller reduction in MU-APV and an increase in MU-APV at shorter target distances (ASD × Dist interaction). Our results are the first to highlight different developmental trends in anticipatory feedforward and compensatory feedback mechanisms of control, contributing to differences in movement kinematics observed between autistic and neurotypical children. These findings point to differences in integration of prospective perceptuomotor information, with implications for embodied cognition and learning from self-generated action in autism.

Metacarpophalangeal joint loads during bonobo locomotion: model predictions versus proxies.

The analysis of internal trabecular and cortical bone has been an informative tool for drawing inferences about behaviour in extant and fossil primate taxa. Within the hand, metacarpal bone architecture has been shown to correlate well with primate locomotion; however, the extent of morphological differences across taxa is unexpectedly small given the variability in hand use. One explanation for this observation is that the activity-related differences in the joint loads acting on the bone are simply smaller than estimated based on commonly used proxies (i.e. external loading and joint posture), which neglect the influence of muscle forces. In this study, experimental data and a musculoskeletal finger model are used to test this hypothesis by comparing differences between climbing and knuckle-walking locomotion of captive bonobos (Pan paniscus) based on (i) joint load magnitude and direction predicted by the models and (ii) proxy estimations. The results showed that the activity-related differences in predicted joint loads are indeed much smaller than the proxies would suggest, with joint load magnitudes being almost identical between the two locomotor modes. Differences in joint load directions were smaller but still evident, indicating that joint load directions might be a more robust indicator of variation in hand use than joint load magnitudes. Overall, this study emphasizes the importance of including muscular forces in the interpretation of skeletal remains and promotes the use of musculoskeletal models for correct functional interpretations.

Musculoskeletal models of a human and bonobo finger: parameter identification and comparison to in vitro experiments.

INTRODUCTION: Knowledge of internal finger loading during human and non-human primate activities such as tool use or knuckle-walking has become increasingly important to reconstruct the behaviour of fossil hominins based on bone morphology. Musculoskeletal models have proven useful for predicting these internal loads during human activities, but load predictions for non-human primate activities are missing due to a lack of suitable finger models. The main goal of this study was to implement both a human and a representative non-human primate finger model to facilitate comparative studies on metacarpal bone loading. To ensure that the model predictions are sufficiently accurate, the specific goals were: (1) to identify species-specific model parameters based on in vitro measured fingertip forces resulting from single tendon loading and (2) to evaluate the model accuracy of predicted fingertip forces and net metacarpal bone loading in a different loading scenario. MATERIALS & METHODS: Three human and one bonobo (Pan paniscus) fingers were tested in vitro using a previously developed experimental setup. The cadaveric fingers were positioned in four static postures and load was applied by attaching weights to the tendons of the finger muscles. For parameter identification, fingertip forces were measured by loading each tendon individually in each posture. For the evaluation of model accuracy, the extrinsic flexor muscles were loaded simultaneously and both the fingertip force and net metacarpal bone force were measured. The finger models were implemented using custom Python scripts. Initial parameters were taken from literature for the human model and own dissection data for the bonobo model. Optimized model parameters were identified by minimizing the error between predicted and experimentally measured fingertip forces. Fingertip forces and net metacarpal bone loading in the combined loading scenario were predicted using the optimized models and the remaining error with respect to the experimental data was evaluated. RESULTS: The parameter identification procedure led to minor model adjustments but considerably reduced the error in the predicted fingertip forces (root mean square error reduced from 0.53/0.69 N to 0.11/0.20 N for the human/bonobo model). Both models remained physiologically plausible after the parameter identification. In the combined loading scenario, fingertip and net metacarpal forces were predicted with average directional errors below 6° and magnitude errors below 12%. CONCLUSIONS: This study presents the first attempt to implement both a human and non-human primate finger model for comparative palaeoanthropological studies. The good agreement between predicted and experimental forces involving the action of extrinsic flexors-which are most relevant for forceful grasping-shows that the models are likely sufficiently accurate for comparisons of internal loads occurring during human and non-human primate manual activities.

A novel experimental design for the measurement of metacarpal bone loading and deformation and fingertip force.

BACKGROUND: Musculoskeletal and finite element modelling are often used to predict joint loading and bone strength within the human hand, but there is a lack of in vitro evidence of the force and strain experienced by hand bones. METHODS: This study presents a novel experimental setup that allows the positioning of a cadaveric digit in a variety of postures with the measurement of force and strain experienced by the third metacarpal. The setup allows for the measurement of fingertip force as well. We tested this experimental setup using three cadaveric human third digits in which the flexor tendons were loaded in two tendon pathways: (1) parallel to the metacarpal bone shaft, with bowstringing; (2) a semi-physiological condition in which the tendons were positioned closer to the bone shaft. RESULTS: There is substantial variation in metacarpal net force, metacarpal strain and fingertip force between the two tendon pathways. The net force acting on the metacarpal bone is oriented palmarly in the parallel tendon condition, causing tension along the dorsum of the metacarpal shaft, while the force increases and is oriented dorsally in the semi-physiological condition, causing compression of the dorsal metacarpal shaft. Fingertip force is also greater in the semi-physiological condition, implying a more efficient grip function. Inter-individual variation is observed in the radioulnar orientation of the force experienced by the metacarpal bone, the fingertip force, and the strain patterns on the metacarpal shaft. CONCLUSION: This study demonstrates a new method for measuring force and strain experienced by the metacarpal, and fingertip force in cadaveric digits that can, in turn, inform computation models. Inter-individual variation in loads experienced by the third digit suggest that there are differences in joint contact and/or internal bone structure across individuals that are important to consider in clinical and evolutionary contexts.

Effects of Carpal Tunnel Syndrome on Force Coordination and Muscle Coherence during Precision Pinch.

Carpal tunnel syndrome (CTS), caused by entrapment of the median nerve in the carpal tunnel, impairs hand function including dexterous manipulation. The purpose of this study was to investigate the effects of CTS on force coordination and muscle coherence during low-intensity sustained precision pinch while the wrist assumed different postures. Twenty subjects (10 CTS patients and 10 asymptomatic controls) participated in this study. An instrumented pinch device was used to measure the thumb and index finger forces while simultaneously collecting surface electromyographic activities of the abductor pollicis brevis (APB) and first dorsal interosseous (FDI) muscles. Subjects performed a sustained precision pinch at 10% maximum pinch force for 15 sec with the wrist stabilized at 30° extension, neutral, or 30° flexion using customized splints. The force discrepancy and the force coordination angle between the thumb and index finger forces were calculated, as well as the ß-band (15-30 Hz) coherence between APB and FDI. The index finger applied greater force than the thumb (p < 0.05); this force discrepancy was increased with wrist flexion (p < 0.05), but was not affected by CTS (p > 0.05). The directional force coordination was not significantly affected by wrist posture or CTS (p > 0.05). In general, digit force coordination during precision pinch seems to be sensitive to wrist flexion, but is not affected by CTS. The ß-band muscular coherence was increased by wrist flexion for CTS patients (p < 0.05), which could be a compensatory mechanism for the flexion-induced exacerbation of CTS symptoms. This study demonstrates that wrist flexion negatively influences muscle and force coordination in CTS patients supporting the avoidance of flexion posture for symptom exacerbation and functional performance.

Assessing Finger Joint Biomechanics by Applying Equal Force to Flexor Tendons In Vitro Using a Novel Simultaneous Approach.

BACKGROUND: The flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) are critical for finger flexion. Although research has recently focused on these tendons' coactivity, their contributions in different tasks remain unclear. This study created a novel simultaneous approach to investigate the coactivity between the tendons and to clarify their contributions in different tasks. METHODS: Ten human cadaveric hands were mounted on our custom frame with the FDS and FDP of the third finger looped through a mechanical pulley connected to a force transducer. Joint range of motion, tendon excursion and loading force were recorded during individual joint motion and free joint movement from rest to maximal flexion. Each flexor tendon's moment arm was then calculated. RESULTS: In individual motions, we found that the FDP contributed more than the FDS in proximal interphalangeal (PIP) joint motion, with an overall slope of 1.34 and all FDP-to-FDS excursion (P/S) ratios greater than 1.0 with force increase. However, the FDP contributed less than the FDS in metacarpophalangeal (MCP) joint motion, with an overall slope of 0.95 and P/S ratios smaller than 1.0 throughout the whole motion except between 1.9% and 13.1% force. In free joint movement, the FDP played a greater role than the FDS, with an overall ratio of 1.37 and all P/S ratios greater than 1.0. CONCLUSIONS: The new findings include differences in finger performance and excursion amounts between the FDS and FDP throughout flexion. Such findings may provide the basis for new hand models and treatments.

Effects of different extents of pulley release on tendon excursion efficiency and tendon moment arms.

To compare the excursion efficiency and moment arms of flexor digitorum superficialis (FDS) and profundus (FDP) among different conditions of pulley integrity related to trigger finger treatment, cadaveric fingers were first tested with an intact pulley system, and then the first (A1) and second (A2) annular pulleys were released gradually from the proximal to distal part. Linear position sensors and a motion capture system were used to measure the tendon excursion and joint rotation simultaneously. The tendon excursion efficiency was defined as the range of motion of the involved joints per unit of tendon excursion, and the tendon moment arm was determined by the slope of the linear fitting result of tendon excursion versus metacarpophalangeal (MCP) joint rotation. No significant differences were found between the release of the A1 pulley and the release extending to half the proximal part of the A2 pulley in the FDP excursion efficiency and the moment arms of FDS and FDP with respect to the MCP joint. These results imply that the release could extend to half the proximal A2 pulley, if necessary, without significantly decreasing the FDP excursion efficiency and increasing the moment arms of FDS and FDP with respect to the MCP joint.

Finger movement function after ultrasound-guided percutaneous pulley release for trigger finger: effects of postoperative rehabilitation.

OBJECTIVE: To develop and test a postoperative rehabilitation protocol for use by individuals with trigger finger undergoing ultrasound-guided percutaneous pulley release. DESIGN: Nonrandomized controlled trial. SETTING: Hospital and local community. PARTICIPANTS: Individuals suffering from trigger finger with joint contracture (N=21) were recruited and grouped into an intervention group (n=9) or a control group (n=12). INTERVENTIONS: All the participants underwent the same surgical procedure performed by the same surgeon. A 4-week postoperative rehabilitation program was designed based on the wound healing process. The intervention group received postoperative rehabilitation after the surgery, whereas the control group received no treatment after the surgery. MAIN OUTCOME MEASURES: The finger movement functions were quantitatively evaluated before and 1 month after the surgery using a 3-dimensional motion capture system. The fingertip workspace and joint range of motion (ROM) were evaluated while the participant was performing a sequential 5-posture movement, including finger extension, intrinsic plus, straight fist, full fist, and hook fist. RESULTS: The intervention group demonstrated significantly more improvements than the control group in the fingertip workspace (49% vs 17%), ROM of the distal interphalangeal (DIP) joint (16% vs 4%), ROM of the proximal interphalangeal (PIP) joint (21% vs 5%), and total active ROM (17% vs 5%). CONCLUSIONS: This pilot study evaluated a postoperative rehabilitation protocol for trigger finger and demonstrated its effects on various finger functions. Participants who underwent the rehabilitation program had significantly more improvements in the fingertip workspace, ROM of the DIP and PIP joints, and total active ROM.

Quantifying catch-and-release: the extensor tendon force needed to overcome the catching flexors in trigger fingers.

The extensor tendon forces required to overcome the catching flexors in trigger fingers are unknown. A biomechanical model with moment equilibrium equations and method of least squares was developed for estimating the tendon force at triggering in trigger fingers. Trigger fingers that exhibited significant catching and sudden release during finger extension were tested. A customized "pulling tester" was used to pull the finger from flexion to extension and provide synchronic measurement of the pulling force. The displacement of the tested finger was measured by a motion capture system. This preliminary study presents kinematic and kinetic data at triggering of 10 trigger fingers. The distal and proximal interphalangeal (PIP) joints presented sudden release while the metacarpophalangeal (MCP) joint started extension in the early phase of finger extension. The tendon tension of flexor digitorum profundus was greater than that of flexor digitorum superficialis (FDS) in six fingers, and less than that of FDS in three fingers. The tension of two flexor tendons was almost equal in one finger. At the PIP and MCP joints, 1.54 times the force of flexors was needed for the extensors to overcome the catching flexors in trigger fingers. This biomechanical model provides clinicians with a clearer idea of the tendon force at triggering. The quantitative results may help in the understanding of movement characteristics of trigger fingers. These findings are useful to better understand the etiology and nature of trigger finger development, and thus aid in further development of better assessments and treatments related to this.

Effect of the Kinesio tape to muscle activity and vertical jump performance in healthy inactive people.

BACKGROUND: Elastic taping applied on the triceps surae has been commonly used to improve the performance of lower extremities. However, little objective evidence has been documented. The purpose of this study was to investigate the effect of elastic taping on the triceps surae during a maximal vertical jump. It was hypothesized that elastic taping to the triceps surae would increase muscle activity and cause positive effect to jump height. METHODS: Thirty-one healthy adults (19 males and 12 females with mean age, body weight and height for 25.3 ± 3.8 years old, 64.1 ± 6.2 kg, and 169.4 ± 7.3 cm, respectively) were recruited. All participants performed vertical jump tests prior to (without taping) and during elastic taping. Two elastic tapes, Kinesio tape and Mplacebo tape from two different manufacturers, were applied to the participants, respectively. RESULTS: The results showed that the vertical ground reaction force increased when Kinesio tape was applied even when the height of jump remained about constant. However, the height of the jump decreased, and there was no difference on the vertical ground reaction force in Mplacebo taping group. Although the EMG activity of medial gastrocnemius tended to increase in Kinesio taping group, we did not see differences in EMG activity for the medial gastrocnemius, tibialis anterior and soleus muscles in either group. CONCLUSIONS: Based on the varied effects of Kinesio tape and Mplacebo tape, different intervention technique was suggested for specific purpose during vertical jump movement. Mplacebo tape was demanded for the benefits of stabilization, protection, and the restriction of motion at the ankle joint. On the other hand, the findings may implicate benefits for medial gastrocnemius muscle strength and push-off force when using Kinesio tape.

Reappraisal of fetal abdominal circumference in an Asian population: analysis of 50,131 records.

OBJECTIVE: Fetuses from different populations may show different growth patterns. In obstetrics, fetal abdominal circumference (AC) is a very useful index for assessing fetal growth. In this study, we attempted to establish the normal fetal growth curves of AC in an Asian population in South Taiwan. MATERIALS AND METHODS: We reviewed our computer ultrasound database of fetal AC records from January 1991 to December 2006. During the study period of 16 years, only the fetuses examined by ultrasonography with gestational age between 14 and 41 weeks were included. We excluded extreme bilateral records after initial analysis. Eventually, 50,131 records of AC were included for final analysis. RESULTS: The observed gestation-specific AC values and the predicted AC values were calculated. The best-fit regression equation of AC versus gestational age is a second-order polynomial equation. In general, fetal AC values in our population showed similar patterns to those in Western populations. Besides, we established a table of the predicted AC values based on specific gestational age, including the 5 th , 10 th , 50 th , 90 th and 95 th centiles, for clinical reference. CONCLUSION: To the best of our knowledge, our series is the largest sample of AC reported in the medical literature. We believe that the gestational age-specific nomogram of fetal AC is important for further clinical assessment of fetal growth.

Reappraisal of normal amniotic fluid index in an Asian population: analysis of 27,088 records.

OBJECTIVE: Amniotic fluid index (AFI) is a very useful index for assessing fetal well-being. In 1998, a study of AFI in mainland China showed that AFI values in normal pregnancies were less than those in Western populations. Therefore, we attempt to investigate whether fetal AFI in our population is less than that in Western populations. MATERIALS AND METHODS: We reviewed our computerized ultrasound database for fetal AFI from January 1991 to December 2002. For the 12-year study period, only the fetuses that fit the following criteria were included: (1) gestational age ranging from 14 to 41 weeks; (2) singletons, and (3) average-for-gestational-age as evaluated by ultrasound examination. Eventually, 27,088 records were included for the final analysis. RESULTS: The gestation-specific AFI showed patterns that were similar to those previously reported for the Western populations, with the mean being 10.6 cm at 14 weeks, increasing to 16.2 cm at 22 weeks, and then gradually declining to 12.7 cm at 40 weeks. In addition, the mean AFI in our population was greater than that in a Chinese population from mainland China. The best-fit regression line was a second-order polynomial regression line. CONCLUSION: To the best of our knowledge, our series is the largest sample of AFI reported in the medical literature. Our AFI data in Taiwan were closer to those in Western populations and greater than those in a Chinese population from mainland China. The underlying causes are still unknown. Further international collaborative studies are warranted.

Burkitt'S lymphoma mimicking a primary gynecologic tumor.

OBJECTIVE: Burkitt's lymphoma (BL) occurs mostly in children; bilateral ovarian involvement mimicking a gynecologic malignancy in adults is extremely rare. Here, we report a patient with BL mimicking a gynecologic tumor. CASE REPORT: A 50-year-old Taiwanese woman presented with the complaint of persistent lower abdominal distension with dull pain, easy satiety, and progressively increasing abdominal girth for 2 weeks. Amenorrhea was also noted for about 2 months, and her review of systems was negative for the common "B" symptoms associated with lymphoma. At our hospital, imaging studies revealed a huge pelvic mass (10.8 x 8.7 cm), suggesting a large subserous myoma or an ovarian tumor. Under the impression of pelvic mass, she underwent exploratory laparotomy. Primary ovarian sex-cord malignancy with cecum involvement was impressed by the primitive intraoperative frozen section report. Subsequently, an optimal cytoreductive operation with right hemicolectomy was performed. However, final histopathologic report was an extranodal multifocal BL. CONCLUSION: Although extranodal BL in ovaries is a rare condition, it should be noted in the differential diagnosis of pelvic gynecologic malignancies.