Peripheral quantitative computed tomography (pQCT) reveals low bone mineral density in adolescents with motor difficulties

Motor competence is related to acquisition of error-based but not reinforcement learning in children ages 6 to 12

Background

An essential component of childhood development is increasing motor competence. Poor motor learning is often thought to underlie impaired motor competence, but this link is unclear in previous studies.

Aims

Our aim was to test the relationship between motor competence and motor learning in the acquisition phase. Both reinforcement learning (RL) and error-based learning (EBL) were tested. We hypothesized that slower RL and slower EBL acquisition rates would relate to lower motor competence.

Methods and procedures

Eighty-six participants ages 6-12 performed a target throwing task under RL and EBL conditions. The Movement Assessment Battery for Children - 2nd edition (MABC-2) provided a measure of motor competence. We assessed EBL and RL acquisition rates, baseline variability, and baseline bias from the throwing task.

Outcomes and results

In a multiple linear regression model, baseline variability (β = -0.49, p = <0.001) and the EBL acquisition rate (β = -0.24, p = 0.018) significantly explained the MABC-2 score. Participants with higher baseline variability and slower EBL acquisition had lower motor competence scores. The RL acquisition rate was independent of MABC-2 score suggesting that RL may be less of a contributor to poor motor competence.

Conclusions and implications

Children with slower EBL acquisition had lower motor competence scores but RL acquisition was unrelated to the level of motor competence. Emphasizing the unrelated reinforcement mechanisms over error-based mechanisms during motor skill interventions may help children with poor motor competence better acquire new motor skills.

Reduced Peak Bone Mass in Young Adults With Low Motor Competence

Although suboptimal bone health has been reported in children and adolescents with low motor competence (LMC), it is not known whether such deficits are present at the time of peak bone mass. We examined the impact of LMC on bone mineral density (BMD) in 1043 participants (484 females) from the Raine Cohort Study. Participants had motor competence assessed using the McCarron Assessment of Neuromuscular Development at 10, 14, and 17 years, and a whole-body dual-energy X-ray absorptiometry (DXA) scan at 20 years. Bone loading from physical activity was estimated from the International Physical Activity Questionnaire at the age of 17 years. The association between LMC and BMD was determined using general linear models that controlled for sex, age, body mass index, vitamin D status, and prior bone loading. Results indicated LMC status (present in 29.6% males and 21.9% females) was associated with a 1.8% to 2.6% decrease in BMD at all load-bearing bone sites. Assessment by sex showed that the association was mainly in males. Osteogenic potential of physical activity was associated with increased BMD dependent on sex and LMC status, with males with LMC showing a reduced effect from increasing bone loading. As such, although engagement in osteogenic physical activity is associated with BMD, other factors involved in physical activity, eg, diversity, movement quality, may also contribute to BMD differences based upon LMC status. The finding of lower peak bone mass for individuals with LMC may reflect a higher risk of osteoporosis, especially for males; however, further research is required. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Association of developmental coordination disorder and low motor competence with impaired bone health: A systematic review

AIMS

Individuals with developmental coordination disorder (DCD) and low motor competence (LMC) may be at increased risk of low bone health due to their lifetime physical activity patterns. Impaired bone health increases an individual's risk of osteoporosis and fracture; therefore, it is necessary to determine whether a bone health detriment is present in this group. Accordingly, this systematic review explores the association between DCD/LMC and bone health.

METHODS AND PROCEDURES

Studies were included with assessment of bone health in a DCD/LMC population. Study bias was assessed using the JBI critical appraisal checklist. Due to heterogeneity, meta-analysis was not possible and narrative synthesis was performed with effect size and direction assessed via harvest plots.

OUTCOMES AND RESULTS

A total of 16 (15 paediatric/adolescent) studies were included. Deficits in bone measures were reported for the DCD/LMC group and were more frequent in weight-bearing sites. Critical appraisal indicated very low confidence in the results, with issues relating to indirectness and imprecision relating to comorbidities.

CONCLUSIONS AND IMPLICATIONS

Individuals with DCD or LMC are at increased risk of bone health deficits. Bone impairment locations indicate insufficient loading via physical activity as a potential cause of bone deficits. Results indicate a potential for earlier osteoporosis onset.

Pediatric care for children with developmental coordination disorder, can we do better?

This paper adopts a method of narrative critical review based on a non-systematic search of the literature to provide insights into the trends of developmental coordination disorder (DCD) treatment and to point out some future alternative approaches to prevent secondary health implications in children with DCD. The cause of DCD is unknown, but evidence suggests that these children have atypical brain structure and function. Interventions to help children cope with their activity limitations are effective in improving motor competence and motor skill related fitness in the short term. Although activity-orientated interventions can improve motor outcomes in children with DCD, high quality intervention trials and evaluation of long-term effects are urgently needed. Importantly, motor coordination problems associated with DCD extend to exercise-related activities leading to reduced participation in play and sports, which causes secondary problems in muscular fitness and body composition. Hence, treatment goals should not be limited to the improvement of motor skills (in ADL), but should also focus on health-related quality of life. We therefore propose when noticing motor problems in a child, already before enrolling but also during intervention, to explore ways to adapt everyday physical activities to optimally match the child's skill level. Hence, such activities will not only train the skills and improve physical fitness but will lead to positive engagement, thereby preventing the child from opting out of active play and sports. This provides the child with chances for exercise-dependent learning and will also positively impact social-emotional well-being.

A systematic review and meta-analysis of pediatric normative peripheral quantitative computed tomography data

BACKGROUND

Peripheral-quantitative computed tomography (pQCT) provides an intriguing diagnostic alternative to dual-energy X-ray absorptiometry (DXA) since it can measure 3D bone geometry and differentiate between the cortical and trabecular bone compartments.

OBJECTIVE

To investigate and summarize the methods of pQCT image acquisition of in children, adolescents and/or young adults (up to age 20) and to aggregate the published normative pQCT data.

EVIDENCE ACQUISITION

A literature search was conducted in MEDLINE and EMBASE from 1947 to December 2020. Quality of the included articles was assessed using Standards for Reporting of Diagnostic Accuracy (STARD) scoring system and United States Preventative Services Task Force (USPSTF) Study Design Categorization. Seven articles, encompassing a total of 2134 participants, were aggregated in the meta-analysis. Due to dissimilar age groups and scan sites, only seven pQCT parameters of the 4% radius, 4% tibia and 38% tibia were analyzed in this meta-analysis.

EVIDENCE SYNTHESIS

The overall fixed-effect estimates of trabecular vBMD of the 4% radius were: 207.16 (201.46, 212.86), mg/cm3 in 8 to 9 year-old girls, 210.42 (201.91, 218.93)in 10 to 12 year-old girls, 226.99 (222.45, 231.54) in 12 to 13 year-old girls, 259.97 (254.85, 265.10) in 12 to 13 year-old boys and 171.55 (163.41,179.69) in 16 to 18 year-old girls. 21 of 54 (38.9%) primary papers received a 'good' STARD quality of reporting score (<90 and 70 ≥ %) (mean STARD score of all articles = 69.4%). The primary articles of this review had a 'good' level USPSTF study design categorization. However, most of the normative data in these articles were non-comparable and non-aggregable due to a lack of standardization of reference lines, acquisition parameters and/or age at acquisition.

CONCLUSION

There is not sufficient evidence to suggest that pQCT is appropriately suited for use in the pediatric clinical setting. Normative pediatric data must be systematically derived for pQCT should it ever be a modality that is used outside of research.

CLINICAL IMPACT

We demonstrate the need for normative pQCT reference data and for clinical guidelines that standardize pediatric acquisition parameters and delineate its use in pediatric settings.

Association between developmental coordination disorder or low motor competence, and risk of impaired bone health across the lifespan: protocol for a systematic review and meta-analysis

OBJECTIVE

This systematic review will assess the association between developmental coordination disorder or low motor competence and impairments in bone health across the lifespan.

INTRODUCTION

Individuals with developmental coordination disorder tend to have a pattern of physical activity associated with bone health impairments. Preliminary studies have found impairments in bone health measures, including fractures, throughout the lifespan with potential public health ramifications. As studies in this area are of small samples across wide age ranges, no comprehensive picture of bone health in this group has been formed, hindering action. A systematic review is needed to determine the potential risk of bone impairment in this population.

INCLUSION CRITERIA

Studies that assess the relationship between developmental coordination disorder/low motor competence and bone health, regardless of measures used, will be included in the review. There will be no exclusions based on region, study design, or participant demographic characteristics.

METHODS

Published studies and gray literature will be searched, with no limits on publication date or language. Assessment of studies for inclusion, as well as data extraction, will be performed by two reviewers, with data cross checked for accuracy. Studies will be appraised using the appropriate JBI tool for the study design. Data to be extracted include unadjusted results and effect sizes for bone health measures. A narrative synthesis will be performed and if there is a sufficient number of studies, a meta-analysis using the same outcome measures will be performed on odds ratios of abnormal bone phenotype and fracture in this population.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020167301.

Suboptimal bone status for adolescents with low motor competence and developmental coordination disorder-It's sex specific

BACKGROUND

Australian adolescents with low motor competence (LMC) have higher fracture rates and poorer bone health compared to European normative data, but currently no normative data exists for Australians.

AIMS

To examine whether there were bone health differences in Australian adolescents with LMC or Developmental Coordination Disorder (DCD) when compared to typically developing age-matched Australian adolescents.

METHODS AND PROCEDURES

Australian adolescents aged 12-18 years with LMC/DCD (n = 39; male = 27; female = 12) and an Australian comparison sample (n = 188; boys = 101; girls = 87) undertook radial and tibial peripheral Quantitative Computed Tomography (pQCT) scans. Stress Strain Index (SSI (mm³)), Total Bone Area (TBA (mm²)), Muscle Density (MuD [mgcm³]), Muscle Area (MuA [cm²]), Subcutaneous Fat Area (ScFA [cm²]), Cortical Density (CoD [mgcm³]), Cortical Area (CoD [mm²]), cortical concentric ring volumetric densities, Functional Muscle Bone Unit Index (FMBU: (SSI/bone length)) and Robustness Index (SSI/bone length^3), group and sex differences were examined.

OUTCOME AND RESULTS

The main finding was a significant sex-x-group interaction for Tibial FMBU (p = .021), Radial MuD (p = .036), and radial ScFA (p = .002). Boys with LMC/DCD had lower tibial FMBU scores, radial MuD and higher ScFA than the typically developing age-matched sample.

CONCLUSION AND IMPLICATIONS

Comparisons of bone measures with Australian comparative data are similar to European findings however sex differences were found in the present study. Australian adolescent boys with LMC/DCD had less robust bones compared to their well-coordinated Australian peers, whereas there were no differences between groups for girls. These differences may be due to lower levels of habitual weight-bearing physical activity, which may be more distinct in adolescent boys with LMC/DCD compared to girls.

Please Don't Move-Evaluating Motion Artifact From Peripheral Quantitative Computed Tomography Scans Using Textural Features

Most imaging methods, including peripheral quantitative computed tomography (pQCT), are susceptible to motion artifacts particularly in fidgety pediatric populations. Methods currently used to address motion artifact include manual screening (visual inspection) and objective assessments of the scans. However, previously reported objective methods either cannot be applied on the reconstructed image or have not been tested for distal bone sites. Therefore, the purpose of the present study was to develop and validate motion artifact classifiers to quantify motion artifact in pQCT scans. Whether textural features could provide adequate motion artifact classification performance in 2 adolescent datasets with pQCT scans from tibial and radial diaphyses and epiphyses was tested. The first dataset was split into training (66% of sample) and validation (33% of sample) datasets. Visual classification was used as the ground truth. Moderate to substantial classification performance (J48 classifier, kappa coefficients from 0.57 to 0.80) was observed in the validation dataset with the novel texture-based classifier. In applying the same classifier to the second cross-sectional dataset, a slight-to-fair (κ = 0.01-0.39) classification performance was observed. Overall, this novel textural analysis-based classifier provided a moderate-to-substantial classification of motion artifact when the classifier was specifically trained for the measurement device and population. Classification based on textural features may be used to prescreen obviously acceptable and unacceptable scans, with a subsequent human-operated visual classification of any remaining scans.

Diversity of activity participation determines bone mineral content in the lower limbs of pre-pubertal children with developmental coordination disorder

This study examined the relationships between activity participation and bone mineralization in children with developmental coordination disorder. Limited participation in physical, recreational, social, and skill-based and self-improvement activities contributed to lower bone mineral content. For improved bone health, these children should participate in a variety of activities, not only physical activities.

INTRODUCTION

Limited activity participation in children with developmental coordination disorder (DCD) may have a negative impact on bone mineral accrual. The objectives of this study were to compare bone mineralization and activity participation patterns of pre-pubertal children with DCD and those with typical development, and to determine the association between activity participation patterns and bone mineralization in children with DCD.

METHODS

Fifty-two children with DCD (mean age = 7.51 years) and 61 children with typical development (mean age = 7.22 years) participated in the study. Appendicular and total body (less head) bone mineral content (BMC) and bone mineral density (BMD) were evaluated by a whole-body dual-energy X-ray absorptiometry scan. Activity participation patterns were assessed using the Children's Assessment of Participation and Enjoyment (CAPE) questionnaire.

RESULTS

Children with DCD had lower appendicular and total body BMCs and BMDs than children with typical development overall (p < 0.05). They also had lower CAPE total activity and physical activity diversity scores (p < 0.05). After accounting for the effects of age, sex, height, lean mass, and fat mass, the total activity diversity score remained independently associated with leg BMC in children with DCD, explaining 5.1% of the variance (p = 0.030). However, the physical activity diversity score was no longer associated with leg BMC (p = 0.090).

CONCLUSIONS

Diversity of activity participation and bone mineralization were lower in pre-pubertal children with DCD. Decreased total activity participation diversity was a contributing factor to lower BMC in the legs of children with DCD.

Motor Competence in Early Childhood Is Positively Associated With Bone Strength in Late Adolescence

The onset of walking in early childhood results in exposure of the lower limb to substantial forces from weight bearing activity that ultimately contribute to adult bone strength. Relationships between gross motor score (GMS), at 18 months and bone outcomes measured at age 17 years were examined in 2327 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC). Higher GMS indicated greater motor competence in weight-bearing activities. Total hip bone mineral density (BMD) and hip cross-sectional moment of inertia (CSMI) were assessed from dual-energy X-ray absorptiometry (DXA). Bone measures including cortical bone mineral content (BMC), periosteal circumference (PC), cortical thickness (CT), cortical bone area (CBA), cortical BMD (BMDC ) and cross-sectional moment of inertia (CSMI) were assessed by peripheral quantitative computed tomography (pQCT) at 50% distal-proximal length. Before adjustment, GMS was associated with hip BMD, CSMI, and tibia BMC, PC, CT, CBA and CSMI (all p < 0.001) but not BMDC (p > 0.25). Strongest associations (standardized regression coefficients with 95% CI) were between GMS and hip BMD (0.086; 95% CI, 0.067 to 0.105) and tibia BMC (0.105; 95% CI, 0.089 to 0.121). With the exception of hip BMD, larger regression coefficients were observed in males (gender interactions all p < 0.05). Adjustment for lean mass resulted in substantial attenuation of regression coefficients, suggesting associations between impaired motor competence and subsequent bone development are partly mediated by alterations in body composition. In conclusion, impaired motor competence in childhood is associated with lower adolescent bone strength, and may represent a risk factor for subsequent osteoporosis. © 2015 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research (ASBMR).