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Kim D, Roh W, Lee Y, Yim S. The Effect of a Table Tennis Exercise Program With a Task-Oriented Approach on Visual Perception and Motor Performance of Adolescents With Developmental Coordination Disorder. Percept Mot Skills 2024:315125241250080. [PMID: 38682611 DOI: 10.1177/00315125241250080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
In this study we investigated the effects of an 8-week table tennis exercise program with a task-oriented approach on visual perception and motor performance of 31 adolescents with developmental coordination disorder (DCD). The participants were identified by their teachers as having greater difficulty than their peers (450 students from three Korean middle schools) in physical education (PE) classes. On the Bruininks-Oseretsky Test of Motor Proficiency-2, these adolescents scored below the 15th percentile and showed difficulties in performing daily life activities due to motor performance problems; they did not have physical defects, intellectual or neurological impairments, or Attention Deficit Hyperactivity Disorder. Of 98 prospective adolescents with PE difficulties, we obtained personal assent and parents' informed consent from 54, and 31 of these met screening criteria for DCD through the Developmental Coordination Disorder Questionnaire-Korean. This final group was divided in non-random fashion (based on the proximal geographic grouping of the children's schools) between an experimental group (n = 16) and a control group (n = 15). The experimental group participated in the 8-week task-oriented table tennis training program with three 90-minute sessions per week, while the control group only participated in regular PE classes twice per week. We measured participants' visual perception and motor performance in the same environment before and after the intervention program. Participants' visual perception was significantly more improved in the experimental group than the control group, with specific improved skills in visual-motor search, visual-motor speed, figure-ground, and visual closure; copying and perceptual constancy skills did not improve significantly. In addition, total motor performance and motor sub-skills, including fine manual control, manual coordination, body coordination, strength, and agility were significantly more improved in the experimental group than in the control group. Thus, our task-oriented table tennis exercise program was of greater assistance than general PE classes for improving visual perception and motor performance in adolescents at risk of DCD.
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Affiliation(s)
- Dongmin Kim
- Department of Special Physical Education, Yong in University, Yongin, Republic of Korea
| | - Woongrae Roh
- Department of Sport Science, Seoul National University, Seoul, Republic of Korea
| | - Yongho Lee
- Department of Sport Science, Seoul National University, Seoul, Republic of Korea
| | - Sanghun Yim
- Department of Special Physical Education, Yong in University, Yongin, Republic of Korea
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Draghi TTG, Smits-Engelsman B, Godoi-Jacomassi D, Cavalcante Neto JL, Jelsma D, Tudella E. Short- and Long-Term Changes in Balance After Active Video Game Training in Children With and Without Developmental Coordination Disorder: A Randomized Controlled Trial. Motor Control 2024:1-19. [PMID: 38290498 DOI: 10.1123/mc.2023-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 02/01/2024]
Abstract
Active video games (AVG) have been used as training tools and are known to ameliorate balance performance in children with Developmental Coordination Disorder (DCD). Our aim was to evaluate balance using clinical tests and by measuring body sway using a force plate with a mixed design of vision (eyes open/eyes closed), surface (rigid/soft), and support (stance/semitandem) before, and after, training and 4 months later (follow-up). Thirty-six DCD children and 40 typically developing children participated in the study, of which 50 children (26 DCD; 24 typically developing) were retested after 4 months. Balance improved on the clinical measures after the training, which was independent of type of AVG (Wii-Fit and Xbox Kinect) used, and this effect was still present after 4 months. The AVG training did not influence general sway behavior, but only sway in the eyes-open condition, corresponding with task demands of the training and indicating a training-specific effect. Overall, DCD children and typically developing children responded comparably to the AVG training, thereby maintaining the gap in performance between the two groups. The changes in postural sway are interpreted as a sign of more confidence and less freezing of the joints, enabling greater flexibility of movements and balance strategies as supported by the improved performance on balance tests in the DCD children. This is the first study that showed long-term effects of AVG training on balance performance. However, these follow-up results should be interpreted with caution given that 35% of the children were lost in follow-up.
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Affiliation(s)
- Tatiane Targino Gomes Draghi
- Núcleo de Estudos em Neuropediatria e Motricidade-NENEM, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Bouwien Smits-Engelsman
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, Division of Physiotherapy, University of Cape Town, Cape Town, South Africa
- Physical Activity, Sport and Recreation, Faculty Health Sciences, North-West University, Potchefstroom, South Africa
| | - Daniela Godoi-Jacomassi
- Motor Behavior Laboratory, Department of Physical Education, Federal University of São Carlos, São Carlos, SP, Brazil
| | | | - Dorothee Jelsma
- Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Eloisa Tudella
- Núcleo de Estudos em Neuropediatria e Motricidade-NENEM, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
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Mercer V, Smith N, Jandial S, Guglieri M, Jones SA, Foster HE. Beyond pGALS: the need for a multifaceted musculoskeletal decision-making tool ('pGALSplus') in community-based clinical practice. Rheumatol Adv Pract 2024; 8:rkae004. [PMID: 38283055 PMCID: PMC10822673 DOI: 10.1093/rap/rkae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Musculoskeletal (MSK) problems in children are common, and health-care professionals must identify those requiring onward referral. Paediatric gait, arms, legs and spine (pGALS) is an MSK assessment to discern abnormal joints. We aimed to identify MSK assessments to add to pGALS (pGALSplus) to facilitate decision-making in the context of exemplar conditions representing a spectrum of MSK presentations, namely JIA, mucopolysaccharidoses, muscular dystrophy and developmental co-ordination disorder. A literature review identified 35 relevant articles that focused on clinical assessments [including questionnaire(s), physical examination and functional tests] used by health-care professionals in the context of the exemplar conditions. We provide a description of these assessments and the rationale regarding how they, or components of such tools, might be useful within pGALSplus. This process provides a foundation for further work to develop and validate pGALSplus.
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Affiliation(s)
- Vicky Mercer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Children’s Physiotherapy, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Nicola Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sharmila Jandial
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
- Paediatric Rheumatology, Great North Children’s Hospital, Newcastle upon Tyne, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon A Jones
- Manchester Centre for Genomic Medicine, Saint Mary’s Hospital, Manchester, UK
| | - Helen E Foster
- Population Health Institute, Newcastle University, Newcastle upon Tyne, UK
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Li LL, Chen FC. Effects of kinesio taping on static balance performance and muscle activity in children with developmental coordination disorder: a single-group pretest-posttest study. J Rehabil Med 2023; 55:jrm13403. [PMID: 37622347 PMCID: PMC10469226 DOI: 10.2340/jrm.v55.13403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE To compare the effects of various kinesio tape applications on static balance and muscle activity in children with developmental coordination disorder. Methods: Four taping conditions were applied to 48 children with developmental coordination disorder: no taping, gastrocnemius taping, tibialis anterior taping; and peroneus longus taping. Postural sway and electromyographic data were assessed, with eyes closed (30 s), standing still in 2-leg stance, dominant-leg stance, and non-dominant-leg stance. RESULTS Kinesio taping significantly reduced postural sway in both anteroposterior and mediolateral directions for dominant-leg stance and non-dominant-leg stance, but not 2-leg stance. During single-leg stances, anteroposterior sway was significantly lower for the gastrocnemius taping condition than for the no taping, tibialis anterior and peroneus longus taping conditions, and significantly lower in the tibialis anterior and peroneus longus taping conditions than in the no taping condition (gastrocnemius < tibialis anterior = peroneus longus < no taping). In addition, mediolateral sway was significantly lower in the tibialis anterior and peroneus longus taping conditions than in the no taping and gastrocnemius taping conditions, and significantly lower in the gastrocnemius taping condition than in the no taping condition (tibialis anterior = peroneus longus < gastrocnemius < no taping). Electromyographic data showed that muscle activity was significantly greater only for muscles where kinesio tape was applied. CONCLUSION Various kinesio tape applications can differentially reduce postural sway and increase muscle activity during single-leg stances in children with developmental coordination disorder.
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Affiliation(s)
- Li-Liang Li
- Physical Education and Health Center, National Kaohsiung University of Hospitality and Tourism, Taiwan
| | - Fu-Chen Chen
- Department of Physical Education, National Kaohsiung Normal University, 116, Heping 1st Rd., Lingya Dist., Kaohsiung 802, Taiwan.
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Woodward K, Spencer APC, Jary S, Chakkarapani E. Factors associated with MRI success in children cooled for neonatal encephalopathy and controls. Pediatr Res 2023; 93:1017-1023. [PMID: 35906304 PMCID: PMC10033414 DOI: 10.1038/s41390-022-02180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate if an association exists between motion artefacts on brain MRI and comprehension, co-ordination, or hyperactivity scores in children aged 6-8 years, cooled for neonatal encephalopathy (cases) and controls. METHODS Case children (n = 50) without cerebral palsy were matched with 43 controls for age, sex, and socioeconomic status. Children underwent T1-weighted (T1w), diffusion-weighted image (DWI) brain MRI and cognitive, behavioural, and motor skills assessment. Stepwise multivariable logistic regression assessed associations between unsuccessful MRI and comprehension (including Weschler Intelligence Scale for Children (WISC-IV) verbal comprehension, working memory, processing speed and full-scale IQ), co-ordination (including Movement Assessment Battery for Children (MABC-2) balance, manual dexterity, aiming and catching, and total scores) and hyperactivity (including Strengths and Difficulties Questionnaire (SDQ) hyperactivity and total difficulties scores). RESULTS Cases had lower odds of completing both T1w and DWIs (OR: 0.31, 95% CI 0.11-0.89). After adjusting for case-status and sex, lower MABC-2 balance score predicted unsuccessful T1w MRI (OR: 0.81, 95% CI 0.67-0.97, p = 0.022). Processing speed was negatively correlated with relative motion on DWI (r = -0.25, p = 0.026) and SDQ total difficulties score was lower for children with successful MRIs (p = 0.049). CONCLUSIONS Motion artefacts on brain MRI in early school-age children are related to the developmental profile. IMPACT Children who had moderate/severe neonatal encephalopathy are less likely to have successful MRI scans than matched controls. Motion artefact on MRI is associated with lower MABC-2 balance scores in both children who received therapeutic hypothermia for neonatal encephalopathy and matched controls, after controlling for case-status and sex. Exclusion of children with motion artefacts on brain MRI can introduce sampling bias, which impacts the utility of neuroimaging to understand the brain-behaviour relationship in children with functional impairments.
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Affiliation(s)
- Kathryn Woodward
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Arthur P C Spencer
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Clinical Research and Imaging Centre, University of Bristol, Bristol, UK
| | - Sally Jary
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ela Chakkarapani
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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Pinero-Pinto E, Romero-Galisteo RP, Sánchez-González MC, Escobio-Prieto I, Luque-Moreno C, Palomo-Carrión R. Motor Skills and Visual Deficits in Developmental Coordination Disorder: A Narrative Review. J Clin Med 2022; 11:jcm11247447. [PMID: 36556062 PMCID: PMC9784736 DOI: 10.3390/jcm11247447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/01/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Developmental coordination disorder (DCD) is a developmental disorder in which numerous comorbidities seem to coexist, such as motor and visual impairment and some executive functions; Methods: A narrative review on motor and visual deficits in children with DCD was carried out; Results and Discussion: Fine and gross motor skills are affected in children with DCD. In addition, they seem to be related to visual deficits, such as difficulty in visual perception, sensory processing and visual memory. Limitations have also been found in accommodation. Interventions in children with DCD should be aimed at improving both aspects, since vision affects motor skills and vice versa; Conclusions: In children with DCD, who present a marked deficit in global shape processing, it causes an association between deficiencies in visual perception and motor skills.
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Affiliation(s)
- Elena Pinero-Pinto
- Department of Physical Therapy. Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
| | - Rita Pilar Romero-Galisteo
- Department of Physiotherapy, Faculty of Science Health, University of Málaga, 29016 Málaga, Spain
- Correspondence:
| | | | - Isabel Escobio-Prieto
- Department of Physical Therapy. Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
- Instituto de Biomedicina de Sevilla (IBIS), 41013 Seville, Spain
| | - Carlos Luque-Moreno
- Department of Physical Therapy. Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
- Instituto de Biomedicina de Sevilla (IBIS), 41013 Seville, Spain
| | - Rocío Palomo-Carrión
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain
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New Technological Approach for the Evaluation of Postural Control Abilities in Children with Developmental Coordination Disorder. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070957. [PMID: 35883941 PMCID: PMC9319863 DOI: 10.3390/children9070957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022]
Abstract
Background: Developmental Coordination Disorder (DCD) causes difficulties in postural control which are crucial to assess due to their impact on everyday life. There is a lack of suitable tools to acquire quantitative data and deeply analyze postural control, especially during the developmental age. The aim of this study is to investigate postural control skills in children with DCD and typically developing children (TD) using the Virtual Reality Rehabilitation System (VRRS). Methods: 18 children with DCD and 30 TD children (mean age 9.12 ± 2.65 and 7.12 ± 2.77 years, respectively) were tested by using the Movement Assessment Battery for Children Second Edition (MABC-2) and a VRRS stabilometric balance platform. A t-test was performed to identify differences in the VRRS parameters between the two groups. Furthermore, we investigated whether a correlation exists between the VRRS data and the MABC-2. Results: Significant differences (p < 0.05) in mean distance and frequency of the COP are found in the two groups. These parameters also correlate with the MABC-2 total score (p ≤ 0.05) and balance subscales (p ≤ 0.05). Conclusions: This study opens a new frontier for the assessment of postural skills in children with DCD and represents a potential basis for a tailored rehabilitation program, from which their postural stability and, consequently, their everyday life will benefit.
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Verbecque E, Johnson C, Rameckers E, Thijs A, van der Veer I, Meyns P, Smits-Engelsman B, Klingels K. Balance control in individuals with developmental coordination disorder: A systematic review and meta-analysis. Gait Posture 2021; 83:268-279. [PMID: 33227605 DOI: 10.1016/j.gaitpost.2020.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/28/2020] [Accepted: 10/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although it is recognized that the majority of children with developmental coordination disorder (DCD) have balance deficits, comprehensive insights into which balance domains are affected, are still lacking in literature. RESEARCH QUESTION To what extent is balance control deficient in individuals with DCD compared to controls? METHODS Pubmed, Scopus and Web of Science were systematically searched. Risk of bias was assessed with the Scottish Intercollegiate Guidelines Network checklist for case-control studies. Mean and standard deviations characterizing balance control were extracted to calculate standardized mean differences (SMD) and pooled, if possible, using Review Manager. RESULTS The results of 31 studies (1152 individuals with DCD, 1103 typically developing (TD) peers, mean age 10.4 years old) were extracted of which 17 were used for meta-analysis. The mean SMD for the balance subscale of the Movement Assessment Battery for Children was 1.63 (pooled 95 %CI =[1.30;1.97]), indicating children with DCD to perform significantly poorer than their TD peers. Force plate studies also revealed that children with DCD present with a larger sway path during bipedal stance with eyes closed (pooled mean SMD = 0.55; 95 %CI=[0.32;0.78]). Children with DCD tend to have direction-specific limited stability limits and task-independent delayed onset of anticipatory postural adjustments. INTERPRETATION Children with DCD perform poorer on different domains of balance compared to TD peers. Future research should focus on comprehensive balance assessment in these children, preferably using a longitudinal design.
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Affiliation(s)
- Evi Verbecque
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium; Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
| | - Charlotte Johnson
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Eugène Rameckers
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium; Department of Rehabilitation Medicine Maastricht University, Maastricht, the Netherlands; Center of Expertise Adelante Rehabilitation, Valkenburg, the Netherlands; AVANSplus, University for Professionals, Breda, the Netherlands
| | - Angelina Thijs
- Center of Development Advancement and Pediatric Neurorehabilitation of the Wildermeth Foundation, Biel/Bienne, Switzerland
| | - Ingrid van der Veer
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium; AVANSplus, University for Professionals, Breda, the Netherlands
| | - Pieter Meyns
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| | - Bouwien Smits-Engelsman
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, Division of Physiotherapy, University, Cape Town, South Africa
| | - Katrijn Klingels
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
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Hagihara H, Ienaga N, Enomoto D, Takahata S, Ishihara H, Noda H, Tsuda K, Terayama K. Computer Vision-Based Approach for Quantifying Occupational Therapists' Qualitative Evaluations of Postural Control. Occup Ther Int 2020; 2020:8542191. [PMID: 32410925 PMCID: PMC7201486 DOI: 10.1155/2020/8542191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/03/2020] [Indexed: 12/02/2022] Open
Abstract
This study aimed to leverage computer vision (CV) technology to develop a technique for quantifying postural control. A conventional quantitative index, occupational therapists' qualitative clinical evaluations, and CV-based quantitative indices using an image analysis algorithm were applied to evaluate the postural control of 34 typically developed preschoolers. The effectiveness of the CV-based indices was investigated relative to current methods to explore the clinical applicability of the proposed method. The capacity of the CV-based indices to reflect therapists' qualitative evaluations was confirmed. Furthermore, compared to the conventional quantitative index, the CV-based indices provided more detailed quantitative information with lower costs. CV-based evaluations enable therapists to quantify details of motor performance that are currently observed qualitatively. The development of such precise quantification methods will improve the science and practice of occupational therapy and allow therapists to perform to their full potential.
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Affiliation(s)
- Hiromichi Hagihara
- Graduate School of Human and Environmental Studies, Kyoto University, Kyoto, Japan
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Naoto Ienaga
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
- Graduate School of Science and Technology, Keio University, Yokohama, Japan
| | | | | | | | - Haruka Noda
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Koji Tsuda
- Graduate School of Frontier Science, University of Tokyo, Tokyo, Japan
- RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Kei Terayama
- RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
- Medical Sciences Innovation Hub Program, RIKEN Cluster for Science, Technology and Innovation Hub, Kanagawa, Japan
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Wearable-based electronics to objectively support diagnosis of motor impairments in school-aged children. J Biomech 2019; 83:243-252. [PMID: 30554812 DOI: 10.1016/j.jbiomech.2018.12.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/12/2018] [Accepted: 12/01/2018] [Indexed: 11/22/2022]
Abstract
Developmental coordination disorder (DCD) and attention-deficit hyperactivity disorder (ADHD) are neuro-developmental disorders, starting in childhood, which can affect the planning of movements and the coordination. We investigated how and in which measure a system based on wearable inertial measurement units (IMUs) can provide an objective support to the diagnosis of motor impairments in school-aged children. The IMUs measured linear and rotational movements of 37 schoolchildren, 7-10yo, 17 patients and 20 control subjects, during the execution of motor exercises, performed under medical and psychiatric supervision, to assess different aspects of the motor coordination. The measured motor parameters showed a high degree of significance in discriminating the ADHD/DCD patients from the healthy subjects, pointing out which motor tasks are worth focusing on. So, medical doctors have a novel key lecture to state a diagnosis, gaining in objectivity with respect to the standard procedures which mainly involve subjective human judgment. Differently to other works, we propose a novel approach in terms of number of used IMUs and of performed motor tasks. Moreover, we demonstrate the meaningful parameters to be considered as more discriminant in supporting the medical diagnosis.
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A Longitudinal Examination of Postural Impairments in Children With Mild Traumatic Brain Injury: Implications for Acute Testing. J Head Trauma Rehabil 2018; 32:E18-E23. [PMID: 26580689 DOI: 10.1097/htr.0000000000000192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine how postural control changes following pediatric mild traumatic brain injury. SETTING Urban pediatric emergency department. PARTICIPANTS Children 11 to 16 years old who presented within 6 hours of sustaining mild traumatic brain injury. DESIGN Prospective observational cohort followed for 1 month. MAIN MEASURES Total center of pressure path velocity and path velocity within distinct frequency bands, ranging from moderate to ultralow, were recorded by the Nintendo Wii Balance Board during a 2-legged stance. Measurements were recorded in 2 separate tests with eyes open and closed. The scores of the 2 tests were compared, and a Romberg quotient was computed. RESULTS Eleven children were followed for 1 month postinjury. The ultralow frequency, which reflects slow postural movements associated with exploring stability boundaries, was lower (p = .02) during the eyes closed stance acutely following injury. The Romberg quotient for this frequency was also significantly lower acutely following injury (p = .007) than at 1 month. CONCLUSION Following mild traumatic brain injury, children acutely demonstrate significantly more rigid sway patterns with eyes closed than with eyes open, which were highlighted by the Romberg quotient. The Romberg quotient could allow for accurate identification and tracking of postural instability without requiring knowledge of preinjury balance ability.
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Scott-Roberts S, Purcell C. Understanding the Functional Mobility of Adults with Developmental Coordination Disorder (DCD) Through the International Classification of Functioning (ICF). CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018; 5:26-33. [PMID: 29497595 PMCID: PMC5818573 DOI: 10.1007/s40474-018-0128-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW This phenomenological study explored the lived experience of six adults with developmental coordination disorder (DCD) and its potential impact on functional mobility. Utilising the International Classification of Functioning (World Health Organisation, 2001), the data derived from interviews were analysed to consider how persistent motor impairments impact on activity engagement and participation. RECENT FINDINGS Much of the research evidence pertaining to DCD focuses on children. However, there is increasing acknowledgment that for some, the motor impairments synonymous with DCD continue into adulthood. SUMMARY The findings from this study suggest that for this group of participants, functional mobility can be compromised, restricting activity and participation. At a body structure/function level, participants identified additional impairments that moved beyond mobility, suggesting that the secondary consequences of fatigue and anxiety were disabling. However, personal factors were seen to mitigate some difficulties encountered to allow participants to remain actively engaged in a range of adult roles.
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Affiliation(s)
- Sally Scott-Roberts
- Occupational Therapy, School of Health Care Sciences, College of Biomedical and Life Sciences, Cardiff University, Ty Dewi Sant, Heath Park, Cardiff, CF14 4XN UK
| | - Catherine Purcell
- School of Psychology, Early Years, Education and Therapeutic Studies, University of South Wales, Treforest, Pontypridd, CF37 1DL UK
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Speedtsberg MB, Christensen SB, Andersen KK, Bencke J, Jensen BR, Curtis DJ. Impaired postural control in children with developmental coordination disorder is related to less efficient central as well as peripheral control. Gait Posture 2017; 51:1-6. [PMID: 27693806 DOI: 10.1016/j.gaitpost.2016.09.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/01/2016] [Accepted: 09/21/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Developmental coordination disorder (DCD) is a neurodevelopmental impairment that affects approximately 6% of children in primary school age. Children with DCD are characterized by impaired postural control. It has yet to be determined what effect peripheral and central neuromuscular control has on their balance control. OBJECTIVE The aim of this study was to investigate the underlying mechanisms to impaired postural control in children with DCD using the rambling-trembling decomposition of the center of pressure (CoP). METHOD Nine children with DCD (9.0±0.5years, 7 boys, 2 girls) and 10 age- and gender-matched typically developing children (TD) with normal motor proficiency (9.1±0.4years, 7 boys and 3 girls) performed 3×30s bipedal standing on a force plate in six sensory conditions following the sensory organization procedure. Sway length was measured and rambling-trembling decomposition of CoP was calculated in medio-lateral (ML) and anterior-posterior (AP) direction. RESULTS Both rambling and trembling were larger for the children with DCD in AP (p=0.031; p=0.050) and ML direction (p=0.025; p=0.007), respectively. ML rambling trajectories did not differ in any conditions with fixed support surface. In ML direction children with DCD had a lower relative contribution of rambling to total sway (p=0.013). CONCLUSION This study showed that impaired postural control in children with DCD is associated with less efficient supraspinal control represented by increased rambling, but also by reduced spinal feedback control or peripheral control manifested as increased trembling.
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Affiliation(s)
- Merete B Speedtsberg
- Laboratory of Human Movement Analysis, Department of Orthopaedic Surgery, Hvidovre University Hospital, University of Copenhagen, Denmark; Biomechanics and Motor Control Lab., Integrated Physiology, Department of Nutrition, Exercise and Sport, University of Copenhagen, Denmark.
| | - Sofie B Christensen
- Biomechanics and Motor Control Lab., Integrated Physiology, Department of Nutrition, Exercise and Sport, University of Copenhagen, Denmark
| | - Ken Kjøller Andersen
- Biomechanics and Motor Control Lab., Integrated Physiology, Department of Nutrition, Exercise and Sport, University of Copenhagen, Denmark
| | - Jesper Bencke
- Laboratory of Human Movement Analysis, Department of Orthopaedic Surgery, Hvidovre University Hospital, University of Copenhagen, Denmark
| | - Bente R Jensen
- Biomechanics and Motor Control Lab., Integrated Physiology, Department of Nutrition, Exercise and Sport, University of Copenhagen, Denmark; Department of Neurology, Odense University Hospital, University of Southern Denmark, Denmark
| | - Derek J Curtis
- Laboratory of Human Movement Analysis, Department of Orthopaedic Surgery, Hvidovre University Hospital, University of Copenhagen, Denmark; Department of Physical and Occupational Therapy, Metropolitan University College, Copenhagen, Denmark
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Abstract
OBJECTIVE To examine the influence of age, sex, attention-deficit hyperactivity disorder (ADHD) status, previous history of concussion, and days since injury on postconcussion postural control assessment in adolescents who have suffered a concussion. DESIGN Prospective cohort study. SETTING Hospital-based outpatient clinic. PARTICIPANTS Seventy-one participants (42 males; 29 females) with mean age 14.14 ± 2.44. INDEPENDENT VARIABLES Age, sex, previous concussion history, ADHD status, total and severity of postconcussion symptoms, and days since injury. MAIN OUTCOME MEASURES Total Balance Error Scoring System score, path length, center-of-pressure (COP) area, sample entropy, and Romberg quotient. RESULTS Pearson product-moment correlation coefficients were calculated to test for potential associations between the continuous participant characteristics and the postural control variables. Spearman correlation was used to test the association between symptom severity and the postural control variables. Standard multiple regression was used to model the extent to which participant characteristics accounted for the variance in the postural sway variables. Age was significantly associated with all of the postural sway variables except COP area for the eyes open condition and sample entropy in the anterior-posterior direction for the eyes closed condition. Sex, ADHD status, and previous concussion history did not significantly predict postural control scores. CONCLUSIONS Age significantly influences scores on common postconcussion postural control assessments. CLINICAL RELEVANCE This study demonstrates that age is a critical factor that needs to be accounted for to improve the clinical appropriateness and utility of current postconcussion postural control assessments.
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Maciaszek J, Kilan N, Bronikowski M. Reaction to the sensory integration therapy in children with postural stability deficits. Minerva Pediatr (Torino) 2016; 73:405-413. [PMID: 27706121 DOI: 10.23736/s2724-5276.16.04607-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The goal was to examine the influence of sensory integration therapy (SIT) on one leg standing in children with deficits of the postural stability. METHODS 28 children 4-6 year old that could not stand on one leg for more than 20 seconds were randomly divided into control "C" and experimental "E" groups. Group "C" participated in standard classes in the kindergarten. Group "E" participated in sensory integration therapy (SIT) for 2 weeks, 5 times a week (additionally to the standard classes). RESULTS Results of the experiment show that the skill of standing on one leg has significantly improved (P<0.01) in the group that underwent additional therapy. The change in time of standing on the right leg with eyes open in the E group was statistically and significantly higher than the changes observed in the same time in group C (F=22.5, P=0.001' η2=0.44). Similarly, significant changes in time of standing on the right leg with eyes closed were observed in group E. The foregoing changes were bigger in group E than in group C (F=16. 1, P=0.004, η2=0.36). The analysis post hoc revealed that while there were no significant differences between the two groups on the pretest (P>0.05), there were significant differences between groups in right leg standing test with eyes open or closed on posttest. (P<0.05). Similar results were observed during on the one, left leg standing. The time of one leg standing with both eyes open and closed improved more significantly in group E than in group C (F=20.4, P=0.001, η2=0.42 respectively for the test with eyes open and F=7.4, P=0.010, η2=0.21 for the test with eyes closed). The analysis post hoc revealed that while there were no significant differences between the two groups on the pretest (P>0.05), there were significant differences between groups in left leg standing test with eyes open or closed on posttest (P<0.05). CONCLUSIONS Research conducted show that there is a positive influence of SIT on children with low level of postural stability. Its significant improvement in children with low levels of postural stability is important not only for the current functioning of those children but for their future - by protecting them from falling down and from injuries.
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Affiliation(s)
- Janusz Maciaszek
- Eugeniusz Piasecki University School of Physical Education, Poznań, Poland -
| | | | - Michał Bronikowski
- Eugeniusz Piasecki University School of Physical Education, Poznań, Poland
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Light finger contact concurrently reduces postural sway and enhances signal detection performance in children with developmental coordination disorder. Gait Posture 2016; 45:193-7. [PMID: 26979905 DOI: 10.1016/j.gaitpost.2016.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/01/2015] [Accepted: 01/24/2016] [Indexed: 02/02/2023]
Abstract
The current study examined the effects of light finger touch on postural sway and signal detection performance in children with developmental coordination disorder (DCD). Children with DCD (n=30; 18 boys, 12 girls; age=11.87 ± 0.48 years) and typically developing children (n=30; 14 boys, 16 girls; age=11.73 ± 0.52 years) were recruited from schools in Pintung County, Taiwan. Participants completed a signal detection task under no finger touch (NT) and light finger touch (LT) conditions, while postural sway in both anteroposterior (AP) and mediolateral (ML) axes was recorded. In both conditions, children with DCD exhibited significantly higher levels of postural sway (p<0.05) and lower signal detection performances (p<0.05) than TDC. Additionally, both groups significantly reduced postural sway (p<0.05) and enhanced signal detection performance (p<0.05) when engaged in light finger touch compared with no finger touch. While the effect of LT on postural sway was greater among TDC relative to children with DCD (p<0.05), the effect of LT on signal detection was greater in children with DCD compared with TDC (p<0.05). These results suggest that light finger touch is effective in concurrently reducing postural sway and enhancing signal detection in both groups.
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Gait patterns in children with Developmental Coordination Disorder. Exp Brain Res 2016; 234:1747-55. [DOI: 10.1007/s00221-016-4592-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/30/2016] [Indexed: 11/28/2022]
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Hatakenaka Y, Kotani H, Yasumitsu-Lovell K, Suzuki K, Fernell E, Gillberg C. Infant Motor Delay and Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations in Japan. Pediatr Neurol 2016; 54:55-63. [PMID: 26706480 DOI: 10.1016/j.pediatrneurol.2015.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 09/08/2015] [Accepted: 09/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Abnormalities of early motor development have been reported in autism spectrum disorder, attention-deficit/hyperactivity disorder, intellectual developmental disorder, developmental coordination disorder, and other Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE). However, few studies have been conducted with a view to following up a clinically representative cohort of children coming for assessment of motor delay before age two years. We performed a prospective clinical cohort study to examine whether or not early motor delay is often an indication of ESSENCE. METHODS The sample comprised a one-year cohort of all children who came to a Japanese neurodevelopmental center before their second birthday because of delayed or abnormal gross motor development. The children were followed up from the ESSENCE viewpoint. RESULTS Of the 30 children, 28 (18 boys and 10 girls) (93%) were given diagnoses subsumed under the ESSENCE umbrella. Of the 15 children with an identified or strongly suspected etiology, 13 (8 boys and 5 girls) (87%) had ESSENCE disorders or symptoms. Of the 15 children without a known etiology, all had ESSENCE disorders or symptoms. CONCLUSION This study indicated that the vast majority of children with motor delay or abnormality in the first two years of life meet criteria for a disorder within the group of ESSENCE at follow-up; this means that young children, presenting with motor problems always need a broad clinical assessment, not just related to motor function, and systematic follow-up.
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Affiliation(s)
- Yuhei Hatakenaka
- Kochi Gillberg Neuropsychiatry Centre, Kochi, Japan; Kochi Prefectural Medical and Welfare Centre, Kochi, Japan.
| | - Haruko Kotani
- Kochi Gillberg Neuropsychiatry Centre, Kochi, Japan; Kochi Prefectural Medical and Welfare Centre, Kochi, Japan
| | - Kahoko Yasumitsu-Lovell
- Kochi Gillberg Neuropsychiatry Centre, Kochi, Japan; Department of Environmental Medicine, Kochi Medical School, Kochi, Japan
| | - Keita Suzuki
- Kochi Gillberg Neuropsychiatry Centre, Kochi, Japan; Kochi University Faculty of Education, Kochi, Japan
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Hatakenaka Y, Fernell E, Sakaguchi M, Ninomiya H, Fukunaga I, Gillberg C. ESSENCE-Q - a first clinical validation study of a new screening questionnaire for young children with suspected neurodevelopmental problems in south Japan. Neuropsychiatr Dis Treat 2016; 12:1739-46. [PMID: 27478377 PMCID: PMC4951052 DOI: 10.2147/ndt.s108411] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early identification of autism spectrum disorder, intellectual developmental disorder, attention-deficit/hyperactivity disorder, and other neurodevelopmental disorders/problems is crucial, yet diagnosis is often delayed for years under the often misguided "wait-and-see" paradigm. The early symptomatic syndromes eliciting neurodevelopmental clinical examinations-questionnaire (ESSENCE-Q) is a brief (12-item) screening questionnaire developed specifically for the purpose of speeding up the identification process of a wide variety of neurodevelopmental problems. The aims were to 1) estimate the reliability of the ESSENCE-Q, 2) evaluate the clinical cutoff levels suggested by the author of the ESSENCE-Q, and 3) propose optimal cutoff levels based on receiver operating characteristic analysis. METHODS The ESSENCE-Q was used for 1 year by a psychiatrist in Kochi, Japan, assessing children under the age of 6 years referred for developmental problems. The children were also clinically assessed with regard to whether or not they met criteria for a developmental disorder (diagnosis positive and diagnosis negative groups). We contrasted the results of the ESSENCE-Q and those of clinical diagnostic assessments in 130 cases. RESULTS Cronbach's alpha was 0.82, sensitivity was 0.94 (95% confidence interval [CI]: [0.88, 0.98]), and specificity 0.53 (95% CI: [0.28, 0.77]), which are reasonable psychometrics for a first-step screening tool. Based on receiver operating characteristic analysis, we recommended an optimal cutoff level of yes ≥2 or maybe/a little ≥3 on the ESSENCE-Q (0.87 (95% CI: [0.79, 0.92]) sensitivity and 0.77 (95% CI: [0.50, 0.93]) specificity). CONCLUSION AND IMPLICATION The ESSENCE-Q can be a good instrument for use as a screening tool for aiding in the process of early identification of neurodevelopmental disorders in clinical settings. To establish the broader validity and reliability of the ESSENCE-Q, case-control studies and general population studies of children in different age groups are needed.
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Affiliation(s)
- Yuhei Hatakenaka
- Kochi Gillberg Neuropsychiatry Centre, Kochi Prefectural Medical and Welfare Centre, Kochi, Japan; Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Masahiko Sakaguchi
- Integrated Centre for Advanced Medical Technologies, Kochi University Medical School, Kochi, Japan
| | - Hitoshi Ninomiya
- Integrated Centre for Advanced Medical Technologies, Kochi University Medical School, Kochi, Japan
| | - Ichiro Fukunaga
- Kochi Gillberg Neuropsychiatry Centre, Kochi Prefectural Medical and Welfare Centre, Kochi, Japan
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Graphomotor skills in children with developmental coordination disorder (DCD): Handwriting and learning a new letter. Hum Mov Sci 2015; 42:318-32. [DOI: 10.1016/j.humov.2015.03.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 02/25/2015] [Accepted: 03/12/2015] [Indexed: 11/16/2022]
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Abstract
Current methods of measuring gross motor abilities in children involve either high-cost specialist apparatus that is unsuitable for use in schools, or low-cost but nonoptimal observational measures. We describe the development of a low-cost system that is capable of providing high-quality objective data for the measurement of head movements and postural sway. This system is based on off-the-shelf components available for the Nintendo Wii: (1) The infrared cameras in a pair of WiiMotes are used to track head movements by resolving the position of infrared-emitting diodes in three dimensions, and (2) center-of-pressure data are captured using the WiiFit Balance board. This allows the assessment of children in school settings, and thus provides a mechanism for identifying children with neurological problems affecting posture. In order to test the utility of the system, we installed the apparatus in two schools to determine whether we could collect meaningful data on hundreds of children in a short time period. The system was successfully deployed in each school over a week, and data were collected on all of the children within the school buildings at the time of testing (N = 269). The data showed reliable effects of age and viewing condition, as predicted from previous small-scale studies that had used specialist apparatus to measure childhood posture. Thus, our system has the potential to allow screening of children for gross postural deficits in a manner that has never previously been possible. It follows that our system opens up the possibility of conducting large-scale behavioral studies concerning the development of posture.
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Responsiveness of clinical and laboratory measures to intervention effects in children with developmental coordination disorder. Pediatr Phys Ther 2015; 27:44-51. [PMID: 25521264 DOI: 10.1097/pep.0000000000000102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare responsiveness of the Movement Assessment Battery for Children-2 (MABC-2) and segment kinematics and center of pressure measures in detecting intervention effects in children with developmental coordination disorder. METHODS Motion Analysis Laboratory (MAL) data from 21 children with developmental coordination disorder (mean age 11.0 years) in a randomized control trial were analyzed using effect size, minimal detectable difference, and parent and child report of meaningfulness (χ2 tests). RESULTS The MABC-2 and MAL data showed moderate-large effect sizes (0.7-1.8). The MABC-2 detected large portions of children whose change exceeded the minimal detectable difference (47.6%-71.4%); MAL data detected small portions (0%-19.0%). Neither tool correlated well with meaningfulness (χ2 = 0.186-5.724; P > .10). Both tools detected change in the overall group; however, only the MABC-2 detected individual change exceeding potential measurement error. CONCLUSIONS Although both assessment tools are responsive, they may be responsive to different types of change. Therefore, assessment constructs should be matched to intervention goals.
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Zhu YC, Cairney J, Li YC, Chen WY, Chen FC, Wu SK. High risk for obesity in children with a subtype of developmental coordination disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1727-1733. [PMID: 24685095 DOI: 10.1016/j.ridd.2014.02.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 02/20/2014] [Accepted: 02/27/2014] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to compare the prevalence of overweight and obesity in typically developing (TD) children, children with developmental coordination disorder (DCD) and balance problems (DCD-BP), and children with DCD without balance problems (DCD-NBP). Two thousand and fifty-seven children (1095 boys, 962 girls) ages 9-12 years were recruited from 18 elementary schools in Taiwan. The Movement Assessment Battery for Children was used to assess motor coordination ability. International cut-off points for body mass index were used to classify participants into the following groups: normal-weight, overweight or obese. Compared with TD children, children in the DCD-BP group were more than twice as likely to be obese (OR=2.28; 95% CI=1.41-3.68). DCD-BP children were also more likely to be obese compared to DCD-NBP children (OR=1.79; 95% CI=1.02-3.16). Boys in the DCD-BP group were more likely to be obese when compared to DCD-BP girls (OR=3.12; 95% CI=1.28-7.57). Similarly, DCD-NBP boys were more likely to be obese when compared to DCD-NBP girls (OR=2.67; 95% CI=1.21-5.89). Children with both DCD and BP were significantly more likely to be obese when compared to TD and DCD-NBP children. From an intervention perspective, the inclusion of regular physical activity, including activities that encourage development of both balance and energy expenditure, may be required to prevent obesity in this population.
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Affiliation(s)
- Yi-Ching Zhu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung City 404, Taiwan
| | - John Cairney
- CanChild Centre for Childhood Disability Research, Departments of Family Medicine, Psychiatry & Behavioural Neurosciences & Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Yao-Chuen Li
- CanChild Centre for Childhood Disability Research, Departments of Family Medicine, Psychiatry & Behavioural Neurosciences & Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Wei-Ying Chen
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
| | - Fu-Chen Chen
- Department of Recreation Sport & Health Promotion, National Pingtung University of Science & Technology, Taiwan
| | - Sheng K Wu
- Institute of Sport Performance, National Taiwan University of Physical Education & Sport, Taichung City 404, Taiwan.
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Loras H, Sigmundsson H, Stensdotter AK, Talcott JB. Postural control is not systematically related to reading skills: implications for the assessment of balance as a risk factor for developmental dyslexia. PLoS One 2014; 9:e98224. [PMID: 24892925 PMCID: PMC4043669 DOI: 10.1371/journal.pone.0098224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/30/2014] [Indexed: 11/18/2022] Open
Abstract
Impaired postural control has been associated with poor reading skills, as well as with lower performance on measures of attention and motor control variables that frequently co-occur with reading difficulties. Measures of balance and motor control have been incorporated into several screening batteries for developmental dyslexia, but it is unclear whether the relationship between such skills and reading manifests as a behavioural continuum across the range of abilities or is restricted to groups of individuals with specific disorder phenotypes. Here were obtained measures of postural control alongside measures of reading, attention and general cognitive skills in a large sample of young adults (n = 100). Postural control was assessed using centre of pressure (CoP) measurements, obtained over 5 different task conditions. Our results indicate an absence of strong statistical relationships between balance measures with either reading, cognitive or attention measures across the sample as a whole.
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Affiliation(s)
- Håvard Loras
- Sør-Trøndelag University College, Trondheim, Norway
| | - Hermundur Sigmundsson
- Sør-Trøndelag University College, Trondheim, Norway
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Joel B. Talcott
- Aston Brain Centre, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
- * E-mail:
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Postural sway and perception of affordances in children at risk for developmental coordination disorder. Exp Brain Res 2014; 232:2155-65. [DOI: 10.1007/s00221-014-3906-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/04/2014] [Indexed: 11/26/2022]
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Abstract
Developmental coordination disorder (DCD) affects around 5% of children and commonly overlaps with other developmental disorders including: attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASDs) and specific language impairment (SLI). There is evidence to demonstrate the wide-ranging impact on all areas of functioning including psychiatric and learning domains. There is increasing evidence of the continuing impact into adulthood and the long-term negative effects on relationships and employment. There is a need for early identification and intervention to limit the likelihood of these secondary consequences from emerging. This paper addresses the diagnosis of DCD.
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Affiliation(s)
- Amanda Kirby
- The Dyscovery Centre, University of South Wales, , Newport, UK
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Alves RF, Rossi AG, Pranke GI, Lemos LFC. Influência do gênero no equilíbrio postural de crianças com idade escolar. REVISTA CEFAC 2012. [DOI: 10.1590/s1516-18462012005000070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: avaliar a relação entre o gênero e o nível de desenvolvimento dos sistemas responsáveis pelo equilíbrio postural em crianças de seis a dez anos de idade. MÉTODO: composto por 282 crianças, divididas em três grupos:geral (meninas e meninos), feminino com 146 crianças, e masculino composto por 136 crianças na faixa etária entre os seis e os dez anos de idade. Para avaliação do equilíbrio postural utilizou-se a posturografia dinâmica foam-laser que avalia os sistemas sensoriais por meio de seis testes distintos. Os dados foram submetidos à estatística descritiva e a testes conforme a normalidade dos dados. RESULTADOS: nos Testes de Organização Sensorial, pode-se observar que os valores encontrados para as meninas foram maiores que os valores encontrados para meninos nas variáveis Teste de Organização Sensorial I e na Média destes. Porém, esses valores para os grupos de meninos e meninas foram inferiores aos valores de referência da Foam-Laser Posturography para adultos. Quando foi realizada a comparação entre os gêneros dentro de cada faixa etária, foram observadas diferenças estatisticamente significantes no Teste de Organização Sensorial I aos oito anos de idade, no Teste de Organização Sensorial V aos nove anos e no Teste de Organização Sensorial VI e na Média dos Testes de Organização Sensorial aos oito anos. CONCLUSÃO: o equilíbrio postural de meninas foi melhor que nos meninos, mas ambos os grupos tiveram valores inferiores aos considerados normais em adultos indicando que a maturação neuronal dos sistemas responsáveis pelo equilíbrio postural ainda não está completa.
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Ghent developmental balance test: a new tool to evaluate balance performance in toddlers and preschool children. Phys Ther 2012; 92:841-52. [PMID: 22383657 DOI: 10.2522/ptj.20110265] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Balance is a fundamental component of movement. Early identification of balance problems is important to plan early intervention. The Ghent Developmental Balance Test (GDBT) is a new assessment tool designed to monitor balance from the initiation of independent walking to 5 years of age. OBJECTIVE The purpose of this study was to establish the psychometric characteristics of the GDBT. METHODS To evaluate test-retest reliability, 144 children were tested twice on the GDBT by the same examiner, and to evaluate interrater reliability, videotaped GDBT sessions of 22 children were rated by 3 different raters. To evaluate the known-group validity of GDBT scores, z scores on the GDBT were compared between a clinical group (n = 20) and a matched control group (n = 20). Concurrent validity of GDBT scores with the subscale standardized scores of the Movement Assessment Battery for Children-Second Edition (M-ABC-2), the Peabody Developmental Motor Scales-Second Edition (PDMS-2), and the balance subscale of the Bruininks-Oseretsky Test-Second Edition (BOT-2) was evaluated in a combined group of the 20 children from the clinical group and 74 children who were developing typically. RESULTS Test-retest and interrater reliability were excellent for the GDBT total scores, with intraclass correlation coefficients of .99 and .98, standard error of measurement values of 0.21 and 0.78, and small minimal detectable differences of 0.58 and 2.08, respectively. The GDBT was able to distinguish between the clinical group and the control group (t(38) = 5.456, P<.001). Pearson correlations between the z scores on GDBT and the standardized scores of specific balance subscales of the M-ABC-2, PDMS-2, and BOT-2 were moderate to high, whereas correlations with subscales measuring constructs other than balance were low. CONCLUSIONS The GDBT is a reliable and valid clinical assessment tool for the evaluation of balance in toddlers and preschool-aged children.
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Tsai CL, Wang CH, Tseng YT. Effects of exercise intervention on event-related potential and task performance indices of attention networks in children with developmental coordination disorder. Brain Cogn 2012; 79:12-22. [DOI: 10.1016/j.bandc.2012.02.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 10/02/2011] [Accepted: 02/06/2012] [Indexed: 12/31/2022]
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de Sousa AMM, de França Barros J, de Sousa Neto BM. Postural control in children with typical development and children with profound hearing loss. Int J Gen Med 2012; 5:433-9. [PMID: 22615538 PMCID: PMC3355845 DOI: 10.2147/ijgm.s28693] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose To describe the behavior of the postural control in children with profound sensorineural hearing loss and compare the results of experimental tests with hearing children aged 7 to 10 years. Patients and methods This is a cross-sectional study where 100 children were divided into experimental and control groups. We used a force platform, AccuSway Plus, where the tests were conducted under the experimental conditions: open base, eyes open (OBEO); open base, eyes closed (OBEC); closed base, eyes open (CBEO); closed base, eyes closed (CBEC). The body sway velocity (V) of the center of pressure, the displacement in the anteroposterior direction (COPap) and mediolateral (COPml) of the center of pressure were the parameters to evaluate the postural control. For statistical analysis we used the nonparametric Mann–Whitney U test, with a significance level of 5%. Results In comparisons of variables between the groups, the experimental group outperformed by at least 75% of the control group values. In terms of global trends, the experimental group shows higher values of body oscillations in all experimental conditions and variables evaluated. Children with hearing loss had poorer balance performance compared to the group of hearing. The inferential analysis revealed a statistically significant difference in the balance between deaf and hearing children in the OBEC experimental condition in relation to the COPml parameter (P = 0.04). There were no statistically significant differences in comparisons between the sexes when the groups were analyzed separately. The prevalence of unknown etiology showed 58% of cases and congenital rubella in 16%. The discovery of deafness occurred in 70% of children before the age of 3 years. Conclusion In this study, children with hearing loss had poorer balance performance compared to the group of hearing children. This finding confirms the need to investigate postural control through longitudinal studies to identify the area of sensory deficit causing poor balance performance and promote more specific early interventions.
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Chen FC, Tsai CL, Stoffregen TA, Chang CH, Wade MG. Postural adaptations to a suprapostural memory task among children with and without developmental coordination disorder. Dev Med Child Neurol 2012; 54:155-9. [PMID: 21883171 DOI: 10.1111/j.1469-8749.2011.04092.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The present study investigated the effects of varying the cognitive demands of a memory task (a suprapostural task) while recording postural motion on two groups of children, one diagnosed with developmental coordination disorder (DCD) and an age-matched group of typically developing children. METHOD Two groups, each comprising 38 child volunteers (21 males, 17 females) aged 9 to 10 years, participated in the study. Each child performed a digital memory task at two levels of difficulty, low and high. Positional variability (standard deviation of position) of the head and torso were recorded as the biomechanical responses to the variation in task difficulty. RESULTS Both groups significantly reduced postural motion when engaged in the high-difficulty condition (p<0.05) compared with the low-difficulty condition. Children with DCD exhibited significantly higher levels of postural motion (p<0.05) than the typically developing children. The typically developing children significantly reduced their postural motion in the high-difficulty condition (p<0.05) compared with the low-difficulty condition, whereas children with DCD did not. INTERPRETATION Our results suggest that the postural responses of children with DCD differ from those of typically developing children while engaging in a memory task with various levels of difficulty.
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Affiliation(s)
- Fu-Chen Chen
- Affordance Perception and Action Laboratory, University of Minnesota, Minneapolis, MN, USA
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Chen FC, Tsai CL, Stoffregen TA, Wade MG. Postural responses to a suprapostural visual task among children with and without developmental coordination disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:1948-1956. [PMID: 21536408 DOI: 10.1016/j.ridd.2011.03.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 03/25/2011] [Accepted: 03/27/2011] [Indexed: 05/30/2023]
Abstract
We sought to determine the effects of varying the perceptual demands of a suprapostural visual task on the postural activity of children with developmental coordination disorder (DCD), and typically developing children (TDC). Sixty-four (32 per group) children aged between 9 and 10 years participated. In a within-participants design, each child performed a signal detection task at two levels of difficulty, low (LD) and high difficulty (HD). During performance of the signal detection tasks we recorded positional variability of the head and torso using a magnetic tracking system. We found that task difficulty had a greater effect on task performance among the TDC group than among children with DCD. Overall positional variability was greater the DCD group than in the TDC group. In the TDC group, positional variability was reduced during performance of the HD task, relative to sway during performance of the LD task. In the DCD group, positional variability was greater during performance of the HD task than during performance of the LD task. In children, DCD may reduce the strength of functional integration of postural activity with the demands of suprapostural visual tasks.
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Affiliation(s)
- F C Chen
- Affordance Perception Action Laboratory (APAL), School of Kinesiology, University of Minnesota, Minnespolis, MN 55455, USA
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Wuang YP, Su CY, Su JH. Wisconsin Card Sorting Test performance in children with developmental coordination disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:1669-1676. [PMID: 21458225 DOI: 10.1016/j.ridd.2011.02.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 02/21/2011] [Indexed: 05/30/2023]
Abstract
The primary purpose of this study was to investigate and compare the executive functions measured by the Wisconsin Card Sorting Test (WCST) between children with developmental coordination disorder (DCD) and age-matched normal controls. A second purpose was to examine the relations between executive functions and school functions in DCD children. Seventy-one children with DCD and 70 children without motor problems were recruited from 14 public schools. Executive functions and school functions were assessed using the WCST, and the School Function Assessment--Chinese Version (SFA-C) respectively. Univariate analyses demonstrated significant between-group differences in five WCST measures. The logistic regression analysis showed differences between two groups on eight SFA-C subscales, and significant correlation between items measured on WCST and SFA-C was also found. The result of the study provides further evidence of impaired sub-domains of executive functions (i.e., mental shifting, flexibility) in children with DCD. The finding also adds to recent investigations into the relationship between executive functions and school functions in DCD. Implications for rehabilitation professionals and recommendations for further research are discussed.
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Affiliation(s)
- Yee-Pay Wuang
- Department of Occupational Therapy, Kaohsiung Medical University, and Department of Physical and Rehabilitation Medicine, Kaohsioung Municipal Hsiaokang Hospital, Kaohsiung, Taiwan.
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Tsai CL, Pan CY, Cherng RJ, Hsu YW, Chiu HH. Mechanisms of deficit of visuospatial attention shift in children with developmental coordination disorder: A neurophysiological measure of the endogenous Posner paradigm. Brain Cogn 2009; 71:246-58. [DOI: 10.1016/j.bandc.2009.08.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 08/10/2009] [Accepted: 08/11/2009] [Indexed: 11/26/2022]
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Tsai CL. The effectiveness of exercise intervention on inhibitory control in children with developmental coordination disorder: using a visuospatial attention paradigm as a model. RESEARCH IN DEVELOPMENTAL DISABILITIES 2009; 30:1268-1280. [PMID: 19497707 DOI: 10.1016/j.ridd.2009.05.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Accepted: 05/05/2009] [Indexed: 05/27/2023]
Abstract
Children with developmental coordination disorder (DCD) have been demonstrated to show a deficit of inhibitory control in volitional shifts of attention. The aim of this study was to use ecological intervention to investigate the efficacy of table-tennis training on treating both problems with attentional networks and motor disorder in children with DCD. Forty-three children aged 9-10 years old were screened using the Movement Assessment Battery for Children and divided into DCD (n=27) and typically developing (TD, n=16) groups. Children with DCD were then quasi-randomly assigned to either a DCD-training group who underwent a ten-week table-tennis training program with a frequency of 3 times a week or a DCD non-training group. Before and after training, the capacity of inhibitory control was examined with the endogenous Posner paradigm task for DCD and TD groups. Table-tennis training resulted in significant improvement of cognitive and motor functions for the children with DCD. The study demonstrated that exercise intervention employed within the school setting can benefit the inhibitory control and motor performance in children with DCD. However, future research efforts should continue to clarify whether the performance gains could be maintained over time.
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Affiliation(s)
- Chia-Liang Tsai
- Institute of Physical Education, Health & Leisure Studies, National Cheng Kung University, Taiwan, ROC.
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Tsai CL, Pan CY, Cherng RJ, Wu SK. Dual-task study of cognitive and postural interference: a preliminary investigation of the automatization deficit hypothesis of developmental co-ordination disorder. Child Care Health Dev 2009; 35:551-60. [PMID: 19638025 DOI: 10.1111/j.1365-2214.2009.00974.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to investigate whether children with developmental co-ordination disorder and balance problem (DCD-BP) had greater problems than controls in performing a primary balance task while concurrently completing different cognitive tasks varying in oral or listening cognitive complexity, as well as to investigate the automatization deficit hypothesis of DCD-BP. METHODS Children with DCD-BP (n= 39), along with age-matched control counterparts (n= 39), were placed on automatic processing situation under dual-task conditions. All children were required to perform a primary task, five dual-task paradigms (oral counting task, auditory-verbal reaction task, auditory-choice reaction task, auditory-memory task and articulation alone) and an eyes-closed balancing task. RESULTS In the primary task condition, the differences were not statistically significant (P= 0.393) between children with and without DCD-BP. However, children with DCD-BP were significantly more impaired on three of five dual-task conditions (oral counting task: P= 0.003; auditory-verbal reaction task: P= 0.011; auditory-memory task: P= 0.041) compared with the single-task situation, with the exception of the auditory-choice reaction task (P= 0.471) and articulation alone (P= 0.067). CONCLUSIONS These results suggest that children with DCD-BP were more cognitively dependant and may have an automatization deficit.
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Affiliation(s)
- C-L Tsai
- Institute of Physical Education, Health & Leisure Studies, National Cheng Kung University, Taiwan
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Tsai CL, Yu YK, Chen YJ, Wu SK. Inhibitory response capacities of bilateral lower and upper extremities in children with developmental coordination disorder in endogenous and exogenous orienting modes. Brain Cogn 2009; 69:236-44. [DOI: 10.1016/j.bandc.2008.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2007] [Revised: 07/22/2008] [Accepted: 07/23/2008] [Indexed: 10/21/2022]
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Ramstrand N, Andersson CB, Rusaw D. Effects of an unstable shoe construction on standing balance in children with developmental disabilities: a pilot study. Prosthet Orthot Int 2008; 32:422-33. [PMID: 18985552 DOI: 10.1080/03093640802339403] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to investigate if prolonged use of shoes incorporating an unstable sole construction could facilitate improvements of balance in a sample of developmentally disabled children. Ten children (six male and four female) aged between 10 and 17 years participated in the study. Children were fitted with shoes incorporating an unstable sole (Masai Barefoot Technology) and instructed to wear them for a minimum of two hours per day for eight weeks. A within subjects repeated measures design was used. Children were tested prior to receiving the shoes, four weeks after receiving the shoes and eight weeks after receiving the shoes. A force plate capable of rotating about a single axis (NeuroCom International Inc, Oregon) was used to test static balance, reactive balance and directional control. Static balance was not found to be influenced by prolonged use of the footwear; however, significant improvements were noted in children's reactive balance both with the shoes and barefoot. Results suggest that reactive balance can be improved by prolonged and regular use of shoes incorporating an unstable sole construction.
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Tsai CL, Wu SK. Relationship of Visual Perceptual Deficit and Motor Impairment in Children with Developmental Coordination Disorder. Percept Mot Skills 2008; 107:457-72. [DOI: 10.2466/pms.107.2.457-472] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study explored the relations of visual perceptual deficits and motor impairments in 60 children with Developmental Coordination Disorder (120.8 ± 4.0 mo.) and 60 controls (121.0 ± 5.3 mo.), who were matched by sex (29 boys and 31 girls) and age. They were separately assessed on fine and gross motor-dexterity tasks of the Movement Assessment Battery for Children, static balance and reaction time of lower extremities with eyes open or closed, and the Test of Visual-Perceptual Skills–Revised. Analysis showed the children with Developmental Coordination Disorder performed significantly worse than the control group, but only the visual perception and motor skills with timed responses were significantly correlated. When visual information was controlled, no significant correlation was noted, so motor-free visual perception appears to be significantly related to motor performance having a speed component in these children.
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Affiliation(s)
- Chia-Liang Tsai
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University
| | - Sheng-Kuang Wu
- Institute of Athletics, National Taiwan Sport University
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TSAI CHIALIANG. RELATIONSHIP OF VISUAL PERCEPTUAL DEFICIT AND MOTOR IMPAIRMENT IN CHILDREN WITH DEVELOPMENTAL COORDINATION DISORDER. Percept Mot Skills 2008. [DOI: 10.2466/pms.107.6.457-472] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
PURPOSE Brain tumours are the most common solid tumours in children and adolescents. The increasing survival rate of these patients makes their follow-up and quality of life assessment an important task. The evaluation of the negative influence of anti-cancer treatment on their balance is the aim of this study. MATERIAL AND METHODS The balance assessment was performed on patients who completed the treatment of CNS tumours and were disease-free at the time of the study. Eighty-eight patients aged 5 to 24 years participated in the study. Postural sway was recorded using Kistler force plate. Balance test parameters from two conditions: eyes open and eyes closed were calculated and compared with reference data. The severity of the balance disorders was scored for both conditions. RESULTS The balance disorders were generally not dependent on the localisation of the tumour. Only patients treated for posterior fossa tumours had a higher score (indicating pronounced balance deficit) in eyes closed condition comparing to others. The patients treated for spinal cord tumours seemed to have increased total sway path in comparison to others. The severity of the balance deficits tended to diminish in time. CONCLUSIONS These results suggest that the repair mechanisms of the CNS could overcome the problems inflicted by the illness and therapy.
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