Do motor ability and handwriting kinematic measures predict organizational ability among children with Developmental Coordination Disorders?

Evaluating handwriting in children with developmental coordination disorder (DCD): Temporal, spatial, pressure and grip-force measures

BACKGROUND

Writing involves complex sensorimotor and biomechanical processes that regulate pressure on the writing surface. Researchers analyze writing to understand kinetics and kinematics by evaluating temporal, spatial, and pressure aspects, yet discerning writing surface pressure and pen-grip force remains challenging.

AIMS

To compare handwriting kinetics (pen grip-force and surface pressure) and kinematics (temporal-spatial) of children with developmental coordination disorder (DCD) with those of typically developing (TD) children.

METHODS AND PROCEDURES

Twenty-seven children with DCD aged 7-12 years and 27 TD children matched by age and gender copied a 29-word passage onto a computerized tablet. Temporal, spatial and surface pressure as well as pen grip-force were measured with a tablet and a wearable device respectively.

OUTCOMES AND RESULTS

The DCD group displayed significantly longer total writing time, mean letter time, and greater letter height, width, variance, spacing, area, and erasures than the TD group. Although there were no significant between-group differences in the surface pressure or maintaining pressure, the DCD group displayed weaker grip-force, p = .01, with greater variance.

CONCLUSIONS AND IMPLICATIONS

The DCD group's weaker grip-force dynamics correlated with reduced legibility, form, and prolonged writing duration, revealing insights into handwriting mechanisms, particularly grip force, crucial for effective clinical interventions.

Benefits of a Light-Painting Technique for Learning to Write New Characters: A Proof of Concept With Adults

Learning to write relies on the effective integration of sensory feedback and a transition from motor control based on written tracings to motor control based on expert writing movements. This study aimed to test whether the photographic technique of light painting (LP) would facilitate this transition. To achieve this, we conducted two experiments using different LP setups. LP involves moving a light source in a dark environment while taking a long-exposure photograph. LP entails both a real-time reduction of product-related visual information and a post-trial addition of process-related visual information. In the first experiment, we conducted a pre-test, training, and post-test in which 16 adults wrote four new characters with the non-dominant hand. During the training sessions, participants stood and wrote in a vertical frame (1 × 1.2 m) two characters in the control condition (with a marker on the vertical support) and two characters in the LP condition (with a flashlight in the air). In the test phases, participants were seated at a table and copied the four characters into a square (4 cm * 4 cm) on a fixed sheet of graphics paper. As in-air writing strongly differs from classical handwriting situations, we performed a second LP experiment. The aim was to implement LP training in a condition closer to writing. Sixteen new participants followed the same protocol but sat at a table and wrote in a horizontal square (20 cm * 20 cm). In both experiments, participants who trained with the LP method wrote faster and with less pressure than those trained in the control condition. We also observed an improvement in spatial accuracy in Experiment 2, whatever the training condition. LP seemed to have led participants to focus on the writing process, probably because it modified the nature and timing of the visual information used for writing. LP may be a promising technique for remediating writing difficulties.

Effects of methylphenidate and physiotherapeutic treatment on graphomotor movements in children with ADHD

In addition to the core symptoms defining ADHD, affected children often experience motor problems; in particular, graphomotor movements including handwriting are affected. However, in clinical settings, there is little emphasis on standardized and objective diagnosing and treatment of those difficulties. The present study investigated for the first time the effects of methylphenidate as well as physiotherapeutic treatment on objectively assessed graphomotor movements compared to a control condition, i.e. parental psychoeducation, in 58 children (mean age: 9.52 ± 1.91 years) newly diagnosed with ADHD in an outpatient clinic for child and adolescent psychiatry. Families were invited to join one of the treatment groups. Before and after 8 weeks of treatment, children performed six different tasks on a digitizing tablet which allowed the objective analysis of three important kinematic parameters of graphomotor movements (fluency, velocity, and pen pressure) in different levels of visual control and automation. Graphomotor movement fluency and velocity improves over time across the groups, especially in tasks with eyes closed. We did not find clear evidence for beneficial effects of methylphenidate or physiotherapeutic treatment on children's overall graphomotor movements suggesting that treatments need to be better tailored towards specific and individual deficits in graphomotor movements.

Achieving trust in health-behavior-change artificial intelligence apps (HBC-AIApp) development: a multi-perspective guide

OBJECTIVE

Trust determines the success of Health-Behavior-Change Artificial Intelligence Apps (HBC-AIApp). Developers of such apps need theory-based practical methods that can guide them in achieving such trust. Our study aimed to develop a comprehensive conceptual model and development process that can guide developers how to build HBC-AIApp in order to support trust creation among the app's users.

METHODS

We apply a multi-disciplinary approach where medical informatics, human-centered design, and holistic health methods are integrated to address the trust challenge in HBC-AIApps. The integration extends a conceptual model of trust in AI developed by Jermutus et al., whose properties guide the extension of the IDEAS (integrate, design, assess, and share) HBC-App development process.

RESULTS

The HBC-AIApp framework consists of three main blocks: (1) system development methods that study the users' complex reality, hence, their perceptions, needs, goals and environment; (2) mediators and other stakeholders who are important for developing and operating the HBC-AIApp, boundary objects that examine users' activities via the HBC-AIApp; and (3) the HBC-AIApp's structural components, AI logic, and physical implementation. These blocks come together to provide the extended conceptual model of trust in HBC-AIApps and the extended IDEAS process.

DISCUSSION

The developed HBC-AIApp framework drew from our own experience in developing trust in HBC-AIApp. Further research will focus on studying the application of the proposed comprehensive HBC-AIApp development framework and whether applying it supports trust creation in such apps.

Relationships between motor skills and executive functions in developmental coordination disorder (DCD): A systematic review

BACKGROUND

Individuals with developmental coordination disorder (DCD) experience motor skill and executive function (EF) difficulties that challenge their daily activities.

AIM/OBJECTIVE

This systematic review aims to provide an in-depth analysis of the relationships between motor skills and EFs in studies among individuals with DCD.

MATERIAL AND METHODS

We conducted a systematic search of eight electronic databases for articles (published 1994-2021) reporting on quantitative studies that estimated relationships between motor skills and EFs when assessing children, adolescents and adults with DCD. Motor skills and EFs were assessed via reliable and validated assessment tools. Two reviewers independently screened the articles. We evaluated the quality of the selected articles according to EPHPP guidelines and the methodological quality of the assessments from these studies using the COSMIN checklist and reported results following the PRISMA-P checklist. This systematic review was registered in PROSPERO (CRD42019124578).

RESULTS

A total of 30,808 articles were screened. Eleven articles met the inclusion criteria and were reviewed. Findings from nine studies demonstrated weak to strong correlations between aspects of motor skills and EFs.

CONCLUSIONS AND SIGNIFICANCE

Limited evidence supports the relationships between motor skills and EFs among individuals with DCD. Occupational therapists should consider the possibility of this relationship and give more consideration to these components when planning intervention for individuals with DCD.

Coordination strategies of lower limb muscles during curve-turning tasks in preschool children

BACKGROUND

Preschoolers are within their critical time in motion development; while muscles are the fundamental units in motion control and by monitoring activated intensity and duration of muscles, preschooler's motor ability which would disclose their potential pathogenesis quality can be objectively and quantitatively assessed. Although a large number of studies were available on this issue, questions still being there: what are the patterns and characteristics of lower limb muscles when they are facing with the curve walking(CW) tasks; and then how individual muscle or muscle groups coordinated while turning curves. Our purpose of this study is first to portray the patterns and characteristics of lower limb muscles of healthy preschoolers while CW and then to insight their muscles' coordination mechanism and "neuro-musculo-skeletal" feedback during motion.

METHOD

35 healthy preschoolers and 35 healthy adults' lower limbs surface electromyography (sEMG) were collected while left and right CW and four muscle groups (Tibialis Anterior, Lateral Gastrocnemius, Rectus Femoris, and Biceps Femoris) were recorded. sEMG variables such as Muscle Activation Time, Total Duration of Activity Time, Average Muscle Activation Rate and Average Rate of Change were calculated. Paired sample t-test was used to explore the differences of sEMG variables between preschoolers and adults when turning curves.

RESULTS

Preschoolers would adjust the gait by changing the activation time and activation rate to fulfill the curve turning tasks; but they also showed variations in coordination mechanism when contrasting with the adults group. Those findings in preschoolers would support to build muscles' coordination mechanism and further insight to neuro-muscular skeletal feedback regulation.

CONCLUSION

Although preschoolers performed good enough to switching gait from normal walking to CW, but gaps in their abilities were still apparent when compared to adults. Hence, with the help of highly recognizable muscle coordination mechanism in CW, motor dysfunction in lower limbs of preschool children can be effectively identified.

How to become an excellent pediatric resident: a qualitative comparative study from China

BACKGROUND

Competency-oriented medical education has become a global trend. However, most current studies focus on the independent effects of various competencies and lack an examination of the combined effects. Therefore, the purpose of this study was to explore the competency configurations of excellent pediatric residents and general pediatric residents and to provide a scientific reference for the talent training and career development of pediatric residents.

METHODS

Behavioral event interviews were conducted with 23 pediatric residents at a children's hospital in Beijing in July and August 2019. Two researchers coded the interview data to summarize the competency of pediatric residents. The research group scored the performance of 23 pediatric residents in various aspects of competency and used the crisp-set qualitative comparative analysis method to explore the competency configurations of excellent pediatric residents and general pediatric residents.

RESULTS

This study concludes that pediatric residents should have six core competencies: professional spirit, clinical skills, communication ability, learning ability, mental capacity and research ability. There are 4 combinations of competencies for becoming an excellent pediatric resident: the clinical type, scientific research type, all-around development type and high emotional intelligence type. In addition, there are 3 combinations of competencies for becoming a general pediatric resident: the comprehensive ability deficiency type, lack of professionalism and mental capacity type, lack of communication ability type.

CONCLUSIONS

There are differences in competence between excellent and general pediatric residents. Excellent pediatric residents do not need to possess all competencies but should specialize in clinical practice, scientific research or communication skills. This study suggests that training in mental capacity, professional spirit and communication ability should be strengthened during pediatric resident training. Pediatric residents should make career development plans according to their actual situation, and hospitals should arrange suitable positions according to the characteristics of pediatric residents.

Kinematic analysis of handwriting movements and pencil grip patterns in children with low vision

PURPOSE

Handwriting skills are important for the academic life of children and the lack of visual-motor performance leads to writing problems in children with low vision. This study aims to reveal handwriting kinematics and pencil grip features in children with low vision by means of a novel method.

MATERIALS AND METHODS

18 children with low vision (mean age: 9.83 ± 1.54 years) and 18 children with typical development (mean age: 9.83 ± 1.62 years) were included in the study. Children performed a sentence writing task on a digitizer tablet. During the task, the writing hand of children was photographed to analyze pencil grip patterns.

RESULTS

Children with low vision performed greater stroke size except for the vertical size, slower writing speed, more dysfluent movements, and less pen pressure than children with typical development. However, participants preferred mature pencil grip patterns and had high grip scores independent from the diagnosis.

CONCLUSIONS

The findings indicate that children with low vision have difficulties in handwriting in terms of spatial and temporal features. These results would be important for interventions to develop specific programs on writing skills to support their educational life.

Test of Motor Proficiency Second Edition (BOT-2) Short Form: A Systematic Review of Studies Conducted in Healthy Children

Motor skill competence of children is one of the important predictors of health because if a child is physically active during early childhood, the possibility of occurrence of many chronic diseases in adulthood will be reduced. The aim of this study was to systematically review the studies conducted in healthy children using the shorter form of the Bruininks-Oseretsky (BOT-2) and to determine the applicability in cross-sectional studies and pre-post designs. The search and analysis of the studies were done in accordance with the PRISMA guidelines. An electronic databases search (Google Scholar, PubMed, Mendeley, Science Direct, and Scopus) yielded 250 relevant studies conducted from 2011 to 2020. A total of 21 studies were included in quantitative synthesis, with a total of 3893 participants, both male and female. Through this study, the BOT-2 test proved its broad applicability, so it can be concluded that this test can be used to improve motor proficiency in a healthy population of children. Hence, it is necessary to invest a lot of time during the implementation of various programs so that children would adequately develop their basic motor skills so they broaden their own repertoire of movements.

Using Android Tablets to develop handwriting skills: A case study

A system to support the teaching and learning of handwriting skills is proposed. It is composed of two components: the hardware component (e.g., Android Tablet); and the software component. The software component as two modules: the server and the client. A teacher chooses what exercises/games a child should do directly in the Android table or using the server, from the existing ones in the system. A child does the exercises/games by logging into the system in the Android Tablet. Automatic feedback about the correctness of the answers is provided by the system. Data (number of tries, time spent, etc.) are automatically grabbed and processed to be presented to the teachers and parents. Registered parents can see the results and follow their children' s “academic life”, by logging into the server side of the system. We found a significant improvement in the development of handwriting skills in the children throughout the academic year, and improvements were also more present when comparing children who had have contact with the system with children who did not have this contact. Educators, children, School Boards, City Town Hall and the Educational Community are unanimous in stating that the implementation of this system was a real success.

The Child Evaluation Checklist (CHECK): A Screening Questionnaire for Detecting Daily Functional "Red Flags" of Underrecognized Neurodevelopmental Disorders among Preschool Children

Background

Early identification of invisible comorbid neurodevelopmental disorders, such as specific learning disorders, attention deficit hyperactive disorders, and developmental coordination disorders, is crucial to improving children's daily functional deficits related to executive functions. However, a practical questionnaire to address parents' concerns is lacking.

Aims

To develop a reliable and valid assessment tool that can identify young children at risk for invisible underrecognized neurodevelopmental disorders. This article describes the development and standardization of the Child Evaluation Checklist (CHECK).

Methods and Procedures

Participants were 186 children aged 3 to 6 years: 91 with suspected invisible neurodevelopmental disorders, and 95 controls with typical development. Parents completed a demographic questionnaire, the CHECK, and the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P).

Outcomes and Results

The CHECK's construct validity indicated high internal consistency for each part (Part A: α = .94; Part B: α = .90) and moderate-to-high consistency for each of Part A's four factors. Significant correlations, as well as significant group differences, were found between the CHECK factors and BRIEF-P scores.

Conclusions and Implications

Use of the CHECK allows for timely identification of suspicious ("red flags") invisible neurodevelopmental disorders. It may support parents' sufficient awareness and knowledge to refer their children for comprehensive evaluation and intervention.

Effects of practice on visual finger-force control in children at risk of developmental coordination disorder

BACKGROUND

The production of finger force control is essential for a large number of daily activities. There is evidence that deficits in the mechanisms of accuracy and control of finger force tasks are associated with children's motor difficulties.

OBJECTIVE

To compare the effect of practice of an isometric finger force/torque task between children with significant movement difficulty and those with no difficulty movement.

METHODS

Twenty-four children aged between 9 and 10 years (12 at risk of developmental coordination disorder and 12 with no movement difficulty - typically developing children) were asked to produce finger force/torque control in a continuous and constant 25% of maximum voluntary torque with visual feedback during 15s. Practice was given during five consecutive days with 15 trials per day. After the practice with visual feedback, children were asked to perform five trials without visual feedback. In these trials, feedback was removed 5s after the start of the trial.

RESULTS

Typically developing children were consistently more accurate in maintaining finger force/torque control than those children at risk of developmental coordination disorder. Children from both groups improved the performance in the task according to practice sessions. Also, children at risk of developmental coordination disorder poorly performed the task without visual feedback as they did when visual feedback was available.

CONCLUSION

The present study give support to the idea that movement difficulty is associated with finger force/torque control and children at risk of developmental coordination disorder can improve finger force/torque control with practice when visual feedback is available.

Inter-relationships between objective handwriting features and executive control among children with developmental dysgraphia

Objective

To describe handwriting and executive control features and their inter-relationships among children with developmental dysgraphia, in comparison to controls.

Method

Participants included 64 children, aged 10–12 years, 32 with dysgraphia based on the Handwriting Proficiency Screening Questionnaire (HPSQ) and 32 matched controls. Children copied a paragraph onto paper affixed to a digitizer that supplied handwriting process objective measures (Computerized Penmanship Evaluation Tool (ComPET). Their written product was evaluated by the Hebrew Handwriting Evaluation (HHE). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire about their child's executive control abilities.

Results

Significant group differences were found for handwriting performance measures (HHE and ComPET) and executive control domains (BRIEF). Based on one discriminate function, including handwriting performance and executive control measures, 98.4% of the participants were correctly classified into groups. Significant correlations were found in each group between working memory and legibility as well as for other executive domains and handwriting measures. Furthermore, twenty percent of the variability of the mean pressure applied towards the writing surface among children with was explained by their 'emotional control' (BRIEF).

Conclusion

The results strongly suggest consideration of executive control domains to obtain better insight into handwriting impairment characteristics among children with dysgraphia to improve their identification, evaluation and the intervention process.

Learning Letters With the Whole Body: Visuomotor Versus Visual Teaching in Kindergarten

What constitutes effective teaching of letter learning in early school years is still uncertain. We assessed the impact of a teacher-implemented visuomotor intervention program to teach 5-year-olds' cursive letter knowledge. We compared a program in which letters were explored with the arm and whole body, with a typical visual training program. Children were tested before and after the intervention with different measures of letter knowledge. We showed a greater improvement in letter recognition following the visuomotor intervention, compared with the visual intervention. Results were mixed for letter handwriting for which we found higher scores on stroke direction and overall quality, but lower scores on fluency following whole body visuomotor teaching. We discuss our results in terms of the link between action and perception, the interaction between the different components of letter knowledge, and the link between fine and gross motor development and handwriting.

Handwriting Analysis in Parkinson's Disease: Current Status and Future Directions

BACKGROUND

The majority of patients with Parkinson's disease (PD) have handwriting abnormalities. Micrographia (abnormally small letter size) is the most commonly reported and easily detectable handwriting abnormality in patients with PD. However, micrographia is perhaps the tip of the iceberg representing the handwriting abnormalities in PD. Digitizing tablet technology, which has evolved over the last 2 decades, has made it possible to study the pressure and kinematic features of handwriting. This has resulted in a surge of studies investigating graphomotor impairment in patients with PD.

METHODS

The objectives of this study were to review the evolution of the kinematic analysis of handwriting in PD and to provide an overview of handwriting abnormalities observed in PD along with future directions for research in this field. Articles for review were searched from the PubMed and SCOPUS databases.

RESULTS

Digitizing tablet technologies have resulted in a shift of focus from the analysis of only letter size to the analysis of several kinematic features of handwriting. Studies based on the kinematic analysis of handwriting have revealed that patients with PD may have abnormalities in velocity, fluency, and acceleration in addition to micrographia. The recognition of abnormalities in several kinematic parameters of handwriting has given rise to the term PD dysgraphia. In addition, certain kinematic properties potentially may be helpful in distinguishing PD from other parkinsonian disorders.

CONCLUSION

The journey from micrographia to PD dysgraphia is indeed a paradigm shift. Further research is warranted to gain better insight into the graphomotor impairments in PD and their clinical implications.

Cognitive and neuroimaging findings in developmental coordination disorder: new insights from a systematic review of recent research

AIM

To better understand the neural and performance factors that may underlie developmental coordination disorder (DCD), and implications for a multi-component account.

METHOD

A systematic review of the experimental literature published between June 2011 and September 2016 was conducted using a modified PICOS (population, intervention, comparison, outcomes, and study type) framework. A total of 106 studies were included.

RESULTS

Behavioural data from 91 studies showed a broad cluster of deficits in the anticipatory control of movement, basic processes of motor learning, and cognitive control. Importantly, however, performance issues in DCD were often shown to be moderated by task type and difficulty. As well, we saw new evidence of compensatory processes and strategies in several studies. Neuroimaging data (15 studies, including electroencephalography) showed reduced cortical thickness in the right medial orbitofrontal cortex and altered brain activation patterns across functional networks involving prefrontal, parietal, and cerebellar regions in children with DCD than those in comparison groups. Data from diffusion-weighted magnetic resonance imaging suggested reduced white matter organization involving sensorimotor structures and altered structural connectivity across the whole brain network.

INTERPRETATION

Taken together, results support the hypothesis that children with DCD show differences in brain structure and function compared with typically developing children. Behaviourally, these differences may affect anticipatory planning and reduce automatization of movement skill, prompting greater reliance on slower feedback-based control and compensatory strategies. Implications for future research, theory development, and clinical practice are discussed.

Graphonomics and its contribution to the field of motor behavior: A position statement

The term graphonomics was conceived in the early 1980s; it defined a multidisciplinary emerging field focused on handwriting and drawing movements. Researchers in the field of graphonomics have made important contribution to the field of motor behavior by developing models aimed to conceptualize the production of fine motor movements using graphical tools. Although skeptics have argued that recent technological advancements would reduce the impact of graphonomic research, a shift of focus within in the field of graphonomics into fine motor tasks in general proves the resilience of the field. Moreover, it has been suggested that the use of fine motor movements due to technological advances has increased in importance in everyday life. It is concluded that the International Graphonomics Society can have a leading role in fostering collaborative multidisciplinary efforts and can help with the dissemination of findings contributing to the field of human movement sciences to a larger public.