Assessing motor proficiency in young adults: The Bruininks Oseretsky Test-2 Short Form and the McCarron Assessment of Neuromuscular Development

Validity of the BOT-2 Short Form for Korean School-Age Children: A Preliminary Study

The Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT-2) is the most common motor assessment in Korea. The BOT-2-Short Form (SF) is preferred over the complete form (CF) in settings with limited time. The present study aimed to assess the validity of the BOT-2 SF in Korean school-age children. First, we verified that the BOT-2 SF reflects developmental changes in motor skills. Second, we compared the BOT-2 SF scores to those of the BOT-2 CF. A total of 283 Korean school-age children performed the BOT-2. The differences in the BOT-2 SF point according to age group (7 years, 8-9 years, and 10-12 years) were analyzed. A correlation analysis of the standard scores between the BOT-2 SF and CF was conducted. The sensitivity and specificity of the BOT-2 SF were calculated in reference to its CF. Overall, the BOT-2 SF point scores increased with age. The correlation between the total scores of the BOT-2 SF and CF was strong. The BOT-2 SF had a sensitivity of 83% and specificity of 92%. This study has demonstrated the validity of the BOT-2 SF in Korean school-age children. The BOT2 SF can be useful in screening Korean school-age children with motor skills problems.

Motor proficiency of persons with attention deficit hyperactivity disorder or autism spectrum disorder diagnosed in adulthood

PURPOSE

To compare (1) motor proficiency of persons diagnosed in adulthood with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) with normative values of motor proficiency, and (2) motor proficiency between persons with ADHD and those with ASD diagnosed in adulthood.

METHODS

A total of 153 adults (median age 32 years, 36% women) participated in this cross-sectional study. Fifty-three persons with predominately inattentive presentation (ADHD-I), 67 persons with combined presentation (ADHD-C), and 33 persons with ASD performed the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). One-sample binominal tests were used to compare motor proficiency against standardized norms of BOT-2 for young adults. One-way ANOVAs and Kruskal-Wallis tests were used to compare test outcomes between the groups.

RESULTS

The total sample showed significantly impaired motor proficiency in comparison to norms in all test domains (p < 0.001-0.006), except for fine motor skills. The ASD group showed significantly poorer body coordination compared with the ADHD-I and ADHD-C groups, with a moderate effect size (p = 0.003-0.02, η2 = 0.061).

CONCLUSIONS

Motor proficiency is impaired in most persons with ADHD or ASD diagnosed in adulthood, suggesting that motor assessment should be included in clinical examinations of adults with suspected neurodevelopment disorders.

The role of the primary motor cortex in motor imagery: A theta burst stimulation study

While mentally simulated actions activate similar neural structures to overt movement, the role of the primary motor cortex (PMC) in motor imagery remains disputed. The aim of the study was to use continuous theta burst stimulation (cTBS) to modulate corticospinal activity to investigate the putative role of the PMC in implicit motor imagery in young adults with typical and atypical motor ability. A randomized, double blind, sham‐controlled, crossover, offline cTBS protocol was applied to 35 young adults. During three separate sessions, adults with typical and low motor ability (developmental coordination disorder [DCD]), received active cTBS to the PMC and supplementary motor area (SMA), and sham stimulation to either the PMC or SMA. Following stimulation, participants completed measures of motor imagery (i.e., hand rotation task) and visual imagery (i.e., letter number rotation task). Although active cTBS significantly reduced corticospinal excitability in adults with typical motor ability, neither task performance was altered following active cTBS to the PMC or SMA, compared to performance after sham cTBS. These results did not differ across motor status (i.e., typical motor ability and DCD). These findings are not consistent with our hypothesis that the PMC (and SMA) is directly involved in motor imagery. Instead, previous motor cortical activation observed during motor imagery may be an epiphenomenon of other neurophysiological processes and/or activity within brain regions involved in motor imagery. This study highlights the need to consider multi‐session theta burst stimulation application and its neural effects when probing the putative role of motor cortices in motor imagery.

A controlled continuous theta burst stimulation protocol was adopted to examine the role of the primary motor cortex in motor imagery. While corticospinal excitability was suppressed in individuals with typical motor ability, no changes in imagery performance were detected after applying active stimulation to the motor regions. This suggests that motor regions may not be causally implicated in motor imagery and/or that multiple stimulation sessions may be required when inducing cognitive‐behavioral changes.

Dual-Task Balance Training for Motor Skill Development among Children with Intelligence Quotient Discrepancy

The motor skills of people with mental disabilities are reportedly reduced compared with those of their peers. Therefore, any task incorporating both motor and cognitive skills was hypothesized to provide better motor recovery. The aim of this study is to find the effect of dual-task balance training (DTBT) on motor skill development in children of 6–13 years with intelligence quotient discrepancy (IQD) (score: 50–79). Overall, 30 individuals with mental disabilities aged 6–13 years having an IQ score of 50–79 were included. The participants were randomly divided into two groups that received dual-task training and standard balance training, respectively. IQ was measured with the Wechsler Intelligence Scale for Children-Revised, motor proficiency with the Bruininks–Oseretsky test, reaction time with COGNIBOARD, and balance with Functional Reach Test scores. Intervention was provided twice a week for 12 consecutive weeks. Participants in both groups showed higher test scores in all tests after the training program. Both training programs positively affected the motor performance of the participants. The DTBT was more effective in improving balance performance than the standard balance training. DTBT is a better tool than conventional balance training for improving motor skills and balance in children of 6–13 years with IQD (score: 50–79).

Mental rotation performance in young adults with and without developmental coordination disorder

While there have been consistent behavioural reports of atypical hand rotation task (HRT) performance in adults with developmental coordination disorder (DCD), this study aimed to clarify whether this deficit could be attributed to specific difficulties in motor imagery (MI), as opposed to broad deficits in general mental rotation. Participants were 57 young adults aged 18-30 years with (n = 22) and without DCD (n = 35). Participants were compared on the HRT, a measure of MI, and the letter number rotation task (LNRT), a common visual imagery task. Only participants whose behavioural performance on the HRT suggested use of a MI strategy were included in group comparisons. Young adults with DCD were significantly less efficient compared to controls when completing the HRT yet showed comparable performance on the LNRT relative to adults with typical motor ability. Our data are consistent with the view that atypical HRT performance in adults with DCD is likely to be attributed to specific difficulties engaging in MI, as opposed to deficits in general mental rotation. Based on the theory that MI provides insight into the integrity of internal action representations, these findings offer further support for the internal modelling deficit hypothesis of DCD.

Error-Related Cognitive Control and Behavioral Adaptation Mechanisms in the Context of Motor Functioning and Anxiety

Motor proficiency reflects the ability to perform precise and coordinated movements in different contexts. Previous research suggests that different profiles of motor proficiency may be associated with different cognitive functioning characteristics thus suggesting an interaction between cognitive and motor processes. The current study investigated this interaction in the general population of healthy adults with different profiles of motor proficiency by focusing on error-related cognitive control and behavioral adaptation mechanisms. In addition, the impact of these processes was assessed in terms of trait anxiety and worries. Forty healthy adults were divided into high and low motor proficiency groups based on an assessment of their motor skills. Using electroencephalography during a flanker task, error-related negativity (ERN) was measured as the neural indicator of cognitive control. Post-error slowing (PES) was measured to represent behavioral adaptation. Participants also completed an anxiety assessment questionnaire. Participants in the high motor proficiency group achieved better task accuracy and showed relatively enhanced cognitive control through increased ERN. Contrastingly, individuals in the lower motor proficiency group achieved poorer accuracy whilst showing some evidence of compensation through increased PES. Trait anxiety reflecting general worries was found to be correlated with motor functioning, but the study could not provide evidence that this was related to cognitive or behavioral control mechanisms. The interaction between cognitive and motor processes observed in this study is unique for healthy and sub-clinical populations and provides a baseline for the interpretation of similar investigations in individuals with motor disorders.

Investigating the compatibility, interchangeability, and clinical usability of BOT2-BF and BOT2-SF in primary school-aged children with and without developmental dyslexia

The aim of our study was to determine the sensitivity and specificity levels of BOT2-BF and BOT2-SF tests applied to children with developmental dyslexia and to examine their clinical usability. This study was designed as a case-controlled study. 82 (study group 41, control group 41) 7-12 year children were included. The study occurred three stages. In the first place, the similarities and differences of BOT2-BF and BOT2-SF tests observed in clinical practices were examined by taking the feedback of experts and test correlations. In the second step, BOT2-BF and BOT2-SF tests were examined with reference to the Core Outcome Set (COS) evaluation criteria. In the last step, in order to examine the sensitivity and specificity levels of the tests, assessments were performed in two groups with 1-week intervals. According to the COS results, the BOT2-BF test was examined better than the BOT2-SF test under cross-cultural validity title. The sensitivity and specificity of BOT2-SF were 0.92 and 0.51, and for BOT2-BF were 0.92 and 0.41, respectively. This study will help clinicians working on children with developmental dyslexia to decide the type of test they will use to evaluate and easy access to materials motor proficiency.

Identifying Developmental Motor Difficulties: A Review of Tests to Assess Motor Coordination in Children

The latest guidelines recommend early identification of children with motor impairments using a standardized norm-referenced test. Motor coordination difficulties in developmental age have been studied extensively over recent years, with experimental literature on developmental coordination disorder (DCD) suggesting that motor proficiency assessments depend on the nature of the task at hand. In this article we reviewed 14 assessment tools to measure movement performance in childhood and adolescence, which are often referred to in an international context. This updated review aims to compare motor tests depending on a) the nature of the tasks included in the battery (i.e., questionnaire and clinical examination), b) psychometric properties, and c) cultural adaptation to relevant developmental norms. Finally, implications for diagnosis and clinical practice are discussed. Considering there are several tests used for DCD, it is important to better define their reliability and validity in different cultures in order to better compare the validation studies and select the most appropriate test to use in the assessment procedure.

Movement difficulties in children with ADHD: Comparing the long- and short-form Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2)

AIMS

Up to 50% of children with attention deficit hyperactivity disorder (ADHD) also present with difficulties with motor proficiency. Several assessments of motor proficiency are available for occupational therapists, though the validity of these measures in an ADHD population requires further exploration. The aim of this paper was to evaluate the consistency of scores obtained using the long-form and short-form of the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2) in a school-age ADHD sample.

METHOD

The BOT-2 long-form was administered to 84 school-age children (78 males) with ADHD; short-form scores were extracted from the relevant long-form items.

RESULTS

Long-form and short-form total scores were highly correlated (r = .87), though the average short-form score was significantly higher. As a categorical measure, 52 children were classified as "at-risk" for movement difficulties by the long-form; but only 36 by the short-form, yielding a false-negative rate of 30.77%. The sensitivity of short-form could be improved by raising the cut-off thresholds of short-form scores as identified by receiver operating characteristic curve analysis but did not yield practical utility.

INTERPRETATION

As a continuous indicator (i.e. total scores), the short-form is comparable to the long-form. However, the short-form overestimates the child's motor proficiency relative to the long-form and yields an unacceptably high rate of false negatives as a categorical measure. The current revision of the short-form is therefore not recommended as a screening nor diagnostic instrument in an ADHD population. In the absence of ADHD-specific norms, use of the long-form provides greater opportunity for occupational therapists to identify those at-risk for movement difficulties. However, any assessment of motor proficiency should be accompanied by a broader comprehensive assessment to best understand a child's motor functioning.

Normative hand grip strength and prediction models for Iranian office employees

BACKGROUND

Normative data on Hand grip strength has a wide range of application and is of great value.

OBJECTIVE

To establish gender and age-specific reference data concerning hand grip strength of Iranian office workers, to explore possible relationships with demographic and anthropometric factors and to develop appropriate predictive models.

METHODS

The study population included 418 (220 males and 198 females) Iranian office employees. They were divided into 5-year age-groups. Hand length, palm width, palm length, forearm length, wrist circumference, and forearm circumference were measured by means of a digital Caliper (±0.01 mm) and a tape meter (±0.1 cm). The value of hand grip strength was measured by JAMAR hydraulic dynamometer respecting the American Society of Hand Therapy recommendations.

RESULTS

The average of grip strength for dominant and non-dominant hands (in Kg) respectively was 51.10±9.50 and 46.90±9.89 for male and 28.76±4.47 and 25.89±4.60 for female. Age was curvilinearly related to hand grip strength. All selected hand dimensions were highly correlated with grip strength; palm width, palm length and hand length being the most correlated ones, respectively. Prediction equations of hand grip strength were developed for dominant and non-dominant hands of both genders.

CONCLUSIONS

Suggested norms would provide more accuracy for ergonomic designers as well as health practitioners especially with regards to proposed prediction models with which grip strength could be estimated faster and easier.

Structural validity of the Bruininks-Oseretsky test of motor proficiency - Second edition brief form (BOT-2-BF)

BACKGROUND

Practitioners often assess the motor skills of children presented with suspected developmental delays. It is essential that the tests used to assess children have strong measurement properties including validity.

AIM

The structural validity of the Bruininks-Oseretsky Test of Motor Proficiency - second edition Brief Form (BOT-2-BF) was investigated.

METHOD

123 healthy children (67 males & 56 females; M = 10 years, 2 months; SD = 1 year, 4 months) completed the BOT-2-BF. The Rasch Measurement Model (RMM) was used to assess the 14-item BOT-2-BF's dimensionality, hierarchical ordering, differential item functioning (DIF), and item and person separation reliability.

RESULTS

Nine BOT-2-BF misfit RMM requirements. A second RMM analysis of a five-item BOT-2-BF version was completed. The five-item version did meet the RMM requirements of item fit, dimensionality, hierarchical ordering, lack of DIF, and adequate item and person separation reliability.

IMPLICATIONS

The 14-item version of the BOT-2-BF is not recommended for use as a screening scale to assess children's motor skill performance. However, a revised five-item version of the BOT-2-BF did appear to meet RMM expectations. Further psychometric assessment of the revised five-item version of the BOT-2-BF is recommended.

Test of Motor Proficiency Second Edition (BOT-2): Compatibility of the Complete and Short Form and Its Usefulness for Middle-Age School Children

Background: The Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT-2) assesses the psychomotor development. It is available in two forms. According to several studies the BOT-2 short form (SF) provides significantly higher results than the BOT-2 complete form (CF). This might be due to the use of an inadequate type of scores when comparing results of the SF and the CF. Objective: To verify whether the degree of psychomotor development assessed by the BOT-2 SF is comparable to the results of the BOT-2 CF in middle-age school children when using standard scores considering age and sex. Methods: The research sample consisted of n = 153 neurotypical children (n = 69 girls, n = 84 boys) from 8 to 11 years (9.53 ± 0.85). The degree of psychomotor development was determined by the standard scores of the BOT-2 CF and BOT-2 SF-both considering sex and age. The conformity in results between the CF and the SF, the sensitivity and specificity of the BOT-2 SF and the relations between the results of each sub-test within the BOT-2 CF and the BOT-2 SF were analyzed. Results: The BOT-2 SF provided a statistically significantly lower standard score x = 45.87 (±5.41) compared to the BOT-2 CF x = 47.57 (±8.29) p < 0.05 with middle effect size value, Hays ω² = 0.09. The ROC analysis showed that the BOT-2 SF obtains sufficient sensitivity (84%) but poor specificity (42.9%) and AUC = 0.484 CI95% (0.31-0.62). Moreover, only 57% of total variance of the BOT-2 CF is explained by the relation between the results of the CF and the SF. Conclusion: The BOT-2 SF does not provide practically significant different results compared to the BOT-2 CF when using a proper scale for comparing both versions. In addition, poor specificity of the BOT-SF suggests that the BOT-2 SF might be a useful tool to reveal mainly psychomotorically delayed but not above average (psychomotorically advanced) children. Further, due to the weak portion of a shared common factor, it remains still unclear whether the BOT-2 CF and the BOT-2 SF measure the same behavioral domain.

White matter organization in developmental coordination disorder: A pilot study exploring the added value of constrained spherical deconvolution

Previous studies of white matter organization in sensorimotor tracts in developmental coordination disorder (DCD) have adopted diffusion tensor imaging (DTI), a method unable to reconcile pathways with ‘crossing fibres’. In response to limitations of the commonly adopted DTI approach, the present study employed a framework that can reconcile the ‘crossing fibre’ problem (i.e., constrained spherical deconvolution- CSD) to characterize white matter tissue organization of sensorimotor tracts in young adults with DCD. Participants were 19 healthy adults aged 18–46: 7 met diagnostic criteria for DCD (4 females) and 12 were controls (3 females). All underwent high angular diffusion MRI. After preprocessing, the left and right corticospinal tracts (CST) and superior longitudinal fasciculi (SLF) were delineated and all tracts were then generated using both CSD and DTI tractography respectively. Based on the CSD model, individuals with DCD demonstrated significantly decreased mean apparent fibre density (AFD) in the left SLF relative to controls (with large effect size, Cohen's d = 1.32) and a trend for decreased tract volume of the right SLF (with medium-large effect size, Cohen's d = 0.73). No differences in SLF microstructure were found between groups using DTI, nor were differences in CST microstructure observed across groups regardless of hemisphere or diffusion model. Our data are consistent with the view that motor impairment characteristic of DCD may be subserved by white matter abnormalities in sensorimotor tracts, specifically the left and right SLF. Our data further highlight the benefits of higher order diffusion MRI (e.g. CSD) relative to DTI for clarifying earlier inconsistencies in reports speaking to white matter organization in DCD, and its contribution to poor motor skill in DCD.

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All previous diffusion studies of white matter in DCD have employed a tensor model

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We employed a non-tensor model to characterize microstructure in adults with DCD

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The non-tensor model showed atypical white matter organization in the SLF in DCD

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The tensor model failed to detect microstructural group differences for any tract

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Motor impairment characteristic of DCD may be subserved by white matter abnormalities

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We need to move beyond the tensor model in characterizing white matter in DCD

Early and anticipatory postural adjustments in healthy subjects under stable and unstable sitting conditions

Clinicians frequently incorporate unstable sitting devices into training plans for improving proximal postural muscle control; however, the effect of unstable sitting conditions on postural adjustments during dynamic activities has not been fully explored. The aim of this study was to characterize early postural adjustments (EPAs) and anticipatory postural adjustments (APAs) under stable and unstable sitting conditions. Using a cross-sectional laboratory study design, 13 healthy college student volunteers used their dominant hand to reach forward and push a target under stable and unstable sitting conditions; subjects sat on an air-filled rubber cushion for the unstable condition. EPAs and APAs were quantified by recording muscle activation of the trunk and lower extremity muscles using electromyography (EMG). The center of pressure (COP) was measured using a force plate. The resulting EMG integral of the ipsilateral gastrocnemius muscle was larger during the EPA phase and smaller during the APA phase under unstable conditions (p = 0.014 and p = 0.041, respectively). COP amplitude in the anterior-posterior direction, path length, and velocity, was larger during the APA phase (p = 0.035, p = 0.023, and 0.023, respectively). This suggests greater distal muscle activation during EPAs in unstable sitting conditions, specifically in the ipsilateral gastrocnemius muscle. In addition, APAs adjusted by reducing the activity of the ipsilateral gastrocnemius muscle and increasing the anterior-posterior shift in the COP to compensate for the expected additional perturbation due to an unstable surface.

Interhemispheric Cortical Inhibition Is Reduced in Young Adults With Developmental Coordination Disorder

Introduction

While the etiology of developmental coordination disorder (DCD) is yet to be established, brain-behavior modeling provides a cogent argument that neuropathology may subserve the motor difficulties typical of DCD. We argue that a number of the core behavioral features of the DCD profile (such as poor surround inhibition, compromised motor inhibition, and the presence of mirror movements) are consistent with difficulties regulating inhibition within the primary motor cortex (M1). This study aimed to be the first account of the integrity of cortical inhibition in motor cortices in DCD.

Method

The sample consisted of eight adults with DCD aged (18–30 years) and 10 aged matched neurotypical controls. Participants received a common battery of single and paired-pulse transcranial magnetic stimulation from which a series of neurophysiological measures classically used to measure intra- [e.g., short-interval cortical inhibition (SICI), long-interval cortical inhibition (LICI), and cortical silent period] and inter hemispheric [e.g., ipsilateral silent period (ISP)] cortical inhibition of the M1 at rest were recorded.

Results

While no group differences were observed for any measure of intrahemispheric cortical inhibition, individuals with DCD demonstrated significantly reduced interhemispheric cortical inhibition relative to controls, shown by consistently lower ISP_ratios.

Conclusion

Our findings are consistent with the view that regulation of cortical inhibition of M1 activity may be atypical in individuals with DCD, indicating differential GABAergic operation. This effect, however, appears to be select to cortical inhibition. Importantly, our data support the notion that reduced interhemispheric M1 cortical inhibition may at least partly explain commonly reported difficulties with bimanual motor control in DCD. The neurochemical implications and limitations of this evidence will be discussed.

Corticospinal excitability during motor imagery is reduced in young adults with developmental coordination disorder

While a compelling body of behavioral research suggests that individuals with developmental coordination disorder (DCD) experience difficulties engaging motor imagery (MI), very little is known about the neural correlates of this deficit. Since corticospinal excitability is a predictor of MI proficiency in healthy adults, we reasoned that decreased MI efficiency in DCD may be paralleled by atypical primary motor cortex (PMC) activity. Participants were 29 young adults aged 18- 36 years: 8 with DCD (DCD) and 21 controls. Six participants with DCD and 15 controls showed behavioral profiles consistent with the use of a MI strategy (MI users) while performing a novel adaptation of the classic hand laterality task (HLT). Single-pulse transcranial magnetic stimulation (TMS) was administered to the hand node of the left PMC (hPMC) at 50ms, 400ms or 650ms post stimulus presentation during the HLT. Motor-evoked potentials (MEPs) were recorded from the right first dorsal interosseous (FDI) via electromyography. As predicted, MI users with DCD were significantly less efficient than MI using controls, shown by poorer performance on the HLT. Importantly, unlike healthy controls, no evidence of enhanced hPMC activity during MI was detected in our DCD group. Our data are consistent with the view that inefficient MI in DCD may be subserved by decreased hPMC activity. These findings are an important step towards clarifying the neuro-cognitive correlates of poor MI ability and motor skill in individuals with DCD.