Anticipatory action planning increases from 3 to 10years of age in typically developing children

Characterizing upper extremity kinematics in typically developing children during box and blocks test

Upper extremity kinematics are important for understanding functional ability and performance improvements. The Box and Blocks test (BBT) is a standardized functional test used to measure manual dexterity when evaluating children or patients following a stroke. The BBT measures the number of blocks moved in one minute and therefore, kinematic measures and compensatory strategies cannot be assessed. This study examined the correlation between upper extremity kinematics and cycle time per block movement during the BBT in three age groups (7-, 9-, and 11-year-olds). Participants completed one BBT session while test scores and kinematic measures (hand velocity and position and shoulder, elbow, and wrist range of motion and peak joint angles) were captured using standard three-dimensional motion capture techniques. Kinematic measures were determined for block movements during the middle of each BBT trial. A mixed-effects model was used to identify group differences (α = 0.05). BBT score was different (p = 0.005) between the 7- (44.88 ± 6.03) and the 11-year-old age group (56.95 ± 8.37) along with peak shoulder flexion (p = 0.024) and abduction (p = 0.022). Peak elbow flexion was different (p = 0.049) between the 9- and 11-year-old age groups. No differences were seen between the 7- and 9-year-old age groups. Pearson's Correlation Coefficients were determined between cycle time and each significant kinematic measure, where the cycle time is specific to each block movement (BBT score) and is correlated to the BBT score. This resulted in weak correlations for all the comparisons. Therefore, using BBT score alone is not representative of UE kinematics and both should be collected during this task to provide insight into movement mechanics in a pediatric population.

Development and Feasibility of a Kinect-Based Constraint-Induced Therapy Program in the Home Setting for Children With Unilateral Cerebral Palsy

Introduction: Cerebral palsy (CP) is the leading cause of childhood-onset physical disability. Children with CP often have impaired upper limb (UL) function. Constraint-induced therapy (CIT) is one of the most effective UL interventions for children with unilateral CP. However, concerns about CIT for children have been repeatedly raised due to frustration caused by restraint of the child’s less-affected UL and lack of motivation for the intensive protocol. Virtual reality (VR), which can mitigate the disadvantages of CIT, potentially can be used as an alternative mediator for implementing CIT. Therefore, we developed a VR-based CIT program for children with CP using the Kinect system.

Aims: The feasibility of the Kinect-based CIT program was evaluated for children with unilateral CP using a two-phase study design.

Materials and Methods: In phase 1, ten children with unilateral CP were recruited. To confirm the achievement of the motor training goals, maximal UL joint angles were evaluated during gameplay. To evaluate children’s perceptions of the game, a questionnaire was used. In phase 2, eight children with unilateral CP were recruited and received an 8 weeks Kinect-based CIT intervention. Performance scores of the game and outcomes of the box and block test (BBT) were recorded weekly.

Results: In phase 1, results supported that the design of the program was CIT-specific and was motivational for children with unilateral CP. In phase 2, game performance and the BBT scores began showing stable improvements in the fifth week of intervention.

Conclusion: It suggested the Kinect-based CIT program was beneficial to the motor function of the affected UL for children with unilateral CP. According to the results of this feasibility study, larger and controlled effectiveness studies of the Kinect-based CIT program can be conducted to further improve its clinical utility.

Clinical Trial Registration: ClinicalTrials.gov, NCT02808195; Comparative effectiveness of a Kinect-based unilateral arm training system vs. CIT for children with CP

Motor planning and movement execution during goal-directed sequential manual movements in 6-year-old children with autism spectrum disorder: A kinematic analysis

BACKGROUND

Atypical motor functioning is prevalent in children with autism spectrum disorder (ASD). Knowledge of the underlying kinematic properties of these problems is sparse.

AIMS

To investigate characteristics of manual motor planning and performance difficulties/diversity in children with ASD by detailed kinematic measurements. Further, associations between movement parameters and cognitive functions were explored.

METHODS AND PROCEDURES

Six-year-old children with ASD (N = 12) and typically developing (TD) peers (N = 12) performed a sequential manual task comprising grasping and fitting a semi-circular peg into a goal-slot. The goal-slot orientation was manipulated to impose different motor planning constraints. Movements were recorded by an optoelectronic system.

OUTCOMES AND RESULTS

The ASD-group displayed less efficient motor planning than the TD-group, evident in the reach-to-grasp and transport kinematics and less proactive adjustments of the peg to the goal-slot orientations. The intra-individual variation of movement kinematics was higher in the ASD-group compared to the TD-group. Further, in the ASD-group, movement performance associated negatively with cognitive functions.

CONCLUSIONS AND IMPLICATIONS

Planning and execution of sequential manual movements proved challenging for children with ASD, likely contributing to problems in everyday actions. Detailed kinematic investigations contribute to the generation of specific knowledge about the nature of atypical motor performance/diversity in ASD. This is of potential clinical relevance.

Second-order motor planning difficulties in children with developmental coordination disorder

The second-order motor planning ability of children with developmental coordination disorder (DCD) has often been studied using tasks that require judgements of end-state comfort (ESC). In these studies, children may have chosen to prioritize other aspects of performance (e.g., a comfortable start-posture) over ESC while still being able to complete the goal of the task. This is a limitation that is inherent to previously used ESC paradigms. To avoid this in the present study, 52 children with and without DCD (aged 5-12 years) completed a task that requires second-order motor planning for its successful completion. In the hexagonal knob task, children were instructed to grasp and rotate a hexagonal knob. The rotation angle varied in size: 60°, 120°, 180°, and 240° rotations. Both the 180° and 240° rotation conditions required an uncomfortable starting posture for successful task completion. Results showed that children with DCD were less likely to adjust their initial grip in anticipation of the required rotation angle, resulting in more task failures compared with typically developing (TD) children. Based on this finding we conclude that children with DCD experience genuine second-order motor planning difficulties. Analysis of temporal outcomes, showed that initial reaction time increased with rotation angle, but this was less pronounced for children with DCD than for TD children. There were no between group differences in timing of subsequent events. These results suggest that the difficulties of children with DCD are related to the initial planning process, that is, before the start of the movement.

Neurophysiology of embedded response plans: age effects in action execution but not in feature integration from preadolescence to adulthood

Performing a goal-directed movement consists of a chain of complex preparatory mechanisms. Such planning especially requires integration (or binding) of various action features, a process that has been conceptualized in the "theory of event coding." Theoretical considerations and empirical research suggest that these processes are subject to developmental effects from adolescence to adulthood. The aim of the present study was to investigate age-related modulations in action feature binding processes and to shed light on underlying neurophysiological development from preadolescence to early adulthood. We examined a group of healthy participants (n = 61) between 10 and 30 yr of age, who performed a task that requires a series of bimanual response selections in an embedded paradigm. For an in-depth analysis of the underlying neural correlates, we applied EEG signal decomposition together with source localization analyses. Behavioral results across the whole group did not show binding effects in reaction times but in intraindividual response variability. From age 10 to 30 yr, there was a decrease in reaction times and reaction time variability but no age-related effect in action file binding. The latter were corroborated by Bayesian data analyses. On the brain level, the developmental effects on response selection were associated with activation modulations in the superior parietal cortex (BA7). The results show that mechanisms of action execution and speed, but not those of action feature binding, are subject to age-related changes between the age of 10 and 30 yr.NEW & NOTEWORTHY Different aspects of an action need to be integrated to allow smooth unfolding of behavior. We examine developmental effects in these processes and show that mechanisms of action execution and speed, but not those of action feature binding, are subject to age-related changes between the age of 10 and 30 yr.

Eliciting End-State Comfort Planning in Children With and Without Developmental Coordination Disorder Using a Hammer Task: A Pilot Study

The end-state comfort (ESC) effect refers to the consistent tendency of healthy adults to end their movements in a comfortable end posture. In children with and without developmental coordination disorder (DCD), the results of studies focusing on ESC planning have been inconclusive, which is likely to be due to differences in task constraints. The present pilot study focused on the question whether children with and without DCD were able to change their planning strategy and were more likely to plan for ESC when demanded by complex object manipulations at the end of a task. To this end, we examined ESC planning in 18 children with and without DCD (aged 5–11years) using the previously used sword-task and the newly developed hammer-task. In the sword-task, children had to insert a sword in a wooden block, which could be relatively easily completed with an uncomfortable end-posture. In the hammer-task, children had to strike down a nail in a wooden pounding bench, which required additional force and speed demands, making it relatively difficult to complete the movement with an uncomfortable end-posture. In line with our hypothesis, the results demonstrated that children with and without DCD were more likely to plan for ESC on the hammer-task compared with the sword-task. Thus, while children with and without DCD show inconsistent ESC planning on many previously used tasks, the present pilot study shows that many of them are able to take into account the end-state of their movements if demanded by task constraints.

Kinematic characteristics of second-order motor planning and performance in 6- and 10-year-old children and adults: Effects of age and task constraints

This study explored age-related differences in motor planning as expressed in arm-hand kinematics during a sequential peg moving task with varying demands on goal insertion complexity (second-order planning). The peg was a vertical cylinder with either a circular or semicircular base. The task was to transport the peg between two positions and rotate it various amounts horizontally before fitting into its final position. The amount of rotation required was either 0°, 90°, 180°, or -90°. The reaching for the peg, the displacement of it, and the way the rotation was accomplished was analyzed. Assessments of end state comfort, goal interpretation errors, and type of grip used were also included. Participants were two groups of typically developing children, one younger (M_age  = 6.7 years) and one older (M_age  = 10.3 years), and one adult group (M_age  = 34.9 years). The children, particularly 6-year-olds, displayed less efficient prehensile movement organization than adults. Related to less efficient motor planning, 6-year-olds, mainly, had shorter reach-to-grasp onset latencies, higher velocities, and shorter time to peak velocities, and longer grasp durations than adults. Importantly, the adults rotated the peg during transport. In contrast, the children made corrective rotations after the hand had arrived at the goal.

End-state comfort effect in manipulative motor actions of typical and atypical children: a systematic review

ABSTRACT This study aimed to make a systematic review of scientific articles on the planning of manual motor actions of typical and atypical children. To do so, a search of articles published between 1996 and 2017 was done on PubMed, LILACS, Science Direct, and SciElo databases. Original articles in English and Portuguese evaluating the planning of motor actions in typical and atypical children performing manual tasks were selected. For the analysis, the population age, number of children, type of task, main results, site of study and impact of the journal were considered. From the eighteen articles found, twelve were about typical children (from nine months old to twenty years old) and six about atypical children (from three to fourteen years old) diagnosed with autism, hemiplegic cerebral palsy, and developmental coordination disorders. In nine- to ten-year-old typical children, the planning ability of manual motor actions develops over the time and is similar to that of an adult. The atypical children showed motor planning ability lower than that of the typical children, and determining the age when this planning ability is acquired was not possible.

The development of anticipatory action planning in children with unilateral cerebral palsy

Background Previous studies suggest that compromised bimanual performance experienced by children with unilateral cerebral palsy (CP) is not only due to difficulties in action execution but may also be a result of impaired anticipatory action planning. Aims The effect of age and side of hemiplegia were examined and the relationship between anticipatory action planning, unimanual capacity and bimanual performance was explored. Methods and procedures Using a multi-centre, prospective, cross-sectional observational design, anticipatory action planning was analyzed in 104 children with unilateral cerebral palsy, aged 6-12 years, using the sword task. Outcomes and results Anticipatory action planning did not improve with age in children with unilateral CP, aged between 6-12 years. No differences were found between children with left or right hemiplegia. Finally, anticipatory action planning was not related to unimanual capacity or bimanual performance. Conclusion and implications This study demonstrates anticipatory action planning, measured using the sword task, does not improve with age in children with unilateral CP and is not related to bimanual performance or laterality. Future studies of anticipatory action planning in children with unilateral CP should consider using measures that require effective anticipatory action planning for successful task completion rather than end state comfort.

Comparative study between school and motor performance in children aged 6 to 11 years according to teachers’ perceptions

Abstract Introduction: Motor skills are enlarged during schooling age, with possible relation between motor and school performance. Objective: Compare motor skills of children with good and poor school performance, according to the teacher’s perception in the classroom. Method: School children aged 6 to 11 years were divided into two groups; poor school performance (PSP) and good school performance (GSP) and evaluated using the Motor Development Scale (MDS). The chronological age, general motor age and the motor quotient of each area evaluated were compared between the groups using the Mann-Whitney Test. The Chi-square test was used to associate the motor performance classification and the school performance. Results: Chronological age was similar between groups, although the general motor age was smaller in the PSP. The general motor quotient and the motor quotients in the areas of body scheme, spatial and temporal organization were significantly smaller in PSP. Most children were classified by the MDS as Low Normal or Medium Normal motor skills in both groups; however in the GSP, 27.5% of the children had a High Normal or Superior motor development and only 2.5% were classified as Very Inferior or Inferior. In the PSP, 12.5% had a Very Inferior or Inferior performance and only 6.25% had a High Normal or Superior performance (p < 0.05 - chi-square test). Conclusion: Results show a direct connection between poor school performance and motor skill difficulties, which illustrates the relation between motor and cognitive skills.

Investigating motor planning in children with DCD: Evidence from simple and complex grip-selection tasks

Several studies suggest that children with Developmental Coordination Disorder (DCD) may be able to plan simple movements as well as their peers, but experience increasing difficulties as the movements become complex. The present study aimed to clarify the nature of motor planning in DCD, including a putative deficit, by being the first to investigate motor planning using converging measures of simple and complex motor planning in a single sample of children with DCD. Boys aged between 8 and 12 years with (n = 10) and without DCD (n = 17) completed three commonly used 'simple' (bar grasping, sword, and bar transport tasks) measures and one 'complex' (octagon task) measure of end-state-comfort (ESC), a classic measurement of motor planning ability. To achieve ESC when manipulating an object, a person may choose to start with an uncomfortable grip in order to end the movement in a comfortable position. Results indicate that the participants with DCD planned for ESC as efficiently as their peers when performing the 'simple' measures of ESC but were significantly less likely to end their performances in ESC than those without DCD for the more 'complex' octagon task. Taken together, our data suggest that school-aged children with DCD may be able to plan simple movements as efficiently as their peers, but have more difficulty doing so for multi-movement or complex sequences. Based on the assumption that the efficiency of such motor planning is dependent on the integrity of internal modelling systems, we argue that our study provides indirect support for the internal modelling deficit hypothesis.

Age-related changes in upper limb motion during typical development

Background and aim

Understanding the maturation of upper limb (UL) movement characteristics in typically developing (TD) children is key to explore UL deficits in those with neurodevelopmental disorders. Three-dimensional motion analysis (3DMA) offers a reliable tool to comprehensively evaluate UL motion. However, studies thus far mainly focused on specific pre-defined parameters extracted from kinematic waveforms. Here, we investigated age-related differences in UL movement characteristics over the entire movement cycle in TD children.

Participants and methods

We assessed the non-dominant UL of 60 TD children (mean age 10y3m±3y1m) using 3DMA during eight tasks: reaching (forwards (RF), upwards (RU), sideways (RS)), reach-to-grasp (sphere (RGS), vertical cylinder (RGV)) and activities-of-daily-living mimicking tasks (hand-to-head (HTH), hand-to-mouth (HTM), hand-to-shoulder (HTS)). We investigated differences between four age-groups (5-7y, 8-10y, 11-12y, 13-15y) in: (1) spatiotemporal parameters (movement duration, peak velocity, time-to-peak velocity and trajectory straightness), and (2) 12 UL joint angles, using Statistical Parametric Mapping (SPM).

Results

We found that the 5-7y children moved with lower peak velocity and less straight trajectories compared to the 11-12y group (peak velocity: RS, HTS, p<0.01; trajectory: RU, RS, RGV, HTS, p<0.01) and the 13-15y group (peak velocity: RF, RS, RGS, RGV, HTH, HTS, p<0.01; trajectory, all tasks, p<0.01). The 5-7y children showed increased scapular protraction compared to older children (8-10y and 11-12y, HTS), as well as increased scapular medial rotation compared to the 13-15y group (RGS). During RU, the 5-7y children moved more towards the frontal plane (shoulder), unlike the 13-15y group. Lastly, the 5-7y group used less elbow flexion than older children (11-12y and 13-15y) during HTH and HTS.

Discussion and conclusion

In conclusion, our results point toward a maturation in UL movement characteristics up to age 11-12y, when UL motion seemed to reach a plateau. The reference values provided in this study will help to further optimize the interpretation of UL deficits in children with neurodevelopmental disorders.

Cognition and bimanual performance in children with unilateral cerebral palsy: protocol for a multicentre, cross-sectional study

Background

Motor outcomes of children with unilateral cerebral palsy are clearly documented and well understood, yet few studies describe the cognitive functioning in this population, and the associations between the two is poorly understood. Using two hands together in daily life involves complex motor and cognitive processes. Impairment in either domain may contribute to difficulties with bimanual performance. Research is yet to derive whether, and how, cognition affects a child’s ability to use their two hands to perform bimanual tasks.

Methods/Design

This study will use a prospective, cross-sectional multi-centre observational design. Children (aged 6–12 years) with unilateral cerebral palsy will be recruited from one of five Australian treatment centres. We will examine associations between cognition, bimanual performance and brain neuropathology (lesion type and severity) in a sample of 131 children. The primary outcomes are: Motor - the Assisting Hand Assessment; Cognitive - Executive Function; and Brain – lesion location on structural MRI. Secondary data collected will include: Motor - Box and Blocks, ABILHAND- Kids, Sword Test; Cognitive – standard neuropsychological measures of intelligence. We will use generalized linear modelling and structural equation modelling techniques to investigate relationships between bimanual performance, executive function and brain lesion location.

Discussion

This large multi-centre study will examine how cognition affects bimanual performance in children with unilateral cerebral palsy. First, it is anticipated that distinct relationships between bimanual performance and cognition (executive function) will be identified. Second, it is anticipated that interrelationships between bimanual performance and cognition will be associated with common underlying neuropathology. Findings have the potential to improve the specificity of existing upper limb interventions by providing more targeted treatments and influence the development of novel methods to improve both cognitive and motor outcomes in children with unilateral cerebral palsy.

Trial registration

ACTRN12614000631606; Date of retrospective registration 29/05/2014.

End-State Comfort Across the Lifespan: A Cross-Sectional Investigation of How Movement Context Influences Motor Planning in an Overturned Glass Task

Young adults plan actions in advance to minimize the cost of movement. This is exemplified by the end-state comfort (ESC) effect. A pattern of improvement in ESC in children is linked to the development of cognitive control processes, and decline in older adults is attributed to cognitive decline. This study used a cross-sectional design to examine how movement context (pantomime, demonstration with image/glass as a guide, actual grasping) influences between-hand differences in ESC planning. Children (5- to 12-year-olds), young adults, and two groups of older adults (aged 60-70, and aged 71 and older) were assessed. Findings provide evidence for adult-like patterns of ESC in 8-year-olds. Results are attributed to improvements in proprioceptive acuity and proficiency in generating and implementing internal representations of action. For older adults early in the aging process, sensitivity to ESC did not differ from young adults. However, with increasing age, differences reflect challenges in motor planning with increases in cognitive demand, similar to previous work. Findings have implications for understanding lifespan motor behavior.

Motor planning in children with cerebral palsy: A longitudinal perspective

INTRODUCTION

Motor planning is important for daily functioning. Deficits in motor planning can result in slow, inefficient, and clumsy motor behavior and are linked to disruptions in performance of activities of daily living in children with cerebral palsy (CP). However, the evidence in CP is primarily based on cross-sectional data.

METHOD

Data are presented on the development of motor planning in children with CP using a longitudinal design with three measurement occasions, each separated by 1 year. Twenty-two children with CP (9 boys, 13 girls; age in years;months, M = 7;1, SD = 1;2) and 22 age-matched controls (10 boys, 12 girls, M  = 7;1, SD = 1;3) participated. Children performed a bar transport task in which some conditions ("critical angles") required participants to sacrifice initial posture comfort in order to achieve end-state comfort. Performance on critical trials was analyzed using linear growth curve modeling.

RESULTS

In general, children with CP showed poor end-state planning for critical angles. Importantly, unlike in controls, motor planning ability did not improve across the three measurement occasions in children with CP.

CONCLUSION

These longitudinal results show that motor planning issues in CP do not resolve with development over childhood. Strategies to enhance motor planning are suggested for intervention.

Sex differences in the end-state comfort effect in pre-adolescent children

There has been recent interest in the developmental trajectory of the end-state comfort effect (ESCE) in young children. However, potential sex differences have yet to be examined in the overturned glass task. We examined the ESCE using this task in a large sample (N=232) of typically-developing elementary school children (111 girls, 121 boys) in grades 1-5 (approximately 7-11years old). We sought to determine whether there were similarities or differences in performance between boys and girls. Children picked up an overturned drinking glass from a table, turned the glass upright, and then poured water into it from a measuring cup. Three trials were performed, and the use of an initial awkward thumb-down grip to pick up the glass was taken as evidence for the ESCE. There were non-significant main effects for sex and grade, but a significant interaction between factors. Boys increased in sensitivity to end-state comfort across the five grades while girls showed a decrease from grades 1-3, followed by an increase between grades 3 and 5. Taken together, the results indicate the presence of adult-like motor planning for the overturned glass task by the 4th grade (i.e., age 10), but also suggest the presence of a motor reorganization in girls, at around the 2nd or 3rd grade (i.e., 8 or 9years of age).

Motor and verbal perspective taking in children with Autism Spectrum Disorder: Changes in social interaction with people and tools

BACKGROUND

Children with Autism Spectrum Disorder (ASD) have difficulty communicating with others nonverbally, via mechanisms such as hand gestures, eye contact and facial expression. Individuals with ASD also have marked deficits in planning future actions (Hughes, 1996), which might contribute to impairments in non-verbal communication. Perspective taking is typically assessed using verbal scenarios whereby the participant imagines how an actor would interact in a social situation (e.g., Sally Anne task; Baron-Cohen, Leslie, & Frith, 1985).

METHOD

The current project evaluated motor perspective taking in five children with ASD (8-11 years old) as they participated in a narrative intervention program over the course of about 16 weeks. The goal of the motor perspective-taking task was to facilitate the action of an experimenter either hammering with a tool or putting it away.

RESULTS

Initially, children with ASD facilitated the experimenter's action less than neurotypical control children. As the narrative intervention progressed, children with ASD exhibited increased motor facilitation that paralleled their increased use of mental state and causal language, indicating a link between verbal and motor perspective taking.

CONCLUSIONS

Motoric perspective taking provides an additional way to assess understanding and communication in children with ASD and may be a valuable tool for both early assessment and diagnosis of children with ASD.

The development of tool use: Planning for end-state comfort

Some grips on the handle of a tool can be planned on the basis of information directly available in the scene. Other grips, however, must be planned on the basis of the final position of the hand. "End-state comfort" grips require an awkward or uncomfortable initial grip so as to later implement the action comfortably and efficiently. From a cognitive perspective, planning for end-state comfort requires a consistent representation of the entire action sequence, including the latter part, which is not based on information directly available in the scene. Many investigators have found that young children fail to demonstrate planning for end-state comfort and that adultlike performance does not appear until about 12 years of age. In 2 experiments, we used a hammering task that engaged children in a goal-directed action with multiple steps. We assessed end-state-comfort planning in novel ways by measuring children's hand choice, grip choice, and tool implementation over multiple trials. The hammering task also uniquely allowed us to assess the efficiency of implementation. We replicated the previous developmental trend in 4-, 8-, and 12-year-old children with our novel task. Most important, our data revealed that 4-year-olds are in a transitional stage during which several competing strategies were exhibited during a single session. Preschoolers changed their grip within trials and across trials, indicating awareness of errors and a willingness to sacrifice speed for more efficient implementation. The end-state-comfort grip initially competes as one grip type among many but gradually displaces all others. Children's sensitivity to costs and drive for efficiency may motivate this change. (PsycINFO Database Record

No Interrelation of Motor Planning and Executive Functions across Young Ages

The present study examined the developmental trajectories of motor planning and executive functioning in children. To this end, we tested 217 participants with three motor tasks, measuring anticipatory planning abilities (i.e., the bar-transport-task, the sword-rotation-task and the grasp-height-task), and three cognitive tasks, measuring executive functions (i.e., the Tower-of-Hanoi-task, the Mosaic-task, and the D2-attention-endurance-task). Children were aged between 3 and 10 years and were separated into age groups by 1-year bins, resulting in a total of eight groups of children and an additional group of adults. Results suggested (1) a positive developmental trajectory for each of the sub-tests, with better task performance as children get older; (2) that the performance in the separate tasks was not correlated across participants in the different age groups; and (3) that there was no relationship between performance in the motor tasks and in the cognitive tasks used in the present study when controlling for age. These results suggest that both, motor planning and executive functions are rather heterogeneous domains of cognitive functioning with fewer interdependencies than often suggested.

Motor imagery training for children with developmental coordination disorder--study protocol for a randomized controlled trial

Background

Previous studies have shown that the predictive control of movements is impaired in children with Developmental Coordination Disorder (DCD), most likely due to a deficit in the internal modeling of movements. Motor imagery paradigms have been used to test this internal modeling deficit. The aim of the present study is to examine whether a training focused on the mental imagery of motor skills, can help to improve the motor abilities of children with DCD.

Methods/Design

A pre-post design will be used to examine the motor performance, motor imagery and motor planning abilities before and after a training of 9 weeks. Two groups will be included in this study (1) one receiving motor imagery (MI) training focused on the forward modeling of purposive actions, (2) one receiving Cognitive Orientation to daily Occupational Performance (CO-OP) training focused on identifying effective cognitive strategies that will increase motor competence. MI training will be given with the use of instruction videos of the motor skill that will be trained. Both groups will participate in 9 individual sessions of 45 min (once a week) with a paediatric physical or occupational therapist, added with homework sessions. Inclusion criteria are: (1) aged 7–12 years, (2) meeting the DSM-V criteria for DCD (motor performance substantially low (score on the m-ABC ≤ 16th percentile) and motor problems that interfere with daily life (DCDQ, and request for help at a paediatric physical or occupational therapist)). Exclusion criteria are IQ < 70 and other medical conditions causing the motor impairment.

Discussion

The results of this study will help to make treatment protocols for children with DCD more evidence-based. This study will increase our knowledge about the efficacy of both the MI training and CO-OP training, and both children with DCD and therapists will benefit from this knowledge.

Trial registration

www.trialregister.nl/NTR5471.

Measurement of Action Planning in Children, Adolescents, and Adults: A Comparison Between 3 Tasks

PURPOSE

To compare age-related action planning performance on 3 different tasks, focusing on differences in task complexity.

METHODS

A total of 119 participants were divided across 6 age groups (4-5, 6-7, 8-9, 10-12, 14-16, and 20-22 years). Participants performed 3 action planning tasks: the overturned cup task, the bar transport task, and the sword task. Anticipatory planning was assessed via the proportion of comfortable end postures.

RESULTS

The increase in proportion of comfortable end postures developed more gradually for the overturned cup task with earlier ceiling effect (6 years) than for the other 2 tasks (10 years and no ceiling). The overturned cup task correlated fairly with the other tasks; the bar transport task and sword task correlated moderately.

CONCLUSIONS

All 3 tasks can be used to measure aspects of action planning but outcomes vary. Therefore, we recommend combining these tasks in assessments of individual children to obtain a good indication of action planning development.

Second-order motor planning in children: insights from a cup-manipulation-task

The present study examined the development of anticipatory motor planning in an object manipulation task that has been used to successfully demonstrate motor planning in non-human primates (Weiss et al. in Psychol Sci 18:1063-1068, 2007). Seventy-five participants from four different age groups participated in a cup-manipulation task. One group was preschool children (average age of 5.1 years), two groups were primary school children (7.7 and 9.8 years old respectively) and the final group was comprised of adults. The experimental task entailed reaching for a plastic cup that was vertically suspended in an apparatus in either upright or inverted orientation, removing the cup by its stem and then retrieving a small toy from the inside of the cup. When the cup was inverted in the apparatus, evidence for anticipatory motor planning could be achieved by initially gripping the stem using an inverted (thumb-down) grip posture. We found that when the cup was in upright orientation, all participants reached for the cup using an upright grip (i.e., thumb-up posture). However, when the cup was inverted in the apparatus, only adults consistently used an inverted grasping posture, though the percentage of inverted grips among participants did increase with age. These results suggest a protracted development for anticipatory motor planning abilities in children. Surprisingly, the performance of adults on this task more closely resembles the performance of several nonhuman primate species as opposed to children even at approximately 10 years of age. We discuss how morphological constraints on flexibility may help account for these findings.

Getting the right grasp on executive function

Executive Function (EF) refers to important socio-emotional and cognitive skills that are known to be highly correlated with both academic and life success. EF is a blanket term that is considered to include self-regulation, working memory, and planning. Recent studies have shown a relationship between EF and motor control. The emergence of motor control coincides with that of EF, hence understanding the relationship between these two domains could have significant implications for early detection and remediation of later EF deficits. The purpose of the current study was to investigate this relationship in young children. This study incorporated the Behavioral Rating Inventory of Executive Function (BRIEF) and two motor assessments with a focus on precision grasping to test this hypothesis. The BRIEF is comprised of two indices of EF: (1) the Behavioral Regulation Index (BRI) containing three subscales: Inhibit, Shift, and Emotional Control; (2) the Metacognition Index (MI) containing five subscales: Initiate, Working Memory, Plan/Organize, Organization of Materials, and Monitor. A global executive composite (GEC) is derived from the two indices. In this study, right-handed children aged 5-6 and 9-10 were asked to: grasp-to-construct (Lego® models); and grasp-to-place (wooden blocks), while their parents completed the BRIEF questionnaire. Analysis of results indicated significant correlations between the strength of right hand preference for grasping and numerous elements of the BRIEF including the BRI, MI, and GEC. Specifically, the more the right hand was used for grasping the better the EF ratings. In addition, patterns of space-use correlated with the GEC in several subscales of the BRIEF. Finally and remarkably, the results also showed a reciprocal relationship between hand and space use for grasping and EF. These findings are discussed with respect to: (1) the developmental overlap of motor and executive functions; (2) detection of EF deficits through tasks that measure lateralization of hand and space use; and (3) the possibility of using motor interventions to remediate EF deficits.

A Systematic Review of the End-State Comfort Effect in Normally Developing Children and in Children With Developmental Disorders

The end-state comfort (ESC) effect signifies the tendency to avoid uncomfortable postures at the end of goal-directed movements and can be reliably observed during object manipulation in adults, but only little is known about its development in children. The aim of the present paper is to provide a review of research on the ESC effect in normally developing children and in children with various developmental disorders, and to identify the factors constraining anticipatory planning skills. Three databases (Medline, Scopus, and PubMed) and relevant journals were scrutinized and a step-wise analysis procedure was employed to identify the relevant studies. Thirteen studies assessed the ESC effect in children, ranging from 1.5–14 years of age. Nine out of these thirteen studies reported the ESC effect to be present in normally developing children, but the results are inconsistent with regard to children’s age and the kind of ESC task used. Some evidence even suggests that these planning skills are intact in children with developmental disorders. Inconsistencies between findings are discussed in the light of moderating factors like the number of action steps, precision requirements, familiarity with the task, the task procedure, motivation, sample size, and age, as well as the cognitive and motor development of the participants. Further research is needed to investigate the onset and the developmental course of ESC planning, as well as the interdependencies with other cognitive abilities and sensory-motor skills.

Motor planning ability is not related to lesion side or functional manual ability in children with hemiplegic cerebral palsy

Optimal task performance requires anticipatory planning to select the most appropriate movement strategy. There is conflicting evidence for hemispheric specialisation of motor planning, with some suggesting left hemisphere dominance, claiming that children with right hemiplegic cerebral palsy (HCP) are therefore disproportionally affected. An alternative view is that there is a positive relationship between functional ability (rather than side of lesion) and motor planning skill. We aimed to compare children with right and left HCP on motor planning ability and to explore its relationship with functional manual ability. Participants were 76 children with HCP (40 left HCP; 30 female), aged 4-15 years (Mean 9.09, SD 2.94). Motor planning was assessed using a measure of end-state comfort, which involved turning a hexagonal handle 180° without readjusting grasp. This is difficult, or in some cases impossible, to achieve unless an appropriate initial grasp is adopted. Children completed 24 turns (12 clockwise), which were video recorded for offline scoring. Functional manual ability was assessed with the ABILHAND-Kids questionnaire, completed by parents. Contrary to the existing literature, no differences were observed between right and left HCP. However, a significant interaction between direction of turn and side of hemiplegia indicated a preferential bias for turns in the medial direction, consistent with the "medial over lateral advantage". There was no relationship between functional ability and motor planning. Therefore, motor planning may not be a priority for therapeutic intervention to improve functional ability in HCP.