Using cluster analysis to interpret the variability of gross motor scores of children with typical development

Gross motor trajectories of pre-term and full-term infants under different parental educational approaches

This study aimed to explore motor trajectories of Brazilian pre-term and full-term infants from 3 to 12 months old whose parents participated in an educational program and had received guidance on gross motor development. Forty-eight Brazilian infants aged 3 months old were divided into Group 1 (full-term infants and their parents who received only verbal guidance, n = 14), Group 2 (full-term infants with parents who received an educative folder in addition to the same verbal guidance, n = 23), and Group 3 (preterm infants with parents who received the same verbal guidance and educative folder, n = 11). The folder had similar information to the verbal guidance; nonetheless, it helped to teach parents and allowed later consultation at home. We applied Alberta Infant Motor Scale, Affordances in Home Environment for Motor Development-Infant Scale, and a questionnaire about infants' information at 3-, 6-, 9-, and 12-months old. In longitudinal comparison, all groups showed a significant difference for AIMS variables on total score and subscales; all subitems of AHEMD-IS; and time spent in prone, supine, sitting, and standing positions. In general, no differences were found between groups. Motor trajectory, home opportunities, and parental positioning practices were similar between full-term and preterm infants with different guidance approaches.

Distinct clusters of movement entropy in children's exploration of a virtual reality balance beam

Although assessing motor competence is vital to advancing current understandings of motor development and its significance in various fields, no consensus exists on how the construct should be operationalised and measured. Existing approaches to assessing motor competence in children typically involve applying qualitative and/or quantitative scoring procedures in which children's performance is evaluated according to certain levels of assessment-specific task performance dependent upon predefined sets of instructions and procedures. Building upon ecological dynamics as a framework, different levels of motor competence can be identified in children's attempts to coordinate their degrees of freedom while trying to complete the interactive task and environmental constraints. Given the dynamic, nonlinear features of that coordinating process, assessments need to consider the inherit structure of inter- and intra-individual variability in patterns of movement. Against that background, we investigated 7-10-year-old children's (n = 58) whole-body joint kinematics as they freely explored a balance beam in a virtual reality playground. Specifically, we used exploratory cluster analysis to examine the discriminatory capability of utilising joint-specific sample entropy as a window into individual differences in movement coordination that emerged from children's exploration of the constraints embedded in the virtual task. Among the results, three clusters of children with distinct profiles of movement variability emerged, all of which showed heterogeneous levels of repeatability in joint movements in combination with the level of spatiotemporal exploration on the balance beam that could not be explained by between-cluster differences in age and gender distributions. Those findings suggest that entropy from whole-body movements can be used to cluster children into distinct groups with different profiles regarding the structure of movement variability, which can inform new understandings and the development of gross motor competence assessments for children.

Modeling gross motor developmental curves of extremely and very preterm infants using the AIMS home-video method

BACKGROUND

Motor development is one of the first signals to identify whether an infant is developing well. For very preterm (VPT) infants without severe perinatal complications, little is known about their motor developmental curves.

AIMS

Explore gross motor developmental curves from 3 until 18 months corrected age (CA) of VPT infants, and related factors. Explore whether separate profiles can be distinguished and compare these to profiles of Dutch term-born infants.

STUDY DESIGN

Prospective cohort study with parents repeatedly recording their infant, using the Alberta Infant Motor Scale (AIMS) home-video method, from 3 to 18 months CA.

SUBJECTS

Forty-two Dutch infants born ≤32.0 weeks gestational age and/or with a birthweight (BW) of <1500 g without severe perinatal complications.

OUTCOME MEASURES

Gross motor development measured with the AIMS.

RESULTS

In total 208 assessments were analyzed, with 27 infants ≥five assessments, 12 with <four, and three with one assessment. Sigmoid-shaped gross motor curves show unidirectional growth and variability. No infant or parental factors significantly influenced motor development, although a trend was seen for the model where lower BW, five-minute Apgar score <7, and Dutch native-speaking parents were associated with slower motor development. Three motor developmental profiles of VPT infants were identified, early developers, gradual developers, and late bloomers, which until 12 months CA are comparable in shape and speed to profiles of Dutch term-born infants.

CONCLUSIONS

VPT infants show great intra- and interindividual variability in gross motor development, with three motor profiles being distinguished. From 12 months CA onwards, VPT infants appear to develop at a slower pace. With some caution, classifying infants into motor developmental profiles may assist clinical decision-making.

Psychometric properties of the Belgian LDCDQ (LDCDQ-BE) in a population based sample

BACKGROUND

Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder usually diagnosed at school-age. It is related to secondary consequences urging early identification. The Little Developmental Coordination Questionnaire (LDCDQ) is a tool to identify young children at risk of a later DCD diagnosis.

AIMS

To explore psychometric properties and cut-off scores for the Belgian version the LDCDQ (LDCDQ-BE).

METHODS AND PROCEDURES

Questionnaires were completed by parents (n = 637) and teachers (n = 249) of children aged 3-5 years in regular schools. Additionally, motor development of 82 children was assessed with the M-ABC-2, Beery-VMI-6 and teacher's Motor Skill Checklist (MSC).

OUTCOMES AND RESULTS

The LDCDQ-BE demonstrates excellent internal consistency (Cronbach's α = 0.92), moderate convergent validity with M-ABC-2 (r = 0.42), and weak to moderate concurrent validity to Beery-VMI-6 (r = 0.30-0.31) and teacher's rating on MSC (r = 0.27). Discriminant validity with M-ABC-2 and Beery-VMI-6 subtest Visual-Motor Integration is poor, but moderate with Beery-VMI-6 subtest Motor Coordination (p = 0.023) and MSC (p = 0.021). A fair agreement was established between parent's and teacher's rating (=0.308; p < 0.001).

CONCLUSIONS AND IMPLICATIONS

Sensitivity of the LDCDQ-BE is low to moderate. It should be interpreted cautiously as predictive validity in children with DCD has yet to be established.

Crosstalk between Gross and Fine Motor Domains during Late Childhood: The Influence of Gross Motor Training on Fine Motor Performances in Primary School Children

Gross and fine motor competence have a close relationship during development and are shown to correlate to some extent. However, the study of the interaction between these domains still requires further insights. In this study, we investigated the developmental changes in overall motor skills as well as the effects of gross motor training programs on fine motor skills in children (aged 6–11, n = 240). Fine motor skills were assessed before and after gross motor intervention using the Box and Block Test. The gross motor intervention was based on the Test of Gross Motor Development—3rd Edition. Results showed that gross and fine motor skills correlate across all years of primary school, both significantly improving with age. Finally, the gross motor intervention appeared to not influence fine motor skills. Our findings show that during primary school age, overall motor development is continuous, but non-linear. From age nine onward, there seems to be a major step-up in overall motor competence, of which teachers/educators should be aware of in order to design motor educational programs accordingly. While gross and fine motor domains might be functionally integrated to enhance children’s motor performances, further research is needed to clarify the effect of gross motor practice on fine motor performances.

Assessing Motor Performance in Preschool Children: The Zurich Neuromotor Assessment-2 and the Movement Assessment Battery for Children-2

Comparing motor assessment tools that are available for young children is important in order to select the most appropriate clinical and research tools. Hence, this study compared motor performance assessed with the Zurich Neuromotor Assessment-2 (ZNA-2) to the Movement Assessment Battery for Children-2 (MABC-2). The sample consisted of 169 children, aged 3-5 years (87 boys; 51%). We used Pearson correlations to examine relationships between the ZNA-2 and MABC-2 component and total scores. In addition, Pearson correlations were performed between individual fine motor and balance items of the ZNA-2 and MABC-2. Results were that the total scores of the ZNA-2 and MABC-2 correlated moderately (r = .40, p < .001). Non-significant to moderate correlations were found between components (r = -.00 to .47) and between individual items of fine motor skills (r = .04 to .38) and balance (r = -.12 to .38). Thus, the ZNA-2 and MABC-2 measure partly similar and partly different aspects of motor performance.

Modeling a gross motor curve of typically developing Dutch infants from 3.5 to 15.5 months based on the Alberta Infant Motor Scale

BACKGROUND

Interindividual variability in gross motor development of infants is substantial and challenges the interpretation of motor assessments. Longitudinal research can provide insight into variability in individual gross motor trajectories.

PURPOSE

To model a gross motor growth curve of healthy term-born infants from 3.5 to 15.5 months with the Alberta Infant Motor Scale (AIMS) and to explore groups of infants with different patterns of development.

METHODS

A prospective longitudinal study including six assessments with the AIMS. A Linear Mixed Model analysis (LMM) was applied to model motor growth, controlled for covariates. Cluster analysis was used to explore groups with different pathways. Growth curves for the subgroups were modelled and differences in the covariates between the groups were described and tested.

RESULTS

In total, data of 103 infants was included in the LMM which showed that a cubic function (F(1,571) = 89.68, p < 0.001) fitted the data best. None of the covariates remained in the model. Cluster analysis delineated three clinically relevant groups: 1) Early developers (32%), 2) Gradual developers (46%), and 3) Late bloomers (22%). Significant differences in covariates between the groups were found for birth order, maternal education and maternal employment.

CONCLUSION

The current study contributes to knowledge about gross motor trajectories of healthy term born infants. Cluster analysis identified three groups with different gross motor trajectories. The motor growth curve provides a starting point for future research on motor trajectories of infants at risk and can contribute to accurate screening.

Standardized motor assessments before the age of five predicting school-aged motor outcome including DCD: A systematic review

AIM

Developmental Coordination Disorder (DCD) is a common neurodevelopmental disorder usually diagnosed at primary-school-age. This systematic review aimed to summarize available standardized motor assessments before five years of age predicting DCD, complex Minor Neurological Disorder (cMND) and motor delay assessed by a standardized motor test.

METHODS

A systematic search was performed in MEDLINE, CINAHL, WoS, Scopus, CENTRAL and ERIC. A hand search was executed. Only data of non-Cerebral Palsy children was included.

RESULTS

At or before two years, the BSID, motor subtests of GMDS, NOMAS, and NSMDA might be valuable in detecting school-aged motor delay, while starting at three years, the PDMS, motor subtests of GMDS, NSDMA, M-ABC-2, and CAMPB show promising results. General movements Assessment is associated with cMND, but does not seem sensitive enough to detect DCD. Predictive values are superior in high-risk groups and improve as children age. However, no assessment instrument reached 80% sensitivity and specificity.

CONCLUSION

Standardized motor assessments before five years seem valuable in detecting early motor problems. More longitudinal research commencing in infancy, including multiple assessments over time and the implementation of clear diagnostic criteria is imperative.

Participation Measures for Infants and Toddlers Aged Birth to 23 Months: A Systematic Review

AIMS

Participation is a key health outcome; however little is known specifically about how to measure participation of infants and toddlers. The aim of this review was to identify and examine the psychometric properties of participation measures for infants and toddlers aged birth to 23 months according to family of Participation-Related Constructs (fPRC).

METHODS

Four electronic databases were searched to identify (i) measures available in English, (ii) that quantify at least one participation concept of 'attendance' and/or 'involvement' according to the fPRC, (iii) with psychometric data for infants or toddlers aged from birth to 23 months published in a full text, peer reviewed journal. Psychometric quality was examined using the COSMIN checklist.

RESULTS

Four measures met the inclusion criteria: Child Engagement in Daily Life (CEDL) measure, Daily Activities of Infants Scale (DAIS), Test of Playfulness (ToP), and Young Children's Participation and Environment Measure (YC-PEM). All measured 'attendance' and three also measured 'involvement'. Measures showed unknown to moderate validity and unknown to moderate reliability, with the CEDL reporting the strongest psychometric properties.

CONCLUSION

There are few measures that evaluate infant and toddler participation. Further research is needed to develop psychometrically sound participation measures that evaluate 'attendance' and 'involvement' for this population.

Identifying latent subgroups of children with developmental delay using Bayesian sequential updating and Dirichlet process mixture modelling

Identifying children who are at-risk for developmental delay, so that these children can have access to interventions as early as possible, is an important and challenging problem in developmental research. This research aimed to identify latent subgroups of children with developmental delay, by modelling and clustering developmental milestones. The main objectives were to (a) create a developmental profile for each child by modelling milestone achievements, from birth to three years of age, across multiple domains of development, and (b) cluster the profiles to identify groups of children who show similar deviations from typical development. The ensemble methodology used in this research consisted of three components: (1) Bayesian sequential updating was used to model the achievement of milestones, which allows for updated predictions of development to be made in real time; (2) a measure was created that indicated how far away each child deviated from typical development for each functional domain, by calculating the area between each child’s obtained sequence of posterior means and a sequence of posterior means representing typical development; and (3) Dirichlet process mixture modelling was used to cluster the obtained areas. The data used were 348 binary developmental milestone measurements, collected from birth to three years of age, from a small community sample of young children (N = 79). The model identified nine latent groups of children with similar features, ranging from no delays in all functional domains, to large delays in all domains. The performance of the Dirichlet process mixture model was validated with two simulation studies.

Age-related validity and reliability of the Dutch Little Developmental Coordination Disorder Questionnaire (LDCDQ-NL)

BACKGROUND

Early recognition of children at risk of Developmental Coordination Disorder (DCD) is important, but variability in motor development in preschool children affects the validity of instruments to reliably detect children at risk of DCD.

AIMS

To investigate the age-related validity and reliability of the Dutch version of the Little Developmental Coordination Disorder Questionnaire (LDCDQ-NL).

METHODS AND PROCEDURES

Two hundred and sixty 3- to 5-year old children were recruited in the Netherlands. Parents filled out the LDCDQ-NL and children were assessed with the Movement Assessment Battery for Children-2 Test (MABC-2 Test). Internal consistency of the LDCDQ-NL was determined by Cronbach's alpha. Construct validity was investigated using factor analysis. Concurrent validity was measured by calculating correlations between the LDCDQ-NL and MABC-2. Receiver Operating Characteristics (ROC) were calculated to assess discriminant validity.

OUTCOMES AND RESULTS

Internal consistency of the LDCDQ-NL was 0.91. Factor analysis resulted in three factors (Fine motor skills, Locomotor skills, Ball skills). Correlation between the LDCDQ-NL and MABC-2 Test increased with increasing age. With a sensitivity of 80%, specificity increased with age.

CONCLUSIONS AND IMPLICATIONS

The LDCDQ-NL is a reliable and valid screening instrument for 4- and 5-year old Dutch children; concurrent and discriminant validity are low for 3-year olds.

High variability of individual longitudinal motor performance over five years in very preterm infants

AIM

To determine longitudinal motor performance in very preterm (VPT) infants from 6 months to 5 years of age for the entire cohort of infants, according to gender and gestational age and at the individual level.

METHOD

Single-center, prospective longitudinal study of 201 VPT infants (106 boys) without severe impairments.

OUTCOMES

Motor performance was assessed with the Bayley Scales of Infant Development (BSID-II-MS: 6, 12, 24 months) and the Movement Assessment Battery for Children (MABC-2-NL: 5 years).

RESULTS

At 6, 12, and 24 months and then at 5 years, 77%, 80%, 48%, and 22% of the infants, respectively, showed delayed motor performance (<-1SD). At 5 years, girls performed significantly better than boys in manual dexterity and balance. MIXED MODEL ANALYSES: that examined interactions between time and gender and time and gestational age, revealed no significant interactions. The variance at child level was 29%. Linear mixed model analysis revealed that mean z-scores of -1.46 at 6 months of age declined significantly to -0.52 at 5 years. Individual longitudinal motor performance showed high variability.

IMPLICATIONS

Longitudinal motor performance improved almost 1 SD over five years. However, the variability of individual longitudinal motor performance hampers evaluation in clinical care and research.

Time trends and determinants of multiple development delays in Bavarian preschool children: a retrospective analysis from 1997 to 2010

OBJECTIVES

The aim of this study was to identify the time trends of multiple developmental delays and to determine the strength of selected factors influencing preschool child's development.

METHODS

We reviewed the records of 13,876 preschoolers in a district of Lower Bavaria to determine prevalence and time trends of combined developmental delays from 1997 to 2010. The effect of age, sex and nationality on development was estimated by using regression models.

RESULTS

The largest increase was in the area of psychosocial development (1997:3.8 % versus 2010:13.8 %), followed by twofold combined delays in motor (2.6 versus 14.4 % in 2009) and twofold delays (1.3 versus 6.2 %) in cognition. Youngest children (4.26-5.49 years) had the highest risk for twofold delays in motor (4.78; 95 % CI 3.30-6.92), whereas strongest protection was observed for girls (0.28; 95 % CI 0.22-0.36) for threefold delays in motor and for a German nationality (0.30; 95 % CI 0.20-0.43) for fourfold delays in cognition.

CONCLUSIONS

According to this study, multiple disabilities in development were increasing in preschool children. These children can be considered as a risk group who therefore require measures in Public Health.

Clustering of developmental delays in Bavarian preschool children - a repeated cross-sectional survey over a period of 12 years

BACKGROUND

While most children display a normal development, some children experience developmental delays compared to age specific development milestones assessed during school entry examination. Data exist on prevalence of delays in single areas, but there is lack of knowledge regarding the clustering patterns of developmental delays and their determinants.

METHODS

During the observation period 1997-2008, 12 399 preschool children (5-7 years of age) in one district of Bavaria, Germany, were assessed in twelve schooling-relevant development areas. The co-occurrence of developmental delays was studied by means of Pearson's correlation. Subsequently, a two-step cluster algorithm was applied to identify patterns of developmental delays, and multinomial logistic regression was conducted to identify variables associated with the specific patterns.

RESULTS

Fourteen percent of preschool children displayed developmental delays in one and 19% in two or more of the studied areas. Among those with at least two developmental delays, most common was the combination of delays in "fine motor skills" + "grapho-motor coordination" (in 9.1% of all children), followed by "memory/concentration" + "endurance" (5.8%) and "abstraction" + "visual perception" (2.1%). In the cluster analysis, five distinct patterns of delays were identified, which displayed different associations with male gender and younger age.

CONCLUSIONS

While developmental delays can affect single areas, clustering of multiple developmental delays is common. Such clustering should be taken into account when developing diagnostic tests, in pediatric practice and considering interventions to reduce delays.

Identifying important life stages for monitoring and assessing risks from exposures to environmental contaminants: results of a World Health Organization review

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We propose a harmonized set of age bins for assessing risks from chemical exposure.

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The set of early life age groups will facilitate consistency with recent guidance.

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The age bins allow results from longitudinal birth cohort studies to be combined.

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Region-specific exposure factors and monitoring data are needed to apply the bins.

In this paper, we summarize exposure-related issues to consider in determining the most appropriate age ranges and life stages for risk assessment. We then propose a harmonized set of age bins for monitoring and assessing risks from exposures to chemicals for global use. The focus is on preconception through adolescence, though the approach should be applicable to additional life stages. A two-tiered set of early life age groups is recommended. The first tier involves the adoption of guidance similar to the childhood age groups recommended by the U.S. Environmental Protection Agency, whereas the second tier consolidates some of those age groups to reduce the burden of developing age-specific exposure factors for different regions. While there is no single “correct” means of choosing a common set of age groups to use internationally in assessing early life exposure and risk, use of a set of defined age groups is recommended to facilitate comparisons of potential exposures and risks around the globe, the collection of data and analyses of aggregate exposure and cumulative risk. Application of these age groups for robust assessment of exposure and risk for specific populations will require region-specific exposure factors as well as local environmental monitoring data.

Motor profile of Portuguese preschool children on the Peabody Developmental Motor Scales-2: a cross-cultural study

This study was designed to examine the cultural sensitivity of the PDMS-2 for Portuguese preschool children aged 36-71 months. A total of 540 children (255 males and 285 females) from 15 public preschools of Viana do Castelo, Portugal, were assessed. Age and gender effects in motor performance were examined. Results indicated that PDMS-2 is valid instrument to differentiate Portuguese age groups. Girls presented higher scores than boys in the Grasping and Visuo-motor integration subtests and lower scores in the Object Manipulation subtest. Portuguese preschoolers performed above US norms on Grasping, Visual-motor integration, and Stationary subtests, and bellow on Locomotion and Object Manipulation subtests. Overall, Portuguese children showed better results on the Fine Motor Quotient comparing to the Gross Motor Quotient. These results underline different motor development profiles between Portuguese and American children.