Populations Norms for "SLURP"-An iPad App for Quantification of Visuomotor Coordination Testing

A Scoping Review on Mobile Health Technology for Assessment and Intervention of Upper Limb Motor Function in Children with Motor Impairments

Upper limb (UL) motor dysfunctions impact residual movement in hands/shoulders and limit participation in play, sports, and leisure activities. Clinical and laboratory assessments of UL movement can be time-intensive, subjective, and/or require specialized equipment and may not optimally capture a child's motor abilities. The restrictions to in-person research experienced during the COVID-19 pandemic have inspired investigators to design inclusive at-home studies with child participants and their families. Relying on the ubiquity of mobile devices, mobile health (mHealth) applications offer solutions for various clinical and research problems. This scoping review article aimed to aggregate and synthesize existing research that used health technology and mHealth approaches to evaluate and assess the hand function and UL movement in children with UL motor impairment. A scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) model was conducted in March 2023 yielding 25 articles (0.32% of 7891 studies). Assessment characteristics included game or task-based tests (13/25, 52%), primarily for neurological disorders (e.g., autism spectrum disorder [ASD], dystonia, dysgraphia) or children with cerebral palsy (CP). Although several mHealth studies were conducted in the clinical environment (10/25, 40%), studies conducted at home or in nonclinical settings (15/25, 60%) reported acceptable and highly satisfactory to the patients as minimizing the potential risks in participation. Moreover, the remaining barriers to clinical translation included object manipulation on a touch screen, offline data analysis, real-world usability, and age-appropriate application design for the wider population. However, the results emphasize the exploration of mHealth over traditional approaches, enabling user-centered study design, family-oriented methods, and large-scale sampling in future research.

Visual Motor Reaction Times Predict Receptive and Expressive Language Development in Early School-Age Children

Proficiency of multisensory processing and motor skill are often associated with early cognitive, social, and language development. However, little research exists regarding the relationship between multisensory motor reaction times (MRTs) to auditory, visual and audiovisual stimuli, and classical measures of receptive language and expressive vocabulary development in school-age children. Thus, this study aimed to examine the concurrent development of performance in classical tests of receptive (Peabody Picture Vocabulary Test; abbreviated as PPVT) and expressive vocabulary (Expressive Vocabulary Test; abbreviated as EVT), nonverbal intelligence (NVIQ) (determined with the aid of Raven's Colored Progressive Matrices; abbreviated as RCPM), speed of visual-verbal processing in the Rapid Automatic Naming (RAN) test, Eye-Hand Co-ordination (EHC) in the SLURP task, and multisensory MRTs, in children (n = 75), aged between 5 and 10 years. Bayesian statistical analysis showed evidence for age group differences in EVT performance, while PPVT was only different for the youngest group of children aged 5-6, supporting different developmental trajectories in vocabulary acquisition. Bayesian correlations revealed evidence for associations between age, NVIQ, and vocabulary measures, with decisive evidence and a higher correlation (r = 0.57 to 0.68) between EVT, MRT tasks, and EHC visuomotor processing. This was further supported by regression analyses indicating that EVT performance was the strongest unique predictor of multisensory MRTs, EHC, and RAN time. Additionally, visual MRTs were found to predict both receptive and expressive vocabulary. The findings of the study have important implications as accessible school-based assessments of the concurrent development of NVIQ, language, and multisensory processing; and hence as rapid and timely measures of developmental and neurodevelopmental status.

The Contribution of Visual and Auditory Working Memory and Non-Verbal IQ to Motor Multisensory Processing in Elementary School Children

Although cognitive abilities have been shown to facilitate multisensory processing in adults, the development of cognitive abilities such as working memory and intelligence, and their relationship to multisensory motor reaction times (MRTs), has not been well investigated in children. Thus, the aim of the current study was to explore the contribution of age-related cognitive abilities in elementary school-age children (n = 75) aged 5-10 years, to multisensory MRTs in response to auditory, visual, and audiovisual stimuli, and a visuomotor eye-hand co-ordination processing task. Cognitive performance was measured on classical working memory tasks such as forward and backward visual and auditory digit spans, and the Raven's Coloured Progressive Matrices (RCPM test of nonverbal intelligence). Bayesian Analysis revealed decisive evidence for age-group differences across grades on visual digit span tasks and RCPM scores but not on auditory digit span tasks. The results also showed decisive evidence for the relationship between performance on more complex visually based tasks, such as difficult items of the RCPM and visual digit span, and multisensory MRT tasks. Bayesian regression analysis demonstrated that visual WM digit span tasks together with nonverbal IQ were the strongest unique predictors of multisensory processing. This suggests that the capacity of visual memory rather than auditory processing abilities becomes the most important cognitive predictor of multisensory MRTs, and potentially contributes to the expected age-related increase in cognitive abilities and multisensory motor processing.

Kinematic Studies of the Go/No-Go Task as a Dynamic Sensorimotor Inhibition Task for Assessment of Motor and Executive Function in Stroke Patients: An Exploratory Study in a Neurotypical Sample

Inhibition of reaching and grasping actions as an element of cognitive control and executive function is a vital component of sensorimotor behaviour that is often impaired in patients who have lost sensorimotor function following a stroke. To date, there are few kinematic studies detailing the fine spatial and temporal upper limb movements associated with the millisecond temporal trajectory of correct and incorrect responses to visually driven Go/No-Go reaching and grasping tasks. Therefore, we aimed to refine the behavioural measurement of correct and incorrect inhibitory motor responses in a Go/No-Go task for future quantification and personalized rehabilitation in older populations and those with acquired motor disorders, such as stroke. An exploratory study mapping the kinematic profiles of hand movements in neurotypical participants utilizing such a task was conducted using high-speed biological motion capture cameras, revealing both within and between subject differences in a sample of healthy participants. These kinematic profiles and differences are discussed in the context of better assessment of sensorimotor function impairment in stroke survivors.

Age-related decrease in motor contribution to multisensory reaction times in primary school children

Traditional measurement of multisensory facilitation in tasks such as speeded motor reaction tasks (MRT) consistently show age-related improvement during early childhood. However, the extent to which motor function increases with age and hence contribute to multisensory motor reaction times in young children has seldom been examined. Thus, we aimed to investigate the contribution of motor development to measures of multisensory (auditory, visual, and audiovisual) and visuomotor processing tasks in three young school age groups of children (n = 69) aged (5-6, n = 21; 7-8, n = 25.; 9-10 n = 18 years). We also aimed to determine whether age-related sensory threshold times for purely visual inspection time (IT) tasks improved significantly with age. Bayesian results showed decisive evidence for age-group differences in multisensory MRT and visuo-motor processing tasks, though the evidence showed that threshold time for visual identification IT performance was only slower in the youngest age group children (5-6) compared to older groups. Bayesian correlations between performance on the multisensory MRT and visuo-motor processing tasks indicated moderate to decisive evidence in favor of the alternative hypothesis (BF10 = 4.71 to 91.346), though not with the threshold IT (BF10 < 1.35). This suggests that visual sensory system development in children older than 6 years makes a less significant contribution to the measure of multisensory facilitation, compared to motor development. In addition to this main finding, multisensory facilitation of MRT within race-model predictions was only found in the oldest group of children (9-10), supporting previous suggestions that multisensory integration is likely to continue into late childhood/early adolescence at least.

Vision and Visuomotor Performance Following Acute Ischemic Stroke

Background

As measurable sensory and motor deficits are key to the diagnosis of stroke, we investigated the value of objective tablet based vision and visuomotor capacity assessment in acute mild-moderate ischemic stroke (AIS) patients.

Methods

Sixty AIS patients (65 ± 14 years, 33 males) without pre-existing visual/neurological disorders and acuity better than 6/12 were tested at their bedside during the first week post-stroke and were compared to 40 controls (64 ± 11 years, 15 males). Visual field sensitivity, quantified as mean deviation (dB) and visual acuity (with and without luminance noise), were tested on MRFn (Melbourne Rapid Field-Neural) iPad application. Visuomotor capacity was assessed with the Lee-Ryan Eye-Hand Coordination (EHC) iPad application using a capacitive stylus for iPad held in the preferred hand.Time to trace 3 shapes and displacement errors (deviations of >3.5 mm from the shape) were recorded. Diagnostic capacity was considered with Receiver Operating Characteristics. Vision test outcomes were correlated with National Institutes of Health Stroke Scale (NIHSS) score at the admission.

Results

Of the 60 AIS patients, 58 grasped the iPad stylus in their preferred right hand even though 31 had left hemisphere lesions. Forty-one patients (68%) with better than 6/12 visual acuity (19 right, 19 left hemisphere and 3 multi-territorial lesions) returned significantly abnormal visual fields. The stroke group took significantly longer (AIS: 93.4 ± 60.1 s; Controls: 33.1 ± 11.5 s, p < 0.01) to complete EHC tracing and made larger displacements (AIS: 16,388 ± 36,367 mm; Controls: 2,620 ± 1,359 mm, p < 0.01) although both control and stroke groups made similar numbers of errors. EHC time was not significantly different between participants with R (n = 26, 84.3 ± 55.3 s) and L (n = 31, 101.3 ± 64.7 s) hemisphere lesions. NIHSS scores and EHC measures showed low correlations (Spearman R: −0.15, L: 0.17). ROC analysis of EHC and vision tests found high diagnostic specificity and sensitivity for a fail at EHC time, or visual field, or Acuity-in-noise (sensivity: 93%, specificity: 83%) that shows little relationship to NIHSS scores.

Conclusions

EHC time and vision test outcomes provide an easy and rapid bedside measure that complements existing clinical assessments in AIS. The low correlation between visual function, NIHSS scores and lesion site offers an expanded clinical view of changes following stroke.

The Age-Related Changes in Speed of Visual Perception, Visual Verbal and Visuomotor Performance, and Nonverbal Intelligence During Early School Years

Speed of sensory information processing has long been recognized as an important characteristic of global intelligence, though few studies have concurrently investigated the contribution of different types of information processing to nonverbal IQ in children, nor looked at whether chronological age vs. months of early schooling plays a larger role. Thus, this study investigated the speed of visual information processing in three tasks including a simple visual inspection time (IT) task, a visual-verbal processing task using Rapid Automatic Naming (RAN) of objects as an accepted preschool predictor of reading, and a visuomotor processing task using a game-like iPad application, (the "SLURP" task) that requires writing like skills, in association with nonverbal IQ (Raven's Coloured Progressive Matrices) in children (n = 100) aged 5-7 years old. Our results indicate that the rate and accuracy of information processing for all three tasks develop with age, but that only RAN and SLURP rates show significant improvement with years of schooling. RAN and SLURP also correlated significantly with nonverbal IQ scores, but not with IT. Regression analyses demonstrate that months of formal schooling provide additional contributions to the speed of dual-task visual-verbal (RAN) and visuomotor performance and Raven's scores supporting the domain-specific hypothesis of processing speed development for specific skills as they contribute to global measures such as nonverbal IQ. Finally, RAN and SLURP are likely to be useful measures for the early identification of young children with lower intelligence and potentially poor reading.

Validation of a novel functional test for assessing metamorphopsia using epiretinal membranes as a model

Current tests for assessing metamorphopsia do not account for confounders such as perceptual filling-in and spatial redundancy, which affect its sensitivity and repeatability. This proof-of-concept study aimed to assess the performance of a novel laboratory-based psychophysical test (Line Sag Test, LST) which addresses these issues for quantification of metamorphopsia in idiopathic epiretinal membranes. The LST quantifies perpendicular metamorphopsia at three eccentricities (3°, 6°, and 9°) along eight meridians (45° steps). Metamorphopsia was assessed using the LST and Amsler grid and the hit rates of both tests for detecting metamorphopsia were compared. Normal metamorphopsia scores using the LST did not differ significantly from 0 and fell within one step-size (p = 0.500). The LST detected significantly more cases of metamorphopsia than the Amsler grid (14/21 versus 3/21) (p = 0.003). Similarly, significantly more cases of visual distortions in asymptomatic iERMs were detected using the LST than the Amsler grid (11/18 versus 0/18) (p = 0.008). The LST has a higher hit rate compared to the Amsler grid (67% versus 14%). This work demonstrates a psychophysically-robust functional test addressing perceptual confounders is more sensitive for quantifying and localising metamorphopsia in macular disease, particularly in asymptomatic disease.