The relationship between kinaesthesia, motor performance, physical fitness and joint mobility in children living in Nigeria

PURPOSE

This study aimed to determine the relationship between kinaesthesia, motor performance, fitness, and joint mobility in children.

METHODS

A descriptive cross-sectional study was conducted involving children from two primary schools in the South-Eastern part of Nigeria. The Beighton criteria were used to measure joint mobility. Motor performance, fitness, and kinaesthesia were measured in all the children. Spearman's rank correlation was used to evaluate the relationship between the outcomes.

RESULTS

A total of 91 children (51.6% girls) participated in the study. The mean age of the children was 8.20 ± 1.98 years. Using a Beighton score of ≥ 6, Generalized Joint Hypermobility (GJH) was identified in a total of 35 (38.46%) children and was more prevalent in females (60.0%). Joint mobility had significant correlations with most fitness and motor performance items, but not kinaesthesia. Agility & power, and motor performance seem to be reduced if mobility is larger. Kinaesthesia was correlated with most fitness and motor performance items, indicating that better fitness and better motor performance cooccur with better kinaesthesia or vice versa.

CONCLUSION

Joint mobility may have a significant influence on fitness and motor performance in children. Hence, it may be useful for future studies to investigate how fitness and motor performance modulate the onset and progression of musculoskeletal symptoms in GJH.

Age and sex effects on Super G performance are consistent across internet devices

There have been recent advances in the application of online games that assess motor skill acquisition/learning and its relationship to age and biological sex, both of which are associated with dementia risk. While this online motor learning assessment (called Super G), along with other computer-based cognitive tests, was originally developed to be completed on a computer, many people (including older adults) have been shown to access the internet through a mobile device. Thus, to improve the generalizability of our online motor skill learning game, it must not only be compatible with mobile devices but also yield replicable effects of various participant characteristics on performance relative to the computer-based version. It is unknown if age and sex differentially affect game performance as a function of device type (keyboard versus touchscreen control). Thus, the purpose of this study was to investigate if device type modifies the established effects of age and sex on performance. Although there was a main effect of device on performance, this effect did not alter the overall relationship between performance vs. age or sex. This establishes that Super G can now effectively be extended to both computer and mobile platforms to further test for dementia risk factors.

Principles into Practice: An Observational Study of Physiotherapists use of Motor Learning Principles in Stroke Rehabilitation

OBJECTIVE(S)

To describe a) how motor learning principles are applied during post stroke physiotherapy, with a focus on lower limb rehabilitation; and b) the context in which these principles are used, in relation to patient and/or task characteristics.

DESIGN

Direct non-participation observation of routine physiotherapy sessions, with data collected via video recording. A structured analysis matrix and pre-agreed definitions were used to identify, count and record: type of activity; repetitions; instructional and feedback statements (frequency and type); strategies such as observational learning and augmented feedback. Data was visualised using scatter plots, and analysed descriptively.

SETTING

6 UK Stroke Units PARTICIPANTS: 89 therapy sessions were observed, involving 55 clinicians and 57 patients.

RESULTS

Proportion of time spent active within each session ranged from 26% to 98% (mean 85, SD 19). The frequency of task repetition varied widely, with a median of 3.7 repetitions per minute (IQR 2.1-8.6). Coaching statements were common (mean 6.46 per minute), with 52% categorised as instructions, 14% as feedback, and 34% as verbal cues/motivational statements. 13% of instructions and 6% of feedback statements were externally focussed. Examining the use of different coaching behaviours in relation to patient characteristics found no associations. Overall, practice varied widely across the dataset.

CONCLUSIONS

To optimise the potential for motor skill learning, therapists must manipulate features of their coaching language (what they say, how much and when) and practice design (type, number, difficulty and variability of task). There is an opportunity to implement motor learning principles more consistently, to benefit motor skill recovery following stroke.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov (NCT03792126). CONTRIBUTION OF THE PAPER.

Validation of the North Star Assessment for Limb-Girdle Type Muscular Dystrophies

OBJECTIVE

The North Star Assessment for limb-girdle type muscular dystrophies (NSAD), a clinician-reported outcome measure (ClinRO) of motor performance, was initially developed and validated for use in dysferlinopathy, an autosomal recessive form of limb-girdle muscular dystrophy (LGMD R2/2B). Recent developments in treatments for limb-girdle muscular dystrophies (LGMD) have highlighted the urgent need for disease-specific ClinROs. The purpose of this study was to understand the ability of the NSAD to quantify motor function across the broad spectrum of LGMD phenotypes.

METHODS

Assessments of 130 individuals with LGMD evaluated by the physical therapy teams at Nationwide Children's Hospital and the John Walton Muscular Dystrophy Research Centre were included in the analysis. NSAD, 100-m timed test (100MTT), and Performance of Upper Limb 2.0 assessment data were collected. Psychometric analysis with Rasch measurement methods was used to examine the NSAD for suitability and robustness by determining the extent to which the observed data "fit" with predictions of those ratings from the Rasch model. The NSAD score was correlated with the 100MTT and Performance of Upper Limb 2.0 assessment scores for external construct validity.

RESULTS

The NSAD demonstrated a good spread of items covering a continuum of abilities across both individuals who had LGMD and were ambulatory and individuals who had LGMD and were weaker and nonambulatory. Items fit well with the construct measured, validating a summed total score. The NSAD had excellent interrater reliability [intraclass correlation coefficient (ICC) = 0.986, 95% CI = 0.981-0.991] and was highly correlated with the 100MTT walk/run velocity (Spearman rho correlation coefficient of rs(134) = .92).

CONCLUSION

Although LGMD subtypes may differ in age of onset, rate of progression, and patterns of muscle weakness, the overall impact of progressive muscle weakness on motor function is similar. The NSAD is a reliable and valid ClinRO of motor performance for individuals with LGMD and is suitable for use in clinical practice and research settings.

IMPACT

Recent developments in potential pharmacological treatments for LGMD have highlighted the urgent need for disease-specific outcome measures. Validated and meaningful outcome measures are necessary to capture disease presentation, to inform expected rates of progression, and as endpoints for measuring the response to interventions in clinical trials. The NSAD, a scale of motor performance for both individuals who have LGMD and are ambulatory and those who are nonambulatory, is suitable for use in clinical and research settings.

Age-related differences in functional tool-use are due to changes in movement quality and not simply motor slowing

Age-related declines in fine motor control may impact tool-use and thereby limit functional independence. Most previous research has, however, focused on the effect of aging on gross motor tasks. Few studies have investigated the effects of aging on the strategy or quality of fine motor skills, especially in tool-use, which may better reflect how age impacts complex movement capability. Twenty-two young (ages 19-35) and 18 older adults (ages 58-87) performed a timed upper extremity task using a tool to acquire and transport objects to different locations. Overall task performance was divided into two phases based on 3-D position of the tool: a gross motor phase (object transport) and a fine motor phase (object acquisition). Overall, older adults took longer to complete the task. A linear model indicated that this was due to the duration of the fine motor phase more so than the gross motor phase. To identify age-related differences in the quality of the fine motor phase, we fit three-dimensional ellipsoids to individual data and the calculated the ellipsoid volume. Results demonstrated a significant volume-by-age interaction, whereby increased ellipsoid volume (space the tool occupied) related to increased mean dwell time for the older adult group only; younger adults did not demonstrate this relationship. Additionally, older adults with longer movement times during the fine motor phase also had lower cognitive scores. No age-related differences were observed for the gross motor phase, suggesting that age-related declines in tool-use may be due to changes in fine motor control and cognitive status.