Asymmetry in sensory-motor function between the lower limbs in children with hemiplegic cerebral palsy: An observational study.

The objective of this study was to examine the difference in sensory-motor impairments (i.e., balance, contracture, coordination, strength, spasticity, and sensation) between legs in children with hemiplegic cerebral palsy. An observational study measured both lower limbs of children with hemiplegic cerebral palsy over one session. Six sensory-motor impairments (balance, coordination, strength, spasticity, contracture, and proprioception) were measured. The between-leg differences were analyzed using the paired t-tests and presented as the mean differences (95% confidence interval (CI)). Twenty-four participants aged 10.3 years (standard deviation: 1.3) participated. The affected leg was less than the less-affected leg in terms of the strength of dorsiflexors (mean difference (MD) -2.8 Nm, 95% CI -4.2 to -1.4), plantarflexors (MD -2.6 Nm, 95% CI -4.1 to -1.0), knee extensors (MD -5.3 Nm, 95% CI -10.2 to -0.5) as well as range of ankle dorsiflexion (MD -8 deg, 95% CI -13 to -3), and balance (median difference -11.1, 95% CI -11.6 to -10.6). There was a trend toward a difference in terms of the strength of hip abductors (MD -2.6 Nm, 95% CI -5.3 to 0.1) and coordination (MD -0.20 taps/s, 95% CI -0.42 to 0.01). The legs were similar in terms of the strength of hip extensors (MD 0.3 Nm, 95% CI -4.7 to 5.3), proprioception (MD 1 deg, 95% CI 0 to 2), and spasticity (median difference 0, 95% CI 0 to 0). Examination of the difference in sensory-motor impairments between legs in children with hemiplegic cerebral palsy has given us some insights into the deficits in both legs. Not only was balance, strength, and coordination decreased compared with the less-affected leg but also the less-affected leg was markedly decreased compared with typically developing children. Therefore, an intervention aimed at increasing muscle strength and coordination in both legs might have a positive effect, particularly on more challenging physical activities. This may, in turn, lead to successful participation in mainstream sport and recreation.

Relative contribution of sensory and motor impairments to mobility limitations in children with cerebral palsy: an observational study.

The purpose of this study was to determine the relative contribution of sensory and motor impairments to mobility limitations in cerebral palsy. An observational study was carried out in 83 children with all types of cerebral palsy with a mean age of 10.8 years (SD 1.2). Five impairments (coordination, strength, spasticity, contracture, proprioception) and three aspects of mobility (standing up from a chair, short and long distance walking) were measured. Standard multiple regression was used to determine the relative contribution of impairments to mobility as well as the relative contribution of strength of individual muscle groups (dorsiflexors, plantarflexors, knee extensors, hip abductors and hip extensors) to mobility. Five impairments accounted for 48% of the variance in overall mobility (p < 0.001): coordination independently accounted for 9%, contracture for 4% and strength for 3% of the variance. Five muscle groups accounted for 53% of the variance in overall mobility (p < 0.001): hip extensors independently accounted for 9%, knee extensors for 4%, dorsiflexors for 4% and plantarflexors for 3% of the variance. Our findings demonstrate that the impairments making a significant independent contribution to mobility in pre-adolescent cerebral palsy were loss of coordination, loss of strength and contracture.

Evaluation of the Psychometric Properties of a Newly Developed Chinese Screening Tool for Speech Disorders in Patients With Parkinson's Disease.

The study aimed to analyze the psychometric properties of a newly developed Chinese screening tool, the Chinese Version of the Speech Disorders in Parkinson's Disease Questionnaire (SDPD-C). The SDPD-C contains a 24-item questionnaire with four assessment domains. Overall, 93 patients with idiopathic Parkinson's disease (PD) (age 70.1 ± 8.9 years) and 76 healthy older adults (age 67.2 ± 8.1 years) participated in the psychometric analysis study. The internal consistency of the SDPD-C was .91 (four dimensions: .69-.85), and test-retest reliability was .91 (four dimensions: .85-.88). The SDPD-C was highly correlated with the Voice Handicap Index-10 and Movement Disorder Society-Unified Parkinson's Disease Rating Scale II 2.1 (r = .83 and .78, respectively). The SDPD-C scores also differed significantly between stages 1 and 4 of the Hoehn and Yahr Scale (p < .05). The area under the receiver operating characteristic curve was .955 (95% confidence interval, .927-.983; asymptotic significance p < .001), and the optimal cut-off score of this study was 36, with a sensitivity of .849 and specificity of .947. The results indicate that SDPD-C showed good reliability, validity, accuracy, and discrimination. It can be used as a screening tool for speech disorders in patients with PD.

Development and feasibility of a virtual reality-based exergaming program to enhance cardiopulmonary fitness in children with developmental coordination disorder.

Introduction: Developmental coordination disorder (DCD) is a neurodevelopmental disorder characterized by motor skill deficits. Such deficits often limit children's participation in physical activities, further affecting their overall health, including through reduced cardiopulmonary fitness. Because virtual reality (VR) devices offer interactive games and activities that require various movements and coordination, they can serve as motivating and enjoyable means for children to perform physical exercise. In this study, we developed a VR-based exergaming system and tested its ability to enhance the cardiopulmonary fitness of children with DCD. Materials and methods: A total of 13 children with DCD and 10 young adults were recruited in phase I to examine the test-retest reliability and concurrent validity of our system (including a custom-made heart rate monitor) with a commercial heart rate device. In phase II, we included an additional 13 children with DCD to test the feasibility of the system. We tested the outcomes using the enjoyment rating scale, intrinsic motivation inventory (IMI), and 20-m shuttle run test (20mSRT). Results: In phase I, test-retest reliability was good to excellent in the static task and moderate to good in the dynamic task. Concurrent validity was excellent in both tasks. In phase II, more than half of the children (18 out of 26) assigned the maximum rating for their enjoyment of the game; they also had high average scores on the IMI. Furthermore, after the 8-week training using the VR program, the average running distance of the 26 children in the 20mSRT had increased significantly from 129.23 m to 176.92 m (p < 0.001). Conclusion: Our VR-based exergaming program can serve as an alternative intervention for enhancing cardiopulmonary fitness in children with DCD.

Rapid automatic naming and phonological awareness deficits in preschool children with probable developmental coordination disorder.

Children with developmental coordination disorder (DCD) have been reported to have a higher risk of dyslexia than children with typical development (TD). Phonological awareness (PA) and rapid automatic naming (RAN) are known to be predictive of children's reading development. The present study examined PA and RAN in preschool children with and without probable DCD in Taiwan. In total, 704 children aged 5-6 years old from 25 preschools in Taichung City were included as participants. The probable DCD children performed more poorly than the children with TD on the PA and the RAN tests. Put in deficit terms, 22% of the children with TD, but 48% of the probable DCD children, had a single or dual PA/RAN deficit. Furthermore, it was manual dexterity that bore the unique relationship with RAN. Automatic visual perceptual-motor coordination may be the common processing component that underlies RAN and probable DCD. The early visual perceptual-motor profile of probable DCD children has not been well recognized before.

Family-centered Care Improved Neonatal Medical and Neurobehavioral Outcomes in Preterm Infants: Randomized Controlled Trial.

BACKGROUND: Family-centered care for preterm infants in Western societies has yielded short- to medium-term benefits. However, the intervention effects have rarely been validated in Eastern societies. OBJECTIVE: The aim of this study was to examine whether a family-centered intervention program (FCIP) could improve the short-term medical and neurobehavioral outcomes in preterm infants with very low birth weight (VLBW; a birth weight of <1,500 g) in Taiwan over the outcomes seen with a usual care program (UCP). DESIGN: This was a multicenter, single-blind, randomized controlled trial study. SETTING: Three medical centers in northern and southern Taiwan were the locations for the study. PARTICIPANTS: The participants were 251 VLBW preterm infants without severe perinatal complications. INTERVENTION: The infants were randomly assigned to receive the FCIP or the UCP during hospitalization. MEASUREMENTS: Infant morbidities, feeding, growth, and neurobehavioral performance were evaluated during the neonatal period. Parental adherence to interventions was measured in the FCIP group. RESULTS: The FCIP promoted earlier full enteral feeding (ß = -1.1 weeks; 95% CI = -1.9 to -0.2 weeks) and hospital discharge (ß = -0.6 week; 95% CI = -1.1 to -0.1 weeks), greater weight gain (ß = 3.3 g/d; 95% CI = 0.1 to 6.6 g/d), and better neurobehavioral performance than the UCP (ß = 1.2 points; 95% CI = 0.2 to 2.3 points). Furthermore, a higher degree of parental motivation in interventions, goal attainment, and comprehensiveness of home activities was significantly associated with greater effects in infants' neurobehavioral performance and weight gain (r = .20-.31; all Ps < .05). LIMITATIONS: The findings may not be generalized to preterm infants with severe perinatal diseases and parents with a low level of interest in interventions. CONCLUSIONS: Family-centered care facilitated short-term medical and neurobehavioral outcomes in VLBW preterm infants in Taiwan; the effects were likely achieved through parental adherence to interventions. The designated strategies may be considered in a future launch of family-centered care in Taiwan.

Effect of Touch Screen Tablet Use on Fine Motor Development of Young Children.

AIM: To investigate the effects of touch-screen tablet use on the fine motor development of preschool children without developmental delay. METHODS: 40 children who used a touch-screen tablet more 60 minutes per week for at least 1 month received a 24-week home fine motor activity program using a touch-screen-tablet. 40 children matched for age (mean = 61.0 months) and sex who did not meet the criteria for previous tablet use received a 24-week program consisting of manual play activities. Motor performance was measured using the Bruininks-Oseretsky Test of Motor Proficiency. The two-factor mixed design ANOVA was used to compare performance of the touch-screen tablet and non-touch-screen tablet groups. RESULTS: Pretest analysis showed no group differences in motor performance and pinch strength. At posttest, children in the nontouch-screen-tablet group made significantly greater changes in fine motor precision (p < 0.001), fine motor integration (p = 0.008), and manual dexterity (p = 0.003). CONCLUSION: Using a touch screen tablet extensively might be disadvantageous for the fine motor development of preschool children.

Relationship between time use in physical activity and gross motor performance of preschool children.

BACKGROUND/AIM: Participation in physical activity is an important health concern for children in most Western communities, but little is known about Asian children's participation. The purpose of this study was to extend the current knowledge on how much time preschool children in Taiwan spend on physical activity, to examine its relationship with gross motor performance and to provide information on the establishment of physical activity guidelines for preschool children in Taiwan. METHODS: Two hundred and sixty-four children between 36 and 71 months old were recruited from a university medical centre and from preschools in Taiwan. The primary outcomes were measured using the Movement Assessment Battery for Children-Second Edition and the modified Preschool-aged Children's Physical Activity Questionnaire. RESULTS: 89.8% of our participants did not meet the recommendations from the National Association for Sport and Physical Education for time spent in physical activities. Participants spent an average of 155 minutes/week in low intensity physical activity. Children with motor difficulties tended to spend less time on physical activity than did typically developing children. The mother's level of education and whether the child was overweight or obese correlated with how much time the children spent on physical activity. CONCLUSIONS: We conclude that paediatric occupational therapists should explain to parents the relationship between physical activity and motor development and advocate for developmentally positive physical activities for preschool children. Physical activity guidelines for Taiwanese preschoolers should be established immediately.

Effects of television exposure on developmental skills among young children.

BACKGROUND: Literature addressing the effects of television exposure on developmental skills of young children less than 36 months of age is scarce. This study explored how much time young children spend viewing television and investigated its effects on cognitive, language, and motor developmental skills. METHODS: Data were collected from the Pediatric Clinics at University Medical Center in Southern Taiwan. The participants comprised 75 children who were frequently exposed to television and 75 children who were not or infrequently exposed to television between 15 and 35 months old. The age and sex were matched in the two groups. The Bayley Scales of Infant Development-second edition and Peabody Developmental Motor Scales-second edition were used to identify developmental skills. Independent t-tests, χ(2) tests, and logistic regression models were conducted. RESULTS: Among 75 children who were frequently exposed to television, young children watched a daily average of 67.4 min of television before age 2, which was excessive according to the American Academy of Pediatrics. Viewing television increased the risk of delayed cognitive, language, and motor development in children who were frequently exposed to television. Cognitive, language, and motor delays in young children were significantly associated with how much time they spent viewing television. The type of care providers was critical in determining the television-viewing time of children. CONCLUSION: We recommend that pediatric practitioners explain the impacts of television exposure to parents and caregivers to ensure cognitive, language, and motor development in young children. Advocacy efforts must address the fact that allowing young children to spend excessive time viewing television can be developmentally detrimental.

The proximate unit in Chinese handwritten character production.

In spoken word production, a proximate unit is the first phonological unit at the sublexical level that is selectable for production (O'Seaghdha et al., 2010). The present study investigated whether the proximate unit in Chinese handwritten character production is the stroke, the radical, or something in between. A written version of the form preparation task was adopted. Chinese participants learned sets of two-character words, later were cued with the first character of each word, and had to write down the second character (the target). Response times were measured from the onset of a cue character to the onset of a written response. In Experiment 1, the target characters within a block shared (homogeneous) or did not share (heterogeneous) the first stroke. In Experiment 2, the first two strokes were shared in the homogeneous blocks. Response times in the homogeneous blocks and in the heterogeneous blocks were comparable in both experiments (Experiment 1: 687 vs. 684 ms, Experiment 2: 717 vs. 716). In Experiment 3 and 4, the target characters within a block shared or did not share the first radical. Response times in the homogeneous blocks were significantly faster than those in the heterogeneous blocks (Experiment 3: 685 vs. 704, Experiment 4: 594 vs. 650). In Experiment 5 and 6, the shared component was a Gestalt-like form that is more than a stroke, constitutes a portion of the target character, can be a stand-alone character itself, can be a radical of another character but is not a radical of the target character (e.g., ± in , , , ; called a logographeme). Response times in the homogeneous blocks were significantly faster than those in the heterogeneous blocks (Experiment 5: 576 vs. 625, Experiment 6: 586 vs. 620). These results suggest a model of Chinese handwritten character production in which the stroke is not a functional unit, the radical plays the role of a morpheme, and the logographeme is the proximate unit.

Musculoskeletal symptoms and associated risk factors among office workers with high workload computer use.

OBJECTIVE: Although the prevalence of reported discomfort by computer workers is high, the impact of high computer workload on musculoskeletal symptoms remains unclear. The purpose of this study was to investigate the prevalence of musculoskeletal symptoms for office workers with high computer workload. The association between risk factors and musculoskeletal symptoms was also assessed. METHODS: Two questionnaires were posted on the Web sites of 3 companies and 1 university to recruit computer users in Tainan, Taiwan, during May to July 2009. The 12-item Chinese Health Questionnaire and Musculoskeletal Symptom Questionnaire were chosen as the evaluation tools for musculoskeletal symptoms and its associated risk factors. Chinese Health Questionnaire greater than 5 and computer usage greater than 7 h/d were used to as the cutoff line to divide groups. Descriptive statistics were computed for mean values and frequencies. χ(2) Analysis was used to determine significant differences between groups. A 0.05 level of significance of was used for statistical comparisons. RESULTS: A total of 254 subjects returned the questionnaire, of which 203 met the inclusion criteria. The 3 leading regions of musculoskeletal symptoms among the computer users were the shoulder (73%), neck (71%), and upper back (60%) areas. Similarly, the 3 leading regions of musculoskeletal symptoms among the computer users with high workload were shoulder (77.3%), neck (75.6%), and upper back (63.9%) regions. High psychologic distress was significantly associated with shoulder and upper back complaints (odds ratio [OR], 3.46; OR, 2.24), whereas a high workload was significantly associated with lower back complaints (OR, 1.89). Females were more likely to report shoulder complaints (OR, 2.25). CONCLUSIONS: This study found that high psychologic distress was significantly associated with shoulder and upper back pain, whereas high workload was associated with lower back pain. Women tended to have a greater risk of shoulder complaints than men. Developing an intervention that addresses both physical and psychologic problems is important for future studies.

Postural adjustment of children with spastic diplegic cerebral palsy during seated hand reaching in different directions.

OBJECTIVES: To examine the effect of reaching in different directions on postural adjustment in children with diplegic cerebral palsy (CP), and to examine the relationship between hand reach performance and postural adjustment, and between postural control ability and postural adjustment. DESIGN: Cross-sectional study. SETTING: A movement science laboratory at a medical university. PARTICIPANTS: Children with CP (n=12) and typically developing (TD) children (n=16). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Two force platforms were used to measure the ground reaction force (GRF) and center of pressure (COP) data. Absolute peak COP velocity, COP sway ratio (SR), and mean GRF in the anterior posterior direction during the acceleration and deceleration segments of a reaching task were the main outcome measures. RESULTS: Children with CP showed a greater absolute peak COP velocity in the medial lateral direction, a smaller SR (wider COP pattern), and greater amplitude of force modulation (exaggerated postural adjustments) than TD children in lateral or medial reaches. There was a moderate correlation between SR and total Pediatric Reach Test score. The chair SR was also negatively correlated with the hand movement units. CONCLUSIONS: Children with CP showed wider, more crooked, and less efficient COP patterns than TD children, especially on medial or lateral reaches. Reaching medially or laterally involves trunk rotation, which produces more postural challenges than reaching anteriorly to children with CP. The patterns of postural adjustments in children with CP were correlated with their postural control ability and hand-reach smoothness.

Reading and writing performances of children 7-8 years of age with developmental coordination disorder in Taiwan.

Developmental coordination disorder (DCD) refers to a delay in motor development that does not have any known medical cause. Studies conducted in English speaking societies have found that children with DCD display a higher co-occurrence rate of learning difficulties (e.g., problems in reading and writing) than typically developing (TD) children. The present study examined the reading and writing performance of school-aged children with DCD and TD children in Taiwan to determine whether reading and writing difficulties also co-occur with DCD in a non-English speaking society. The Chinese Reading Achievement Test and the Basic Reading and Writing Test were administered to 37 children with DCD (7.8 ± 0.6 years) and 93 TD children (8.0 ± 0.7 years). Children with DCD had significantly lower writing composite scores than TD children on the Basic Reading and Writing Test (105.9 ± 20.0 vs. 114.4 ± 19.9). However, there were no significant differences between children with DCD and TD children in their scores on the Chinese Reading Achievement Test and in their reading composite scores on the Basic Reading and Writing Test. These results contrasted interestingly with those obtained from English-speaking children: English-speaking DCD children showed poorer reading and poorer writing than English-speaking TD children. The possibility that the logographic nature of the Chinese script might have protected the DCD children against additional reading difficulty is discussed.

The agreement of caregivers' initial identification of children's developmental problems with the professional assessment in Taiwan.

Children's developmental problems vary, with some easier to identify than others. The accuracy of caregivers' initial identification of children's developmental problems is important in the timely treatment of those problems by medical professionals. In this study, we investigated the degree to which caregivers' initial identification of children's developmental problems matched the clinical assessment by a team of qualified professionals in a developmental assessment unit of a medical center in Taiwan. The practitioners included a pediatric neurologist, a psychiatrist, a psychologist, an occupational therapist, a physical therapist, and two speech therapists. Caregivers of 943 children (age range: 2-80 months; mean: 37.7 months) who visited the unit for a suspected developmental problem were interviewed about the chief problem that led to the caregivers bringing their children to the unit. The results showed high agreement in the global and the motor domains between the caregivers and the professionals, and low agreement in the cognitive and the speech/language domains. The agreement was significantly related to the caregivers' native origin and socioeconomic status index (SSI). Caregivers with a foreign origin (immigrant mothers) and low SSI were more likely to misidentify their children's problems. It is recommended that pediatric practitioners offer continuing education to caregivers, especially in the domains of cognitive and speech/language development.

Effect of task constraint on reaching performance in children with spastic diplegic cerebral palsy.

The purposes of the study were to examine the effect of task constraint on the reaching performance in children with spastic cerebral palsy (CP) and to examine the correlations between the reaching performance and postural control. Eight children with CP and 16 typically developing (TD) children participated in the study. They performed a reach-and-return task with a seated posture on a stool. The target for reaching was set at a 120% arm-length distance in three directions (anterior, medial, and lateral). Reaching speed was modulated with a metronome at a rate of 46 beats/min. A motion analysis system recorded the kinematic data of reaching at a sampling rate of 150 Hz. Postural control was assessed with a pediatric reaching test. Movement time (MT), straightness ratio (SR), hand peak velocity (PV), and movement unit (MU) of reaching were compared between groups and among task conditions with repeated measure ANOVAs. Pearson's product-moment correlation coefficients were used to examine the correlations between reaching and postural control. Children with CP presented longer MT, larger SR and more MU than did TD children. Further, the children with CP showed larger SR while reaching medially and laterally than anteriorly. But TD children were not affected by these task constraints. Moderate correlations between postural control ability and SR and MU were noted. In conclusion, the children with CP showed a slower, more skewed, less efficient and less coordinated pattern of reaching than the TD children. Reaching laterally and medially seemed to impair the reaching performance (more skewed and less efficient) of the children with CP, but not of the TD children. Reaching laterally and medially may involve trunk rotation which produces more postural challenges than reaching anteriorly. This finding may explain the difference in the effect of task constraint on hand reaching performance between the two groups of children. Moreover, the better the postural control ability, the straighter, and more efficient and coordinated reaching performance the children showed.

Reciprocal influences on performances of a postural-suprapostural task by manipulating the level of task-load.

The objective of this study was to investigate the reciprocal influences of stance pattern (bilateral stance vs. unilateral stance) and thumb-index precision grip task (static target vs. dynamic target) on postural-suprapostural tasks by manipulating task-load. Fifteen healthy volunteers participated in four postural-suprapostural tasks, including static force-matching in bilateral/unilateral stance (BS_static; US_static), dynamic force-matching in bilateral/unilateral stance (BS_dynamic; US_dynamic), and two control tasks in bilateral and unilateral stances without a finger task. The normalized force error (NFE), reaction time (RT) of the finger tasks, and normalized change in center of pressure sway (Delta NCoP) were measured. For suprapostural task performance, a significant interaction effect between postural and suprapostural tasks on NFE of the finger tasks was noted (static: BSUS), but RT was not different among the four tasks. For postural task performance, negative Delta NCoP during unilateral stance indicated a spontaneous reduction in postural sway due to added force-matching. In contrast, addition of force-matching tended to increase postural sway during bilateral stance, but postural fluctuations decreased as task-load of suprapostural task increased (BS_dynamic

Mechanisms of deficit of visuospatial attention shift in children with developmental coordination disorder: a neurophysiological measure of the endogenous Posner paradigm.

The purpose of this study was to investigate and compare the mechanisms of brain activity, as revealed by a combination of the visuospatial attention shifting paradigm and event-related potentials (ERP) in children with developmental coordination disorder (DCD) and typically developing children. Twenty-eight DCD children and 26 typically developing children were recorded with regard to their behavioral performance and ERP measures during a variant of the endogenous Posner paradigm, in which they should react to visual targets preceded by spatial cues or presented uncued. Children with DCD showed longer reaction time and a deficit in inhibitory response capacity when compared to typically developing children. The electrophysiological characteristics also showed distinct modulatory effects upon attentional orienting, anticipatory mechanisms, and cognitive-to-motor transfer in children with DCD: longer cue-P3 and target-N1 latency, smaller target-P3 amplitude, an elongated interval between N2 and the motor response (N2-RT), and small areas on contingent negative variation (CNV). The combined analysis of behavioral performance and ERP data suggested that children with DCD had deficits of slower target identification (N1), less ability in interhemispheric (P3) and cognitive-to-motor transfer speed (N2-RT), as well as a less mature anticipatory and executive process (CNV).

Effect of seat surface inclination on postural stability and forward reaching efficiency in children with spastic cerebral palsy.

The purpose of this study was to examine the effect of seat surface inclination on postural stability and forward reaching efficiency in 10 children with spastic cerebral palsy (CP) and 16 typically developing (TD) children. The children performed a static sitting and a forward reaching task while sitting on a height- and inclination-adjustable stool at flat, three anterior-inclined, and three posterior-inclined positions. Postural stability was expressed as normalized (with body weight) peak vertical ground reaction force, center of pressure displacement in the anterior/posterior directions (COP_AP), in the medial/lateral directions (COP_ML), and sway ratio (COP_AP/COP_ML). Reaching efficiency was expressed as reaction time and movement time of arm reaching forward to a target. The results showed that seat inclination affected children's postural stability and the effects were comparable for CP and TD children in all measures except for COP_ML. Children with CP presented much larger COP_ML than TD children at the posterior-inclined positions relative to the flat and the anterior-inclined positions. Seat inclination affected reaching efficiency for both groups of children equally. Efficiency was better at the anterior positions than the posterior positions. Anterior-inclined positions improved postural stability and reaching efficiency. Posterior positions posed greater postural challenge and the challenge was tougher for children with CP.

Comorbidity of motor and language impairments in preschool children of Taiwan.

Comorbidity of motor and speech/language impairments was investigated in 363 preschool children between the ages of 5 and 6 years (boys: 205, age 6.04+/-0.48 years; girls: 158, age 5.98+/-0.53 years). The children were sampled from two municipals of Taiwan, and were determined to present no apparent neurological, musculoskeletal, cardiopulmonary system impairment or mental insufficiency. They were administered with three speech/language tests and a motor test (Movement Assessment Battery for Children, or M-ABC). The results showed a significant correlation between the total score of the motor test and the total score of each of the speech and language tests. Regression analysis that controlled for IQ (C-TONI) further showed that manual dexterity, but not ball skills or balance, of M-ABC was predictive of all scores on the speech and language tests. To determine a deficit on a test, a score at or below the 10th percentile of the norm or a score at or below 1.25SD from the group mean was established as the cutoff. For the speech/language impairment, a deficit on at least two out of the three tests also applied. Following these criteria, 22 children (6.1%) were identified to have Developmental Speech and Language Disorder (DSLD), and 45 (12.4%) to have Developmental Coordination Disorder (DCD). Comorbid DSLD and DCD were found in six children (1.65%). Chi-square analysis revealed a significant correlation between DSLD and DCD (p<.03). The odds of DSLD was higher (by about three-fold) among the children with DCD than among the children without (0.15 vs. 0.05). Comorbid motor and speech/language impairments in preschool children appear to be a significant clinical condition that requires the attention of the therapeutic community. Manual dexterity, in particular, seems to be an important clue for understanding the shared mechanism of motor and speech/language impairments.

Modulation of soleus H reflex due to stance pattern and haptic stabilization of posture.

The quiet stance is a complicated motor act requiring sophisticated sensorimotor integration to balance an artificial inverted pendulum with the ankle musculature. The objective of this study was to characterize the effects of stance pattern (bilateral stance vs. unilateral stance) and directional influence of light finger touch (medial-lateral vs. anterior-posterior) in unilateral stance upon responsiveness of the soleus H reflex. Sixteen healthy volunteers (mean age, 24.25+/-1.77 years) participated in four postural tasks with the eyes open, including the bilateral stance (BS), the unilateral stance without finger touch (USNT), and with finger touch in the medial-lateral direction (USML) and anterior-posterior direction (USAP). Meanwhile, the soleus H reflex, the pre-stimulus background activity of ankle antagonist pairs, and center of pressure (CoP) sway were measured. In reference to the BS, the USNT resulted in a significant stance effect on suppression of the soleus H reflex (H/M(max)) associated with enhancement of CoP sway. Among the conditions of unilateral stance, there was a marked directional effect of finger touch on modulation of the H/M(max). A greater disinhibition of the H/M(max) in consequence to light touch in the ML direction than in the AP direction was noted (H/M(max): USML>USAP>USNT). This directional modulation of the soleus H reflex concurred with haptic stabilization of posture in unilateral stance, showing a more pronounced reduction in CoP sway in the USML condition than in the USAP condition. However, alteration in postural sway and modulation of the soleus H reflex were not mutually correlated when stance pattern or touch vector varied. In conclusion, gating of the soleus H reflex indicated adaptation of an ankle strategy to stance pattern and haptic stabilization of posture. Relative to bilateral stance, postural maintenance in unilateral stance relied less on reflexive correction of the soleus. When finger touch was provided in line with prevailing postural threat in the lateral direction, postural stability in unilateral stance was better secured than finger touch in anterior-posterior direction, resulting in more pronounced disinhibition of the monosynaptic reflex pathway.