Reliability and validity of the Finnish version of the motor observation questionnaire for teachers.

OBJECTIVES: Observational screening instruments are often used as an effective, economical first step in the identification of children with Developmental Coordination Disorder (DCD). The aim was to investigate the psychometric properties of the Finnish version of the Motor Observation Questionnaire for Teachers (MOQ-T-FI). METHODS: The psychometric properties were tested using two separate samples (S1: age range 6-12, M 9y 5mo, females 101, males 92; S2: age range 6-9, M 7y 7mo, females 404, males 446). Teachers completed the MOQ-T-FI in both samples, and in sample 2 teachers' ratings were compared to student's performance on the Movement Assessment Battery for Children-Second Edition (MABC-2). Internal consistency was investigated by using Cronbach's alpha, predictive validity by receiver operating characteristic (ROC) analysis, concurrent validity by correlation analysis, and construct validity by factor analysis. RESULTS: The MOQ-T-FI behaves consistently with its original Dutch version. The internal consistency was excellent (α=0.97). The bifactor model, with one general factor and two specific factors, fit the data significantly better than the first-order model. The concurrent validity with the MABC-2 was moderate (r=0.37 p<0.001). Sensitivity was 82.5% and specificity 44.5%, respectively. CONCLUSION: Notwithstanding the low specificity the MOQ-T-FI can be considered as a promising screening tool in the school environment for Finnish children at risk of motor learning problems.

What is the evidence of impaired motor skills and motor control among children with attention deficit hyperactivity disorder (ADHD)? Systematic review of the literature.

This article presents a review of the studies that have analysed the motor skills of ADHD children without medication and the influence of medication on their motor skills. The following two questions guided the study: What is the evidence of impairment of motor skills and aspects of motor control among children with ADHD aged between 6 and 16 years? What are the effects of ADHD medication on motor skills and motor control? The following keywords were introduced in the main databases: attention disorder and/or ADHD, motor skills and/or handwriting, children, medication. Of the 45 articles retrieved, 30 described motor skills of children with ADHD and 15 articles analysed the influence of ADHD medication on motor skills and motor control. More than half of the children with ADHD have difficulties with gross and fine motor skills. The children with ADHD inattentive subtype seem to present more impairment of fine motor skills, slow reaction time, and online motor control during complex tasks. The proportion of children with ADHD who improved their motor skills to the normal range by using medication varied from 28% to 67% between studies. The children who still show motor deficit while on medication might meet the diagnostic criteria of developmental coordination disorder (DCD). It is important to assess motor skills among children with ADHD because of the risk of reduced participation in activities of daily living that require motor coordination and attention.

A systematic review of instruments for assessment of capacity in activities of daily living in children with developmental co-ordination disorder.

Children with developmental co-ordination disorder (DCD) face evident motor difficulties in activities of daily living (ADL). Assessment of their capacity in ADL is essential for diagnosis and intervention, in order to limit the daily consequences of the disorder. The aim of this study is to systematically review potential instruments for standardized and objective assessment of children's capacity in ADL, suited for children with DCD. As a first step, databases of MEDLINE, EMBASE, CINAHL and PsycINFO were searched to identify studies that described instruments with potential for assessment of capacity in ADL. Second, instruments were included for review when two independent reviewers agreed that the instruments (1) are standardized and objective; (2) assess at activity level and comprise items that reflect ADL; and (3) are applicable to school-aged children that can move independently. Out of 1507 publications, 66 publications were selected, describing 39 instruments. Seven of these instruments were found to fulfil the criteria and were included for review: the Bruininks-Oseretsky Test of Motor Performance-2 (BOT2); the Do-Eat (Do-Eat); the Movement Assessment Battery for Children-2 (MABC2); the school-Assessment of Motor and Process Skills (schoolAMPS); the Tuffts Assessment of Motor Performance (TAMP); the Test of Gross Motor Development (TGMD); and the Functional Independence Measure for Children (WeeFIM). As a third step, for the included instruments, suitability for children with DCD was discussed based on the ADL comprised, ecological validity and other psychometric properties. We concluded that current instruments do not provide comprehensive and ecologically valid assessment of capacity in ADL as required for children with DCD.

The effect of the height to which the hand is lifted on horizontal curvature in horizontal point-to-point movements.

In point-to-point reaching movements, the trajectory of the fingertip along the horizontal plane is not completely straight but slightly curved sideward. The current paper examines whether this horizontal curvature is related to the height to which the finger is lifted. Previous research suggested that the height to which the hand is lifted might be a determinant of horizontal curvature. We asked participants to make point-to-point movements in three conditions: constrained movements (i.e., fingertip keeps contact with table top) over vertically curved surfaces that differed in height, constrained movements over a flat surface, and unconstrained movements (i.e., fingertip lifted from table top). In constrained movements, we found a strong relation between horizontal curvature and lifted height of the finger. Interestingly, for unconstrained movements, the relation between horizontal curvature and height to which the finger was lifted was weak. This demonstrates that the height to which the finger was lifted relates to horizontal curvature in some, but not in all conditions. This suggests that the height to which the hand is lifted should be included, in particular for constrained movements, when giving a full account of horizontal curvature in point-to-point movements.

Neuromotor task training for children with developmental coordination disorder: a controlled trial.

The aim of this study was to evaluate neuromotor task training (NTT), a recently developed child-centred and task-oriented treatment programme for children with developmental coordination disorder (DCD). A treatment and a non-treatment control group of children with DCD were included. Children were selected if they scored below the 15th centile on the Movement Assessment Battery for Children (MABC). The children in the treatment group were recently referred for physiotherapy (n=26; 20 males, 6 females; mean age 7y 2mo [SD 1y 3mo]). The parents of the non-treated children were concerned about their children's motor performance and responded to advertisements for free testing (n=13; 10 males, 3 females; mean age 7y 2mo [SD 2y 1mo]). Before and after nine weekly 30-minute sessions of NTT or at least 9 weeks of no intervention, the MABC and the Test of Gross Motor Development - 2 (TGMD-2) were administered. Therapists reported per session on treatment goals and tasks trained. The results indicate that motor performance does not improve spontaneously and that NTT is effective. During the intervention period, only the treated group improved on the MABC and the TGMD-2. Children improved most on tasks similar to those trained. In older children with poorer motor patterns, NTT's treatment success was higher. The Child Behavior Checklist subscales withdrawn, thought problems, anxious/depressed, and delinquency were determinants of effects on motor patterns.

Effectiveness of neuromotor task training for children with developmental coordination disorder: a pilot study.

The aim of this pilot study was to evaluate the effectiveness of a Neuromotor Task Training (NTT), recently developed for the treatment of children with Developmental Coordination Disorder (DCD) by pediatric physical therapists in the Netherlands. NTT is a task-oriented treatment program based upon recent insights from motor control and motor learning research. Ten children with DCD (intervention group) were tested before and after 9 and 18 treatment sessions on the Movement ABC and a dysgraphia scale in order to measure the effectiveness of treatment on gross and fine motor skills in general and handwriting in particular. Five children (no-treatment control group) were tested twice with a time lag of nine weeks on the Movement ABC in order to measure spontaneous improvement. No improvement was measured for the children in the no-treatment control group, whereas a significant improvement was found for children in the intervention group for both quality of handwriting and performance on the Movement ABC after 18 treatment sessions.

Analysis of handwriting of children during treatment for acute lymphoblastic leukemia.

BACKGROUND: Children treated for acute lymphoblastic leukemia (ALL) often complain about handwriting problems. PROCEDURE: Using a computerized writing task, we have prospectively studied the processes necessary for the production of handwriting movements in 11 children (5-12 years old) during treatment for ALL. Children were tested at time points closely related to the vincristine administration. RESULTS AND CONCLUSIONS: Children treated for ALL drew slower, with longer pause durations and increased drawing pressure. Children were able to overcome the problems, except for a consistently increased drawing pressure. This increased drawing pressure may be an attempt of the children to obtain sufficient kinesthetic information and thus can be seen as an adequate adaptation mechanism in case of peripheral neuropathy due to the neurotoxic effects of vincristine. However, neurotoxic effects of other cytostatic drugs cannot be excluded.

Perceptual skills of children with developmental coordination disorder.

The aim of this study was to investigate whether children with a Developmental Coordination Disorder (DCD) experience problems in the processing of visual, proprioceptive or tactile information. Different aspects of visual perception were tested with the Developmental Test of Visual Perception (DTVP-2), tactile perception was assessed with the Tactual Performance Test (TPT), and a manual pointing task was employed to measure the ability to use visual and proprioceptive information in goal-directed movements. Nineteen children with DCD and nineteen age and sex-matched controls participated in this study. Differences between groups were most pronounced in the subtests measuring visual-motor integration of the DTVP-2, and in two subtests measuring visual perception (visual closure and position in space). On average the children with DCD performed slightly below the norm for tactile perception, with only three children failing the norm. On the manual pointing task, children with DCD made inconsistent responses towards the targets in all three conditions (visual, visual-proprioceptive and proprioceptive condition). No significant differences between groups were found for absolute error. Inspection of the individual data revealed that only two children failed on the majority of perceptual tasks in the three modalities. Across tasks, no consistent pattern of deficits appeared, illustrating the heterogeneity of the problems of children with DCD.

Clinical and research diagnostic criteria for developmental coordination disorder: a review and discussion.

The aim of this review was to investigate the selection criteria used in the past in studies of children with developmental motor problems (excluding those suffering from neurological dysfunctions such as cerebral palsy, muscular dystrophy, etc.). We therefore conducted an extensive analysis of 176 publications. First, an overview of the main characteristics of these studies (terminology, population, type and purpose) and the selection criteria that are reported in these publications are presented. Following this, the DSM-IV selection criteria for developmental coordination disorder (DCD) are contrasted with the selection criteria reported in 41 publications that have used this terminology to classify the children. The results of this comparison show that the inclusion criteria are largely followed, albeit with little consistency concerning selection instruments and quantitative cut-offs, while adherence to the exclusion criteria is not common practice. Strengths and weaknesses of the DSM-IV criteria, complementary to the previous discussion by Henderson and Barnett in the HMS special issue on DCD in 1998 on this same topic, are discussed. The results of the review also show that many studies have used additional selection criteria related to the specific research questions of the study concerned. In the broader context of clinical practice as well as basic research, the latter result suggests the usefulness of a distinction between Clinical Diagnostic Criteria and Research Diagnostic Criteria. This distinction helps to develop a unifying view on the use of diagnostic criteria for research and clinical practice. We conclude with a number of recommendations concerning the selection criteria for children with DCD.

Mild axonal neuropathy of children during treatment for acute lymphoblastic leukaemia.

Neurophysiological functioning was studied prospectively in children treated for acute lymphoblastic leukaemia with a low dose vincristine regime (8 x 1.5 mg/m2/dose), to obtain more insight into vincristine neuropathy. A WHO neurotoxicity score was estimated and vibration sense and electrophysiological measurements were taken at standardized times during vincristine treatment. The WHO neurotoxicity score showed decreased or disappearance of Achilles tendon reflexes, and mild sensory disturbances, but a grade 3-4 neurotoxicity was not demonstrated by any of the children. Vibration perception thresholds increased progressively during treatment and amplitudes of action potentials of peroneal and sensory ulnar and median nerves decreased, whereas nerve conduction velocities stayed unchanged. Both vibration perception thresholds and the electrophysiological findings hardly exceeded the limits of normality. We conclude that children treated for acute lymphoblastic leukaemia with a low dose vincristine regimen have mild axonal neuropathy which may be responsible for the motor problems in these children.

Fine motor and handwriting problems after treatment for childhood acute lymphoblastic leukemia.

Motor skills were investigated in 18 children 2 years after treatment for acute lymphoblastic leukemia (ALL). Gross and fine motor functioning were examined with the Movement Assessment Battery for Children. Handwriting as a specific fine motor skill was studied with a computerized writing task. We conclude that 2 years after cessation of treatment motor problems in ALL survivors were still present. Dysfunctions were mainly pronounced in handwriting and fine motor skills.

Physiotherapy for clumsy children: an evaluation study.

This study reports the findings of an effect-evaluation study of physiotherapy for clumsy children. 18 children were identified by school doctors as having poor motor co-ordination. They were followed for three months in order to exclude spontaneous improvement of motor problems; none spontaneously improved. Subsequently, these children were enrolled on a regular physiotherapy programme. Treatment was administered individually twice a week over three months. The effects of treatment for clumsy children appeared to be promising: important improvements were found on various motor skills. These benefits were maintained for a three-month period after the end of treatment.

Some aspects of the reliability of Touwen's examination of the child with minor neurological dysfunction.

Three studies concerning the inter-rater and test-retest reliability of the Touwen examination are presented. The results of the first study showed that it was not possible to achieve acceptable levels of reliability using the manual as the only reference for instruction. Although the reliability estimates of the total scores were good, inter-rater reliability for the nine groups of items and the individual tasks within them was poor. When methodology and interpretation of performance was agreed between observers, a second study showed that these disagreements diminished. The third study demonstrated that the short-term stability of total scores is good, but reliability for group and individual item scores remained poor.