A Range of Service Delivery Modes for Children With Developmental Coordination Disorder Are Effective: A Randomized Controlled Trial.

PURPOSE: To investigate whether the environment and personnel providing intervention to children with developmental coordination disorder make a difference in motor outcomes and perceived competency. METHODS: Ninety-three children (66 males), aged 5 years 1 month to 8 years 11 months, with developmental coordination disorder were randomized to receive a 13-week group-based task-oriented intervention, either at school by a school assistant or physical therapist, or in a health clinic by a physical therapist. The Movement Assessment Battery for Children (MABC) assessed motor skills pre- and postintervention. Self-perception and cost-effectiveness were also assessed. RESULTS: Participants demonstrated a significant improvement in motor skills following intervention for all modes of delivery up to 6 months postintervention, MABC mean difference 7.20 (95% confidence interval, 5.89-8.81), effect size = 0.98. CONCLUSION: Group intervention programs for developmental coordination disorder can be run by either a health professional or a school assistant (supported by physical therapist) in either the school or clinic environment and provide successful outcomes.

Alterations in Aerobic Exercise Performance and Gait Economy Following High-Intensity Dynamic Stepping Training in Persons With Subacute Stroke.

BACKGROUND AND PURPOSE: Impairments in metabolic capacity and economy (O2cost) are hallmark characteristics of locomotor dysfunction following stroke. High-intensity (aerobic) training has been shown to improve peak oxygen consumption in this population, with fewer reports of changes in O2cost. However, particularly in persons with subacute stroke, inconsistent gains in walking function are observed with minimal associations with gains in metabolic parameters. The purpose of this study was to evaluate changes in aerobic exercise performance in participants with subacute stroke following high-intensity variable stepping training as compared with conventional therapy. METHODS: A secondary analysis was performed on data from a randomized controlled trial comparing high-intensity training with conventional interventions, and from the pilot study that formed the basis for the randomized controlled trial. Participants 1 to 6 months poststroke received 40 or fewer sessions of high-intensity variable stepping training (n = 21) or conventional interventions (n = 12). Assessments were performed at baseline (BSL), posttraining, and 2- to 3-month follow-up and included changes in submaximal (Equation is included in full-text article.)O2 ((Equation is included in full-text article.)O2submax) and O2cost at fastest possible treadmill speeds and peak speeds at BSL testing. RESULTS: Significant improvements were observed in (Equation is included in full-text article.)O2submax with less consistent improvements in O2cost, although individual responses varied substantially. Combined changes in both (Equation is included in full-text article.)O2submax and (Equation is included in full-text article.)O2 at matched peak BSL speeds revealed stronger correlations to improvements in walking function as compared with either measure alone. DISCUSSION AND CONCLUSIONS: High-intensity stepping training may elicit significant improvements in (Equation is included in full-text article.)O2submax, whereas changes in both peak capacity and economy better reflect gains in walking function. Providing high-intensity training to improve locomotor and aerobic exercise performance may increase the efficiency of rehabilitation sessions.Video Abstract available for more insights from the authors (see Supplemental Digital Content, http://links.lww.com/JNPT/A142).

Use of the TIMP in Assessment of Motor Development of Infants With Down Syndrome.

PURPOSE: Infants with Down syndrome (DS) who are admitted to rehabilitation centers are several weeks old, and the tests that they undergo are often not specific enough to highlight the main developmental disorders in the first postnatal trimester. The aim of this study was to assess the possibility of using the Test of Infant Motor Performance (TIMP) to examine motor development of children with DS. METHODS: Using the TIMP, 141 infants, including 64 infants with DS, with a mean age of 9.4 weeks, were examined. The control group represented 77 infants without developmental disorders, with a mean age of 10.0 weeks. RESULTS: The results show that children with DS achieve lower TIMP scores in comparison with children without developmental disorders. CONCLUSIONS: The TIMP is a sensitive measure of delayed motor development in infants with DS and can be used to confirm the need for therapy.

Ecosystemic needs assessment for children with developmental coordination disorder in elementary school: multiple case studies.

This study explored the needs of children with developmental coordination disorder (DCD) from an ecosystemic viewpoint as part of a theory-driven program evaluation process. A multiple case study needs assessment was conducted. Participants included ten children with DCD, their parents (n = 12), teachers (n = 9), and service providers (n = 6). Data collection involved semi-structured interviews, validated questionnaires, and a review of the children's records. The results support the relevance of using an ecosystemic model to assess the needs of children with DCD in their life and social contexts. More specifically, the results highlight the need to provide additional services at school, such as occupational therapy and special education, as well as information and training regarding DCD for parents and teachers. The results also point to the relevant variables to consider in an intervention program based on theory-driven evaluations. This study shows how employing an ecosystemic frame of reference provides a better understanding of the needs of children with DCD. Future research should document the ecosystemic profiles and evolution of the needs of children with DCD with a larger sample from diverse socioeconomic backgrounds using a longitudinal study design.

Assessment of oculomotor control and balance post-concussion: a preliminary study for a novel approach to concussion management.

PRIMARY OBJECTIVE: Balance disturbances occur in ∼30% of concussion injuries, with vestibular dysfunction reported as the main contributor. However, few have studied oculomotor control post-concussion to assess vestibular dysfunction. RESEARCH DESIGN: The current research measured the differences in oculomotor control between athletes post-concussion (PC) and athletes without concussion (NC) during an active balance control task. METHODS: Nine PC and nine NC athletes wore a monocular eye tracking device, while balance tests were performed using the Nintendo WiiFit® soccer heading game. Average game scores, eye deviations from centre (Gaze Deviations) and gaze fixation (Percentage Time on Centre) were measured. RESULTS: PC made significantly greater Gaze Deviations from centre compared to NC (p < 0.001), however Percentage Time on Centre and game scores were not significantly different between groups. Correlations between gaze and balance within groups revealed a significant positive correlation in NC, while a significant negative correlation in PC. CONCLUSIONS: Results from this exploratory examination of oculomotor behaviour post-concussion revealed significant differences in gaze stability between athletes with a concussion and those without, suggesting vestibular involvement post-concussion. Assessment of oculomotor control during balance activities may provide further insight into dysfunction of the vestibular system following a concussion injury.

Comparison of three instruments to assess changes of motor impairment in acute hemispheric stroke: the Stroke Impairment Assessment Set (SIAS), the National Institute of Health Stroke Scale (NIHSS) and the Canadian Neurological Scale (CNS).

PURPOSE: The purpose was to compare the performance of three representative instruments to measure changes of motor recovery with acute hemispheric stroke. METHOD: In 41 consecutive patients with acute hemispheric infarction, motor recovery was assessed within 3 days of onset and then every 2 weeks until the 12th week with the Stroke Impairment Assessment Set (SIAS), the National Institutes of Health stroke scale (NIHSS) and the Canadian Neurological Scale (CNS). We analyzed the relationships among the corresponding subscales of the three instruments with the Spearman's rank correlation method, and compared their responsiveness by plotting the temporal profiles of scores of each instrument and by testing the significance of changes over time with the Friedman test. RESULTS: High correlations were observed among the three instruments at each examination point. However, the SIAS scores were more widely dispersed at the same NIHSS and CNS scores. Friedman test revealed that the scores changed significantly during the observation period with the SIAS and the CNS but not with the NIHSS. The changes were detected later with the CNS than with the SIAS. CONCLUSIONS: Although the assessment results with the three instruments were highly inter-correlated, the SIAS performed better with respect to responsiveness to changes. Implication for Rehabilitation When providing rehabilitation services to patients with stroke, it is important to document objectively the level of their impairment from the acute stage and during the entire course of rehabilitation with standardized instrument, and to predict their functional outcomes as early and accurately as possible. This study therefore compared three representative instruments with established psychometric properties, the SIAS, the NIHSS and the CNS, with respect to their ability to document motor impairment and their responsiveness to recovery in patients with acute hemispheric stroke.

The effectiveness of a fundamental motor skill intervention in pre-schoolers with motor problems depends on gender but not environmental context.

This study evaluated the effect of a 10-week fundamental motor skill programme in pre-schoolers with motor problems. Alongside the general effect of the intervention, we also explored possible gender differences and the role of the environmental context (living community, socio-economic status, and recreational space inside/outside the house). The intervention group (n=47; 20 ♂ and 27 ♀) received twenty 60-min motor skill sessions (2 per week) in addition to the regular physical education curriculum for pre-schoolers; the control group (n=46; 21 ♂ and 25 ♀) did not receive additional practice. General motor competence, and locomotor and object control subscales, were assessed before and after the intervention using the Test of Gross Motor Development 2nd edition (TGMD-2). Data regarding environmental factors were gathered through a questionnaire. A Group×Gender×Time ANOVA revealed that the intervention group benefited significantly from the intervention and scored better than the control group at the post-test for general motor competence and both sub-categories (locomotor and object control skill). Moreover, the intervention programme was found to be effective in helping 49% of the intervention group to achieve an average motor skill level, according to the TGMD-2 norms, while a further decline in motor competence was observed in the control group. Interestingly, the effect appeared to be gender-specific, since object control skill improved only in girls of the intervention group. Considering the environmental context, none of the above-mentioned factors was found to have an influence on the effectiveness of the intervention. The present study highlights the need for an early motor skill programme with a gender-specific approach in order to help low skilled boys and girls master a diverse set of motor skills.

Low-cost virtual reality intervention program for children with developmental coordination disorder: a pilot feasibility study.

PURPOSE: To explore the feasibility of using a low-cost, off-the-shelf virtual reality (VR) game to treat young children with developmental coordination disorder (DCD) and to determine the effect of this intervention on motor function. METHODS: Nine children, aged 4 to 6 years, referred to physical therapy because of suspected DCD participated in 10 game-based intervention sessions. OUTCOME MEASURES: Outcome measures included Movement Assessment Battery for Children-2 (M-ABC-2), the DCD Questionnaire (DCD-Q), the 6-minute walk test, and 10-m walk test. RESULTS: Statistically significant changes were observed in the total standard score (P = .024) and the balance subscore (P = .012) of the M-ABC-2 and in the DCD-Q (P < .05). The children seemed to be motivated and to enjoy the interaction with the VR environment. CONCLUSION: VR games seemed to be beneficial in improving the children's motor function.

Students with disabilities in higher education - perceptions of support needs and received support: a pilot study.

Students with disabilities in higher education frequently need support to succeed in their studies. Perceived problems in managing studies and everyday life may be the same for students with different disabilities, although the reasons for support may vary between them. In this pilot study, a questionnaire aimed to survey everyday functioning in students with disabilities was tested. Thirty-four students with Asperger syndrome, motor disabilities or deafness/hearing impairments were asked 55 close-ended and open-ended questions on participation restrictions and available support programmes. One aim of this study was to test the usefulness of the questionnaire, and another aim was to identify students' perceptions of their everyday student life and the support they are offered, with a special focus on comparing perceptions of needs and support between students with Asperger syndrome and other student groups. The results indicate the need to plan recruitment of participants carefully and that the questionnaire was useful. The descriptive analyses indicated that the groups primarily reported the same difficulties; however, the open-ended comments indicated that the reasons for the problems vary between the groups. It indicates that Likert-type responses to questions concerning perceived difficulties need to be supplemented by open-ended questions on the perceived reasons to problems.

Development, implementation, and evaluation of the Apollo model of pediatric rehabilitation service delivery.

This article presents the experience of a rehabilitation program that undertook the challenge to reorganize its services to address accessibility issues and improve service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical perspective on the planning; implementation; and evaluation phases of the process are described. In the planning phase, the constitution of the working committee, the data collected, and the information found in the literature are presented. Apollo, the new service delivery model, is then described along with each of its components (e.g., community, group, and individual interventions). Actions and lessons learnt during the implementation of each component are presented. We hope by sharing our experiences that we can help others make informed decisions about service reorganization to improve the quality of services provided to children with disabilities, their families, and their communities.

A critical review of functional assessment tools for upper limbs in Duchenne muscular dystrophy.

The recent development of therapeutic approaches for Duchenne muscular dystrophy (DMD) has highlighted the need to identify clinical outcome measures for planned efficacy studies. Although several studies have reported the value of functional scales, timed tests, and measures of endurance aimed at ambulant individuals, less has been done to identify reliable measures of function in individuals who have lost ambulation. The aim of this paper is to provide a critical review of the existing literature on functional measures assessing upper extremity function in DMD. Four observer-rated, performance-based measures and four self-reported scales have been previously used in DMD. Each scale provides useful information but none reflects all the different levels of functional ability in activities of daily living observed in individuals with DMD at different ages.

Mental health difficulties in children with developmental coordination disorder.

OBJECTIVE: To explore the associations between probable developmental coordination disorder (DCD) defined at age 7 years and mental health difficulties at age 9 to 10 years. METHODS: We analyzed of prospectively collected data (N = 6902) from the Avon Longitudinal Study of Parents and Children. "Probable" DCD was defined by using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria as those children below the 15th centile of the Avon Longitudinal Study of Parents and Children Coordination Test, with functional limitations in activities of daily living or handwriting, excluding children with neurologic difficulties or an IQ <70. Mental health was measured by using the child-reported Short Moods and Feelings Questionnaire and the parent-reported Strengths and Difficulties Questionnaire. Multiple logistic regression models, with the use of multiple imputation to account for missing data, assessed the associations between probable DCD and mental health difficulties. Adjustments were made for environmental confounding factors, and potential mediating factors such as verbal IQ, associated developmental traits, bullying, self-esteem, and friendships. RESULTS: Children with probable DCD (N = 346) had an increased odds of self-reported depression, odds ratio: 2.08 (95% confidence interval: 1.36-3.19) and parent-reported mental health difficulties odds ratio: 4.23 (95% confidence interval: 3.10-5.77). The odds of mental health difficulties significantly decreased after accounting for verbal IQ, social communication, bullying, and self-esteem. CONCLUSIONS: Children with probable DCD had an increased risk of mental health difficulties that, in part, were mediated through associated developmental difficulties, low verbal IQ, poor self-esteem, and bullying. Prevention and treatment of mental health difficulties should be a key element of intervention for children with DCD.

Itinerario terapéutico de las personas con discapacidad y mediaciones en el cuidado de la salud: la mirada de los familiares / Itinerary therapeutic for people with disabilities and mediation in health care: the viewpoint of relatives

Las familias son agentes cualificados de las prácticas en salud y contribuyen en la búsqueda del cuidado de las personas con discapacidad. Este artículo presenta los itinerarios que recorren los adultos con discapacidad motriz en torno de su rehabilitación y la participación de sus familiares en este proceso. A tal fin se analizan las entrevistas semi-estructuradas a familiares que viven con personas con discapacidad motriz de 50 años o más en el Área Metropolitana de Buenos Aires (AMBA). Para el relevamiento de la información de carácter cualitativo, se utilizó una muestra de tipo intencional (18 casos) por cuotas según sexo, nivel socioeconómico y tipo de vínculo (hijo/a o cónyuge). Los hallazgos muestran que los itinerarios terapéuticos en vistas del cuidado y la rehabilitación de las personas con discapacidad se dividen en dos etapas centrales: la búsqueda de un diagnóstico y la búsqueda del tratamiento. Ambas instancias se configuran de acuerdo a los factores sociales, económicos y culturales de sus familias. Según las evidencias se concluyó que los servicios de salud pueden funcionar, por momentos, como obstaculizadores de los itinerarios terapéuticos de sus usuarios si desatienden el vínculo entre sus acciones y la red familiar, en la cual se toman decisiones sobre el tratamiento a seguir y se gestiona cotidianamente el cuidado.

Families are qualified agents of health practices and contribute in the search for care of people with disabilities. This paper presents the itineraries taken by adults with mobility disabilities around their rehabilitation and the participation of their families in this process. To this end we analyzed semi-structured interviews with family members living with physically disabled people aged 50 or more in the Buenos Aires Metropolitan Area. For the survey of the qualitative information, we used a sample of intentional type (18 cases) according to sex, socioeconomic status and link (child / spouse). The findings show that the therapeutic in view of the care and rehabilitation of people with disabilities are divided into two main stages: the search for a diagnosis and seeking treatment. Both instances are configured according to the social, economic and cultural rights of the families. According to the evidence we concluded that health services can work, at times, as obstacles to the therapeutic itinerary of users and disregard the link between their actions and the family network, in which decisions about treatment options are taken and daily care is managed.

Rationale, design and methods for a randomised and controlled trial of the impact of virtual reality games on motor competence, physical activity, and mental health in children with developmental coordination disorder.

BACKGROUND: A healthy start to life requires adequate motor development and physical activity participation. Currently 5-15% of children have impaired motor development without any obvious disorder. These children are at greater risk of obesity, musculoskeletal disorders, low social confidence and poor mental health. Traditional electronic game use may impact on motor development and physical activity creating a vicious cycle. However new virtual reality (VR) game interfaces may provide motor experiences that enhance motor development and lead to an increase in motor coordination and better physical activity and mental health outcomes. VR games are beginning to be used for rehabilitation, however there is no reported trial of the impact of these games on motor coordination in children with developmental coordination disorder. METHODS: This cross-over randomised and controlled trial will examine whether motor coordination is enhanced by access to active electronic games and whether daily activity, attitudes to physical activity and mental health are also enhanced. Thirty children aged 10-12 years with poor motor coordination (≤ 15th percentile) will be recruited and randomised to a balanced ordering of 'no active electronic games' and 'active electronic games'. Each child will participate in both conditions for 16 weeks, and be assessed prior to participation and at the end of each condition. The primary outcome is motor coordination, assessed by kinematic and kinetic motion analysis laboratory measures. Physical activity and sedentary behaviour will be assessed by accelerometry, coordination in daily life by parent report questionnaire and attitudes to physical activity, self-confidence, anxiety and depressed mood will be assessed by self report questionnaire. A sample of 30 will provide a power of > 0.9 for detecting a 5 point difference in motor coordination on the MABC-2 TIS scale (mean 17, sd = 5). DISCUSSION: This is the first trial to examine the impact of new virtual reality games on motor coordination in children with developmental coordination disorder. The findings will provide critical information to understand whether these electronic games can be used to have a positive impact on the physical and mental health of these children. Given the importance of adequate motor coordination, physical activity and mental health in childhood, this project can inform interventions which could have a profound impact on the long term health of this group of children. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000400965.

Assisting people with developmental disabilities to improve computer pointing efficiency through Multiple Mice and Automatic Pointing Assistive Programs.

This study combines multi-mice technology (people with disabilities can use standard mice, instead of specialized alternative computer input devices, to achieve complete mouse operation) with an assistive pointing function (i.e. cursor-capturing, which enables the user to move the cursor to the target center automatically), to assess whether two people with developmental disabilities would be able to improve their pointing performance through a Multiple Mice Automatic Pointing Assistive Program (MMAPAP), where driver technology is adopted to enable people with disabilities to export the remaining ability of each limb to complete the mouse operation. At the beginning of the study, both participants received their baseline sessions. Then the first participant started his intervention session. The second participant had her intervention when the first participant's performance was consolidated. In the end, both participants were exposed to the maintenance phase, in which their pointing performance improved significantly. Data showed that both participants improved their pointing efficiency with the use of MMAPAP and remained highly successful through the maintenance phase. Implications of the findings are discussed.

Validity of using the Assessment of Motor and Process Skills to determine the need for assistance.

OBJECTIVE: This study evaluated the validity of using Assessment of Motor and Process Skills (AMPS) measures as evidence of the need for assistance in the community. METHOD: In a retrospective analysis of existing data (N = 64,466), receiver operating characteristic (ROC) curves were generated, and a split-sample method was used to validate the predictions. RESULTS: When identifying people who need assistance versus those who do not need assistance in the community, activity of daily living (ADL) motor and ADL process measures have fair and good discriminating value, respectively (areas under the ROC curves were .78 and .84). Evidence supports placing ADL motor and ADL process independence cutoff measures at 1.50 logits (sensitivity = .67, specificity = .72) and 1.00 logit (sensitivity = .81, specificity = .70), respectively. Accuracy was highest when matched motor and process decisions occurred (sensitivity = .85, specificity = .83). CONCLUSION: Evidence supports using ADL ability measures from the AMPS to provide evidence of a client's need for assistance in the community.

Effects of group-based versus individual-based exercise training on motor performance in children with developmental coordination disorder: a randomized controlled study.

OBJECTIVE: To compare the effects of group-based and individual-based motor skill training on motor performance in children with developmental coordination disorder. DESIGN: Randomized controlled pilot intervention study. SUBJECTS/PATIENTS: Twenty-three children (4 girls) with developmental coordination disorder (mean age (standard deviation (SD)) 8 years (1 year and 2 months)). METHODS: Twelve children were randomly assigned to undergo a motor training programme once a week for 8 consecutive weeks in a group setting, and 11 children received the same training on an individual basis during the same period. Each child was also instructed to perform home exercises on a daily basis. The Movement Assessment Battery for Children (MABC) was used to assess motor ability. Home exercise compliance and parental satisfaction with the programmes were also evaluated. RESULTS: A significant reduction in the MABC total impairment score was found following both group-based (mean -4.4 (SD 5.0), p = 0.003) and individual-based training (mean -5.2 (SD 5.1), p = 0.016). However, the change in total impairment score did not differ significantly between the 2 groups (p = 0.379). There was similarly no significant between-group difference in home exercise compliance (p = 0.288) and parental satisfaction (p = 0.379). CONCLUSION: Group-based training produced similar gains in motor performance to individual-based training. Group-based training may be the preferred treatment option due to the associated cost savings.

Parental experience of home adaptation for children with motor disabilities.

Home adaptation is essential in increasing independence of children with disabilities and reducing the burden of care for parents. Physical and occupational therapists involved in home adaptations are faced with various challenges in meeting the needs and expectations of parents. This study aimed at exploring the experience of parents throughout the home adaptation process. We conducted an exploratory qualitative study, whereby we interviewed a sample of 11 parents of children with motor disabilities, using focus groups and individual interviews. Dominant themes that emerged were financial and organizational constraints, child's independence/self-esteem, respect of temporal aspects, safety, respect for parent's roles, need for information, and appearance of the home. Parents wish physical and occupational therapists to take on roles that extend beyond provision of home adaptation, such as those of consultants and advocates.

Interrater reliability of a new handwriting assessment battery for adults.

OBJECTIVE: The objective of this study was to develop, pilot, and evaluate the interrater reliability of a new Handwriting Assessment Battery for adults. DESIGN: Test development included item selection and interrater reliability involving two raters. METHOD: The test assessed pen control and manipulation, writing speed, and writing legibility. Ten people with brain injury completed the test with two occupational therapists independently rating 10 writing samples. Results were analyzed for reliability using kappa and intraclass correlation coefficients (ICC2,1). RESULTS: Pen control and manipulation subtests showed high to perfect agreement (line drawing subtest, kappa = 1.0; dot subtest, kappa = 0.80). The speed subtest showed perfect agreement (ICC= 1.0). Writing legibility showed high agreement for all five subtests (ICC = 0.71-0.83), although a ceiling effect was evident for two subtests. CONCLUSION: Although the test showed excellent interrater reliability, further reliability and validity testing are needed before the test is used clinically.