Evaluating the impact of virtual reality game training on upper limb motor performance in children and adolescents with developmental coordination disorder: a scoping review using the ICF framework.

OBJECTIVE: This scoping review aims to explore published literature testing Virtual Reality (VR) interventions for improving upper limb motor performance in children and adolescents with Developmental Coordination Disorder (DCD). Our primary focus was on the types of VR systems used and the measurement tools employed within the International Classification of Functioning, Disability and Health Children and Youth Version (ICF-CY) domains in these studies. METHODS: A comprehensive search of six electronic databases up to 11th January 2024 was conducted using predefined terms. Inclusion and exclusion criteria were applied to determine study eligibility, with two authors independently assessing titles, abstracts, and full-text articles. RESULTS: Out of 788 potential studies, 14 met the eligibility criteria. Studies predominantly utilized non-immersive VR (nVR) systems, for example, commercial platforms such as Nintendo Wii. Most interventions targeted general motor coordination or balance, with only four studies specifically focusing on upper limb motor performance. The Movement Assessment Battery for Children-2 was the predominant assessment tool. However, the use of game scores and trial durations raised concerns about the accuracy of assessments. The majority of studies reported no significant improvement in upper limb motor performance following VR interventions, though some noted improvements in specific tasks or overall outcomes. CONCLUSION: The findings suggest that, while nVR interventions are being explored for paediatric motor rehabilitation, their impact on enhancing upper limb motor performance in children with DCD is unclear. The variability in intervention designs, outcome measures, and the predominant focus on general motor skills rather than specific upper limb improvements highlight the need for more targeted research in this area. IMPACT: This review underscores the importance of developing precise and clinically relevant measurement tools in a broader range of VR technologies to optimize the use of VR in therapy for children with DCD. Future research should aim for more rigorous study designs and emerging immersive technologies to maximize therapeutic benefits.

Occupational performance and participation in children with developmental coordination disorders before and during Covid-19.

INTRODUCTION: Developmental coordination disorder (DCD) is a neurodevelopmental disorder that affects children's occupational performance and participation. It is known that the Covid pandemic has adversely affected the whole world in many areas. We aim to investigate the occupational performance and participation of children with DCD before and during the COVID-19. METHODS: Sixty-five children aged 5-12 years included in the study were assessed by the Canadian Measure of Occupational Performance and the Participation and Environment Measure for Children and Youth. RESULTS: Statistically significant differences were detected in occupational performance and satisfaction scores (p < 0.01). Additionally, except for 'involvement in the home environment' (p > 0.05), there were statistically significant differences in all other areas of participation (p < 0.01). CONCLUSION: The occupational performance and participation of children with DCD are impacted during COVID-19. In addition, it is seen that the desire of families to change regarding participation has increased due to COVID-19. It would be beneficial to include strategies to improve these areas in the rehabilitation processes.

Early Identification of Atypical Motor Performance of Infants With Prenatal Opioid Exposure.

PURPOSE: To investigate the association between prenatal opioid exposure (POE) and newborn infants' motor performance to aid in the early identification of developmental delays. METHODS: Nineteen infants with POE requiring pharmacological treatment, 27 infants with POE without pharmacological treatment, and 25 infants without POE were assessed via the Test of Infant Motor Performance (TIMP). RESULTS: Infants in both groups with POE had lower TIMP scores than infants without POE. There was no difference between the TIMP scores of infants with POE who required pharmacological treatment and infants with POE who did not require pharmacological treatment. CONCLUSIONS: The TIMP can detect differences in motor performance of infants with POE. Regardless of whether infants required pharmacological treatment, POE was associated with lower motor performance. Those working in hospital or early intervention settings can use the TIMP to identify early delays in infants with POE and refer for intervention.

Effects of a remote-handling-concept-based task-oriented arm training (ReHab-TOAT) on arm-hand skill performance in chronic stroke: a study protocol for a two-armed randomized controlled trial.

BACKGROUND: Improving arm-hand skill performance is a major therapeutic target in stroke rehabilitation and needs intensive and varied training. However, guided treatment time is limited. Technology can assist in the training of patients, offering a higher intensity and more variety in content. A new task-oriented arm training approach was developed, using a 'Remote Handling concept based' device to provide haptic feedback during the performance of daily living activities (ReHab-TOAT). This study aims to investigate the effects of ReHab-TOAT on patients' arm-hand function and arm-hand skill performance, quality of life of both patients in the chronic phase after stroke and their caregivers and the patients' perception regarding the usability of the intervention. METHODS: A randomized clinical trial was designed. Adult chronic stroke patients suffering from hemiparesis and arm-hand problems, with an Utrechtse Arm-hand Test score of 1-3, will be invited to participate. Participants in the experimental group receive ReHab-TOAT additional to care as usual. ReHab-TOAT contains task-oriented arm training for stroke patients in combination with haptic feedback, generated by a remote handling device. They will train for 4 weeks, 3× per week, 1.5h per day. Participants in the control group will receive no additional therapy apart from care as usual. The Fugl-Meyer Assessment (FMA), measuring participants' motor performance of the affected arm, is used as the primary outcome measure. Secondary outcome measures are arm-hand capacity of the patient (ARAT), perceived arm-hand skill performance (MAL), actual arm-hand skill performance (accelerometry), patients' quality of life (EuoQol-5D) and caregivers' quality of life (CarerQoL). Participants' perception regarding the usability of the intervention, including both the developed approach and technology used, will be evaluated by the System Usability Scale and a questionnaire on the user experience of technology. Measurements will be performed at 1, 2, 3 and 4 weeks pre-intervention (baseline); immediately post-intervention; and 3, 6 and 9 months post-intervention. Statistical analysis includes linear mixed model analysis. DISCUSSION: This study is designed to investigate the evidence regarding the effects of ReHab-TOAT on patients' performance at different levels of the International Classification of Functioning, disability and health (ICF) model, i.e. a framework measuring functioning and disability in relation to a health condition, and to provide insights on a successful development and research process regarding technology-assisted training in co-creation. TRIAL REGISTRATION: Netherlands Trial Register NL9541. Registered on June 22, 2021.

Atypical adaptive postural responses in children with developmental coordination disorder: Implications for rehabilitation.

BACKGROUND: Adaptive postural control is an important yet underexamined area in children with developmental coordination disorder (DCD). This study compared adaptive postural responses between children with DCD and those with typical development. METHODS: This was an exploratory cross-sectional study. Fifty-two children with DCD (aged 6-9 years) and 52 age- and sex-matched children with typical development participated in the study. Their adaptive postural (motor) responses were assessed using the Adaptation Test (ADT) on a computerized dynamic posturography machine. The sway energy score (SES) for each ADT trial and the average SES of five trials for both toes-up and toes-down platform inclination conditions were recorded. RESULTS: The SESs were lower in the DCD group than in the control group in ADT toes-up trial 1 (p = 0.009) and on average (p = 0.044). In the control group, the SES decreased from trial 1 to trial 2 for both the ADT toes-up (p = 0.005) and toes-down conditions (p < 0.001). SIGNIFICANCE: Adaptive postural responses were absent in children with DCD, and these children used less force (i.e., sway energy) to overcome postural instability. Therefore, both adaptive balance and neuromuscular training should be factored into rehabilitation programs for children with DCD.

The SIT-PT Trial Protocol: A Dose-Matched Randomized Clinical Trial Comparing 2 Physical Therapist Interventions for Infants and Toddlers With Cerebral Palsy.

OBJECTIVE: Although early intervention for infants at risk for cerebral palsy is routinely recommended, the content of intervention is poorly described, varies widely, and has mixed supporting evidence. The purpose of this study was to compare efficacy of 2 interventions grounded in differing domains of the International Classification of Functioning, Disability and Health on developmental outcomes of infants with or at high risk of cerebral palsy. METHODS: Infants who meet inclusion criteria will be randomized into either Sitting Together and Reaching To Play or Movement, Orientation, Repetition, Exercise Physical Therapy groups. Both groups will receive intervention twice weekly for 3 months and follow-up at 3, 6, 9, and 12 months from baseline. The primary objectives compare changes over time and between groups in sitting, gross motor, and cognitive development. The setting is the infant's home unless the caregiver requests otherwise. One hundred and fifty infants between 8 and 24 months of age will be enrolled in 3 geographically, racially, and ethnically diverse sites: Los Angeles, California; Omaha, Nebraska; and Seattle, Washington. Enrolled infants will demonstrate motor delays, emerging sitting skills, and signs of neurologic impairment. Sitting Together and Reaching To Play targets activities including sitting, reaching, and motor-based problem solving to improve global development. In contrast, Movement, Orientation, Repetition, Exercise Physical Therapy focuses on strengthening and musculoskeletal alignment while encouraging repeated movement practice. Outcome measures include the Gross Motor Function Measure, Bayley Scales of Infant Development-IV, Assessment of Problem Solving in Play, and a Parent Child Interaction assessment. Enrolled children will maintain usual intervention services due to ethical concerns with intervention withdrawal. IMPACT: This will be the first study, to our knowledge, comparing efficacy of early physical therapy with dose-matched interventions and well-defined key principles. The outcomes will inform selection of key principle of intervention in this population.

Effectiveness and feasibility of We12BFit!: improving physical fitness and lifestyle physical activity in children with developmental coordination disorder in a paediatric rehabilitation setting-a small sample field study.

OBJECTIVES: To examine the effectiveness and feasibility of We12BFit!, a family-focused intervention aimed at increasing physical fitness (PF) and motivation for physical activity (PA) in 7-year-old to 12-year-old children with developmental coordination disorder (DCD). DESIGN: A single-arm mixed methods small sample field study. SETTING: Rehabilitation centres and schools for special education in The Netherlands. PARTICIPANTS: Twenty children with DCD diagnosis. INTERVENTIONS: We12BFit! consists of We12BFit!-PF and We12BFit!-Lifestyle PA. During We12BFit!-PF, cardiorespiratory fitness (CRF), muscle strength and anaerobic power were trained in small groups (10 weeks 2*60 min/week). We12Bfit!-Lifestyle PA, which addresses motivation for PA in children and parents, was added in week 6 of We12BFit!-PF and ended 12 weeks after We12BFit!-PF. OUTCOME MEASURES: The 20-Metre Shuttle Run Test (20mSRT), Muscle Power Sprint Test and Hand Held Dynamometry were performed before and after We12BFit!-PF and after We12BFit!-Lifestyle PA (T0-T1-T2). Parents and coaches were interviewed and trainers participated in a focus group to assess motivation for PA, perceived effectiveness, and feasibility of the intervention. RESULTS: Attendance rates of participants were 88% (We12BFit!-PF) and 89% (We12BFit!-Lifestyle PA). From T0 to T1, significant improvements were found in VO2peak, number of runs on the 20mSRT and mean anaerobic power. From T1 to T2, improvements were maintained. No changes were found after We12BFit!-Lifestyle PA in time spent on moderate to vigorous activity and metabolic equivalent of task; parents observed their child improved in qualitative aspects of activities and participation. Feasibility of We12Bfit! was confirmed, although some adaptations were recommended. CONCLUSIONS: We12BFit! resulted in significant improvements and maintenance of CRF and anaerobic power in a small group of children with DCD and seemed to improve motivation for PA. The group aspect of We12BFit!-PF, the high intensity and positive motivational climate of We12BFit!-PF may have improved children's self-efficacy. We12BFit! seems feasible to improve PF and PA in children with DCD. TRIAL REGISTRATION NUMBER: NTR6334.

The effect of physical exercise on the rehabilitation quality of human waist dysfunction / O efeito do exercício físico na qualidade da reabilitação da disfunção da cintura humana / El efecto del ejercicio físico en la calidad de rehabilitación de la disfunción de la cintura humana

ABSTRACT Introduction Human motor dysfunction can affect the quality of life, especially waist dysfunction. And an effective means to improve muscle strength during exercise. Object This article compares and analyzes the effectiveness of human muscle exercise on the decline in quality of life caused by motor dysfunction. Method The article divides patients with motor dysfunction into trunk isokinetic training group (experimental group) and waist and abdominal muscle functional training group (control group), and comparative analysis of related indicators before and after treatment. Results Before treatment, the specific indicators of the two were different (P>0.05). After treatment, the patients' quality of life indicators and motor function indicators were significantly different (P<0.05). Conclusion Exercise has an obvious curative effect for patients with human motor dysfunction, and it is worthy of clinical promotion. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução A disfunção motora humana pode afetar a qualidade de vida, principalmente a disfunção da cintura. E um meio eficaz de melhorar a força muscular é o exercício. Objetivo este artigo compara e analisa a eficácia do exercício muscular humano no declínio da qualidade de vida causado por disfunção motora. Método O artigo divide os pacientes com disfunção motora em grupo treinamento isocinético de tronco (grupo experimental) e grupo treinamento funcional de cintura e músculos abdominais (grupo controle), e análise comparativa dos indicadores relacionados antes e após o tratamento. Resultados Antes do tratamento, os indicadores específicos dos dois eram diferentes (P> 0,05). Após o tratamento, os indicadores de qualidade de vida e indicadores de função motora dos pacientes foram significativamente diferentes (P <0,05). Conclusão O exercício tem um efeito curativo óbvio para pacientes com disfunção motora humana e é digno de promoção clínica. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción La disfunción motora humana puede afectar la calidad de vida, especialmente la disfunción de la cintura. Y un medio eficaz para mejorar la fuerza muscular es el ejercicio. Objeto Este artículo compara y analiza la efectividad del ejercicio muscular humano sobre el deterioro de la calidad de vida causado por la disfunción motora. Método El artículo divide a los pacientes con disfunción motora en grupo de entrenamiento isocinético del tronco (grupo experimental) y grupo de entrenamiento funcional de cintura y músculos abdominales (grupo control), y análisis comparativo de indicadores relacionados antes y después del tratamiento. Resultados Antes del tratamiento, los indicadores específicos de los dos eran diferentes (P> 0.05). Después del tratamiento, los indicadores de calidad de vida de los pacientes y los indicadores de función motora fueron significativamente diferentes (P <0,05). Conclusión El ejercicio tiene un efecto curativo obvio para los pacientes con disfunción motora humana y es digno de promoción clínica. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

A Pilot Study Delivering Physiotherapy Support for Rett Syndrome Using a Telehealth Framework Suitable for COVID-19 Lockdown.

Background: Rett syndrome (RTT) is a genetically caused neurodevelopmental disorder associated with severe disability. We assessed the feasibility of a telehealth program supporting gross motor skills in RTT.Methods: Five girls with RTT were assessed and a home-based exercise program developed in response to functional goals. Families then participated in monthly Skype sessions for 6 months, guided by a physiotherapist to monitor progress and adjust the program as necessary. Goal Attainment Scaling was used to evaluate progress and a parental satisfaction questionnaire was administered.Results: Four goals were established for each participant and progress was greater than would be expected in 16 of 20 goals. Parents evaluated the program as feasible and useful for their daughters.Discussion: A telehealth model of home-based intervention supported individuals with RTT to achieve gross motor skills and was found to be feasible. This model is important at present times during COVID-19 outbreak and lockdown.

Developing a fidelity measure of early intervention programs for children with neuromotor disorders.

AIM: To describe the development of an intervention-specific fidelity measure and its utilization and to determine whether the newly developed Sitting Together and Reaching to Play (START-Play) intervention was implemented as intended. Also, to quantify differences between START-Play and usual early intervention (uEI) services. METHOD: A fidelity measure for the START-Play intervention was developed for children with neuromotor disorders by: (1) identifying key intervention components, (2) establishing a measurement coding system, and (3) testing the reliability of instrument scores. After establishing acceptable interrater reliability, 103 intervention videos from the START-Play randomized controlled trial were coded and compared between the START-Play and uEI groups to measure five dimensions of START-Play fidelity, including adherence, dosage, quality of intervention, participant responsiveness, and program differentiation. RESULTS: Fifteen fidelity variables out of 17 had good to excellent interrater reliability evidence with intraclass correlation coefficients (ICCs) ranging from 0.77 to 0.95. The START-Play therapists met the criteria for acceptable fidelity of the intervention (rates of START-Play key component use ≥0.8; quality ratings ≥3 [on a scale of 1-4]). The START-Play and uEI groups differed significantly in rates of START-Play key component use and quality ratings. INTERPRETATION: The START-Play fidelity measure successfully quantified key components of the START-Play intervention, serving to differentiate START-Play from uEI.

Effect of Intensive Physiotherapy Training for Children With Congenital Zika Syndrome: A Retrospective Cohort Study.

OBJECTIVE: To investigate the effect of intensive physiotherapy training on the motor function of children with congenital Zika syndrome (CZS). DESIGN: A retrospective cohort study. SETTING: A support center for children with microcephaly. PARTICIPANTS: Children (N=7) aged 14 to 18 months old who were diagnosed with CZS and previously monitored more than 1 year. INTERVENTIONS: A 2-stage protocol repeated uninterruptedly for 1 year. In the first stage, the children were submitted to 1 hour of conventional physiotherapy and 1 hour of suit therapy 5 times a week for 4 weeks. The second stage consisted of 1 hour of suit therapy 3 times a week for 2 weeks. MAIN OUTCOME MEASURES: Gross motor function measure (GMFM) and body weight. RESULTS: Six evaluations were conducted approximately 3 months apart. An increase in the overall GMFM score was observed between the first and second (P=.046), first and third (P=.018), first and fourth (P=.018), first and fifth (P=.043), and first and sixth evaluations (P=.018). Differences in the scores of the individual GMFM dimensions were found only for dimension A (lying and rolling) between the first and fourth evaluations (P=.027) and for dimension B (sitting) between the first and third (P=.018), first and fourth (P=.046), and first and sixth evaluations (P=.027). No difference was found in body weight between the first and sixth evaluations (P=.009). During follow-up, only 1 child required hospitalization, and another had increased irritability. CONCLUSIONS: Children with CZS were able to perform 2 hours of motor physiotherapy daily with no serious complications, resulting in an increase or stabilization in GMFM scores.

Clinical factors associated with trunk control after stroke: A prospective study.

INTRODUCTION: Poor trunk control after stroke can impact recovery of global functional abilities. Therefore, the aim of this study was to evaluate whether clinical and functional data from stroke participants can be used to predict trunk control at 90 days. METHODS: This is a prospective study of 37 participants with stroke. The variables evaluated at hospital discharge were stroke severity (National Institute of Health Stroke Scale - NIHSS); functional capacity (modified Rankin scale - mRS); handgrip; and cognitive function. At 90 days, the variables evaluated were autonomy (Functional Independence Measure - FIM, Barthel Index); gait mobility (Tinetti mobility test -TMT); quality of life (European Quality of Life Scale - EuroQol-5D) and trunk control (trunk impairment scale - TIS). The participants were considered to have satisfactory (TIS³14) or non-satisfactory trunk control (TIS≤13), and the differences between them were assessed by chi-square test (categorical variables) and Mann-Whitney/unpaired t-test (continuous variables). A ROC curve was used to show cut-off value of clinical variables to predict trunk control. RESULTS: The unsatisfactory trunk control group presented ahigher NIHSS at discharge (p=0.01), higher mRS at discharge (p=0.00), lower Barthel Index at 90 days (p=0.03), lower FIM at 90 days (p=0.01) and lower TMT at 90 days (p=0.00) than the satisfactory trunk control group. The best cut-off points for the NIHSS and mRS scores at discharge for predicting unsatisfactory trunk control are ≥6 and ≥3, respectively. CONCLUSION: Greater NIHSS and mRS scores at hospital discharge increase the chance of unsatisfactory trunk control at 90 days after stroke.

Physical Therapy Management of Children With Developmental Coordination Disorder: An Evidence-Based Clinical Practice Guideline From the Academy of Pediatric Physical Therapy of the American Physical Therapy Association.

BACKGROUND: Developmental coordination disorder (DCD), classified as a neurodevelopmental disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), affects approximately 5% to 6% of school-aged children. Characteristics of DCD include poor motor coordination and delayed development of motor skills, not explained by other conditions. Motor deficits negatively affect school productivity, performance in activities of daily living, and recreation participation. Children with coordination problems, at risk for or diagnosed with DCD, should be evaluated by a team of professionals, including a physical therapist (PT). PURPOSE: This clinical practice guideline (CPG) provides management strategies for PTs and informs clinicians and families about DCD. It links 13 action statements with specific levels of evidence through critical appraisal of the literature and provides recommendations for implementation. RESULTS/CONCLUSIONS: The DCD CPG addresses examination, referral, first choice and supplemental interventions, discharge, compliance audits, implementation, and research recommendations. Supplemental tools are provided to support PT management.

Field-Based Tests of Strength and Anaerobic Capacity Used in Children With Developmental Coordination Disorder: A Systematic Review.

OBJECTIVE: Children with developmental coordination disorder (DCD) are reported to have lower levels of strength and anaerobic capacity. The purpose of this study was to (1) identify field-based tests for strength and anaerobic capacity used in studies comparing children with DCD and children who were typically developing (TD), (2) examine the methodological quality of studies reporting psychometric properties and rate the psychometric properties of the examined test, and (3) summarize available evidence by combining the methodological quality of the studies and the quality of the psychometric properties of the test. METHODS: An electronic search was conducted in July 2019 in 4 electronic databases. For purpose 1, primary studies were included with no exclusion of study design in which children aged 4 to 18 years with DCD were compared with children who were TD on strength and/or anaerobic capacity measures. For purpose 2, primary studies were included with no exclusion of study design in which a psychometric property was investigated. The Consensus-Based Standards for Selection of Health Measurement Instruments (COSMIN) was used to evaluate the methodological quality of the 34 studies and rate the psychometric properties of the tests used. RESULTS: Hand-held dynamometer, bent knee push-up, vertical jump, standing long-jump, functional strength measurement, fitness test, and test battery can be recommended for TD, and the shuttle run item of the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition and 10 m × 5 m sprints (straight and slalom) can be recommended for DCD. CONCLUSION: Information regarding psychometric properties of field-based tests for strength and anaerobic capacity in children with DCD is lacking. IMPACT: Information about the psychometric properties of field-based tests for strength and anaerobic capacity in children with DCD is lacking. More information is available on TD children, but it is also not complete; information regarding validity and responsiveness, especially, is missing. When using measures in children with DCD, it is important to keep in mind this lack of evidence for the validity and reliability of the outcomes for this target group.

CO-OP for Children with DCD: Goals Addressed and Strategies Used.

INTRODUCTION.: Developmental coordination disorder (DCD) is a neurodevelopmental disorder that impacts motor coordination and interferes with participation in everyday activities. Cognitive Orientation to Occupational Performance (CO-OP) is a client-centered treatment approach that focuses on skill acquisition through cognitive strategy use. OBJECTIVES.: To determine which types of goals a sample of children with DCD choose most frequently and which domain-specific strategies were most commonly used to address these goals. METHODS.: Retrospective chart review of 50 children (8-12 years) with DCD who completed CO-OP intervention was conducted to identify goal types and strategy use. RESULTS.: Leisure was the most common goal type. Supplementing task knowledge, body position, and task modification were the most frequently used strategies. CONCLUSIONS.: Results confirm the types of goals that are commonly selected by children with DCD and highlight commonly used strategies used to meet these goals. Findings will help guide occupational therapists in selecting appropriate strategies to meet children's goals.

Motor imagery and action observation for predictive control in developmental coordination disorder.

In 2019, international clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder (DCD) were published. Informing our understanding of mechanisms, recent systematic reviews have shown that children with DCD have difficulties with the predictive control of movements, including aspects of motor planning, which is expressed as the internal modeling deficit hypothesis. This motor control deficit is most evident when the spatial and temporal demands of a task increase. An increasing number of empirical studies suggest that motor planning problems can be remediated through training based on one or a combination of motor imagery and action observation. In this review, we show evidence of motor planning problems in children with DCD and show that task demands or complexity affects its appearance. Implications of these findings are treatments based on motor imagery and action observation to remediate motor planning issues. The article concludes with recommendations for future research.

Experiences in Physical Education for Children at Risk for Developmental Coordination Disorder.

Children with developmental coordination disorder (DCD) may experience stress in physical activity contexts due to emphasis on their poor motor skills. The purpose of this study was to explore the lived experiences of children at risk for DCD in physical education in order to develop a deeper understanding about what they experience as stress and how they cope with it. Using interpretative phenomenological analysis, six children in Grades 4-6 participated in two semistructured interviews. A motivational (and developmental) stress and coping theory informed interpretation of the three themes that described the children's experiences: (a) they hurt me-psychological and physical harm sustained from peers, (b) it's hard for me-difficulties encountered in activities, and (c) I have to-pressure to meet the teacher's demands. Although the children at risk for DCD were confronted with various stressors in physical education, they coped more adaptively when social support was provided.

Physical Therapy Management of Wiedemann-Steiner Syndrome From Birth to 3 Years.

PURPOSE: To investigate Wiedemann-Steiner syndrome (WSS), its correlation to hypotonia and developmental delay, and to determine the relative intervention strategies that may be useful during early intervention from birth to 3 years. METHODS: A literature search using PEDro and PubMed was conducted using key words "Wiedemann-Steiner syndrome," "hypotonia," and "developmental delay" and a case study is presented. RESULTS: A 36-month-old child with WSS received PT intervention beginning at 2 months old. Addition of orthotics and treadmill walking was added at 13 and 19 months, respectively. The child progressed through developmental sequences from rolling, sitting, standing, and walking although consistently scored with motor delay of -2 SD. CONCLUSIONS: Fifty-seven percent of children diagnosed with WSS have hypotonia, and 90% have developmental delay. The diagnosis of WSS should require physical therapy services through early intervention programs due to its high correlation with motor developmental delay and disability. Determination of progress should be measured with achievement of function rather than norm-referenced outcome measures.Video Abstract: For more insights from the authors, access Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A292.

Stander Use in Spinal Muscular Atrophy: Results From a Large Natural History Database.

PURPOSE: The purpose of this study was to describe stander use in a natural history cohort of drug therapy-naïve children with spinal muscular atrophy (SMA) who are not walking and identify factors associated with consistent stander use. METHODS: Data from 397 children with SMA types 1 and 2 characterized the prevalence and frequency of stander use. Predictors of consistent stander use explored were SMA type, survival motor neuron 2 gene (SMN2) copy number, respiratory support, and motor performance. RESULTS: Prevalence of consistent stander use was 13% in type 1 and 68% in type 2. SMA type, SMN2 copy number, respiratory support, and head rotation control each predicted consistent stander use. CONCLUSIONS: Findings characterize stander use in children with SMA who are not walking, address important safety considerations, identify factors that may inform physical therapists' clinical decision-making related to standing program prescription, and provide guidance for future prospective studies.

Motor imagery during action observation enhances imitation of everyday rhythmical actions in children with and without developmental coordination disorder.

Children with developmental coordination disorder (DCD) exhibit deficits both in imitation and motor imagery (MI) compared to typically developing children. Combined action observation and motor imagery (AO + MI) instructions can however enhance automatic imitation in both groups. In the present study we investigated the effects of AO + MI instructions on intentional imitation in children both with (n = 13) and without DCD (n = 12). On each trial participants observed and/or imagined before executing a familiar rhythmical pantomime action. These target actions were either habitually fast (tooth brushing or window wiping) or habitually slow (paint brushing or face washing), in the vertical or horizontal plane. Within each habitual speed, the target action speed was subtly manipulated across trials (fast vs. slow). Instruction condition was manipulated across three blocks of 16 trials: (1) observe before imitating the target action; (2) observe then imagine the action before imitating; (3) observe while imagining the same action before imitating (AO + MI). Kinematic analyses revealed typically developing children imitated the observed cycle times significantly better than children with DCD. A main effect of instruction showed imitation improved for AO + MI compared to the other two instructions. Within-group analyses found a significant advantage in DCD for AO + MI compared to observe then imagine. In typically developing children, imitation was significantly enhanced for AO + MI compared to observe then imitate. Combined AO + MI instructions therefore represent a promising new approach to refining performance of everyday rhythmical actions in children both with and without DCD, with implications for movement therapy and sports training.