Spina Bifida Global Learning Collaborative: Educating the next generation of clinicians, researchers, and advocates.

PURPOSE: This project aimed to launch an international learning community to guide the development of a spina bifida (SB) curriculum for global health trainees. METHODS: Using a descriptive study design, a convenience sample of SB curricula were identified in 2022-23 by members of the Spina Bifida World Congress Outreach Committee and evaluated during a series of monthly Zoom calls to discuss SB education in a global health context. Participants included (1) leadership from the ReachAnother Foundation, (2) invited panelists from the Spina Bifida World Congress Global Health Symposium, and (3) global health students and preceptors. Education initiatives in Ethiopia, Sweden, Argentina, Ecuador, and the United States were evaluated vis-à-vis format and content. RESULTS: All of the education initiatives referenced the framework of the World Health Organization International Classification of Functioning, Disability and Health. Formats varied and included both virtual and interactive workshops, print materials, videos, and guides for small group discussion. Content addressed four domains: Folate Prevention, Neurosurgical Training, After Care, and Data Collection. A multidisciplinary approach, partnerships with families, and workforce pipeline training were identified as guiding themes for educating the next generation of SB researchers and clinicians in global health settings. CONCLUSION: The Spina Bifida Global Learning Collaborative is a transnational group of advocates, clinicians, and investigators whose mission is the advancement of SB-related global health education. Lessons learned from the collaborative are being leveraged to develop a global health curriculum for learners, which may improve services for individuals with SB around the globe.

Role of Pediatric Physical Therapists in Promoting Sports Participation in Developmental Coordination Disorder.

PURPOSE: To explore the role of pediatric physical therapists (PPT) in promoting sports participation in children with developmental coordination disorder (DCD) and identify associated barriers and facilitators. METHODS: Questionnaires were provided to 243 PPTs. Qualitative, semistructured, in-depth interviews were administered with the PPTs, children with DCD, and parents. RESULTS: Approximately 67% of questionnaires were returned. Approximately 46% of PPTs were active in guiding children with DCD to sports clubs. This guidance was facilitated by knowledge of local sports, clubs that include children with DCD, and contact persons. Barriers to sports participation were the motor impairment or coincident disorder, insufficient participants to compose a team, and lack of guidance on how to include children with DCD. CONCLUSIONS: PPTs currently guide children with DCD to sports clubs, but this guidance may be improved by connecting them to special exercise programs and mainstream sports clubs and examining children's experiences during sports.

Learning of writing letter-like sequences in children with physical and multiple disabilities.

This study compared implicit and explicit learning instructions in hand writing. Implicit learning is the ability to acquire a new skill without a corresponding increase in knowledge about the skill. In contrast, explicit learning uses declarative knowledge to build up a set of performance rules that guide motor performance or skills. Explicit learning is dependent on working memory, implicit learning is not. Therefore, implicit learning was expected to be easier than explicit learning in children in special education, given their expected compromised working memory. Two groups of children (5-12 years) participated, children in special education with physical or multiple disabilities (study group, n=22), and typically developing controls (n=32). Children learned to write letter-like patterns on a digitizer by tracking a moving target (implicitly) and verbal instruction (explicitly). We further tested visual working memory, visual-motor integration, and gross manual dexterity. Learning curves were similar for both groups in both conditions; children in the study group did learn both implicitly and explicitly. Motor performance was related to the writing task. In contrast to our hypothesis, visual working memory was not an important factor in the explicit condition. These results shed new light on the conceptual difference between implicit and explicit learning, and the role of working memory therein.

Implicit motor sequence learning in children with learning disabilities: deficits limited to a subgroup with low perceptual organization.

This study tested whether deficiencies in implicit motor sequence learning occurred exclusively in a subgroup of children with learning disabilities (LD). An experimental motor sequence task showed that LD children with low Perceptual Organization did not learn the sequence through implicit training, whereas they improved considerably after a few explicit test trials. In contrast, children with low Freedom From Distractibility (or sequencing) experienced the same benefit from implicit training as the control children. These results suggest that training motor skills (e.g., writing) should be adapted to suit the visuospatial abilities of a child with LD.

Handwriting development in grade 2 and grade 3 primary school children with normal, at risk, or dysgraphic characteristics.

The wide variation in prevalence of dysgraphic handwriting (5-33%) is of clinical importance, because poor handwriting has been identified as one of the most common reasons for referring school-age children to occupational therapy or physiotherapy, and is included as an criterion for the diagnosis of Developmental Coordination Disorder. This study aimed to map the development and improvement in handwriting during the early grades to differentiate between temporary and consistent dysgraphic handwriting. In this longitudinal and cross-sectional study, children in grade 2 (age 7-8 years, n=169) and grade 3 (8-9 years, n=70) took handwriting (Concise Assessment Method for Children's Handwriting; acronym BHK) and visuomotor integration (BeeryVMI) screening tests twice within one school year. Dysgraphia decreased strongly from 37% to 17% in grade 2 and diminished further to a low and stable rate of 6% in grade 3. Stability in handwriting quality only occurred in the children whose scores were within the normal range. The at risk and dysgraphic children continued to show significant and substantial improvement during grades 2 and 3. BeeryVMI was inappropriate as a screening instrument for handwriting problems. It was concluded that handwriting must be consistently dysgraphic before making any decisions about a diagnosis of dysgraphia or referral for therapy.

Learning new movement patterns: a study on good and poor writers comparing learning conditions emphasizing spatial, timing or abstract characteristics.

In the earliest stages of motor-skill learning cognitive, visuo-spatial and dynamic processes play an important role. Which of these should be addressed first when children need to learn a new complex movement sequence? This study compares three learning methods in a within-subject design by having 18 good and 18 poor 8-year-old writers master unfamiliar, letter-like patterns by (1) tracing a trajectory on a screen, (2) tracking a moving target (pursuit), and (3) performing the pattern using written explicit instructions. Following each 10-trial learning phase, the children completed a short test phase. Besides errors and kinematic data, Dynamic Time Warping (DTW) was used to calculate the deviation for each pattern from the ideal shape (DTW-distance). As predicted, the number of errors and DTW-distance were very low during the learning phase of the tracing and pursuit conditions and higher in the explicit condition. Conversely, in the test phase, tracing yielded the highest DTW-distance and the explicit condition the lowest DTW-distance and error percentages. The results were remarkably similar for the good and poor writers. The poor learning results of the tracing condition and the good results of the explicit condition have important implications for the teaching of handwriting and remedial therapy.

Dynamic time warping: a new method in the study of poor handwriting.

Poor handwriting is a diagnostic criterion for developmental coordination disorder. Typical of poor handwriting is its low overall quality and the high variability of the spatial characteristics of the letters, usually assessed with a subjective handwriting scale. Recently, Dynamic Time Warping (DTW), a technique originally developed for speech recognition, was introduced for pattern recognition in handwriting. The present study evaluates its application to analyze poor handwriting. Forty children attending Dutch mainstream primary schools were recruited and based on their scores on the Concise Evaluation Scale for Children's Handwriting (Dutch abbreviation: BHK), 20 good and 20 poor writers (of whom 13 were scheduled for handwriting intervention) were identified. The groups were matched for age (7-9 years), school grade (grades 2 and 3) and handedness. The children subsequently wrote sequences of the letter "a" on a graphics tablet in three conditions (normal, fast, and accurate). Classical kinematics were obtained and for each individual letter DTW was used to calculate the distance from the mean shape. The DTW data revealed much higher variability in the letter forms of the poor writers that was independent of the kinematic results of larger trajectories, faster movements, and higher pen pressure. The current results suggest that DTW is a valid and objective technique for letter-form analysis in handwriting and may hence be useful to evaluate the rehabilitation treatments of children suffering from poor handwriting. In education research it may be exploited to explore how children (should) learn to write.