Participation in Physical Activity, Fitness, and Risk for Obesity in Children with Developmental Coordination Disorder: A Cross-cultural Study.

Decreased physical activity has been linked to poor fitness and obesity, resulting in increased risk for health concerns. The objective is to study the relationships between children's motor coordination and their physical activity, sedentary behaviour, fitness and weight status in a cross-cultural study in the United States and Israel. Participants included 118 children 6-11 years of age: 53 children with developmental coordination disorder (DCD) and 65 typical children. The US sample included 31 DCD children and 44 typical children. The Israeli sample included 22 DCD children and 21 typical children. Participants were assessed on Movement Assessment Battery for Children 2, strength test of the Bruininks-Oseretsky Test of Motor Proficiency 2 and Six-minute Walk Test and wore an accelerometer. Parents completed physical activity questionnaires and demographic information. Body mass index was calculated based on height and weight. Testing took place in two sessions. Findings are that in both Israel and the United States, children with DCD demonstrated significantly reduced physical activity, increased sedentary behaviour, poorer fitness and increased overweight compared with typical children. No significant differences were found for country. With relevance to clinical practice, fitness and obesity are major concerns for children with DCD in both countries. Inclusion of occupational therapy in health promotion for this population is critical. Additional studies with testers blind to group, larger samples and other countries are recommended.

Relationship between motor skills, participation in leisure activities and quality of life of children with Developmental Coordination Disorder: temporal aspects.

The study examined the relationship between motor skills, participation in leisure activities and quality of life (QOL), within a temporal context (school year vs. summer vacation and school days vs. weekends). Parents of 22 children with Developmental Coordination Disorder (DCD) and of 55 typically developing children, aged 6-11, filled out two questionnaires relating to their children's participation in leisure activities (vigorous, moderate and sedentary) and QOL. The Movement Assessment Battery for Children-2 (MABC-2) was administered to their children. Results showed that among the children with DCD, balance scores positively correlated with participation in sedentary activities, and in both groups both balance and aiming and catching were related to the physical and school aspects of QOL. Furthermore, participation in vigorous activities in the summer was positively correlated with social and school QOL. In contrast, among typically developing children, participation in vigorous activities during the school year was negatively correlated with school QOL. Finally, in both groups, participation in sedentary activities during school days was negatively correlated with school QOL. These results suggest that the parents' perceptions of their children's QOL may be related to the level of activeness of the leisure activities but also to temporal aspects. Therefore, it is important that therapists and educators consider the temporal aspects, when consulting with parents and their children regarding participation in leisure activities.

Physical fitness and overweight in Israeli children with and without developmental coordination disorder: gender differences.

Physical fitness and overweight among children has become paramount in the general population and more so in children with developmental coordination disorder (DCD). The purpose of the current study was to examine the association between physical fitness and overweight in a sample of Israeli children in comparison to typical children, and to examine gender differences. DCD was identified through total scores on the movement assessment battery for children 2 (MABC-2) equal to or less than the 16th percentile as well as parents' report that the child's deficits in motor skills interfered with at least two daily life activities. The sample included a group of children with DCD (n=22, M age=8.70 [SD=1.36], 16 boys [73%]) and a control group of typical children (n=47, M age=8.90 [SD=1.52], 34 boys [72%]). Measures included the strength subtest of the Bruininks-Oseretsky test of motor proficiency (BOT-2), the six minutes' walk test (6MWT) with heart rate measure, BMI and the percentage of body fat. Significant differences between DCD and typical children were found on all variables of physical fitness and weight. A two-way analysis of variance (ANOVA) analysis (group/gender) also revealed significant interactions for the percentage of body fat (F=8.51, p<.005) and BMI (F=4.50, p<.038) meaning that less fit children are more obese. The current study supports previous findings that children with DCD are less physically fit and more overweight compared to typically developing children. Moreover, in comparing between the genders, the girls in the study sample weighed more and had a significantly higher percentage of body fat than boys, it is essential to further our understanding of the relationships between obesity, physical fitness and gender among children with and without DCD.

Sensory clusters of toddlers with autism spectrum disorders: differences in affective symptoms.

BACKGROUND: Individuals with autism spectrum disorders (ASDs) show variability in their sensory behaviors. In this study we identified clusters of toddlers with ASDs who shared sensory profiles and examined differences in affective symptoms across these clusters. METHOD: Using cluster analysis 170 toddlers with ASDs were grouped based on parent rating of the Infant Toddler Sensory Profile (Dunn, 2002) under-responsivity, over-responsivity, and seeking scales. Affective symptoms were evaluated with the Infant Toddler Social Emotional Assessment (Carter & Briggs-Gowan, 2005). RESULTS: Three clusters were identified: (1) low frequency of sensory symptoms (n = 44); (2) high frequency of symptoms (n = 49); and (3) mixed (n = 77); high frequency of under-and over-responsivity and low frequency of seeking). Relative to the low frequency cluster, parents rated toddlers in the high frequency and mixed clusters (both characterized by high frequencies of sensory under- and over-responsivity) as higher on negative emotionality, depression, and anxiety symptoms. Sensory and affective differences among clusters remained after co-varying severity of ASD symptoms. CONCLUSIONS: Interdisciplinary assessments are recommended for toddlers with ASDs in order to identify the interplay of sensory and affective symptoms.

Time use in Russian Baby Homes.

BACKGROUND: We investigated time use of Russian children residing in Baby Homes to document their opportunities and experiences during institutional care. METHODS: Time use of 138 non-special needs, randomly selected children (65 female vs. 73 male, age 1 month to 4 years) in Baby Homes in Murmansk, Russia, was analysed. Baby Home specialists were trained in time-use spot observation methodology. Each child was observed every 10 min for 5 h (31 observations/child; >4000 data points). At each observation, we coded: who the child was with, adult role, what the child was doing, location and vocalizations. RESULTS: Children spent 50% of their time alone, 27% with a caregiver, 15% with another adult, and 7% with another child. Infants spent significantly more time alone (65%) than toddlers (43%) or pre-schoolers (46%) [F(2,133) = 13.05, P < 0.0001]. Caregivers supervised children (58%), led group activities (16%), cared for individuals (14%), or were absent from the room (12%). Children spent the most time (32%) in activities of daily living; remaining time was spent in meaningful play (27%), non-purposeful activity (16%) or sleep (18%). The percentage of time spent in meaningful play significantly increased across age groups [infants 10%, toddlers 25%, pre-schoolers 36%, F(2,133) = 26.9, P < 0.001]. Infants (23%) and toddlers (20%) spent significantly more time than the older group (10%) in non-purposeful activity [F(2,133) = 26.9, P < 0.001]. In 12% of observations, an adult was speaking to the child, in 10% to the group, and <1% to another adult. Child vocalizations varied by age: infants 42% of observations, toddlers 56%, and pre-schoolers 59%. Older children directed more vocalizations to adults than younger children [F(2,133) = 24.47, P < 0.001]. CONCLUSION: Time use of children residing in Baby Homes is limited by routinized schedules and care, at the expense of child-directed or interactive play with adults. Despite close proximity and living in group care, children's vocalizations and interactions with others are limited.

Including the family perspective in sensory integration outcomes research.

Occupational therapy, along with other health and rehabilitation professions, is experiencing an increased emphasis on measurement of intervention outcomes. The results of outcomes research are being used to develop practice guidelines, set standards for reimbursement, and justify health care policy. The outcome assessments used by therapists reflect our belief systems and the assumptions about behaviors we expect to influence. Using a sensory integration perspective to illustrate key points, we present a conceptual framework that is based on the disablement framework and Coster's occupational functioning for children model. We highlight the need to examine each of the multiple levels at which intervention may influence child and family function and the links among levels. Sensory integration theory and efficacy studies are reviewed to identify assumptions relative to how sensory integration affects the everyday occupations of children in the context of their families. Potential research methods and assessments are suggested to include the family perspective in outcome studies.

Sensory processing in the postinstitutionalized child.

OBJECTIVE: The purpose of this study was to examine whether children adopted from Romanian orphanages have difficulty with sensory processing and related behaviors. METHOD: Seventy-three children adopted from Romanian orphanages were compared with 72 peers who were typically developing. The subjects' ages ranged from 3 to 6 years. The parent-report Developmental and Sensory Processing Questionnaire was used to assess sensory processing and related behaviors. The tool consists of questions in six sensory processing domains and five related behavioral domains. RESULTS: Multiple t tests indicated that the subjects adopted from Romanian orphanages demonstrated significantly greater problems than those in the control group on five of the six sensory processing domains: touch, movement-avoids, movement-seeks, vision, and audition. Additionally, the Romanian subjects exhibited significantly greater problems than the control subjects on four of the five behavioral domains: activity level, feeding, organization, and social-emotional. CONCLUSIONS: These findings substantiate clinical observations and parent reports of sensory processing deficits in children adopted from Romanian orphanages and highlight the critical importance of the environment for sensory integration. The findings also enhance our understanding of how children who were previously institutionalized respond to the human and physical environment.

Supervision and consultation services for pediatric occupational therapists.

OBJECTIVE: Occupational therapists with advanced experience or expertise provide supervision and consultation services in a variety of settings. This pilot study examined the use of such supervision and consultation services by pediatric occupational therapists. METHOD: Special education administrators and pediatric occupational therapists from Massachusetts, a state often regarded as a leader in special education, responded to surveys designed especially for this study. These surveys asked about current supervision and consultation use, satisfaction with present services, and the need for additional resources in this area. Opinions regarding practice areas that would best be addressed by supervision and consultation were also obtained. RESULTS: Both administrator and therapist respondents agreed that expert occupational therapy supervision and consultation are needed. Identified areas of interest were classroom supervision and consultation strategies, service delivery decisions, and evaluation methods. CONCLUSION: Pediatric occupational therapists need expert supervision and consultation from occupational therapists with advanced experience or expertise in addition to traditional management, education, and training methods.

Effects of left-sided movements on line bisection in unilateral neglect.

Thirteen patients with left neglect performed line bisection under four conditions: no cue, visual cueing involving the report of a digit placed at the left end of the line, circling the left-end digit, and digit circling plus tracing of the line with the right index finger from its left end to its midpoint before bisection. Digit circling plus finger tracing was unequivocally more effective in reducing left neglect than digit circling alone, which was in turn more effective than visual cueing; indeed, digit circling with tracing completely abolished the rightward bisection bias. Thus continuously directing visuomotor control to the left side of the line (even with the right hand) until bisection is performed reduces neglect more than only requiring patients to attend to left-sided visual cues. The facilitatory effects of the cueing procedures may reflect their differential efficacy in constraining as well as attracting attention and action to the left part of the target line. These findings have implications for neglect rehabilitation.

Performance of Americans and israelis with cerebrovascular accident on the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA).

OBJECTIVE: The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) measures the cognitive performance of persons with cerebrovascular accident (CVA). Although this assessment was developed and standardized in Israel, it is frequently used in the United States. The purpose of this study was to identify whether differences in performance on the LOTCA existed between Americans and Israelis who have had strokes. Additionally, this study was designed to compare the performance of persons with right CVA with the performance of persons with left CVA because the normative data for the LOTCA does not include separate information for these two groups. METHOD: The LOTCA was administered to 25 Americans with CVA (19 right CVA and 6 left CVA) and 56 Israelis with CVA (26 right CVA and 30 left CVA). RESULTS: On the majority of LOTCA subtests, there were no significant differences between American and Israeli subjects. Only one subtest, Orientation to Time, revealed significant differences between Americans and Israeli subjects both for subjects with right CVA and subjects with left CVA. Examination of subjects with right CVA versus subjects with left CVA also indicated few differences. Only one subtest, Pegboard Construction, revealed significant differences between subjects with right CVA and subjects with left CVA for both American and Israeli subjects. CONCLUSION: The LOTCA is an appropriate tool for occupational therapists to use in assessing Americans who have had strokes. In addition, for the most part, the subtests of the LOTCA assess cognitive-perceptual abilities that are not specific to the right or left cerebral hemisphere.

Visual perception and praxis in adults after stroke.

OBJECTIVES: The purpose of this study was to examine the performance of persons with right cerebrovascular accident (RCVA) and persons with left cerebrovascular accident (LCVA) on a variety of measures of praxis and visual perception in order to examine the relative contributions of the left and right cerebral hemispheres to praxis and perception. METHODS: Forty-five subjects, 15 with RCVA, 15 with LCVA, and 15 without CVA (control subjects), were tested on three tests of praxis-praxic production, gesture comprehension, and gesture discrimination-and selected tests of visual perception, including the Judgement of Line Orientation Test, the Motor Free Visual Perception Test, the Hooper Visual Organization Test, and the Line Bisection Test. RESULTS: Subjects in both groups with CVA performed more poorly on all of the tests than did control subjects. The group with LCVA performed most poorly on tests of gesture comprehension and praxis production, whereas the group with RCVA performed most poorly on tests of gesture discrimination and visual perception. CONCLUSION: These findings suggest that both the right and left cerebral hemispheres contribute to different aspects of praxis. Elements of visual perception may be related to gesture comprehension, gesture discrimination, and praxis production in adults who have had stroke. These findings have clinical implications regarding instructional style and perceptual and praxic training.

The influence of ergonomic factors and perceptual-motor abilities on handwriting performance.

Difficulty with handwriting is one of the most frequent reasons that children in the public schools are referred to occupational therapy. Current research on the influence of ergonomic factors, such as pencil grip and pressure, and perceptual-motor factors traditionally believed to affect handwriting, is reviewed. Factors such as visual perception show little relationship to handwriting, whereas tactile-kinesthetic, visual-motor, and motor planning appear to be more closely related to handwriting. By better understanding the ergonomic and perceptual-motor factors that contribute to and influence handwriting, therapists will be better able to design rationally based intervention programs.

Patterns of visual spatial inattention and their functional significance in stroke patients.

The relationship between patterns of visual spatial inattention and activities of daily living (ADL) performance was investigated in 64 Chinese patients with right brain lesions, using the Klein-Bell ADL Scale and the Random Chinese Word Cancellation Test. The result showed that patients demonstrating hemi-inattention were significantly worse in ADL performance than patients with nonlateralized inattention or patients with normal attention, but that the latter two groups did not differ from each other. Although ADL performance was also found to be significantly related to somatosensation, motor status, and visual factors, after controlling the effects of these variables by partial correlation, hemi-inattention still was highly related to ADL performance. Independence in dressing, mobility, and elimination appeared to be more adversely affected by hemi-inattention than were bathing/hygiene, eating, and telephone use.

Fine motor activities in elementary school: preliminary findings and provisional implications for children with fine motor problems.

This study was designed to obtain a detailed picture of the fine motor requirements in regular elementary school classrooms. This knowledge is critical for occupational therapists in working with children with fine motor and handwriting problems who are main-streamed into regular classes. The allocation of time to fine motor activities and the types of fine motor tasks children are expected to perform in elementary school were investigated through the observation of six elementary school classrooms. A written minute-by-minute record of one whole day's activities in each classroom showed that 30% to 60% of the day was allocated to fine motor activities, with writing tasks predominating over other manipulative tasks. Implications for children with fine motor difficulties include the need for modifications to volume of work, types of tasks, and materials.

The validity of the Constructional subtests of the Sensory Integration and Praxis Tests.

This study was designed to examine the validity of the Design Copying and Constructional Praxis subtests of the Sensory Integration and Praxis Tests (SIPT) (Ayres, 1989) through an examination of convergent validity and the use of contrast groups. The subjects were 39 children aged 5 to 8 years. Of these children, 21 had learning disabilities and 18, who served as the control group, had no learning disabilities. The subjects were administered the SIPT as well as four other standardized measures of constructional abilities: the Developmental Test of Visual-Motor Integration (Beery, 1980), the Block Design subtest of the Wechsler Intelligence Scale for Children-Revised (Wechsler, 1974), the Primary Visual Motor Test (Haworth, 1970), and the Rey-Osterrieth Complex Figure Test (Waber & Holmes, 1985). The results indicated that the children with learning disabilities performed significantly more poorly than did the control subjects on both the Design Copying and Constructional Praxis subtests. These two subtests showed moderately high correlations (.46 to .71) with the other tests of constructional abilities when both groups were combined. Correlations were mostly in the moderate range for the children with learning disabilities but were generally not significant for the control sample. The results are discussed in terms of task demands and subject variability.

Praxis on verbal command and imitation.

Nondysfunctional 4-year-old and 6-year-old children were administered the Praxis on Verbal Command subtest of the Sensory Integration and Praxis Tests (SIPT) (Ayres, 1989) under two conditions. One condition was administered in the standardized manner on verbal command; the other involved administration of the same items on imitation. An analysis of variance indicated that the variables of age and condition were significant, whereas sex was not significant. The Age x Condition interaction was also significant. Scheffé multiple comparisons revealed a significant difference between 4-year-olds and 6-year-olds on verbal command but not on imitation. Verbal-command scores were significantly lower than imitation scores for the 4-year-olds but not for the 6-year-olds.

The relationship between form and space perception, constructional abilities, and clumsiness in children.

The Sensory Integration and Praxis Tests (SIPT) (Ayres, 1989) were administered to 21 children with learning disabilities and 18 children without learning disabilities, aged 5 to 8 years. The children with learning disabilities were divided into two groups, clumsy and nonclumsy, on the basis of their scores on the Test of Motor Impairment (Stott, Moyes, & Henderson, 1984). It was hypothesized that the learning-disabled children in the clumsy group would score significantly lower than the learning-disabled children in the nonclumsy group on the six SIPT subtests that measure form and space perception and visual construction and that the nonclumsy learning-disabled children, in turn, would score significantly lower than the non-learning-disabled children. It was further hypothesized that there would be a significant correlation between the degree of clumsiness and the degree of visual-perceptual and constructional deficits. An analysis of the data indicated that both groups of learning-disabled children scored lower than the non-learning-disabled children on four of the six SIPT subtests. The clumsy and nonclumsy children with learning disabilities, however, differed from each other on only two subtests. The degree of clumsiness correlated significantly with three of the six subtests. The results are discussed in terms of variations in perceptual and motor skills related to subtypes of learning disabilities.

Integrating motor control and motor learning concepts with neuropsychological perspectives on apraxia and developmental dyspraxia.

This paper reviews selected pertinent literature on the learning and performance of skilled motor acts. Information on normal motor performance is integrated with that on adult apraxia and related to common problems observed in children with developmental dyspraxia. The process of motor skill acquisition is outlined, and aspects of styles of motor organization, modes of control, premovement organization, sensory organization, and analysis of the types of errors are presented. Recommendations for clinicians working with children with developmental dyspraxia are offered.

Bilateral motor coordination in 5- to 9-year-old children: a pilot study.

The purpose of this study was to collect normative data on and to assess the clinical usefulness of scales designed to measure the quality of children's ability to perform three bilateral motor coordination tasks: jumping jacks, symmetrical stride jumps, and reciprocal stride jumps. One hundred children, aged 5 to 9 years, were tested according to the scales developed for this study. Results indicated that scores tended to increase with age and that sex differences were not significant. Jumping jacks were found to be the most reliable and the easiest of the three tasks. Reciprocal stride jumps were the most difficult. Quality of performance was assessed, and the number of jumps in a 10-sec trial was recorded for each age. The data from this study may be useful in comparing the performance of children with motor deficits to the performance of normal children of the same age.