Publications by authors named "Bert Steenbergen"

129 Publications

Home-based (virtual) rehabilitation improves motor and cognitive function for stroke patients: a randomized controlled trial of the Elements (EDNA-22) system.

J Neuroeng Rehabil 2021 Nov 25;18(1):165. Epub 2021 Nov 25.

School of Design, RMIT, Melbourne, VIC, Australia.

Background: Home-based rehabilitation of arm function is a significant gap in service provision for adult stroke. The EDNA-22 tablet is a portable virtual rehabilitation-based system that provides a viable option for home-based rehabilitation using a suite of tailored movement tasks, and performance monitoring via cloud computing data storage. The study reported here aimed to compare use of the EDNA system with an active control (Graded Repetitive Arm Supplementary Program-GRASP training) group using a parallel RCT design.

Methods: Of 19 originally randomized, 17 acute-care patients with upper-extremity dysfunction following unilateral stroke completed training in either the treatment (n = 10) or active control groups (n = 7), each receiving 8-weeks of in-home training involving 30-min sessions scheduled 3-4 times weekly. Performance was assessed across motor, cognitive and functional behaviour in the home. Primary motor measures, collected by a blinded assessor, were the Box and Blocks Task (BBT) and 9-Hole Pegboard Test (9HPT), and for cognition the Montreal Cognitive Assessment (MoCA). Functional behaviour was assessed using the Stroke Impact Scale (SIS) and Neurobehavioural Functioning Inventory (NFI).

Results: One participant from each group withdrew for personal reasons. No adverse events were reported. Results showed a significant and large improvement in performance on the BBT for the more-affected hand in the EDNA training group, only (g = 0.90). There was a mild-to-moderate effect of training on the 9HPT for EDNA (g = 0.55) and control (g = 0.42) groups, again for the more affected hand. In relation to cognition, performance on the MoCA improved for the EDNA group (g = 0.70). Finally, the EDNA group showed moderate (but non-significant) improvement in functional behaviour on the SIS (g = 0.57) and NFI (g = 0.49).

Conclusion: A short course of home-based training using the EDNA-22 system can yield significant gains in motor and cognitive performance, over and above an active control training that also targets upper-limb function. Intriguingly, these changes in performance were corroborated only tentatively in the reports of caregivers. We suggest that future research consider how the implementation of home-based rehabilitation technology can be optimized. We contend that self-administered digitally-enhanced training needs to become part of the health literacy of all stakeholders who are impacted by stroke and other acquired brain injuries. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12619001557123. Registered 12 November 2019, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378298&isReview=true.
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http://dx.doi.org/10.1186/s12984-021-00956-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8613521PMC
November 2021

The diagnostic trajectory of developmental coordination disorder in the Netherlands: Experiences of mothers.

Child Care Health Dev 2022 Jan 27;48(1):139-149. Epub 2021 Sep 27.

Behavioural Science Institute (BSI), Radboud University, Nijmegen, The Netherlands.

Background: Receiving a diagnosis can have a major impact on the child and its family. Parental satisfaction concerning the diagnostic trajectory is important with regard to acceptance and coping with their child's problems. Our aim was to describe the diagnostic trajectory of developmental coordination disorder (DCD) in the Netherlands and identify factors that are related to parents' satisfaction.

Method: Mothers of 60 children with a DCD diagnosis completed an online survey concerning their experiences during and after the diagnostic trajectory of obtaining this diagnosis.

Results: Forty percent of the mothers rated the diagnostic trajectory towards a DCD diagnosis as stressful and 47% rated the knowledgeability of the first professional they consulted (mostly a general practitioner, paediatric physical therapist, or youth health care physician) as having no or just superficial knowledge about DCD. Around 60% of the mothers described a lack of knowledge and support at their child's school after receiving the diagnosis. Notwithstanding this, the majority of the participating mothers was (very) satisfied with the diagnostic trajectory. Higher appreciation of both the manner of the diagnosing professional and the post-diagnostic support provided were predictive of higher satisfaction.

Conclusions: Our results underline the importance of improving the knowledgeability in primary schools and primary health care professionals with regard to DCD.
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http://dx.doi.org/10.1111/cch.12914DOI Listing
January 2022

Second-order motor planning difficulties in children with developmental coordination disorder.

Hum Mov Sci 2021 Oct 10;79:102836. Epub 2021 Jul 10.

Behavioural Science Institute (BSI), Radboud University, Nijmegen, the Netherlands; Centre for Disability and Development Research (CeDDR), School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.

The second-order motor planning ability of children with developmental coordination disorder (DCD) has often been studied using tasks that require judgements of end-state comfort (ESC). In these studies, children may have chosen to prioritize other aspects of performance (e.g., a comfortable start-posture) over ESC while still being able to complete the goal of the task. This is a limitation that is inherent to previously used ESC paradigms. To avoid this in the present study, 52 children with and without DCD (aged 5-12 years) completed a task that requires second-order motor planning for its successful completion. In the hexagonal knob task, children were instructed to grasp and rotate a hexagonal knob. The rotation angle varied in size: 60°, 120°, 180°, and 240° rotations. Both the 180° and 240° rotation conditions required an uncomfortable starting posture for successful task completion. Results showed that children with DCD were less likely to adjust their initial grip in anticipation of the required rotation angle, resulting in more task failures compared with typically developing (TD) children. Based on this finding we conclude that children with DCD experience genuine second-order motor planning difficulties. Analysis of temporal outcomes, showed that initial reaction time increased with rotation angle, but this was less pronounced for children with DCD than for TD children. There were no between group differences in timing of subsequent events. These results suggest that the difficulties of children with DCD are related to the initial planning process, that is, before the start of the movement.
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http://dx.doi.org/10.1016/j.humov.2021.102836DOI Listing
October 2021

Implicit motor learning in primary school children: A systematic review.

J Sports Sci 2021 Nov 3;39(22):2577-2595. Epub 2021 Jul 3.

Behavioural Science Institute (BSI), Radboud University, Nijmegen, The Netherlands.

The aim of this study was to assess the current state of evidence and methodological quality of studies on implicit and explicit motor learning in both typically developing children and children with developmental disorders. A systematic literature review was conducted on the experimental literature published up to April 2020. A total of 25 studies were included. Studies were evaluated on methodological quality, paradigm used, and level of evidence. The results showed that implicit paradigms are as effective as explicit paradigms in both groups of children. Studies are predominantly experimental in nature involving mostly upper limb aiming tasks. The few studies that were performed outside the lab (n = 5) suggest superior efficacy of the implicit paradigm. Methodological quality varied between studies and was not always of sufficient standard to allow conclusions. In particular, manipulation checks were only performed in 13 studies (52% of all studies), limiting conclusions. Further progress can be made by focussing on improving methodological quality through retention testing by the inclusion of a control group, by the inclusion of a manipulation check, and via assessment of relevant co-variables, such as working memory, age, and motor competence.
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http://dx.doi.org/10.1080/02640414.2021.1947010DOI Listing
November 2021

Eliciting End-State Comfort Planning in Children With and Without Developmental Coordination Disorder Using a Hammer Task: A Pilot Study.

Front Psychol 2021 28;12:625577. Epub 2021 Jan 28.

Behavioural Science Institute (BSI), Radboud University, Nijmegen, Netherlands.

The end-state comfort (ESC) effect refers to the consistent tendency of healthy adults to end their movements in a comfortable end posture. In children with and without developmental coordination disorder (DCD), the results of studies focusing on ESC planning have been inconclusive, which is likely to be due to differences in task constraints. The present pilot study focused on the question whether children with and without DCD were able to change their planning strategy and were more likely to plan for ESC when demanded by complex object manipulations at the end of a task. To this end, we examined ESC planning in 18 children with and without DCD (aged 5-11years) using the previously used sword-task and the newly developed hammer-task. In the sword-task, children had to insert a sword in a wooden block, which could be relatively easily completed with an uncomfortable end-posture. In the hammer-task, children had to strike down a nail in a wooden pounding bench, which required additional force and speed demands, making it relatively difficult to complete the movement with an uncomfortable end-posture. In line with our hypothesis, the results demonstrated that children with and without DCD were more likely to plan for ESC on the hammer-task compared with the sword-task. Thus, while children with and without DCD show inconsistent ESC planning on many previously used tasks, the present pilot study shows that many of them are able to take into account the end-state of their movements if demanded by task constraints.
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http://dx.doi.org/10.3389/fpsyg.2021.625577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875891PMC
January 2021

Lateralized EEG mu power during action observation and motor imagery in typically developing children and children with unilateral Cerebral Palsy.

Clin Neurophysiol 2020 12 13;131(12):2829-2840. Epub 2020 Oct 13.

Donders Institute for Brain, Cognition, and Behaviour, Donders Centre for Cognition, Radboud University Nijmegen, the Netherlands.

Objective: During motor execution (ME), mu power is diminished over the contralateral hemisphere and increased over the ipsilateral hemisphere, which has been associated with cortical activation of the contralateral motor areas and inhibition of the ipsilateral motor areas respectively. The influence of action observation (AO) and motor imagery (MI) on mu power is less clear, especially in children, and remains to be studied in children with unilateral cerebral palsy (uCP).

Methods: We determined mu power during ME, AO, and MI of 45 typically developing (TD) children and 15 children with uCP over both hemispheres, for each hand.

Results: In TD children, over the left hemisphere mu power was lowered during ME when the right hand was used. In line, over the right hemisphere mu power was lowered when the left hand was addressed. In addition, during AO and MI increased mu power was observed when the right hand was addressed. In children with uCP, over the spared hemisphere mu power was diminished during ME when the less-affected hand was used. However, over the lesioned hemisphere, no mu changes were observed.

Conclusions: The results of TD children fit the activation/inhibition model of mu power.

Significance: The results of children with uCP suggest that the lesioned hemisphere is unresponsive to the motor tasks.
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http://dx.doi.org/10.1016/j.clinph.2020.08.022DOI Listing
December 2020

Cognitive and motor function in developmental coordination disorder.

Dev Med Child Neurol 2020 11 8;62(11):1317-1323. Epub 2020 Aug 8.

Radboud University, Nijmegen, the Netherlands.

Aim: To analyse the development of motor skill and executive function in school-aged children with and without developmental coordination disorder (DCD).

Method: Using a longitudinal design, 186 children (86 males, 100 females) aged 6 to 11 years at Time 1 were tested over a 2-year period, 52 of whom were diagnosed with DCD at Time 1 (27 males, 25 females; mean age 8y 5mo, SD 1y 6mo) using DSM-5 criteria. The McCarron Assessment of Neuromuscular Development assessed motor status at Time 1 and at 2-year follow-up (Time 2). Executive function was assessed using a well-validated measure, the Groton Maze Learning Test.

Results: The DCD cohort at Time 1 had moderate incidence of executive function deficit (41%). Most importantly, at a group level, children with persisting DCD (across Times 1 and 2) also showed significantly lower levels of executive function than children with typical motor development at both time points. At an individual level, around 26% of children in this group had persisting executive function deficits relative to normal ranges of performance.

Interpretation: Children with persisting DCD are at significant risk of executive function issues. The combination of motor and cognitive issues as a potential risk factor in the longer-term development of children is discussed.

What This Paper Adds: Around half of children initially diagnosed with developmental coordination disorder (DCD) had the same diagnosis at 2-year follow-up. 41% of children with DCD have impaired executive function. Children with persisting DCD show poorer executive function than those with typical motor development or remitting DCD.
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http://dx.doi.org/10.1111/dmcn.14646DOI Listing
November 2020

Development of motor planning in children: Disentangling elements of the planning process.

J Exp Child Psychol 2020 11 1;199:104945. Epub 2020 Aug 1.

Behavioural Science Institute, Radboud University, 6525 HR Nijmegen, the Netherlands; Centre for Disability and Development Research, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC 3065, Australia.

Second-order motor planning of grasping movements is usually measured using tasks that focus on the relative (dis)comfort of end posture of the arm and hand regardless of the objective outcome of performance. This may underestimate the ability for forward planning in young children. In the current study, we aimed to examine the developmental mechanisms of motor planning in children using a task that necessitates second-order motor planning for its successful completion. We tested 311 children (aged 5-12 years) who were instructed to grasp and rotate a hexagonal knob over 60°, 120°, 180°, or 240°. The 180° and 240° rotation conditions necessitated adjustment of the preferred start grip for successful task completion. We examined successful or unsuccessful task completion, reaction time (RT), and movement time (MT) as a function of task demands (i.e., rotation angle) and age. Results showed that most children of all ages were able to successfully complete the task in the 180° rotation condition. In the most demanding 240° rotation condition, many children had difficulty in completing the task, but successful task completion increased with age. Time course analysis showed increased RT and MT with increasing task demands. Furthermore, whereas RT decreased with age for each rotation angle, MT remained stable with the exception of an increase in MT for the most demanding rotation condition. Together, these results exemplify that children aged 5-12 years are indeed able to engage in forward planning. With development, second-order motor planning proficiency increases, especially for more demanding movements, and the process becomes more efficient.
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http://dx.doi.org/10.1016/j.jecp.2020.104945DOI Listing
November 2020

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

Dev Med Child Neurol 2020 12 31;62(12):1352-1355. Epub 2020 Jul 31.

Centre for Disability and Development Research (CeDDR), School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.

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.
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http://dx.doi.org/10.1111/dmcn.14612DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689853PMC
December 2020

Characteristics of peer play in children with visual impairments.

Res Dev Disabil 2020 Oct 2;105:103714. Epub 2020 Jul 2.

Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, the Netherlands. Electronic address:

Background: Although many studies report children with vision impairments (VIs) experience play difficulties compared to sighted peers, large variation is present within the population of children with VIs.

Aims: The present study investigated peer play variation in 70 elementary school-aged children with VIs (M age = 8;11 years, SD = 2.25) and associations with specific child characteristics in sub-groups of participants. Also, it was examined how play materials with supportive auditory cues affected social play in children with varying cooperative play skills.

Methods And Procedures: Play behavior was coded while participants used play materials with and without auditory cues and parents filled in questionnaires about child characteristics. Data were analyzed using binomial logistic regression analyses.

Outcomes And Results: Although the profoundness of the VI was not associated to cooperative or symbolic play, age, language ability and gender did predict the demonstration of these play behaviors. Furthermore, auditory cues were particularly facilitative of social play in children with VIs with low cooperative play capabilities.

Conclusions And Implications: In sum, this emphasizes that child characteristics other than the VI can play a significant role during peer play and interaction, and that individual variation should be considered when providing peer play support.
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http://dx.doi.org/10.1016/j.ridd.2020.103714DOI Listing
October 2020

Wii training versus non-Wii task-specific training on motor learning in children with developmental coordination disorder: A randomized controlled trial.

Ann Phys Rehabil Med 2021 Mar 29;64(2):101390. Epub 2020 May 29.

Department of physical therapy, universidade Federal de São Carlos, São Carlos, São Paulo, Brazil.

Background: Wii-based interventions have shown significant benefits in motor learning for children with developmental coordination disorder (DCD); however, studies comparing the effects of Wii interventions versus matched non-Wii interventions, such as task-specific training (TST), are scarce.

Objective: We compared motor learning in children with DCD who participated in 12 sessions of Wii-based training and those participating in 12 closely matched non-Wii TST sessions as well as when the highest improvements in performance occurred.

Methods: In total, 32 children with DCD (16 per group) were randomly allocated to receive the Wii intervention or TST during 12 sessions. Motor learning was assessed in 3 consecutive phases during the intervention and was determined by the mean of the games scores obtained in the: (1) first 4 sessions, (2) intermediate 4 sessions, and (3) last 4 sessions. Six different tasks (table tennis, frisbee, archery, bowling, tightrope walking/balance beam, and marble balance/balance disc) were performed in every session. Each session lasted 42min (time on task).

Results: Wii training and TST elicited improvements in motor learning, as assessed by increased scores with the frisbee and marble balance/balance disc tasks. However, Wii training elicited better performance in the archery and bowling tasks, whereas only TST elicited improvements in the balance beam and table tennis tasks.

Conclusion: Wii training is not always superior to non-Wii training, and improvements are based on the type of task trained. Thus, each type of intervention benefits a certain skill.
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http://dx.doi.org/10.1016/j.rehab.2020.03.013DOI Listing
March 2021

The role of working memory capacity in implicit and explicit sequence learning of children: Differentiating movement speed and accuracy.

Hum Mov Sci 2020 Feb 12;69:102556. Epub 2019 Dec 12.

Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, PO box 9104, 6500 HE Nijmegen, the Netherlands; School of Psychology, Australian Catholic University, Melbourne, VIC, Australia.

This study investigated the role of working memory capacity on implicit and explicit motor sequence learning in young children. To this end, a task was utilized that required a gross motor response (flexing the elbow) and that could differentiate between movement speed (i.e., reaction time and movement time) and movement accuracy. Children aged 7-9 years practiced a serial reaction time task that involved the production of a fixed sequence of elbow flexions of prescribed magnitude across two consecutive days. Children in the explicit group were informed about the presence of the sequence and were shown this sequence, while children in the implicit group were not made aware of the sequence. Additionally, children's verbal and visuospatial working memory capacity was assessed. Results of day 1 regarding movement speed revealed no evidence of sequence learning for either group, but movement accuracy results suggested that sequence learning occurred for the implicit group. For both groups, only improvements in movement accuracy were consolidated on day 2, indicating both general and sequence specific learning. Working memory capacity did not correlate with learning in either of the groups. Children in the explicit group accumulated more sequence knowledge compared to children in the implicit group, but this knowledge did not translate to more or better sequence learning. The minimal differences found between the implicit and explicit condition and the absence of a role for working memory capacity add to the increasing evidence that the observed differences between implicit and explicit sequence learning in adults may be less distinct in children.
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http://dx.doi.org/10.1016/j.humov.2019.102556DOI Listing
February 2020

Motor intervention with and without Nintendo® Wii for children with developmental coordination disorder: protocol for a randomized clinical trial.

Trials 2019 Dec 30;20(1):794. Epub 2019 Dec 30.

Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, Brazil.

Background: Despite the benefits highlighted by motor interventions based on virtual reality for children with Developmental Coordination Disorder (DCD), there are still doubts as to whether these are greater than those obtained with conventional interventions due to the absence of systematized protocols, and lack of evidence. Here, we present a protocol to systematically compare the effects of two motor-training programs (one Nintendo® Wii-based and the other no-Wii motor activities) on the motor learning in children with DCD.

Methods/design: Two intervention protocols (one based on Nintendo® Wii and the other no-Wii motor activities) will be carried out, with interventions occurring twice a week in 60-min sessions, with a minimum of 12 and a maximum of 16 sessions per child. The protocols were developed based on the domains of the Movement Assessment Battery for Children - Second Edition (MABC-2) (Manual Dexterity, Aiming and Catching, Balance), with two activities for each of the MABC - two domains. The study will include children aged 7 to 10 years with a total MABC-2 score ≤ 16, and a Developmental Coordination Disorder Questionnaire (DCDQ) score < 46 (age of 7 years), score < 55 (age group of 8 to 9 years and 11 months), or score < 57 (age of 10 years) as scored by the parents. Children will be randomly allocated by draw in one of the two intervention protocols. MABC-2 and DCDQ will be applied before and after intervention to evaluate the effects of the interventions on motor performance and parents' perception, respectively. Motor learning will be assessed by means of the scores obtained in the games. Evaluators and therapists will be trained and evaluators will be blind regarding the data of the children in the study.

Discussion: Owing to its motivating aspects, training with Nintendo® Wii may be particularly beneficial for children with DCD. The results of this study protocol should help researchers and therapists to better understand the benefits of Nintendo® Wii-based motor intervention over those obtained with no-Wii interventions in children with DCD. It should also create references about more systematized protocols for replication in clinical practice, seeking the improvement of the motor components of these children.

Trial Registration: RBR-89ydgj.
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http://dx.doi.org/10.1186/s13063-019-3930-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937960PMC
December 2019

The effects of modified constraint-induced movement therapy combined with intensive bimanual training in children with brachial plexus birth injury: a retrospective data base study.

Disabil Rehabil 2021 08 8;43(16):2275-2284. Epub 2019 Dec 8.

Department of Pediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.

Background: In children with Brachial Plexus Birth Injury, a non-use of the affected upper limb despite sufficient capacity, is sometimes observed, called developmental disregard. The combination of modified constraint-induced-movement-therapy with bimanual training is frequently applied to overcome developmental disregard in unilateral Cerebral Palsy. In the current study the effects of the combination of modified constraint-induced-movement-therapy with bimanual training are investigated in children with Brachial Plexus Birth Injury in comparison to children with unilateral Cerebral Palsy. We hypothesize that the combination of modified constraint-induced-movement-therapy with bimanual training is effective in Brachial Plexus Birth Injury.

Methods: Data of 19 children with Brachial Plexus Birth Injury (: 4.1 years) and 18 with unilateral Cerebral Palsy (: 4.5 years) were compared. The effects of modified constraint-induced-movement-therapy with bimanual training (54 h modified constraint-induced-movement-therapy, 18 h bimanual training, 8-10 weeks) was investigated by assessing spontaneous affected-upper-limb-use ("Assisting Hand Assessment"), manual abilities ("ABILHAND-kids") and subjective performance and satisfaction of problematic bimanual activities ("Canadian Occupational Performance Measure") at three time points (pre-treatment, post-treatment, follow-up). This data was analyzed using repeated-measures analysis.

Results: Children with Brachial Plexus Birth Injury showed significant improvements on all outcome measures following modified constraint-induced-movement-therapy with bimanual training. These results were comparable to those observed in the group of children with unilateral Cerebral Palsy.

Discussion: These results suggest that modified constraint-induced-movement-therapy with bimanual training is effective in Brachial Plexus Birth Injury. They indicate a comparable improved bimanual performance in children with Brachial Plexus Birth Injury than in unilateral Cerebral Palsy and suggests that both groups of children have affectively overcome their developmental disregard.IMPLICATIONS FOR REHABILITATIONChildren with Brachial Plexus Birth Injury frequently experience difficulties in activities of daily living.It has recently been suggested that children with Brachial Plexus Birth Injury may also show a non-use of the affected upper limb despite sufficient capacity, called developmental disregard.Children with Brachial Plexus Birth Injury and developmental disregard might therefore benefit from intensive therapies aimed at overcoming developmental disregard, originally developed for children with unilateral Cerebral Palsy.A combination of modified Constrained-Induced Movement Therapy with intensive Bimanual Training has shown to be affective in children with unilateral Cerebral Palsy.In a small sample, this study shows that a combination of modified Constrained-Induced Movement Therapy with intensive bimanual training is effective in children with Brachial Plexus Birth Injury, comparable and even more than in unilateral Cerebral Palsy.
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http://dx.doi.org/10.1080/09638288.2019.1697381DOI Listing
August 2021

Examining complexity in grip selection tasks and consequent effects on planning for end-state-comfort in children with developmental coordination disorder: A systematic review and meta-analysis.

Child Neuropsychol 2020 05 26;26(4):534-559. Epub 2019 Nov 26.

Institute for Health Research, University of Notre Dame, Perth, Australia.

This is the first review to provide both a systematic and meta-analytic approach to characterizing motor planning deficits in children with Developmental Coordination Disorder (DCD). Task complexity appears to be a key factor affecting motor planning in children with DCD. However, the different task-related factors and how they affect motor planning ability has not been examined. By systematically reviewing ten studies examining motor planning in children aged 4- to 14 years with and without DCD using grip selection tasks, task complexity was determined according to grip choices, level of precision, number of action steps and degree of rotation. A meta-analysis (N = 607; DCD = 255) revealed that, overall, those with DCD were 6.8% less likely to plan motor actions comfortably than typically developing children. This ability was moderated by task complexity ( = 66.7%), with performance differences ranging from 2.33% for low ( = 0.21) to 13.77% ( = 0.79) for high complexity. The results confirmed that children with DCD are able to plan for comfortable end states for tasks with simple and medium complexity level. When task complexity increased, compared to typically developing children, the motor planning ability of those with DCD was affected to a significantly greater extent. These findings provide important implications for both behavioral and neurological interventions.
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http://dx.doi.org/10.1080/09297049.2019.1695768DOI Listing
May 2020

Activation of Mirror Neuron Regions Is Altered in Developmental Coordination Disorder (DCD)-Neurophysiological Evidence Using an Action Observation Paradigm.

Front Hum Neurosci 2019 11;13:232. Epub 2019 Jul 11.

Behavioural Science Institute (BSI), Radboud University, Nijmegen, Netherlands.

Children with Developmental Coordination Disorder (DCD) have difficulty performing and learning motor skills. Automatic activation of the mirror neuron system (MNS) during action observation and its coupling to the motor output system are important neurophysiological processes that underpin observational motor learning. In the present study, we tested the hypothesis that MNS function is disrupted in children with DCD by using sensitive electroencephalography (EEG)-based measures of MNS activation during action observation. Specifically, we predicted reduced mu-suppression and coherence in DCD compared with typically developing children. Neural activation of the motor network was measured by EEG, specifically event-related desynchronization (ERD) of mu rhythms and fronto-parietal coherence. Children (15 DCD/15 controls) were tested under two task conditions: observational learning (imitation of an observed action) and detection (report a deviant movement after observation). EEG-metrics were compared between groups using linear mixed-effects models. As predicted, children with DCD showed lower levels of mu suppression and reduced modulation of coherence during the observational learning task compared with their non-DCD peers. Notably, mu suppression was reduced in DCD over the entire imitation task (repetitions, and both observation and pause intervals). Action observation can be used for the acquisition of new motor skills. This form of learning entails the transposition of the observed action to the existing internal representations of the observer's own motor system. The present neurophysiological results suggest that this process of learning is impaired in children with DCD. The results are discussed in relation to current hypotheses on mechanisms of DCD.
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http://dx.doi.org/10.3389/fnhum.2019.00232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637752PMC
July 2019

Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study.

J Neuroeng Rehabil 2019 05 15;16(1):56. Epub 2019 May 15.

Centre for Disability and Development Research (CeDDR) and School of Behavioural and Health Science, Australian Catholic University, Melbourne, VIC, Australia.

Background: Virtual reality technologies show potential as effective rehabilitation tools following neuro-trauma. In particular, the Elements system, involving customized surface computing and tangible interfaces, produces strong treatment effects for upper-limb and cognitive function following traumatic brain injury. The present study evaluated the efficacy of Elements as a virtual rehabilitation approach for stroke survivors.

Methods: Twenty-one adults (42-94 years old) with sub-acute stroke were randomized to four weeks of Elements virtual rehabilitation (three weekly 30-40 min sessions) combined with treatment as usual (conventional occupational and physiotherapy) or to treatment as usual alone. Upper-limb skill (Box and Blocks Test), cognition (Montreal Cognitive Assessment and selected CogState subtests), and everyday participation (Neurobehavioral Functioning Inventory) were examined before and after inpatient training, and one-month later.

Results: Effect sizes for the experimental group (d = 1.05-2.51) were larger compared with controls (d = 0.11-0.86), with Elements training showing statistically greater improvements in motor function of the most affected hand (p = 0.008), and general intellectual status and executive function (p ≤ 0.001). Proportional recovery was two- to three-fold greater than control participants, with superior transfer to everyday motor, cognitive, and communication behaviors. All gains were maintained at follow-up.

Conclusion: A course of Elements virtual rehabilitation using goal-directed and exploratory upper-limb movement tasks facilitates both motor and cognitive recovery after stroke. The magnitude of training effects, maintenance of gains at follow-up, and generalization to daily activities provide compelling preliminary evidence of the power of virtual rehabilitation when applied in a targeted and principled manner.

Trial Registration: this pilot study was not registered.
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http://dx.doi.org/10.1186/s12984-019-0531-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518680PMC
May 2019

Is Wii-based motor training better than task-specific matched training for children with developmental coordination disorder? A randomized controlled trial.

Disabil Rehabil 2020 09 22;42(18):2611-2620. Epub 2019 Feb 22.

Department of Physical Therapy, Universidade Federal de São Carlos, São São Paulo, Brazil.

To evaluate in children with developmental coordination disorder (DCD) the effects of Wii-training compared with task-specific matched training (TST). A randomized controlled trial (RCT) was conducted with 32 children having DCD, aged 7-10 years. Children were randomly assigned to the Wii or task-specific training. Both interventions consisted of 16, 60-min sessions over an 8-week period. The primary outcome measure of movement skill was the Movement Assessment Battery for Children-2 (MABC-2), administered by blinded assessors. Measures included total standard scores (TSS), manual dexterity, aiming/catching, and balance component scores. From pre- to post-test, both groups improved significantly on TSS and balance after intervention. The Wii intervention group also improved on manual dexterity. Neither group improved significantly on aiming/catching. Both the Wii and task-specific training improved overall motor performance and balance. On other MABC-2 component scores, treatment effects differed between groups: Task-specific training had more pronounced effects on balance skills, while Wii training had slightly stronger treatment effects than task-specific training on manual dexterity. It was concluded that task-specific training affords stronger benefits for general motor skill than Wii-based training. Whether Wii training can promote clinically significant benefits for upper-limb function remains to be seen. This study is registered in a clinical trials registry platform (Protocol: RBR-89YDGJ). Available on the Brazilian Clinical Trials Registry Implications for rehabilitationWii-training and task-specific matched training programs afforded gains in motor performance in children with developmental coordination disorder, similarly;The selected Wii tasks were able to improve the motor performance in children with developmental coordination disorder, but should not be used as an exclusive strategy for these children;Our findings suggest caution in recommending Wii-based training as a viable alternative to more task-specific matched training for children with developmental coordination disorder.
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http://dx.doi.org/10.1080/09638288.2019.1572794DOI Listing
September 2020

Interventions to improve functioning, participation, and quality of life in children with visual impairment: a systematic review.

Surv Ophthalmol 2019 Jul - Aug;64(4):512-557. Epub 2019 Jan 28.

Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.

Visual impairment in childhood often has life-long implications. To aim for the highest levels of functioning, participation, and quality of life and to ensure children's well-being, children should be entitled to the most effective rehabilitation programs. We review evidence for the effectiveness of rehabilitation interventions for children with visual impairment to improve skills and behavior, thereby improving participation and quality of life as an ultimate goal. Of the 441 potentially relevant articles identified, 66 studies met our inclusion criteria (i.e., 28 randomized controlled trials, 18 nonrandomized controlled trials, and 20 before-after comparisons). The results suggest that sports camps, prescription and training in the use of low vision devices, and oral hygiene programs might be effective in improving functioning and elements of participation and quality of life in children with visual impairment. Other interventions showed mixed or negative results. The results should be interpreted with caution because of moderate to high risk of bias and suboptimal reporting. Heterogeneity of results and the use of over 50 different outcome measures prevented a meta-analysis. Future studies should focus on promising interventions for which effectiveness is still unclear (e.g., mobility, social skills), with adequately designed methodology.
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http://dx.doi.org/10.1016/j.survophthal.2019.01.010DOI Listing
December 2019

The development of anticipatory action planning in children with unilateral cerebral palsy.

Res Dev Disabil 2019 Feb 14;85:163-171. Epub 2018 Dec 14.

Department of Paediatrics, Monash University, Clayton, Victoria, 3168, Australia; School of Occupational Therapy, La Trobe University, Bundoora, Victoria, 3168, Australia; Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, 246 Clayton Rd, Clayton, Victoria, 3168, Australia. Electronic address:

Background Previous studies suggest that compromised bimanual performance experienced by children with unilateral cerebral palsy (CP) is not only due to difficulties in action execution but may also be a result of impaired anticipatory action planning. Aims The effect of age and side of hemiplegia were examined and the relationship between anticipatory action planning, unimanual capacity and bimanual performance was explored. Methods and procedures Using a multi-centre, prospective, cross-sectional observational design, anticipatory action planning was analyzed in 104 children with unilateral cerebral palsy, aged 6-12 years, using the sword task. Outcomes and results Anticipatory action planning did not improve with age in children with unilateral CP, aged between 6-12 years. No differences were found between children with left or right hemiplegia. Finally, anticipatory action planning was not related to unimanual capacity or bimanual performance. Conclusion and implications This study demonstrates anticipatory action planning, measured using the sword task, does not improve with age in children with unilateral CP and is not related to bimanual performance or laterality. Future studies of anticipatory action planning in children with unilateral CP should consider using measures that require effective anticipatory action planning for successful task completion rather than end state comfort.
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http://dx.doi.org/10.1016/j.ridd.2018.12.002DOI Listing
February 2019

The use of augmented toys to facilitate play in school-aged children with visual impairments.

Res Dev Disabil 2019 Feb 24;85:70-81. Epub 2018 Nov 24.

Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, the Netherlands. Electronic address:

Background: Children with visual impairments (VIs) face challenges in social play activities, which limits their opportunities to practice social skills.

Aims: We investigated whether augmented toys were effective to facilitate play in 52 children with VIs who attended special schools for students with visual impairments and blindness.

Methods And Procedures: 52 children with VIs (mean age: 9.22 years, SD = 2.07) played three times with both an augmented and a non-augmented toy. A Playmobil® knight's castle was augmented with Radio Frequency Identification (RFID) technology, such that each play figure produced audio feedback during play. The RFID-technology could be activated and deactivated. Social and cognitive aspects of play were coded from video and data were analyzed using multilevel logistics.

Outcomes And Results: Children showed less disengagement and more parallel play, but less cooperative play when they used the augmented versus the non-augmented castle. This pattern persisted after repeated play sessions with both toys.

Conclusions: The addition of sounds to physical toys increased shared attention between children with VIs during the exploration of play materials, yet it interfered with social interaction during peer play.
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http://dx.doi.org/10.1016/j.ridd.2018.11.006DOI Listing
February 2019

Motor learning in children with developmental coordination disorder: The role of focus of attention and working memory.

Hum Mov Sci 2018 Dec 9;62:211-220. Epub 2018 Nov 9.

Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, PO Box 9104, 6500 HE Nijmegen, The Netherlands; Centre for Disability and Development Research, Australian Catholic University, Melbourne, Australia.

Effective motor learning paradigms are essential for children with motor difficulties to enhance their motor skills and facilitate performance in physical activities and in daily life. This study aimed to examine the effect of feedback with an internal or external focus of attention on motor learning of children with probable Developmental Coordination Disorder (pDCD). In addition, the role of working memory capacity was examined. Children were recruited via physical therapists, who integrated the experimental procedures within therapy sessions. We analyzed data of 25 children between 5 and 11 years old. They practiced a novel motor task of throwing a 'slingerball' over three weeks, while receiving feedback with an internal or external focus of attention. Results showed that children improved throwing accuracy regardless of the type of feedback they received. Visuospatial working memory capacity enhanced learning, especially for children receiving feedback with an external focus of attention. These findings corroborate clinical recommendations stating that children with DCD benefit from task specific training and feedback, which is promoted with both foci of attention. However, the findings contrast the expected benefits of practice with an external focus of attention. It highlights that the exact mechanisms and task constraints that influence the learning processes with an internal and external focus among children are not yet understood and warrant further study.
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http://dx.doi.org/10.1016/j.humov.2018.11.001DOI Listing
December 2018

The Roles of Declarative Knowledge and Working Memory in Explicit Motor Learning and Practice Among Children With Low Motor Abilities.

Motor Control 2019 Jan;23(1):34-51

Radboud University and Australian Catholic University.

Effective learning methods are essential for motor skill development and participation in children with low motor abilities. Current learning methods predominantly aim to increase declarative knowledge through explicit instructions that necessitate sufficient working memory capacity. This study investigated the roles of declarative knowledge and working memory capacity in explicit motor learning of children with low motor abilities. We studied both acquisition performance (i.e., performance during practice) and learning (i.e., the improvement in performance from pretest to posttest). After practice with explicit instructions, children with low motor abilities showed significant learning, albeit that improvement was relatively small. However, working memory capacity and declarative knowledge did not predict learning. By contrast, working memory capacity and declarative knowledge did predict performance during practice. These findings suggest that explicit instructions enhance motor performance during practice, but that motor learning per se is largely implicit in children with low motor abilities.
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http://dx.doi.org/10.1123/mc.2017-0060DOI Listing
January 2019

Motor learning and movement automatization in typically developing children: The role of instructions with an external or internal focus of attention.

Hum Mov Sci 2018 Aug 23;60:183-190. Epub 2018 Jun 23.

Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, PO Box 9104, 6500 HE Nijmegen, The Netherlands; Centre for Disability and Development Research, Australian Catholic University, Melbourne, Australia.

The aim of the current study was to examine the effects of an external focus of attention (i.e., on the movement outcome) versus an internal focus of attention (i.e., on the movement itself) on motor learning in typically developing children. We examined both immediate motor performance (i.e., practice effect, when focus instructions are given) as well as motor performance after one week (i.e., learning effect). In addition, we examined if an external and an internal focus of attention differently affected movement automatization, as measured using a dual-task paradigm. Finally, we explored whether the effect of attentional focus instructions on motor learning was influenced by children's working memory capacity. Participants were 8-12 year old (N = 162) typically developing children. Participants practiced a new motor task (i.e., 'Slingerball throwing task'). Results showed that an external focus of attention led to higher throwing accuracy during practice, but this beneficial effect did not extent to the retention test one week later. Furthermore, movement automatization did not differ after external or internal focus of attention instructions, and working memory capacity did not predict motor learning in children in either of the instruction conditions. This is the first study to show that the beneficial effects of an external focus of attention on discrete motor tasks found in previous studies with a child population seem to be short lived and decline after a one-week interval.
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http://dx.doi.org/10.1016/j.humov.2018.06.010DOI Listing
August 2018

Response to the Letter to the Editor From Moncrieff (2017) Regarding de Wit et al. (2016), "Characteristics of Auditory Processing Disorders: A Systematic Review".

J Speech Lang Hear Res 2018 06;61(6):1517-1519

Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands.

Purpose: The purpose of this letter is to respond to Moncrieff's (2017) letter to the editor, "Response to de Wit et al., 2016, 'Characteristics of Auditory Processing Disorders: A Systematic Review,'" published in May 2017 by the Journal of Speech, Language, and Hearing Research.

Conclusion: We believe that our original conclusions are valid given the limited evidence that is currently available about the etiology of auditory processing disorders (APD). The focus of our systematic review was to identify the characteristics of children with a diagnosis of APD or a suspicion of APD. The results of our study showed that the characteristics of these children are not specific or limited to the auditory modality but are multimodal instead. In our view, it is incorrect to use the diagnosis APD, because there is not necessarily a specific auditory deficit in a large group of children suffering from listening difficulties. Before we start using any new diagnoses, a better insight into how bottom-up and top-down processes are precisely involved in listening needs to be developed. In addition, more insight is needed with respect to the similarities and differences between the different developmental disorders of children.
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http://dx.doi.org/10.1044/2018_JSLHR-H-17-0412DOI Listing
June 2018

Home-based bimanual training based on motor learning principles in children with unilateral cerebral palsy and their parents (the COAD-study): rationale and protocols.

BMC Pediatr 2018 04 18;18(1):139. Epub 2018 Apr 18.

Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.

Background: Home-based training is considered an important intervention in rehabilitation of children with unilateral cerebral palsy. Despite consensus on the value of home-based upper limb training, no evidence-based best practice exists. Promoting compliance of children to adhere to an intensive program while keeping parental stress levels low is an important challenge when designing home-based training programs. Incorporating implicit motor learning principles emerges to be a promising method to resolve this challenge.

Methods: Here we describe two protocols for home-based bimanual training programs, one based on implicit motor learning principles and one based on explicit motor learning principles, for children with unilateral spastic cerebral palsy aged 2 through 7 years. Children receive goal-oriented, task-specific bimanual training in their home environment from their parents for 3.5 h/week for 12 weeks according to an individualized program. Parents will be intensively coached by a multidisciplinary team, consisting of a pediatric therapist and remedial educationalist. Both programs consist of a preparation phase (goal setting, introductory meetings with coaching professionals, design of individualized program, instruction of parents, home visit) and home-based training phase (training, video-recordings, registrations, and telecoaching and home visits by the coaching team). The programs contrast with respect to the teaching strategy, i.e. how the parents support their child during training. In both programs parents provide their child with instructions and feedback that focus on the activity (i.e. task-oriented) or the result of the activity (i.e. result-oriented). However, in the explicit program parents are in addition instructed to give exact instructions and feedback on the motor performance of the bimanual activities, whereas in the implicit program the use of both hands and the appropriate motor performance of the activity are elicited via manipulation of the organization of the activities.

Discussion: With the protocols described here, we aim to take a next step in the development of much needed evidence-based home-based training programs for children with unilateral cerebral palsy.
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http://dx.doi.org/10.1186/s12887-018-1110-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5907414PMC
April 2018

Individual Differences Influencing Immediate Effects of Internal and External Focus Instructions on Children's Motor Performance.

Res Q Exerc Sport 2018 Jun 4;89(2):190-199. Epub 2018 Apr 4.

a Radboud University Nijmegen.

Purpose: A large pool of evidence supports the beneficial effect of an external focus of attention on motor skill performance in adults. In children, this effect has been studied less and results are inconclusive. Importantly, individual differences are often not taken into account. We investigated the role of working memory, conscious motor control, and task-specific focus preferences on performance with an internal and external focus of attention in children.

Methods: Twenty-five children practiced a golf putting task in both an internal focus condition and external focus condition. Performance was defined as the average distance toward the hole in 3 blocks of 10 trials. Task-specific focus preference was determined by asking how much effort it took to apply the instruction in each condition. In addition, working memory capacity and conscious motor control were assessed.

Results: Children improved performance in both the internal focus condition and external focus condition (ŋ = .47), with no difference between conditions (ŋ = .01). Task-specific focus preference was the only factor moderately related to the difference between performance with an internal focus and performance with an external focus (r = .56), indicating better performance for the preferred instruction in Block 3.

Conclusion: Children can benefit from instruction with both an internal and external focus of attention to improve short-term motor performance. Individual, task-specific focus preference influenced the effect of the instructions, with children performing better with their preferred focus. The results highlight that individual differences are a key factor in the effectiveness in children's motor performance. The precise mechanisms underpinning this effect warrant further research.
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http://dx.doi.org/10.1080/02701367.2018.1442915DOI Listing
June 2018

Windmill-task as a New Quantitative and Objective Assessment for Mirror Movements in Unilateral Cerebral Palsy: A Pilot Study.

Arch Phys Med Rehabil 2018 08 23;99(8):1547-1552. Epub 2018 Mar 23.

Department of Pediatrics, Monash University, Clayton, Victoria, Australia.

Objective: To introduce the Windmill-task, a new objective assessment tool to quantify the presence of mirror movements (MMs) in children with unilateral cerebral palsy (UCP), which are typically assessed with the observation-based Woods and Teuber scale (W&T).

Design: Prospective, observational, cohort pilot study.

Setting: Children's hospital.

Participants: Prospective cohort of children (N=23) with UCP (age range, 6-15y, mean age, 10.5±2.7y).

Interventions: Not applicable.

Main Outcome Measures: The concurrent validity of the Windmill-task is assessed, and the sensitivity and specificity for MM detection are compared between both assessments. To assess the concurrent validity, Windmill-task data are compared with W&T data using Spearman rank correlations (ρ) for 2 conditions: affected hand moving vs less affected hand moving. Sensitivity and specificity are compared by measuring the mean percentage of children being assessed inconsistently across both assessments.

Results: Outcomes of both assessments correlated significantly (affected hand moving: ρ=.520; P=.005; less affected hand moving: ρ=.488; P=.009). However, many children displayed MMs on the Windmill-task, but not on the W&T (sensitivity: affected hand moving: 27.5%; less affected hand moving: 40.6%). Only 2 children displayed MMs on the W&T, but not on the Windmill-task (specificity: affected hand moving: 2.9%; less affected hand moving: 1.4%).

Conclusions: The Windmill-task seems to be a valid tool to assess MMs in children with UCP and has an additional advantage of sensitivity to detect MMs.
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http://dx.doi.org/10.1016/j.apmr.2018.01.035DOI Listing
August 2018

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

Pediatr Phys Ther 2018 04;30(2):106-111

Behavioural Science Institute (Dr Adams and Steenbergen), Radboud University Nijmegen, Nijmegen, the Netherlands; Fysiotherapie Kompas (Ms Broekkamp), Hengelo, the Netherlands; School of Psychology (Drs Wilson and Steenbergen) and Centre for Disability and Development Research (Drs Wilson, Imms, and Steenbergen), Australian Catholic University, Melbourne, Australia; Radboud University Medical Center (Dr Overvelde), Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands.

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.
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http://dx.doi.org/10.1097/PEP.0000000000000485DOI Listing
April 2018

Understanding the relationship between brain and upper limb function in children with unilateral motor impairments: A multimodal approach.

Eur J Paediatr Neurol 2018 Jan 12;22(1):143-154. Epub 2017 Oct 12.

Department of Neuroimaging, King's College London, London, UK.

Atypical brain development and early brain injury have profound and long lasting impact on the development, skill acquisition, and subsequent independence of a child. Heterogeneity is present at the brain level and at the motor level; particularly with respect to phenomena of bilateral activation and mirrored movements (MMs). In this multiple case study we consider the feasibility of using several modalities to explore the relationship between brain structure and/or activity and hand function: Electroencephalography (EEG), both structural and functional Magnetic Resonance Imaging (sMRI, fMRI), diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), Electromyography (EMG) and hand function assessments.

Methods: 15 children with unilateral CP (ages: 9.4 ± 2.5 years) undertook hand function assessments and at least two additional neuroimaging and/or neurophysiological procedures: MRI/DTI/fMRI (n = 13), TMS (n = 11), and/or EEG/EMG (n = 8). During the fMRI scans and EEG measurements, a motor task was performed to study cortical motor control activity during simple hand movements. DTI tractography analysis was used to study the corpus-callosum (CC) and cortico-spinal tracts (CST). TMS was used to study cortico-spinal connectivity pattern.

Results: Type and range of severity of brain injury was evident across all levels of manual ability with the highest radiological scores corresponded to children poorer manual ability. Evidence of MMs was found in 7 children, mostly detected when moving the affected hand, and not necessarily corresponding to bilateral brain activation. When moving the affected hand, bilateral brain activation was seen in 6/11 children while 3/11 demonstrated unilateral activation in the contralateral hemisphere, and one child demonstrated motor activation predominantly in the supplementary motor area (SMA). TMS revealed three types of connectivity patterns from the cortex to the affected hand: a contralateral (n = 3), an ipsilateral (n = 4) and a mixed (n = 1) connectivity pattern; again without clear association with MMs. No differences were found between children with and without MMs in lesion scores, motor fMRI laterality indices, CST diffusivity values, and upper limb function. In the genu, midbody, and splenium of the CC, higher fractional anisotropy values were found in children with MMs compared to children without MMs. The EEG data indicated a stronger mu-restoration above the contralateral hemisphere in 6/8 children and above the ipsilateral hemisphere in 2/8 children.

Conclusion: The current results demonstrate benefits from the use of different modalities when studying upper-limb function in children with CP; not least to accommodate to the variations in tolerance and feasibility of implementation of the differing methods. These exposed multiple individual brain-reorganization patterns corresponding to different functional motor abilities. Additional research is warranted to understand the transactional influences of early brain injury, neuroplasticity and developmental and environmental factors on hand function in order to develop targeted interventions.
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http://dx.doi.org/10.1016/j.ejpn.2017.09.012DOI Listing
January 2018
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