Standardized motor assessments before the age of five predicting school-aged motor outcome including DCD: A systematic review

An Explorative Retrospective Video Analysis of Movement Quality in Infants Later Diagnosed with Developmental Coordination Disorder

Developmental Coordination Disorder (DCD) is a neurodevelopmental condition affecting coordinated motor skill acquisition usually diagnosed after 5y. However, parents and clinicians report poorer movement quality at earlier ages. Using the 'Observable Movement Quality' scale (OMQ), we compared movement quality between children with typical development (TD), with DCD, and with DCD and Autism Spectrum Disorder (ASD). Using blinded retrospective video analysis, a trained physical therapist observed 5-min compilations of home videos at 6-12 m (n = 53), 12-18 m (n = 54), and 18-24 m (n = 47) followed by OMQ-scoring and a three-point scale for clinical judgement (will/might/will not develop DCD). A 15% sample was re-evaluated to assess intra-rater reliability using Spearman coefficients. OMQ group performance was assessed using Kruskal-Wallis tests, while dichotomized (good/poor quality) data were examined with Fisher exact tests. OMQ scores' association with later motor performance (MABC-2 and DCDQ) was analysed via Spearman coefficients. Cramer's V determined the strength of association between clinical judgment and diagnostic outcome. Intra-rater reliability for total OMQ score was strong (rs = 0.79, p ≤ 0.001). Reduced movement quality was found at 18-24 m in children with DCD (median 69, interquartile range [IQR] 10) and DCD+ASD (median 69, IQR 14) compared to TD children (median 74, IQR 2) (p ≤ 0.001). Five times more compilations in the DCD groups demonstrated poor overall movement quality at 18-24 m. At 18-24 m, movement quality correlated strongly with MABC-2 (rs = 0.66) and DCDQ (rs = 0.67). The therapist correctly identified 63-67% of DCD and DCD+ASD children respectively (Cramer's V = 0.62, p ≤ 0.001). These findings underscore the importance of investigating movement quality as a potential early feature of DCD.

Systematic Review to Inform the Developmental Coordination Disorder Clinical Practice Guideline Update: Physical Therapy Examination/Evaluation

PURPOSE/HYPOTHESIS

Systematically review current evidence on the content of physical therapy (PT) examination and evaluation to inform the update to the 2020 Developmental Coordination Disorder (DCD) Clinical Practice Guideline (CPG).

METHODS

Eight databases were searched for studies that informed the content of PT examination and evaluation, including psychometric properties of tests and measures used in the PT management of DCD. Methodological quality and certainty of evidence were assessed.

RESULTS

Three systematic reviews and 30 cohort studies were included. Two findings impacting the 2020 DCD CPG are: (1) very low- to high-quality evidence supports cultural adaptations and cutoff scores for DCD-specific questionnaires, and (2) very low-quality evidence supports 4 outcome measures that are responsive to change with intervention.

CONCLUSION

Newer evidence reaffirms 4 of 5 recommendations on examination of the 2020 DCD CPG and adds evidence that could increase the recommendation strength of 2 action statements from best practice to moderate.

Clinical utility and psychometric properties of tools for early detection of developmental concerns and disability in young children: A scoping review

AIM

To explore the clinical utility and psychometric properties of standardized tools for the early detection of developmental concerns or disability in young children.

METHOD

Systematic reviews and clinical practice guidelines containing psychometric data on tools appropriate for use with children from birth to 5 years 11 months were searched for in MEDLINE, CINAHL, Embase, and PsycINFO for the years 2000 to 2023, with no language restrictions.

RESULTS

Eighty-six systematic reviews and six clinical practice guidelines guided identification of tools. A total of 246 tools were identified across domains of neurological, motor, cognition, communication/language, social-emotional, sensory processing, and/or specific diagnostic conditions of attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, developmental coordination disorder, and fetal alcohol spectrum disorder. After critical evaluation, 67 tools were included in the recommendations. Recommendations for screening and diagnostic assessment tools were based on best available evidence for predictive and discriminative validity, diagnostic accuracy, together with consideration of resource use and accessibility.

INTERPRETATION

This comprehensive scoping review provides recommendations on the best tools for primary care, medical, allied health professionals, nursing, and other health workers to detect and identify developmental concerns or disability in young children using evidence-based tools.

Relationship between early infant motor repertoire and neurodevelopment on the hammersmith infant neurological examination in a developmentally vulnerable First Nations cohort

AIM

To implement a culturally-adapted screening program aimed to determine the ability of infant motor repertoire to predict early neurodevelopment on the Hammersmith Infant Neurological Examination (HINE) and improve Australian First Nations families' engagement with neonatal screening.

METHODS

A prospective cohort of 156 infants (55 % male, mean (standard deviation [SD]) gestational age 33.8 (4.6) weeks) with early life risk factors for adverse neurodevelopmental outcomes (ad-NDO) participated in a culturally-adapted screening program. Infant motor repertoire was assessed using Motor Optimality Score-revised (MOS-R), captured over two videos, 11-13+6 weeks (V1; <14 weeks) and 14-18 weeks (V2; ≥14 weeks) corrected age (CA). At 4-9 months CA neurodevelopment was assessed on the HINE and classified according to age-specific cut-off and optimality scores as; developmentally 'on track' or high chance of either adverse neurodevelopmental outcome (ad-NDO) or cerebral palsy (CP).

RESULTS

Families were highly engaged, 139/148 (94 %) eligible infants completing MOS-R, 136/150 (91 %), HINE and 123 (83 %) both. Lower MOS-R at V2 was associated with reduced HINE scores (β = 1.73, 95 % confidence interval [CI] = 1.03-2.42) and high chance of CP (OR = 2.63, 95%CI = 1.21-5.69) or ad-NDO (OR = 1.38, 95%CI = 1.10-1.74). The MOS-R sub-category 'observed movement patterns' best predicted HINE, infants who score '4' had mean HINE 19.4 points higher than score '1' (95%CI = 12.0-26.9). Receiver-operator curve analyses determined a MOS-R cut-off of <23 was best for identifying mild to severely reduced HINE scores, with diagnostic accuracy 0.69 (sensitivity 0.86, 95%CI 0.76-0.94 and specificity 0.40, 95 % CI 0.25-0.57). A trajectory of improvement on MOS-R (≥2 point increase in MOS-R from 1st to 2nd video) significantly increased odds of scoring optimally on HINE (OR = 5.91, 95%CI 1.16-29.89) and may be a key biomarker of 'on track' development.

INTERPRETATION

Implementation of a culturally-adapted program using evidence-based assessments demonstrates high retention. Infant motor repertoire is associated with HINE scores and the early neurodevelopmental status of developmentally vulnerable First Nations infants.

Neonatal hyperbilirubinemia and repercussions on neurodevelopment: A systematic review

BACKGROUND

Accumulation of bilirubin above normal levels is considered a neurological risk factor for both premature and full-term newborns. This systematic review aimed to determine the effect of neonatal hyperbilirubinemia on neurodevelopment in preterm and full-term newborns.

METHODS

PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, Scopus and Lilacs databases were searched for articles published until 1 June 2022. The quality of cohort and case-control studies was assessed with the Newcastle-Ottawa Scale, and the MINCir scale was used to evaluate the methodological quality of therapy studies or the therapeutic procedures. Premature neonates without neurological conditions and those born at term with hyperbilirubinemia as the sole risk factor were included. Studies reporting one or more neurodevelopmental outcomes were included with an inter-group comparison of a hyperbilirubinemia group versus a non-hyperbilirubinemia or non-pathological hyperbilirubinemia group. The main outcomes were auditory function, visual function, cognitive function, motor function, behavior, global development and neurological risk.

RESULTS

The search identified 951 studies, 19 of which (n = 2210 newborns) were finally included. Fifteen of the cohort and case-control studies presented low risk of bias, and six studies showed high methodological quality. Within the preterm population, hyperbilirubinemia as the sole risk factor was not shown to affect neurodevelopment. Auditory, neurological and motor development alterations were found in the population of full-term newborns with hyperbilirubinemia, which were more evident during the first year of life.

CONCLUSIONS

Elevated bilirubin levels may be a trigger for the onset of neurodevelopmental disorders in full-term infants during the first year of life. More studies are warranted in the preterm population with hyperbilirubinemia to draw conclusions about its impact on their neurodevelopment.

Fine motor skill automatization and working memory in children with and without potential fine motor impairments: An explorative study

AIMS

The present study explored fine motor skill automatization and working memory in kindergarten children with and without potential fine motor impairments. For both groups, lower performance was expected in a cognitive-motor dual-task compared to single-tasks. Children with potential fine motor impairments were expected to show higher dual-task costs (indicating lower automatization) and lower working memory performance compared to children without potential fine motor impairments.

METHODS

The sample included 18 kindergarten children (mean age M = 67.17 months, SD = 4.34 months) with potential fine motor impairments (scoring at or below the 9th percentile of the manual dexterity scale of the Movement ABC-2; Petermann, 2011) and 36 children scoring above the 9th percentile of the manual dexterity scale of the Movement ABC-2 (mean age M = 67.56 months; SD = 3.74). All children completed a fine motor task (trail drawing) and a working memory task (digit span backwards) in single- and dual-task conditions.

RESULTS

Results showed an overall lower cognitive but not fine motor performance in the dual-task condition compared to the single-task condition. Overall, the group scoring above the 9th percentile showed a lower error-to-length ratio and higher working memory performance than the group with potential fine motor impairments. The dual-task costs did not differ between the groups.

CONCLUSIONS

Although the potential fine motor impaired children did not show an automatization deficit, they might be at risk of academic problems due to their lower fine motor and working memory performance. Implications for school and interventions are discussed.

Neurocognitive outcomes of children with non-syndromic single-suture craniosynostosis

While the focus of craniosynostosis surgery is to improve head shape, neurocognitive sequelae are common and are incompletely understood. Neurodevelopmental problems that children with craniosynostosis face include cognitive and language impairments, motor delays or deficits, learning disabilities, executive dysfunction, and behavioral problems. Studies have shown that children with multiple suture craniosynostosis have more impairment than children with single-suture craniosynostosis. Children with isolated single-suture subtypes of craniosynostosis such as sagittal, metopic, and unicoronal craniosynostosis can have distinct neurocognitive profiles. In this review, we discuss the unique neurodevelopmental profiles of children with single-suture subtypes of craniosynostosis.

Developmental Coordination Disorder before the Age of Three: A Longitudinal Retrospective Study in a Belgian Center for Developmental Disabilities

This study aimed to explore the association between developmental coordination disorder (DCD) diagnosed after the age of three and both a standardized motor test—the Alberta Infant Motor Scale (AIMS)—and non-standardized observation of movement quality carried out before the age of three. Children at risk or with developmental concerns were studied retrospectively. Children were excluded in case of a diagnosis, excluding DCD, e.g., cerebral palsy, or IQ < 70. Of the 503 included children, 246 were diagnosed with (at-risk) DCD. Multivariate binary logistic regression revealed a significant association between DCD diagnosis after the age of three and male gender and with different aspects of poor movement quality in different age groups before the age three. Univariate analyses revealed an association between DCD diagnosis and the number of poor movement-quality descriptions at 0−6 months, 6−12 months, and 18 months−3 years but not with the AIMS scores. The MABC-2 scores after the age of three were significantly correlated with the number of poor movement-quality descriptions in age groups 0−6 months and 18 months−3 years and with the AIMS scores in age groups 6−12 months and 12−18 months. The results suggest that DCD can be associated with poor movement quality before the age of three.