The efficacy of two task-orientated interventions for children with Developmental Coordination Disorder: Neuromotor Task Training and Nintendo Wii Fit Training

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

OBJECTIVE

This scoping review aims to explore published literature testing Virtual Reality (VR) interventions for improving upper limb motor performance in children and adolescents with Developmental Coordination Disorder (DCD). Our primary focus was on the types of VR systems used and the measurement tools employed within the International Classification of Functioning, Disability and Health Children and Youth Version (ICF-CY) domains in these studies.

METHODS

A comprehensive search of six electronic databases up to 11th January 2024 was conducted using predefined terms. Inclusion and exclusion criteria were applied to determine study eligibility, with two authors independently assessing titles, abstracts, and full-text articles.

RESULTS

Out of 788 potential studies, 14 met the eligibility criteria. Studies predominantly utilized non-immersive VR (nVR) systems, for example, commercial platforms such as Nintendo Wii. Most interventions targeted general motor coordination or balance, with only four studies specifically focusing on upper limb motor performance. The Movement Assessment Battery for Children-2 was the predominant assessment tool. However, the use of game scores and trial durations raised concerns about the accuracy of assessments. The majority of studies reported no significant improvement in upper limb motor performance following VR interventions, though some noted improvements in specific tasks or overall outcomes.

CONCLUSION

The findings suggest that, while nVR interventions are being explored for paediatric motor rehabilitation, their impact on enhancing upper limb motor performance in children with DCD is unclear. The variability in intervention designs, outcome measures, and the predominant focus on general motor skills rather than specific upper limb improvements highlight the need for more targeted research in this area.

IMPACT

This review underscores the importance of developing precise and clinically relevant measurement tools in a broader range of VR technologies to optimize the use of VR in therapy for children with DCD. Future research should aim for more rigorous study designs and emerging immersive technologies to maximize therapeutic benefits.

The Effect of a Table Tennis Exercise Program With a Task-Oriented Approach on Visual Perception and Motor Performance of Adolescents With Developmental Coordination Disorder

In this study we investigated the effects of an 8-week table tennis exercise program with a task-oriented approach on visual perception and motor performance of 31 adolescents with developmental coordination disorder (DCD). The participants were identified by their teachers as having greater difficulty than their peers (450 students from three Korean middle schools) in physical education (PE) classes. On the Bruininks-Oseretsky Test of Motor Proficiency-2, these adolescents scored below the 15th percentile and showed difficulties in performing daily life activities due to motor performance problems; they did not have physical defects, intellectual or neurological impairments, or Attention Deficit Hyperactivity Disorder. Of 98 prospective adolescents with PE difficulties, we obtained personal assent and parents' informed consent from 54, and 31 of these met screening criteria for DCD through the Developmental Coordination Disorder Questionnaire-Korean. This final group was divided in non-random fashion (based on the proximal geographic grouping of the children's schools) between an experimental group (n = 16) and a control group (n = 15). The experimental group participated in the 8-week task-oriented table tennis training program with three 90-minute sessions per week, while the control group only participated in regular PE classes twice per week. We measured participants' visual perception and motor performance in the same environment before and after the intervention program. Participants' visual perception was significantly more improved in the experimental group than the control group, with specific improved skills in visual-motor search, visual-motor speed, figure-ground, and visual closure; copying and perceptual constancy skills did not improve significantly. In addition, total motor performance and motor sub-skills, including fine manual control, manual coordination, body coordination, strength, and agility were significantly more improved in the experimental group than in the control group. Thus, our task-oriented table tennis exercise program was of greater assistance than general PE classes for improving visual perception and motor performance in adolescents at risk of DCD.

Evaluating the influence of feedback on motor skill learning and motor performance for children with developmental coordination disorder: a systematic review

Introduction

Children with developmental coordination disorder (DCD) have difficulties with learning and performing physical tasks. It is well known that task-specific practice is effective in improving motor skills. Additional feedback during practice may function as a quality improvement mechanism and therefore enhance motor skill outcomes.

Aims

To investigate the effect of different forms of feedback on motor learning and motor performance in children with DCD.

Methods

A systematic review was conducted (registration CRD42020175118) to investigate the effectiveness of different types of feedback, compared to other forms of feedback, or no additional feedback, on motor learning and motor performance outcomes in children with DCD. The search was run across six electronic databases (last search January 2024). Two reviewers independently screened studies for inclusion, assessed the quality of included studies, and extracted relevant data. A narrative synthesis was performed and included studies that assessed motor learning and/or performance outcomes following an intervention that delivered a specific form of feedback in comparison to another form of feedback or no specific feedback.

Results

14 articles from 13 trials were included in this review. Feedback was delivered by providing various forms of feedback, including: knowledge of results, focus of attention and augmented feedback delivered via technology. No significant differences were found between different forms of feedback for motor learning or performance outcomes for children with DCD. Interventions that used technology (with augmented feedback) to deliver the intervention were found to be as effective as traditional therapy. All groups who participated in therapy, regardless of the presence or type of feedback received, improved in overall scores on a motor performance outcome assessment.

Conclusion

Despite the clear rationale for using feedback-oriented interventions for children with DCD, there is surprisingly limited and low-quality research. There is no clear evidence that one form of feedback is more effective than another, although it appears that feedback delivered via technology may be as effective as feedback delivered in traditional therapy interventions for children with DCD. Further exploration is required from appropriately powered and well-designed trials.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=175118, identifier (CRD42020175118).

The wide world of technological telerehabilitation for pediatric neurologic and neurodevelopmental disorders - a systematic review

Introduction

The use of Information and Communication Technology (ICT) for assessing and treating cognitive and motor disorders is promoting home-based telerehabilitation. This approach involves ongoing monitoring within a motivating context to help patients generalize their skills. It can also reduce healthcare costs and geographic barriers by minimizing hospitalization. This systematic review focuses on investigating key aspects of telerehabilitation protocols for children with neurodevelopmental or neurological disorders, including technology used, outcomes, caregiver involvement, and dosage, to guide clinical practice and future research.

Method

This systematic review adhered to PRISMA guidelines and was registered in PROSPERO. The PICO framework was followed to define the search strategy for technology-based telerehabilitation interventions targeting the pediatric population (aged 0-18) with neurological or neurodevelopmental disorders. The search encompassed Medline/PubMed, EMBASE, and Web of Science databases. Independent reviewers were responsible for selecting relevant papers and extracting data, while data harmonization and analysis were conducted centrally.

Results

A heterogeneous and evolving situation emerged from our data. Our findings reported that most of the technologies adopted for telerehabilitation are commercial devices; however, research prototypes and clinical software were also employed with a high potential for personalization and treatment efficacy. The efficacy of these protocols on health or health-related domains was also explored by categorizing the outcome measures according to the International Classification of Functioning, Disability, and Health (ICF). Most studies targeted motor and neuropsychological functions, while only a minority of papers explored language or multi-domain protocols. Finally, although caregivers were rarely the direct target of intervention, their role was diffusely highlighted as a critical element of the home-based rehabilitation setting.

Discussion

This systematic review offers insights into the integration of technological devices into telerehabilitation programs for pediatric neurologic and neurodevelopmental disorders. It highlights factors contributing to the effectiveness of these interventions and suggests the need for further development, particularly in creating dynamic and multi-domain rehabilitation protocols. Additionally, it emphasizes the importance of promoting home-based and family-centered care, which could involve caregivers more actively in the treatment, potentially leading to improved clinical outcomes for children with neurological or neurodevelopmental conditions.

Systematic review registration

PROSPERO (CRD42020210663).

Gamification and neurological motor rehabilitation in children and adolescents: a systematic review

INTRODUCTION

Gamification consists of the use of games in non-playful contexts. It is widely employed in the motor rehabilitation of neurological diseases, but mainly in adult patients. The objective of this review was to describe the use of gamification in the rehabilitation of children and adolescents with neuromotor impairment.

METHODS

We performed a systematic review of clinical trials published to date on the MEDLINE (PubMed), Scielo, SCOPUS, Dialnet, CINAHL, and PEDro databases, following the PRISMA protocol. The methodological quality of the studies identified was assessed using the PEDro scale.

RESULTS

From a total of 469 studies, 11 clinical trials met the inclusion criteria. We analysed the gamification systems used as part of the rehabilitation treatment of different neuromotor conditions in children and adolescents. Cerebral palsy was the most frequently studied condition (6 studies), followed by developmental coordination disorder (3), neurological gait disorders (1), and neurological impairment of balance and coordination (1).

CONCLUSION

The use of gamification in rehabilitation is helpful in the conventional treatment of neuromotor disorders in children and adolescents, with increased motivation and therapeutic adherence being the benefits with the greatest consensus among authors. While strength, balance, functional status, and coordination also appear to improve, future research should aim to determine an optimal dosage.

Motion-based technology to support motor skills screening in developing children: A scoping review

BACKGROUND

Acquiring motor skills is fundamental for children's development since it is linked to cognitive development. However, access to early detection of motor development delays is limited.

AIM

This review explores the use and potential of motion-based technology (MBT) as a complement to support and increase access to motor screening in developing children.

METHODS

Six databases were searched following the PRISMA guidelines to search, select, and assess relevant works where MBT recognised the execution of children's motor skills.

RESULTS

164 studies were analysed to understand the type of MBT used, the motor skills detected, the purpose of using MBT and the age group targeted.

CONCLUSIONS

There is a gap in the literature aiming to integrate MBT in motor skills development screening and assessment processes. Depth sensors are the prevailing technology offering the largest detection range for children from age 2. Nonetheless, the motor skills detected by MBT represent about half of the motor skills usually observed to screen and assess motor development. Overall, research in this field is underexplored. The use of multimodal approaches, combining various motion-based sensors, may support professionals in the health domain and increase access to early detection programmes.

A Clinical Practice Guide to Enhance Physical Activity Participation for Children with Developmental Coordination Disorder in Canada

Purpose

This clinical practice guide (CPG) aims to provide evidence-based recommendations for promoting and enhancing the participation and integration of children with developmental coordination disorder (DCD) into physical activities that take place in the home, school, community, or rehabilitation clinic contexts.

Methods

A panel of key stakeholders relevant to these contexts (parents, instructors, rehabilitation professionals) developed evidence-based recommendations using a consensus methodology after reviewing results from a recent systematic review of relevant literature. The quality of the evidence on which the recommendations were based was evaluated (2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence scale) as was the strength of the final CPG recommendations (American Society of Plastic Surgeons Grade Recommendation Scale).

Results

Recommendations (n = 50; 36% supported by robust, empirically derived evidence) for the different stakeholder groups fell into three categories: 1) Choose an appropriate activity for your child, 2) Harmonize the activity with the child's interests and abilities, and 3) Help the child learn new movements prior to the activity.

Conclusions

This comprehensive CPG provides concrete recommendations, based on the currently available evidence, that can be used by stakeholders to address the physical activity participation and integration needs of children with DCD in a variety of contexts.

Social exercise interventions for children who have complex developmental needs: A systematic review

Exercise interventions are identified as effective treatments for children not meeting developmental milestones. This systematic review synthesizes research regarding exercise interventions that involved social participatory elements, for children with complex developmental needs. Academic Search Complete, CINAHL, Emcare, Proquest Theses and Dissertations, MEDLINE, and Google Scholar were searched systematically for relevant studies. Peer-reviewed studies meeting the review aim and published between 2000 and 2021 in English, were included. Methodological quality of 49 eligible studies (47 controlled trials, two mixed methods, total of 2355 participants) was appraised using the Mixed Methods Appraisal Tool. Narrative synthesis identified two groups of studies: Group 1 incorporated intentional social participatory elements; Group 2 likely involved incidental social participation. Most studies were of moderate to low methodological quality. Few measured impacts of interventions upon total physical activity levels. Short-term improvements in physical outcomes - particularly motor skills - were most frequently reported and were the main benefit of social exercise interventions for children with complex developmental needs, for which evidence exists. Further rigorous, longitudinal research is needed to assess social, psychological, and executive function outcomes of social exercise interventions in this population. Such interventions should incorporate booster sessions to provide children with greater opportunity to meet developmental milestones.

Efficacy of a Task-Oriented Intervention for Children with a Dual Diagnosis of Specific Learning Disabilities and Developmental Coordination Disorder: A Pilot Study

Background: Task-oriented approaches are recommended for children with developmental coordination disorder (DCD) to address deficits in motor performance and reduce activity limitations. Although this approach is used in several settings, the efficacy of these approaches in children with in dual-diagnosis of specific learning disabilities (SLD) and DCD is less widely known. This study aims to determine the effect of a group-based intervention based on neuromotor task training (NTT) principles on the motor performance of children aged 6–10 years with SLD/DCD. Methods: A pre-post-test controlled study design was conducted in children with a primary diagnosis of specific learning disabilities (SLD). DCD status was confirmed based on clinical assessment. Children scoring ≤16th percentile on the Motor Assessment Battery for Children 2nd Edition (MABC-2), who also presented with a functional motor problem, according to the MABC checklist were considered as having DCD. Children were allocated to the NTT intervention group based on teachers’ perceived notion of need and received two 45–60 min training sessions per week for nine weeks. Children allocated to the usual care (UC) group, received their planned occupational therapy and physical education. The MABC-2 was used to assess changes in motor performance. Outcome and Results: Our numbers confirm that it is crucial to identify the presence of motor coordination difficulties in children who have been diagnosed with SLD. A task-oriented training program based on NTT principles, presented in small groups, has a positive effect on the motor performance in learners with neurodevelopmental disorders and this effect was larger than in the usual care group. Conclusion and Implications: Although using a small group format in children with multiple neurodevelopmental disorders may be challenging for the therapists, it may be a way of delivering services to children in schools for special education. What this paper adds: Children with DCD plus LSD show improvement in their motor skills by performing group-based NTT in the school environment. Group-based NTT shows a significant improvement in the TSS score of the MABC-2 compared to usual care. Children with DCD plus SLD show equal effect sizes after NTT intervention as DCD without SLD.

Type of active video-games training does not impact the effect on balance and agility in children with and without developmental coordination disorder: A randomized comparator-controlled trial

AIM

To compare the effect of the Nintendo Wii-Fit and Xbox Kinect on motor performance and to assess differential effects in children with Developmental Coordination Disorder (DCD) and typical development (TD).

METHOD

In an assessor-blinded randomized comparator-controlled design, 68 participants (34 DCD and 34 TD) aged 7-10 years, were randomly assigned to train on one of two devices (34 Wii-Fit; 34 Xbox Kinect).

RESULTS

Repeated measure ANOVA revealed a significant main effect of time on balance and agility variables (MABC-2, Wii Yoga stance, PERF-FIT side-hop, PERF-FIT ladder-stepping; all p ≤ 0.02), but not on running variables (BOT2-sprint, 10 × 5 m sprint and PERF-FIT ladder running; p > 0.05). No significant interactions were observed, indicating similar changes on both devices. Overall, 35% of the TD children and 76% of the children with DCD improved on one or more of the outcomes beyond the smallest detectable difference. However, at the individual level, larger differences in improvement were found in the Kinect group compared to the Wii between TD and DCD groups.

CONCLUSION

Both Wii-Fit and Kinect devices can be used to train with similar results on motor performance. An important percentage (76%) of children with DCD improved on at least one motor task after training.

Are active video games useful in the development of gross motor skills among non-typically developing children? A meta-analysis

Background

Proficiency in gross motor skills (GMS) lays the foundation for developing more complex motor skills. Improving these motor skills may provide enhanced opportunities for the development of a variety of perceptual, social, and cognitive skills. However, GMS development and intervention effects are not ideal for many non-typically developing children.

Objective

To systematically evaluate the effect of active video games on the development of gross motor skills in non-typically developing children and adolescents.

Methods

Seven Chinese and English databases were searched for randomized controlled trials, and the risk of bias in included studies were qualitative evaluation according to the revised Cochrane risk of bias tool for randomised trials (RoB 2). Then a meta-analysis was conducted to estimate the overall effect of active video games on the development of gross motor skills in non-typically developing children.

Results

Twenty papers were included. In the three subordinate concepts of gross motor skills, active video games significantly improved locomotor skills [ SMD = 0.59, 95% CI (0.40, 0.77)] and non-locomotor skills [SMD = 0.51, 95% CI (0.20, 0.81)] in non-typically developing children. However, there was no significant difference compared with the control group [ SMD = 0.32, 95% CI (− 0.17, 0.82)] in object control skills.

Conclusions

The study shows that active video games can improve locomotor skill and stability skill in non-typically developing children, but the effect on object control skill is uncertain, and more high-quality literature needs to be included in the future.

Trial registration The meta-analysis was registered on INPLASY (202,250,124) and is available in full on inplasy.com (https://inplasy.com/inplasy-2022-5-0124/).

Eight-week virtual reality training improves lower extremity muscle strength but not balance in adolescents with intellectual disability: A randomized controlled trial

Purpose: This study aims to assess the effects of 8-week virtual reality (VR) training on balance and lower extremity muscle strength in adolescents with intellectual disability (ID).

Methods: Thirty adolescents with intellectual disability were randomly divided into the virtual reality group and control group. The participants in the virtual reality group and the control group received the virtual reality training and the physical education (PE) course, respectively, for 8 weeks. The Berg Balance Scale (BBS), Timed Up and Go (TUG) test and lower extremity muscle strength were measured before and after the training.

Results: The between-group results showed that the participants in the virtual reality group increased the muscle strength of hip flexors (p < 0.001), hip extensors (p = 0.002), hip abductors (p < 0.001), knee flexors (p < 0.001), knee extensors (p = 0.002) and ankle plantar flexors (p = 0.042) significantly after training, compared to the control group. However, no significant improvement was found in the berg balance scale and timed up and go scores between the virtual reality group and control group after training (p > 0.05). The within-group results showed that the strength of all the muscle groups significantly increased after training in the virtual reality group (p < 0.05) compared to the baseline. However, no significant difference was found in the muscle strength in the control group before and after training. The within-group berg balance scale and timed up and go scores showed no significant improvements in both groups.

Conclusion: Virtual reality training intervention might be effective in improving the lower extremity muscle strength, but no significant improvement was found on balance ability in adolescents with intellectual disability.

New Technological Approach for the Evaluation of Postural Control Abilities in Children with Developmental Coordination Disorder

Background: Developmental Coordination Disorder (DCD) causes difficulties in postural control which are crucial to assess due to their impact on everyday life. There is a lack of suitable tools to acquire quantitative data and deeply analyze postural control, especially during the developmental age. The aim of this study is to investigate postural control skills in children with DCD and typically developing children (TD) using the Virtual Reality Rehabilitation System (VRRS). Methods: 18 children with DCD and 30 TD children (mean age 9.12 ± 2.65 and 7.12 ± 2.77 years, respectively) were tested by using the Movement Assessment Battery for Children Second Edition (MABC-2) and a VRRS stabilometric balance platform. A t-test was performed to identify differences in the VRRS parameters between the two groups. Furthermore, we investigated whether a correlation exists between the VRRS data and the MABC-2. Results: Significant differences (p < 0.05) in mean distance and frequency of the COP are found in the two groups. These parameters also correlate with the MABC-2 total score (p ≤ 0.05) and balance subscales (p ≤ 0.05). Conclusions: This study opens a new frontier for the assessment of postural skills in children with DCD and represents a potential basis for a tailored rehabilitation program, from which their postural stability and, consequently, their everyday life will benefit.

Effect of Wii Fit training on visual perception and executive function in boys with developmental coordination disorders: A randomized controlled trial

BACKGROUND

This paper elucidated the influence of Wii Fit training on visual perception and executive function in boys with developmental coordination disorders (DCD).

METHODS

50 school boy with DCD (Mean Age = 9.55 ± 2.24) were randomly assigned to one of two groups, Wii Fit training (intervention; n = 25) or usual school program (control; n = 25). Visual perception and executive function were measured pre-, post- (8 weeks, 3 sessions per week, 30 minute per session), using Cognitive Assessment System (CAS) and Test of Visual-Perceptual Skills-Revised (TVPS-R), respectively. Pre- and post-test changes in executive function and visual perception were calculated using one-way ANCOVA, with pre-test values as covariate and post-test values as dependent variables.

RESULTS

The findings show that the rates of change in total score of visual perception from pre to post were significantly different between groups (F(1, 47) = 660.76, P = 0.024). Similarly, intervention group showed significantly different rates of change in total score of executive function from pre to post (F (1, 47) = 26.15, P = 0.013).

CONCLUSION

Findings support that when developing interventions for the improvement or management of visual perception and executive function in children with DCD, key stakeholders should include the Wii Fit training programs.

Integrating Regular Exergaming Sessions in the ExerCube into a School Setting Increases Physical Fitness in Elementary School Children: A Randomized Controlled Trial

This study aimed to investigate the effects of a school-based exergame intervention on anthropometric parameters and physical fitness. Fifty-eight students (10.4 ± 0.8 years; 48% girls) were randomized into an intervention (IG) and a control (CG) group. Both groups participated in regular physical education classes during the three-month intervention period. The IG additionally received a 20-minute exergame intervention twice per week. At baseline and following the intervention period, body mass index (BMI) and waist-to-height ratio (WHtR) were assessed. Furthermore, a sprint test (ST), a countermovement jump test (CMJ), and a shuttle run test (SRT) were performed. Due to prescribed quarantine measures, only 34 students (18 IG; 16 CG) were included in the final analysis. A significant group−time interaction was determined in CMJ performance (p < 0.001; η2 = 0.403), with a significant increase (+2.6 ± 2.4 cm; p < 0.001; η2 = 0.315) in the IG and a significant decrease (−2.0 ± 3.1 cm; p = 0.009; η2 = 0.190) in the CG. Furthermore, ST performance significantly improved in the IG (−0.03 ± 0.08 s; p = 0.012; η2 = 0.180) but not in the CG (0.13 ± 0.16 s; p = 0.460; η2 = 0.017), revealing significant interaction effects (p = 0.02; η2 = 0.157). Significant group−time interaction was observed for the SRT (p = 0.046; η2 = 0.122), with a significant increase (+87.8 ± 98.9 m; p = 0.028; η2 = 0.147) in the IG and no changes (−29.4 ± 219.7 m; p = 0.485; η2 = 0.016) in the CG. Concerning BMI (p = 0.157; η2 = 0.063) and WHtR (p = 0.063; η2 = 0.114), no significant interaction effects were detected. School-based exergaming is a suitable tool to influence students’ physical fitness positively.

A Ten-Week Motor Skills Training Program Increases Motor Competence in Children with Developmental Coordination Disorder

The present study aimed to investigate the effect of a motor skills training program in children with DCD considering their gender. The Movement Assessment Battery for Children (MABC-2) classified the children and assessed their skill changes over time. The study was implemented at four kindergartens in the Khorezm region of Uzbekistan. In the study, all the children suffered from DCD (5.17 ± 0.70 years; 10 girls), and all the indicators of MABC-2 were less than 16%. The participants were divided into an experimental group (n = 17), receiving ten weeks of motor skills training program for 45 min twice per week; and a control group (n = 7), which proceeded with exercises of everyday living. The ANCOVA showed differences between the groups in the post-test concerning each domain: manual dexterity (F _(1, 20) = 18.703, p < 0.001; η² = 0.471); aiming and catching (F _(1, 20) = 9.734, p = 0.005; η² = 0.317); balance (F _(1, 20) = 35.140, p = 0.000; η² = 0.626); and total MABC-2 test score (F _(1, 20) = 66.093, p < 0.001; η² = 0.759), with all the children in the EG exhibiting better results. The Wilcoxon test revealed statistically significant differences for the EG between moments for all the variables (p < 0.001) but not for the CG (p > 0.050). The effectiveness of the intervention program was similar across both genders. The study suggests that a 10 week motor skills training program can increase the quality of children’s motor competence and represent a valuable procedure for physical education specialists to enhance motor competence for children with DCD.

Pediatric care for children with Developmental Coordination Disorder, can we do better?

This paper adopts a method of narrative critical review based on a non-systematic search of the literature to provide insights into the trends of developmental coordination disorder (DCD) treatment and to point out some future alternative approaches to prevent secondary health implications in children with DCD. The cause of DCD is unknown, but evidence suggests that these children have atypical brain structure and function. Interventions to help children cope with their activity limitations are effective in improving motor competence and motor skill related fitness in the short term. Although activity-orientated interventions can improve motor outcomes in children with DCD, high quality intervention trials and evaluation of long-term effects are urgently needed. Importantly, motor coordination problems associated with DCD extend to exercise-related activities leading to reduced participation in play and sports, which causes secondary problems in muscular fitness and body composition. Hence, treatment goals should not be limited to the improvement of motor skills (in ADL), but should also focus on health-related quality of life. We therefore propose when noticing motor problems in a child, already before enrolling but also during intervention, to explore ways to adapt everyday physical activities to optimally match the child's skill level. Hence, such activities will not only train the skills and improve physical fitness but will lead to positive engagement, thereby preventing the child from opting out of active play and sports. This provides the child with chances for exercise-dependent learning and will also positively impact social-emotional well-being.

Effect of a 6-Week Physical Education Intervention on Motor Competence in Pre-School Children with Developmental Coordination Disorder

The objective of this research was to analyze the impact of an intervention program performed by a specialist in physical education (PE) to contribute to the development of motor competence (MC) in pre-school children with motor development problems. The sample consisted of 28 children (12 from the intervention group and 16 from the control group) aged between 4.1 and 5.9 years (mean = 4.71 ± 0.54) who were in the fifth and sixth grades of pre-school education in two schools from Lugo, Spain. The Movement Assessment Battery for Children-2 (MABC-2) was used for data collection. The data revealed that, in the pre- and post-test intervention groups, there are statistically significant differences in manual dexterity (p < 0.001; d = 2.63), aiming and catching (p < 0.002; d = 1.13), balance (p < 0.001; d = 1.68), total test score (p < 0.001; d = 3.30) and total percentile score (p < 0.001; d = 1.88). Between the control and intervention post-test groups, significant differences were found in manual dexterity (p = 0.015; η²&nbsp;= 0.22), aiming and catching (p = 0.003; η²&nbsp;= 0.32), balance (p = 0.050; η² = 0.15), total test score (p < 0.001; η² = 0.47) and total percentile score (p < 0.001; η² = 0.48). Based on the results obtained, a specific MC program implemented by a PE specialist contributed to the improvement of manual dexterity, aiming and catching and balance, as well as a better percentile in the general MC of pre-school children diagnosed with motor skill problems.

Effects of Graded Exergames on Fitness Performance in Elementary School Children With Developmental Coordination Disorder

Developmental Coordination Disorder (DCD) is a common childhood disorder affecting movement and coordination skills, fitness, and academic performance. Increased physical fitness may have a positive influence on physical and mental health outcomes in children with DCD. Yet, little has been done to develop interventions to improve fitness performance in this group. The purpose of this study was to determine the effects of graded exergames in 7 to 12-year-old children with DCD and typically developing (TD) peers. Participants (32 DCD and 28 TD children) received a 30-min training session twice weekly for 10 weeks. Performance on motor coordination (MABC-2 test), balance, aerobic, and anaerobic fitness tests were assessed at the beginning and end of training. In addition, enjoyment and perception of exertion were measured for each participant during the training period. Both children with DCD and TD children significantly improved on motor coordination, balance, aerobic, and anaerobic fitness at the end of the training. A significant Group by Time interaction was observed on the MABC-2 total [F (1, 55) = 13.19; p < 0.001] and balance scores [F (1, 55) = 26.83; p < 0.0001], with the DCD group demonstrating larger improvements than the TD children. Both groups enjoyed the program throughout the training period even though they rated the training to be of high intensity. These findings indicate that graded exergames may serve as potential treatment for impaired fitness in children with DCD. Regular participation in graded exergames in school settings may be needed to enhance and maintain fitness performance in young children with and without DCD.

The effects of exergames on muscle strength: A systematic review and meta-analysis

This systematic review and meta-analysis examined studies on the chronic effects of exergames on muscle strength in humans. PubMed, Scopus, CENTRAL, Web of Science, SciELO, Biblioteca Virtual em Saúde, and Google Scholar were searched, and manual searches of the reference lists of included studies and hand-searches on Physiotherapy Evidence Database and ResearchGate were conducted from inception to August 10, 2020. Randomized and non-randomized exergame intervention studies with or without a non-exercise group and/or a "usual care intervention group" (any other intervention that did not incorporate exergames), which evaluated muscle strength through direct measurements, were included. Forty-seven and 25 studies were included in the qualitative review and meta-analysis, respectively. The between-groups meta-analyses showed no significant differences between exergames and non-exercise control groups for handgrip strength in heathy/unhealthy middle-aged/older adults or knee extension maximum voluntary isometric contraction (MVIC) in healthy older adults. However, exergames provided a greater increase in handgrip strength, knee flexion MVIC, and elbow extension MVIC, but not knee extension MVIC or elbow flexion MVIC, in individuals with different health statuses when compared to usual care interventions. Also, there was a greater increase in handgrip strength in children with hemiplegic cerebral palsy favouring usual care plus exergames compared to usual care interventions. These results suggest that exergames may improve upper and lower limb muscle strength in individuals with different heath statuses compared to usual care interventions, but not muscle strength in middle age/older adults after accounting for random error. Also, exergames appear to be a useful tool for improving handgrip strength in children with hemiplegic cerebral palsy when added to usual care. However, as the exergame interventions were applied in different populations and there currently are many different approaches to perform exergames, future randomized controlled trials with high methodological quality and large sample sizes are needed to provide more compelling evidence in favour of a specific exergame protocol, or to elucidate exergame protocol design principles that appear to strongly influence outcomes.

Gamification and neurological motor rehabilitation in children and adolescents: A systematic review

INTRODUCTION

Gamification consists of the use of games in non-playful contexts. It is widely employed in the motor rehabilitation of neurological diseases, but mainly in adult patients. The objective of this review was to describe the use of gamification in the rehabilitation of children and adolescents with neuromotor impairment.

METHODS

We performed a systematic review of clinical trials published to date on the MEDLINE (PubMed), Scielo, SCOPUS, Dialnet, CINAHL, and PEDro databases, following the PRISMA protocol. The methodological quality of the studies identified was assessed using the PEDro scale.

RESULTS

From a total of 469 studies, 10 clinical trials met the inclusion criteria. We analysed the gamification systems used as part of the rehabilitation treatment of different neuromotor conditions in children and adolescents. Cerebral palsy was the most frequently studied condition (6studies), followed by developmental coordination disorder (3), and neurological impairment of balance and coordination (1).

CONCLUSION

The use of gamification in rehabilitation is helpful in the conventional treatment of neuromotor disorders in children and adolescents, with increased motivation and therapeutic adherence being the benefits with the greatest consensus among authors. While strength, balance, functional status, and coordination also appear to improve, future research should aim to determine an optimal dosage.

The Virtual Challenge: Virtual Reality Tools for Intervention in Children with Developmental Coordination Disorder

This narrative review highlights the latest achievements in the field of tele-rehabilitation: Virtual Reality (VR) and Augmented Reality (AR) serious games aimed at restoring and improving cognitive functions could be effectively used in Developmental Coordination Disorder Training. Studies investigating the effects of the abovementioned tech applications on cognitive improvement have been considered, following a comprehensive literature search in the scientific electronic databases: Pubmed, Scopus, Plos One, ScienceDirect. This review investigates the effects of VR and AR in improving space/motor skills through mental images manipulation training in children with developmental coordination disorders. The results revealed that in spite of the spreading of technology, actually only four studies investigated the effects of VR/AR tools on mental images manipulation. This study highlights new, promising VR and AR based therapeutic opportunities for digital natives now available, emphasizing the advantages of using motivational reward-oriented tools, in a playful therapeutic environment. However, more research in this filed is needed to identify the most effective virtual tool set for clinical use.

Neural Basis and Motor Imagery Intervention Methodology Based on Neuroimaging Studies in Children With Developmental Coordination Disorders: A Review

Although the neural bases of the brain associated with movement disorders in children with developmental coordination disorder (DCD) are becoming clearer, the information is not sufficient because of the lack of extensive brain function research. Therefore, it is controversial about effective intervention methods focusing on brain function. One of the rehabilitation techniques for movement disorders involves intervention using motor imagery (MI). MI is often used for movement disorders, but most studies involve adults and healthy children, and the MI method for children with DCD has not been studied in detail. Therefore, a review was conducted to clarify the neuroscientific basis of the methodology of intervention using MI for children with DCD. The neuroimaging review included 20 magnetic resonance imaging studies, and the neurorehabilitation review included four MI intervention studies. In addition to previously reported neural bases, our results indicate decreased activity of the bilateral thalamus, decreased connectivity of the sensory-motor cortex and the left posterior middle temporal gyrus, bilateral posterior cingulate cortex, precuneus, cerebellum, and basal ganglia, loss of connectivity superiority in the abovementioned areas. Furthermore, reduction of gray matter volume in the right superior frontal gyrus and middle frontal gyrus, lower fractional anisotropy, and axial diffusivity in regions of white matter pathways were found in DCD. As a result of the review, children with DCD had less activation of the left brain, especially those with mirror neurons system (MNS) and sensory integration functions. On the contrary, the area important for the visual space processing of the right brain was activated. Regarding of characteristic of the MI methods was that children observed a video related to motor skills before the intervention. Also, they performed visual-motor tasks before MI training sessions. Adding action observation during MI activates the MNS, and performing visual-motor tasks activates the basal ganglia. These methods may improve the deactivated brain regions of children with DCD and may be useful as conditioning before starting training. Furthermore, we propose a process for sharing the contents of MI with the therapist in language and determining exercise strategies.

Effects of Transcranial Direct Current Stimulation on Motor Function in Children 8-12 Years With Developmental Coordination Disorder: A Randomized Controlled Trial

Background and objectives: Developmental coordination disorder (DCD) is a neurodevelopmental motor disorder occurring in 5-6% of school-aged children. It is suggested that children with DCD show deficits in motor learning. Transcranial direct current stimulation (tDCS) enhances motor learning in adults and children but is unstudied in DCD. We aimed to investigate if tDCS, paired with motor skill training, facilitates motor learning in a pediatric sample with DCD.

Methods: Twenty-eight children with diagnosed DCD (22 males, mean age: 10.62 ± 1.44 years) were randomized and placed into a treatment or sham group. Anodal tDCS was applied (1 mA, 20 min) in conjunction with fine manual training over 5 consecutive days. Children's motor functioning was assessed with the Purdue Pegboard Test and Jebsen-Taylor Hand Function Test at baseline, post-intervention and 6 weeks following intervention. Group differences in rates of motor learning and skill transfer/retention were examined using linear mixed modeling and repeated measures ANOVAs, respectively.

Results: There were no serious adverse events or drop-outs and procedures were well-tolerated. Independent of group, all participants demonstrated improved motor scores over the 5 training days [F_(69.280), p < 0.001, 95% CI (0.152, 0.376)], with no skill decay observed at retention. There was no interaction between intervention group and day [F_(2.998), p = 0.086, 95% CI (−0.020, 0.297)].

Conclusion: Children with DCD demonstrate motor learning with long-term retention of acquired skill. Motor cortex tDCS did not enhance motor learning as seen in other populations. Before conclusions of tDCS efficacy can be drawn, additional carefully designed trials with reproducible results are required.

Clinical Trial Registration:ClinicalTrials.gov: NCT03453983

Motor skill intervention for pre-school children: A scoping review

Background

There is a high prevalence of motor skill difficulties amongst pre-school children living in low socio-economic areas. Motor skill impairment can affect these children’s school readiness and academic progress, social skills, play and general independence.

Objectives

This scoping review investigates the key elements of existing motor skill interventions for pre-school children.

Method

We gathered information through structured database searches from Cinahl, Eric, PubMed, Cochrane, ProQuest, Psych Net, PEDro and Scopus, using a keyword string. The PRISMA-SCR design was used to identify 45 eligible studies. All included studies investigated a motor skill intervention with well-defined outcome measures for children aged 4–7 years with motor skill difficulties. Studies that exclusively focused on children with neurological conditions such as cerebral palsy, physical disabilities or medical/physical deteriorating conditions were excluded. Information was charted on MS Excel spreadsheets. Fundamental concepts were categorised into common key themes and were converted into a proposed framework.

Results

Fifteen intervention approaches were identified. Treatment is mostly managed by occupational therapists and physiotherapists. Evidence supports individual and group treatment with a child-centred, playful approach in a school or therapeutic setting. Whilst session information varied, there is moderate evidence to suggest that a 15-week programme, with two weekly sessions, may be feasible.

Conclusion

Children with motor skill difficulties need therapeutic intervention. This study identified the key elements of existing therapy intervention methods and converted it into a proposed framework for intervention planning. It is a first step towards addressing motor skill difficulties amongst pre-school children in low socio-economic areas.

International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder - Chinese (Mandarin) translation

目的

本国际临床指南由欧洲残疾儿童学会（the European Academy of Childhood Disability，EACD）牵头制定，旨在解决发育性协调障碍（developmental coordination disorder，DCD）的定义、诊断、评估、干预以及与社会心理方面的临床应用关键问题。

方法

本指南针对五个领域的关键问题，通过文献综述和专家团队的正式讨论达成共识。为保证指南的循证基础，以“机制”、“评估”和“干预”为检索词, 对2012年更新以来提出的最新建议以及新增的“社会心理问题”和“青少年/成人”为检索词进行检索。根据牛津大学循证医学中心证据等级 (证据水平 [level of evidence, LOE]1–4) 将结果进行分类，最终转化为指南建议。并由国际、多学科专家小组举行了两次会议，5个回合的Delphi 专家问卷调查，制定了高质量临床应用实践 (good clinical practice，GCP) 。

结果

本指南共制定35条建议。其中8条以文献综述为依据 (3 条涉及“评估”，5条涉及“干预”)； 22 条在 2012 年指南的基础上进行了更新；其他为涉及诊断、评估 (3条GCP) 及社会心理问题 (2 条 GCP) 的新建议。此外，其中有1条(LOE)新建议提出视频游戏可作为以活动和参与为导向的传统干预措施的辅助手段，并针对青少年和成人DCD提出了 2 条新建议 (1 条 GCP，1 条 LOE)。

结论

本指南是基于当前的研究证据和专家共识对DCD进行全面概述。它反映了不同学科临床和科研人员的最新科技水平。本国际指南可作为各国制定指南的基础。

Children With Developmental Coordination Disorder Show Altered Visuomotor Control During Stair Negotiation Associated With Heightened State Anxiety

Safe stair negotiation is an everyday task that children with developmental coordination disorder (DCD) are commonly thought to struggle with. Yet, there is currently a paucity of research supporting these claims. We investigated the visuomotor control strategies underpinning stair negotiation in children with (N = 18, age = 10.50 ± 2.04 years) and without (N = 16, age = 10.94 ± 2.08 years) DCD by measuring kinematics, gaze behavior and state anxiety as they ascended and descended a staircase. A questionnaire was administered to determine parents' confidence in their child's ability to safely navigate stairs and their child's fall history (within the last year). Kinematics were measured using three-dimensional motion capture (Vicon), whilst gaze was measured using mobile eye-tracking equipment (Pupil labs). The parents of DCD children reported significantly lower confidence in their child's ability to maintain balance on the stairs and significantly more stair-related falls in the previous year compared to the parents of typically developing (TD) children. During both stair ascent and stair descent, the children with DCD took longer to ascend/descend the staircase and displayed greater handrail use, reflecting a more cautious stair negotiation strategy. No differences were observed between groups in their margin of stability, but the DCD children exhibited significantly greater variability in their foot-clearances over the step edge, which may increase the risk of a fall. For stair descent only, the DCD children reported significantly higher levels of state anxiety than the TD children and looked significantly further along the staircase during the initial entry phase, suggesting an anxiety-related response that may bias gaze toward the planning of future stepping actions over the accurate execution of an ongoing step. Taken together, our findings provide the first quantifiable evidence that (a) safe stair negotiation is a significant challenge for children with DCD, and that (b) this challenge is reflected by marked differences in their visuomotor control strategies and state anxiety levels. Whilst it is currently unclear whether these differences are contributing to the frequency of stair-related falls in children with DCD, our findings pave the way for future research to answer these important questions.

Motor skill learning in children with and without Developmental Coordination Disorder

OBJECTIVE

The question whether children with DCD have motor learning deficits is difficult to answer based on the current body of knowledge. The aim of this study was to examine the impact of practice on motor skill acquisition, retention and transfer in children with and without DCD using a variety of games in a virtual environment.

METHOD

Performance on a criterion task (Wii ski game) and MABC-2 balance subscore was compared between children with DCD (n = 33) and TD children (n = 28) following 10 weeks of playing active video games. Repeated measures ANOVA was used to compare changes in the two groups.

RESULTS

The children with DCD demonstrated lower performance on the criterion task than the TD group (p = 0.031). A time by group interaction indicated that the difference in performance on the criterion task became larger over time (p = 0.039). No differences were found in retention between groups. Large improvement (Cohen d 1.11) was observed for the children with DCD on the MABC-2 balance subscore.

CONCLUSION

Based on the criterion task results, typically developing children seem more proficient in learning new skills compared to children with DCD. More research is needed to confirm that children with DCD have a problem to transfer skills to other contexts.

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

BACKGROUND

Developmental coordination disorder (DCD), classified as a neurodevelopmental disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), affects approximately 5% to 6% of school-aged children. Characteristics of DCD include poor motor coordination and delayed development of motor skills, not explained by other conditions. Motor deficits negatively affect school productivity, performance in activities of daily living, and recreation participation. Children with coordination problems, at risk for or diagnosed with DCD, should be evaluated by a team of professionals, including a physical therapist (PT).

PURPOSE

This clinical practice guideline (CPG) provides management strategies for PTs and informs clinicians and families about DCD. It links 13 action statements with specific levels of evidence through critical appraisal of the literature and provides recommendations for implementation.

RESULTS/CONCLUSIONS

The DCD CPG addresses examination, referral, first choice and supplemental interventions, discharge, compliance audits, implementation, and research recommendations. Supplemental tools are provided to support PT management.

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

OBJECTIVE

Children with developmental coordination disorder (DCD) are reported to have lower levels of strength and anaerobic capacity. The purpose of this study was to (1) identify field-based tests for strength and anaerobic capacity used in studies comparing children with DCD and children who were typically developing (TD), (2) examine the methodological quality of studies reporting psychometric properties and rate the psychometric properties of the examined test, and (3) summarize available evidence by combining the methodological quality of the studies and the quality of the psychometric properties of the test.

METHODS

An electronic search was conducted in July 2019 in 4 electronic databases. For purpose 1, primary studies were included with no exclusion of study design in which children aged 4 to 18 years with DCD were compared with children who were TD on strength and/or anaerobic capacity measures. For purpose 2, primary studies were included with no exclusion of study design in which a psychometric property was investigated. The Consensus-Based Standards for Selection of Health Measurement Instruments (COSMIN) was used to evaluate the methodological quality of the 34 studies and rate the psychometric properties of the tests used.

RESULTS

Hand-held dynamometer, bent knee push-up, vertical jump, standing long-jump, functional strength measurement, fitness test, and test battery can be recommended for TD, and the shuttle run item of the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition and 10 m × 5 m sprints (straight and slalom) can be recommended for DCD.

CONCLUSION

Information regarding psychometric properties of field-based tests for strength and anaerobic capacity in children with DCD is lacking.

IMPACT

Information about the psychometric properties of field-based tests for strength and anaerobic capacity in children with DCD is lacking. More information is available on TD children, but it is also not complete; information regarding validity and responsiveness, especially, is missing. When using measures in children with DCD, it is important to keep in mind this lack of evidence for the validity and reliability of the outcomes for this target group.

The contribution of motor functions to academic achievement in primary school: State of the art and future directions

This review is intended to point out the role played by motor skills proficiency in the academic achievement of typically and atypically developing pupils who are attending primary school. First, the interplay between motor and cognitive development will be presented. Next, the cognitive phenotype, not yet deeply investigated, of a neurodevelopmental condition associated with the atypical development of motor functions (known as Developmental Coordination Disorder) will be illustrated. Thus, the contribution of motor functions to academic learning and the impact of motor difficulties for pupils attending primary school will be discussed. In addition, the importance of developing observational tools to be used in educational settings and the need for effective interventions designed to empower motor functioning and academic achievement of atypically developing pupils with motor deficits will be highlighted. Finally, future directions within the educational agencies for the early detection of the atypically developing motor trajectories and their treatment will be traced.

Measuring treatment outcome in children with developmental coordination disorder; responsiveness of six outcome measures

Purpose: Although measuring outcome of rehabilitation in children with Developmental Coordination Disorder is considered important no consensus exists on which instruments to use. An important attribute of a measurement instrument would be that it is sensitive to clinical changes. The aim of this prospective, observational study was therefore to investigate the responsiveness of six potentially suitable instruments.Methods: Forty-one children (34 boys, median age 7.8 years, Inter Quartile Range: 7.2-9.2) receiving multidisciplinary rehabilitation treatment for Developmental Coordination Disorder were included (mean treatment time: 32.8 h, Standard Deviation 7.3). The following instruments were applied before and after rehabilitation: Movement-Asessment-Battery-Children-2 (MABC-2), Canadian Occupational Performance Measure (COPM), Systematic detection writing problems (SOS-2-NL), DCD-daily, Behaviour Rating Inventory of Executive Function (BRIEF), and TNO-AZL children's Quality of Life questionnaire (TACQOL)). Change-scores (paired t-test/Wilcoxon-test) and responsiveness (Effect-sizes and Standardized-Response-Means) were calculated.Results: Significant differences over time were found for the Canadian Occupational Performance Measure, DCDdaily and Movement-Asessment-Battery-Children-2 (p < 0.05). The responsiveness of these instruments was moderate-high (Canadian Occupational Performance Measure-performance Effect-Size:1.70/Standardized-Response-Mean:1.81, Canadian Occupational Performance Measure-satisfaction Effect-Size:1.65/Standardized-Response-Mean 1.53; DCDdaily-total-score Effect-Size:0.40/Standardized-Response-Mean:0.62, DCDdaily-Quality-score Effect-Size:0.74/Standardized-Response-Mean:0.89, DCDdaily-time-score Effect-Size:0.21/Standardized-Response-Mean:0.43; MABC-2-total-score Effect-Size:0.42/Standardized-Response-Mean:0.43, MABC-2-Ball-skills-score Effect-Size:0.33/Standardized-Response-Mean:0.36). Systematic detection of writing problems (SOS-2-NL), Behaviour Rating Inventory of Executive Function (BRIEF) and TNO-AZL children's Quality of Life questionnaire (TACQOL) were not responsive to change.Conclusion: Although the Movement-Asessment-Battery-Children-2 test is the most widely used instrument when measuring rehabilitation outcome in Developmental Coordination Disorder, the Canadian Occupational Performance Measure and DCDdaily seem to be more responsive and constitute a valuable addition.Implications for rehabilitationCurrently, there is no consensus on the preferred measurement instruments to evaluate the outcomes of rehabilitation in children with Developmental Coordination Disorder.The responsiveness of the Canadian Occupational Performance Measure (COPM) was found to be large, of the DCDdaily moderate to large, and of the Movement-Assessment-Battery-Children-2 (MABC-2) small, whereas the systematic detection of writing problems (SOS-2-NL; Systematisch Opsporing Schrijfproblemen-2-NL), Behavior Rating Inventory of Executive Functioning (BRIEF) and TNO-AZL Questionnaire for Children's Health-Related Quality of Life (TACQOL) were not responsive to change.Although the Movement-Assessment-Battery-Children-2 (MABC-2) is commonly used in Developmental Coordination Disorder rehabilitation, applying the Canadian Occupational Performance Measure (COPM) and DCDdaily should be considered, as these instruments were more sensitive to clinical changes.

Do Infants at Risk of Developing Cerebral Palsy or Other Neurodevelopmental Disorders Learn What They Practice?

Through secondary analyses of the Small Step. Randomized Control Trial, we tested the hypothesis that children at risk of developing cerebral palsy (CP) or other neurodevelopmental disorders would learn what they practice, i.e., that they would have a more rapid development within the specifically trained foci (hand use or mobility) of each time period compared to the development rate within the foci not trained at that time. Nineteen infants (6.3 (1.62) months corrected age) included in the Small Step program were assessed at six time points during the intervention. For statistical analysis, general and mixed linear models were used, and the independent variables were the Peabody Developmental Motor scale (stationary, locomotion, grasping and visuomotor sub scales), the Gross Motor Function Measure-66 and the Hand Assessment for Infants. Outcomes related to gross motor function improved significantly more after mobility training than after hand use training, while fine motor function was improved to the same extent following both training types. Significantly higher improvements after the first training period were seen in one out of three outcome measures in both gross and fine motor assessments. The improvements observed were all independent of diagnosis at two years. The concept “you learn what you practice” was most clearly confirmed in the case of gross motor development.

Rehabilitation and Disability Spectrum From Adverse Childhood Experience: The Impact of the Movement Cognition and Narration of Emotions Treatment (MCNT) Version 2.0

Adverse Childhood Experiences (ACE) are associated with an increased risk of cerebral, behavioral, and cognitive outcomes, and vulnerability to develop a Borderline Intellectual Functioning (BIF). BIF is characterized by an intelligence quotient (IQ) in the range 70-85, poor executive functioning, difficulties in emotion processing, and motor competencies. All these difficulties can lead to mental and/or neurodevelopmental disorders that require long-term care. Accordingly, we developed an intensive and multidomain rehabilitation program for children with ACE and BIF, termed the Movement Cognition and Narration of emotions Treatment (MCNT1.0). The efficacy of MCNT1.0 on cognitive and social functioning was demonstrated with a previously reported randomized controlled trial (RCT). To extend the impact of the treatment also to the motor domain a new version, called MCNT2.0, was implemented. The present study aims to verify the feasibility of MCNT2.0 and its effects on the motor domain. A quasi-experimental approach was used in which a group of 18 children with ACE and BIF were consecutively recruited and participated in the MCNT 2.0 program. Participants were compared with the MCNT1.0 group as an active comparator, using the dataset of the RCT. The two groups received a full evaluation comprising: the Wechsler Intelligent Scale for Children-IV (WISC-IV), the Movement-ABC (M-ABC), the Test of Gross Motor Development (TGMD), the Social Skills from Vineland Adaptive Behavioral Scale-II (VABS-II) and the Child Behavior Check List 6-18 (CBCL). An ANCOVA was carried out on changes in the scale scores from baseline with age and baseline score as covariates. Results showed a mean adherence to treatment of 0.85 (sd = 0.07), with no differences between groups in IQ, and Social Skills changes, while greater improvements for motor abilities were shown in the MCNT 2.0 group: M-ABC (p = 0.002), and TGMD (p = 0.002). Finally, greater improvement in the CBCL scale was observed in the MCNT 1.0 group (p = 0.002). Results indicate that due to its positive effects on cognitive, social participation and motor domains, MCNT2.0 may represent a protective factor against maladaptive outcomes of children with ACE and BIF.

Developmental coordination disorder

Developmental coordination disorder (DCD) is a neurodevelopmental disorder that affects children's ability to execute coordinated motor actions, resulting in slow, clumsy, or inaccurate motor performances and learning difficulties (of new motor tasks or to adapt previously learned gestures to a modified or additional constraint). In the course of development, children with DCD exhibit a diversity of motor signs, including fine and gross motor problems with impaired postural control and balance, and sensorimotor coordination or motor learning difficulties. The prevalence ranges between 1.8% and 8%, depending on the diagnostic criteria used, based on the cutoff of motor scores from standardized scales. Four main hypotheses have been postulated to explain DCD in terms of deficits in visuospatial functions, procedural learning, internal modeling, or executive functions. Neuroimaging studies are scarce but have highlighted several brain regions, including the parietal, frontal, and cerebellar cortices. Meta-analyses have supported task-oriented approaches as effective therapies to improve motor performance in children with DCD.

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

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.

Benefits of Activity-Based Interventions Among Female Adolescents Who Are Overweight and Obese

PURPOSE

The purpose of this study was to compare the effects of 2 activity-based motor interventions among female adolescents who are overweight and obese.

METHODS

This study was conducted in a low-income community of Cape Town, South Africa. The study involved 52 participants classified as overweight and obese. Participants were randomly assigned to task-oriented functional training or Wii Fit intervention. Both interventions were 45 minutes of active training once a week for 14 weeks. Outcome measures included aerobic fitness, motor coordination, and self-efficacy. Data were collected before and after the interventions.

RESULTS

Participants in both groups demonstrated significant improvement in aerobic fitness and motor coordination but not self-efficacy. However, no between-group differences were observed on any of the outcomes.

CONCLUSIONS

Activity-based interventions may improve aerobic fitness and motor coordination in female adolescents who are overweight and obese and may also help prevent declines in physical fitness and coordination in this population.

Developmental coordination disorder and dysgraphia: signs and symptoms, diagnosis, and rehabilitation

Developmental coordination disorder (DCD) is a common and well-recognized neurodevelopmental disorder affecting approximately 5 in every 100 individuals worldwide. It has long been included in standard national and international classifications of disorders (especially the Diagnostic and Statistical Manual of Mental Disorders). Children and adults with DCD may come to medical or paramedical attention because of poor motor skills, poor motor coordination, and/or impaired procedural learning affecting activities of daily living. Studies show DCD persistence of 30-70% in adulthood for individuals who were diagnosed with DCD as children, with direct consequences in the academic realm and even beyond. In particular, individuals with DCD are at increased risk of impaired handwriting skills. Medium-term and long-term prognosis depends on the timing of the diagnosis, (possible) comorbid disorders (and their diagnosis), the variability of signs and symptoms (number and intensity), and the nature and frequency of the interventions individuals receive. We therefore chose to investigate the signs and symptoms, diagnosis, and rehabilitation of both DCD and developmental dysgraphia, which continues to receive far too little attention in its own right from researchers and clinicians.

Automated Fine Motor Evaluation for Developmental Coordination Disorder

Developmental coordination disorder (DCD) is a type of motor learning difficulty that affects five to six percent of school-aged children, which may have a negative impact on the life of the sufferers. Timely and objective diagnosis of DCD are important for the success of the intervention. The present evaluation methods of DCD rely heavily on the observational analysis of occupational therapists and physiotherapists, who score the performance when children conduct some designed tasks. However, these methods are expensive, subjective, and are not easy to expand to a larger population. A fine motor evaluation system (FMES) is proposed with two views of cameras to record children's performance, when they carry out three fine motor tasks. Automated algorithms are developed to perform automated scoring of fine motor skill. The automated algorithms include task localization and individual task evaluation. The purpose of task localization is to detect each task and extract segments belonging to each task from the original video that includes multiple segments of different tasks. A convolutional neural network with temporal filtering is used to do frame-wise classification, and a boundary localization algorithm is proposed to localize each task segment. For individual task evaluation, the extracted video segments of task 1 and task 2 are evaluated based on the proposed feature extraction and time positioning algorithm, and the paper drawings of task 3 are evaluated based on image processing. The proposed methods are validated on a diverse population of children with or without DCD by comparing automated scoring with manual scoring from a professional evaluator. The experimental results suggest that the proposed methods can effectively achieve fine motor evaluation for DCD assessment. Besides, our system is a low-cost solution, and the evaluation methods developed are automated, objective, and can be suited for large population evaluation and analysis.

International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder

AIM

These international clinical practice recommendations (CPR) for developmental coordination disorder (DCD), initiated by the European Academy of Childhood Disability (EACD), aim to address key questions on the definition, diagnosis, assessment, intervention, and psychosocial aspects of DCD relevant for clinical practice.

METHOD

Key questions in five areas were considered through literature reviews and formal expert consensus. For recommendations based on evidence, literature searches on 'mechanisms', 'assessment', and 'intervention' were updated since the last recommendations in 2012. New searches were conducted for 'psychosocial issues' and 'adolescents/adults'. Evidence was rated according to the Oxford Centre for Evidence-Based Medicine (level of evidence [LOE] 1-4) and transferred into recommendations. For recommendations based on formal consensus, two meetings of an international, multidisciplinary expert panel were conducted with a further five Delphi rounds to develop good clinical practice (GCP) recommendations.

RESULTS

Thirty-five recommendations were made. Eight were based on the evidence from literature reviews (three on 'assessment', five on 'intervention'). Twenty-two were updated from the 2012 recommendations. New recommendations relate to diagnosis and assessment (two GCPs) and psychosocial issues (three GCPs). Additionally, one new recommendation (LOE) reflects active video games as adjuncts to more traditional activity-oriented and participation-oriented interventions, and two new recommendations (one GCP, one LOE) were made for adolescents and adults with DCD.

INTERPRETATION

The CPR-DCD is a comprehensive overview of DCD and current understanding based on research evidence and expert consensus. It reflects the state of the art for clinicians and scientists of varied disciplines. The international CPR-DCD may serve as a basis for national guidelines.

WHAT THIS PAPER ADDS

Updated international clinical practice guidelines on developmental coordination disorder (DCD). Refined and extended recommendations on clinical assessment and intervention for DCD. A critical synopsis of current research on mechanisms of DCD. A critical synopsis of psychosocial issues in DCD, with implications for clinical practice. The first international recommendations to consider adolescents and adults with DCD.

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

Purpose: To evaluate in children with developmental coordination disorder (DCD) the effects of Wii-training compared with task-specific matched training (TST).Material and methods: 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.Results: 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.Conclusions: 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.Trial Registration: This study is registered in a clinical trials registry platform (Protocol: RBR-89YDGJ). Available on the Brazilian Clinical Trials Registry <http://www.ensaiosclinicos.gov.br/>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.

Do video game interventions improve motor outcomes in children with developmental coordination disorder? A systematic review using the ICF framework

Background

Children with developmental coordination disorder (DCD) experience a range of difficulties that can potentially limit their academic, social and physical ability. Recent research has developed interventions that aim to improve motor outcomes in a variety of paediatric cohorts using video gaming equipment. Therefore, we aimed to systematically review the literature on virtual reality or video game interventions that aim to improve motor outcomes in children with DCD.

Methods

Seven databases were searched for studies using the following criteria: a) virtual reality or video game based intervention; b) children with DCD; and c) motor outcomes relating to body structure and function, activity or participation. Data were extracted relating to study design, participant characteristics, details of the intervention, outcome measures, results, and feasibility/adherence.

Results

Fifteen articles were included for review, including eight randomised controlled trials. No studies used virtual reality equipment, with all interventions using video games (Nintendo Wii in 12/15 articles). Mixed effects of video game intervention on outcome were found, with conflicting evidence across studies. Studies that reported on feasibility found most children enjoyed and adhered to the video game interventions.

Conclusions

This review found limited evidence for the effectiveness of video game interventions for children with DCD to improve motor outcomes due to limitations in the research including low sample sizes and low to moderate methodological quality. Further research is needed to determine the effect of video game or virtual reality interventions on motor outcomes in children with DCD.

Protocol registration

The protocol for this systematic review can be found on PROSPERO (CRD42017064427).

Electronic supplementary material

The online version of this article (10.1186/s12887-018-1381-7) contains supplementary material, which is available to authorized users.

Do Active Video Games Improve Motor Function in People With Developmental Disabilities? A Meta-analysis of Randomized Controlled Trials

OBJECTIVE

To conduct a meta-analysis to examine the effectiveness of active video games (AVGs) interventions on motor function in people with developmental disabilities.

DATA SOURCES

An electronic search of 7 databases (PubMed, EbscoHost, Informit, Scopus, ScienceDirect, Proquest, PsychInfo) was conducted for randomized controlled trials (RCTs) evaluating AVGs to improve motor function in people with developmental disability, published through to May 2018.

STUDY SELECTION

Only articles in a peer-reviewed journal in English were selected and screened by 2 independent reviewers for RCTs that compared AVGs to conventional therapy. Twelve RCTs involving 370 people with developmental disabilities met the inclusion criteria for quantitative analysis.

DATA EXTRACTION

Two independent reviewers assessed risk of bias and study quality using the Egger's R, grading of recommendation, assessment, development and evaluation, and Template for Intervention Description and Replication checklists.

DATA SYNTHESIS

Three meta-analyses revealed a large effect size for AVGs to improve gross motor skills (Hedges' g=0.833, 95% confidence interval [95% CI]=0.247-1.420), small to medium effects for balance (g=0.458, 95% CI=0.023-0.948), and a small, nonsignificant effect for functional mobility (g=0.425, 95% CI= -0.03 to 0.881). Training frequency (ie, number of sessions per week) moderated the effect of AVGs on motor function in people with developmental disabilities.

CONCLUSION

We conclude that AVGs show task-specific effectiveness for gross motor skills but the effects are moderated by training intensity. However, because of the low number of trials, diverse diagnoses, variable dosage, and multiple outcome measures of the included trials, these results need to be interpreted with caution.

Pedagogical Approaches to and Effects of Fundamental Movement Skill Interventions on Health Outcomes: A Systematic Review

BACKGROUND

Fundamental movement skills (FMS) are assumed to be the basic prerequisite motor movements underpinning coordination of more integrated and advanced movement capabilities. FMS development and interventions have been associated with several beneficial health outcomes in individual studies.

OBJECTIVE

The primary aim of this review was to identify FMS intervention characteristics that could be optimised to attain beneficial outcomes in children and adolescents, while the secondary aim was to update the evidence as to the efficacy of FMS interventions on physiological, psychological and behavioural health outcomes.

METHODS

A systematic search [adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines] was conducted in seven databases. Studies were included if they conducted an FMS intervention and targeted at least one physiological, behavioural or psychological outcome in school-aged children (5-18 years).

RESULTS

Twenty-nine studies examining the effect of FMS interventions relative to controls were identified. Specialist-led interventions, taught in conjunction with at-home practice and parent involvement, appeared more efficacious in enhancing FMS proficiency than school physical education alone. Intervention environments encouraging psychological autonomy were likely to enhance perceived and actual competence in FMS alongside physical activity. FMS interventions had little influence on overweight/obesity reduction, strength or flexibility. In 93% of studies, evidence indicated interventions improved FMS motor proficiency. Favourable specific physiological, psychological and behavioural outcomes were also identified across a variety of interventions.

CONCLUSION

With reference to clinical and normative school-age populations, future studies should be directed toward determining validated standard FMS assessments to enable accurate effect estimates, permit intervention comparisons and improve the efficacy of FMS development.

Is virtual reality effective in improving the motor performance of children with developmental coordination disorder? A systematic review

INTRODUCTION

Although virtual reality (VR) is an increasingly popular approach within studies that propose interventions for children with developmental coordination disorder (DCD), evidence on the effectiveness of VR remains debatable. The aim of this study was to synthesize evidence on the effectiveness of VR interventions for motor performance improvement in children with DCD.

EVIDENCE ACQUISITION

Searches were conducted in the MEDLINE/PubMed, Scopus, Web of Science and ERIC databases to select studies published from 1 January 2006 to 30 November 2017. Two independent reviewers performed the primary study selection based on titles, abstracts and full-text reading; this selection included randomized controlled trials (RCTs) that applied VR interventions to children with DCD and assessed outcomes related to motor performance. The methodological quality of the studies included in the search was assessed through the PEDro scale. PRISMA guidelines and Cochrane recommendations for systematic reviews were followed. The effect size of each intervention was calculated to allow for the interpretation of clinical effects, and the body of evidence was synthesised through the GRADE approach.

EVIDENCE SYNTHESIS

A total of 2160 publications were retrieved; by the end of the selection process, twelve RCTs had been included. Of these twelve, seven were classified as having high methodological quality. Only three studies satisfied the homogeneity conditions to be assessed through the GRADE system, which showed a low level of evidence in favor of VR for improving the motor performance of children with DCD.

CONCLUSIONS

Not enough evidence currently exists to support or refute the use of VR over non-VR interventions for improving motor performance in children with DCD. Despite the potential for improving the motor performance of DCD children, the absence of specific protocols prevents formal recommendations of VR for these children. Future studies should consider VR protocols that are more specific regarding the tasks, features and target motor skills to be developed by DCD children. In addition, comparisons of similar groups at baseline, the concealment of allocation and the blinding of assessors are internal validity aspects which deserve researchers' attention.

Y-Balance Test Performance and Leg Muscle Activations of Children with Developmental Coordination Disorder

This study compared Lower Quarter Y-Balance Test (YBT-LQ) performance and leg muscle kinetics between children with and without developmental coordination disorder (DCD), and investigated the association between YBT-LQ performance and muscle kinetics in children with DCD. Forty-eight children with DCD and 51 children without DCD participated in the study. Leg muscle kinetics were measured using surface electromyography when performing YBT-LQ. Children with DCD exhibited an overall lower YBT-LQ scores than controls. They had a lower peak gastrocnemius medialis activation for YBT-LQ posteromedial direction and shorter duration for the muscle to reach peak torque for YBT-LQ anterior direction. No relationship was found between YBT-LQ performance and leg muscle activations in children with DCD. Children with DCD exhibited a less competent YBT-LQ performance with atypical neuromuscular control.

Subtyping children with developmental coordination disorder based on physical fitness outcomes

PURPOSE

Children with Developmental Coordination Disorder (DCD) are known to have poor physical fitness. However, differentiating homogenous subgroups of DCD using fitness performance has not yet been established. Therefore the purpose of this study was to identify subtypes in children with and without DCD using measures of physical fitness.

METHOD

Children (aged 6-10 years, n = 217) constituted the sample for this study. They were assessed on 1) aerobic fitness (20m Shuttle Run test), 2) anaerobic fitness (Muscle Power Sprint Test), 3) isometric muscle strength (handheld dynamometry) 4) functional upper and lower body strength (Functional Strength Measurement) and 5) motor coordination [Movement Assessment Battery for Children-2nd edition (MABC-2) test]. The Ward method was used to identify the various clusters.

RESULTS

Five subtypes emerged in the entire sample. In the typically developing (TD) children mainly 2 subtypes (number 5 and 2) were found containing 89% of the TD children (n = 55), with the largest group demonstrating above average performance on all measures (cluster 5). Children in subtype 2 had just above average motor coordination and good aerobic fitness but lower muscle strength. Subtypes 1, 3 and 4 were clearly "DCD" clusters, however they showed difference in fitness performance. Subtype 1 contained children with DCD who showed poor performance on all fitness outcomes (n = 45). Children with DCD in subtype 3 had poor aerobic but average strength and anaerobic fitness (n = 48). Subtype 4 contained children with DCD (n = 45) who had good muscle strength and anaerobic fitness. Of these, 36% were at risk of DCD while 24% had definite motor coordination problems.

CONCLUSION

Our findings indicate that children with and without DCD demonstrate heterogeneous physical fitness profiles. The majority of the children (66%) with DCD belonged to subtypes with lower fitness performance. Further studies are needed to confirm these findings in other samples of DCD children.

Relationship between Body Mass Index, Cardiorespiratory and Musculoskeletal Fitness among South African Adolescent Girls

Background: Cardiorespiratory and musculoskeletal fitness are important health indicators that support optimal physical functioning. Understanding the relationship between body mass index and these health markers may contribute to the development of evidence-based interventions to address obesity-related complications. The relationship between body mass index, cardiorespiratory and musculoskeletal fitness has not been well explored, particularly in female adolescents. The aim of this study was to investigate the association between body mass index, cardiorespiratory and musculoskeletal fitness among South African adolescent girls in low-income communities. Methods: This cross-sectional study included 151 adolescent girls, aged 13⁻16 years. Cardiorespiratory fitness was measured using the 20 m shuttle run test and musculoskeletal fitness was assessed using a variety of field-based tests. Height and weight were measured with standardised procedures and body mass index (BMI) was derived by the formula [BMI = weight (kg)/height (m)²]. Participants were categorised into three BMI groups using the International Obesity Task Force age- and gender-specific cut-off points. Pearson correlations were used to determine the association between body mass index, cardiorespiratory fitness and measures of musculoskeletal fitness at p ≤ 0.05. Results: Overweight and obese girls were found to have lower cardiorespiratory fitness, decreased lower extremity muscular strength, greater grip strength, and more hypermobile joints compared to normal-weight peers. BMI was negatively associated with cardiorespiratory fitness and lower extremity muscular strength. Conclusions: The findings indicate that increased body mass correlates with decreased cardiorespiratory and musculoskeletal fitness. Interventions should be developed to target these important components of physical fitness in this demographic group.