Development of kinaesthetic sensitivity and motor performance in children

The effects of age and amplitude on wrist proprioceptive acuity

This study examined wrist proprioception in a cross-sectional sample of 44 children aged between 8-to 14-years and a control group of 10 neurologically and physically healthy adults. Using a 3-degrees of freedom robotic device, participants performed an ipsilateral joint position matching task in which target amplitude (40% or 80% functional range of motion [fRoM]) and degrees-of-freedom (Flexion/Extension [FE], Radial/Ulnar deviation [RUD], Pronation/Supination [PS]) were manipulated. Results indicated that proprioceptive function became more accurate and consistent over the developmental spectrum, but that the ability to utilize proprioceptive feedback did not reach adult levels till the age of 10-11 years. Furthermore, proprioceptive acuity was influenced by target amplitude, such that movements were more accurate for the 80% fROM compared to the 40% fROM target for both the RUD and PS DoFs, independently of age. The present results provide critical information about the typical development of wrist proprioception that will enable clinicians to chart the course of development and dysfunction in neurological disorders in children, and help establish protocols for the robotic diagnosis and assessment of neurodevelopmental disorders.

Kinesthetic deficits after perinatal stroke: robotic measurement in hemiparetic children

Background

While sensory dysfunction is common in children with hemiparetic cerebral palsy (CP) secondary to perinatal stroke, it is an understudied contributor to disability with limited objective measurement tools. Robotic technology offers the potential to objectively measure complex sensorimotor function but has been understudied in perinatal stroke. The present study aimed to quantify kinesthetic deficits in hemiparetic children with perinatal stroke and determine their association with clinical function.

Methods

Case–control study. Participants were 6–19 years of age. Stroke participants had MRI confirmed unilateral perinatal arterial ischemic stroke or periventricular venous infarction, and symptomatic hemiparetic cerebral palsy. Participants completed a robotic assessment of upper extremity kinesthesia using a robotic exoskeleton (KINARM). Four kinesthetic parameters (response latency, initial direction error, peak speed ratio, and path length ratio) and their variabilities were measured with and without vision. Robotic outcomes were compared across stroke groups and controls and to clinical measures of sensorimotor function.

Results

Forty-three stroke participants (23 arterial, 20 venous, median age 12 years, 42% female) were compared to 106 healthy controls. Stroke cases displayed significantly impaired kinesthesia that remained when vision was restored. Kinesthesia was more impaired in arterial versus venous lesions and correlated with clinical measures.

Conclusions

Robotic assessment of kinesthesia is feasible in children with perinatal stroke. Kinesthetic impairment is common and associated with stroke type. Failure to correct with vision suggests sensory network dysfunction.

Development of Proprioceptive Acuity in Typically Developing Children: Normative Data on Forearm Position Sense

This study mapped the development of proprioception in healthy, typically developing children by objectively measuring forearm position sense acuity. We assessed position sense acuity in a cross-sectional sample of 308 children (5–17 years old; M/F = 127/181) and a reference group of 26 healthy adults (18–25 years old; M/F = 12/14) using a body-scalable bimanual manipulandum that allowed forearm flexion/extension in the horizontal plane. The non-dominant forearm was passively displaced to one of three target positions. Then participants actively matched the target limb position with their dominant forearm. Each of three positions was matched five times. Position error (PE), calculated as the mean difference between the angular positions of the matching and reference arms, measured position sense bias or systematic error. The respective standard deviation of the differences between the match and reference arm angular positions (SDP_diff) indicated position sense precision or random error. The main results are as follows: First, systematic error, measured by PE, did not change significantly from early childhood to late adolescence (Median PE at 90° target: −2.85° in early childhood; −2.28° in adolescence; and 1.30° in adults). Second, response variability as measured by SDP_diff significantly decreased with age (Median SDP_diff at 90° target: 9.66° in early childhood; 5.30° in late adolescence; and 3.97° in adults). The data of this large cross-sectional sample of children document that proprioceptive development in typically developing children is characterized as an age-related improvement in precision, not as a development or change in bias. In other words, it is the reliability of the perceptual response that improves between early childhood and adulthood. This study provides normative data against which position sense acuity in pediatric patient populations can be compared. The underlying neurophysiological processes that could explain the observed proprioceptive development include changes in the tuning of muscle spindles at the spinal level, the maturation of supraspinal somatosensory pathways and the development of interhemispheric callosal connections responsible for the transfer of somatosensory information.

Measuring change in somatosensation across the lifespan

OBJECTIVE

The study aim was to determine natural variability in somatosensation across age groups using brief measures. We validated measures in a community-dwelling population as part of the National Institutes of Health (NIH) Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox; http://www.nihtoolbox.org).

METHOD

Participants included community-dwelling children and adults (N=367, ages 3-85 yr) across seven sites. We tested haptic recognition, touch detection-discrimination, and proprioception using brief affordable measures as required by the NIH Toolbox.

RESULTS

Accuracy improved from young children to young adults; from young to older adults, the pattern reversed slightly. We found significant differences between adults and older adults. One proprioception test (kinesthesia; p=.003) showed gender differences (females more accurate). We provide expected score ranges for age groups as a basis for understanding age-related expectations for somatosensory perception.

CONCLUSION

The age-related patterns of somatosensory perception from this study refine decision making about performance.

Kinaesthetic Acuity in Preprimary Children at Risk of Developmental Coordination Disorder

The current study examined kinaesthetic acuity and Performance IQ in preprimary children (aged 4-5 years) at risk of Developmental Coordination Disorder (DCD; American Psychiatric Association, 1994). Individual assessment of 317 children over four sessions at their pre-primary centre identified 31 children at risk of Developmental Coordination Disorder. These children were matched with 31 control children on age, gender, and Verbal IQ. The two groups were assessed using three Performance IQ subtests of the WPPSI-R and the Kinaesthetic Acuity Test (KAT, Livesey & Parkes, 1995). The results indicate that kinaesthetic acuity and Performance IQ subtests significantly differentiate children at risk of DCD from control children. These results suggest a need to assess the efficacy of kinaesthetic training in young children at risk of DCD. Furthermore, psychologists may be able to assist in the early detection of children at-risk of DCD via the WPPSI-R assessment results routinely obtained for young children.

Developmental coordination disorders: state of art

In the literature, descriptions of children with motor coordination difficulties and clumsy movements have been discussed since the early 1900s. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), it is a marked impairment in the development of fine or global motor coordination, affecting 6% of school-age children. All these children are characterized for developmental coordination disorder (DCD) in motor learning and new motor skill acquisition, in contrast to adult apraxia which is a disorder in the execution of already learned movements. No consensus has been established about etiology of DCD. Intragroup approach through factor and cluster analysis highlights that motor impairment in DCD children varies both in severity and nature. Indeed, most studies have used screening measures of performance on some developmental milestones derived from global motor tests. A few studies have investigated different functions together with standardized assessments, such as neuromuscular tone and soft signs, qualitative and quantitative measures related to gross and fine motor coordination and the specific difficulties -academic, language, gnosic, visual motor/visual-perceptual, and attentional/executive- n order to allow a better identification of DCD subtypes with diagnostic criteria and to provide an understanding of the mechanisms and of the cerebral involvement.

Measuring kinaesthetic sensitivity in typically developing children

This study presents a method to quantify a child's sensitivity to passive limb motion, which is an important aspect of kinaesthesia not easily examined clinically. Psychophysical detection thresholds to passive forearm motion were determined in a group of 20 typically developing pre-adolescent children (mean age 12y 6mo, SD 10mo, range 11-13y) and a group of 10 healthy adults (mean age 29y 10mo, SD 10y 7mo, range 18-50y). A newly designed passive motion apparatus was used to measure the time to detection of forearm motion and the errors in determining movement direction. Results showed that limb motion sensitivity became increasingly variable below 0.3 degrees /s in children and adults. In comparison with adults, movement detection times in the pediatric group were increased by between 4% and 108% for the range of tested velocities (0.075-1.35 degrees /s). At 0.075 degrees /s, 5% of the children, but 50% of the adults, made no directional error, indicating that motion perception became unreliable at such low velocity in both groups. The findings demonstrate that sensitivity to passive forearm motion in children should be tested at a range between 0.075 and 0.3 degrees /s. They further suggest that passive motion sensitivity may not be fully developed in pre-adolescent children.

Practitioner review: approaches to assessment and treatment of children with DCD: an evaluative review

BACKGROUND

Movement clumsiness (or Developmental Coordination Disorder--DCD) has gained increasing recognition as a significant condition of childhood. However, some uncertainty still exists about diagnosis. Accordingly, approaches to assessment and treatment are varied, each drawing on distinct theoretical assumptions about the aetiology of the condition and its developmental course.

METHOD

This review evaluates the current status of different approaches to motor assessment and treatment for children with DCD. These approaches are divided according to their broad conceptual origin (or explanatory framework): Normative Functional Skill Approach, General Abilities Approach, Neurodevelopmental Theory, Dynamical Systems Theory, and the Cognitive Neuroscientific Approach.

CONCLUSIONS

Each conceptual framework is shown to support assessment and treatment methods with varying degrees of conceptual and psychometric integrity. The normative functional skill approach supports the major screening devices for DCD and cognitive (or top-down) approaches to intervention. The general abilities approach and traditional neurodevelopmental theory are not well supported by recent research. The dynamical systems approach supports promising trends in biomechanical or kinematic analysis of movement, ecological task analysis, and task-specific intervention. Finally, and more recently, the cognitive neuroscientific approach has generated some examples of process-oriented assessment and treatment based on validated (brain-behaviour) models of motor control and learning. A multi-level approach to movement assessment and treatment is recommended for DCD, providing a more complete representation of motor development at different levels of function--behavioural, neurocognitive, and emotional.

Development of upper limb proprioceptive accuracy in children and adolescents

This study was designed to determine differences in the proprioceptively guided movements of children (8-10 years) and adolescents (16-18 years). Participants were blindfolded and asked to actively match passively determined target positions of the elbow joint under three matching conditions. Overall, children were less accurate than adolescents in all matching tasks and utilized different kinematic strategies for making the matching movements. Specifically, children made larger absolute errors and utilized matching movements which, compared to adolescents, were of shorter duration and less irregular in terms of their velocity profiles. An assessment of limb asymmetry was also performed revealing a non-dominant arm matching advantage but only for children and only in the task requiring interhemispheric transfer of a memory-based model of limb position. The proprioceptive differences observed in this study are likely the result of experience-driven refinement in the utilization of somatosensory feedback throughout childhood and into adolescence.

Use of proprioception in normal and clumsy children

This study investigates the relation between performance on simple tasks dependent on proprioception, and performance of complex perceptual-motor skills in clumsy children and age-matched control children. One hundred and forty-six right-handed children aged between 5 and 8 years were tested on non-visual aiming, non-visual posture matching, the Kinaesthetic Sensitivity Test (KST), and the Movement Assessment Battery for Children (ABC). Half of the children had scores below the 15th centile on the Movement ABC and were classed into the developmental coordination disorder (clumsiness) group. Scores on the proprioceptive tasks were used to predict performance on complex tasks of the subscales of the Movement ABC (manual dexterity, ball skills, and balance). Specific relations were found between the proprioceptive tasks and the subscales of the Movement ABC, but the KST did not predict differences in motor skills, and no relation was found between tasks carried out without vision. Simple non-visual movement tasks do predict performance in more complex skilled tasks but this is affected by many task features rather than simply the reliance on proprioception for information about movement.

Planning and execution of action in children with and without developmental coordination disorder

Ninety-five children from six English primary schools were identified on the basis of the Movement Assessment Battery for Children (Movement ABC) as having developmental coordination disorder (DCD) and, together with age- and ability-matched controls, were given three tasks that involved proprioception in the control and discrimination of limb position, and two tasks that involved planning for end state comfort after a bar was grasped and turned. The children in the DCD group performed less well on the majority of the proprioceptive tasks, but did not differ from controls in planning of grip selection. There was an improvement in grip planning with age. The results are contrasted with research indicating that people with autism do have a difficulty with planning grip selection.

Kinaesthetic acuity and fine motor skills in children with attention deficit hyperactivity disorder: a preliminary report

Two groups of 9-year-old children (24 children with attention deficit hyperactivity disorder [ADHD] and 24 controls) were assessed for kinaesthetic acuity and fine motor skills with medication withdrawn. Results showed significantly poorer performance on both tasks for children with ADHD, but only a weak association between fine motor and kinaesthetic performance. The implications are discussed, particularly the role of attention to proprioceptive signals in children with the diagnosis of ADHD.

The remediation of clumsiness. I: An evaluation of Laszlo's kinaesthetic approach

The effectiveness of a kinaesthetic training programme proposed by Laszlo for children with movement difficulties was evaluated by comparing two groups of 10 'clumsy' children matched pairwise on age, IQ and sex as well as degree of kinaesthetic and motor impairment. Tests of kinaesthetic ability, using the Parameter Estimation by Sequential Testing (PEST) procedure, and motor competence administered before and after treatment revealed an improvement in both groups on all measures but no differential effect of the training programme. Immediately after training, the changes we obtained in motor performance were confined to balance skills but, at follow up, 3 months later, changes in manual and ball skills were also evident. This unusual pattern of change requires replication. Our findings forced us to consider the possibility that any effect of Laszlo's recommended training programme had been obscured by our use of the PEST procedure, which had in itself facilitated motor learning.

Kinaesthetic sensitivity and motor performance of children with developmental co-ordination disorder

Earlier research has demonstrated a number of variables contributing to motor co-ordination problems (clumsiness) in children. The present study examined the contribution of kinaesthetic sensitivity in determining level of motor co-ordination in children. 20 children with significant movement problems were compared with 20 control children matched for age, gender and Verbal IQ. The kinaesthetic perception and memory test from Laszlo and Bairstow's Kinaesthetic Sensitivity test was a powerful measure for distinguishing clumsy from control children. The authors' passive kinaesthetic acuity test did not distinguish the two groups, but did so when administered actively. These results indicate that future research on clumsiness in children should involve more complex tasks, as problems associated with the central translation processes may cause the co-ordination difficulties seen in clumsy children.

Evaluation of cutaneous and proprioceptive sensation in children: a reliability study

Forty-three healthy children aged between six and 12 years were tested to determine the intra-rater reliability of four clinical cutaneous and proprioceptive sensory assessment tools: touch pressure, vibration perception, thermal discrimination and kinaesthesis. The tests were carried out bilaterally on proximal and distal upper- and lower- extremity sites. The mean intraclass coefficients represented good to excellent reliability, which suggests that these assessment tools allow objective and reproducible measurements of cutaneous and proprioceptive sensation in children. The results were compared with existing data in the literature: in general, children and adults obtain similar sensory scores, and sex, age and laterality have no significant effect on the results for any test. However, the touch-pressure and vibration scores were significantly influenced by the site tested, the index fingerpad being the most sensitive area in both tests.

Kinaesthetic abilities of clumsy children

Kinaesthesis was examined in 80 clumsy and 80 control children aged between six and nine years. Seven tasks were administered which required passive and active movements in both kinaesthetic and kinaesthetic-visual modes. Clumsy children performed inferiorly on three tasks which involved passive or active demands. A range of tasks appears to be necessary to identify kinaesthetic dysfunction.

Visuomotor performance of normal and clumsy children. I: Fast goal-directed arm-movements with and without visual feedback

The mechanisms underlying accuracy in fast goal-directed arm-movements were investigated in normal and clumsy children in two age-groups, six to seven and 10 to 11 years. Clumsy children in both age-groups had a longer movement time than normal children; this difference increased slightly when there was visual feedback. For both normal and clumsy children, the relative variability of the total distance moved was smaller than that of the distance moved during acceleration, indicating a variability reduction mechanism in the course of a movement. In the six- to seven-year-old group, the relative variability of the distance moved during acceleration and of the total distance was larger for clumsy than for normal children; this did not reach significance in the 10- to 11-year-old group. It is suggested that motor difficulties are linked to inaccuracy in open-loop control processes and to less efficient use of visual feedback.