A sensorimotor approach to the training of manual actions in children with developmental coordination disorder

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.

Enhancing Handwriting Performance of Children with Developmental Coordination Disorder (DCD) Using Computerized Visual Feedback

Recent studies have analyzed the writing metrics of children with developmental coordination disorder (DCD) using computerized systems. To date, the use of computerized visual feedback to improve handwriting has not been investigated. This study aimed to examine the effects of computerized visual feedback on handwriting performance in time, spatial orientation, and pressure indices for children with DCD. Twenty-seven children aged 7 to 12 years with DCD assessed by the Movement Assessment Battery for Children and the Developmental Coordination Disorder Questionnaire received one weekly intervention session for 8 weeks, during which they twice copied an excerpt onto a tablet. Once, they received visual feedback where the writing color corresponded to the degree of pressure on the writing surface, and once they received no visual feedback. The two conditions were counterbalanced throughout the sessions. Pre-intervention sessions were compared with post-intervention sessions and with new texts for time, spatial orientation, and pressure measures. The findings revealed significantly decreased total and mean letter writing, in-air, and writing time and increased capacity in the visual feedback condition. In the spatial variables, a significant decrease in letter height variance was found. Pressure increased significantly throughout the intervention with visual feedback, whereas it decreased post-test in the writing task in both conditions and was maintained in the new text. Visual feedback intervention can increase the kinesthetic-haptic feedback required to regulate pressure during writing, promoting more efficient feedforward processes and improving output quality and capacity. The training effectiveness was transferable, and the intervention accessibility could increase student autonomy.

Table Tennis, as a Method of Sensorimotor Training, Induces Haptic and Motor Gains in Children With a Probable Developmental Coordination Disorder

This study examined whether table tennis as a method of sensorimotor training improves haptic and motor function and to what extent haptic function gain correlates with changes in motor ability in children with probable developmental coordination disorder (pDCD). Children with pDCD were randomly assigned to the table tennis and nontraining control groups. The children in the table tennis group received 36 sessions of table tennis training, including ball balancing, hitting the ball against the wall, strokes, and serving. Haptic sensitivity, acuity, and motor function domains were measured. The results showed a 41.5% improvement in haptic sensitivity in children exposed to table tennis training compared with 2.8% in those without training. This improved haptic sensitivity significantly correlated with motor function gain, suggesting that somatosensory gains occur simultaneously with changes in motor function in children with pDCD. This novel upper limb motor training approach may be an interesting method of sensorimotor training in neurological rehabilitation in children with pDCD.

Making all the right moves: Clinician-led development and pilot of an evaluative toolkit for a community-based school readiness group program

Introduction

Children often present to occupational therapy with delays in pre-school occupations, with underlying skill deficits. If unaddressed, deficits may affect adjustment to school, jeopardising educational progress. Although evidence supports group-based interventions, evaluation can be time-intensive and expensive. We developed and piloted an evaluative toolkit to measure and report outcomes for short school readiness groups.

Method

We sought measures that were inexpensive, reliable and responsive to change in key domains. Skills and pre-school occupations were measured in children [n = 58; mean = 5 years] before and after our school starters group program. Parents rated their children's skills, school readiness and level of school-related anxiety.

Results

Our resource-efficient, multi-measure, skills-based evaluative toolkit reliably recorded changes in children's performance in our school readiness program. Measures were adapted for groups. Children demonstrated improvements in skills important for successful school transition pre-post program; including static and dynamic balance, pencil grasp/control, pre-writing/drawing skills and name writing. Parents' confidence in their child's readiness for school increased, while school-related-anxiety decreased.

Conclusion

The evaluative toolkit proved responsive to change and showed excellent inter-rater reliability. Measures were practicable for groups, easy to administer and score, and engaged parents in their child's progress. In our six-session School Starters group, important pre-school skills were improved in participating children.

Exploring disturbance as a force for good in motor learning

Disturbance forces facilitate motor learning, but theoretical explanations for this counterintuitive phenomenon are lacking. Smooth arm movements require predictions (inference) about the force-field associated with a workspace. The Free Energy Principle (FEP) suggests that such 'active inference' is driven by 'surprise'. We used these insights to create a formal model that explains why disturbance might help learning. In two experiments, participants undertook a continuous tracking task where they learned how to move their arm in different directions through a novel 3D force field. We compared baseline performance before and after exposure to the novel field to quantify learning. In Experiment 1, the exposure phases (but not the baseline measures) were delivered under three different conditions: (i) robot haptic assistance; (ii) no guidance; (iii) robot haptic disturbance. The disturbance group showed the best learning as our model predicted. Experiment 2 further tested our FEP inspired model. Assistive and/or disturbance forces were applied as a function of performance (low surprise), and compared to a random error manipulation (high surprise). The random group showed the most improvement as predicted by the model. Thus, motor learning can be conceptualised as a process of entropy reduction. Short term motor strategies (e.g. global impedance) can mitigate unexpected perturbations, but continuous movements require active inference about external force-fields in order to create accurate internal models of the external world (motor learning). Our findings reconcile research on the relationship between noise, variability, and motor learning, and show that information is the currency of motor learning.

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

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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.

Training children aged 5-10 years in manual compliance control to improve drawing and handwriting

A large proportion of school-aged children exhibit poor drawing and handwriting. This prevalence limits the availability of therapy. We developed an automated method for training improved manual compliance control and relatedly, prospective control of a stylus. The approach included a difficult training task, while providing parametrically modifiable support that enables the children to perform successfully while developing good compliance control. The task was to use a stylus to push a bead along a 3D wire path. Support was provided by making the wire magnetically attractive to the stylus. Support was progressively reduced as 3D tracing performance improved. We report studies that (1) compared performance of Typically Developing (TD) children and children with Developmental Coordination Disorder (DCD), (2) tested training with active versus passive movement, (3) tested progressively reduced versus constant or no support during training, (4) tested children of different ages, (5) tested the transfer of training to a drawing task, (6) tested the specificity of training in respect to the size, shape and dimensionality of figures, and (7) investigated the relevance of the training task to the Beery VMI, an inventory used to diagnose DCD. The findings were as follows. (1) Pre-training performance of TD and DCD children was the same and good with high support but distinct and poor with low support. Support yielded good self-efficacy that motivated training. Post training performance with no support was improved and the same for TD and DCD children. (2) Actively controlled movements were required for improved performance. (3) Progressively reduced support was required for good performance during and after training. (4) Age differences in performance during pre-training were eliminated post-training. (5) Improvements transferred to drawing. (6) There was no evidence of specificity of training in transfer. (7) Disparate Beery scores were reflected in pre-training but not post-training performance. We conclude that the method improves manual compliance control, and more generally, prospective control of movements used in drawing performance.

Evaluating the evidence for motor-based interventions in developmental coordination disorder: A systematic review and meta-analysis

BACKGROUND

As part of the process of creating an update of the clinical practice guidelines for developmental coordination disorder (DCD) (Blank, Smits-Engelsman, Polatajko, & Wilson, 2012), a systematic review of intervention studies, published since the last guidelines statement was conducted.

AIM

The aim of this study was to 1) systematically review the evidence published from January 2012 to February 2017 regarding the effectiveness of motor based interventions in individuals with DCD, 2) quantify treatment effects using a meta-analysis, 3) examine the available information on different aspects of delivery including use of group intervention, duration and frequency of therapy, and 4) identify gaps in the literature and make recommendations for future intervention research.

METHOD

An electronic search of 5 databases (PubMed, Embase, Pedro, Scopus and Cochrane) was conducted for studies that evaluated motor-based interventions to improve performance for individuals with DCD.

RESULTS

Thirty studies covering 25 datasets were included, 19 of which provided outcomes on standardized measures of motor performance. The overall effect size (Cohen's d) across intervention studies was large (1.06), but the range was wide: for 11 interventions, the observed effect was large (>0.80), in eight studies moderate (>0.50), and in five it was small or negligible (<0.50). Positive benefits were evident for activity-oriented approaches, body function-oriented combined with activities, active video games, and small group programs.

CONCLUSION

Results showed that activity-oriented and body function oriented interventions can have a positive effect on motor function and skills. However, given the varied methodological quality and the large confidence intervals of some studies, the results should be interpreted with caution.

Catching-up: Children with developmental coordination disorder compared to healthy children before and after sensorimotor therapy

The aims of the present study were to (a) compare healthy children in terms of sensorimotor maturity to untreated children diagnosed with developmental coordination disorder (DCD) and (b) compare healthy children to diagnosed children following completed treatment with sensorimotor therapy. Participants were 298 children, 196 boys and 102 girls, distributed into a Norm group of healthy children (n = 99) and a group of children diagnosed with DCD (n = 199) with a total mean age of 8.77 years (SD = 2.88). Participants in both groups were assessed on instruments aimed to detect sensorimotor deviations. The children in the DCD group completed, during on average 36 months, sensorimotor therapy which comprised stereotypical fetal- and infant movements, vestibular stimulation, tactile stimulation, auditory stimulation, complementary play exercises, gross motor milestones, and sports-related gross motor skills. At the final visit a full assessment was once more performed. Results showed that the Norm group performed better on all sensorimotor tests as compared to the untreated children from the DCD group, with the exception of an audiometric test where both groups performed at the same level. Girls performed better on tests assessing proprioceptive and balance abilities. Results also showed, after controls for natural maturing effects, that the children from the DCD group after sensorimotor therapy did catch up with the healthy children. The concept of "catching-up" is used within developmental medicine but has not earlier been documented with regard to children and youth in connection with DCD.

Relationship between perceived competence and performance during real and virtual motor tasks by children with developmental coordination disorder

PURPOSE

(i) To compare children with DCD and typically developing participants via standard motor assessments, two interactive virtual games, measures of physical, social and cognitive self-competence and feedback while playing the virtual games and (ii) To examine the contribution of age and each motor assessment to predict self-competence.

METHODS

Participants were 25 boys with DCD and 25 typically developing boys, aged 5-9 years. They completed the M-ABC-2, the Pictorial Scale of Perceived Competence, the 6-Minute Walk Test, and then played the two Kinect games and completed the Short Feedback Questionnaire for Children.

RESULTS

Children with DCD showed lower physical competence and lower performance than the typical controls in all standard motor assessments. This performance significantly correlated with the children achievements in part of virtual games and with their self-perceived experience while performing within virtual environments. Among the DCD group, Kinect Running game significantly predicted physical and social competence.

CONCLUSIONS

The significant correlations between the virtual games and standard motor assessments support the feasibility of using these games when evaluating children with DCD for the richer profile they provide. Implications for rehabilitation Clinicians should refer to the impacts of DCD on child's self-competence and daily life. Technological rehabilitation and the use of VR games have the potential to improve self-competence of children with DCD. By including VR games that simulate real life in the intervention for DCD, clinicians may raise child's enjoyment, self-competence and involvement in therapy.

A systematic review of high quality randomized controlled trials investigating motor skill programmes for children with developmental coordination disorder

OBJECTIVE

To identify effective motor training interventions for children with developmental coordination disorder from research graded as high quality (using objective criteria) for the purpose of informing evidence-based clinical practice.

DATA SOURCES

We followed the guidance for conducting systematic reviews issued by the Centre for Reviews and Dissemination. Six OvidSP electronic databases (AMED, All EBM reviews (including Cochrane), Embase, Ovid MEDLINE, PsychARTICLES Full Text, PsycINFO) were searched systematically. We aimed to retain only randomized control trials and systematic reviews of randomized control trials, defined as the highest level of evidence by the Oxford Centre for Evidence-Based Medicine. We searched reference lists of retained articles to identify further appropriate articles.

REVIEW METHODS

Two reviewers critically appraised and categorized articles by effect size (including confidence intervals), inclusion of power calculations and quality using the Physiotherapy Evidence Database (PEDro) scale. Only studies scoring seven or more on the PEDro scale (classed by the PEDro as high reliability) were retained.

RESULTS

No systematic reviews met our criteria for inclusion from 846 articles yielded by the systematic search. Nine randomized control trials investigating 15 interventions to improve motor skills met our inclusion criteria for 'high quality'. Nevertheless, not all included studies were adequately powered for determining an effect.

CONCLUSION

Large effect sizes associated with 95 % confidence intervals suggest that 'Neuromotor Task Training', 'Task-oriented Motor Training' and 'Motor Imagery + Task Practice Training' are the most effective reported interventions for improving motor skills in children with developmental coordination disorder.

Training compliance control yields improved drawing in 5-11year old children with motor difficulties

There are a large number of children with motor difficulties including those that have difficulty producing movements qualitatively well enough to improve in perceptuo-motor learning without intervention. We have developed a training method that supports active movement generation to allow improvement in a 3D tracing task requiring good compliance control. Previously, we tested a limited age range of children and found that training improved performance on the 3D tracing task and that the training transferred to a 2D drawing test. In the present study, school children (5-11years old) with motor difficulties were trained in the 3D tracing task and transfer to a 2D drawing task was tested. We used a cross-over design where half of the children received training on the 3D tracing task during the first training period and the other half of the children received training during the second training period. Given previous results, we predicted that younger children would initially show reduced performance relative to the older children, and that performance at all ages would improve with training. We also predicted that training would transfer to the 2D drawing task. However, the pre-training performance of both younger and older children was equally poor. Nevertheless, post-training performance on the 3D task was dramatically improved for both age groups and the training transferred to the 2D drawing task. Overall, this work contributes to a growing body of literature that demonstrates relatively preserved motor learning in children with motor difficulties and further demonstrates the importance of games in therapeutic interventions.

Robot Guided 'Pen Skill' Training in Children with Motor Difficulties

Motor deficits are linked to a range of negative physical, social and academic consequences. Haptic robotic interventions, based on the principles of sensorimotor learning, have been shown previously to help children with motor problems learn new movements. We therefore examined whether the training benefits of a robotic system would generalise to a standardised test of ‘pen-skills’, assessed using objective kinematic measures [via the Clinical Kinematic Assessment Tool, CKAT]. A counterbalanced, cross-over design was used in a group of 51 children (37 male, aged 5–11 years) with manual control difficulties. Improved performance on a novel task using the robotic device could be attributed to the intervention but there was no evidence of generalisation to any of the CKAT tasks. The robotic system appears to have the potential to support motor learning, with the technology affording numerous advantages. However, the training regime may need to target particular manual skills (e.g. letter formation) in order to obtain clinically significant improvements in specific skills such as handwriting.

Progressive reduction versus fixed level of support during training: When less is less

Previous empirical and theoretical work suggests that effective skill acquisition requires movements to be generated actively and that learning new skills supports the acquisition of prospective control. However, there are many ways in which practice can be structured, that may affect the acquisition and use of prospective control after training. Here, we tested whether the progressive modulation and reduction of support during training was required to yield good performance after training without support. The task was to use a stylus to push a bead over a complex 3D wire path. The support "magnetically" attracted and held the stylus onto the wire. Three groups of adult participants each experienced one of three training regimes: gradual reduction of magnetic attraction, only a medium level of attraction, or low magnetic attraction. The results showed that use of a single (medium) level of support was significantly less effective in yielding good performance with low support after training. Training with low support yielded post-training performance that was equally good as that yielded by training with progressive reduction of support; however, performance during training was significantly poorer in the former. Thus, less support during training yields effective learning but more difficult training sessions. The results are discussed in the context of application to training with special populations.

Postural Sway and Clinical Characteristics in Patients with Psychotic Disorders: A Review

Postural instability is a feature that is frequently observed in patients with psychotic disorders. Previous studies applied rating scales or behavioral test to assess postural instabilities. Recently, a pressure-sensitive platform has been used to study detailed characteristics of postural sway and regulation. However, characteristics of posturography indices in patients with psychotic disorders have not been well documented. To integrate the findings from studies that assessed postural sway using posturography in patients with psychotic disorders, we conducted a systematic review. Following database literature search, we identified nine eligible articles. Assessment conditions and indices of postural stability varied between studies. Postural control was associated with negative and general psychopathology in two studies. Two studies reported associations between posturographic variables and medication dose, whereas four studies reported no associations. This review identified the need to develop standards to assess postural sway in patients with psychiatric disorders. Further studies need to report associations between postural sway and confounding factors.

Training to improve manual control in 7-8 and 10-12 year old children: Training eliminates performance differences between ages

Many children have difficulty producing movements well enough to improve in perceptuo-motor learning. We have developed a training method that supports active movement generation to allow improvement in a 3D tracing task requiring good compliance control. We previously tested 7-8 year old children who exhibited poor performance and performance differences before training. After training, performance was significantly improved and performance differences were eliminated. According to the Dynamic Systems Theory of development, appropriate support can enable younger children to acquire the ability to perform like older children. In the present study, we compared 7-8 and 10-12 year old school children and predicted that younger children would show reduced performance that was nonetheless amenable to training. Indeed, the pre-training performance of the 7-8 year olds was worse than that of the 10-12 year olds, but post-training performance was equally good for both groups. This was similar to previous results found using this training method for children with DCD and age-matched typically developing children. We also found in a previous study of 7-8 year old school children that training in the 3D tracing task transferred to a 2D drawing task. We now found similar transfer for the 10-12 year olds.

Individual differences in learning a novel discrete motor task

Many motor learning studies focus on average performance while it is known from everyday life experience that humans differ in their way of learning new motor tasks. This study emphasises the importance of recognizing individual differences in motor learning. We studied individual tool grasping profiles of individuals who learned to pick up objects with a novel tool, a pair of pliers. The pair of pliers was attached to the thumb and the index finger so that the tip of the thumb and the tip of the index finger were displaced to the beaks of the pair of pliers. The grasp component was manipulated by varying the location of the hinge of the pair of pliers, which resulted in different relations between beak opening and closing and finger opening and closing. The Wider Beak group had the hinge at 7 cm, the Same Beak group had the hinge at 10 cm (i.e., in the middle), and the Smaller Beak group had the hinge at 13 cm from the digits. Each group consisted of ten right-handed participants who picked up an object with one of the pairs of pliers 200 times on two subsequent days. Hand opening, plateau phase, hand closing, grasping time and maximum aperture were analyzed. To characterize individual changes over practice time, a log function was fitted on these dependent variables and the ratio of improvement was determined. Results showed that at the beginning stage of tool use learning the characteristic grasping profile consisted of three phases; hand opening, plateau phase and hand closing. Over practicing individual participants differed in the number of phases that changed, the amount of change in a phase and/or the direction of change. Moreover, with different pliers different learning paths were found. The importance of recognizing individual differences in motor learning is discussed.

Training compliance control yields improvements in drawing as a function of Beery scores

Many children have difficulty producing movements well enough to improve in sensori-motor learning. Previously, we developed a training method that supports active movement generation to allow improvement at a 3D tracing task requiring good compliance control. Here, we tested 7–8 year old children from several 2^nd grade classrooms to determine whether 3D tracing performance could be predicted using the Beery VMI. We also examined whether 3D tracing training lead to improvements in drawing. Baseline testing included Beery, a drawing task on a tablet computer, and 3D tracing. We found that baseline performance in 3D tracing and drawing co-varied with the visual perception (VP) component of the Beery. Differences in 3D tracing between children scoring low versus high on the Beery VP replicated differences previously found between children with and without motor impairments, as did post-training performance that eliminated these differences. Drawing improved as a result of training in the 3D tracing task. The training method improved drawing and reduced differences predicted by Beery scores.

Understanding the mechanisms of cognitive impairments in developmental coordination disorder

Developmental coordination disorder (DCD), a neurodevelopmental disability in which a child's motor coordination difficulties significantly interfere with activities of daily life or academic achievement, together with additional symptoms of diseases with childhood sensorimotor impairments, increases the risk of many cognitive problems. This exhibits the dynamic interplay between sensorimotor and cognition systems. However, the brain structures and pathways involved have remained unknown over the past decades. Here, we review developments in recent years that elucidate the neural mechanisms involved in the sensorimotor-cognitive difficulties. First, we briefly address the clinical and epidemiological discoveries in DCD as well as its comorbidities. Subsequently, we group the growing evidence including our findings that support the notion that sensorimotor manipulation indeed affects the cognition development at systematic, circuitry, cellular, and molecular levels. This corresponds to changes in diverse brain regions, synaptic plasticity, and neurotransmitter and receptor activity during development under these effects. Finally, we address the treatment potentials of task-oriented sensorimotor enhancement, as a new therapeutic strategy for cognitive rehabilitation, based on our current understanding of the neurobiology of cognitive-sensorimotor interaction.

Active prospective control is required for effective sensorimotor learning

Passive modeling of movements is often used in movement therapy to overcome disabilities caused by stroke or other disorders (e.g. Developmental Coordination Disorder or Cerebral Palsy). Either a therapist or, recently, a specially designed robot moves or guides the limb passively through the movement to be trained. In contrast, action theory has long suggested that effective skill acquisition requires movements to be actively generated. Is this true? In view of the former, we explicitly tested the latter. Previously, a method was developed that allows children with Developmental Coordination Disorder to produce effective movements actively, so as to improve manual performance to match that of typically developing children. In the current study, we tested practice using such active movements as compared to practice using passive movement. The passive movement employed, namely haptic tracking, provided a strong test of the comparison, one that showed that the mere inaction of the muscles is not the problem. Instead, lack of prospective control was. The result was no effective learning with passive movement while active practice with prospective control yielded significant improvements in performance.