Sequencing,co-ordination and rhythm ability in young children

BACKGROUND: Sequencing ability is recognized as a fundamental component in motor co-ordination, language and reading performance. METHODS: Sequencing relationships are studied in a sample of 1013 children selected from an existing data set of 3750. Associations are analysed between scores for motor co-ordination tasks and a rhythm repetition task performed in the routine school beginners' medical examination by 4-, 5- and 6-year-old children, and class teachers' assessment of their co-ordination activities and language performance when 6, 7 and 8 years old, together with scores for a routine reading test. RESULTS: Associations are reported between motor tasks and language and reading, and between rhythm repetition and co-ordination activities, language and reading. Associations between successive motor tasks and language and reading are found to be stronger in boys, and those between hopping and reading stronger in girls. Associations between the rhythm repetition task and co-ordination activities, language and reading are also all found to be stronger in girls. DISCUSSION: Discussion finds a place for ball-catching as a sequencing task, and for sequencing ability as a component of handwriting skills. Discussion also attributes the findings of gender differences to an experiential difference in play activity, and advances a variant of the rhythm repetition task for use in further exploration of sequencing ability in young children.     

Visual contribution to walking in children with Developmental Coordination Disorder

BACKGROUND: The motor co-ordination problems of children with Developmental Coordination Disorder (DCD) have been frequently associated with poor visuospatial processing. In order to extend these findings mainly based on fine motor experiments, the present study investigates the contribution of vision to the control of walking in children with DCD. METHODS: Children with DCD (n = 12) walked at their preferred speed on a straight, firm and uncluttered walkway in a condition with normal lighting and in a dark condition. Spatiotemporal gait variables were assessed by means of a three-dimensional ProReflex camera system and compared with the gait pattern of matched, typically developing (TD) children (n = 12). RESULTS: In normal lighting, the gait pattern of both groups was similar, with the exception of subtle differences in the temporal phasing, showing a slightly longer support phase in the children with DCD. In the dark, step frequency and step length were decreased in the children with DCD, resulting in a significantly slower walking velocity. In addition, the medio-lateral excursion of the centre of mass tended to increase in this group. In the TD children, adaptations to the spatiotemporal pattern remained absent. CONCLUSIONS: These results suggest that children with DCD are more dependent on global visual flow information than TD children for the maintenance of balance and the control of velocity during walking. This increased dependency on visual control might be associated with a poorly developed internal sensorimotor model.     

Early identification: are speech/language‐impaired toddlers at increased risk for Developmental Coordination Disorder?

BACKGROUND: Developmental Coordination Disorder (DCD) is a movement skill disorder which impacts upon a child's ability to perform age-appropriate self-care and academic tasks. DCD is commonly comorbid with speech/language learning disabilities. AIM: The present study was conducted to determine whether children who had been identified with speech/language delays as toddlers demonstrated characteristics of DCD and/or speech/language problems at kindergarten age. RESULTS: Speech/language and motor assessments who were followed up at 63-80 months of age. Of the 40 children, 18 showed evidence of significant motor impairment and two-thirds of these met diagnostic criteria for DCD at follow-up. Twelve children were identified as having persistent speech/language problems and, of these, nine presented with significant motor co-ordination difficulties. Parental report of gross motor and fine motor problems at follow-up correlated highly with actual motor impairment scores. CONCLUSIONS: Young children who are in early intervention programmes for speech/language delays may have significant co-ordination difficulties that will become more evident at kindergarten age when motor deficits begin to impact self-care and academic tasks. Clinical implications for early recognition of motor issues by speech/language pathologists and the potential use of parental reporting tools are addressed.     

Motor performance and behaviour in preterm and full-term 3-year-old children

AIM: To compare the motor performance and behaviour at 3 years of age of very preterm, moderately preterm and full-term children (n = 221), who needed neonatal intensive care (NIC), and of 72 neonatally healthy full-term children (reference group). METHOD: A model for combined assessment of motor performance and behaviour (CAMPB) was used. The children's performance was assessed on the basis of observations and documentation of categories of co-ordination, attention and social behaviour included in CAMPB. RESULTS: Significantly more very preterm children showed deviations in co-ordination than children in the other groups, and this difference was most evident in comparison with the reference group. No differences were found between the groups regarding attention and social behaviour during the assessment. CONCLUSION: Very preterm children differ from moderately preterm and full-term children in their motor performance at 3 years of age. By means of CAMPB, individual children with pronounced incoordination were identified in all groups, and some of them also showed pronounced lack of attention.     

Deficits in motor co-ordination and attention at 3 years of age predict motor deviations in 6.5-year-old children who needed neonatal intensive care

Background   A total of 189 children without major impairments who needed neonatal intensive care (NIC) were followed up at ages 3 and 6.5 years.
Aim   To determine the prevalence of different motor deviations at age 6.5 years and the co-occurrence of attention deficits; also, to analyse the predictive ability of motor co-ordination and attention assessments at age 3 years for motor deviations at 6.5 years.
Method   A combined assessment of motor performance and behaviour (CAMPB) was used at the 3-year examination. The Test of Motor Impairment (TOMI) and the Motor-Perceptual Development (MPU) were used together with the criteria of the diagnostic and statistical manual of mental disorders (DSM-IV-TR) to define motor deviations.
Results   At 6.5 years 64% of the children showed a motor deviation either as a delay according to MPU, a problem according to TOMI or Developmental Coordination Disorder (DCD) according to DSM-IV-TR. Higher proportions of children with attention deficit (50%) were found in the DCD group. The predictive ability of CAMPB was analysed in two ways: when all children with either a co-ordination or attention deficit, or both, at 3 years were considered to be at risk for motor deviations at 6.5 years, the sensitivity reached 78% and the specificity was 42%. But when only the 3 year olds with a combined deficit were considered to be at risk, the sensitivity was 37% and the specificity 89%; however, a positive predictive value of 86% was reached.
Conclusion   At 6.5 years of age a majority of NIC children with no major impairments showed motor deviations. To fulfil the DCD criteria in DSM-IV-TR, a strict definition of motor deviations is recommended. Attention deficits are more prevalent among children with DCD. Deficits in motor co-ordination and/or attention in 3-year-old children are strong predictors of motor deviations and, especially, of DCD at 6.5 years of age.     

Associations of motor co-ordination and attention with motor-perceptual development in 3-year-old preterm and full-term children who needed neonatal intensive care

BACKGROUND: Children who have needed neonatal intensive care (NIC) are considered to be at risk for deficits such as developmental co-ordination disorder and attention-deficit/hyperactivity disorder. By assessing motor-perceptual development, motor co-ordination and attention already at 3 years of age, it might be possible to identify such deficits earlier than they are today. AIM: To investigate the motor-perceptual development in a group of 202 NIC children but had no major impairments, to describe associations of deficits in co-ordination and attention with motor-perceptual delays, and to estimate the prevalence of NIC children with combined deficits together with a motor-perceptual delay. METHOD: Co-ordination and attention in children born very preterm (n = 57), moderately preterm (n = 75) and full-term (n = 70) were observed according to a model for Combined Assessment of Motor Performance and Behaviour while they were assessed using a developmental scale, Motor-Perceptual Development, 0-7 years, MPU. RESULTS: In two out of 14 MPU areas, a larger proportion of very preterm than of moderately preterm and full-term children had marked developmental delay. Overall, the proportion of NIC children having a motor-perceptual delay increased with increasing incoordination and especially increasing lack of attention. Twenty-one (11%) of the NIC children had different motor-perceptual delays combined with pronounced incoordination and pronounced lack of attention. CONCLUSION: Deficits in co-ordination and attention were associated with motor-perceptual delays in areas important for daily living and development of academic skills. Therefore, to find children at risk for developmental co-ordination disorder and attention-deficit/hyperactivity disorder, assessments of co-ordination and attention should be added to assessments of motor-perceptual development in 3-year-old NIC children.     

Neuropsychological function in retired workers with previous long-term occupational exposure to solvents

OBJECTIVES: It is plausible that neurodegenerative processes of aging might have a contributing role in the development of chronic effects of exposure to organic solvents. This study evaluated the risk for neuropsychological deficits among retired workers, relative to their histories of exposure to occupational solvents. METHODS: This cross sectional study evaluated retired male workers, 62-74 years of age, including 89 people with previous long-term occupational exposure to solvents (67 retired painters and 22 retired aerospace manufacturing workers), and 126 retired carpenters with relatively minimal previous exposure to solvents. Subjects completed a standardised neuropsychological evaluation and psychiatric interview, structured interviews for histories of occupational exposure and alcohol consumption, and questionnaires assessing neurological and depressive symptoms. RESULTS: By comparison with the carpenters, the painters on average reported greater cumulative alcohol consumption and had lower scores on the WAIS-R vocabulary subtest, usually presumed to reflect premorbid intellectual functioning. These findings, however, were not sufficient to account for the other study findings. Controlling for age, education, vocabulary score, and alcohol use, the painters had lower mean scores on test measures of motor, memory, and reasoning ability; and a subgroup of aerospace workers with moderate to high cumulative exposure to solvents (n = 8) had lower mean scores on measures of visuomotor speed, and motor, attention, memory, and reasoning ability. Subjects were more likely to have an increased number of relatively abnormal test scores (three or more outlier scores on 17 test measures) among both the painter group (odds ratio (OR), 3.1; 95% confidence interval (95% CI) 1.5 to 6.2) and the subgroup of aerospace workers with higher cumulative exposure (OR 5.6; 95% CI 1.0 to 38). The painters, but not the aerospace workers, reported significantly more neurological and depressive symptoms. CONCLUSIONS: The findings are consistent with residual central nervous system dysfunction from long-term exposure to organic solvents, persisting years after the end of exposure.

 

     

Do ‘clumsy’ children have visual recognition problems?

OBJECTIVE: Visual recognition by 8-year-old children with hand-eye co-ordination problems (HECP), and by a control group of children without such problems was tested using a task of visual closure. DESIGN: The task required the children to identify common objects from an incomplete visual presentation. RESULT: As predicted, it was found that the HECP children, who were designated as such solely on the basis of their motor difficulties, identified significantly fewer correct objects than their control counterparts. CONCLUSIONS: This finding raises the possibility that the visual processing problems of clumsy children contribute to, or even strongly determine, not only their movement problems but also their learning difficulties.     

Relations between playing activities and fine motor development

Children’s fine motor skills (FMS) are being increasingly recognized as an important aspect of preschool development; yet, we know very little about the experiences that foster their development. We utilized a parent-administered children’s fine and gross motor activities questionnaire (MAQ) to investigate links with FMS. We recruited a sample of 225 preschool children (aged 5;9) and assessed FMS and vocabulary. Additionally, parents completed the MAQ and a questionnaire on home literacy environment (HLE) to test two competing accounts. According to a differential account, fine motor activities lead to greater FMS, whereas according to an epiphenomenal account, a generally more educative home environment fosters FMS alongside other skills. Findings were highly differential: FMS linked to the fine-MAQ but not to the gross-MAQ or the HLE, whereas vocabulary linked to the HLE, but not the fine- or gross-MAQ. The data underscore fine motor activities as a distinct factor in the preschool period.     

Quality of motor performance in preterm and full-term 3-year-old children

BACKGROUND: A combined assessment of motor performance and behaviour (CAMPB) was introduced previously for use in a longitudinal study of children who needed neonatal intensive care (NIC) and were born very preterm (n = 68), moderately preterm (n = 81) and full-term (n = 77) and in a reference group of neonatally healthy full-term children (n = 72). Aim To follow up the quality of motor performance at 3 years of age in the above groups of children. METHOD: A detailed assessment of motor performance and an assessment of co-ordination were performed according to the CAMPB protocol. The results were compared between the different groups of children, and the relation between the two ways of assessing quality of motor performance was examined. RESULTS: The detailed assessment showed that the very preterm children had a significantly higher total score of deviations than any of the other gestational age groups of children. Also, some types of deviations were much more frequently observed in the very preterm children than in the other three groups. Some types of deviations were more often seen in children with pronounced incoordination than in children with no incoordination. The results from the two ways of assessing motor performance were strongly correlated. CONCLUSION: At 3 years of age, NIC children born very preterm have a lower quality of motor performance than NIC children born at a higher gestational age and healthy children born at term. The two ways of assessing quality of motor performance proved useful in identifying children with deviations indicating minor motor impairments.     

Rethinking clinical reasoning: time for a dialogical turn

Medical Education 2012: 46 : 1174–1178 Context Clinical reasoning lies at the heart of medical practice and has been the subject of scholarly inquiry and research for some decades. However, despite this, it is still poorly understood. This is largely because current theoretical models are limited in their explanatory power because they are based on particular assumptions of what constitutes clinical reasoning. Discussion A variety of ways of articulating and conceptualising clinical reasoning can provide us with richer means of understanding what is involved in clinical encounters. A dialogical approach to clinical reasoning is proposed. Dialogism provides a vocabulary that encourages us to integrate insights from different frameworks in ways that combine the strengths of each. Dialogism also puts a focus on the complex ways in which we use language in clinical reasoning to generate meaning. The complexity of language includes narrative, rhetoric and metaphor. Conclusions A dialogical approach does not require us to discard the findings of earlier theories about clinical reasoning, but provides us with a means of integrating what we know in ways that are more useful in the reality of clinical practice.     

Standardization of the motor scales of the Griffiths Test II on children aged 3 to 6 years in Greece

AIMS: The present study aimed at the standardization of the motor scales (A-locomotor and D-eye-hand co-ordination) of the Griffiths Test II on Greek preschool-aged children. PARTICIPANTS: Nine hundred and thirty children living in Northern Greece were assessed (455 boys and 475 girls), aged from 37 to 72 months (3-6 years old). RESULTS: Percentile ranks were determined depending on the developmental quotient and the chronological age of the child. Through the present application of the Griffiths Test to the children in our country, we showed that the average developmental quotients of the two scales were higher than the relevant published quotients of the Griffiths Test II. DISCUSSION: Some of the factors that may have contributed to faster motor development are passage of time and the environmental and cultural differences between countries. The findings reinforce the need for standardization of a test before it is applied to the population of a country, and its re-standardization on the population of the country where it was first applied.     

Evaluating a school skills programme for Australian indigenous children: A pilot study

The purpose of this study was to evaluate the effectiveness of an occupational therapy skill development programme in improving handwriting, scissor use, visual motor co-ordination and classroom behaviour, in a group of grade-one Australian urban Indigenous students. The sample (N = 13) was randomly assigned to an experimental group or comparison group. Both groups were exposed to the intervention. The experimental group received a six week school skills programme in addition to regular schooling, while the comparison group received regular schooling only. Following this, the comparison group received the same six week programme. Participants underwent pre- and post-testing using Beery-Buktenica's Developmental Test of Visual Motor Integration, Conner's Abbreviated Symptom Questionnaire, and two non-standardized handwriting and scissor skill measures. Results indicated that participants significantly improved in aspects of handwriting, scissor skills, and behaviour, but not visual motor co-ordination, following participation in the programme. The experimental group demonstrated greater improvements only in handwriting ability scores (p = 0.037), compared to a comparison group. It was concluded that a school-based occupational therapy programme was effective in improving handwriting, in a group of grade-one Australian Indigenous children.     

Patterns of cognitive function in aging: the Rotterdam Study

Cognitive impairment is an important hallmark of dementia, but deterioration of cognition also occurs frequently in non-demented elderly individuals. In more than 3,000 non-demented persons, aged 45–99 years, from the population-based Rotterdam Study we studied cross-sectional age effects on cognitive function across various domains. All participants underwent an extensive cognitive test battery that tapped into processing speed, executive function, verbal fluency, verbal recall and recognition, visuospatial ability and fine motor skills. General cognitive function was assessed by the g-factor, which was derived from principal component analysis and captured 49.2 % of all variance in cognition. We found strongest associations for age with g-factor [difference in z-score ?0.59 per 10 years; 95 % confidence interval (CI) ?0.62 to ?0.56], fine motor skill (?0.53 per 10 years; 95 % CI ?0.56 to ?0.50), processing speed (?0.49 per 10 years; 95 % CI ?0.51 to ?0.46), and visuospatial ability (?0.48 per 10 years; 95 % CI ?0.51 to ?0.45). In contrast, the effect size for the association between age and immediate recall was only ?0.25 per 10 years (95 % CI ?0.28 to ?0.22), which was significantly smaller than the relation between age and fine motor skill (P < 0.001). In conclusion, in non-demented persons of 45 years and older, general cognition deteriorates with aging. More specifically, fine motor skill, processing speed and visuospatial ability, but not memory, are affected most by age.     

Reduction of food cravings through concurrent visuospatial processing

OBJECTIVE: Two experiments adopted a working memory approach to evaluate the effectiveness of visuospatial tasks as a technique for reducing food cravings. METHOD: Dieting and non-dieting women were asked to form images of both food-related and nonfood items, induced by either pictures (Experiment 1) or verbal cues (Experiment 2). They were required to concurrently perform one of three tasks that load on the visuospatial sketch pad of working memory: saccadic eye movements, dynamic visual noise, or spatial tapping. RESULTS: In support of the working memory model of limited visuospatial capacity, concurrent visuospatial activity reduced the vividness of food-related images which, in turn, reduced the intensity of the associated craving. The same pattern of results was observed across dieters and non-dieters and for all stimulus types. DISCUSSION: Visuospatial tasks may provide a useful technique for the treatment of food craving episodes in both nonclinical and clinical populations.     

基于SWOT分析的江苏省职工医保门诊共济优化路径设计

目的：了解江苏省职工医保门诊共济机制发展环境,为其优化路径设计提供依据。方法：运用SWOT分析法探讨江苏省职工医保门诊共济机制运行的优势与劣势,面临的机遇与威胁。结果：江苏省职工医保门诊共济机制的发展有着财务基础、经办管理、医疗机构、政策导向、现实需求、数字医保背景等多方位的优势与机遇,但面临着法律体系、基金监管、协议管理、参保观念、筹资标准、待遇水平、疫情冲击等层面的劣势与威胁。结论：建立SWOT矩阵,从四个组合策略维度出发,综合分析相关对策,设计江苏省职工医保门诊共济机制的优化路径。     

Sequelae of epidemic meningococcal meningitis in Africa

Audiological and other long-term neurological sequelae were determined in 157 cases and their controls matched for age, sex and village 6 to 12 months after an epidemic of group A meningococcal meningitis in rural West Africa. 19 cases (12.1%) and 3 controls (1.9%) had moderate or severe neurological sequelae of any type (P less than 0.001); 6 cases (3.9%) and no controls had severe or profound sensorineural hearing loss (P = 0.03). There was no difference in conductive hearing loss between cases and controls. Other cranial nerve sequelae (except visual defects) and generalized neurological and motor and co-ordination sequelae were also significantly increased in cases. Sensorineural hearing loss and other cranial nerve sequelae occurred significantly more frequently in males than in females, and co-ordination sequelae more frequently in cases aged 10 years or more than in younger cases. Sensorineural hearing loss and loss of visual acuity were found significantly more frequently in cases whose treatment was delayed for 4 d or more, compared with those who received treatment sooner.     

Language and motor development in pre-term children: some questions

Summary A cohort of 37 pre-term children was assessed for both morphosyntactical and for vocabulary skills at the age of 2 and again at the age of 3 years and 6 months. They were compared with two comparison groups of full-term children (adjusted age and chronological age). The results Indicated (1) a clear asynchrony between the two components of language production assessed at both ages, (2) an accurate prediction of language delay at age 2 for pre-term children (35% of pre-term children were detected for morphosyntax as measured by Mean Length of Utterance and 27% of pre-term children were detected for vocabulary as measured by the number of different words) and, (3) no evidence on the relationship of language and motor development as measured by formal tests. Such findings strongly challenge the validity of standardized developmental tests and support to a certain extent the hypothesis that language development is independent of motor skills. A neurodevelopmental assessment is suggested.     

Case management for high-intensity service users: towards a relational approach to care co-ordination

This study is based on a formative evaluation of a case management service for high-intensity service users in Northern England. The evaluation had three main purposes: (i) to assess the quality of the organisational infrastructure; (ii) to obtain a better understanding of the key influences that played a role in shaping the development of the service; and (iii) to identify potential changes in practice that may help to improve the quality of service provision. The evaluation was informed by Gittell's relational co-ordination theory, which focuses upon cross-boundary working practices that facilitate task integration. The Assessment of Chronic Illness Care Survey was used to assess the organisational infrastructure and qualitative interviews with front line staff were conducted to explore the key influences that shaped the development of the service. A high level of strategic commitment and political support for integrated working was identified. However, the quality of care co-ordination was variable. The most prominent operational factor that appeared to influence the scope and quality of care co-ordination was the pattern of interaction between the case managers and their co-workers. The co-ordination of patient care was much more effective in integrated co-ordination networks. Key features included clearly defined, task focussed, relational workspaces with interactive forums where case managers could engage with co-workers in discussions about the management of interdependent care activities. In dispersed co-ordination networks with fewer relational workspaces, the case managers struggled to work as effectively. The evaluation concluded that the creation of flexible and efficient task focused relational workspaces that are systemically managed and adequately resourced could help to improve the quality of care co-ordination, particularly in dispersed networks.