The effect of subclinical infantile thiamine deficiency on motor function in preschool children

We investigated the long‐term implications of infantile thiamine (vitamin B1) deficiency on motor function in preschoolers who had been fed during the first 2 years of life with a faulty milk substitute. In this retrospective cohort study, 39 children aged 5–6 years who had been exposed to a thiamine‐deficient formula during infancy were compared with 30 age‐matched healthy children with unremarkable infant nutritional history. The motor function of the participants was evaluated with The Movement Assessment Battery for Children (M‐ABC) and the Zuk Assessment. Both evaluation tools revealed statistically significant differences between the exposed and unexposed groups for gross and fine motor development (p < .001, ball skills p = .01) and grapho‐motor development (p = .004). The differences were especially noteworthy on M‐ABC testing for balance control functioning (p < .001, OR 5.4; 95% CI 3.4–7.4) and fine motor skills (p < .001, OR 3.2; 95% CI 1.8–4.6). In the exposed group, both assessments concurred on the high rate of children exhibiting motor function difficulties in comparison to unexposed group (M‐ABC: 56% vs. 10%, Zuk Assessment: 59% vs. 3%, p < .001). Thiamine deficiency in infancy has long‐term implications on gross and fine motor function and balance skills in childhood, thiamine having a crucial role in normal motor development. The study emphasizes the importance of proper infant feeding and regulatory control of breast milk substitutes.     

Impact of Vitamin D Supplementation on Gross Motor Development of Healthy Term Infants: A Randomized Dose-Response Trial

In addition to benefits for bone health, vitamin D is implicated in muscle function in children and adults. Aims: To determine if vitamin D dosage positively correlated with gross motor development at 3 and 6 months of age. We hypothesized that higher doses would be associated with higher scores for gross motor skills. Methods: A consecutive sample of 55 healthy, term, and breastfed infants from Montreal, Canada were recruited from a randomized trial of vitamin D supplementation between 2009 and 2012. Infants were randomized to 400 International Units (IU) (n = 19), 800 IU (n = 18) or 1,200 IU (n = 18) vitamin D₃/day. Motor performance at 3 and 6 months was quantified by the Alberta Infant Motor Scale (AIMS). Plasma vitamin D₃ metabolites were measured by tandem mass spectrometry. Results: AIMS scores did not differ at 3 months. However, total AIMS scores and sitting subscores were significantly higher at 6 months in infants receiving 400 IU/day compared to 800 IU/day and 1,200 IU/day groups (p < .05). There were weak negative correlations with length and C-3 epimer of 25(OH)D. Conclusions: In contrast to our hypothesis, gross motor achievements were significantly higher in infants receiving 400 IU/day vitamin D. Our findings also support longer infants being slightly delayed.     

Responsiveness of the Test of Basic Motor Skills of Children with Down Syndrome

The aim of this study was to examine the responsiveness of the Test of Basic Motor Skills for Children with Down Syndrome (BMS). Forty-one children with Down Syndrome, 3 to 36 months of age, participated in the study. Gross motor skills were assessed three times using the BMS and the Gross Motor Function Measure (GMFM) before and after a baseline period of 2 weeks (T1-T2) and after a period of 16 weeks (T2-T3). Internal and external responsiveness of the BMS was analyzed using Guyatt's Responsiveness Index (GRI) and 2 × 2 repeated measures. Change in BMS scores was compared to change in GMFM scores and parent and physiotherapist ratings of change. The responsiveness of the BMS was large (GRI = 2.55). A significant Time × Age interaction [F(1,37) = 8.87, p < .01] indicated that BMS scores increased more for children ≤ 2 years compared with children 2 to 3 years of age. The difference in GRI between the BMS and GMFM was 0.75 (95% CI ?0.25–1.75), indicating that the BMS and GMFM did not significantly differ in responsiveness. The Time × Measure interaction was not significant, indicating that the increase in mean BMS and GMFM scores did not differ. Change in BMS scores were correlated with parent ratings of change (r = 0.65, p < .001) but not physiotherapist ratings (r = 0.36, p = .23). The results provide evidence that the BMS is responsive to change in gross motor development in children with Down Syndrome from 3 to 36 months of age.     

Effect of Touch Screen Tablet Use on Fine Motor Development of Young Children

Aim: To investigate the effects of touch-screen tablet use on the fine motor development of preschool children without developmental delay. Methods: 40 children who used a touch-screen tablet more 60 minutes per week for at least 1 month received a 24-week home fine motor activity program using a touch-screen-tablet. 40 children matched for age (mean = 61.0 months) and sex who did not meet the criteria for previous tablet use received a 24-week program consisting of manual play activities. Motor performance was measured using the Bruininks–Oseretsky Test of Motor Proficiency. The two-factor mixed design ANOVA was used to compare performance of the touch-screen tablet and non-touch-screen tablet groups. Results: Pretest analysis showed no group differences in motor performance and pinch strength. At posttest, children in the nontouch-screen-tablet group made significantly greater changes in fine motor precision (p < 0.001), fine motor integration (p = 0.008), and manual dexterity (p = 0.003). Conclusion: Using a touch screen tablet extensively might be disadvantageous for the fine motor development of preschool children.     

Psychometric Properties of the Canadian Little Developmental Coordination Disorder Questionnaire for Preschool Children

ABSTRACT

Aims: Test the psychometric properties and cut-off scores for the Canadian Little Developmental Coordination Disorder Questionnaire (Little DCDQ), which screens for coordination difficulties in children aged 3 to 4 years. Methods: Parents of children with typical development (n = 108) and children at risk for motor problems (n = 245) completed the questionnaire. A subgroup (n = 119) of children was tested with the Movement Assessment Battery for Children-2 (MABC-2) and the Beery–Buktenica Developmental Test of visual-motor integration (VMI) to determine motor impairment (MI). Results: Test-retest reliability (r = 0.956, p < .001) and internal consistency (Cronbach's alpha = 0.94) were high. Construct validity was supported by a factor analysis and significant difference in scores of children who were typically developing and were at risk. Concurrent validity was evaluated for the children who received standardized motor testing, with significant difference between children with and without MI. Discriminant function analysis showed that all 15 items were able to distinguish the two groups. The questionnaire correlated well with the MABC-2 and VMI. Validity as a screening tool was assessed using logistic regression modeling (X²(5) = 25.87, p < .001) and receiver operating curves, establishing optimal cut-off values with adequate sensitivity. Conclusions: The Little DCDQ is a reliable, valid instrument for early identification of children with motor difficulties.     

Concurrent Validity of the Bayley-III and the Peabody Developmental Motor Scales-2 at 18 Months

Aim: To determine concurrent validity between the Bayley Scales of Infant and Toddler Development, 3^rd edition (Bayley-III) and the Peabody Developmental Motor Scales, 2^nd edition (PDMS-2). Methods: Both assessments were administered to 184 preterm children at 18?months corrected age; standard scores for total score, gross motor, and fine motor were calculated for each child. Cross-tabulation and Pearson correlation coefficient (r) determined concurrent validity between the Bayley-III and the PDMS-2 motor domains. Results: High correlations were found between total motor (r?=?0.88), gross motor (r?=?0.88), and fine motor scores (r?=?0.79). Both assessments had 93% agreement on classification for motor impairment; 23 children were identified by both assessments as having motor impairments, but 12 children were identified differently on each assessment (7 as impaired on PDMS-2 but average on Bayley-III; 5 as impaired on Bayley-III but average on PDMS-2). Most children with motor impairments were identified as 1SD below the mean on the PDMS-2 (27/30) and Bayley-III (18/28); however, the Bayley-III identified more children 2SD below the mean (10/28) compared to the PDMS-2 (3/30). Conclusions: Both the Bayley-III and PDMS-2 identify motor delays in children; however, clinicians should be aware of the concurrent validity as each assessment may lead to differing results.     

Validation of the Revised Child Version of the Assessment of Computer Task Performance

Objective. The purpose of this study was to examine test-retest reliability, internal consistency, and construct validity of the revised child version of the Assessment of Computer Task Performance. The subjects were 155 children of 5 to 11 years of age who did not have any visual or motor impairment. Children 5 through 9 years of age were administered the revised test, which included some additional tasks. Children 10 and 11 years of age were administered selected tasks from the adult version. A subgroup of 52 children were administered the test for the second time to examine test-retest reliability. Intra-class correlations for the mean time to complete two trails indicated moderate to good test-retest reliability (0.66–0.91). The alpha coefficient for tasks administered to children 5 through 9 years of age (0.85) supports internal consistency. Removal of one task increased the alpha coefficient to 0.79 for tasks administered to children 10 and 11 years of age. Three factors explained 84% of the total variance in scores of children 5–9 years of age and 75% of the variance in scores of children 10 and 11 years of age. The mean time to complete keyboard tasks decreased with age and the mean time to mouse tasks decreased between 5 and 9 years. Conclusion. The results provide evidence of test-retest reliability, internal consistency, and construct validity of the revised Assessment of Computer task Performance.     

Effect of Group Setting on Gross Motor Performance in Children 3–5 Years Old with Motor Delays

Aims: The purpose of this study was to evaluate differences in gross motor performance of children 3–5 years of age with motor delays when assessed individually compared to assessment in a group setting among peers with typical development (TD). Methods: Twenty children with motor delays and 42 children with TD were recruited from a preschool program. A within-subject repeated measures design was used; each child with delay was tested both in an individual setting and in a group setting with two to four peers with TD. Testing sessions were completed 4–8 days apart. Ten different motor skills from the Peabody Developmental Motor Scales-2 were administered. Performance of each item was videotaped and scored by a blinded researcher. Results: Overall gross motor performance was significantly different (p < .05) between the two settings, with 14 of 20 children demonstrating better performance in the group setting. In particular, children performed better on locomotion items (p < .05). Conclusions: The higher scores for locomotion in the group setting may be due to the influence of competition, motivation, or modeling. Assessing a child in a group setting is recommended as part of the evaluation process.     

Motor Planning and Gait Coordination Assessments for Children with Developmental Coordination Disorder

Aims: The purposes were to examine construct validity of the Motor Planning Maze Assessment (Maze) and three items from the Functional Gait Assessment (FGA) that were modified for children (pediatric modified FGA, pmFGA), by comparing performance of children with DCD and age matched peers with typical development (TD); the construct validity of total scores of the Dynamic Gait Index (DGI) and the FGA. Methods: Twenty pairs of children with DCD and TD, age from 5 to 12 years, participated in this study. Children in both groups were tested on the Maze, pmFGA, DGI, and FGA. Paired t-tests and agreement tables were used to compare the motor performances between two groups. Results: The DCD group showed higher summary scores in the Maze (p < 0.001) and demonstrated significantly fewer steps (p ≤ 0.001) while doing the pmFGA items than the TD group. However, the FGA quality scores demonstrated minimal differences between the two groups on all three items. Children with DCD showed significantly lower DGI and FGA total scores (p < 0.001) than the TD group. Conclusion: The Maze, DGI, and FGA tests are easily applied in clinical settings and can differentiate motor planning and gait coordination between children with DCD and with TD.     

Effects of Modified Instructions on Peabody Developmental Motor Scales,Second Edition,Gross Motor Scores in Children with Typical Development

Aims: The current study assessed whether modifying instructions on the Peabody Developmental Motor Scales, Second Edition (PDMS-2) affected scores in children with typical development. Methods: The gross motor portion of the PDMS-2 was administered twice, 2–10?days apart, to 38 children. Age- and gender-matched groups received instructions in both standard and modified formats, with order depending on group assignment. Results: Gross Motor Quotient results showed an effect for instruction type (p?=?.03) and an interaction between instruction type and order (p?=?.02). Improved scores for those given modified instructions during the second session indicated the interaction favored modifications. Stationary scores showed an effect for instruction type (p?=?.01) and an interaction between instruction type and age (p?=?.02). Object Manipulation scores showed an interaction between instruction type and order only (p =.002); Locomotion scores showed no significant changes (p?=?.25). Percentile rank changes ranged from 9% to 22% across subtests. Conclusions: Findings suggested instruction modifications may change PDMS-2 gross motor scores, even in children with typical development. Findings also suggested normative scores should not be reported if modifications were used during testing. Research is needed to determine optimal cues for the best representation of true motor ability during standardized assessment.     

Early childhood development and stunting: Findings from the MAL‐ED birth cohort study in Bangladesh

Information on the association between stunting and child development is limited from low‐income settings including Bangladesh where 36% of children under‐ 5 are stunted. This study aimed to explore differences in early childhood development (ECD) between stunted (length‐for‐age z‐score [LAZ] < ?2) and nonstunted (LAZ ≥ ?2) children in Bangladesh. Children (n = 265) aged 6–24 months who participated in the MAL‐ED birth cohort study were evaluated by trained psychologists at 6, 15, and 24 months of age using the Bayley Scales of Infant and Toddler Development‐III; child length and weight were measured using standard procedures. ECD scores (z‐scores derived from cognitive, motor, language and socio‐emotional skills) were compared between stunted, underweight (weight‐for‐age z‐score < ?2), and wasted (weight‐for‐length z‐score < ?2) children, controlling for child age and sex and maternal age, education, body mass index (BMI), and depressive symptoms. Stunted children had significantly lower ECD scores than their nonstunted peers on cognitive (P = .049), motor (P < .001), language (P < .001) and social–emotional (P = .038) scales where boys had significantly lower fine motor skills compared with girls (P = .027). Mother's schooling and BMI were significant predictors of ECD. Similar to stunting, underweight children had developmental deficits in all domains (cognitive: P = .001; fine motor: P = .039, and P < .001 for both gross motor and total motor; expressive communication: P = .032; total language: P = .013; social–emotional development: P = .017). Wasted children had poor motor skills (P = .006 for the fine motor; P < .001 for both gross motor and total motor development) compared with the nonwasted peers. Early childhood stunting and underweight were associated with poor developmental outcomes in Bangladesh.     

A Group Motor Skills Program for Children with Coordination Difficulties: Effect on Fundamental Movement Skills and Physical Activity Participation

Aims: Children with coordination difficulties are at risk of low levels of physical activity (PA) participation. This intervention examined the effects of a multidisciplinary program that emphasized parent participation on motor skill performance and PA. Methods: Ten boys (5–7 years) completed a group program consisting of conditioning exercises and activities designed to address child-selected goals. Motor proficiency and PA participation were assessed before and after the program using the Test of Gross Motor Development (TGMD-2) and triaxial accelerometers, respectively. Rating scales captured child and parent perceptions of performance for each child's goals. Results: TGMD-2 subtest raw scores, age equivalent and percentile scores improved, along with parent ratings of their child's performance. Six children reported skill improvements. On average, moderate to vigorous PA improved by 10 min per day although these gains were not significant. Time spent in sedentary activities was unchanged. None of the children met the Canadian PA and sedentary behaviour guidelines. Conclusions: The results support effectiveness of a group program to improve gross motor performance and levels of PA in children with coordination difficulties. Gains in both of these domains also have the potential to impact quality of life and reduce health risks associated with inactivity.     

Developmental Progression of Motor Skills in Children Prenatally Exposed to Cocaine

This study tested the motor development of 73 infants who were prenatally exposed to cocaine using the Peabody Developmental Motor Scales at 6, 12, 18, and 24 months of age. Repeated measures MANOVA found a main effect for age with scores decreasing as children increased in age. The significant interactive effect between age and skill type indicated that fine motor quotient scores decreased more than the comparable gross motor scores. T-tests showed significant differences between the two skill types: fine motor skills were higher at the first two testing periods and lower at the last two periods. This article discusses the nature of the delays at specified age periods and the implications for future assessment and programming.     

Effect of Hippotherapy on Motor Proficiency and Function in Children with Cerebral Palsy Who Walk

Aims: To evaluate the effects of hippotherapy on physical capacities of children with cerebral palsy. Methods: Thirteen children (4–12 years old) with cerebral palsy classified in Gross Motor Function Classification System Level I or II were included in this prospective quasi-experimental ABA design study. Participants received 10 weeks of hippotherapy (30 min per week). Gross motor function and proficiency were measured with the Bruininks–Oseretski Motor Proficiency short form [BOT2-SF]) and the Gross Motor Function Measure-88 [GMFM-88] (Dimension D and E) twice before the program (T1 and T1′), immediately after (T2), and 10 weeks following the end of the program (T3). Results: Mean scores for dimensions D and E of the GMFM-88 Dimension scores (p = .005) and three out of the eight items of the BOT2-SF (fine motor precision (p = .013), balance (p = .025), and strength (p = .012) improved between baseline and immediately after intervention; mean scores immediately following and 10 weeks following intervention did not differ. Conclusions: Hippotherapy provided by a trained therapist who applies an intense and graded session for 10 weeks can improve body functions and performance of gross motor and fine motor activities in children with cerebral palsy.     

Visual impairment in very low birthweight children

AIMS—To compare the visual function of a cohort of very low birthweight (VLBW) children in early adolescence with that of their normal birthweight peers; to correlate visual impairment in this group with available perinatal data; and to examine the relation between the visual ability of VLBW children and their cognitive and motor skills.
METHODS—As part of a long term neurodevelopmental study, 137 VLBW children and 163 normal birthweight controls were visually assessed between the ages of 11 and 13 years. Their eyes were examined for strabismus and movement disorders, and the use of visual correction for refractive errors was noted. Measures were made of visual acuity, stereopsis, and contrast sensitivity. All children had standardised tests of motor ability and cognitive skills. Perinatal data, including cranial ultrasonography results, had been obtained from the children''s notes. No data were available however, regarding retinopathy of prematurity as screening was not established when these infants were born.
RESULTS—On all measures, the visual function of the VLBW children was poorer than that of the controls. Reduced visual function was present in 63.5% of VLBW children compared with 36% of controls. Poor contrast sensitivity and strabismus were predictive of poor motor skills in the VLBW children. Poor contrast sensitivity and poor visual acuity (at 0.3 metres) were
predictive of lower IQ. Low birthweight, intraventricular haemorrhage, intrauterine growth retardation and low 1 minute Apgar scores predicted reduced visual function.
CONCLUSIONS—VLBW children have a high incidence of impaired vision. Stereopsis and contrast sensitivity are useful additions to the screening of this high risk group. They identified impaired vision that was not detected by normal screening and were related to impaired neurodevelopmental outcome.

     

Measurement and Prediction of Motor Proficiency in Children Using the Bayley Infant Scales and the Bruininks-Oseretsky Test

A sample of 76 Irish girls and boys of about 9 years of age, for whom neonatal (birthweight, Apgar and Neonatal Behavioural Assessment Scale) and infancy measures (Bayley Infant Scales at 18 months) were available, were administered the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). The main focus of this paper is on a longitudinal analysis of the relationships between the neonatal and infancy measures and the BOTMP administered at about 9 years. However, since the literature expresses some doubts about the basis of the division of the BOTMP subtests into fine motor and gross motor groups and about the meaningfulness of the overall battery score, an initial statistical analysis was undertaken to examine these construct validity issues with this sample of children. This analysis indicated that the division of subtests into fine motor and gross motor skills groups, as formulated by the BOTMP, is not supported. The longitudinal analysis, therefore, focused mainly on subtest scores and provided some evidence of a degree of continuity in measured motor proficiency between birth, 18 months and the prepubertal period. Continuity was more evident for female children.     

Psychometric Properties of the Revised Developmental Coordination Disorder Questionnaire

The Developmental Coordination Disorder Questionnaire (DCDQ) is a parent-completed measure designed to identify subtle motor problems in children of 8 to 14.6 years of age. The purpose of this study was to extend the lower age range to children aged 5 to 7 years, revise items to ensure clarity, develop new scoring, and evaluate validity of the revised questionnaire. Additional items with improved wording were generated by an expert panel. Analyses of internal consistency, factor loading, and qualitative/quantitative feedback from researchers, clinicians, and parents were used to select 15 items with the strongest psychometric properties. Internal consistency was high (alpha =. 94). The expanded questionnaire was completed by the parents of 287 children, aged 5–15 years, who were typically developing. Logistic regression modeling was used to generate separate cutoff scores for three age groups (overall sensitivity = 85%, specificity = 71%). The revised DCDQ was then compared to other standardized measures in a sample of 232 children referred for therapy services. Differences in scores between children with and without DCD (p <. 001) provide evidence of construct validity. Correlations between DCDQ scores and Movement Assessment Battery for Children (r =. 55) and Test of Visual-Motor Integration (r =. 42) scores support concurrent validity. The results provide evidence that the revised DCDQ is a valid clinical screening tool for DCD.     

Gross motor development in full-term Greek infants assessed by the Alberta Infant Motor Scale: Reference values and socioeconomic impact

Objective

The aims of this study were to investigate gross motor development in Greek infants and establish AIMS percentile curves and to examine possible association of AIMS scores with socioeconomic parameters.

Methods

Mean AIMS scores of 1068 healthy Greek full-term infants were compared at monthly age level with the respective mean scores of the Canadian normative sample. In a subgroup of 345 study participants, parents provided, via interview, information about family socioeconomic status. Multiple linear regression analysis was performed to evaluate the relationship of infant motor development with socioeconomic parameters.

Results

Mean AIMS scores did not differ significantly between Greek and Canadian infants in any of the 19 monthly levels of age. In multiple linear regression analysis, the educational level of the mother and also whether the infant was being raised by grandparents/babysitter were significantly associated with gross motor development (p = 0.02 and p < 0.001, respectively), whereas there was no significant correlation of mean AIMS scores with gender, birth order, maternal age, paternal educational level and family monthly income.

Conclusions

Gross motor development of healthy Greek full-term infants, assessed by AIMS during the first 19 months of age, follows a similar course to that of the original Canadian sample. Specific socioeconomic factors are associated with the infants' motor development.     

The Effect of Visual Environmental Distraction on Gait Performance in Children

Purpose: Identify the effect of visual distraction on gait parameters in children and describe the role of walking experience (WE) in the management of visual distraction. Methods: Forty-two typically developing children, mean age 43.2 months (SD = 22.9) participated and were divided into three groups according to WE: early walkers (6–11 months of WE), preschool walkers (12–37 months of WE), and experienced walkers (38–79 months of WE). Gait parameters measured under two conditions (no visual distraction and with visual distraction) included: velocity, step length, step width, and double limb support percentage (DLS%) of gait cycle. Multivariate analysis of variance assessed differences in gait between groups (effect of WE) and within groups (effect of condition). Results: Significant main effects of WE group F(8,74) = 5.300, p ≤.001 and visual distraction condition F(4,36) = 2.586, p = 0.053 were found. Visual environmental distraction significantly affected gait performance in children regardless of walking experience. Velocity decreased from 110.04 to 97.73 cm/sec (p = 0.003) while DLS% of gait cycle increased from 18.29% to 20.39% (p = 0.025). Conclusions: Results suggest physical therapists need to consider attentional requirements when assessing gait; even in children with more WE. If attention to task is a limiting factor for performance or learning of a motor task, it may need to be addressed directly as part of the treatment plan.