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Aim To analyse the development of motor skill and executive function in school-aged children with and without developmental coordination disorder (DCD). Method Using a longitudinal design, 186 children (86 males, 100 females) aged 6 to 11 years at Time 1 were tested over a 2-year period, 52 of whom were diagnosed with DCD at Time 1 (27 males, 25 females; mean age 8y 5mo, SD 1y 6mo) using DSM-5 criteria. The McCarron Assessment of Neuromuscular Development assessed motor status at Time 1 and at 2-year follow-up (Time 2). Executive function was assessed using a well-validated measure, the Groton Maze Learning Test. Results The DCD cohort at Time 1 had moderate incidence of executive function deficit (41%). Most importantly, at a group level, children with persisting DCD (across Times 1 and 2) also showed significantly lower levels of executive function than children with typical motor development at both time points. At an individual level, around 26% of children in this group had persisting executive function deficits relative to normal ranges of performance. Interpretation Children with persisting DCD are at significant risk of executive function issues. The combination of motor and cognitive issues as a potential risk factor in the longer-term development of children is discussed. What this paper adds Around half of children initially diagnosed with developmental coordination disorder (DCD) had the same diagnosis at 2-year follow-up. 41% of children with DCD have impaired executive function. Children with persisting DCD show poorer executive function than those with typical motor development or remitting DCD.

Purpose: To appraise and synthesize evidence from previous systematic reviews (SRs) concerning the impacts of goal setting on engagement in the rehabilitation process and on outcomes of participation and occupational performance for individuals with acquired brain injury (ABI). Materials and methods: Systematic review of SRs following the preferred reporting items for SRs and meta-analysis guidelines. Sixteen full text articles were assessed for eligibility, from which four were included in the review. The Critical Appraisal Skills Programme checklists for SRs was used to rate quality and risk of bias. Results: Four SRs of moderate to high quality included a variety of methodologies. Evidence of moderate quality showed clients’ active participation in goal setting had positive impacts on the client and their engagement in the process. Findings suggested that goal-directed interventions, particularly in outpatient rehabilitation, may improve occupational performance. There was some indication that goal setting may support adherence to therapeutic exercises, but relevance to rehabilitation outcomes was less clear. Findings related to participation outcomes were minimal. Conclusions: Goal setting is a complex and multidimensional process. Goal setting may contribute to improved engagement in rehabilitation although few studies explored occupational performance and participation outcomes for individuals with ABI.Implications for rehabilitation Active goal setting may contribute to improved engagement in rehabilitation, however, including individual clients in the goal setting process requires creativity and flexibility on behalf of professionals. A model is presented to promote understanding of the personal and environmental barriers and facilitators that may interact with goal setting approaches to promote engagement in rehabilitation. There is a need for more research exploring impact of active client-centered goal setting on occupational performance and participation outcomes for people with acquired brain injury.

Contains fulltext : 181510.pdf (Publisher’s version ) (Open Access) Atypical brain development and early brain injury have profound and long lasting impact on the development, skill acquisition, and subsequent independence of a child. Heterogeneity is present at the brain level and at the motor level; particularly with respect to phenomena of bilateral activation and mirrored movements (MMs). In this multiple case study we consider the feasibility of using several modalities to explore the relationship between brain structure and/or activity and hand function: Electroencephalography (EEG), both structural and functional Magnetic Resonance Imaging (sMRI, fMRI), diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), Electromyography (EMG) and hand function assessments. Methods : 15 children with unilateral CP (ages: 9.4±2.5 years) undertook hand function assessments and at least two additional neuroimaging and/or neurophysiological procedures: MRI/DTI/fMRI (n=13), TMS (n=11), and/or EEG/EMG (n=8). During the fMRI scans and EEG measurements, a motor task was performed to study cortical motor control activity during simple hand movements. DTI tractography analysis was used to study the corpus-callosum (CC) and cortico-spinal tracts (CST). TMS was used to study cortico-spinal connectivity pattern. Results: Type and range of severity of brain injury was evident across all levels of manual ability with the highest radiological scores corresponded to children poorer manual ability. Evidence of MMs was found in 7 children, mostly detected when moving the affected hand, and not necessarily corresponding to bilateral brain activation. When moving the affected hand, bilateral brain activation was seen in 6/11 children while 3/11 demonstrated unilateral activation in the contralateral hemisphere, and one child demonstrated motor activation predominantly in the supplementary motor area (SMA). TMS revealed three types of connectivity patterns from the cortex to the affected hand: a contralateral (n=3), an ipsilateral (n=4) and a mixed (n=1) connectivity pattern; again without clear association with MMs. No differences were found between children with and without MMs in lesion scores, motor fMRI laterality indices, CST diffusivity values, and upper limb function. In the genu, midbody, and splenium of the CC, higher fractional anisotropy values were found in children with MMs compared to children without MMs. The EEG data indicated a stronger mu-restoration above the contralateral hemisphere in 6/8 children and above the ipsilateral hemisphere in 2/8 children. Conclusion: The current results demonstrate benefits from the use of different modalities when studying upper-limb function in children with CP; not least to accommodate to the variations in tolerance and feasibility of implementation of the differing methods. These exposed multiple individual brain-reorganization patterns corresponding to different functional motor abilities. Additional research is warranted to understand the transactional influences of early brain injury, neuroplasticity and developmental and environmental factors on hand function in order to develop targeted interventions. 12 p.

Purpose of the Review This paper examines physical and emotional coherence in young people with developmental coordination disorder (DCD). Specifically, the transactional relationship between motor and non-motor/executive dysfunction in children with DCD and its impact on psychosocial functioning is explored. Recent Findings This paper integrates the subjective reported experiences of young people with DCD with objective measurements and findings from neuroimaging studies. Summary Consideration of the transactional relationship between the person, the activity and the environment, whether these factors be physical, social, attitudinal or virtual, will be fundamental to our understanding of the mechanisms underpinning organisational and emotional issues presenting in DCD. Integrating the experiences of young people with research evidence will be essential to improve outcomes for young people with DCD in clinical practice.

Background/Aims: Use of placebo is the ideal for comparison in clinical trials to reduce biases. With digital technology being used more frequently in healthcare interventions, how do we determine the placebo effect where interventions exploit technology? If placebo in medicine is traditionally defined by a lack of pharmacological agents, how might we begin to move towards controlling for effects of digital technology? Method: This paper explores the traditional placebo effect and discusses its impact in healthcare contexts with digital technology with reference to a particular trial. Different meanings of placebo in the context of evaluating technology suggest new challenges and positive consequences. Results: Methodological considerations are discussed, which enabled the development of a placebo-controlled evaluation of a digital technology in healthcare and rehabilitation. Conclusion: Digital placebo was controlled in our trial by employing technology across all groups in the absence of evidence-based practice and shows how to control for unknown and hidden effects of technology.

The diagnosis of Developmental Coordination Disorder (DCD) is based on poor motor coordination in the absence of other neurological disorders. In order to identify the presence of movement difficulties, a standardised motor assessment is recommended to determine the extent of movement problems which may contribute to deficits in daily task performance. A German version of the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (German BOT-2) was recently published. This study aimed to determine the ecological validity of the German BOT-2 by considering the relationship between assessment of fundamental motor skills with the BOT-2 and performance of everyday motor activities as evaluated by parents. This study used data obtained from the German BOT-2 standardisation study (n=1.177). Subtests were compared with theoretically corresponding tasks via parental ratings of overall fine and gross motor abilities and performance in six typical motor activities. Non-parametric Jonckheere Terpstra test was used to identify differences in ordered contrasts. Subtests reflecting 'Strength', 'Running Speed and Agility', 'Upper-Limb Coordination', 'Balance', and 'Fine Motor Precision' were associated with parental evaluation of gross motor skills (p

Mastery of many tasks in daily life requires role differentiated bimanual hand use with high spatiotemporal cooperation and minimal interference. The authors investigated developmental changes in the performance of a disparate bimanual movement task requiring sequenced movements. Age groups were attributed to changes in CNS structures critical for bimanual control such as the corpus callosum (CC) and the prefrontal cortex; young children (5-6 years old), older children (7-9 years old), and adolescents (10-16 years old). Results show qualitative changes in spatiotemporal sequencing between the young and older children which typically marks a phase of distinct reduction of growth and myelination of the CC. Results show qualitative changes in spatiotemporal sequencing between the young and older children, which coincides with distinct changes in the growth rate and myelination of the CC. The results further support the hypothesis that CC maturation plays an important role in the development of bimanual skills.

Co-production is essential to ensure patient needs are identified, outcomes met and implementation achieved. A modified Delphi approach involving key stakeholders was used to: identify and prioritise outcomes of importance in relation to Virtual Reality (VR) technology design in order to address clinical issues; define outcome measures/develop bespoke project measures; and determine clinical trial design. Results reflect three key themes of motivation for system design and evaluation: autonomy, relatedness and competence. Young people with disabilities and their families have invaluable contributions to the design and implementation of VR technologies in rehabilitation.

Purpose: Evidence is increasing for effective virtual reality therapy for motor rehabilitation for children with Cerebral Palsy. We assessed the feasibility of a virtual reality therapy mode of intervention, appropriateness of measures, and potential cost-effectiveness. Methods: A 12-week, 2-group, parallel-feasibility trial (ISRCT 17624388) using Nintendo Wii FitTM at home. Children aged 5–16, with ambulatory Cerebral Palsy, who were able to follow simple instructions were randomised to two groups; one supported by physiotherapists (individualised activity programme), the other unsupported with children having free choice (control). Children were assessed in clinic at baseline, week 6, and week 12 by blinded assessors. Feasibility of the intervention was assessed via recruitment, adherence, and usefulness of measurement tools. Results: Forty-four children were eligible (out of 48 approached): 31 consented, 30 were randomised, 21 completed the study; 10 in the supported group and 11 in the unsupported group. Nine children discontinued from tiredness, after-school activities, homework, surgery, technical difficulties or negative system feedback. The supported group completed 19 of 36 (IQR 5-35) possible sessions; the unsupported group 24 of 36 sessions (IQR 8-36). Gross Motor Function Measure scores varied by Cerebral Palsy severity after the intervention. There were no adverse events. Conclusion: Virtual reality therapy offers potential as a therapeutic adjunct for children with Cerebral Palsy, warranting substantive confirmatory study. Gross Motor Function Measure, with modifications to improve sensitivity, appeared appropriate as a primary measure, with Timed up and Go test secondary. The intervention was inexpensive costing £20 per child. An explanatory trial to evaluate the clinical/cost effectiveness of commercial system virtual reality therapy is feasible with minor methodological adaptation.

Aim These international clinical practice recommendations (CPR) for developmental coordination disorder (DCD), initiated by the European Academy of Childhood Disability (EACD), aim to address key questions on the definition, diagnosis, assessment, intervention, and psychosocial aspects of DCD relevant for clinical practice. Method Key questions in five areas were considered through literature reviews and formal expert consensus. For recommendations based on evidence, literature searches on ‘mechanisms’, ‘assessment’, and ‘intervention’ were updated since the last recommendations in 2012. New searches were conducted for ‘psychosocial issues’ and ‘adolescents/adults’. Evidence was rated according to the Oxford Centre for Evidence‐Based Medicine (level of evidence [LOE] 1–4) and transferred into recommendations. For recommendations based on formal consensus, two meetings of an international, multidisciplinary expert panel were conducted with a further five Delphi rounds to develop good clinical practice (GCP) recommendations. Results Thirty‐five recommendations were made. Eight were based on the evidence from literature reviews (three on ‘assessment’, five on ‘intervention’). Twenty‐two were updated from the 2012 recommendations. New recommendations relate to diagnosis and assessment (two GCPs) and psychosocial issues (three GCPs). Additionally, one new recommendation (LOE) reflects active video games as adjuncts to more traditional activity‐oriented and participation‐oriented interventions, and two new recommendations (one GCP, one LOE) were made for adolescents and adults with DCD. Interpretation The CPR–DCD is a comprehensive overview of DCD and current understanding based on research evidence and expert consensus. It reflects the state of the art for clinicians and scientists of varied disciplines. The international CPR–DCD may serve as a basis for national guidelines. What this paper adds Updated international clinical practice guidelines on developmental coordination disorder (DCD).Refined and extended recommendations on clinical assessment and intervention for DCD.A critical synopsis of current research on mechanisms of DCD.A critical synopsis of psychosocial issues in DCD, with implications for clinical practice.The first international recommendations to consider adolescents and adults with DCD., What this paper adds Updated international clinical practice guidelines on developmental coordination disorder (DCD).Refined and extended recommendations on clinical assessment and intervention for DCD.A critical synopsis of current research on mechanisms of DCD.A critical synopsis of psychosocial issues in DCD, with implications for clinical practice.The first international recommendations to consider adolescents and adults with DCD. This article's abstract has been translated into Spanish and Portuguese. Follow the links from the http://onlinelibrary.wiley.com/doi/10.1111/dmcn.14132/abstract to view the translations. A pocket version of these guidelines is available as Appendix S1 (https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.14132#support-information-section)

To conduct a review of research literature on the use of dance and movement with music (rhythmic auditory stimulation [RAS]) in the neurorehabilitation of children and adults with cerebral palsy (CP).We conducted a systematic search and quality appraisal of the research literature on dance and RAS in CP. Additionally, we linked the research outcomes to the International Classification of Functioning, Disability and Health (ICF) framework.Studies showed preliminary evidence of the benefits of dance and RAS on body functions, particularly balance, gait, walking, and cardiorespiratory fitness for individuals with CP. Research gaps are evident across all domains of the ICF, particularly in the participation and environment domains.To facilitate translation of quantitative research outcomes to the clinical classification of the ICF, a table was constructed that links traditional areas of quantitative rehabilitation research with the ICF categories highlighting areas of research strengths and areas where increased rigor is desirable. The potential for dance and RAS to have positive impacts on body functions, emotional expression, social participation, and attitudinal change are indicated areas for consideration in future research.The potential for dance and movement to music help balance, gait, and walking in children and adults with cerebral palsy. Research gaps are evident across International Classification of Functioning, Disability and Health domains, particularly participation and environment domains.LA DANZA Y LA REHABILITACIÓN EN LA PARÁLISIS CEREBRAL: UNA BÚSQUEDA SISTEMÁTICA Y REVISIÓN: OBJETIVO: Realizar una revisión de la literatura de investigación sobre el uso de la danza y el movimiento con la música (estimulación auditiva rítmica [RAS]) en la neurorrehabilitación de niños y adultos con parálisis cerebral (PC). MÉTODO: Llevamos a cabo una búsqueda sistemática y una evaluación de calidad de la literatura de investigación sobre danza y RAS en PC. Además, vinculamos los resultados de la investigación al marco teórico de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF), RESULTADOS: Los estudios mostraron evidencia preliminar de los beneficios de la danza y el RAS en las funciones corporales, particularmente el equilibrio, la marcha, la marcha y la capacidad cardiorrespiratoria para las personas con PC. Las brechas de investigación son evidentes en todos los dominios de la CIF, particularmente en los ámbitos de participación y medio ambiente. INTERPRETACIÓN: Para facilitar la traducción de los resultados de la investigación cuantitativa a la clasificación clínica de la CIF, se construyó una tabla que vincula las áreas tradicionales de investigación de rehabilitación cuantitativa con las categorías CIF. destacando áreas de fortalezas de investigación y áreas donde es deseable un mayor rigor. El potencial de la danza y el RAS para tener un impacto positivo en las funciones corporales, la expresión emocional, la participación social y el cambio de actitud son áreas identificadas para tener en consideración en investigaciones futuras.DANÇA E REABILITAÇÃO EM PARALISIA CEREBRAL: UMA PESQUISA E REVISÃO SISTEMÁTICA: OBJETIVO: Conduzir uma revisão da literaturs sobre o uso da dança e movimento com música (estimulação auditiva rítmica [EAR]) na neuroreabilitação de crianças e adolescentes com paralisia cerebral (PC). MÉTODO: Conduzimos uma busca sistemática e avaliação de qualidade da literatura sobre dança e EAR em PC. Adicionalmente, relacionamos os resultados da pesquisa com a estrutura da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). RESULTADOS: Os estudos mostraram evidência preliminar dos benefícios e EAR nas funções do corpo, particularmente equilíbrio, marcha, caminhar e aptidão cárdio-respiratória em indivíduos com PC. Lacunas nas pesquisas são evidentes em todos os domínios da Classificação Internacional de Funcionalidade, Incapacidade e Saúde , particularmente nos domínios de participação e ambiente. INTERPRETAÇÃO: Para facilitar a transição de resultados de pesquisas quantitativas para a classificação clínica da CIF, uma tabela foi elaborada para relacionar áreas tradicionais de pesquisas quantitativas em reabilitação com as categorias da CIF. Foram realçadas áreas de em que pesquisas estão fortes e áreas onde maior rigor é necessário. O potencial da dança e EAR para proporcionar impactos positivos nas funções do corpo, expressão emocional, participação social, e mudança atitudinal são indicados como áreas para consideração em futuras pesquisas.

© 2019 Reiko Miyamoto et al. This study compared growth-facilitating and growth-constraining experiences of practice placements as perceived by occupational therapy students from Japan and the United Kingdom (UK). Fifteen students from Japan and 14 from the UK used a nominal group technique (NGT) to rank, individually and in groups, their subjective learning experiences during practice placements. Qualitative analysis and simple tabulation based on ranking of items obtained in the NGT were perfo1med. Five item categories were identified from both Japanese and UK students: self-reflection, the role of supervisor, sense of responsibility, clinical knowledge and skills, and time management. Results showed that all students perceived opportunities for self-reflection and feedback from supervisors as growth-facilitating, and students' passive attitudes towards requirements of practice placements as growth-constraining. Country-specific differences between students were observed in clinical knowledge and skills, sense of responsibility, and time management. Japanese students perceived that preparatory study led to successfully treating clients during placement, and they tended to commit to placement assignn1ents at the expense of time outside. UK students valued working independently with a sense of responsibility, but considered time-management problems within their placement hours as growth-constraining. These differences can be explained by different social norms and expectations of students from Japan and the UK. Tokyo Metropolitan University under Discretionary Funds of the Dean of Faculty of Health Sciences for the research project titled “Basic research on occupational therapy and promoting internationalization” (2011-2016).

Opsoclonus-myoclonus syndrome is a rare but serious neurological condition resulting in loss of control of eye movements, often accompanied by difficulties in posture and movement control with reports of sensory sensitivities potentially impacting on behavior. This pilot study characterizes the presence of atypical sensory behaviors in opsoclonus-myoclonus syndrome through questionnaire survey of a cohort of families. The Short Sensory Profile, Vineland Adaptive Behavior Scale, and Developmental Behaviour Checklist were distributed to 30 families; 16 were returned anonymously. Atypical sensory behaviors were identified in a large proportion (62.5%). Children reported as being more anxious showed greater sensitivity to auditory stimuli, U(14) 11, P = .026. This is consistent with recent recognition of more extensive disease neurocognitive effects in Opsoclonus-myoclonus syndrome. Further research is needed to increase understanding of the complex pathology of this disease and to provide indicators for sensory and behavioral as well as pharmacological interventions.

Overlapping samples in systematic reviews and meta-analyses : Interpreting findings of cognitive outcomes following preterm birth

© 2018 The Author(s). Aims: To explore the validity of change scores of the Children's Hand-use Experience Questionnaire (CHEQ). Methods: Analysis of the CHEQ included 44 children (15 girls) between 6–16 years (median 9.0; IQR 8–11) with unilateral cerebral palsy, with baseline and post- (two-week intensive) intervention assessments using the Goal Attainment Scale (GAS) as external anchor for change. Hypotheses on the magnitude of expected change were formulated and correlation coefficients and effect sizes calculated. Receiver operating curve analysis was performed and the area under the curve (AUC) calculated to investigate the ability of CHEQ to discriminate between improvement and non-improvement according to GAS. Results: All hypotheses about the magnitude of change were confirmed supporting longitudinal validity of CHEQ scales to measure change in the perception of bimanual performance. AUCs for the Grasp efficacy and the Time utilization were slightly below, and for the Feeling bothered slightly above the threshold. The latter one accurately discriminating between children that improved and did not improve according to the GAS. Conclusions: Evidence was found that CHEQ scales capture change in bimanual performance but with limited accuracy for two out of three scales. The validity of CHEQ change scores needs to be further explored in a wider population.

Aim The aims of this study were twofold: first, to develop and validate a timed test of unimanual and bimanual dexterity suitable for those with disability affecting hand function; second, to explore relationships between unimanual and bimanual completion times. Method We developed the Tyneside Pegboard Test (TPT), an electronically timed test with three peg sizes, incorporating an asymmetrical bimanual task. Nine hundred and seventy‐four participants (455 males, 519 females; age range 4–80y) provided normative data. Test–retest reliability and construct validity were assessed (50 adults: 14 males, 36 females; 15–73y) on two occasions 2 weeks apart. Bimanual and unimanual completion times were measured in 87 children (51 males, 36 females) with unilateral cerebral palsy (CP) and 498 individuals in a comparison group (238 males, 260 females; 5–15y). Results The comparison group showed an asymmetrical U‐shaped relationship between completion times and age. Intraclass correlation coefficients ranged from 0.74 to 0.91, indicating moderate test–retest reliability. There was a negative relationship between average TPT bimanual times and Purdue pegboard bimanual scores (Spearman's rho −0.611, degrees of freedom 44, p, What this paper adds We developed an adapted, electronically timed 9‐hole pegboard test.Our modifications facilitate use by those with disability affecting hand function.The test incorporates an asymmetrical bimanual task.Children with unilateral cerebral palsy showed disproportionate bimanual dexterity deficits even allowing for unimanual dexterity. This article is commented on by Green on page 224 of this issue. This article's abstract has been translated into Spanish and Portuguese. Follow the links from the abstract to view the translations. Video Podcast: https://www.youtube.com/watch?v=FcaDrZcLlOg&feature=youtu.be

To compare the effect of bimanual training with or without constraint on manual functions in children with unilateral cerebral palsy (UCP).Seventeen children aged 6-11 years with UCP participated in one of two intensive therapeutic camps: bimanual (n = 9) incorporating one hour of constraint ("Hybrid") or Bimanual (n = 8). Each camp met for 2 weeks, 5 days per week for 6 hours each day. The Assisting Hand Assessment (AHA) and the Jebsen Taylor Test of Hand Function (JTTHF) examined bimanual and unimanual functions pre, post- and 3-months post-intervention.A significant improvement was noted in AHA scores for both groups between the pre-, post- and three months post-intervention [Hybrid (F2; 16 = 85.5, p0.01); Bimanual (F2; 16 = 15.4, p0.01)] with no significant differences between groups over time (F2; 30 = 0.74, p = 0.48). For the JTTHF, a significant improvement was noted in the affected hand following the Hybrid program (F2; 30 = 7.45, p = 0.01), while following the Bimanual program a significant difference was noted only in the less-affected hand (F2; 16 = 6.02, p0.01].Both interventions Hybrid and Bimanual were similarly effective for improving use of the affected hand in bimanual tasks. The unique contribution of each intervention, the Hybrid program on the affected and the Bimanual on the less-affected side, warrants further examination.

Unusual reactions to sensory input became part of the diagnostic criteria for autism spectrum disorder in the DSM-5. Measures accurately assessing these symptoms are important for clinical decisions. This study examined the reliability and validity of the Sensory Behavior Questionnaire, a parent-report scale designed to assess frequency and impact of sensory behaviors in autistic children. The scale demonstrated excellent internal consistency and concurrent validity, and was a better predictor of autistic symptoms than the Short Sensory Profile within a group of 66 school-age autistic children. The scale also successfully discriminated between autistic and typical children of similar age and ability. The Sensory Behavior Questionnaire has potential as a measure of sensory behaviors in children on the autism spectrum. Medical Research Council; Research at the Centre for Research in Autism and Education; The Clothworkers’ Foundation and Pears Foundation

Challenges in combining upper limb and lower limb interventions in protocols for children with brain injury

International audience; In 1994, leading researchers in the field of Developmental Coordination Disorder (DCD) research gathered at the London International Consensus Conference in Canada for discussions on the nomenclature, description and definition, assessment and management of motor coordination problems in children. Since then, biannual international conferences on children with DCD have been held, becoming leading events to exchange and update information for researchers, clinicians and students, and also for parents and patients. The last International conference in DCD was held in Toulouse, France from the July 2nd to 4th, 2015. Each conference has covered a specific theme with the organizing committee proposing the following " Developmental coordination disorder and other neurodevelopmental disorders: a focus on comorbidity ". Comorbidity refers to the presence of two or more disorders in the same individual. Co-morbidity in neurodevelopmental disorders is pronounced, (particularly DCD, dyslexia, autism spectrum disorders (ASD) and attention deficit hyperactivity disorder ADHD in the area of developmental disorders). Many studies suggest that as many as 50% of individuals diagnosed with a psychiatric or neurodevelopmental problem suffer in fact from more than one disorder (e.g. (Williams, 2013)&Green & Baird, 2005). Comorbidity or a co-occurring disorder seriously impacts outcomes and creates a significant constraint on family and school life. Furthermore, it complicates diagnostic procedures and organization of health care. The 11th congress on DCD aimed to provide some answers to the important questions of diagnostic criteria, causal factors, prognostic markers, management of DCD and associated disorders. This conference was a real success and welcomed nearly 400 participants from 22 countries. The plenary sessions included keynote presentations focusing specifically on DCD (A. Kirby, D. Dewey, ML Kaiser and B. Smits-Engelsman) or more broadly on motor learning and comorbidity (M Habib, H Forssberg, R Nicolson), setting DCD into the broader area of neurodevelopmental disorders. Seventy-eight oral presentations were distributed between 24 sessions addressing both fundamentals and applied topics: physical manifestations, perinatology, locomotion, perceptual motor integration, manual functions and handwriting, cognition, internal model, neural correlates, assessment, participation, physical activity, intervention adulthood, mental health. Poster sessions were an

Contains fulltext : 162678.pdf (Publisher’s version ) (Open Access) Aim: In children with unilateral cerebral palsy (CP), it is widely believed that mirror movements contribute to non-use of the affected hand despite preserved capacity, a phenomenon referred to as developmental disregard. We aimed to test whether mirror movements are related to developmental disregard, and to clarify the relation between mirror movements and bimanual function. Method: A repetitive squeezing task simultaneously measuring both hands' grip-forces was developed to assess mirror movements by using maximum cross-correlation coefficient (CCCmax) as well as strength measures (MMstrength). Developmental disregard, bimanual performance, and capacity were assessed using a validated video-observation method. Twenty-one children with unilateral CP participated (Median age 10y 7mo, interquartile range [IQR] 10y 1mo-12y 9mo). Outcome measures of mirror movements were correlated to developmental disregard, bimanual performance, and capacity scores using Spearman's correlations (significance level: alpha

Atypical responses to sensory stimuli are a new criterion in DSM-5 for the diagnosis of an autism spectrum disorder (ASD) but are also reported in other developmental disorders. Using the Short Sensory profile (SSP) and Autism Diagnostic Interview-Revised we compared atypical sensory behaviour (hyper- or hypo-reactivity to sensory input or unusual sensory interests) in children aged 10-14 years with (N = 116) or without an ASD but with special educational needs (SEN; N = 72). Atypical sensory behaviour was reported in 92 % of ASD and 67 % of SEN children. Greater sensory dysfunction was associated with increased autism severity (specifically restricted and repetitive behaviours) and behaviour problems (specifically emotional subscore) on teacher and parent Strengths and Difficulties Questionnaires but not with IQ.

The brain has a remarkable capacity for reorganization following injury, especially during the first years of life. Knowledge of structural reorganization and its consequences following perinatal injury is sparse. Here we studied changes in brain tissue volume, morphology, perfusion, and integrity in children with hemiplegia compared to typically developing children, using MRI. Children with hemiplegia demonstrated reduced total cerebral volume, with increased cerebrospinal fluid (CSF) and reduced total white matter volumes, with no differences in total gray matter volume, compared to typically developing children. An increase in cortical thickness at the hemisphere contralateral to the lesion (CLH) was detected in motor and language areas, which may reflect compensation for the gray matter loss in the lesion area or retention of ipsilateral pathways. In addition, reduced cortical thickness, perfusion, and surface area were detected in limbic areas. Increased CSF volume and precentral cortical thickness and reduced white matter volume were correlated with worse motor performance. Brain reorganization of the gray matter within the CLH, while not necessarily indicating better outcome, is suggested as a response to neuronal deficits following injury early in life. Guy’s and St Thomas’ Charity and the Marnie Kimelman Trust

Contains fulltext : 157727.pdf (Publisher’s version ) (Closed access) This paper examines how current understandings of childhood participation and motor development provide opportunities for using new technologies (such as virtual reality—VR) for children with neurodevelopmental disorders. Specifically, the International Classification of Functioning, Disability and Health is used to conceptualize the role of technology in treatment across body structures and body function, activity performance, and participation (WHO 2007, 2012). First, we review the particular motor control and learning mechanisms that have been implicated in children with atypical motor development, like DCD. This section will highlight avenues for targeted remediation. Next, VR-based rehabilitation systems are reviewed in relation to neurodevelopmental disorders, focusing first on CP and second on more recent applications for children with DCD. We describe the evolution of particular design innovations in virtual rehabilitation including recent advances using tangible interfaces, as well as other methods targeting cognitive function more specifically. Benefits of these various treatments will be viewed through the lens of current theory and evaluated at the level of child and family outcomes. Finally, we consider the broader aspects of the potential for technological innovation in rehabilitation and its impact on brain function, activity competence, and longer-term participation. 14 p.

Contains fulltext : 155905.pdf (Publisher’s version ) (Closed access) Children with unilateral Cerebral Palsy (uCP) experience problems performing tasks requiring the coordinated use of both hands (bimanual coordination; BC). Additionally, some children with uCP display involuntary symmetrical activation of the opposing hand (mirrored movements). Measures, used to investigate therapy-related improvements focus on the functionality of the affected hand during unimanual or bimanual tasks. None however specifically address spatiotemporal integration of both hands. We explored the kinematics of hand movements during a bimanual task to identify parameters of BC. Thirty-seven children (aged 10.9 +/- 2.6 years, 20 male) diagnosed with uCP participated. 3D kinematic motion analysis was performed during the task requiring opening of a box with their affected- (AH) or less-affected hand (LAH), and pressing a button inside with the opposite hand. Temporal and spatial components of data were extracted and related to measures of hand function and level of impairment. Total task duration was correlated with the Jebsen-Taylor Test of Hand Function in both conditions (either hand leading with the lid-opening). Spatial accuracy of the LAH when the box was opened with their AH was correlated with outcomes on the Children's Hand Use Experience Questionnaire. Additionally, we found a subgroup of children displaying non-symmetrical movement interference associated with greater movement overlap when their affected hand opened the box. This subgroup also demonstrated decreased use of the affected hand during bimanual tasks. Further investigation of bimanual interference, which goes beyond small scaled symmetrical mirrored movements, is needed to consider its impact on bimanual task performance following early unilateral brain injury. 12 p.

Prognostication and the unpredictable nature of HIV encephalopathy with bilateral lower limb spasticity

Background. Motor-learning interventions may improve hand function in children with unilateral cerebral palsy (UCP) but with inconsistent outcomes across participants. Objective. To examine if pre-intervention brain imaging predicts benefit from bimanual intervention. Method. Twenty children with UCP with Manual Ability Classification System levels I to III, aged 7-16 years, participated in an intensive bimanual intervention. Assessments included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF) and Children’s Hand Experience Questionnaire (CHEQ) at baseline (T1), completion (T2) and 8-10 weeks post-intervention (T3). Imaging at baseline included conventional structural (radiological score), functional (fMRI) and diffusion tensor imaging (DTI). Results. Improvements were seen across assessments; AHA ( P = 0.04), JTTHF ( P < .001) and CHEQ ( P < 0.001). Radiological score significantly correlated with improvement at T2; AHA ( r = .475) and CHEQ ( r = .632), but negatively with improvement on unimanual measures at T3 (JTTFH r = −.514). fMRI showed negative correlations between contralesional brain activation when moving the affected hand and AHA improvements (T2: r = −.562, T3: r = −0.479). Fractional Anisotropy in the affected posterior limb of the internal capsule correlated negatively with increased bimanual use on CHEQ at T2 ( r = −547) and AHA at T3 ( r = −.656). Conclusions. Children with greater structural, functional and connective brain damage showed enhanced responses to bimanual intervention. Baseline imaging may identify parameters predicting response to intervention in children with UCP.

This study was undertaken to determine whether questionnaire-based screening could be part of the solution to a long waiting list of referrals for occupational therapy assessment by identifying the requirement for clinical assessments. The performance of two questionnaires – the Developmental Coordination Disorder Questionnaire (DCDQ) completed by parents and the Checklist of the Movement Assessment Battery for Children (C-ABC) completed by teachers – was compared with a more traditional clinical assessment for the identification of DCD in children already referred to occupational therapy. It was found that the parent report was quite reliable in the identification of DCD if no other developmental problem was present. However, there was little benefit to using the teacher report to screen children.Several confounding variables, including an unequal proportion of children with DCD in the sample and the inclusion of children who were younger than the age range of the DCDQ, may have influenced how well the questionnaires performed. Although questionnaires cannot replace a full clinical assessment, the results showed that there may be some value in including the parent report in the identification of DCD.

This project investigated the prevalence of sensory processing problems in a clinical group and also examined the clinical effectiveness of a specialised therapeutic technique, sensory integrative ...