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Adolescents with sports-related concussion (SRC) demonstrate acute and persistent deficits in subtle motor function. However, there is limited research examining related neurological underpinnings. This pilot study examined changes in motor-associated white matter pathways using diffusion tensor imaging (DTI) and their relationship with subtle motor function. Twelve adolescents with SRC (12–17 years) within two-weeks post-injury and 13 never-injured neurotypical peers completed DTI scanning. A subset of 6 adolescents with SRC returned for a follow-up visit post-medical clearance from concussion. Subtle motor function was evaluated using the Physical and Neurological Examination of Subtle Signs (PANESS). Adolescents with SRC showed higher mean diffusivity (MD) of the superior corona radiata and greater subtle motor deficits compared to controls. Across all participants, greater subtle motor deficits were associated with higher (more atypical) MD of the superior corona radiata. Preliminary longitudinal analysis indicated reduction in fractional anisotropy of the corpus callosum but no change in the MD of the superior corona radiata from the initial visit to the follow-up visit post-medical clearance. These findings support preliminary evidence for a brain–behavior relationship between superior corona radiata microstructure and subtle motor deficits in adolescents with SRC that merits further investigation.

This study examined the developmental trajectory of neurodevelopmental motor signs among boys and girls with attention-deficit/hyperactivity disorder (ADHD) and typically-developing (TD) children. Seventy children with ADHD and 48 TD children, aged 8–17 years, were evaluated on at least two time-points using the Physical and Neurological Assessment of Subtle Signs (PANESS). Age-related changes in subtle motor signs (overflow, dysrhythmia, speed) were modeled using linear mixed-effects models to compare the developmental trajectories among four subgroups (ADHD girls and boys and TD girls and boys). Across visits, both boys and girls with ADHD showed greater overflow, dysrhythmia, and slower speed on repetitive motor tasks compared to TD peers; whereas, only girls with ADHD were slower on sequential motor tasks than TD girls. Developmental trajectory analyses revealed a greater reduction in overflow with age among boys with ADHD than TD boys; whereas, trajectories did not differ among girls with and without ADHD, or among boys and girls with ADHD. For dysrhythmia and speed, there were no trajectory differences between the subgroups, with all groups showing similar reductions with age. Children with ADHD show developmental trajectories of subtle motor signs that are consistent with those of TD children, with one clear exception: Boys with ADHD show more significant reductions in overflow from childhood to adolescence than do their TD peers. Our findings affirm the presence of subtle motor signs in children with ADHD and suggest that some of these signs, particularly motor overflow in boys, resolve through adolescence while dysrhythmia and slow speed, may persist.

BACKGROUND: Children with traumatic brain injury (TBI) are reported to have persistent deficits in executive functioning and subtle motor functions. AIM: This study examined the relationship between subtle motor signs and executive functioning in children with TBI. METHODS: Eighteen children aged 13-18 years with mild to severe TBI at least one year before study participation and 16 age-matched typically-developing controls were examined using the Revised Physical and Neurological Examination of Subtle Signs (PANESS), a simplified Go/No-go task, portions of the Delis-Kaplan Executive Function System Verbal Fluency and Trail Making tests, and a Wechsler Coding test. RESULTS: There were significant associations between PANESS scores and executive functioning measures in children with TBI but not in controls. CONCLUSION: Results suggest that assessment of subtle motor signs may provide broader information regarding functioning after paediatric TBI.

OBJECTIVE: To systematically examine the safety and effectiveness of transcranial direct current stimulation (tDCS) interventions in pediatric motor disorders. DATA SOURCES: PubMed, EMBASE, Cochrane, CINAHL, Web of Science, and ProQuest databases were searched from inception to August 2018. STUDY SELECTION: tDCS randomized controlled trials (RCTs), observational studies, conference proceedings and dissertations in pediatric motor disorders were included. Two authors independently screened articles based on predefined inclusion criteria. DATA EXTRACTION: Data related to participant demographics, intervention, and outcomes were extracted by two authors. Quality assessment was independently performed by two authors. DATA SYNTHESIS: Twenty-three studies involving a total of 391 participants were included. There was no difference in drop-out rates between active (1/144) and sham (1/144) tDCS groups, risk difference 0.0, 95% CI [−.05, .04]. Across studies, the most common adverse effects in the active group were tingling (17.2%), discomfort (8.02%), itching (6.79%), and skin redness (4%). Across 3 studies in children with cerebral palsy, tDCS significantly improved gait velocity (MD = .23; 95% CI [0.13, 0.34], p < .0005), stride length (MD = 0.10; 95% CI [0.05, 0.15], p< .0005), and cadence (MD = 15.7; 95% CI [9.72, 21.68], p< .0005). Mixed effects were found on balance, upper-extremity function, and overflow movements in dystonia. CONCLUSION: Based on the studies reviewed, tDCS is a safe technique in pediatric motor disorders and may improve some gait measures and involuntary movements. Research to date in pediatric motor disorders shows limited effectiveness in improving balance and upper-extremity function. tDCS may serve as a potential adjunct to pediatric rehabilitation; to better understand if tDCS is beneficial for pediatric motor disorders, more well-designed RCTs are needed.

Date Presented 04/01/2022 Disorders of consciousness (DOC) have a severe impact on an individual’s awareness and arousal. Sensory stimulation is an intervention approach to promote arousal and behavioral responsiveness by the application of environmental stimuli in patients with DOC. Eighteen articles were included in this review and showed that patients had a greater increase in arousal when auditory stimulation was applied unimodally, multimodally, or by family members and was personally salient to the patient. Primary Author and Speaker: Haley Robinson Contributing Authors: Jewel E. Crasta

Date Presented 04/02/2022 OT interventions for individuals diagnosed with autism spectrum disorder (ASD) often emphasize areas of functioning such as attention, sensory processing, and social responsiveness. It is essential to understand the relationships between these variables to develop best-fit interventions. This study demonstrates that sensory processing plays a mediating role in the relationship between attention and social responsiveness with young adults with and without autism. Primary Author and Speaker: Olivia J. Green Additional Authors and Speakers: Jewel E. Crasta

OBJECTIVE The aim of this study was to examine the effect of age and level of competition on subtle motor performance in adolescents who have recently been medically cleared postconcussion and never-injured controls. DESIGN Thirty adolescents who were recently medically cleared postconcussion (12-18 yrs) and 30 never-concussed, typically developing controls were examined using the Revised Physical and Neurological Examination of Subtle Signs (PANESS) and the Immediate Post-Concussion Assessment and Cognitive Testing. RESULTS Older age was associated with better Immediate Post-Concussion Assessment and Cognitive Testing scores in both groups, whereas only the control group showed improved motor performance on the PANESS with increasing age. Adolescents across both groups participating at a higher level of competition (school or travel level) had better motor performance on the PANESS than those participating at a lower level of competition (recreational level or no sports participation). Adolescents medically cleared postconcussion had greater motor deficits on the PANESS than controls did. CONCLUSION After medical clearance, adolescents with a history of recent concussion demonstrate alterations in the relationship between motor function and age. The PANESS merits further exploration as a measure that is sensitive to factors affecting motor performance, such as age and level of athletic competition, as well as to persistent subtle motor deficits in adolescents medically cleared postconcussion.

Children with autism spectrum disorder (ASD) frequently demonstrate atypical processing of sensory information and deficits in attentional abilities. These deficits may impact social and academic functioning. Although music therapy has been used to address sensory and attentional needs, there are no studies including physiologic indicators of sensory processing to determine the impact of music therapy. The objective of this study was to determine the feasibility of conducting study protocols, determine the adequacy of electroencephalography (EEG) and behavioral measures in identifying attentional differences in children with ASD compared with typically developing (TD) children, and to gather preliminary evidence of intervention effects on brain responses and attention outcomes. Seven children with high functioning ASD ages 5 –12 and seven age- and gender-matched TD completed procedures measuring brain responses (EEG) and behaviors (the Test of Everyday Attention for Children). Children with ASD then completed a 35-min individual music therapy attention protocol delivered by a board-certified music therapist ten times over 5 weeks. Children with ASD completed measures of brain responses and behavior post-intervention to determine pre- to post-test differences. Consent and completion rates were 100% for children who met the study criteria. Feasibility measures indicated that measures of brain responsivity could be used to determine attentional differences between children with ASD and typical children. Initial outcome data for brain responses and behavior indicated positive trends for the impact of music therapy on selective attention skills.

The aim of the study was to characterize subtle motor signs in children with moderate-severe traumatic brain injury in the chronic phase of injury.Fourteen children with moderate (n = 6) or severe (n = 8) traumatic brain injury, ages 11-18 yrs, who had sustained their injury at least 1-yr before study participation (range 1-14 yrs since injury), and 14 matched typically developing controls were examined using the Physical and Neurological Examination of Subtle Signs (PANESS). To examine the neural correlates of subtle motor signs, measures of total cerebral volume and motor/premotor volume were derived from magnetic resonance imaging.Children with traumatic brain injury had significantly poorer PANESS performance than controls on the total timed subscore, proximal overflow, and the PANESS total score. Participants with severe traumatic brain injury had greater proximal overflow than those with moderate injury, after controlling for age at injury. Across all participants, greater proximal overflow correlated with reduced total cerebral volume, whereas within the traumatic brain injury group, reduced motor/premotor volume correlated with lower PANESS total score.The study highlights the importance of examining subtle motor signs including overflow during clinical evaluation of chronic pediatric traumatic brain injury and establishes the clinical utility of the PANESS as a measure sensitive to chronic subtle motor signs in this population.Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Define subtle motor signs including motor overflow; (2) Identify subtle motor signs such as motor overflow during clinical evaluation of children with brain injury; and (3) Explain the relevance of examining subtle motor signs in chronic pediatric brain injury during clinical evaluations.Advanced.The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Neurophysiological research has shown that auditory and motor systems interact during movement to rhythmic auditory stimuli through a process called entrainment. This study explores the neural oscillations underlying auditory-motor entrainment using electroencephalography. Forty young adults were randomly assigned to one of two control conditions, an auditory-only condition or a motor-only condition, prior to a rhythmic auditory-motor synchronization condition (referred to as combined condition). Participants assigned to the auditory-only condition auditory-first group) listened to 400 trials of auditory stimuli presented every 800 ms, while those in the motor-only condition (motor-first group) were asked to tap rhythmically every 800 ms without any external stimuli. Following their control condition, all participants completed an auditory-motor combined condition that required tapping along with auditory stimuli every 800 ms. As expected, the neural processes for the combined condition for each group were different compared to their respective control condition. Time-frequency analysis of total power at an electrode site on the left central scalp (C3) indicated that the neural oscillations elicited by auditory stimuli, especially in the beta and gamma range, drove the auditory-motor entrainment. For the combined condition, the auditory-first group had significantly lower evoked power for a region of interest representing sensorimotor processing (4–20 Hz) and less total power in a region associated with anticipation and predictive timing (13–16 Hz) than the motor-first group. Thus, the auditory-only condition served as a priming facilitator of the neural processes in the combined condition, more so than the motor-only condition. Results suggest that even brief periods of rhythmic training of the auditory system leads to neural efficiency facilitating the motor system during the process of entrainment. These findings have implications for interventions using rhythmic auditory stimulation.

Objective This study examined sensory gating in children with autism spectrum disorders (ASD). Gating is usually examined at the P50 component and rarely at mid- and late-latency components. Methods Electroencephalography data were recorded during a paired-click paradigm, from 18 children with ASD (5–12 years), and 18 typically-developing (TD) children. Gating was assessed at the P50, N1, P2, and N2 event-related potential components. Parents of all participants completed the Short Sensory Profile (SSP). Results TD children showed gating at all components while children with ASD showed gating only at P2 and N2. Compared to TD children, the ASD group showed significantly reduced gating at P50, N1, and P2. No group differences were found at N2, suggesting typical N2 gating in the ASD group. Time-frequency analyses showed reduced orientation and neural synchronization of auditory stimuli. P50 and N1 gating significantly correlated with the SSP. Conclusion Although children with ASD have impaired early orientation and filtering of auditory stimuli, they exhibited gating at P2 and N2 components suggesting use of different gating mechanisms compared to TD children. Sensory deficits in ASD may relate to gating. Significance The data provide novel evidence for impaired neural orientation, filtering, and synchronization in children with ASD.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Statistical modeling analysis reveal that attention skills mediate the relationship between brain measures of sensory processing (measured by electroencephalography) and behavioral sensory processing in young adults with and without autism. Thus, attention abilities facilitate brain mechanisms to better process sensory stimuli to perform everyday sensory processing activities and social skills. Results suggest that therapy emphasizing attention skills in autism can modify sensory and social participation. Primary Author and Speaker: Jewel Elias Crasta Additional Authors and Speakers: Patricia Davies Contributing Authors: William J. Gavin

To compare the burden among the primary caregivers (PCG) of children with autism and intellectual disability (ASD + ID) against intellectual disability (ID) only, and identify the factors that predict high caregiver burden.Children with either ASD + ID (N = 41) or ID (N = 56) and their PCG were recruited and assessed using the Family Burden Interview Schedule, Binet Kamat Scale of Intelligence or Gesell's Developmental Schedule and Vineland Social Maturity Scale, Childhood Autism Rating Scale, Sensory Profile and Brief Autism Mealtime Behavior Inventory after collecting the socio-demographic details. Appropriate bivariate and multivariate statistical test were used.The total burden and level of burden was similar among PCG of children with ASD + ID and ID (P = 0.8). However, financial burden (P = 0.03) and burden due to the effects on the physical health of other family members (P = 0.03) was more among the ID group. The burden due to the effects on family interaction was more (P = 0.009) in the ASD + ID group. The socio-economic status (OR = 3.60; P = 0.03) and the kinship of the primary care-giver (OR = 0.37; P = 0.008) were significantly associated with high level of burden. In addition, the diagnosis, and gender of the child contributed to the prediction model for high level of burden.The interventions for children with ASD + ID and ID should have modules to address burden among PCG. Disability specific burden alleviating strategies should be used among PCG who are at risk of having high burden.

There is no validated measure for assessing sensory processing among children with Developmental Disorders (DD) in India, and therefore, the authors validated the Sensory Profile Caregiver Questionnaire (SPCQ). Parents of 119 children with DD or typical development completed the SPCQ. The diagnosis of DD was confirmed by psychologists using standardized measures. Two experienced occupational therapists independently diagnosed sensory processing dysfunction by consensus as reference standard diagnosis. The convergent and divergent validity were assessed by another rater. The data was analyzed for diagnostic accuracy, reliability and validity appropriately. A total SPCQ score of ≤ 481 (Sn = 81.58 %, Sp = 85.19 %; AUC = 0.90, z = 14.95; P 0.0001) is appropriate for the diagnosis of sensory processing dysfunction. The inter-rater reliability (ICC = 0.87), test- retest reliability (ICC = 0.90), internal consistency (Cronbach’s α = 0.86), section-total correlation, face and content validity for the SPCQ were good. Convergent validity with the Sensory Processing Measure (r = −0.76, P 0.001), and divergent validity with the subscale scores for social skills/ oppositional behavior of ADD-H Comprehensive Teacher Rating Scale (r = 0.32; P 0.1/ r = 0.08; P 0.6) was established. The SPCQ has adequate psychometric properties for use in the Indian population for identifying sensory processing dysfunction.

Date Presented 04/04/19 This study evaluated the relationship between sensory processing and social responsiveness in young adults with ASD and age-matched neurotypical controls. Compared to controls, young adults with ASD had significant differences on all four quadrants of the sensory profile. However, low registration and sensory gating (the ability to filter irrelevant information) appear to be key predictors of social responsiveness. Primary Author and Speaker: Jewel Crasta Additional Authors and Speakers: Patricia Davies Contributing Authors: William Gavin

Date Presented 4/19/2018 Results of this study indicate that young adults with high-functioning autism spectrum disorder have significant deficits in both behavioral and neural measures of sensory processing. Additionally, attention influences early stages of neural sensory processing. Primary Author and Speaker: Jewel Crasta Additional Authors and Speakers: Patricia L. Davies Contributing Authors: William J. Gavin

To compare the prevalence and profile of feeding problems (FP) and their relationship with sensory processing in children with autism and intellectual disability (ID).Children between ages 3 to 10 y with autism (N = 41) and ID (N = 56) were recruited and assessed with Brief Autism Mealtime Behavior Inventory, Sensory Profile Questionnaire, Childhood Autism Rating Scale and Binet-Kamat Scale of Intelligence or Gesell's Developmental Schedule. Assessments were done by independent raters. Bivariate and multivariate analyses were used appropriately.The prevalence of FP were 61 and 46.4% among children with autism and ID respectively. Feeding problems were severe among children with autism (P 0.001), especially in young children with autism (P 0.05), and gender was not related to FP. Disruptive meal-time behaviors (P 0.001) and food over-selectivity (P 0.02) were significantly more among children with autism in the bivariate and multivariate analysis. Feeding problems and various dimensions of sensory processing were significantly associated after controlling the confounders.These findings underscore the need for mandatory assessment of FP in children with developmental disabilities, and if present, they need to be addressed with multimodal-multidisciplinary interventions.

Date Presented 4/10/201 Children with high-functioning autism have different brain processing and brain–behavior relationships than typically developing peers. Results may inform how occupational therapists select therapeutic approaches and stimulate adaptive responses during therapy for improving everyday activities. Primary Author and Speaker: Emily Marshall Contributing Authors: Mary Khetani, Blythe LaGasse, Mei-Heng Lin, Jewel Crasta, William J. Gavin, Patricia Davies

Date Presented 4/10/2016 Children with high-functioning autism (HFA) display significantly reduced brain responses while processing auditory information compared with typically developing children. Our results can help practitioners understand the neurophysiological basis of some behavioral manifestations of HFA. Primary Author and Speaker: Jewel Crasta Additional Author and Speaker: Patricia Davies Contributing Authors: Blythe LaGasse, William J. Gavin