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Background: Developmental Coordination Disorder (DCD) affects school-age children and interferes with the practice of their daily activities. Task-oriented work and motor imagery have shown great efficacy in addressing this problem., Objective: This study presents a protocol that seeks to understand the effectiveness of a combined program of both modalities on the motor competence of children susceptible to the presence of DCD., Desing: Randomised controlled trial., Methods: The participants are children susceptible to the presence of DCD (from 6 to 12 years old) distributed into an intervention group that received a total of 20 protocol sessions and a control group that continued with their usual school routine.

Background: Motor coordination concerns are estimated to affect 5%-6% of school-aged children. Motor coordination concerns have variable impact on children's lives, with gait and balance often affected. Textured insoles have demonstrated positive impact on balance and gait in adults with motor coordination disorders related to disease or the ageing process. The efficacy of textured insoles in children is unknown. Our primary aim was to identify the feasibility of conducting a randomised controlled trial involving children with motor control issues. The secondary aim was to identify the limited efficacy of textured insoles on gross motor assessment balance domains and endurance in children with movement difficulties., Methods: An assessor-blinded, randomised feasibility study. We advertised for children between the ages of 5-12 years, with an existing diagnosis or developmental coordination disorder or gross motor skill levels assessed as 15th percentile or below on a norm-referenced, reliable and validated scale across two cities within Australia. We randomly allocated children to shoes only or shoes and textured insoles. We collected data across six feasibility domains; demand (recruitment), acceptability (via interview) implementation (adherence), practicality (via interview and adverse events), adaptation (via interview) and limited efficacy testing (6-min walk test and balance domain of Movement ABC-2 at baseline and 4 weeks)., Results: There were 15 children randomised into two groups (eight received shoes alone, seven received shoes and textured insoles). We experienced moderate demand, with 46 potential participants. The insoles were acceptable, however, some parents reported footwear fixture issues requiring modification. The 6-min walk test was described as problematic for children, despite all but one child completing. Social factors impacted adherence and footwear wear time in both groups. Families reported appointment locations and parking impacting practicality. Underpowered, non-significant small to moderate effect sizes were observed for different outcome measures. Improvement in balance measures favoured the shoe and insole group, while gait velocity increase favoured the shoe only group., Conclusion: Our research indicates that this trial design is feasible with modifications such as recruiting with a larger multi-disciplinary organisation, providing velcro shoe fixtures and using a shorter timed walk test. Furthermore, progressing to a larger well-powered randomised control trial is justified considering our preliminary, albeit underpowered, efficacy findings., Trial Registration: This trial was retrospectively registered with the Australian and New Zealand Clinical Trial Registration: ACTRN12624000160538., (© 2024 The Author(s). Journal of Foot and Ankle Research published by John Wiley & Sons Australia, Ltd on behalf of Australian Podiatry Association and The Royal College of Podiatry.)

Eye-gaze technology provides access to a computer through the control of eye movements, thus allowing students with severe motor and communication difficulties to communicate and participate in curriculum activities and leisure; however, few studies have investigated whether any challenges exist to its implementation. This study examines the feasibility for teachers, parents, and therapists of applying an eye-gaze technology intervention for students with severe motor and communication difficulties in everyday settings. A mixed-method design was applied, focusing on the acceptability, demands, implementation, and practicality of the technology applications. Data was collected from 16 participants who assisted five students using eye-gaze technology in a previous 6-month intervention. The intervention comprised (a) use of eye-gaze devices with individualized content; and (b) services including training in use, team meetings, and bi-monthly support on implementation problems. The results showed that the participants perceived the technology as appropriate to enhance interaction and understanding of the students' learning and communication messages. Portable and easy-to-adjust systems were crucial to apply eye-gaze technology in different contexts. Improving eye-gaze services was required to afford in-service education, follow-up services, and loaning programs for sustainable implementation. The facilitators and barriers could guide researchers and practitioners to enhance the implementation of eye-gaze technology.

Virtual reality (VR) applications in paediatric rehabilitation are recent but promising. This brief report describes a VR rehabilitation program for a small sample of children with Developmental Coordination Disorder (DCD). The program focused explicitly on executive functions, a key area of concern for this population. It was conducted over 11 weeks in the CARE Lab. This lab was designed with appropriate structural characteristics and sophisticated technology to provide a rehabilitative setting with recreational and semi-immersive features. Before and after the VR training, the children were evaluated in terms of visual attention, inhibition, planning abilities, and visual-motor coordination. The rehabilitation programs were customised according to the clinical needs and the functional profile of each patient, proposing different games with variable complexity levels. These preliminary results showed a global and clinically significant change in executive functions, especially visual attention and inhibition skills. These findings suggest interesting implications for clinical practice, providing new information for professionals regarding the application of VR in the field of paediatric rehabilitation.

Background: The present study analyses the effect of a Movement-Based Intervention to improve Actual and Perceived Motor Competence in children with probable Developmental Coordination Disorder aged four and six years., Methods and Procedures: A longitudinal pre-experimental study was designed with measurements conducted at pre-test, post-test and follow-up (after 5 months without intervention). The group, composed of children with probable Developmental Coordination Disorder or low motor competence, consisted of 57 participants, and the duration of a Movement-Based Intervention was 27 sessions allocated in nine weeks., Outcomes and Results: Actual Motor Competence was evaluated with the Movement Assessment Battery for School children and Perceived Motor Competence with Pictorial Scale of Perceived Motor Skill Competence for Children. The results showed significant improvements in both study variables (Actual Motor Competence and Perceived Motor Competence), both at post-test and follow-up, five months after the end of the intervention. In conclusion, a Movement-based Intervention is effective in improving Actual and Perceived Motor Competence in the participants of this research, children with low motor competence or probable Developmental Coordination Disorder., What This Paper Adds: Considering the improvements observed after the program in Spanish sample, it seems that the usual practice in Early Childhood Education in our context may not be sufficient, i.e., it may not provide children with the necessary support (number of lesson and time) and appropriate learning contexts to promote the development of their motor skills. Considering the results, this study suggests that using an Movement-Based Intervention with an appropriate pedagogical approach, and offering different learning opportunities to children according to their needs, could positively influence their Actual and Perceived Motor Competence, and could motivate them towards future practice., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In this study we investigated the effects of an 8-week table tennis exercise program with a task-oriented approach on visual perception and motor performance of 31 adolescents with developmental coordination disorder (DCD). The participants were identified by their teachers as having greater difficulty than their peers (450 students from three Korean middle schools) in physical education (PE) classes. On the Bruininks-Oseretsky Test of Motor Proficiency-2, these adolescents scored below the 15th percentile and showed difficulties in performing daily life activities due to motor performance problems; they did not have physical defects, intellectual or neurological impairments, or Attention Deficit Hyperactivity Disorder. Of 98 prospective adolescents with PE difficulties, we obtained personal assent and parents' informed consent from 54, and 31 of these met screening criteria for DCD through the Developmental Coordination Disorder Questionnaire-Korean. This final group was divided in non-random fashion (based on the proximal geographic grouping of the children's schools) between an experimental group ( n = 16) and a control group ( n = 15). The experimental group participated in the 8-week task-oriented table tennis training program with three 90-minute sessions per week, while the control group only participated in regular PE classes twice per week. We measured participants' visual perception and motor performance in the same environment before and after the intervention program. Participants' visual perception was significantly more improved in the experimental group than the control group, with specific improved skills in visual-motor search, visual-motor speed, figure-ground, and visual closure; copying and perceptual constancy skills did not improve significantly. In addition, total motor performance and motor sub-skills, including fine manual control, manual coordination, body coordination, strength, and agility were significantly more improved in the experimental group than in the control group. Thus, our task-oriented table tennis exercise program was of greater assistance than general PE classes for improving visual perception and motor performance in adolescents at risk of DCD., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: A large proportion of adolescents with developmental coordination disorder (DCD) are physically inactive. Physical literacy has been described as an important determinant in promoting health behaviours. The potential of exergames to improve physical literacy and activity has been recognized in typically developing children. The aim of the present scoping review was to identify and map the available evidence of this potential for adolescents with DCD., Methods: A scoping review was performed via a literature search in PubMed, Web of Science, Embase, ERIC and CINHAIL., Results: From 2860 search records, six studies (two studies in DCD and four studies in cerebral palsy [CP]) assessed physical activity, 12 studies discussed exergame features and 16 studies assessed physical literacy domains. In DCD, one study showed positive effects of exergaming on physical activity and the other failed to show any significant effects of exergaming. In CP, all four studies demonstrated positive effects of exergaming on energy expenditure and daily physical activity. Furthermore, positive effects of exergames on the different physical literacy domains were shown, namely motor competence, self-concept and affect, motivation and social/experiential. Finally, exergame features including multiplayer modes, realism, game rewards, challenges and enjoyment were shown to have a significant effect on motivating and encouraging adolescents to exert more effort while playing., Conclusion: Based on the positive effects of exergaming on physical activity in other populations, more in-depth research in adolescents with DCD is warranted such that the decline in physical activity behaviour that is present in individuals with DCD can be counteracted. Physical literacy should be regarded as an important determinant in this regard., (© 2024 The Author(s). Child: Care, Health and Development published by John Wiley & Sons Ltd.)

Purpose: Participation difficulties among adults with developmental coordination disorder (DCD) have been documented. However, little attention has been given to the subjective aspects of participation, also called occupational experience, including feeling during engagement in activities and their meaning. This study aimed to explore the occupational experience of young adults with DCD., Materials and Methods: Informed by the phenomenological approach, we conducted semi-structured interviews with 10 young adults with DCD., Findings: Three themes emerged: (1) Complexity of occupational experience; describes the motives for participation, with variations in experience across activities and individuals. Participants engage in activities that provide them with pleasure and fulfillment, while other activities require constant effort and cause stress and shame; (2) The role of internal factors; illustrates the influence of poor motor and organizational/planning skills, self-acceptance; and utilizing strategies on the participants' occupational experience; and (3) The role of the social environment; reveals the participants' dual perception of their environment - as a source of criticism as well as a source of support., Conclusions: Individuals with DCD may benefit from intervention during young adulthood to enhance their well-being. The interventions should target their subjective occupational experiences in addition to their objective performance difficulties, by enhancing their psycho-social resources.

Objective: This scoping review aims to explore published literature testing Virtual Reality (VR) interventions for improving upper limb motor performance in children and adolescents with Developmental Coordination Disorder (DCD). Our primary focus was on the types of VR systems used and the measurement tools employed within the International Classification of Functioning, Disability and Health Children and Youth Version (ICF-CY) domains in these studies., Methods: A comprehensive search of six electronic databases up to 11th January 2024 was conducted using predefined terms. Inclusion and exclusion criteria were applied to determine study eligibility, with two authors independently assessing titles, abstracts, and full-text articles., Results: Out of 788 potential studies, 14 met the eligibility criteria. Studies predominantly utilized non-immersive VR (nVR) systems, for example, commercial platforms such as Nintendo Wii. Most interventions targeted general motor coordination or balance, with only four studies specifically focusing on upper limb motor performance. The Movement Assessment Battery for Children-2 was the predominant assessment tool. However, the use of game scores and trial durations raised concerns about the accuracy of assessments. The majority of studies reported no significant improvement in upper limb motor performance following VR interventions, though some noted improvements in specific tasks or overall outcomes., Conclusion: The findings suggest that, while nVR interventions are being explored for paediatric motor rehabilitation, their impact on enhancing upper limb motor performance in children with DCD is unclear. The variability in intervention designs, outcome measures, and the predominant focus on general motor skills rather than specific upper limb improvements highlight the need for more targeted research in this area., Impact: This review underscores the importance of developing precise and clinically relevant measurement tools in a broader range of VR technologies to optimize the use of VR in therapy for children with DCD. Future research should aim for more rigorous study designs and emerging immersive technologies to maximize therapeutic benefits., (© 2024. The Author(s).)

Background. Current international clinical practice guidelines indicate that children with developmental coordination disorder (DCD) should receive therapy, yet school and community-based occupational therapy is not standard of care. Purpose. To understand parent perspectives on best practice for treatment and what supports and services are required to meet their children's needs. Method. An online cross-sectional survey (impACT for DCD) was distributed to parents of children <18 years with self-reported suspected or diagnosed DCD living in British Columbia. Data analysis included descriptive statistics and contingency analyses to explore whether access to therapy differed with income, age of child, or geographical location. Open-ended questions were analyzed using content analysis. Findings. Of the 237 respondents, 194 children had suspected/confirmed DCD; however, only 20% (38/198) of the children had received therapy at school. Some parents (32/58) pursued private therapy. Geographic location and income had no relationship with therapy access ( p  > 0.05). Parents expressed frustration with poor awareness and understanding of the impact of DCD among educators, health-care professionals, and community members, and identified the need for funded and accessible school and community services and supports. Conclusion. Evidenced-based occupational therapy intervention should be standard of care for children with DCD as per clinical guidelines and parent-identified need.

Introduction: Developmental coordination disorder (DCD) is a neurodevelopmental disorder that affects children's occupational performance and participation. It is known that the Covid pandemic has adversely affected the whole world in many areas. We aim to investigate the occupational performance and participation of children with DCD before and during the COVID-19., Methods: Sixty-five children aged 5-12 years included in the study were assessed by the Canadian Measure of Occupational Performance and the Participation and Environment Measure for Children and Youth., Results: Statistically significant differences were detected in occupational performance and satisfaction scores (p < 0.01). Additionally, except for 'involvement in the home environment' (p > 0.05), there were statistically significant differences in all other areas of participation (p < 0.01)., Conclusion: The occupational performance and participation of children with DCD are impacted during COVID-19. In addition, it is seen that the desire of families to change regarding participation has increased due to COVID-19. It would be beneficial to include strategies to improve these areas in the rehabilitation processes., (© 2023 John Wiley & Sons Ltd.)

Purpose: To investigate the association between prenatal opioid exposure (POE) and newborn infants' motor performance to aid in the early identification of developmental delays., Methods: Nineteen infants with POE requiring pharmacological treatment, 27 infants with POE without pharmacological treatment, and 25 infants without POE were assessed via the Test of Infant Motor Performance (TIMP)., Results: Infants in both groups with POE had lower TIMP scores than infants without POE. There was no difference between the TIMP scores of infants with POE who required pharmacological treatment and infants with POE who did not require pharmacological treatment., Conclusions: The TIMP can detect differences in motor performance of infants with POE. Regardless of whether infants required pharmacological treatment, POE was associated with lower motor performance. Those working in hospital or early intervention settings can use the TIMP to identify early delays in infants with POE and refer for intervention., Competing Interests: S.K. Campbell is a developer of TIMP and a partner in IMPS LLC. The other authors have no conflicts of interest., (Copyright © 2023 Academy of Pediatric Physical Therapy of the American Physical Therapy Association.)

Background: Improving arm-hand skill performance is a major therapeutic target in stroke rehabilitation and needs intensive and varied training. However, guided treatment time is limited. Technology can assist in the training of patients, offering a higher intensity and more variety in content. A new task-oriented arm training approach was developed, using a 'Remote Handling concept based' device to provide haptic feedback during the performance of daily living activities (ReHab-TOAT). This study aims to investigate the effects of ReHab-TOAT on patients' arm-hand function and arm-hand skill performance, quality of life of both patients in the chronic phase after stroke and their caregivers and the patients' perception regarding the usability of the intervention., Methods: A randomized clinical trial was designed. Adult chronic stroke patients suffering from hemiparesis and arm-hand problems, with an Utrechtse Arm-hand Test score of 1-3, will be invited to participate. Participants in the experimental group receive ReHab-TOAT additional to care as usual. ReHab-TOAT contains task-oriented arm training for stroke patients in combination with haptic feedback, generated by a remote handling device. They will train for 4 weeks, 3× per week, 1.5h per day. Participants in the control group will receive no additional therapy apart from care as usual. The Fugl-Meyer Assessment (FMA), measuring participants' motor performance of the affected arm, is used as the primary outcome measure. Secondary outcome measures are arm-hand capacity of the patient (ARAT), perceived arm-hand skill performance (MAL), actual arm-hand skill performance (accelerometry), patients' quality of life (EuoQol-5D) and caregivers' quality of life (CarerQoL). Participants' perception regarding the usability of the intervention, including both the developed approach and technology used, will be evaluated by the System Usability Scale and a questionnaire on the user experience of technology. Measurements will be performed at 1, 2, 3 and 4 weeks pre-intervention (baseline); immediately post-intervention; and 3, 6 and 9 months post-intervention. Statistical analysis includes linear mixed model analysis., Discussion: This study is designed to investigate the evidence regarding the effects of ReHab-TOAT on patients' performance at different levels of the International Classification of Functioning, disability and health (ICF) model, i.e. a framework measuring functioning and disability in relation to a health condition, and to provide insights on a successful development and research process regarding technology-assisted training in co-creation., Trial Registration: Netherlands Trial Register NL9541. Registered on June 22, 2021., (© 2023. The Author(s).)

Background: Adaptive postural control is an important yet underexamined area in children with developmental coordination disorder (DCD). This study compared adaptive postural responses between children with DCD and those with typical development., Methods: This was an exploratory cross-sectional study. Fifty-two children with DCD (aged 6-9 years) and 52 age- and sex-matched children with typical development participated in the study. Their adaptive postural (motor) responses were assessed using the Adaptation Test (ADT) on a computerized dynamic posturography machine. The sway energy score (SES) for each ADT trial and the average SES of five trials for both toes-up and toes-down platform inclination conditions were recorded., Results: The SESs were lower in the DCD group than in the control group in ADT toes-up trial 1 (p = 0.009) and on average (p = 0.044). In the control group, the SES decreased from trial 1 to trial 2 for both the ADT toes-up (p = 0.005) and toes-down conditions (p < 0.001)., Significance: Adaptive postural responses were absent in children with DCD, and these children used less force (i.e., sway energy) to overcome postural instability. Therefore, both adaptive balance and neuromuscular training should be factored into rehabilitation programs for children with DCD., Competing Interests: Declaration of Competing Interest No potential conflict of interest is reported by the authors., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: Although early intervention for infants at risk for cerebral palsy is routinely recommended, the content of intervention is poorly described, varies widely, and has mixed supporting evidence. The purpose of this study was to compare efficacy of 2 interventions grounded in differing domains of the International Classification of Functioning, Disability and Health on developmental outcomes of infants with or at high risk of cerebral palsy., Methods: Infants who meet inclusion criteria will be randomized into either Sitting Together and Reaching To Play or Movement, Orientation, Repetition, Exercise Physical Therapy groups. Both groups will receive intervention twice weekly for 3 months and follow-up at 3, 6, 9, and 12 months from baseline. The primary objectives compare changes over time and between groups in sitting, gross motor, and cognitive development. The setting is the infant's home unless the caregiver requests otherwise. One hundred and fifty infants between 8 and 24 months of age will be enrolled in 3 geographically, racially, and ethnically diverse sites: Los Angeles, California; Omaha, Nebraska; and Seattle, Washington. Enrolled infants will demonstrate motor delays, emerging sitting skills, and signs of neurologic impairment. Sitting Together and Reaching To Play targets activities including sitting, reaching, and motor-based problem solving to improve global development. In contrast, Movement, Orientation, Repetition, Exercise Physical Therapy focuses on strengthening and musculoskeletal alignment while encouraging repeated movement practice. Outcome measures include the Gross Motor Function Measure, Bayley Scales of Infant Development-IV, Assessment of Problem Solving in Play, and a Parent Child Interaction assessment. Enrolled children will maintain usual intervention services due to ethical concerns with intervention withdrawal., Impact: This will be the first study, to our knowledge, comparing efficacy of early physical therapy with dose-matched interventions and well-defined key principles. The outcomes will inform selection of key principle of intervention in this population., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To examine the effectiveness and feasibility of We12BFit!, a family-focused intervention aimed at increasing physical fitness (PF) and motivation for physical activity (PA) in 7-year-old to 12-year-old children with developmental coordination disorder (DCD)., Design: A single-arm mixed methods small sample field study., Setting: Rehabilitation centres and schools for special education in The Netherlands., Participants: Twenty children with DCD diagnosis., Interventions: We12BFit! consists of We12BFit!-PF and We12BFit!-Lifestyle PA. During We12BFit!-PF, cardiorespiratory fitness (CRF), muscle strength and anaerobic power were trained in small groups (10 weeks 2*60 min/week). We12Bfit!-Lifestyle PA, which addresses motivation for PA in children and parents, was added in week 6 of We12BFit!-PF and ended 12 weeks after We12BFit!-PF., Outcome Measures: The 20-Metre Shuttle Run Test (20mSRT), Muscle Power Sprint Test and Hand Held Dynamometry were performed before and after We12BFit!-PF and after We12BFit!-Lifestyle PA (T0-T1-T2). Parents and coaches were interviewed and trainers participated in a focus group to assess motivation for PA, perceived effectiveness, and feasibility of the intervention., Results: Attendance rates of participants were 88% (We12BFit!-PF) and 89% (We12BFit!-Lifestyle PA). From T0 to T1, significant improvements were found in VO 2peak , number of runs on the 20mSRT and mean anaerobic power. From T1 to T2, improvements were maintained. No changes were found after We12BFit!-Lifestyle PA in time spent on moderate to vigorous activity and metabolic equivalent of task; parents observed their child improved in qualitative aspects of activities and participation. Feasibility of We12Bfit! was confirmed, although some adaptations were recommended., Conclusions: We12BFit! resulted in significant improvements and maintenance of CRF and anaerobic power in a small group of children with DCD and seemed to improve motivation for PA. The group aspect of We12BFit!-PF, the high intensity and positive motivational climate of We12BFit!-PF may have improved children's self-efficacy. We12BFit! seems feasible to improve PF and PA in children with DCD., Trial Registration Number: NTR6334., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background : Rett syndrome (RTT) is a genetically caused neurodevelopmental disorder associated with severe disability. We assessed the feasibility of a telehealth program supporting gross motor skills in RTT. Methods : Five girls with RTT were assessed and a home-based exercise program developed in response to functional goals. Families then participated in monthly Skype sessions for 6 months, guided by a physiotherapist to monitor progress and adjust the program as necessary. Goal Attainment Scaling was used to evaluate progress and a parental satisfaction questionnaire was administered. Results : Four goals were established for each participant and progress was greater than would be expected in 16 of 20 goals. Parents evaluated the program as feasible and useful for their daughters. Discussion : A telehealth model of home-based intervention supported individuals with RTT to achieve gross motor skills and was found to be feasible. This model is important at present times during COVID-19 outbreak and lockdown.

Introduction: Poor trunk control after stroke can impact recovery of global functional abilities. Therefore, the aim of this study was to evaluate whether clinical and functional data from stroke participants can be used to predict trunk control at 90 days., Methods: This is a prospective study of 37 participants with stroke. The variables evaluated at hospital discharge were stroke severity (National Institute of Health Stroke Scale - NIHSS); functional capacity (modified Rankin scale - mRS); handgrip; and cognitive function. At 90 days, the variables evaluated were autonomy (Functional Independence Measure - FIM, Barthel Index); gait mobility (Tinetti mobility test -TMT); quality of life (European Quality of Life Scale - EuroQol-5D) and trunk control (trunk impairment scale - TIS). The participants were considered to have satisfactory (TIS³14) or non-satisfactory trunk control (TIS≤13), and the differences between them were assessed by chi-square test (categorical variables) and Mann-Whitney/unpaired t-test (continuous variables). A ROC curve was used to show cut-off value of clinical variables to predict trunk control., Results: The unsatisfactory trunk control group presented ahigher NIHSS at discharge (p=0.01), higher mRS at discharge (p=0.00), lower Barthel Index at 90 days (p=0.03), lower FIM at 90 days (p=0.01) and lower TMT at 90 days (p=0.00) than the satisfactory trunk control group. The best cut-off points for the NIHSS and mRS scores at discharge for predicting unsatisfactory trunk control are ≥6 and ≥3, respectively., Conclusion: Greater NIHSS and mRS scores at hospital discharge increase the chance of unsatisfactory trunk control at 90 days after stroke.

Objective: To investigate the effect of intensive physiotherapy training on the motor function of children with congenital Zika syndrome (CZS)., Design: A retrospective cohort study., Setting: A support center for children with microcephaly., Participants: Children (N=7) aged 14 to 18 months old who were diagnosed with CZS and previously monitored more than 1 year., Interventions: A 2-stage protocol repeated uninterruptedly for 1 year. In the first stage, the children were submitted to 1 hour of conventional physiotherapy and 1 hour of suit therapy 5 times a week for 4 weeks. The second stage consisted of 1 hour of suit therapy 3 times a week for 2 weeks., Main Outcome Measures: Gross motor function measure (GMFM) and body weight., Results: Six evaluations were conducted approximately 3 months apart. An increase in the overall GMFM score was observed between the first and second (P=.046), first and third (P=.018), first and fourth (P=.018), first and fifth (P=.043), and first and sixth evaluations (P=.018). Differences in the scores of the individual GMFM dimensions were found only for dimension A (lying and rolling) between the first and fourth evaluations (P=.027) and for dimension B (sitting) between the first and third (P=.018), first and fourth (P=.046), and first and sixth evaluations (P=.027). No difference was found in body weight between the first and sixth evaluations (P=.009). During follow-up, only 1 child required hospitalization, and another had increased irritability., Conclusions: Children with CZS were able to perform 2 hours of motor physiotherapy daily with no serious complications, resulting in an increase or stabilization in GMFM scores., (Copyright © 2020 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Aim: To describe the development of an intervention-specific fidelity measure and its utilization and to determine whether the newly developed Sitting Together and Reaching to Play (START-Play) intervention was implemented as intended. Also, to quantify differences between START-Play and usual early intervention (uEI) services., Method: A fidelity measure for the START-Play intervention was developed for children with neuromotor disorders by: (1) identifying key intervention components, (2) establishing a measurement coding system, and (3) testing the reliability of instrument scores. After establishing acceptable interrater reliability, 103 intervention videos from the START-Play randomized controlled trial were coded and compared between the START-Play and uEI groups to measure five dimensions of START-Play fidelity, including adherence, dosage, quality of intervention, participant responsiveness, and program differentiation., Results: Fifteen fidelity variables out of 17 had good to excellent interrater reliability evidence with intraclass correlation coefficients (ICCs) ranging from 0.77 to 0.95. The START-Play therapists met the criteria for acceptable fidelity of the intervention (rates of START-Play key component use ≥0.8; quality ratings ≥3 [on a scale of 1-4]). The START-Play and uEI groups differed significantly in rates of START-Play key component use and quality ratings., Interpretation: The START-Play fidelity measure successfully quantified key components of the START-Play intervention, serving to differentiate START-Play from uEI., (© 2020 Mac Keith Press.)

In 2019, international clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder (DCD) were published. Informing our understanding of mechanisms, recent systematic reviews have shown that children with DCD have difficulties with the predictive control of movements, including aspects of motor planning, which is expressed as the internal modeling deficit hypothesis. This motor control deficit is most evident when the spatial and temporal demands of a task increase. An increasing number of empirical studies suggest that motor planning problems can be remediated through training based on one or a combination of motor imagery and action observation. In this review, we show evidence of motor planning problems in children with DCD and show that task demands or complexity affects its appearance. Implications of these findings are treatments based on motor imagery and action observation to remediate motor planning issues. The article concludes with recommendations for future research., (© 2020 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.)

Background: Developmental coordination disorder (DCD), classified as a neurodevelopmental disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), affects approximately 5% to 6% of school-aged children. Characteristics of DCD include poor motor coordination and delayed development of motor skills, not explained by other conditions. Motor deficits negatively affect school productivity, performance in activities of daily living, and recreation participation. Children with coordination problems, at risk for or diagnosed with DCD, should be evaluated by a team of professionals, including a physical therapist (PT)., Purpose: This clinical practice guideline (CPG) provides management strategies for PTs and informs clinicians and families about DCD. It links 13 action statements with specific levels of evidence through critical appraisal of the literature and provides recommendations for implementation., Results/conclusions: The DCD CPG addresses examination, referral, first choice and supplemental interventions, discharge, compliance audits, implementation, and research recommendations. Supplemental tools are provided to support PT management.

Introduction.: Developmental coordination disorder (DCD) is a neurodevelopmental disorder that impacts motor coordination and interferes with participation in everyday activities. Cognitive Orientation to Occupational Performance (CO-OP) is a client-centered treatment approach that focuses on skill acquisition through cognitive strategy use., Objectives.: To determine which types of goals a sample of children with DCD choose most frequently and which domain-specific strategies were most commonly used to address these goals., Methods.: Retrospective chart review of 50 children (8-12 years) with DCD who completed CO-OP intervention was conducted to identify goal types and strategy use., Results.: Leisure was the most common goal type. Supplementing task knowledge, body position, and task modification were the most frequently used strategies., Conclusions.: Results confirm the types of goals that are commonly selected by children with DCD and highlight commonly used strategies used to meet these goals. Findings will help guide occupational therapists in selecting appropriate strategies to meet children's goals.

Objective: Children with developmental coordination disorder (DCD) are reported to have lower levels of strength and anaerobic capacity. The purpose of this study was to (1) identify field-based tests for strength and anaerobic capacity used in studies comparing children with DCD and children who were typically developing (TD), (2) examine the methodological quality of studies reporting psychometric properties and rate the psychometric properties of the examined test, and (3) summarize available evidence by combining the methodological quality of the studies and the quality of the psychometric properties of the test., Methods: An electronic search was conducted in July 2019 in 4 electronic databases. For purpose 1, primary studies were included with no exclusion of study design in which children aged 4 to 18 years with DCD were compared with children who were TD on strength and/or anaerobic capacity measures. For purpose 2, primary studies were included with no exclusion of study design in which a psychometric property was investigated. The Consensus-Based Standards for Selection of Health Measurement Instruments (COSMIN) was used to evaluate the methodological quality of the 34 studies and rate the psychometric properties of the tests used., Results: Hand-held dynamometer, bent knee push-up, vertical jump, standing long-jump, functional strength measurement, fitness test, and test battery can be recommended for TD, and the shuttle run item of the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition and 10 m × 5 m sprints (straight and slalom) can be recommended for DCD., Conclusion: Information regarding psychometric properties of field-based tests for strength and anaerobic capacity in children with DCD is lacking., Impact: Information about the psychometric properties of field-based tests for strength and anaerobic capacity in children with DCD is lacking. More information is available on TD children, but it is also not complete; information regarding validity and responsiveness, especially, is missing. When using measures in children with DCD, it is important to keep in mind this lack of evidence for the validity and reliability of the outcomes for this target group., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: To investigate Wiedemann-Steiner syndrome (WSS), its correlation to hypotonia and developmental delay, and to determine the relative intervention strategies that may be useful during early intervention from birth to 3 years., Methods: A literature search using PEDro and PubMed was conducted using key words "Wiedemann-Steiner syndrome," "hypotonia," and "developmental delay" and a case study is presented., Results: A 36-month-old child with WSS received PT intervention beginning at 2 months old. Addition of orthotics and treadmill walking was added at 13 and 19 months, respectively. The child progressed through developmental sequences from rolling, sitting, standing, and walking although consistently scored with motor delay of -2 SD., Conclusions: Fifty-seven percent of children diagnosed with WSS have hypotonia, and 90% have developmental delay. The diagnosis of WSS should require physical therapy services through early intervention programs due to its high correlation with motor developmental delay and disability. Determination of progress should be measured with achievement of function rather than norm-referenced outcome measures.Video Abstract: For more insights from the authors, access Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A292.

Purpose: The purpose of this study was to describe stander use in a natural history cohort of drug therapy-naïve children with spinal muscular atrophy (SMA) who are not walking and identify factors associated with consistent stander use., Methods: Data from 397 children with SMA types 1 and 2 characterized the prevalence and frequency of stander use. Predictors of consistent stander use explored were SMA type, survival motor neuron 2 gene (SMN2) copy number, respiratory support, and motor performance., Results: Prevalence of consistent stander use was 13% in type 1 and 68% in type 2. SMA type, SMN2 copy number, respiratory support, and head rotation control each predicted consistent stander use., Conclusions: Findings characterize stander use in children with SMA who are not walking, address important safety considerations, identify factors that may inform physical therapists' clinical decision-making related to standing program prescription, and provide guidance for future prospective studies.

Children with developmental coordination disorder (DCD) may experience stress in physical activity contexts due to emphasis on their poor motor skills. The purpose of this study was to explore the lived experiences of children at risk for DCD in physical education in order to develop a deeper understanding about what they experience as stress and how they cope with it. Using interpretative phenomenological analysis, six children in Grades 4-6 participated in two semistructured interviews. A motivational (and developmental) stress and coping theory informed interpretation of the three themes that described the children's experiences: (a) they hurt me-psychological and physical harm sustained from peers, (b) it's hard for me-difficulties encountered in activities, and (c) I have to-pressure to meet the teacher's demands. Although the children at risk for DCD were confronted with various stressors in physical education, they coped more adaptively when social support was provided.

Problems have been reported in the execution and development of motor skills and its treatment as a cause of cancer in children. The purpose of this study was to examine the effect of the task-orientated rehabilitation program (ToRP) on motor skills of children with childhood cancer. Following the consort guideline, 93 children (49 males and 44 females) with pediatric cancer were randomized to either study (n = 52; 12.35 ± 3.43 years) or control (n = 41; 11.89 ± 3.56 years) groups. The study group received ToRP, and the control group received a home-based therapeutic strategies program for 20 sessions. Motor skill outcomes were assessed with Bruininks-Oseretsky Test of Motor Proficiency, Short Form (BOTMP-SF) by assessor who was blind to group allocation and interventions. The groups were homogenous in terms of demographic characteristics and motor skills. The study group showed a significant increase in both gross and fine motor skills (P values for all subtests: P < 0.001), whereas running speed, bilateral coordination, strength, response speed and visual motor control did not show significant improvement with the control group (P > 0.05). The ToRP appears to provide beneficial effects in improving motor skills at the early stages of rehabilitation for children with childhood cancer.

Background and Aim: Previous studies have supported the advantages of an external focus of attention (EFA) relative to an internal focus of attention (IFA) in healthly adults. However, effects of attentional focus instructions on skill performance and acquisition in children are equivocal. The aim of this study was to examine the effects of attentional focus instructions on performance of a whole body coordination task in children with and without developmental coordination disorder (DCD)., Methods: Children with DCD (n = 18) and typically developing (TD) children (n = 21) (9-10 years) were asked to perform 3 countermovement vertical jumps in the IFA (Concentrate on the swing of your arms), EFA (Concentrate on getting as close to the ceiling as possible), and control conditions., Results: The results showed that regardless of children's motor development proficiency, the jump height and vertical take-off velocity (V TO ) were higher in EFA relative to both IFA and Con conditions. In addition, V TO was significantly higher in the Con relative to IFA condition., Conclusion: The results of the current study showed that EFA relative to IFA instructions could enhance the neuromuscular activation of dynamic contractions of the leg muscles in both children with and without DCD. The findings suggest that the beneficial effects of EFA relative to IFA instructions on children's motor performance is identical across children with different levels of motor proficiency., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Children with developmental coordination disorder (DCD) exhibit deficits both in imitation and motor imagery (MI) compared to typically developing children. Combined action observation and motor imagery (AO + MI) instructions can however enhance automatic imitation in both groups. In the present study we investigated the effects of AO + MI instructions on intentional imitation in children both with (n = 13) and without DCD (n = 12). On each trial participants observed and/or imagined before executing a familiar rhythmical pantomime action. These target actions were either habitually fast (tooth brushing or window wiping) or habitually slow (paint brushing or face washing), in the vertical or horizontal plane. Within each habitual speed, the target action speed was subtly manipulated across trials (fast vs. slow). Instruction condition was manipulated across three blocks of 16 trials: (1) observe before imitating the target action; (2) observe then imagine the action before imitating; (3) observe while imagining the same action before imitating (AO + MI). Kinematic analyses revealed typically developing children imitated the observed cycle times significantly better than children with DCD. A main effect of instruction showed imitation improved for AO + MI compared to the other two instructions. Within-group analyses found a significant advantage in DCD for AO + MI compared to observe then imagine. In typically developing children, imitation was significantly enhanced for AO + MI compared to observe then imitate. Combined AO + MI instructions therefore represent a promising new approach to refining performance of everyday rhythmical actions in children both with and without DCD, with implications for movement therapy and sports training., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Aim: To explore the efficacy of movement-based interventions to improve motor skills in preschool-age children with, or at risk of, motor impairment, including those with a diagnosis of cerebral palsy, autism spectrum disorder, and developmental coordination disorder., Method: Relevant electronic databases were searched for randomized or quasi-randomized controlled trials. Outcomes were classified using domains of the International Classification of Functioning, Disability and Health: Children & Youth version. Quality was assessed using the Physiotherapy Evidence Database scale. Risk of bias was assessed using the Cochrane Risk of Bias tool. Effect sizes were calculated using Cohen's d., Results: Seventeen articles exploring a heterogeneity of intervention types, population groups, and outcome measures met the inclusion criteria. Movement-based interventions did not significantly improve outcomes in either the body structure and function or activity domains in most studies. No studies used a participation outcome measure., Interpretation: There is a paucity of evidence exploring movement-based interventions in the preschool-age group. Although movement-based interventions showed potential for improving body structure and function and activity outcomes for children with motor impairment, results were mostly not significant. Small sample sizes, variable study quality, and risk of bias limit confidence in the results., What This Paper Adds: The evidence is inconclusive to support movement-based interventions in this group. No studies used outcome measures assessing participation. Variability in intervention type and study quality limit confidence in results., (© 2019 Mac Keith Press.)

Aim: Developmental Coordination Disorder (DCD) is a motor disorder affecting coordination and performance in daily tasks. Studies regarding design and implementation of knowledge translation strategies effecting DCD practice changes in pediatric rehabilitation settings is limited and DCD remains under-recognized and under-diagnosed with an under-utilization of evidence-based practice. This knowledge-to-practice gap was identified in central Alberta, Canada when a lower caseload of clients with DCD and a lower rate of DCD referrals to a neurodevelopmental assessment clinic was observed, given its 5-6% prevalence in children. This paper describes and discusses the development and implementation of a replicable process of knowledge translation for integrating DCD evidence into frontline practice. Methods: Structures such as the Knowledge to Action framework were retrofitted and used to describe activities that occurred during the knowledge translation process. Main activities consisted of: information dissemination; education; addition of DCD to a neurodevelopmental assessment clinic; and development of a Community of Practice. Outcome evaluation methods included surveys, interviews, referral tracking, and database creation. Results: Knowledge translation strategy implementation resulted in increased knowledge among clinicians and community stakeholders, process standardization, increased referrals querying DCD, established knowledge brokers, and practice change. Conclusion: Pre-determined and systematic implementation strategy design is essential for embedding evidence into frontline practice.

Objective : To explore the effects of a web platform, aiming to support parents of children 5-12 years old with suspected or diagnosed developmental coordination disorder (DCD), on parental knowledge and skills. Method : A randomized pilot trial was undertaken (Clinical trial NCT03141333). Parents of the intervention group (n = 15) had access to a web platform (including resources, forum and virtual interactions) for three months. The control group (n = 13) only had access to resources. The primary outcome was measured pre- and post-intervention with the Parent Knowledge and Skills Questionnaire. Pre- post-questionnaires evaluated secondary outcomes (parents' sense of competence, children's strenghts and difficulties, and occupational performance). Results and discussion : All outcome measures improved over time for the intervention group. However, those improvements were not clinically or statistically significant ( p 0.08-0.41). Conclusion : Web platforms supporting parents of children with DCD need further evaluation. Especially, usability of web platforms and new outcome measures should be explored.

Description: In June 2019, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved an update of the joint clinical practice guideline for rehabilitation after stroke. This synopsis summarizes the key recommendations from this guideline., Methods: In February 2018, the VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included clinical stakeholders and stroke survivors and conformed to the National Academy of Medicine (formerly the Institute of Medicine) tenets for trustworthy clinical practice guidelines. The guideline panel identified key questions, systematically searched and evaluated the literature, and developed 2 algorithms and 42 key recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Stroke survivors and their family members were invited to share their perspectives to further inform guideline development., Recommendations: The guideline recommendations provide evidence-based guidance for the rehabilitation care of patients after stroke. The recommendations are applicable to health care providers in both primary care and rehabilitation. Key features of the guideline are recommendations in 6 areas: timing and approach; motor therapy; dysphagia; cognitive, speech, and sensory therapy; mental health therapy; and other functions, such as returning to work and driving.

Background: Early rehabilitation after stroke is essential to help reduce disability., Purpose: To summarize evidence on the benefits and harms of nonpharmacologic and pharmacologic treatments for motor deficits and mood disorders in adults who have had stroke., Data Sources: English-language searches of multiple electronic databases from April 2009 through July 2018; targeted searches to December 2018 for studies of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors., Study Selection: 19 systematic reviews and 37 randomized controlled trials addressing therapies for motor deficits or mood disorders in adults with stroke., Data Extraction: One investigator abstracted the data, and quality and GRADE assessment were checked by a second investigator., Data Synthesis: Most interventions (for example, SSRIs, mental practice, mirror therapy) did not improve motor function. High-quality evidence did not support use of fluoxetine to improve motor function. Moderate-quality evidence supported use of cardiorespiratory training to improve maximum walking speed and repetitive task training or transcranial direct current stimulation to improve activities of daily living (ADLs). Low-quality evidence supported use of robotic arm training to improve ADLs. Low-quality evidence indicated that antidepressants may reduce depression, whereas the frequency and severity of antidepressant-related adverse effects was unclear. Low-quality evidence suggested that cognitive behavioral therapy and exercise, including mind-body exercise, may reduce symptoms of depression and anxiety., Limitation: Studies were of poor quality, interventions and comparators were heterogeneous, and evidence on harms was scarce., Conclusion: Cardiorespiratory training, repetitive task training, and transcranial direct current stimulation may improve ADLs in adults with stroke. Cognitive behavioral therapy, exercise, and SSRIs may reduce symptoms of poststroke depression, but use of SSRIs to prevent depression or improve motor function was not supported., Primary Funding Source: U.S. Department of Veterans Affairs, Veterans Health Administration.

Intrauterine spinal cord infarcts (IUSCI) with resulting tetraplegia are extremely rare, and there is minimal evidence describing outcomes in this population. This case describes the functional progress of a 3-year-old girl born with IUSCI who participated in activity-based therapies (ABT). Children have developing nervous systems and are particularly suited to benefit from ABT. Over the course of treatment, the child in this case has demonstrated improvements in developmental milestone achievement including fine and gross motor skills and social/cognitive development. Intense, interdisciplinary ABT should be considered for the treatment of children with IUSCI., Competing Interests: The authors report no conflicts of interest.

Motor disorders often accompany autism spectrum disorder (ASD), although they are not included in its diagnostic criteria. Slower motor development is evident in early childhood in this population, making early motor skills intervention advisable. As educational games and modern technology can represent new forms of treatment, this study evaluated four Kinect-based visuo-motor games called Fruits that were specially designed for this research. We sought to test whether children with ASD would show behavior changes during their game play and whether any effects would generalize to another game called Rackets. The study included 10 elementary school children with ASD, aged 9-13 years, who were divided into (a) an experimental group ( n  = 5) who, in addition to standard treatment, played Fruits once a week for a 5-week period and Rackets both before and after the 5-week period and (b) a control group ( n  = 5) who received only standard treatment during this period and also played Rackets before and after it. We found significant improvements in gross motor skills and successful generalization of acquired skills among children in the experimental group relative to the control group. The experimental group also showed an increase in positive emotions and a decrease in loss of attention while playing the games. These preliminary findings indicate a motor skill benefit for children with ASD who play Kinect-based educational games, but further research is needed to replicate and expand these findings with larger participant samples.

Background: Adaptive balance control is often compromised in children with developmental coordination disorder (DCD). Neuromuscular training (NMT) is commonly used in clinical settings to improve neuromuscular control and hence balance performance in these children. However, its effectiveness has not been proven scientifically. This randomized controlled study aimed to explore the effectiveness of NMT for improving adaptive balance performance and the associated leg muscle activation times in children with DCD., Methods: Eighty-eight children with DCD were randomly assigned to the NMT or control group (44 per group). The NMT group received two 40-minute NMT sessions/week for 3 months, whereas the control group received no intervention. The outcomes were measured at baseline and 3 and 6 months. The primary outcome was the sway energy score (SES) in both the toes-up and toes-down conditions as derived using the Adaptation Test (ADT). Secondary outcomes included the medial gastrocnemius, medial hamstring, tibialis anterior and rectus femoris muscle activation onset latencies during ADT, measured using surface electromyography and accelerometry. Data were analyzed using a repeated measures analysis of covariance based on the intention-to-treat principle., Results: At 3 months, no significant within-group or between-group differences were noted in the SESs for either group. At 6 months, the toes-down SES decreased by 6.8% compared to the baseline value in exclusively the NMT group (P = .004). No significant time, group or group-by-time interaction effects were observed in any leg muscle activation outcomes., Conclusions: Short-term NMT failed to improve adaptive balance performance and leg muscle activation times in children with DCD. Further studies should explore the clinical applications of longer-term task-specific interventions intended to improve the adaptive balance performance of these children.

Purpose: Classical galactosaemia is an inborn error of galactose metabolism which may lead to impairments in body functions and accordingly, need for additional care. The primary aim of this study was to establish the type and intensity of this additional care. Materials and methods: Patients with classical galactosaemia aged ≥2 years were evaluated with the Capacity Profile, a standardised method to classify additional care needs according to type and intensity. Based on a semi-structured interview, current impairments in five domains of body functions were determined. The intensity of additional care was assessed (from 0, usual care, to 5, total dependence). Results: Forty-four patients with classical galactosaemia, 18 males and 26 females (median age 15 years, range 2-49 years), were included. There was a wide spectrum of impairments in mental functions. Motor function impairments were present in four patients, and mild speech impairments in eight patients. Additional care for sensory functions was uncommon. All patients needed a diet, which care is scored in the physical health domain. Conclusions: Apart from the diet all patients need, classical galactosaemia leads to the need for additional care mainly in the domains of mental functions and speech and voice functions. Implications for rehabilitation The Capacity Profile is a useful tool to demonstrate additional care needs in classical galactosaemia. In classical galactosaemia additional care is mostly indicated by mental impairments and speech and voice functions. One-fifth of patients have impairment of speech and voice functions at time of the study, and half of all patients had received speech therapy in childhood. Over 70% of patients need additional care/help due to impairment of mental functions, ranging from coaching due to social vulnerability to full day care.

Study Design: Systematic review., Introduction: Children with cerebral palsy (CP) may have limited use of their hands for functional activities and for fine motor skills. Virtual reality (VR) is a relatively new and innovative approach to facilitate hand function in children with CP., Purpose of the Study: The primary purpose of this study was to determine the effectiveness of VR as an intervention to improve hand function in children with CP compared to either conventional physiotherapy or other therapeutic interventions. The secondary purpose was to classify the outcomes evaluated according to the International Classification of Functioning, Disability and Health (ICF) dimensions., Methods: A International prospective register of systematic reviews (PROSPERO)-registered literature search was carried out in August 2015 in MEDLINE, CINAHL, ERIC, HealthSTAR, AMED, BNI, Embase, PsycINFO, PEDro, Cochrane Central Register, DARE, OTSeeker, REHABDATA, HaPI, CIRRIE, and Scopus. PRISMA guidelines were followed. Only randomized controlled trials (RCTs) were included, and their methodological qualities were examined using the Cochrane collaboration's risk of bias (RoB) tool. A narrative synthesis was performed., Results: The 6 RCTs published on this topic provide conflicting results. Four studies reported improved hand function (2 low RoB, 1 high RoB, and 1 unclear RoB), whereas 2 studies reported no improvement. All of the RCTs reported the activity element of ICF, but no study explicitly described the effect of VR intervention based on the ICF model., Conclusion: The role of VR ti imrpove hand fucntion in children with CP is unclear due to limited evidence; use as an adjunct has some support., (Copyright © 2018 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Among children with Down syndrome, the frequency of motor rehabilitation intervention and the age at the start of this intervention are independently related to the age at onset of independent walking. Early motor rehabilitation, before age 6 months, may be effective in reducing motor delay in children with Down syndrome., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: CHARGE syndrome is a multifaceted syndrome of complex birth defects. The heterogeneous nature of children with CHARGE syndrome brings unique issues and challenges affecting the overall motor development of the child, often resulting in developmental delays including motor delays., Aims: The purpose of this research was to assess children with CHARGE Syndrome on locomotor and object control skills to better understand their motor development. This information is relevant to adapted physical education teachers, paraeducators, vision teachers, health care professionals (occupational therapists, physical therapists, and physicians) and parents and family members of children with CHARGE Syndrome., Methods and Procedures: Thirty-seven children with CHARGE syndrome and thirty peers without disabilities participated in the study. Each participant was assessed on two object control and three locomotor skills with modifications, if necessary. In addition, the age of onset of independent walking was recorded for each participant., Outcome and Results: Children with CHARGE syndrome performed significantly behind their same age peers in most gross motor skills with the biggest deficits found in the run and kick. Age of onset of walking was associated with performance in jumping, running, and throwing., Conclusions and Implications: Early intervention services should focus on gross motor skills such as throwing, kicking, as well as walking at an early age., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Assessment of anaerobic capacity in children with Developmental Coordination Disorder (DCD) is essential for treatment planning. However, available field-based measures have no established validity and reliability in this population. Purpose: To examine the psychometric properties of selected field-based anaerobic capacity tests in children with and without DCD. Methods: School-aged children (6-16 years) with and without DCD participated in the study. The children completed the shuttle run sub-item of the Bruninks-Oseretsky test of motor proficiency-second edition, the 10 × 5 m sprint tests (straight and slalom) and the muscle power sprint test (MPST). Results: The shuttle run test item of the Bruninks-Oseretsky test of motor proficiency-second edition and 10 × 5 m sprint tests possess good construct validity and test-retest reliability in children with DCD. The 10 × 5 m sprint test-slalom was found to be the most responsive test among children with DCD. However, the MPST was less reliable in children with DCD compared to their typically developing peers, leading to a very large Smallest Detectable Difference. Conclusions: The findings suggest that the selected anaerobic capacity measures have sound psychometric properties among children with DCD with the exception of the MPST. Clinicians working on children with DCD could use these tests in their practice, especially in situations where logistical resources are limited. Implications for Rehabilitation Field-based anaerobic capacity tests are suitable measures for assessing anaerobic capacity in children with Developmental Coordination Disorder, particularly in situations where laboratory assessments are not feasible. The shuttle run test item of the Bruninks-Oseretsky test of motor proficiency-second edition and the 10 × 5 sprint tests (straight and slalom) have good construct validity in this population. The 10 × 5 sprint test (slalom) is the most sensitive anaerobic capacity test among children with Developmental Coordination Disorder.

Purpose: A systematic review was performed to (1) evaluate the effectiveness of augmented visual feedback-based treatments for motor rehabilitation in Parkinson's disease, and (2) examine treatment design factors associated with enhanced outcomes following these treatments., Methods: Eight databases were searched from their start-date up to January 2017 using the key terms Parkinson's Disease and augmented visual feedback. Two independent raters screened the abstracts and full articles for inclusion. Relevant data were extracted and summarized, and methodological quality of accepted articles was assessed., Results: Eight single-group studies and 10 randomized control trials were included in the review. Augmented visual feedback-based treatments resulted in improved outcomes with small to large effect sizes post-treatment for the majority of impairment, activity, participation, and global motor function measures, and these improvements were often superior to traditional rehabilitation/education programs. Enhanced treatment outcomes were observed in studies that provided large amounts and high intensities of treatment; gamified feedback; and provided knowledge of performance feedback in real-time on 100% of practice trials., Conclusion: Augmented visual feedback appears to be a useful motor rehabilitation tool in Parkinson's disease; however, high-quality, rigorous studies remain limited. Future studies should consider factors that enhance rehabilitation outcomes when designing augmented visual feedback-based interventions. Implications for rehabilitation Augmented visual feedback is a useful tool for motor rehabilitation in Parkinson's disease; augmented visual feedback-based treatments are often superior to traditional programs. These treatments are associated with improved outcomes in impairment, activity, participation, and global motor function domains. Rehabilitation professionals can optimize their use of augmented visual feedback-based treatments by providing large amounts and a high intensity of treatment, gamifying feedback, and providing knowledge of performance feedback in real-time and at a high frequency.

Introduction: Although virtual reality (VR) is an increasingly popular approach within studies that propose interventions for children with developmental coordination disorder (DCD), evidence on the effectiveness of VR remains debatable. The aim of this study was to synthesize evidence on the effectiveness of VR interventions for motor performance improvement in children with DCD., Evidence Acquisition: Searches were conducted in the MEDLINE/PubMed, Scopus, Web of Science and ERIC databases to select studies published from 1 January 2006 to 30 November 2017. Two independent reviewers performed the primary study selection based on titles, abstracts and full-text reading; this selection included randomized controlled trials (RCTs) that applied VR interventions to children with DCD and assessed outcomes related to motor performance. The methodological quality of the studies included in the search was assessed through the PEDro scale. PRISMA guidelines and Cochrane recommendations for systematic reviews were followed. The effect size of each intervention was calculated to allow for the interpretation of clinical effects, and the body of evidence was synthesised through the GRADE approach., Evidence Synthesis: A total of 2160 publications were retrieved; by the end of the selection process, twelve RCTs had been included. Of these twelve, seven were classified as having high methodological quality. Only three studies satisfied the homogeneity conditions to be assessed through the GRADE system, which showed a low level of evidence in favor of VR for improving the motor performance of children with DCD., Conclusions: Not enough evidence currently exists to support or refute the use of VR over non-VR interventions for improving motor performance in children with DCD. Despite the potential for improving the motor performance of DCD children, the absence of specific protocols prevents formal recommendations of VR for these children. Future studies should consider VR protocols that are more specific regarding the tasks, features and target motor skills to be developed by DCD children. In addition, comparisons of similar groups at baseline, the concealment of allocation and the blinding of assessors are internal validity aspects which deserve researchers' attention.

Objectives:: To investigate the feasibility and potential efficacy of a six-week interactive computer play training on balance and gross motor function in children with moderate cerebral palsy., Design:: A pilot single-blinded matched randomized controlled study., Setting:: Community., Participants:: In total, 18 children with moderate cerebral palsy were recruited, paired according to age and severity of cerebral palsy and randomized into intervention group or control group., Intervention:: The intervention group received additional trunk control training using the interactive computer play in sitting four times per week, 20 minutes per session for six weeks. All study children continued their usual physiotherapy programme., Measurements:: All study children were assessed at baseline, week 3, week 6 (completion of intervention) and week 12 using the Pediatric Reach Test, Gross Motor Function Measure-66-Item Set and 2-Minute Walk Test., Results:: All intervention children completed and enjoyed the training with no reported adverse event. All children were assessed at all time points. No significant difference was found between the two groups in all assessments. In both groups of children, significant improvements were found in the Gross Motor Function Measure-66-Item Set between week 3 (intervention group: mean 53.41, SD 5.34; control group: mean 52.86, SD 8.33) and week 6 (intervention group: mean 55.00, SD 6.32; control group: mean 54.20, SD 8.35)., Conclusion:: The intervention protocol of a six-week interactive computer play training was feasible and safe for children with moderate cerebral palsy in special school settings. Future studies with larger sample sizes or using single-subject designs are recommended.

Purpose: The proposed project tests the principle that frequency of rehabilitation is an important regulator of therapeutic response in infants., Methods: We will randomize 75 infants with cerebral palsy, 6 to 24 months of age and/or Gross Motor Function Classification System levels III to V (higher severity), to determine the short-term and long-term effects of 3 dosing protocols consisting of an identical number of 2-hour sessions of the same motor learning-based therapy applied over a different total number of calendar weeks., Results and Conclusions: The results will inform clinicians, families, and scientists about dosing and will provide needed recommendations for frequency of rehabilitation to optimize motor function and development of young children with cerebral palsy.

Objectives: To compare sensitivity to light touch in children with developmental coordination disorder and those with typical development. Also, to investigate how changes/increases in sensitivity to light touch influence the effects of light fingertip touch on reducing body sway in both groups, while controlling for the confounding effects of arm configuration., Methods: Twenty-six children with developmental coordination disorder and 26 typically developing children were enrolled in the study. To change/increase sensitivity to light touch, participants immersed their dominant index finger in a surfactant-water solution. Sensitivity to light touch was measured before and after soaking. Participants performed all conditions (no fingertip touch, light fingertip touch, and light fingertip touch after soaking) with the same arm configuration, while body sway was measured., Results: Analysis of variance (ANOVA) revealed that the children with developmental coordination disorder were less sensitive to light touch than typically developing children (p <0.05). For both groups, immersing a fingertip in surfactant-water solution increased sensitivity to light touch (p < 0.05). Finger soaking enhanced the effects of light fingertip touch on reducing body sway only in those children with developmental coordination disorder (p < 0.05)., Conclusion: Finger soaking can be used as a rehabilitation strategy for promoting sensitivity to light touch, as well as for enhancing the effects of light fingertip touch in reducing body sway in children with developmental coordination disorder.

Discrete and rhythmic movements are two fundamental motor primitives being, at least partially, controlled by separate neural circuitries. After a stroke, both primitives may be impaired in the upper limb. Currently, intensive functional movement therapy is recommended after stroke, but it is mainly composed of discrete movements. No recommendation is made for the specific training of rhythmic movements. However, if they form two different primitives, both should receive a specific training to recover the complete motor repertoire, as many daily live movements integrate both of them. This paper reports the effects of a pure unilateral rhythmic movement therapy on motor performance, after stroke. Thirteen patients with chronic stroke participated in this longitudinal pilot study. They were assessed twice before the therapy to validate their chronic state, and twice after the last session to establish the short-term and long-term effects of the therapy. The therapy itself was composed of 12 sessions spread over 1 month. The exercises consisted in performing straight or circular rhythmic movements, while receiving assistance as need through a robotic device. Short-term and long-term improvements were observed in rhythmic movements regarding smoothness, velocity, and harmonicity. More surprisingly, some transfer occurred to the untrained discrete movements. This finding disputes previous studies that reported no transfer from rhythmic to discrete movements with healthy participants.

Objective:: To evaluate the effects of an intervention based on a specific set of goals on goal attainment, manual dexterity, hand grip strength and finger prehension force compared to a standardized approach in patients with Parkinson's disease., Design:: Randomized controlled trial., Setting:: Home-based., Participants:: Fifty patients with a clinical diagnosis of Parkinson's disease acknowledging impaired manual ability were randomized into two groups., Interventions:: Patients in the experimental group ( n = 25) were included in an intervention focused on task components that involved goals proposed by participants. Patients in the control group ( n = 25) received a standard intervention focused on impairments in range of motion, grasp and manipulation. Home condition and duration (four weeks, twice a week) were similar in both groups., Main Outcome Measures:: The primary outcome measure was goal achievement assessed with the Goal Attainment Scaling. Secondary outcomes were manual dexterity evaluated with the Purdue Pegboard Test and hand grip strength and finger prehension force assessed using a dynamometer., Results:: After four weeks, significant between-group improvement in goal attainment was observed in the experimental group (change 17.36 ± 7.48 vs. 4.03 ± 6.43, P < 0.001). Compared to the control group, the experimental group also showed a significant improvement ( P < 0.05) in manual dexterity (postintervention values in the most affected arm 10.55 ± 1.95 vs. 7.33 ± 3.63 pins, P < 0.001) and finger prehension force (postintervention values in the most affected arm 8.03 ± 1.93 vs. 6.31 ± 1.85 kg, P = 0.010)., Conclusions:: Targeting therapy toward specific goals leads to greater changes in arm function than a standardized approach in people with Parkinson's disease.