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In addition to the core symptoms defining ADHD, affected children often experience motor problems; in particular, graphomotor movements including handwriting are affected. However, in clinical settings, there is little emphasis on standardized and objective diagnosing and treatment of those difficulties. The present study investigated for the first time the effects of methylphenidate as well as physiotherapeutic treatment on objectively assessed graphomotor movements compared to a control condition, i.e. parental psychoeducation, in 58 children (mean age: 9.52 ± 1.91 years) newly diagnosed with ADHD in an outpatient clinic for child and adolescent psychiatry. Families were invited to join one of the treatment groups. Before and after 8 weeks of treatment, children performed six different tasks on a digitizing tablet which allowed the objective analysis of three important kinematic parameters of graphomotor movements (fluency, velocity, and pen pressure) in different levels of visual control and automation. Graphomotor movement fluency and velocity improves over time across the groups, especially in tasks with eyes closed. We did not find clear evidence for beneficial effects of methylphenidate or physiotherapeutic treatment on children's overall graphomotor movements suggesting that treatments need to be better tailored towards specific and individual deficits in graphomotor movements. [ABSTRACT FROM AUTHOR]

Although motor problems are highly prevalent in children with autism spectrum disorder (ASD), they remain underdiagnosed. Questionnaire-based screening for motor problems could optimize current clinical practice. This study aimed to examine the psychometric properties of the developmental coordination disorder questionnaire (DCDQ) to screen for co-occurring motor problems in individuals with ASD (n = 115; aged 5–15 years). Results indicated an excellent internal consistency; concurrent and discriminant validity with the Movement Assessment Battery for Children, second edition. Sensitivity was excellent, but specificity was lower. The positive and negative predictive values indicate that the DCDQ can be used to detect motor problems in children with ASD and can exclude the presence of developmental coordination disorder. [ABSTRACT FROM AUTHOR]

This work seeks to, based on the product development methodology developed by Pahl et al. (2005), present the design and development of a CPM (Continuous Passive Motion) prototype indicated for the rehabilitation of lower limbs. In this project, the product development methodology was employed until the final variant of the lower limb rehabilitation system was obtained. The preliminary design and manufacturing details were developed, so that the concept could be validated, the prototype was manufactured to test its functioning. To ensure that the drive system is designed and manufactured in the most correct way possible, the installation position of the actuator was defined by means of 3D software simulation, this simulation, using the imaginary axis that crosses the patient's knee as a reference. The articulation points and the stroke of the actuator were simulated, ensuring that the patient's leg movement was performed correctly. The objective of the kinematic study in software was to ensure that the behavior of the prototype was correct before manufacturing, what can be proven with the tests with the prototype. [ABSTRACT FROM AUTHOR]

Abstract Background Children with the neurogenetic disorder neurofibromatosis type 1 (NF1) often have problems with learning and behaviour. In both parent reports and neuropsychological assessment, motor problems are reported in approximately one third to one half of the children with NF1. Studies using broad motor performance test batteries with relatively large groups of children with NF1 are limited. The aim of this cross-sectional observational study was to describe the severity of motor problems in children with NF1 and to explore the predictive value of demographics, intelligence, and behavioural problems. Methods From 2002 to 2014, 69 children with NF1, aged 4 to 16 years (age = 9.5 ± 2.8 years; 29 girls) had a motor, psychological, and neurological evaluation in an NF1 expertise centre. Data were collected about (1) motor performance (M-ABC: Movement Assessment Battery for Children), (2) intelligence, and (3) emotional and behavioural problems as rated by parents. Results Sixty-one percent of these children scored within the clinical range of the M-ABC. In ordinal logistic regression analyses, motor problems were associated with symptoms of attention-deficit/hyperactivity disorder (ADHD), symptoms of autism spectrum disorder (ASD), and externalising behavioural problems. Motor outcome was not predicted by age, intelligence, scoliosis, hypotonia, nor hypermobility. Conclusions Motor problems are among the most common comorbid developmental problems in children with NF1, and these problems do not diminish with age. Because of their impact on daily functioning, motor problems need to be specifically addressed in diagnosis, follow-up, and treatment of NF1.

Aim: To investigate whether behaviour problems are independently related to mild motor impairment in 11-13-year-old children born preterm with extremely low birthweight (ELBW).Methods: The cross-sectional study included 48 (27 males) non-disabled, otherwise healthy ELBW children (<1000 g) and 55 (28 males) term-born peers. Parents reported behaviour using the Child Behaviour Checklist (CBCL). Children completed the Movement Assessment Battery for Children (Movement ABC).Results: Extremely low birthweight children had poorer behaviour scores (CBCL Total Problem T score: mean difference = 5.89, 95% confidence interval = 10.29, 1.49, p = 0.009) and Movement ABC Total Motor Impairment Scores (ELBW group median = 17.5, IQR = 12.3; term-born group median = 7.5, IQR = 9, p < 0.01) than term-born peers. Behaviour was related to motor score (regression coefficient 2.16; 95% confidence interval 0.34, 3.97, p = 0.02) independent of gender, socio-economic factors or birthweight. Motor score had the strongest association with attention (ρ = 0.51; p < 0.01) and social behaviours (ρ = 0.50; p < 0.01).Conclusion: Behaviour problems of otherwise healthy 11- to 13-year-old ELBW children are not related to prematurity independent of their motor difficulties. Supporting improved motor competence in ELBW preteen children may support improved behaviour, particularly attention and social behaviours. [ABSTRACT FROM AUTHOR]

Introduction: Children born too soon (preterm) and or too small (small for gestational age) have increased risk of mortality and morbidity. Main section: Motor problems are frequently reported in children born preterm. Studies on motor skills in children born small for gestational age (SGA) at term have shown inconsistent results. The aim was to study the prevalence of motor problems, whether visual impairments influenced their motor problems, whether integration of vision and proprioception was reduced, and if early motor evaluations could identify children with motor problems in adolescence. We found that a higher proportion of very low body weight (VLBW) and SGA adolescents had motor problems compared with controls. A substantial part of the motor problems in the VLBW, but not in the SGA group, was influenced by visual impairments. The VLBW adolescents with cerebral palsy or low estimated intelligence quotient had poorer inter- and intra-sensory integration, whereas SGA adolescents performed poorer with their non-preferred than their preferred hand. Most of the VLBW adolescents with motor problems were identified already at one year. Conclusion: The results suggest that motor problems in the VLBW group are due to a general brain damage following preterm birth, whereas in the SGA group they may be caused by subtle brain dysfunctions following intrauterine growth restriction.

This study examined reliability and validity of the Zuk Assessment for diagnosis of motor problems and determined standardized scores in an Israeli population aged 5 to 6 years. For standardization, 156 children recruited from 13 Kindergartens of typically developing children were evaluated with the Zuk Assessment. Intrarater and interrater reliability were examined on 2 samples of 15 and 13 children, respectively. A total of 151 children referred for motor problems were examined with the Zuk and Movement Assessment Battery for Children assessment tools for validation of the Zuk Assessment. Findings showed that the Zuk total score had a normal distribution similar to that found in the literature identifying 5.1% (–2 standard deviations) and 12% (between –1 and –2 standard deviations) of children with motor-related problems. Reliability was indicated by high intraclass correlation scores both in intrarater (intraclass correlation = .89) and interrater (intraclass correlation = .95) paradigms. The Zuk assessment identified differences in subgroups, namely, typical, suspicious, and impaired, as found in the Movement Assessment Battery for Children, confirming the Zuk validity. [ABSTRACT FROM PUBLISHER]

Highlights: [•] We evaluated the effect of a motor programme in pre-schoolers with motor problems. [•] A significant gender-specific effect of the intervention was observed. [•] Environmental context did not seem to influence the effect. [•] A further decline of motor competence over time was found in the control group. [•] The results indicate the need for a gender-specific teaching approach. [Copyright &y& Elsevier]

Background: Most children who are diagnosed with attention deficit-hyperactivity disorder (ADHD) have moderate-to-severe motor problems using the Motor Function Neurological Assessment battery (MFNU). The MFNU focuses on specific muscle adjustment problems associated with ADHD, especially motor inhibition problems and high muscle tone. Here we investigated whether adults with ADHD/hyperkinetic disorder (HKD) have similar motor problems. In our clinical experience, adults with ADHD often complain about back, shoulder, hip, and leg pain. We also investigate reported pain in adults with ADHD. Methods: Twenty-five adult outpatients diagnosed with ADHD/HKD who were responders to methylphenidate (MPH) were compared to 23 non-ADHD controls on 16 MFNU subtests and using a 'total score' ('TS') parameter. The MFNU test leader was blinded to group identity. The two groups were also compared using the Pain Drawing and Numerical Pain Rating Scale. Results: The adult ADHD group had significantly (p < .001) more motor problems (higher TS) than controls. On the muscle regulation subtests, 36-96% of the ADHD group showed 'moderate' to 'severe' problems compared to 13-52% of the control group, and 80% of the ADHD group reported widespread pain. Highly significant differences were found between the ADHD and control groups for the variables 'pain level' (p < .001) and 'pain location' (p < .001). Significant correlations were found between TS and 'pain location' and between TS and 'pain level'. Conclusions: These findings suggest that similar to children with ADHD, adults diagnosed with ADHD also have motor inhibition problems and heightened muscle tone. The presence of significantly higher pain levels and more widespread pain in the ADHD group compared to non-ADHD controls might indicate that pain is a long-term secondary effect of heightened muscle tone and restricted movement that can be demonstrated in children and adults by the MFNU battery. [ABSTRACT FROM AUTHOR]

Aim: Hyperactivity, impulsivity and poor attention are the core problems of ADHD and central stimulant medication is the preferred treatment. Many children with ADHD also display motor problems. The present study investigated the presence of motor problems in subjects who showed positive response to central stimulants on ADHD symptoms, compared with non-responders. Method: This is a retrospective study of 73 children diagnosed ADHD, aged 5–17 years, who had been assessed with parts of the ‘Motor Function Neurological Assessment’ (MFNU) and evaluated with regard to effect of central stimulant medication. The sample was divided into two subgroups based on the responses to methylphenidate: Medicine responders and Non medicine responders. Results: Stimulant responders showed significantly more motor problems than the non-responders on all sub-tests and on the total problem score of the MFNU. Motor problems were present both in younger (age 5–10 years) and older (11–17 years) stimulant responders. There were no gender differences in motor performance. Conclusion: Our findings indicate that the probability of positive effect of central stimulants on core problems of ADHD is higher when motor problems are present in addition to ADHD symptoms, than when motor problems are absent. [ABSTRACT FROM AUTHOR]

Background: Motor problems occur in 30% to 50% of children with ADHD, and have a severe impact on daily life. In clinical practice there seems to be little attention for this comorbidity with the possible consequence that these motor problems go undertreated. Method: Clinical interview and questionnaire survey of treatment by physiotherapy and factors predicting treatment of motor problems in 235 children with ADHD and 108 controls. Results: Half of motor-affected children had received physiotherapy. Treated children had more severe motor problems, and less frequently presented with comorbid anxiety and conduct disorder. Treated and untreated children were similar in age, and rated similarly on ADHD inattentive and hyperactive-impulsive scales and parental socio-economic status. Conclusion: Currently, undertreatment of motor problems in ADHD occurs. Behavioural factors play a role in referral and intervention. [ABSTRACT FROM AUTHOR]

Abstract: Currently there is no specific treatment for the brain insults leading to motor dysfunction in cerebral palsy. The available symptomatic therapeutic options place cerebral palsy among the costliest chronic childhood conditions. Therefore, it is necessary to make well-informed decisions in an effort to match cost-effectiveness with patient and family needs. This presentation aims to analyze the efficacy of rehabilitation therapy, orthoses, oral medications, botulinum toxin, intrathecal baclofen, complementary or alternative treatments and discuss guidelines for a goal oriented approach. Despite insufficient reporting of trials, physiotherapy has shifted from traditional to goal oriented approaches, based on principles of motor learning, strength and fitness training. Correct choice and use of orthoses is stressed, yet evidence from primary studies is limited. Pharmacological treatments of spasticity (oral agents, botulinum toxin, intrathecal baclofen) may be alternatives or supplements to orthopaedic surgery. There is evidence that botulinum toxin combined with conservative treatments reduces the number of complex orthopaedic interventions. Intrathecal baclofen effectively reduces spasticity; criteria describing the ideal candidate are needed. Complementary or alternative treatment use is widespread; research needs to determine what factors make these modalities desirable and effective in cerebral palsy. It is concluded that the introduction of new therapies facilitates an individualized management plan. Multimodal treatment is optimized with a multidisciplinary team. Outcome measurement according to the World Health Organization''s new International Classification of Functioning, Disability and Health is emphasized. [Copyright &y& Elsevier]

Abstract: Background: Motor problems are common in children born preterm or small for gestational age. Aim: To study the predictive value of early motor assessments for later motor skills. Subjects: Twenty-eight children born preterm with very low birth weight (VLBW: birth weight ≤1500 g), 57 children born small for gestational age (SGA: birth weight <10th centile) at term and 77 term-born controls with normal birth weight. Methods: The psychomotor development index (PDI) of the Bayley Scales of Infant Development was used as a measure of motor skills at age one, the Peabody Developmental Motor Scales (PDMS) at age five and the Movement Assessment Battery for Children (Movement ABC) at age 14. Low/borderline low scores were defined as <−2SD/−1SD (PDI) or <5th/15th centile (PDMS; Movement ABC). Results: In the VLBW group, motor problems in adolescence were identified both by low PDI (sensitivity: 0.80; 95%CI:0.38–0.96) and PDMS scores (sensitivity: 0.83; 95%CI:0.44–0.97). In the SGA and the control group sensitivity was poor for low PDI and moderate for low PDMS scores. However, in the SGA group, sensitivity increased when borderline low PDMS scores were used as cut-off (sensitivity: 0.75; 95%CI:0.41–0.93). Specificity of PDI and PDMS was high in all three groups. Conclusions: Both PDI and PDMS may be valuable tools for early identification of motor problems in VLBW children, whereas PDMS best predicted motor problems in the two other groups. In all three groups, a normal motor examination at 1 and 5 years was highly predictive of normal motor skills at age 14. [Copyright &y& Elsevier]

Abstract: Background: Increased prevalence of motor and visual problems has been reported in low birth weight populations, but the association between them is less studied. Aim: To examine how visual impairments may be associated with the increased risk of motor problems in low birth weight adolescents. Methods: Fifty-one very low birth weight adolescents (VLBW), 56 term small for gestational age (SGA) and 75 term control adolescents, without cerebral palsy, were examined at the age of 14. Motor skills were examined by the Movement Assessment Battery for Children. Visual functions included visual acuity, contrast sensitivity, nystagmus, strabismus, stereoacuity, accommodation, convergence and visual perception (Visual-Motor Integration test). An abnormality score was calculated as the sum of visual impairments. We used odds ratio as an estimate of the relative risk of having motor problems. Results: The odds of having motor problems were 10.4 (95% CI: 2.2–49.4) in the VLBW group and 5.1 (95% CI: 1.0–25.8) in the SGA group compared with the control group. The odds of having motor problems in the VLBW group were influenced by all visual variables, and most by visual acuity, when we adjusted for these separately. The greatest reduction in OR was found when adjusting for the abnormality score (adjusted OR: 6.8; 95% CI: 1.3–34.5). In the SGA group the odds of having motor problems were relatively unaffected by the visual variables and the abnormality score. Conclusions: Visual impairments influence motor problems in VLBW adolescents, whereas motor problems in SGA adolescents seem to be unaffected by visual impairments. [Copyright &y& Elsevier]

It has been shown that some children with reading difficulties have underlying developmental delay and that this may be related to the persistence of primary reflexes. This study investigated the prevalence of persistent primary reflexes in the ordinary primary school population and how this related to other cognitive and social factors. Three groups of 41 children were drawn from a representative, cross-sectional sample of 409 children (aged 9–10 years) attending 11 ordinary primary schools in N. Ireland. The three groups represented the bottom, middle and top 10% respectively of readers from the total sample population. The relative persistence (on a scale of 0 to 4) of the Asymmetrical Tonic Neck Reflex (ATNR) and the prevalence of motor difficulties were assessed for these 3 groups. The rôle of 5 predictor variables (verbal IQ, social deprivation, sex, month of birth and religious affiliation) in determining the reading level of the total sample was also investigated. It was found that the lowest reading group had a significantly higher mean level of ATNR (1.56 [95% CI 1.22–1.90]) compared with the middle reading group (0.56 [0.22–0.90]) and the top reading group (0.59 [0.25–0.92]). 17% of children in the lowest reading group had extremely high levels of the ATNR while 24% showed no presence of ATNR. This contrasted with 0% and 66%, respectively for both middle and top reading groups. It was also found that there was a significant difference between the lowest reading group and the top reading group on a standardised test of motor ability. Furthermore, there was evidence that ATNR persistence but not motor ability was associated with the sex of the child with boys, in particular, at risk. There was no evidence that ATNR persistence or motor ability was significantly associated with social deprivation. It was also found that there were no significant differences between dyslexic and non-dyslexic children with reading difficulties in motor (including balance) performance. This study highlights the high levels of primary reflex persistence in children with reading difficulties and it provides further evidence of the association between reading difficulties and movement difficulties in young children. However, while the implications for intervention are discussed, it is stressed that the persistence of primary reflexes cannot be used as a causal model for reading difficulties, including dyslexia. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Several studies have described problems in a wide area of motor functions in language impaired children. The purpose of this study was to identify the nature of the motor deficits in two subgroups of language impaired children. A standard neurological examination was performed on 18 children with an expressive language disorder and 21 children with a receptive language disorder. The motor performance of the language disordered children was compared with the motor performance of 23 normal children. The standard neurological examination allowed for a qualitative and quantitative assessment of five specific neurological subsystems. Handedness was determined for all children. The language impaired children had more motor problems than the control children on most neurological subsystems. There were few statistically significant differences between the two groups of language impaired children. An excess in left-handedness was established in the group of children with a receptive language disorder. There was a co-occurrence of verbal and non-verbal deficits in language impaired children. As these motor problems put an additional burden on the development of language impaired children, they should be diagnosed as early as possible. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Unlabelled: Parents' and teachers' ratings were used to evaluate the behavioural characteristics of children with early-treated congenital hypothyroidism (CH). Comparisons were made between 63 children with early-treated CH and 34 healthy controls at the ages of 7.5 and 9.5 y. Additional comparisons were made between the two largest CH subgroups (thyroid agenesis, thyroid dysgenesis) and controls. The most marked differences were found on the introversion cluster and the motor clumsiness scale within it. Children with CH, particularly those with thyroid agenesis, showed introversion and motor clumsiness rather than social negativity and inattention. It is suggested that this behavioural profile may well have its origins in the often-reported inefficient motor behaviour of these children. Results are discussed in the light of recent findings suggesting an association between thyroid hormone problems and attention deficit hyperactivity disorder.Conclusion: Early-treated CH is associated with introversion rather than with social negativity. [ABSTRACT FROM AUTHOR]

The motor hand function of 16 children, aged between 4 and 7 years, with developmental speech and language disorders, was compared with that of 16 control children. The children with developmental speech and language disorders were significantly slower than controls on three out of four motor tasks. They were also more likely than controls to have mixed hand preference although this result was not significant. Children with developmental speech and language disorders should be assessed to ensure that motor deficits are diagnosed and that appropriate support is given. [ABSTRACT FROM AUTHOR]

Objective: This study investigated behavior problems and educational achievement between children with and without motor problems. Materials & Methods: Seventeen children with motor problems (as case group) and twenty five children without motor problems (as control group) whom had been identified by Lincoln-Oseretsky Motor Development Scale, were randomly selected and participated in this comparative study. The parent form of the Child Behavior Checklist was used to assess children’s emotional and behavioral problems. Data were analyzed by Independent T test. Results: Results revealed that children with motor problems obtained significantly poorer scores on school achievement areas than control group (P

We reviewed literature on long-term motor outcomes of individuals aged five years or older born very preterm (VP: ≤32 weeks of gestation) or with very low birth weight (VLBW: ≤1500g), without cerebral palsy (CP). PubMed produced 2827 articles, whereof 38 were eligible. Assessed by standardised and norm-based motor tests, the Movement Assessment Battery for Children being the most widely used, VP/VLBW individuals showed poorer motor skills compared with term-born controls with differences of approximately 1 SD in magnitude. Some studies assessed subdomains and differences were present in fine motor/manual dexterity, ball skills and gross motor/balance. Prevalence of motor problems varied largely from 8-37% in studies with cut-off at the 5th percentile or -1.5 SD to 12-71% in studies with cut-off at the 15th percentile or -1 SD. This review shows that the degree of motor impairments continues to be substantial among VP/VLBW individuals who do not develop CP. [ABSTRACT FROM AUTHOR]

Background: Children with the neurogenetic disorder neurofibromatosis type 1 (NF1) often have problems with learning and behaviour. In both parent reports and neuropsychological assessment, motor problems are reported in approximately one third to one half of the children with NF1. Studies using broad motor performance test batteries with relatively large groups of children with NF1 are limited. The aim of this cross-sectional observational study was to describe the severity of motor problems in children with NF1 and to explore the predictive value of demographics, intelligence, and behavioural problems., Methods: From 2002 to 2014, 69 children with NF1, aged 4 to 16 years (age = 9.5 ± 2.8 years; 29 girls) had a motor, psychological, and neurological evaluation in an NF1 expertise centre. Data were collected about (1) motor performance (M-ABC: Movement Assessment Battery for Children), (2) intelligence, and (3) emotional and behavioural problems as rated by parents., Results: Sixty-one percent of these children scored within the clinical range of the M-ABC. In ordinal logistic regression analyses, motor problems were associated with symptoms of attention-deficit/hyperactivity disorder (ADHD), symptoms of autism spectrum disorder (ASD), and externalising behavioural problems. Motor outcome was not predicted by age, intelligence, scoliosis, hypotonia, nor hypermobility., Conclusions: Motor problems are among the most common comorbid developmental problems in children with NF1, and these problems do not diminish with age. Because of their impact on daily functioning, motor problems need to be specifically addressed in diagnosis, follow-up, and treatment of NF1.