Anuschka S. Niemeijer

Fine motor deficiencies in children diagnosed as DCD based on poor grapho-motor ability

A sample of 125 children from grades 4 and 5 of two normal Dutch primary schools were investigated regarding the incidence of handwriting problems and other fine motor disabilities. Handwriting quality was assessed with the concise assessment method for childrens handwriting (BHK) and the school questionnaire for teachers (SQT). Two groups of 12 children each were formed, one group of good writers and a group of poor writers selected from the lower performance range. The latter group was investigated in depth by assessing general and fine motor ability using the Movement Assessment Battery for Children (M-ABC test) and the Motor Performance School Readiness Test (MSRT). We hypothesised that poor handwriting is part of a wider neuromotor condition characterised by faster and cruder movements, lack of inhibition of co-movements and poor co-ordination of fine motor skills. To test the theory kinematic measures of drawing movements were collected on the flower-trail-drawing item of the M-ABC test. Moreover, the experimental group of poor writers received physiotherapy during a three-month period and was tested for handwriting proficiency after therapy and again nine months later. The results revealed that 34% of the group of 125 children displayed handwriting problems. The analysis confirmed that serious handwriting problems are accompanied by fine motor deficits. We suggest that in these children an enhanced level of neuromotor noise is compensated for by enhanced phasic stiffness of the limb system. This results in higher movement velocity and fewer velocity peaks. In the children who received physiotherapy the quality of handwriting improved.

Neuromotor task training for children with developmental coordination disorder: a controlled trial

The aim of this study was to evaluate neuromotor task training (NTT), a recently developed child‐centred and task‐oriented treatment programme for children with developmental coordination disorder (DCD). A treatment and a non‐treatment control group of children with DCD were included. Children were selected if they scored below the 15th centile on the Movement Assessment Battery for Children (MABC). The children in the treatment group were recently referred for physiotherapy (n=26; 20 males, 6 females; mean age 7y 2mo [SD 1y 3mo]). The parents of the non‐treated children were concerned about their childrens motor performance and responded to advertisements for free testing (n=13; 10 males, 3 females; mean age 7y 2mo [SD 2y 1mo]). Before and after nine weekly 30‐minute sessions of NTT or at least 9 weeks of no intervention, the MABC and the Test of Gross Motor Development ‐ 2 (TGMD‐2) were administered. Therapists reported per session on treatment goals and tasks trained. The results indicate that motor performance does not improve spontaneously and that NTT is effective. During the intervention period, only the treated group improved on the MABC and the TGMD‐2. Children improved most on tasks similar to those trained. In older children with poorer motor patterns, NTTs treatment success was higher. The Child Behavior Checklist subscales withdrawn, thought problems, anxious/depressed, and delinquency were determinants of effects on motor patterns.

Is the Movement Assessment Battery for Children-2nd edition a reliable instrument to measure motor performance in 3 year old children?

Formal testing of 3 year old children is a new feature in the revised version of the Movement Assessment Battery for Children (Movement ABC-2). Our study evaluated the reliability and explored the clinical applicability of the Movement ABC-2 Test in this young age group. A total of 50 typically children were given two trials of the test within a one to two week interval by two physical therapists: same assessor (n=28 children) and different assessors (n=22 children). Psychometric properties were evaluated by calculating internal consistency (Cronbach α), intra-class correlation (ICC), the standard error of measurement (SEM), the smallest detectable difference (SDD) and Kappa values for classification agreement. The results are promising for future implementation of the Movement ABC-2 in clinical practice. The childrens performance was highly reproducible when tested by the same assessor (ICC .94) The SEM was 1.7 or 2.1 standard scores for 90% or 95% confidence intervals respectively, making the test sensitive enough to detect individual changes. If two different assessors tested the children the ICC was .76. In conclusion, the revised test can be applied to assess motor performance in typically developing 3-year old children. Future studies are needed to confirm if the same can be said for children with motor delays.

Validity and reliability of the Movement Assessment Battery for Children-2 Checklist for children with and without motor impairments

Aim  The aim of this study was to investigate the validity and reliability of the Movement Assessment Battery for Children‐2 Checklist (MABC‐2).

The relationship between joint mobility and motor performance in children with and without the diagnosis of developmental coordination disorder

BackgroundThe purpose of this study was to determine whether joint mobility is associated with motor performance in children referred for Developmental Coordination Disorder (DCD-group) in contrast to a randomly selected group of children between 3–16 years of age (Random-Group).Methods36 children with DCD and 352 typically developing children (Random-Group) participated. Hypermobility was classified based on the Beighton score (cut-off ≥5 for 3–9 years and ≥4 for 10–16 years) using goniometry. Motor performance was assessed with the Movement Assessment Battery for Children (MABC).ResultsThe mean Beighton score in the DCD-group was 5.0 versus 2.6 in the Random group. Prevalence of hypermobility was higher in the DCD-group than in the Random Group (64% and 33% respectively; χ 2 = 16.09, p < .001). There was a significant [negative] correlation (rp = −.38, p = .02) between Beighton score and total MABC scores within the DCD group, but not in the Random Group (rp = −0.07, p = .20). More specifically, in the DCD group we found a significant negative correlation between the MABC total score and the degree of hyperextension of the knees.ConclusionThe extremely high prevalence of hypermobility when applying the recommended cut-off scores stresses the need for an international agreement on firm cut-off points and the use of standardized measurement of Beighton mobility manoeuvres. The results of this study show that a cut-off of 7 is more appropriate, resulting in a prevalence of 6% in children aged 3–16 years. Although in the general population motor performance and joint mobility are not related, this is the case in children referred for DCD. We argue that more mobility of the joints may be a disadvantage when motor coordination is poorly developed.

Crossing the North Sea seems to make DCD disappear: cross-validation of Movement Assessment Battery for Children-2 norms

The Movement Assessment Battery for Children has been revised as the Movement ABC-2 (Henderson, Sugden, & Barnett, 2007). In Europe, the 15th percentile score on this test is recommended for one of the DSM-IV diagnostic criteria for Developmental Coordination Disorder (DCD). A representative sample of Dutch and Flemish children was tested to cross-validate the UK standard scores, including the 15th percentile score. First, the mean, SD and percentile scores of Dutch children were compared to those of UK normative samples. Item standard scores of Dutch speaking children deviated from the UK reference values suggesting necessary adjustments. Except for very young children, the Dutch-speaking samples performed better. Second, based on the mean and SD and clinical relevant cut-off scores (5th and 15th percentile), norms were adjusted for the Dutch population. For diagnostic use, researchers and clinicians should use the reference norms that are valid for the group of children they are testing. The results indicate that there possibly is an effect of testing procedure in other countries that validated the UK norms and/or cultural influence on the age norms of the Movement ABC-2. It is suggested to formulate criterion-based norms for age groups in addition to statistical norms.

Increased B-type natriuretic peptide and decreased proteinuria might reflect decreased capillary leakage and is associated with a better outcome in patients with severe burns

IntroductionIt is difficult to adjust fluid balance adequately in patients with severe burns due to various physical changes. B-type natriuretic peptide (BNP) is emerging as a potential marker of hydration state. Proteinuria is used as a predictor of outcome in severe illness and might correlate to systemic capillary leakage. This study investigates whether combining BNP and proteinuria can be used as a guide for individualized resuscitation and as a predictor of outcome in patients with severe burns.MethodsFrom 2006 to 2009, 38 consecutive patients (age 47 ± 15 years, 74% male) with severe burns were included and followed for 20 days. All had normal kidney function at admission. BNP and proteinuria were routinely measured. Ordered and actually administered fluid resuscitation volumes were recorded. The Sequential Organ Failure Assessment (SOFA) score was used as the measure of outcome.ResultsBNP increased during follow-up, reaching a plateau level at Day 3. Based on median BNP levels at Day 3, patients were divided into those with low BNP and those with high BNP levels. Both groups had comparable initial SOFA scores. Patients with high BNP received less fluid from Days 3 to 10. Furthermore, patients with a high BNP at Day 3 had less morbidity, reflected by lower SOFA scores on the following days. To minimize effects of biological variability, proteinuria on Days 1 and 2 was averaged. By dividing the patients based on median BNP at Day 3 and median proteinuria, patients with high BNP and low proteinuria had significantly lower SOFA scores during the entire follow-up period compared to those patients with low BNP and high proteinuria.ConclusionsPatients with higher BNP levels received less fluid. This might be explained by a lower capillary leakage in these patients, resulting in more intravascular fluid and consequently an increase in BNP. In combination with low proteinuria, possibly reflecting minimal systemic capillary leakage, a high BNP level was associated with a better outcome. BNP and proteinuria have prognostic potential in severely burned patients and may be used to adjust individual resuscitation.

Clinical outcome of patients with self-inflicted burns

INTRODUCTION Patients with self-inflicted burns (SIB) are thought to have a longer length of stay compared to patients with accidental burns. However, other predictors for a longer length of stay are often not taken into account, e.g. percentage of the body surface area burned, age or comorbidities. Therefore, we wanted to study the outcome of patients with SIB at our burn center. METHODS A retrospective, observational study was conducted. All adult patients with acute burns admitted to the burn center of the Martini Hospital Groningen, between January 1, 2009 and December 31, 2013 were included. Data on characteristics of the patient, injury, and outcome (LOS, mortality, discharge destination) were collected. In patients with SIB, suicide attempts (SA) were distinguished from self-harm without the intention to die (non-suicidal self-injury, NSSI). To evaluate differences in outcome, each patient with SIB was matched on variables and total score of the Abbreviated Burn Severity Index (ABSI) to a patient with accidental burns (AB). RESULTS In total 29 admissions (21 SA and 8 NSSI) were due to SIB and 528 due to accidents. Overall, when compared to AB, there were significant differences with respect to mortality and LOS for SA and/or NSSI. Mortality was higher in the SA group, while the LOS was higher in both the SA and NSSI groups compared to the AB group. However, after matching on ABSI, no statistical significant differences between the SA and SA-match or the NSSI and NSSI-match group were found. CONCLUSION With the right and timely treatment, differences in mortality rate or length of stay in hospital could all be explained by the severity of the burn and the intention of the patient.

Epidemiology and Outcome of Patients With Burns Treated With Cerium Nitrate Silversulfadiazine.

In this study, the outcome of treatment with Flammacerium in burn patients is studied. The retrospective study involved patients with acute burns admitted to the Burn Centre of Martini Hospital, Groningen, The Netherlands, between 2009 and 2014. The outcome parameters were mortality, complications (noninfectious and infectious), need of surgery, and length of stay. The group of patients consisted of 853 patients, of which 554 were male (64.9%). There were 23 patients with a total burn size of 40% TBSA or more (2.7%). In total, 13 of the 853 patients (1.5%) died, and none of them were children (<16 years). The overall mortality in the group of patient with burns >40% TBSA was 30.4%. In the elderly group (>70 years), the mortality rate was 6.3%. Treatment with Flammacerium is applicable in all thermal burn patients. Especially children, elderly patients, and patients with severe burns can benefit from a more conservative treatment with Flammacerium whereby the first operation can be postponed until the patient is stabilized and in which the wounds can be covered directly with skin transplants.

Effect and mechanism of hydrocortisone on organ function in patients with severe burns

INTRODUCTION In patients with severe burns, resuscitation with large volumes of fluid is needed, partly because of an increase in capillary leakage. Corticosteroids might be beneficial by diminishing capillary leakage. This study aimed to assess in severely burned nonseptic patients whether hydrocortisone (HC) improved outcome and diminished capillary leakage. METHODS Retrospective analyses of a prospectively collected database were performed, including 39 patients (age 52 [35-62] years, 72% male). Patients were divided based on HC therapy. First, in patients in whom HC was started late, that is when deteriorating (late; 5-12 days postburn) data before and after start of HC were compared. Second, patients in whom HC was started day 0 or 1 postburn (upfront; within 48 hours) were compared with patients who did not receive HC (control). Outcome was assessed as organ dysfunction by Denver Multiple Organ Failure (MOF) score and Sequential Organ Failure Assessment (SOFA) score. As markers for capillary leakage and hydration state, proteinuria, B-type natriuretic peptide (BNP), and fluid administration were assessed. Follow-up was 20 days postburn. Possible adverse effects including mortality were recorded. Repeated measurement regression analyses were performed using MLwiN. RESULTS In the late group, Denver MOF and SOFA scores significantly decreased after HC (P<.001). Proteinuria tended to decrease (P=.13), BNP increased on the days HC was used (P<.001), and amounts of fluids diminished (P<.001). In the upfront vs control group, Denver MOF and SOFA scores (P<.001) decreased more quickly. Proteinuria (P=.006) and administered fluids decreased more rapidly (P<.001). Mortality rate, numbers of positive blood cultures, incidence of pneumonia, and graft loss were similar in all groups. CONCLUSIONS Hydrocortisone treatment in severe burned patients without sepsis might improve organ dysfunction possibly because of a reduction in capillary leakage, as reflected by a decrease of proteinuria, an increase of BNP, and diminished fluid resuscitation volumes.