Bouwien Smits-Engelsman

Clinical and research diagnostic criteria for developmental coordination disorder: a review and discussion

The aim of this review was to investigate the selection criteria used in the past in studies of children with developmental motor problems (excluding those suffering from neurological dysfunctions such as cerebral palsy, muscular dystrophy, etc.). We therefore conducted an extensive analysis of 176 publications. First, an overview of the main characteristics of these studies (terminology, population, type and purpose) and the selection criteria that are reported in these publications are presented. Following this, the DSM-IV selection criteria for developmental coordination disorder (DCD) are contrasted with the selection criteria reported in 41 publications that have used this terminology to classify the children. The results of this comparison show that the inclusion criteria are largely followed, albeit with little consistency concerning selection instruments and quantitative cut-offs, while adherence to the exclusion criteria is not common practice. Strengths and weaknesses of the DSM-IV criteria, complementary to the previous discussion by Henderson and Barnett in the HMS special issue on DCD in 1998 on this same topic, are discussed. The results of the review also show that many studies have used additional selection criteria related to the specific research questions of the study concerned. In the broader context of clinical practice as well as basic research, the latter result suggests the usefulness of a distinction between Clinical Diagnostic Criteria and Research Diagnostic Criteria. This distinction helps to develop a unifying view on the use of diagnostic criteria for research and clinical practice. We conclude with a number of recommendations concerning the selection criteria for children with DCD.

European Academy for Childhood Disability (EACD): Recommendations on the definition, diagnosis and intervention of developmental coordination disorder (long version)*

This clinical practice guideline on developmental coordination disorder (CPG-DCD) for German-speaking countries, particularly Germany and Switzerland, is strongly in accordance with the European recommendations of the European Academy of Childhood Disability (EACD) from May 2010 (Brussels) and an international consensus, the International Leeds Consensus (2006).

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.

Understanding performance deficits in developmental coordination disorder: a meta‐analysis of recent research

Aim  Developmental coordination disorder (DCD) is a significant disorder of childhood, characterized by core difficulties in learning fine and/or gross motor skills, and the attendant psychosocial problems. The aim of the meta‐analysis presented here (the first on DCD since 1998) was to summarize trends in the literature over the past 14 years and to identify and describe the main motor control and cognitive deficits that best discriminate children with DCD from those without.

A Five-Week Exercise Program Can Reduce Falls and Improve Obstacle Avoidance in the Elderly

Background: Falls in the elderly are a major health problem. Although exercise programs have been shown to reduce the risk of falls, the optimal exercise components, as well as the working mechanisms that underlie the effectiveness of these programs, have not yet been established. Objective: To test whether the Nijmegen Falls Prevention Program was effective in reducing falls and improving standing balance, balance confidence, and obstacle avoidance performance in community-dwelling elderly people. Methods: A total of 113 elderly with a history of falls participated in this study (exercise group, n = 79; control group, n = 28; dropouts before randomization, n = 6). Exercise sessions were held twice weekly for 5 weeks. Pre- and post-intervention fall monitoring and quantitative motor control assessments were performed. The outcome measures were the number of falls, standing balance and obstacle avoidance performance, and balance confidence scores. Results: The number of falls in the exercise group decreased by 46% (incidence rate ratio (IRR) 0.54, 95% confidence interval (CI) 0.36–0.79) compared to the number of falls during the baseline period and by 46% (IRR 0.54, 95% CI 0.34–0.86) compared to the control group. Obstacle avoidance success rates improved significantly more in the exercise group (on average 12%) compared to the control group (on average 6%). Quiet stance and weight-shifting measures did not show significant effects of exercise. The exercise group also had a 6% increase of balance confidence scores. Conclusion: The Nijmegen Falls Prevention Program was effective in reducing the incidence of falls in otherwise healthy elderly. There was no evidence of improved control of posture as a mechanism underlying this result. In contrast, an obstacle avoidance task indicated that subjects improved their performance. Laboratory obstacle avoidance tests may therefore be better instruments to evaluate future fall prevention studies than posturographic balance assessments.

Efficacy of interventions to improve motor performance in children with developmental coordination disorder: a combined systematic review and meta‐analysis

Aim  The aim of this study was to review systematically evidence about the efficacy of motor interventions for children with developmental coordination disorder (DCD), and to quantify treatment effects using meta‐analysis.

The assessment of children with Developmental Coordination Disorders in the Netherlands: The relationship between the Movement Assessment Battery for Children and the Körperkoordinations Test für Kinder

Abstract The Movement Assessment Battery for Children (Movement ABC; Henderson, S.E., Sugden, D.A., 1992. Movement Assessment Battery for children: Manual. Psychological Corporation, London.) is used throughout the world in the evaluation of children with movement difficulties. Within Europe, another test commonly used for the same purpose is the Korperkoordinations Test fur Kinder (KTK; Kiphard, B.J., Schilling F., 1974 Korperkoordinations Test fur Kinder. Beltz Test Gmbh, Weinheim.). The aims of this study were: (i) to take a preliminary look at the suitability of the published norms of these two tests for use with Dutch children, (ii) to examine the correlations between scores on the two tests and, (iii) to examine the concordance between the tests in detecting cases of impairment among children believed to be poorly coordinated. Two hundred and eight children completed both tests. The results suggested that the current norms for the Movement ABC are satisfactory for Dutch children but for the KTK, they may require adjustment. The overall correlation between the two tests was 0.62. Although there were children who failed one test and passed the other, the degree of concordance between the tests was statistically significant. PsycINFO classification: 2221; 2330

Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials

SummaryExercise can reduce falls and fall-related fractures in healthy individuals; however, evidence for individuals with low BMD is limited. The results from this systematic review indicate that exercise interventions for individuals with low BMD to reduce falls and fractures should include balance, muscle strengthening, and weight-bearing exercises.IntroductionThe purpose of this systematic review was to investigate which exercise interventions are effective in individuals with low bone mineral density (BMD; osteopenia or osteoporosis) in reducing (1) falls and fractures and (2) risk factors for falls and fractures.MethodsDatabases were searched for relevant studies between 1996 and June 2008. Methodological quality was assessed with the Jadad score and the PEDro scale.ResultsOf the 1,369 publications found, 23 met the inclusion criteria. Five additional articles were included after checking reference lists and searching author’s names and related articles. Interventions with balance exercises reduced falls or fall-related fractures and improved balance in the majority of the studies. Muscle strengthening exercises were effective in improving lower extremity strength and back extensor strength; however, not all RCT’s reported positive effects. Bone strength was improved by weight-bearing aerobic exercise with or without muscle strengthening exercise when the duration of the intervention was at least a year.ConclusionsExercise can reduce falls, fall-related fractures, and several risk factors for falls in individuals with low BMD. Exercise interventions for patients with osteoporosis should include weight-bearing activities, balance exercise, and strengthening exercises to reduce fall and fracture risk.

Beighton Score: A Valid Measure for Generalized Hypermobility in Children

OBJECTIVE To evaluate the validity of the Beighton score as a generalized measure of hypermobility and to measure the prevalence of hypermobility and pain in a random population of school age children. STUDY DESIGN Prospective study of 551 children attending various Dutch elementary schools participated; 47% were males (258) and 53% (293) females, age range was 6 to 12 years. Childrens joints and movements were assessed according to the Beighton score by qualified physiotherapists and by use of goniometry measuring 16 passive ranges of motion of joints on both sides of the body. RESULTS More than 35% of children scored more than 5/9 on the Beighton score. Children who scored high on the Beighton score also showed increased range of motion in the other joints measured. Moreover 12.3% of children had symptoms of joint pain, and 9.1% complained of pain after exercise or sports. Importantly, this percentage was independent of the Beighton score. There were no significant differences in Beighton score for sex in this population. CONCLUSION The Beighton score, when goniometry is used, is a valid instrument to measure generalized joint mobility in school-age children 6 to 12 years. No extra items are needed to improve the scale.

Clinimetric evaluation of active range of motion measures in patients with non-specific neck pain: a systematic review

The study is to provide a critical analysis of the research literature on clinimetric properties of instruments that can be used in daily practice to measure active cervical range of motion (ACROM) in patients with non-specific neck pain. A computerized literature search was performed in Medline, Cinahl and Embase from 1982 to January 2007. Two reviewers independently assessed the clinimetric properties of identified instruments using a criteria list. The search identified a total of 33 studies, investigating three different types of measurement instruments to determine ACROM. These instruments were: (1) different types of goniometers/inclinometers, (2) visual estimation, and (3) tape measurements. Intra- and inter-observer reliability was demonstrated for the cervical range of motion instrument (CROM), Cybex electronic digital instrument (EDI-320) and a single inclinometer. The presence of agreement was assessed for the EDI-320 and a single inclinometer. The CROM received a positive rating for construct validity. When clinical acceptability is taken into account both the CROM and the single inclinometer can be considered appropriate instruments for measuring the active range of motion in patients with non-specific neck pain in daily practice. Reliability is the aspect most frequently evaluated. Agreement, validity and responsiveness are documented less frequently.