Traci-Anne Goyen

Developmental coordination disorder in “apparently normal” schoolchildren born extremely preterm

Aims: To determine the prevalence of developmental coordination disorder (DCD) in “apparently normal” extremely premature (<29 weeks) or extremely low birthweight (<1000 g) schoolchildren at 8 years of age and whether motor skill assessments at an earlier age could predict DCD. Method: From a neonatal intensive care unit cohort, 50 of the 53 eligible children (IQ >84 and without disabilities at age 5 and residing in Sydney metropolitan) and full-term classroom controls matched for gender and age were assessed with the Movement Assessment Battery for Children (MABC) at school. Previous Griffith’s Scales (1 and 3 years) and Peabody Motor Scales (3 and 5 years) results were evaluated for prediction. Results: The prevalence of DCD (MABC impairment scores >1 SD below the norm) was significantly higher in the study group than controls (42% vs 8%, respectively), and severe DCD (scores >1.5 SD) was also significantly higher (30% vs 0%). DCD was independently associated with prolonged rupture of membranes and retinopathy of prematurity but not with parental education or occupation. Motor assessment using Peabody Fine Motor Scales at 3 years with a cut-off of <27th centile was the best predictor of DCD (areas under curve 78%). Conclusions: Apparently normal high-risk infants are at risk of motor dysfunction into their school years. Most of these could be identified at age 3.

Sensitivity and specificity of General Movements Assessment for diagnostic accuracy of detecting cerebral palsy early in an Australian context

The aim of this study was to calculate the sensitivity and specificity of the General Movements Assessment (GMA) for estimating diagnostic accuracy in detecting cerebral palsy (CP) in an Australian context by a newly established NSW rater network.

Respecting the evidence: Responsible assessment and effective intervention for children with handwriting difficulties

School students use handwriting, among other media, to demonstrate the depth and breadth of their learning, creativity and knowledge. Composition, or quality of content of written work, is therefore an important outcome of the process of producing written work. Competency in idea generation and organisation, spelling, grammar, sentence construction, punctuation, vocabulary, self-monitoring and motivation contribute to the content of written work (Jones & Christensen, 1999). Research indicates that examiners assign lower marks to written work which is poorly handwritten, but contains content of equal quality to work which is attractively and legibly handwritten (Sweedler-Brown, 1992). Handwriting, therefore, needs to be sufficiently legible for examiners to read and understand the content without effort, and to ascribe marks which accurately reflect and reward a student’s composition. Students should also be able to write sufficient quantity of content within required timeframes to adequately express the extent of their ideas and knowledge. Students who are able to generate handwriting fluently and automatically have greater capacity to access their cognitive, language and attentional resources (Berninger et al., 1997; Graham, Harris & Fink, 2000; Jones & Christensen, 1999; Medwell, Strand & Wray, 2009). Students with handwriting difficulties or developing handwriters have reduced capacity for idea generation, planning and revision when required to focus on the mechanics of handwriting in addition to the demands of composing written work (Medwell et al.). Even for children without handwriting difficulties, more complex tasks such as self-generated formal written work with demanding academic content are associated with decreased legibility when compared with less demanding handwriting tasks such as copying from the board (Graham, Struck, Santoro & Berninger, 2006). This phenomenon is proposed to result from increased demand placed on cognitive and attentional capacity by learning, language and cognitive components of the written task, leaving less available time for generating handwriting (Swanson & Berninger, 1996). Such issues may be amplified for children with coordination, learning or physical disabilities, or disorders of attention and behaviour. Automatic handwriting which is legible, generated at sufficient speed and without need for conscious attention is predicated on effective orthographic-motor integration and not simply on motor processes (Berninger et al., 1997; Jones & Christensen, 1999; Medwell et al., 2009). Orthographic-motor integration involves automatic retrieval of orthographic codes which have been encoded in memory, and automatic and effective transcription of these codes onto paper (Jones & Christensen; Weintraub & Graham, 2000). Orthographic codes are accurate representations in memory of the visual characteristics and verbal labels given to letters and words, as well as processes for forming these letters and words. Transcription of orthographic codes onto paper is presumably dependent on motivation to write and adequate capacity to use writing implements without pain, amongst other factors. Orthographic-motor Margaret Wallen PhD, MA, BAppSc (OT); Senior Occupational Therapist – Research and Adjunct Lecturer. Sharon Duff BAppSc (OT); Senior Occupational Therapist. TraciAnne Goyen PhD, BAppSc (OT); Clinical Specialist – Occupational Therapist. Elspeth Froude PhD, GradDip (NeuroSc), BAppSc (OT); Senior Lecturer.

A Retrospective Study of Therapeutic Hypothermia in Neonatal Hypoxic Ischemic Encephalopathy

Abstract Objectives: Therapeutic hypothermia (TH) is now standard treatment for moderate to severe hypoxic ischemic encephalopathy (HIE), secondary to intrapartum hypoxia, and has been performed in our neonatal unit since 2008. Objectives of this study included the assessment of compliance with the TH protocol and the evaluation of 2-year outcomes. Materials and Methods: Medical records of all the infants who underwent TH (2008-2014) were reviewed and relevant data were extracted. The laboratory database was used to extract blood test results. Follow-up clinic records were reviewed to gather data for 2-year outcomes. Outcome at 2 years was dichotomized as normal (survival with no or mild impairment) and abnormal (death or survival with moderate or severe impairment). Regression analysis was performed to determine the association of perinatal variables with an abnormal outcome. Results: Seventy-seven infants were treated with TH with 40/77 (52%) cooled as per the protocol. Treatment with TH for stage 1 HIE was the most common reason for protocol noncompliance. A total of 71 infants had HIE (n = 26, 24, and 21 with modified Sarnat stages 1, 2, and 3 respectively). Sixteen infants with HIE (22.5%) died; all had stage 3 HIE. Forty-one infants were seen at ≥2 years. Of these, 34 infants (83%) had a normal outcome. The clinical stage of HIE was the strongest predictor of an abnormal outcome. Normal 2-year outcome was seen in 94%, 84%, and 5% of stages 1, 2, and 3 HIE respectively. Conclusions: We noted a high degree of variation from the TH protocol. Clinical staging of HIE remains the strongest predictor of long-term outcome.