Tsu Hsin Howe

Cooccurrence of problems in activity level, attention, psychosocial adjustment, reading and writing in children with developmental coordination disorder.

The purpose of this paper was to investigate the cooccurrence of problems in activity level, attention, reading, writing and psychosocial adjustment of children with developmental coordination disorder (DCD). A parent-report questionnaire, the Developmental Coordination Disorder Questionnaire – Chinese version (DCDQ-C), was used to screen first to third graders from 13 mainstream schools in Taipei. Two standardized motor tests were then administered to those who scored below 10% on the DCDQ-C. Tests of activity level, attention, reading, writing and psychosocial adjustment were then administered to this sample. Thirty-eight children identified as DCD, 32 as suspect for DCD and 82 as normal comparison were included in the final sample. Multivariate analysis of variance comparing the three groups (DCD, suspect DCD, and comparison) revealed that both children with DCD and suspect for DCD obtained significantly poorer scores on measures of attention and reading, and were more hyperactive than comparison children. Children with DCD and suspect for DCD were also reported to have more internalizing and social problems than children without motor problems. No significant differences, however, were noted between children with different degree of motor coordination problems (categorized as DCD and suspect for DCD) on any measure. Furthermore, a high percentage of children in both the DCD and suspect groups fell in the clinical range of attention, activity level and psychosocial adjustment problems. The results revealed a high risk for these problems in nonreferred children with motor coordination problems. The high percentage of clinical range behavioral problems warrants attention of clinicians who work with children with motor coordination difficulties to the need to promote early identification and referral.

A review of psychometric properties of feeding assessment tools used in neonates

OBJECTIVE To appraise the psychometric properties of clinical feeding assessment tools used in a neonatal population. DATA SOURCES PubMed, OvidMedline, CINHAL, and PsycINFO databases from 1980 to 2007. Reference lists of all identified articles were also reviewed. STUDY SELECTION Research reports written in English that utilized or validated clinical feeding assessment tools. DATA EXTRACTION In total, 941 articles were reviewed. Seven neonatal clinical feeding assessment tools were identified and categorized into three groups: tools used for assessing either bottle-feeding or breastfeeding behaviors, tools used only for assessing bottle-feeding behaviors, and tools used only for assessing breastfeeding behaviors. RESULTS The psychometric properties of none of the seven assessment tools identified were satisfactory, and the limited representativeness of the samples of the psychometric research was noted in all assessment tools identified. The Neonatal Oral-Motor Assessment Scale appeared to have been examined more thoroughly and showed more consistent results in psychometric properties than the others, despite its own limitations. CONCLUSIONS A psychometrically sound neonate feeding assessment tool has not yet been empirically validated. Clinicians who use these tools for clinical and research purposes should take into account this lack of evidence of psychometric soundness and interpret results of assessment with precautions. Well-designed research is needed to study the scientific integrity of these instruments for program evaluations in neonatal care.

Assessing handwriting intervention effectiveness in elementary school students: a two-group controlled study.

This study examined the effectiveness of two approaches used in elementary schools to improve childrens handwriting. Participants were 72 New York City public school students from the first and second grades. A nonequivalent pretest-posttest group design was used in which students engaged in handwriting activities using two approaches: intensive handwriting practice and visual-perceptual-motor activities. Handwriting speed, legibility, and visual-motor skills were examined after a 12-wk Handwriting Club using multivariate analysis of variance. The results showed that students in the intensive handwriting practice group demonstrated significant improvements in handwriting legibility compared with students in the visual-perceptual-motor activity group. No significant effects in handwriting speed and visual-motor skills were found between the students in intensive handwriting practice group and the students in visual-perceptual-motor activities group. The Handwriting Club model is a natural intervention that fits easily into existing school curriculums and can be an effective short-term intervention (response to intervention Tier II).

Psychometric characteristics of the Neonatal Oral‐Motor Assessment Scale in healthy preterm infants

We examined the reliability, validity, and responsiveness of the Neonatal Oral‐Motor Assessment Scale (NOMAS) in healthy preterm infants. Feeding records of 147 infants (71 males, 76 females; gestational age [GA] ≤ 36wks), taken from the day bottle‐feeding was initiated to the day the infants were discharged, were used to examine the psychometric properties of the normal and disorganized categories of the NOMAS. The infants, with or without experience of breastfeeding, were all fed by bottle, with either formula and/or breast milk. GA ranged from 24 to 35.9 weeks (mean 29.7wks, SD 2.7) and birthweight ranged from 470g to 2570g (mean 1251.1g, SD 425.9). Postmenstrual age (PMA) at the starting point of bottle‐feeding ranged from 29.4 to 40.1 weeks (mean 33.8wks, SD 1.7). We found that the NOMAS had satisfactory internal consistency (Cronbachs α >0.70) in the normal category for 32 to 35 weeks’PMA. Moderate correlations were found between scores on the NOMAS and feeding performance for all age groups except for PMA of ≥ 36 weeks (absolute Spearmans rs=0.51‐0.69), indicating acceptable convergent validity. The NOMAS demonstrated moderate responsiveness to changes in oral‐motor skills in every 2‐week period, ranging from 32 to 36 weeks’PMA (standard response mean greater than 0.5). This study demonstrated that the normal and disorganized categories of the NOMAS are useful, with acceptable psychometric properties, in assessing oral‐motor function in preterm infants aged 32 to 35 weeks’PMA. Future research on infants with abnormal oral‐motor skills is needed to further validate psychometric properties of the dysfunction category of the NOMAS.

Systematic Review of Interventions Used in or Relevant to Occupational Therapy for Children With Feeding Difficulties Ages Birth–5 Years

Research articles on the effectiveness of feeding interventions for infants and young children were identified, appraised, and synthesized. Thirty-four studies met the inclusion criteria and were reviewed. Three broad intervention themes regarding feeding approaches were identified on the basis of their theoretical orientations. These three feeding approaches were (1) behavioral interventions, (2) parent-directed and educational interventions, and (3) physiological interventions. Synthesis of the evidence suggested that various feeding approaches may result in positive outcomes in the areas of feeding performance, feeding interaction, and feeding competence of parents and children. This synthesis of empirical evidence supporting interventions for feeding problems provides a foundation for future research to define the types of outcomes that can be expected for children with different diagnoses or functional impairments and to develop best practice guidelines.

Neuromotor outcomes in children with very low birth weight at 5 yrs of age

Objective: The aim of this study was to assess a cohort of children with very low birth weight (VLBW) with premature history at the age of 5 yrs for the proportion of deficits in growth, motor, cognitive, and adaptive functions and to compare them with children with normal birth weight (>2500 g) in these areas. Design: This is a descriptive, exploratory study using a convenience sample. A cohort of 160 children with VLBW and 124 children with normal birth weight were examined. Standardized clinical and neuropsychologic assessments were administered. Correlation and multiple comparison procedures were used to analyze the relationships among all continuous outcome variables. Results: There is a significant difference in overall performance between the VLBW children and children with normal birth weight. Deficits in motor, cognitive, visual perception, visual‐motor, and adaptive functions were more prominent when we further examined the VLBW children with motor problems. Conclusions: The VLBW children performed more poorly at age 5 yrs than did their counterparts. This validates the need for early screening and regular follow‐up of VLBW preterm children, particularly those who have motor problems.

Postural control during standing reach in children with Down syndrome.

The purpose of the present study was to investigate the dynamic postural control of children with Down syndrome (DS). Specifically, we compared postural control and goal-directed reaching performance between children with DS and typically developing children during standing reach. Standing reach performance was analyzed in three main phases using the kinematic and kinetic data collected from a force plate and a motion capture system. Fourteen children with DS, age and gender matched with fourteen typically developing children, were recruited for this study. The results showed that the demand of the standing reach task affected both dynamic postural control and reaching performance in children with DS, especially in the condition of beyond arms length reaching. More postural adjustment strategies were recruited when reaching distance was beyond arms length. Children with DS tended to use inefficient and conservative strategies for postural stability and reaching. That is, children with DS perform standing reach with increased reaction and execution time and decreased amplitudes of center of pressure displacements. Standing reach resembled functional balance that is required in daily activities. It is suggested to be considered as a part of strength and balance training program with graded task difficulty.

Hand function and its prognostic factors of very low birth weight preterm children up to a corrected age of 24 months.

A delay in functional hand performance broadly affects a childs successful participation in daily activities as well as later academic performance. Despite its high prevalence, hand function has received much less attention than other developmental domains, especially for young children. The aims of this study, therefore, were to examine hand function in preterm children up to a corrected age of 24 months; to establish predictive models for estimating preterm childrens hand function; and to identify the contribution of early neuromotor assessments. This study included 230 preterm children (69, 76, and 85 children at corrected ages of 6-, 12-, and 24-months, respectively) who were recruited from the database of the preemie follow-up clinic at the National Cheng Kung University Hospital in Tainan, Taiwan. Hand function was evaluated using the Peabody Developmental Motor Scales II. Demographic information, birth history, and developmental documents were obtained from the medical records of routine preemie clinic follow-ups. Approximately half of healthy preterm children demonstrate hand function deficits at 12 and 24 months of corrected age. The Neonatal Medical Index, representing an infants history of medical complication, was the best predictor of hand function at 12 and 24 months of corrected age. The social factor, represented by maternal educational year, was found to have influence on hand function only in preterm children at corrected age of 24 months old. Finally, early neuromotor performance demonstrated significant predictability of later hand function that supports the importance of continuous follow-up examinations in children with a history of prematurity. An understanding of a preterm childs early hand function as well as how its risk factors evolve helps clinicians both target children who might benefit from early intervention and ensure that children reach their full developmental potential.

Contribution of tactile and kinesthetic perceptions to handwriting in Taiwanese children in first and second grade

This study examined the contribution of tactile and kinesthetic perceptions to handwriting legibility and speed of 177 Taiwanese children in first and second grade. Five standardized instruments assessed tactile and kinesthetic perceptions using handwriting legibility and speed as outcome measures. Fine motor coordination, mental processing speed, age, and gender were measured and served as covariates. Pearson correlations and regression analyses examined the relationship between handwriting and tactile and kinesthetic perceptions. Handwriting speed and legibility both significantly correlated with tactile perception, kinesthetic perception, and covariates. Results from the regression analysis supported tactile and kinesthetic perceptions as being significant predictors of both handwriting speed (F (6,170) = 25.87, p < .001, R = .477) and legibility (F (6,170) = 11.043, p < .001, R = .280). Tactile perception contributed more to handwriting speed and legibility than kinesthetic perception. Tactile and kinesthetic perception should be assessed when evaluating handwriting. When children have difficulty writing quickly or legibly, professionals should assess childrens tactile and kinesthetic abilities.

Ball Catching Skills of 5- to 11-Year-Old Typically Developing Children in Real and Virtual Environments

Howe T-H, Wang T-N, Sheu C-F, Hsu Y-W: Ball catching skills of 5- to 11-year-old typically developing children in real and virtual environments. Objective:The two aims of this study are (1) to examine the concurrent and discriminant validity of a newly developed virtual ball catching test and (2) to explore the ball catching performance of typically developing children in a virtual environment. Design:Three groups of children aged 60- to 140-mo-old (n = 368) participated in this study: (1) typically developing children (n = 272), (2) children with diagnoses of developmental coordination disorders (n = 33), and (3) children with premature birth history (n = 63). Results:The concurrent validity of the virtual ball catching test was good, with Pearsons correlation coefficient = 0.67 between the virtual ball catching test and the Van Waelveldes short ball catching test in successful catching rate. The discriminant validity of the virtual ball catching test was acceptable in differentiating the performance among typically developing children, children with developmental coordination disorders, and children with preterm history. The significant main effects in age, sex, speed, and location (Ps < 0.001) as well as significant interaction effects in age × location and age × speed were found when examining the virtual ball catching performance of typically developing children. Conclusions:The virtual ball catching test demonstrates acceptable psychometric properties in assessing the ball catching performance of children aged 5–11 yrs. We propose that testing childrens motor performance in a virtual environment might be a useful and promising alternative for clinical assessment. Future research on its clinical application is needed.