Adaptations to walking on an uneven terrain for individuals with and without Developmental Coordination Disorder

Given the importance of walking in everyday life, understanding why this is challenging for some populations is particularly important. Studies focusing on gait patterns of individuals with Developmental Coordination Disorder (DCD) have shown that whilst increased variability is characteristic of walking patterns for this group, differences in spatio-temporal gait variables seem only to arise when task demands increase. However, these differences occur under rather artificial conditions, for example using a treadmill. The aim of this study, therefore was to examine the step characteristics of individuals with and without DCD whilst walking along an irregular terrain. Thirty-five individuals with DCD aged 8–32 years and 35 age and gender-matched controls participated in this study. Participants were divided into 3 age groups; 8–12 years (n = 12), 13–17 years (n = 12) and 18–32 years (n = 11). Participants walked up and down a 6 m walkway for two minutes on two terrains: level and irregular. VICON 3D motion analysis was used to extract measures of foot placement, velocity and angle of the head and trunk. Results showed that both groups adapted their gait to negotiate the irregular terrain, but the DCD group was more affected than their TD peers; walking significantly slower with shorter, wider steps and inclining their head more towards the ground. This suggests an adaptive approach used by individuals with DCD to preserve stability and increase visual sampling whilst negotiating an irregular terrain.     

The effect of exergames on functional strength,anaerobic fitness,balance and agility in children with and without motor coordination difficulties living in low-income communities

Children with Developmental Coordination Disorder (DCD) are physically less active, preferring more sedentary behavior and are at risk of developing health problems or becoming overweight. 18 children (age 6–10 years) with lower levels of motor coordination attending a primary school in a low-income community in South Africa (score on Movement Assessment Battery for Children Second edition equal to or below the 5th percentile) were selected to participate in the study and were age-matched with typically developing peers (TD). Both groups of children engaged in 20 min of active Nintendo Wii Fit gaming on the balance board, twice a week for a period of five weeks. All children were tested before and after the intervention using the lower limb items of the Functional Strength Measurement, the 5 × 10 meter sprint test, the 5 × 10 meter slalom sprint test, and the Balance, Running speed and Agility subtest of the Bruininks Oseretsky Test of Motor Proficiency 2nd edition (BOT-2).After intervention, both groups of children improved in functional strength and anaerobic fitness. The magnitude of these changes was not related to participant’s motor coordination level. However, differences in change between the TD and DCD group were apparent on the motor performance tests; children with DCD seemed to benefit more in balance skills of the BOT-2, while the TD children improved more in the Running speed and Agility component of the BOT-2. Compliance to the study protocol over 5 weeks was high and the effect on physical functioning was shown on standardized measures of physical performance validated for children with and without DCD.     

Visual perceptual and handwriting skills in children with Developmental Coordination Disorder

ObjectiveChildren with Developmental Coordination Disorder demonstrate a lack of automaticity in handwriting as measured by pauses during writing. Deficits in visual perception have been proposed in the literature as underlying mechanisms of handwriting difficulties in children with DCD. The aim of this study was to examine whether correlations exist between measures of visual perception and visual motor integration with measures of the handwriting product and process in children with DCD.MethodThe performance of twenty-eight 8–14 year-old children who met the DSM-5 criteria for DCD was compared with 28 typically developing (TD) age and gender-matched controls. The children completed the Developmental Test of Visual Motor Integration (VMI) and the Test of Visual Perceptual Skills (TVPS). Group comparisons were made, correlations were conducted between the visual perceptual measures and handwriting measures and the sensitivity and specificity examined.ResultsThe DCD group performed below the TD group on the VMI and TVPS. There were no significant correlations between the VMI or TVPS and any of the handwriting measures in the DCD group. In addition, both tests demonstrated low sensitivity.ConclusionClinicians should execute caution in using visual perceptual measures to inform them about handwriting skill in children with DCD.     

The influence of task paradigm on motor imagery ability in children with Developmental Coordination Disorder

Children with Developmental Coordination Disorder (DCD) have difficulty imagining movements such that they conform to the customary temporal constraints of real performance. We examined whether this ability is influenced by the choice of task used to elicit motor imagery (MI). Performance of typically developing (TD) (n = 30) and children with DCD (n = 30) was compared on two tasks: the Visually Guided Pointing Task (VGPT) and the Computerized Virtual Radial Fitts Task (C-VRFT). Since the VGPT places higher demands on executive functions like working memory but requires less spatial planning, we reasoned that the C-VRFT would provide a purer measure of motor imagery (or simulation). Based on our earlier work, we predicted that imagery deficits in DCD would more likely manifest on the C-VRFT. Results showed high correlations between tasks in terms of executed and imagined movement time suggest that both tasks measure MI ability. However, group differences were more pronounced in the imagined condition of the radial Fitts’ task. Taken together, the more spatially complex C-VRFT appears to be a more sensitive measure of motor imagery, better discriminating between DCD and TD. Implications for theory and practice are discussed.     

Advanced age brings a greater reliance on visual feedback to maintain balance during walking

We implemented a virtual reality system to quantify differences in the use of visual feedback to maintain balance during walking between healthy young (n = 12, mean age: 24 years) and healthy old (n = 11, 71 years) adults. Subjects walked on a treadmill while watching a speed-matched, virtual hallway with and without mediolateral visual perturbations. A motion capture system tracked center of mass (CoM) motion and foot kinematics. Spectral analysis, detrended fluctuation analysis, and local divergence exponents quantified old and young adults’ dynamic response to visual perturbations. Old and young adults walked normally with comparable CoM spectral characteristics, lateral step placement temporal persistence, and local divergence exponents. Perturbed visual flow induced significantly larger changes in mediolateral CoM motion in old vs. young adults. Moreover, visual perturbations disrupted the control of lateral step placement and compromised local dynamic stability more significantly in old than young adults. Advanced age induces a greater reliance on visual feedback to maintain balance during waking, an effect that may compensate for degradations in somatosensation. Our findings are relevant to the early diagnosis of sensory-induced balance impairments and also point to the potential use of virtual reality to evaluate sensory rehabilitation and balance training programs for old adults.     

Do kinematic metrics of walking balance adapt to perturbed optical flow?

Visual (i.e., optical flow) perturbations can be used to study balance control and balance deficits. However, it remains unclear whether walking balance control adapts to such perturbations over time. Our purpose was to investigate the propensity for visuomotor adaptation in walking balance control using prolonged exposure to optical flow perturbations. Ten subjects (age: 25.4 ± 3.8 years) walked on a treadmill while watching a speed-matched virtual hallway with and without continuous mediolateral optical flow perturbations of three different amplitudes. Each of three perturbation trials consisted of 8 min of prolonged exposure followed by 1 min of unperturbed walking. Using 3D motion capture, we analyzed changes in foot placement kinematics and mediolateral sacrum motion. At their onset, perturbations elicited wider and shorter steps, alluding to a more cautious, general anticipatory balance control strategy. As perturbations continued, foot placement tended toward values seen during unperturbed walking while step width variability and mediolateral sacrum motion concurrently increased. Our findings suggest that subjects progressively shifted from a general anticipatory balance control strategy to a reactive, task-specific strategy using step-to-step adjustments. Prolonged exposure to optical flow perturbations may have clinical utility to reinforce reactive, task-specific balance control through training.     

Children with developmental coordination disorder (DCD) can adapt to perceptible and subliminal rhythm changes but are more variable

Children with DCD demonstrate impairments in bimanual finger tapping during self-paced tapping and tapping in synchrony to different frequencies. In this study, we investigated the ability of children with DCD to adapt motorically to perceptible or subliminal changes of the auditory stimuli without a change in frequency, and compared their performance to typically developing controls (TDC). Nineteen children with DCD between ages 6–11 years (mean age ± SD = 114 ± 21 months) and 17 TDC (mean age ± SD = 113 ± 21 months) participated in this study. Auditory perceptual threshold was established. Children initially tapped bimanually to an antiphase beat and then to either a perceptible change in rhythm or to gradual subliminal changes in rhythm. Children with DCD were able to perceive changes in rhythm similar to TDC. They were also able to adapt to both perceptible and subliminal changes in rhythms similar to their age- and gender- matched TDC. However, these children were significantly more variable compared with TDC in all phasing conditions. The results suggest that the performance impairments in bilateral tapping are not a result of poor conscious or sub-conscious perception of the auditory cue. The increased motor variability may be associated with cerebellar dysfunction but further behavioral and neurophysiological studies are needed.     

Longitudinal examination of objectively-measured physical activity and sedentary time among children with and without significant movement impairments

BackgroundChildren with Developmental Coordination Disorder (DCD) tend to be less active than typically-developing (TD) children. Current evidence, however, is based on cross-sectional and self-reported activity, and little is known about sedentary time among children with significant movement impairments such as DCD. The current study examines the longitudinal patterns of objectively measured physical activity and sedentary time in children with and without possible DCD (pDCD).MethodsData is from a longitudinal nested case-control study, with 103 participants (n = 60 males ages = 12 and 13 at baseline). Participants averaging ⩽16th percentile on the Movement Assessment Battery for Children were considered having significant movement impairments and pDCD (n = 49). All participants wore accelerometers for seven days.ResultsThere were significant main effects for time (Estimate = −23.98, p < .01) and gender (Estimate = 59.86, p < .05) on total physical activity, and time spent being sedentary (Estimate = 15.58, p < .05). Significant main effects for pDCD (Estimate = −5.38, p < .05) and gender (Estimate = 26.89, p < .01), and time by gender interaction (Estimate = −7.50, p < .05) were found for moderate-to-vigorous physical activity (MVPA). Sedentary time did not differ between children with and without DCD.ConclusionsResults suggest children with pDCD engaged in less MVPA compared to TD children. Consistent patterns of MVPA over time, however, suggest that the divergence in MVPA occurs earlier in childhood. Further longitudinal research following a younger cohort is necessary to identify the specific point that differences in MVPA emerge.     

Goal equivalent manifold analysis of task performance in non-specific LBP and healthy subjects during repetitive trunk movement: Effect of load,velocity, symmetry

Motor abundance allows reliability of motor performance despite its variability. The nature of this variability provides important information on the flexibility of control strategies. This feature of control may be affected by low back pain (LPB) and trunk flexion/extension conditions.Goal equivalent manifold (GEM) analysis was used to quantify the ability to exploit motor abundance during repeated trunk flexion/extension in healthy individuals and people with chronic non-specific LBP (CNSLBP).Kinematic data were collected from 22 healthy volunteers and 22 CNSLBP patients during metronomically timed, repeated trunk flexion/extension in three conditions of symmetry, velocity, and loading; each at two levels. A goal function for the task was defined as maintaining a constant movement time at each cycle. Given the GEM, flexibility index and performance index were calculated respectively as amounts of goal-equivalent variability and the ratio of goal-equivalent to non-goal-equivalent variability.CNSLBP group was as similar as healthy individuals in both flexibility index (p = 0.41) and performance index (p = 0.24). Performance index was higher in asymmetric (p < 0.001), high velocity (p < 0.001), and loaded (p = 0.006) conditions.Performance and flexibility in using motor abundance were influenced by repeated trunk flexion/extension conditions. However, these measures were not significantly affected by CNSLBP.     

The impact of speed and time on gait dynamics

To determine the effects of speed on gait previous studies have examined young adults walking at different speeds; however, the small number of strides may have influenced the results. The aim of this study was to investigate the immediate and long-term impact of continuous slow walking on the mean, variability and structure of stride-to-stride measures. Fourteen young adults walked at a constant pace on a treadmill at three speeds (preferred walking speed (PWS), 90% and 80% PWS) for 30 min each. Spatiotemporal gait parameters were computed over six successive 5-min intervals. Walking slower significantly decreased stride length, while stride period and width increased. Additionally, stride period and width variability increased. Signal regularity of stride width increased and decreased in stride period. Persistence of stride period and width increased significantly at slower speeds. While several measures changed during 30 min of walking, only stride period variability and signal regularity revealed a significant speed and time interaction. Healthy young adults walking at slower than preferred speeds demonstrated greater persistence and signal regularity of stride period while spatiotemporal changes such as increased stride width and period variability arose. These results suggest that different control processes are involved in adapting to the slower speeds.     

Motor imagery ability and internal representation of movement in children with probable developmental coordination disorder

It has been hypothesised that deficits in the functioning of the mirror neuron system (MNS) and internal modelling may contribute to the motor impairments associated with DCD. These processes can be explored behaviourally through motor imagery paradigms. Motor imagery proficiency of children with and without probable DCD (pDCD) was examined using a complex hand rotation task to explore whether motor imagery strategies could be used during more complex tasks. Forty-four boys aged 7–13 years participated, 22 with pDCD (mean = 9.90 years ± 1.57) and 22 controls (mean = 9.68 years ± 1.53). Participants completed the task twice: with and without motor imagery instructions. Stimuli were presented in two rotational axes – palm/back, and eight 45° rotational steps. Both groups showed evidence of following the biomechanical and postural constraints of actual movements. Responses of children with pDCD were slower and less accurate than controls, with group differences increasing alongside task complexity. A greater impact of biomechanical constraints for accuracy was observed in the DCD group. The response characteristics of children with pDCD likely reflects a reduced capacity to mentally manipulate a body schema and reduced visuo-motor processing capabilities. Behaviourally, these processes are linked to MNS and internal modelling function, suggesting deficits in these systems may contribute to the movement difficulties characteristic of DCD.     

Intra- and inter-subject variation in lower limb coordination during countermovement jumps in children and adults

The purpose of the present study was to investigate the coordination pattern and coordination variability (intra-subject and inter-subject) in children and adults during vertical countermovement jumps. Ten children (mean age: 11.5 ± 1.8 years) and ten adults (mean age: 26.1 ± 4.9 years) participated in the experiment. Lower body 3D-kinematics and kinetics from both legs were obtained during 9 vertical jumps of each subject. Coordination pattern and coordination variability of intra-limb and inter-limb coupling were established by modified vector coding and continuous relative phase. The adult group jumped higher and with less performance variability compared to the children. Group differences were mainly observed in the right–left foot coupling. The intra-subject coordination variability was higher in coupling of proximal segments in children compared to adults. No group differences were observed in inter-subject variability. Based on these results, it was concluded that the same movement solutions were available to both age groups, but the children were less able to consistently utilize the individually chosen coordination pattern. Thus, this ability appears to be developed through normal ontogenesis.     

Multisensory integration in children with Developmental Coordination Disorder

This study examines how multisensory stimuli affect the performance of children with Developmental Coordination Disorder (DCD) on a choice reaction time (CRT) task. Ten children with DCD, identified using the Movement Assessment Battery for Children-2, aged 7–10 years (4F, M = 8 y 3 m, SD = 17 m) and 10 typically developing peers (TDC) (5F, M = 8 y 4 m, SD = 17 m) reached to unimodal (auditory (AO), visual (VO)) and bimodal (audiovisual (AV)) stimuli at one of three target locations. A multisensory (AV) stimulus reduced RTs for both groups (p < 0.001, η² = 0.36). While the children with DCD had a longer RT in all conditions, the AV stimulus produced RTs in children with DCD (494 ms) that were equivalent to those produced by the TDC to the VO stimulus (493 ms). Movement Time (DCD = 486 ms; TDC = 434 ms) and Path Length (DCD = 25.6 cm; TDC = 24.2 cm) were longer in children with DCD compared to TDC as expected (p < 0.05). Only the TDC benefited from the AV information for movement control, as deceleration time of the dominant hand was seen to decrease when moving to an AV stimulus (p < 0.05). Overall, data shows children with DCD do benefit from a bimodal stimulus to plan their movement, but do not for movement control. Further research is required to understand if this is a result of impaired multisensory integration.     

Propulsion strategy in the gait of primary school children; the effect of age and speed

The strategy used to generate power for forward propulsion in walking and running has recently been highlighted as a marker of gait maturation and elastic energy recycling. This study investigated ankle and hip power generation as a propulsion strategy (PS) during the late stance/early swing phases of walking and running in typically developing (TD) children (15: six to nine years; 17: nine to 13 years) using three-dimensional gait analysis. Peak ankle power generation at push-off (peakA2), peak hip power generation in early swing (peakH3) and propulsion strategy (PS) [peakA2/(peakA2 + peakH3)] were calculated to provide the relative contribution of ankle power to total propulsion. Mean PS values decreased as speed increased for comfortable walking (p < 0.001), fast walking (p < 0.001) and fast running (p < 0.001), and less consistently during jogging (p = 0.054). PS varied with age (p < 0.001) only during fast walking. At any speed of fast walking, older children generated more peakA2 (p = 0.001) and less peakH3 (p = 0.001) than younger children. While the kinetics of running propulsion appear to be developed by age six years, the skills of fast walking appeared to require additional neuromuscular maturity. These findings support the concept that running is a skill that matures early for TD children.     

Effort to reduce postural sway affects both cognitive and motor performances in individuals with Parkinson’s disease

ObjectivesTo assess the effects of voluntarily reducing postural sway on postural control and to determine the attention level needed to do so in healthy adults (n = 16, 65.9 ± 9.7) and persons with PD (n = 25, 65.8 ± 9.5 years). Tasks: quiet and still standing conditions with and without a category task. Cognitive performance, center of pressure (CoP) displacement variability (RMSCoP) and velocity (VCoP) were assessed in the anterior-posterior (AP) and medial-lateral (ML) directions.Controls showed larger RMSCoP (AP) and VCoP (AP and ML) during still versus quiet standing (p < 0.01), while the PD group demonstrated no changes. In the PD group, RMSCoP and VCoP (ML) increased in still standing when performed with the cognitive task (p < 0.05). In both groups, cognitive responses decreased in still standing (p < 0.05).In PD, attempting to reduce postural sway did not affect postural control under single task conditions, however ML CoP variability and velocity did increase as a dual task. In older adults, increased displacement and velocity in both AP and ML directions was observed during single, but not dual task conditions. Therefore standing still might not be an adequate postural strategy as it increases the attentional demand and affects motor performance, putting persons with PD at greater risk for falls.     

Alterations in stride-to-stride variability during walking in individuals with chronic ankle instability

The aim of this study was to evaluate stride-to-stride variability of the lower extremity during walking in individuals with and without chronic ankle instability (CAI) using a nonlinear analysis. Twenty-five participants with self-reported CAI and 27 healthy control participants volunteered for this study. Participants walked on a motor-driven treadmill for 3 min at their selected speed. Lower extremity kinematics in the sagittal and frontal planes were recorded using a passive retroreflective marker motion capture system. The temporal structure of walking variability was analyzed with sample entropy (SampEn). The CAI group produced lower SampEn values in frontal-plane ankle kinematics compared to the control group (P = .04). No significant group differences were observed for SampEn values of other kinematics (P > .05). Participants with CAI demonstrated less stride-to-stride variability of the frontal plane ankle kinematics compared to healthy controls. Decreased variability of walking patterns demonstrated by participants with CAI indicates that the presence of CAI may be associated with a less adaptable sensorimotor system to environmental changes. The altered sensorimotor function associated with CAI may be targets for clinical interventions, and it is critical to explore how interventions protocols affect sensorimotor system function.     

Comparison of the trunk-pelvis and lower extremities sagittal plane inter-segmental coordination and variability during walking in persons with and without chronic low back pain

Inter-segmental coordination can be influenced by chronic low back pain (CLBP). The sagittal plane lower extremities inter-segmental coordination pattern and variability, in conjunction with the pelvis and trunk, were assessed in subjects with and without non-specific CLBP during free-speed walking. Kinematic data were collected from 10 non-specific CLBP and 10 non-CLBP control volunteers while the subjects were walking at their preferred speed. Sagittal plane time-normalized segmental angles and velocities were used to calculate continuous relative phase for each data point. Mean absolute relative phase (MARP) and deviation phase (DP) were derived to quantify the trunk-pelvis and bilateral pelvis-thigh, thigh-shank and shank-foot coordination pattern and variability over the stance and swing phases of gait. Mann-Whitney U test was employed to compare the means of DP and MARP values between two groups (same side comparison). Statistical analysis revealed more in-phase/less variable trunk-pelvis coordination in the CLBP group (P < 0.05). CLBP group demonstrated less variable right or left pelvis-thigh coordination pattern (P < 0.05). Moreover, the left thigh-shank and left shank-foot MARP values in the CLBP group, were more in-phase than left MARP values in the non-CLBP control group during the swing phase (P < 0.05). In conclusion, the sagittal plane lower extremities, pelvis and trunk coordination pattern and variability could be generally affected by CLBP during walking. These changes can be possible compensatory strategies of the motor control system which can be considered in the CLBP subjects.     

Development of motor imagery and anticipatory action planning in children with developmental coordination disorder – A longitudinal approach

Children with impaired motor coordination (or Development Coordination Disorder – DCD) have difficulty with the predictive control of movements, evidenced by cross-sectional studies that show impaired motor imagery and action planning abilities. What remains unclear is whether this deficit in predictive control reflects immaturity of the motor system (a developmental delay) or some deviation from normal development (a disorder). To advance this discussion the present study used a longitudinal design to examine the development of motor imagery and action planning in children with DCD. Thirty children were included in the DCD group (aged 6–11 years) and age- and gender-matched to 30 controls. The DCD group had a mABC-2 score ≤ 16th percentile, the control group > 20th percentile. Motor imagery was assessed with the hand rotation task, action planning with a test for end-state comfort. Children participated in three measurements, with one year in between measurements. Results showed that children with DCD were slower and less accurate than their typically developing peers in all subsequent years but were able to improve their motor imagery ability over time. Furthermore, children with DCD showed less planning for ESC at the start of the present study, but were able to catch up with their peers during two-year follow up. These results exemplify that improvement of motor imagery and action planning ability is possible in DCD, and they lend theoretical support to the use of new training techniques that focus on training motor imagery to improve motor skills in children with DCD.     

Different coordination and flexibility of the spine and pelvis during lateral bending between young and older adults

This study examined coordination of the spine and pelvis during lateral bending of the trunk in older adults. Thirty-four healthy subjects (17 young and 17 older adults) demonstrated lateral bending at a controlled speed while holding a bar at approximately 180 degrees of shoulder flexion. Kinematic data collection was completed on the thoracic spine, lumbar spine, and pelvis. The coupling angle was calculated to examine the thorax–lumbar, lumbar–pelvis, and thorax–pelvis coordination patterns. The older adults demonstrated a reduced range of motion (ROM) of the lumbar spine, while both groups revealed similar ROM in the thorax and in the pelvis. The coupling angle between the straightening and bending phases was different only for the older adults in the thorax–lumbar (23.4 ± 8.0 vs. −1.6 ± 4.4, p = 0.004) and the lumbar–pelvis (65.4 ± 7.2 vs. 86.1 ± 7.8, p = 0.001) coordination. However, there was no group difference in the thorax–pelvis coordination. These findings indicate that age-related changes in the lumbar region affect coordination patterns only during the bending phase. The older adults preserved a similar pattern of movement to the young adults during the straightening phase, but the coordination variability of the coupling angles was greater for the older adults than for the young adults. This movement pattern suggests that the older adults lacked consistent trunk control in an attempt to optimize lateral bending coordination.     

Movement adjustments in preparation for single-leg jumps in individuals with functional ankle instability

There is some evidence showing that people with functional ankle instability (FAI) can present changes in postural control during the landing phase of a jump. These studies also show preliminary results indicating possible changes during phases prior to landing. Therefore, the objective of this study was to investigate whether movement adjustments prior to a jump are different between people with and without FAI. Sixty participants with (n = 30) and without (n = 30) FAI participated in this study. The main outcome measures were the variability of range of motion in ankle inversion/eversion and dorsiflexion/plantarflexion; and variability of center of pressure for the directions anterior-posterior and medio-lateral during the pre-jump period for drop jump, vertical jump and during single-leg stance. The group with instability showed more variability of center of pressure in anterior-posterior direction (p = 0.04) and variability of range of motion in ankle dorsiflexion/plantar flexion (p = 0.04) compared to control in the single-leg stance test. For the within-group comparisons, the group with instability showed more variability of center of pressure in anterior-posterior direction in the drop jump higher than single-leg stance and vertical jump. The same pattern was seen for the control group. Thus, this study suggests that people with FAI have greater ankle range of motion variability and center of pressure variability in the anterior-posterior axis when compared to healthy individuals during single-leg stance. For those same two variables, preparation for a drop jump causes more postural instability when compared to the preparation for a vertical jump and to single-leg stance.