Client Advocacy and Collaboration with Insurance and Laboratory Testing Agencies: A Case Study Illustrating Genetic Counselor Roles

Genetic counseling and the many roles a genetic counselor must assume to provide quality genetic health care are becoming increasingly complex, especially when the genetic condition is rare, and DNA testing is costly and not yet routinely used. A case study of a couple with a family history of retinoblastoma and their pursuit of DNA testing for prenatal diagnosis is presented. The case study illustrates the instrumental role of the genetic counselor in advocating for clients for genetic services such as DNA testing and in educating insurance companies in the nature and importance of such services to achieve improved client health care outcomes.     

Qualitative analyses of critical aspects of adaptation to the visually left-right reversed world

In this article, mechanisms of perceptual adaptation to the transposed world are analyzed based on introspective and behavioral performance data gathered during an extended period of wearing left-right reversing goggles. Three aspects central to this study were the mental map of the living space surrounding the subject, body image (both seen and felt), and the sensorimotor coordination system, which reflects the relationship between the subject and surroundings. These were investigated through map-drawing tests, self-representation tests when postures other than face forward were adopted, and after effects observed immediately after removal of the reversing goggles. It was concluded that the main course of the perceptual adaptation to the visually left-right reversed world consists of double reversals of the mental map and body image as well as the establishment of a new sensorimotor coordination system. In sharp contrast to the proprioceptive-change hypothesis, the importance of the visual nature of the body image was emphasized.     

Controlling the flight on double-handed foiling catamarans: The role of shared equipment on the crew members' mutual modes of regulation

The purpose of this study was to contribute to the understanding of the role of shared sport equipment in the collective coordination of a team. It was conducted within an enactive approach of human cognition by mobilizing the methodological tools and methods of the Course of Action framework. Six crew members of hydrofoil sailing catamarans participated in this study. Data collection consisted in video-recording training sessions followed by individual self-confrontation interviews. A qualitative analysis of the data allowed typical modes of regulation of the flight to be characterized from each crew member's perspective. Three main modes of regulation were identified. All of them involved either salient perception of the boat's movements, or actions directed to regulating the boat’s movement. In the discussion, we propose a distinction between three types of collective sport situations, regarding the role of the material environment of athletes in their coordination. This distinction opens new perspectives both for future research on team coordination, and for pedagogical and training implications.     

Examining the Spatiotemporal Disruption to Gaze When Using a Myoelectric Prosthetic Hand

The aim of this study was to provide a detailed account of the spatial and temporal disruptions to eye-hand coordination when using a prosthetic hand during a sequential fine motor skill. Twenty-one able-bodied participants performed 15 trials of the picking up coins task derived from the Southampton Hand Assessment Procedure with their anatomic hand and with a prosthesis simulator while wearing eye-tracking equipment. Gaze behavior results revealed that when using the prosthesis, performance detriments were accompanied by significantly greater hand-focused gaze and a significantly longer time to disengage gaze from manipulations to plan upcoming movements. The study findings highlight key metrics that distinguish disruptions to eye-hand coordination that may have implications for the training of prosthesis use.     

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.     

A unified approach for revealing multiple balance recovery strategies

In human balance recovery, different strategies have been proposed with generally overlooked knee motions but extensive focus on the ankle, hip, and step strategies. It is not well understood whether maintaining balance is regulated at the lower “muscular–articular” level of coordinating segment joints or at a higher level of controlling whole body dynamics. Whether balance control is to minimize joint degrees of freedom (DOF) or utilize all the available DOF also remains unclear. This study aimed to use a realistic musculoskeletal human model to identify multiple balance recovery strategies with a single optimization criterion. Movements were driven by neural excitations (which activated muscle force generation) and were assumed to be symmetric. Balance recoveries were simulated with forward-inclined straight body postures as the initial conditions. When the position of the toes was fixed, balance was regained with virtually straight knees and mixed ankle/hip strategies. Under a severely perturbed condition, use of the forward hop strategy after releasing the fixed-toes constraint indicated spontaneous recruitment or suppression of DOF, which mimicked functions of optimally computed CNS commands in humans. The results also indicated that increase/decrease in the number of DOF depends on the imposed perturbation intensity and movement constraints.     

Reprint of “Co-occurring motor,language and emotional–behavioral problems in children 3–6 years of age”

PurposeDevelopmental Coordination Disorder (DCD) has been shown to co-occur with behavioral and language problems in school-aged children, but little is known as to when these problems begin to emerge, or if they are inherent in children with DCD. The purpose of this study was to determine if deficits in language and emotional–behavioral problems are apparent in preschool-aged children with movement difficulties.MethodTwo hundred and fourteen children (mean age 4 years 11 months, SD 9.8 months, 103 male) performed the Movement Assessment Battery for Children 2nd Edition (MABC-2). Children falling at or below the 16th percentile were classified as being at risk for movement difficulties (MD risk). Auditory comprehension and expressive communication were examined using the Preschool Language Scales 4th Edition (PLS-4). Parent-reported emotional and behavioral problems were assessed using the Child Behavior Checklist (CBCL).ResultsPreschool children with diminished motor coordination (n = 37) were found to have lower language scores, higher externalizing behaviors in the form of increased aggression, as well as increased withdrawn and other behavior symptoms compared with their typically developing peers.ConclusionsMotor coordination, language and emotional–behavioral difficulties tend to co-occur in young children aged 3–6 years. These results highlight the need for early intervention.     

Co-occurring motor,language and emotional–behavioral problems in children 3–6 years of age

PurposeDevelopmental Coordination Disorder (DCD) has been shown to co-occur with behavioral and language problems in school-aged children, but little is known as to when these problems begin to emerge, or if they are inherent in children with DCD. The purpose of this study was to determine if deficits in language and emotional–behavioral problems are apparent in preschool-aged children with movement difficulties.MethodTwo hundred and fourteen children (mean age 4 years 11 months, SD 9.8 months, 103 male) performed the Movement Assessment Battery for Children 2nd Edition (MABC-2). Children falling at or below the 16th percentile were classified as being at risk for movement difficulties (MD risk). Auditory comprehension and expressive communication were examined using the Preschool Language Scales 4th Edition (PLS-4). Parent-reported emotional and behavioral problems were assessed using the Child Behavior Checklist (CBCL).ResultsPreschool children with diminished motor coordination (n = 37) were found to have lower language scores, higher externalizing behaviors in the form of increased aggression, as well as increased withdrawn and other behavior symptoms compared with their typically developing peers.ConclusionsMotor coordination, language and emotional–behavioral difficulties tend to co-occur in young children aged 3–6 years. These results highlight the need for early intervention.     

Exercise can improve physical self perceptions in adolescents with low motor competence

Adolescents with low motor competence have diminished perceptions of their physical self and tend to avoid physical activities. This study examined the outcomes of an exercise intervention that focused on improving aerobic fitness, strength, and self-perceptions in the physical domain in adolescents with poor motor coordination. The sample included 35 adolescents with low motor competence, comprising boys (n = 25) and girls (n = 10) ranging in age from 13 to 17 years, who attended two sessions per week in the 13 week exercise intervention study (AMP it up). Physical self-perceptions were measured before and after the intervention using the Physical Self Perception Profile and Perceived Importance Profile. Significant improvements in perceived Physical Condition, Attractive Body and Physical Strength sub domain scores were identified between pre and post-test. Adjusting for age, gender, BMI and attendance, regression analyses revealed that Attractive Body was the strongest predictor of Physical Self Worth at pre-test, joined by Physical Condition at post-test. This exercise intervention had a positive impact on adolescent physical self-perceptions, in particular males, with improvements in those sub domains specifically related to the exercise program. Changes in specific aspects of Physical Self Worth can be facilitated by exercise interventions, after a relatively short period of time, in adolescents with poor motor coordination.     

A crossover randomised and controlled trial of the impact of active video games on motor coordination and perceptions of physical ability in children at risk of Developmental Coordination Disorder

BackgroundImpaired motor development can significantly affect a child’s life and may result in an increased risk of a range of physical and psychological disorders. Active video game (AVG) interventions have been demonstrated to enhance motor skills in children with Developmental Coordination Disorder (DCD); however a home-based intervention has not been assessed.ObjectivesThe primary aim of this study was to compare the changes in motor coordination between a 16 week period of AVG use, with 16 weeks of normal activities (NAG). The secondary aim was to compare the child and parent perceptions of their physical performance between the AVG and NAG conditions.MethodsTwenty-one 9–12 year olds (10 males) were confirmed to be at risk of DCD (⩽16th percentile Movement Assessment Battery for Children-2nd edition (MABC-2) and ⩽15th percentile Developmental Coordination Disorder Questionnaire (DCDQ)) and participated in this crossover randomised and controlled trial. Data was collected at study entry, after the first 16 week condition and following the final 16 week condition, including; (1) the MABC-2, (2) three-dimensional motion analysis of single leg balance and finger–nose tasks, and (3) parent perception of physical skills. Participant perception of physical skills was collected only after the first and second conditions.ResultsThere was no significant difference between AVG and NAG for any of the primary variables including the MABC-2, balance centre-of-mass path distance and finger–nose path distance. There was no significant intervention effect for secondary measures of motor coordination; however the children perceived their motor skills to be significantly enhanced as a result of the AVG intervention in comparison to the period of no intervention.ConclusionA 16 week home based AVG intervention did not enhance motor skills in children with DCD, although they perceived their physical skills to be significantly improved.Trial Registration: Australia and New Zealand Clinical trials Registry (ACTRN 12611000400965).