Proximal and distal movement patterns during a graphomotor task in typically developing children and children with handwriting problems

Background Therapists specializing in handwriting difficulties in children often address motor problems including both proximal and distal movements in the upper extremity. Kinematic measures can be used to investigate various aspects of handwriting. This study examined differences in movement patterns in proximal and distal joints of the upper extremity during graphomotor tasks between typically developing children with and without handwriting problems. Additionally, it explored relationships between movement patterns, speed, and legibility of writing. Methods Forty-one children, aged 7–11 years, were assessed with the Aleph Aleph Ktav Yad Hebrew Handwriting assessment and the Beery Test of Visual Motor Integration and, based on their scores, were divided into a research group (with handwriting difficulties) and a control group (without handwriting difficulties). Upper extremity joint movement patterns were analyzed with a motion capture system. Differences in the quality of shapes traced and copied on a graphics tablet positioned horizontally and vertically were compared. Between-group differences and relationships with speed and legibility were analyzed. Results In both groups, there was greater movement in the distal compared to the proximal joints, greater movement when performing the task in a horizontal compared to a vertical plane, and greater movement when tracing than copying. Joint movements in the arm executed scaled-down versions of the shapes being drawn. While the amount of joint displacement was similar between groups, children in the research group showed greater dissimilarity between the drawn shape and the shape produced by the proximal joints. Finally, the drawing measure on the tablet was a significant predictor of legibility, speed of writing, visual motor integration and motor coordination, whereas the dissimilarity measure of joint movement was a significant predictor of speed of writing and motor coordination. Conclusions This study provides support for the role of the distal upper extremity joints in the writing process and some guidance to assist clinicians in devising treatment strategies for movement-related handwriting problems. While we observed differences in proximal joint movements between the children with and without handwriting difficulties, the extent to which they are responsible for the differences in drawing quality remains to be determined. Further studies should use a similar methodology to examine additional tasks such as drawing shapes of varying sizes.

Effect of using adaptive seating equipment on grasping and visual motor integration in children with hemiparetic cerebral palsy: a randomized controlled trial

Background Adaptive seating is commonly used as an intervention method to enhance postural control. The aim of this study is to investigate the effect of using therapy ball as a seat alternative to using typical chair on grasping and visual motor integration in the children with hemiparetic cerebral palsy. For this aim, thirty children with hemiparetic cerebral palsy from both sexes were included in this study. The children ages ranged from 3 to 6 years old. The degree of spasticity was 1 to 1+ according to modified Ashworth scale. The children were able to sit independently and follow instructions. Children were randomly assigned into two groups (experimental group and control group). Each child was evaluated before and after 3 successive months of selected occupational therapy exercises program. All the children of both groups received the same selected occupational therapy exercises program, but the children in the experimental group performed the exercises while sitting on therapy ball, and the children in the control group performed the exercises while sitting on typical chair. Results There was a significant improvement in the measured variables for both groups after treatment. The post-treatment results of the two groups of grasping and visual motor integration for age equivalent scores revealed significant difference (p=0.008 and p=0.011 respectively) in favor of the experimental group. Conclusions Therapy ball could be used as a seat alternative to using typical chair to facilitate visual motor integration and grasping in the children with hemiparetic cerebral palsy.

Latent Profiles of Teacher-Reported Self-Regulation and Assessed Executive Function in Low-Income Community Preschools: Relations With Motor, Social, and School Readiness Outcomes

This study contributes to understandings of early childhood self-regulation and executive function, and their components, through taking a person-centered approach to investigating how these skills cluster together in children aged 4–5years. A sample of children (N=206) from preschools in low socioeconomic communities were assessed through teacher report of self-regulation and three executive function tasks at the commencement of the preschool year. Outcome variables included teacher report of social skills and behavioral problems, and children’s school readiness and visual motor integration skills were directly assessed. When the scores from this low-income sample were compared to available norms, over 70% of children scored below the 50th percentile in executive function measures, approximately 20% were below average in self-regulation skills, 48% were delayed in school readiness scores, 36% had above average levels of internalizing problems, and 25% were above average in externalizing problems. A series of four latent profile models each used different measurement approaches and combinations of self-regulation and executive function components. In three of the four models (two which combined self-regulation and executive function measures and one with teacher report of self-regulation only), a high skill and low skill profile were found with 31 to 42% of children in the low profile depending on the model. Children were very similarly classified across all three models. When three executive function scores were modeled alone, a more complex three-profile solution emerged (low, moderate, and high) with 52% in the low profile. Children identified in the low profiles across all models were at greater risk of poorer school readiness, visual motor integration and social skills, and increased behavioral problems. Taken together, the findings suggest that self-regulation and executive function skills tend to cluster together at this age and in this low-income sample. Composite scores of teacher report of self-regulation are somewhat sufficient in identifying children who also have poorer executive function skills and are at risk of poorer motor, social, and school readiness outcomes. These children are an important target group for additional supports prior to school entry.

THE EFFECT OF CO-OP APPROACH IN IMPROVING VISUAL MOTOR INTEGRATION SKILLS IN CHILDREN WITH LEARNING DISABILITY

The importance of visual perception, motor coordination and visual motor integration (VMI) skills for school achievements has been shown in various studies. Cognitive orientation to daily occupational performance or CO-OP is an evidence-based approach that has been effective in children with developmental coordination disorder and autism spectrum. The present study evaluated the effect of CO-OP approach in improving VMI skills in children with learning disability. Sample of 58 children were included in the study. National Centre for Learning Disabilities (NCLD) Checklist was used as a screen tool and pre and post intervention Beery VMI and Canadian Occupational Performance Measures (COPM) was used as outcome measures.Occupational therapy program using CO-OP approach, based on each childs individualized goals. children were thought global strategy of GO-PLAN-DO-CHECK the sessions were conducted for 12 weeks one hour a day three times a week. After 12 weeks post assessment was done using t test. There significant difference in pre and post CO-OP intervention. p-value was found to be less than 0.0001 for VMI, COPM performance and satisfaction whereas, there was significant difference in motor coordination and visual perception component of Beery VMI. The result shows that CO-OP approach is effective in improving visual motor integration skills of children with learning disability.

A-170 Socioeconomic Status as a Predictor of Fine Motor and Graphomotor Outcomes in Patients with Pediatric Brain Tumor

Objective As the field of neuropsychology strives to provide equitable care among diverse and disadvantaged populations, disparities in treatment and long-term outcomes continue to disproportionately impact individuals of lower socioeconomic status (SES). Motor deficits are common following pediatric brain tumor (PBT) diagnoses. However, while the relationship between SES and cognitive outcomes in this population is well documented, the role of SES in predicting more basic motor outcomes is not yet understood. This retrospective cross-sectional study was designed to determine the impact of SES on fine motor and graphomotor outcomes in PBT patients to ensure appropriate interventions and accommodations for those at higher risk. Method 225 patients with PBT (52.9% male; $ \overset{-}{\textrm{x}} $ age = 12 yrs; SD = 5.3 yrs) underwent neuropsychological evaluation, including assessment of graphomotor speed/coordination, visual-motor integration, and fine motor dexterity. Estimated median household income was used as a proxy for SES ($ \overset{-}{\textrm{x}} $=$71,543; SD = $23,480). Linear regression analyses were used to explore the role of SES in predicting motor outcomes. Results Lower SES predicted poorer graphomotor speed, F(1,96) = 5.205, p = 0.013, graphomotor coordination, F(1,60) = 3.890, p = 0.027, visual-motor integration, F(1,88) = 8.116, p = 0.003, and fine motor dexterity, F(1,166) = 3.755, p = 0.027. All analyses were significant even after implementing false discovery rates. Conclusions Consistent with lower SES predicting poorer cognitive late effects, SES also plays a role in motor-related outcomes of PBT. Unfortunately, lower SES is also associated with barriers in accessing formal evaluations and services required to mitigate such deficits. Therefore, patients with lower SES should be considered higher risk and receive interventions and accommodations even in the absence of formal assessment to prevent delays in care.

Development of visual-motor integration scale for the Korean old people

Effective methods to detect old people cognitive decline in early stages are needed in Korea, which is the fastest aging country in the world. This study aimed to develop a brief cognitive function measurement, Visual-Motor Integration Scale for the Korean elderly (VMIS-KE). In this methodological research, 16 preliminary items on visual-motor integration for the old people were chosen after literature review and expert validation. One hundred eighty participants aged 20-79 years were recruited to verify the validity and reliability of this measurement from community sources in Daegu city. The collected data were analyzed by exploratory factor analysis and confirmative factor analysis using SPSS and AMOS 18.0 program. The three factors (figure cognition, memory, and spatial cognition) with 12 items were finally extracted. Goodness of the fit was confirmed through confirmatory factor analysis. The Cronbach α was 0.867. The scores of overall VMIS-KE and every subcategory significantly decreased with age, especially in the 70s. VMIS-KE is the first valid and reliable measurement to assess cognitive decline of the Korean old people through visual motor integration, and can easily and quickly detect high-risk groups of dementia regardless of their educational level.

Use of Gardening Programs as an Intervention to Increase Children’s Visual-motor Integration

Visual-motor integration is influential in childhood development. Historical anecdotal evidence supports gardening as aiding in children’s development of fine and gross motor skills. The main objective of this study was to examine the effect of a school gardening program on children’s development of visual-motor integration. Preschool children ages 2 to 6 years old enrolled in private tuition-based schools were included in the sample. For 6 months, control group students studied using a traditional school curriculum whereas treatment group students participated in gardening as part of their lessons. The Beery-Buktenica visual-motor integration short-form instrument was used to quantitatively measure students’ levels of visual-motor integration. No significant differences were found in overall comparisons between the treatment and control group students. However, in demographic comparisons, significance was found; standardized scores for males in the treatment group improved whereas scores for males in the control group decreased. Results indicated that male preschoolers may respond especially well to gardening programs in the classroom in developing visual-motor integration.