BACKGROUND: Approximately 5%-10% of elementary school children show delayed development of fine motor skills. To address these problems, detection is required. Current assessment tools are time-consuming, require a trained supervisor, and are not motivating for children. Sensor-augmented toys and machine learning have been presented as possible solutions to address this problem.OBJECTIVE: This study examines whether sensor-augmented toys can be used to assess children's fine motor skills. The objectives were to (1) predict the outcome of the fine motor skill part of the Movement Assessment Battery for Children Second Edition (fine MABC-2) and (2) study the influence of the classification model, game, type of data, and level of difficulty of the game on the prediction.METHODS: Children in elementary school (n=95, age 7.8 [SD 0.7] years) performed the fine MABC-2 and played 2 games with a sensor-augmented toy called "Futuro Cube." The game "roadrunner" focused on speed while the game "maze" focused on precision. Each game had several levels of difficulty. While playing, both sensor and game data were collected. Four supervised machine learning classifiers were trained with these data to predict the fine MABC-2 outcome: k-nearest neighbor (KNN), logistic regression (LR), decision tree (DT), and support vector machine (SVM). First, we compared the performances of the games and classifiers. Subsequently, we compared the levels of difficulty and types of data for the classifier and game that performed best on accuracy and F1 score. For all statistical tests, we used α=.05.RESULTS: The highest achieved mean accuracy (0.76) was achieved with the DT classifier that was trained on both sensor and game data obtained from playing the easiest and the hardest level of the roadrunner game. Significant differences in performance were found in the accuracy scores between data obtained from the roadrunner and maze games (DT, P=.03; KNN, P=.01; LR, P=.02; SVM, P=.04). No significant differences in performance were found in the accuracy scores between the best performing classifier and the other 3 classifiers for both the roadrunner game (DT vs KNN, P=.42; DT vs LR, P=.35; DT vs SVM, P=.08) and the maze game (DT vs KNN, P=.15; DT vs LR, P=.62; DT vs SVM, P=.26). The accuracy of only the best performing level of difficulty (combination of the easiest and hardest level) achieved with the DT classifier trained with sensor and game data obtained from the roadrunner game was significantly better than the combination of the easiest and middle level (P=.046).CONCLUSIONS: The results of our study show that sensor-augmented toys can efficiently predict the fine MABC-2 scores for children in elementary school. Selecting the game type (focusing on speed or precision) and data type (sensor or game data) is more important for determining the performance than selecting the machine learning classifier or level of difficulty.
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Motor learning is particularly challenging in neurological rehabilitation: patients who suffer from neurological diseases experience both physical limitations and difficulties of cognition and communication that affect and/or complicate the motor learning process. Therapists (e.g.,, physiotherapists and occupational therapists) who work in neurorehabilitation are therefore continuously searching for the best way to facilitate patients during these intensive learning processes. To support therapists in the application of motor learning, a framework was developed, integrating knowledge from the literature and the opinions and experiences of international experts. This article presents the framework, illustrated by cases from daily practice. The framework may assist therapists working in neurorehabilitation in making choices, implementing motor learning in routine practice, and supporting communication of knowledge and experiences about motor learning with colleagues and students. The article discusses the framework and offers suggestions and conditions given for its use in daily practice.
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Movement is an essential part of our lives. Throughout our lifetime, we acquire many different motor skills that are necessary to take care of ourselves (e.g., eating, dressing), to work (e.g., typing, using tools, care for others) and to pursue our hobbies (e.g., running, dancing, painting). However, as a consequence of aging, trauma or chronic disease, motor skills may deteriorate or become “lost”. Learning, relearning, and improving motor skills may then be essential to maintain or regain independence. There are many different ways in which the process of learning a motor skill can be shaped in practice. The conceptual basis for this thesis was the broad distinction between implicit and explicit forms of motor learning. Physiotherapists and occupational therapists are specialized to provide therapy that is tailored to facilitate the process of motor learning of patients with a wide range of pathologies. In addition to motor impairments, patients suffering from neurological disorders often also experience problems with cognition and communication. These problems may hinder the process of learning at a didactic level, and make motor learning especially challenging for those with neurological disorders. This thesis focused on the theory and application of motor learning during rehabilitation of patients with neurological disorders. The overall aim of this thesis was to provide therapists in neurological rehabilitation with knowledge and tools to support the justified and tailored use of motor learning in daily clinical practice. The thesis is divided into two parts. The aim of the first part (Chapters 2‐5) was to develop a theoretical basis to apply motor learning in clinical practice, using the implicit‐explicit distinction as a conceptual basis. Results of this first part were used to develop a framework for the application of motor learning within neurological rehabilitation (Chapter 6). Afterwards, in the second part, strategies identified in first part were tested for feasibility and potential effects in people with stroke (Chapters 7 and 8). Chapters 5-8 are non-final versions of an article published in final form in: Chapter 5: Kleynen M, Moser A, Haarsma FA, Beurskens AJ, Braun SM. Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study. Disabil Rehabil. 2017 Aug;39(17):1729-1737. doi: 10.1080/09638288.2016.1207111. Chapter 6: Kleynen M, Beurskens A, Olijve H, Kamphuis J, Braun S. Application of motor learning in neurorehabilitation: a framework for health-care professionals. Physiother Theory Pract. 2018 Jun 19:1-20. doi: 10.1080/09593985.2018.1483987 Chapter 7: Kleynen M, Wilson MR, Jie LJ, te Lintel Hekkert F, Goodwin VA, Braun SM. Exploring the utility of analogies in motor learning after stroke: a feasibility study. Int J Rehabil Res. 2014 Sep;37(3):277-80. doi: 10.1097/MRR.0000000000000058. Chapter 8: Kleynen M, Jie LJ, Theunissen K, Rasquin SM, Masters RS, Meijer K, Beurskens AJ, Braun SM. The immediate influence of implicit motor learning strategies on spatiotemporal gait parameters in stroke patients: a randomized within-subjects design. Clin Rehabil. 2019 Apr;33(4):619-630. doi: 10.1177/0269215518816359.
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Objective: Motor competence development from early to middle childhood is accompanied by great variance. This course can be influenced by many factors in the ecosystem. The objective of this study was to examine which individual characteristics are associated with an undesirable motor competence development during the transition from early to middle childhood. Methods: A longitudinal study was conducted between February 2020 and May 2022. Actual and perceived motor competence and the potential determinants physical activity enjoyment, weight status, and organized sports participation of children (49% boys) aged 4–6 years old at T0 (N = 721) were measured at two points in time, separated by a two-year interval. Associations between potential determinants and AMC, including interactions with time, were analyzed using linear mixed-effect regression models with continuous motor quotient scores as outcome variables. Results: Overweight, obesity, and lack of organized sports participation were associated with lower motor quotient scores over time. Multivariate analyses showed that associations of weight status (overweight and obesity) and sports participation with motor quotient scores remained significant after adjustment for variations in perceived motor competence and physical activity enjoyment. Conclusions: Excessive body weight and lack of sports participation from early childhood are associated with an increased risk of an undesirable motor competence development over time.
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Objectives: The development of children’s motor competence (MC) from early to middle childhood can follow different courses. The purpose of this longitudinal study was to describe and quantify the prevalence of patterns of MC development from early to middle childhood and to identify undesirable patterns. Design: The study used a longitudinal design. Data were collected in three consecutive years, between February 2020 (T0) and May 2022 (T2). Methods: A total of 1128 typically developing Dutch children (50.2% male) between 4 and 6 years old at baseline (M = 5.35 ± 0.69 years) participated in this study. MC was measured with the Athletic Skills Track and converted into Motor Quotient (MQ) scores. To convert all individual MQ scores into meaningful patterns of MC development, changes in MQ categories were analyzed between the different timepoints. Results: A total of 11 different developmental patterns were found. When grouping the different patterns, five undesirable patterns were found with 18.2% of the children, showing an undesirable pattern of MC development between T0 and T2. The patterns of motor development of the other children showed a normal or fluctuating course. Conclusions: There is a lot of variation in MC in early and middle childhood. A substantial percentage of young children showed undesirable MC developmental patterns emphasizing the need for early and targeted interventions.
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Background: Differential learning (DL) is a motor learning method characterized by high amounts of variability during practice and is claimed to provide the learner with a higher learning rate than other methods. However, some controversy surrounds DL theory, and to date, no overview exists that compares the effects of DL to other motor learning methods.Objective: To evaluate the effectiveness of DL in comparison to other motor learning methods in the acquisition and retention phase.Design: Systematic review and exploratory meta-analysis.Methods: PubMed (MEDLINE), Web of Science, and Google Scholar were searched until February 3, 2020. To be included, (1) studies had to be experiments where the DL group was compared to a control group engaged in a different motor learning method (lack of practice was not eligible), (2) studies had to describe the effects on one or more measures of performance in a skill or movement task, and (3) the study report had to be published as a full paper in a journal or as a book chapter.Results: Twenty-seven studies encompassing 31 experiments were included. Overall heterogeneity for the acquisition phase (post-pre; I2 = 77%) as well as for the retention phase (retention-pre; I2 = 79%) was large, and risk of bias was high. The meta-analysis showed an overall small effect size of 0.26 [0.10, 0.42] in the acquisition phase for participants in the DL group compared to other motor learning methods. In the retention phase, an overall medium effect size of 0.61 [0.30, 0.91] was observed for participants in the DL group compared to other motor learning methods.Discussion/Conclusion: Given the large amount of heterogeneity, limited number of studies, low sample sizes, low statistical power, possible publication bias, and high risk of bias in general, inferences about the effectiveness of DL would be premature. Even though DL shows potential to result in greater average improvements between pre- and post/retention test compared to non-variability-based motor learning methods, more high-quality research is needed before issuing such a statement. For robust comparisons on the relative effectiveness of DL to different variability-based motor learning methods, scarce and inconclusive evidence was found.
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This dissertation describes the dynamics of motor competence (MC) development from early childhood (EC) to middle childhood (MCD). Being motor competent in early childhood creates a window of opportunity for taking part in physical activities later in childhood and adulthood. However, there is a worrying trend in MC development during childhood. This trend shows that, last decades, children struggle more with executing fundamental movement skills (e.g., hopping, dribbling, balancing, throwing and catching) and that general motor fitness levels of children are decreasing. A delay in MC development during childhood has a negative impact on the general health status later in life. Therefore, it is important to support young children to develop their MC. The main research question of this dissertation was: How can motor competence be promoted as efficient and effective as possible in early childhood by sport professionals? Chapter 2 showed that MC development from early to middle childhood proceeds with variation. The majority of the children had a stable ‘normal’ or increasing ‘high’ development of MC over time. However, a concerning level of 18.2% of the young children showed an undesirable pattern (i.e., a negative course of motor development over time and a ‘low’ MQ score during the final measurement) of MC development as they grow older. Chapters 3 and 4 showed that characteristics of the social and physical home environment and direct living environment were associated with MC disparities during early childhood. Both parenting practices and parental PA-involved behaviours were relevant modifiable factors. For example, stronger parental active transportation routines and PA parental practices decreased the odds of a lower MC. Also, the presence of a home garden decreased the likelihood of children being classified as low motor competent. With regard to gender differences, girls showed lower levels of MC compared to boys. Special attention should also be paid to obese children as they experience less enjoyment of PA compared with normal weighted peers (chapter 3). Excessive body weight is also a risk factor associated with an undesirable MC development, just like lack of sports participation (chapter 5). Intervention strategies (chapter 6) incorporating all fundamental movement skills with a great variety of activities for at least 3 to 4 times a week seem to be most effective to stimulate MC development. Methodological and didactical aspects like deliberate practice and play should be implemented together with training and coaching sessions for sport professionals to increase the effectiveness of the interventions. With respect to the efficiency of promoting MC development, policy makers and sport professionals should pay more attention on early childhood and especially focus on those children at risk for a delay in MC development. So, overweighted children and children not participating in organized sports should be given more attention by sport professionals. Additionally, the effectiveness of MC interventions can be increased by making use of the home environment, childcare context and school context of young children. Sport professionals can act as connectors between parents, school, and sports clubs.
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Background: Current use of smartphone cameras by parents create opportunities for longitudinal home-video-assessments to monitor infant development. We developed and validated a home-video method for parents, enabling Pediatric Physical Therapists to assess infants’ gross motor development with the Alberta Infant Motor Scale (AIMS). The objective of the present study was to investigate the feasibility of this home-video method from the parents’ perspective. Methods: Parents of 59 typically developing infants (0–19 months) were recruited, 45 parents participated in the study. Information about dropout was collected. A sequential mixed methods design was used to examine feasibility, including questionnaires and semi-structured interviews. While the questionnaires inquired after the practical feasibility of the home-video method, the interviews also allowed parents to comment on their feelings and thoughts using the home-video method. Results: Of 45 participating parents, 34 parents returned both questionnaires and eight parents agreed to an interview. Parent reported effort by the infants was very low: the home-video method is perceived as similar to the normal routine of playing. The parental effort level was acceptable. The main constraint parents reported was time planning. Parents noted it was sometimes difficult to find the right moment to record the infant’s motor behavior, that is, when parents were both at home and their baby was in the appropriate state. Technical problems with the web portal, reported by 28% of the parents were also experienced as a constraint. Positive factors mentioned by parents were: the belief that the home videos are valuable for family use, receiving feedback from a professional, the moments of one-on-one attention and interaction with their babies. Moreover, the process of recording the home videos resulted in an increased parental awareness of, and insight into, the gross motor development of their infant. Conclusion: The AIMS home-video method is feasible for parents of typically developing children. Most constraints are of a practical nature that can be addressed in future applications. Future research is needed to show whether the home-video method is also applicable for parents with an infant at risk of motor development problems.
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This thesis focuses on topics such as preterm birth, variation in gross motor development, factors that influence (premature) infant gross motor development, and parental beliefs and practices. By gaining insight into these topics, this thesis aims to contribute to clinical decision-making of paediatric physiotherapists together with parents, and with that shape early intervention.
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Basic motor competencies (BMC) are a prerequisite for children to be physically active, participate in sports and thus develop a healthy, active lifestyle. The present study provides a broad screening of BMC and associations with age, sex, body mass index (BMI) and extracurricular physical activity (PA) in 10 different European countries. The different country and regional contexts within Europe will offer a novel view on already established BMC associations. The cross-sectional study was conducted in 11 regions in 10 European countries in 2018. The motor competence areas, object movement (OM) and self-movement (SM), were assessed using the MOBAK-1-2 test instrument in 3758 first and second graders (age: M = 6.86 ± 0.60 years; 50% girls) during Physical Education classes. Children were questioned about their extracurricular PA and age. Their body weight and height were measured in order to calculate BMI. Statistical analyses included variances and correlations. The results showed significant differences in BMC levels between countries (OM: F = 18.74, p < 0.001, η 2 = 0.048; SM: F = 73.10, p < 0.001, η 2 = 0.163) whereas associations between BMC and correlates were similar. Boys performed significantly better in OM while girls performed better in SM. Age was consistently positively related to OM and SM with older children reaching higher levels of BMC than younger ones. While participation rates for extracurricular PA differed widely, participation in ball sports was correlated with OM and SM. Participation in individual sports showed a significant association with SM. In summary, BMC levels of children seem to depend on where they live and are strongly related to their participation in extracurricular PA. Therefore, education and health policies, in order to enhance motor competence development and PA participation, are recommended. Further research on country-specific Physical Education frameworks and their influence on BMC will provide more insights into structural factors and cultural characteristics of BMC development. On a school level, support tools and educational materials for teachers about BMC may enable children to achieve a basic level of motor competencies through Physical Education, contributing to lifelong participation in PA.
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