Starting with finger foods is recommended from 7 months in typically developing children. However, information on which finger foods are appropriate and accepted for which age is largely lacking. The purpose of this exploratory study was to determine whether chewing skills, hand motor skills, and other personal and food characteristics influence the intake of finger foods in early life. Thirty children aged 12 to 18 months participated in this study. All children were offered four finger foods in a fixed order on four consecutive days at their home. Two finger foods varied mainly in texture (fresh banana vs. freeze-dried banana) and two other finger foods mainly in shape (stick vs. heart shaped cracker). The intake was measured after ten minutes of exposure to the product. Chewing skills were measured with the Mastication Observation and Evaluation instrument and fine motor skills with selected items of the Bayley-III-NL scales. The results suggest that texture but not shape was found to affect intake, as fresh banana was eaten more than freeze-dried banana and the consumed quantity of the two crackers was not significantly different. Hand motor skills affected the intake of fresh banana only and chewing skills did not affect intake of any of the finger foods. Age and experience with chewable foods were associated with an increased intake of some of the finger foods. In conclusion, the intake of the four finger foods in this study was found to be mainly affected by texture, hand motor skills, age and experience.
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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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Smart tangible toys, designed for hand manipulation, can transform fine motor skills assessment into enjoyable activities which are engaging for children to play (partially) unsupervised. Such toys can support school teachers and parents for early detection of deficiencies in motor skills development of children, as well as objectively monitor the progress of skills development over time. To make a game enjoyable for children with different skills level, these smart toys could offer an adaptive game play. In this paper we describe the design and deployment of a digital board game, equipped with sensors, which we use to explore the potential of using smart toys for fine motor skills assessment in children.
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The purpose of this study was to examine the feasibility and validity of an Athletic Skills Track (AST) to assess fundamental movement skills among 6- to 12-year-old children in a physical education setting. 463 Dutch children (211 girls, 252 boys) completed three tests: the Körperkoordination-Test für Kinder (KTK) and two Athletic Skills Tracks (AST-1, AST-2). The validity of AST-1 and AST-2 was examined by correlating the time (sec) needed to complete the tracks and the KTK Motor Quotient (KTK MQ). Overall, there was a small correlation between AST-1 and the KTK MQ (r = - 0.474 (p = 0.01)) and a medium correlation between AST-2 and the KTK MQ (r = - 0.502 (p = 0.01)). When split up by age group the associations between the Athletic Skills Tracks and the KTK MQ were large for 12-year old children (AST-1: r = - 0.767; AST-2: r = - 0.727) and smallest for 8-year olds with a medium association (AST-1: r = - 0.501; AST-2: r = - 0.469). The results suggest that children’s motor skills can be assessed with a quick, convenient, and low-cost motor competence test in a physical education setting, i.e. an Athletic Skills Track. This is an Accepted Manuscript of an article published by Taylor & Francis in "Journal of Sports Sciences" on 3 March 2016, available online: https://doi.org/10.1080/02640414.2016.1151920
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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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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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Objective. Clinicians may use implicit or explicit motor learning approaches to facilitatemotor learning of patients with stroke. Implicit motor learning approaches have shown promising results in healthy populations. The purpose of this study was to assess whether an implicit motor learning walking intervention is more effective compared with an explicit motor learning walking intervention delivered at home regarding walking speed in people after stroke in the chronic phase of recovery. Methods. This randomized, controlled, single-blind trial was conducted in the home environment. The 79 participants, who were in the chronic phase after stroke (age = 66.4 [SD = 11.0] years; time poststroke = 70.1 [SD = 64.3] months; walking speed = 0.7 [SD = 0.3] m/s; Berg Balance Scale score = 44.5 [SD = 9.5]), were randomly assigned to an implicit (n = 38) or explicit (n = 41) group. Analogy learning was used as the implicit motor learning walking intervention, whereas the explicit motor learning walking intervention consisted of detailed verbal instructions. Both groups received 9 training sessions (30 minutes each), for a period of 3 weeks, targeted at improving quality of walking. The primary outcome was walking speed measured by the 10-MeterWalk Test at a comfortable walking pace. Outcomes were assessed at baseline, immediately after intervention, and 1 month postintervention. Results. No statistically or clinically relevant differences between groups were obtained postintervention (between-group difference was estimated at 0.02 m/s [95% CI = −0.04 to 0.08] and at follow-up (between-group difference estimated at −0.02 m/s [95% CI = −0.09 to 0.05]). Conclusion. Implicit motor learning was not superior to explicit motor learning to improve walking speed in people after stroke in the chronic phase of recovery. Impact. To our knowledge, this is the first study to examine the effects of implicit compared with explicit motor learning on a functional task in people after stroke. Results indicate that physical therapists can use (tailored) implicit and explicit motor learning strategies to improve walking speed in people after stroke who are in the chronic phase of recovery.
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There is a wide range of literature suggesting that implicit learning is more effective than explicit learning when acquiring motor skills. However, the acquisition of nursing skills in educational settings continues to rely heavily on detailed protocols and explicit instructions. This study aimed to examine the necessity for comprehensive protocols in the acquisition of nursing skills. In the context of bandaging techniques, three studies were conducted to investigate whether students who practiced with an instruction card containing minimal instructions (implicit group) performed comparably to the students who practiced with a protocol containing step-by-step instructions (explicit group). Study 1 was designed to determine whether both groups performed equally well in applying a bandage during training. Study 2 and 3 were designed to determine if both groups performed equally well during a retention and transfer (multitasking) test, administered after a series of three training sessions. In comparison with the explicit group, the implicit group demonstrated comparable performance with their practice attempts in Study 1 and performed equally well during the retention and transfer test in Study 2. Furthermore, several results from Study 3 indicated better performance of the implicit group. In conclusion, the use of protocols with explicit step-by-step instructions may not be essential for the acquisition of nursing skills. Instead, instructional methods that facilitate implicit learning may be preferable, as students in the implicit group demonstrated at least comparable performance in all studies and tended towards greater consistency when multitasking.
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Background: Motor learning is central to domains such as sports and rehabilitation; however, often terminologies are insufficiently uniform to allow effective sharing of experience or translation of knowledge. A study using a Delphi technique was conducted to ascertain level of agreement between experts from different motor learning domains (i.e., therapists, coaches, researchers) with respect to definitions and descriptions of a fundamental conceptual distinction within motor learning, namely implicit and explicit motor learning. Methods: A Delphi technique was embedded in multiple rounds of a survey designed to collect and aggregate informed opinions of 49 international respondents with expertise related to motor learning. The survey was administered via an online survey program and accompanied by feedback after each round. Consensus was considered to be reached if $70% of the experts agreed on a topic. Results: Consensus was reached with respect to definitions of implicit and explicit motor learning, and seven common primary intervention strategies were identified in the context of implicit and explicit motor learning. Consensus was not reached with respect to whether the strategies promote implicit or explicit forms of learning. Discussion: The definitions and descriptions agreed upon may aid translation and transfer of knowledge between domains in the field of motor learning. Empirical and clinical research is required to confirm the accuracy of the definitions and to explore the feasibility of the strategies that were identified in research, everyday practice and education.
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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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