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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Purpose: To evaluate the effects of a combination of wheelchair mobility skills (WMS) training and exercise training on physical activity (PA), WMS, confidence in wheelchair mobility, and physical fitness. Methods: Youth using a manual wheelchair (n = 60) participated in this practice-based intervention, with a waiting list period (16 weeks), exercise training (8 weeks), WMS training (8 weeks), and follow-up (16 weeks). Repeated measures included: PA (Activ8), WMS (Utrecht Pediatric Wheelchair Mobility Skills Test), confidence in wheelchair mobility (Wheelchair Mobility Confidence Scale), and physical fitness (cardiorespiratory fitness, (an)aerobic performance) and were analysed per outcome parameter using a multilevel model analyses. Differences between the waiting list and training period were determined with an unpaired sample t-test. Results: Multilevel model analysis showed significant positive effects for PA (p = 0.01), WMS (p < 0.001), confidence in wheelchair mobility (p < 0.001), aerobic (p < 0.001), and anaerobic performance (p < 0.001). Unpaired sample t-tests underscored these effects for PA (p < 0.01) and WMS (p < 0.001). There were no effects on cardiorespiratory fitness. The order of training (exercise before WMS) had a significant effect on confidence in wheelchair mobility. Conclusions: A combination of exercise and WMS training appears to have significant positive long-term effects on PA, WMS, confidence in wheelchair mobility, and (an)aerobic performance in youth using a manual wheelchair.Implications for rehabilitationExercise training and wheelchair mobility skills (WMS) training can lead to a sustained improvement in physical activity (PA) in youth using a manual wheelchair.These combined trainings can also lead to a sustained increase in WMS, confidence in wheelchair mobility, and (an)aerobic performance.More attention is needed in clinical practice and in research towards improving PA in youth using a manual wheelchair.
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Background: People with dementia have a yearly risk of falling of 60 to 80 percent. Therefore, a walker is often recommended. However, the use of a walker in people with dementia is associated with a threefold increased odds of falls compared to their healthy peers. Better advice and training could reduce fall risk. Therefore, a tool to assess functional walking skills with a walker is needed. The SUMAC was developed to fill this gap. So far, there is no Dutch instrument available that can assess functional walking skills with a walker in people with dementia. Methods: Reliability was evaluated by scoring videos of people with dementia (n = 9) using a walker performing the SUMAC-NL. ICC was used to assess inter-rater and test-retest reliability. An expert panel (n = 8) evaluated the content validity using the content validity index (CVI) and the content validity ratio (CVR). Results: Inter-rater reliability of the SUMAC-NL was statistically significant for the PF domain (ICC = 0.94, 95%CI (0.84, 0.98, p < 0.001) and for the EQ domain (ICC = 0.79, 95%CI (0.49 – 0.95), p < 0.001). Test-retest reliability was statistically significant for both the PF domain (ICC = 0.95, 95%CI (0.89, 0.99), p < 0.001) and EQ domain (ICC = 0.92, 95%CI (0.82, 0.98), p < 0.001). The SUMAC-NL shows content validity with a CVI >0.79 for both domains and a CVR of 0.53 on the PF domain and 0.78 on the EQ domain. Conclusions: The SUMAC-NL shows good to excellent reliability and content validity for both the PF and the EQ domain. The SUMAC-NL seems to be a promising tool to assess walking with a walker in people with dementia in the Netherlands.
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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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Aim The aim of this study is to gain more insight into child and environmental factors that influence gross motor development (GMD) of healthy infants from birth until reaching the milestone of independent walking, based on longitudinal research. Background A systematic search was conducted using Scopus, PsycINFO, MEDLINE and CINAHL to identify studies from inception to February 2020. Studies that investigated the association between child or environmental factors and infant GMD using longitudinal measurements of infant GMD were eligible. Two independent reviewers extracted key information and assessed risk of bias of the selected studies, using the Quality in Prognostic Studies tool (QUIPS). Strength of evidence (strong, moderate, limited, conflicting and no evidence) for the factors identified was described according to a previously established classification. Results In 36 studies, six children and 11 environmental factors were identified. Five studies were categorized as having low risk of bias. Strong evidence was found for the association between birthweight and GMD in healthy full-term and preterm infants. Moderate evidence was found for associations between gestational age and GMD, and sleeping position and GMD. There was conflicting evidence for associations between twinning and GMD, and breastfeeding and GMD. No evidence was found for an association between maternal postpartum depression and GMD. Evidence for the association of other factors with GMD was classified as ‘limited’ because each of these factors was examined in only one longitudinal study. Conclusion Infant GMD appears associated with two child factors (birthweight and gestational age) and one environmental factor (sleeping position). For the other factors identified in this review, insufficient evidence for an association with GMD was found. For those factors that were examined in only one longitudinal study, and are therefore classified as having limited evidence, more research would be needed to reach a conclusion.
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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: A significant part of neurological rehabilitation focuses on facilitating the learning of motor skills. Training can adopt either (more) explicit or (more) implicit forms of motor learning. Gait is one of the most practiced motor skills within rehabilitation in people after stroke because it is an important criterion for discharge and requirement for functioning at home. Objective: The aim of this study was to describe the design of a randomized controlled study assessing the effects of implicit motor learning compared with the explicit motor learning in gait rehabilitation of people suffering from stroke. Methods: The study adopts a randomized, controlled, single-blinded study design. People after stroke will be eligible for participation when they are in the chronic stage of recovery (>6 months after stroke), would like to improve walking performance, have a slow walking speed (<1 m/s), can communicate in Dutch, and complete a 3-stage command. People will be excluded if they cannot walk a minimum of 10 m or have other additional impairments that (severely) influence gait. Participants will receive 9 gait-training sessions over a 3-week period and will be randomly allocated to an implicit or explicit group. Therapists are aware of the intervention they provide, and the assessors are blind to the intervention participants receive. Outcome will be assessed at baseline (T0), directly after the intervention (T1), and after 1 month (T2). The primary outcome parameter is walking velocity. Walking performance will be assessed with the 10-meter walking test, Dynamic Gait Index, and while performing a secondary task (dual task). Self-reported measures are the Movement Specific Reinvestment Scale, verbal protocol, Stroke and Aphasia Quality of Life Scale, and the Global Perceived Effect scale. A process evaluation will take place to identify how the therapy was perceived and identify factors that may have influenced the effectiveness of the intervention. Repeated measures analyses will be conducted to determine significant and clinical relevant differences between groups and over time. Results: Data collection is currently ongoing and results are expected in 2019. Conclusions: The relevance of the study as well as the advantages and disadvantages of several aspects of the chosen design are discussed, for example, the personalized approach and choice of measurements.
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The main aim of this study was to determine the agreement in classification between the modified KörperKoordinations Test für Kinder (KTK3+) and the Athletic Skills Track (AST) for measuring fundamental movement skill levels (FMS) in 6- to 12-year old children. 3,107 Dutch children (of which 1,625 are girls) between 6 and 12 years of age (9.1 ± 1.8 years) were tested with the KTK3+ and the AST. The KTK3+ consists of three items from the KTK and the Faber hand-eye coordination test. Raw scores from each subtest were transformed into percentile scores based on all the data of each grade. The AST is an obstacle course consisting of 5 (grades 3 till 5, 6–9 years) or 7 (grades 6 till 8, 9–12 years) concatenated FMS that should be performed as quickly as possible. The outcome measure is the time needed to complete the track. A significant bivariate Pearson correlation coefficient of 0.51 was found between the percentile sum score of the KTK3+ and the time to complete the AST, indicating that both tests measure a similar construct to some extent. Based on their scores, children were classified into one of five categories: <5, 5–15, 16–85, 86–95 or >95%. Cross tabs revealed an agreement of 58.8% with a Kappa value of 0.15 between both tests. Less than 1% of the children were classified more than two categories higher or lower. The moderate correlation between the KTK3+ and the AST and the low classification agreement into five categories of FMS stress the importance to further investigate the test choice and the measurement properties (i.e., validity and reliability) of both tools. PE teachers needs to be aware of the context in which the test will be conducted, know which construct of motor competence they want to measure and know what the purpose of testing is (e.g., screening or monitoring). Based on these considerations, the most appropriate assessment tool can be chosen.
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The main aim of this study was to evaluate a new combination of test items on its practical use as a tool for determining the fundamental movement skills performance in 6- to 10-year old primary school children. This combination of tests should cover the different aspects of fundamental movement skills (i.e., locomotion, balance and object control), measure performance levels within the broad spectrum of this age range in both boys and girls and be able to detect the existing performance differences between ages. For this purpose, 1121 primary school children (6–10 years) were assessed during their regular PE class using three test items of the Korper Köordinations Test für Kinder (KTK-3), i.e., walking backwards (WB), moving sideways (MS), jumping sideways (JS), and an eye hand coordination test item (EHC). Univariate General Linear Model analyses were used to evaluate main and interaction effects of sex and age on the test outcomes. Pearson 's correlation coefficients were calculated to confirm the different constructs measured by the four test items. Moreover, in line with previous studies the raw scores were converted into movement quotients (i.e., MQKTK−3 and MQKTK−3+EHC) to classify the children 's performance level. Accordingly, percentage of agreement and Cohen 's kappa between both classifications was determined to gain insight in the influence of the addition of the EHC to the KTK-3. Significant effects for sex and age were found. Girls outperformed boys on WB and boys outperformed girls on EHC (P < 0.05). On all test items children of a certain age group scored better than their 1-year younger peers, except at WB between 10- and the 8- and 9-year olds and at MS and JS between 10-year olds and 9-year olds. Moderate positive associations between the test items were found (P < 0.05). An 80.8% agreement of classification of children was found based on the MQKTK−3 or the MQKTK−3+EHC [Cohen 's kappa 0.59 (P < 0.001)]. Consequently, The KTK-3+EHC appears to adequately cover different aspects of the fundamental movement skills. It provides practitioners a tool that can objectively assess the broad performance spectrum within young children in applied settings, which better meets children 's individual developmental needs. https://doi.org/10.3389/feduc.2018.00075
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The aim of this systematic review was to provide an overview of the effectiveness of fundamental movement skill interventions in young children (2–5 years) and to identify elements that determine the effectiveness of these interventions. A systematic literature search was conducted in four electronic databases (PubMed, Academic Search Complete, Education Resources Information Centre and SPORTDiscus). First, intervention-related data (e.g., intervention length, volume, focus, and content) were extracted. Next, the methodological quality and risk of bias of the selected studies were evaluated using a 10-item checklist. Sixteen studies (13 randomised controlled trials and 3 controlled trials) met the inclusion criteria of which 9 had a high methodological quality. Fourteen studies reported statistically significant intervention effects, ranging from small negative to very strong positive effects. Four studies executed a retention test of which two showed positive effects. Elements that influence the effectiveness are: incorporating all fundamental movement skills in the intervention with a variety of activities; combining deliberate practice and deliberate play; the intervention length; the intervention volume and; providing a training programme with coaching during the intervention for the professional involved in delivering the intervention. However more studies containing retention tests are needed.
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