Assessment Of Motor Performance Research Articles

Upper Limb Function as an Outcome Predictor in Acute Stroke

To the Editor: The article by the Early Prediction of functional Outcome after Stroke study (EPOS)1 investigators demonstrated how the active finger extension scale may be a strong predictor of recovery in patients with stroke. This finding has for a long time been considered a relevant item in daily clinical practice with the purpose of planning tailored rehabilitation programs.2,3 A diffused and useful tool for the assessment of distal limb motor function is the Canadian Neurological Scale.4,5 This scale is well known and validated among both neurological and physiatric settings with good interrater reliability.6,7 A multicentric study was …

Force sensing system for automated assessment of motor performance during fMRI

Finger tapping sequences are a commonly used measure of motor learning in functional imaging studies. Subjects repeat a defined sequence of finger taps as fast as possible for a set period of time. The number of sequences completed per unit time is the measure of performance. Assessment of speed and accuracy is generally accomplished by video recording the session then replaying in slow motion to assess rate and accuracy. This is a time consuming and error prone process. Keyboards and instrumented gloves have also been used for task assessment though they are relatively expensive and not usually compatible in a magnetic resonance imaging (MRI) scanner. To address these problems, we developed a low cost system using MRI compatible force sensitive resistors (FSR) to assess the performance during a finger sequence task. This system additionally provides information on finger coordination including time between sequences, intervals between taps, and tap duration. The method was validated by comparing the FSR system results with results obtained by video analysis during the same session.

The effect of footwear and sports-surface on dynamic neurological screening for sport-related concussion

The Sport Concussion Assessment Tool (SCAT) is a standardised global assessment for the identification of sport-related concussion (SRC). An integral component of the SCAT is the neurological screen, which contains the assessment of motor performance including gait evaluation. However, it is not known how performance of gait is affected by the surface/footwear interactions encountered in various sporting environments. The purpose of this study was to investigate the effect of footwear and sporting surface on the time to perform a standardised Tandem Gait (TG) task. One hundred and eight amateur athletes were recruited, and three common sports-surfaces (grass, hardwood court, artificial turf) were compared. All groups were tested barefoot and with sports-surface specific footwear. Mixed model ANOVA, controlling for covariates and including a post hoc Bonferroni procedure, was used to investigate the influence of footwear and sports-surface on TG time. The study demonstrated that times for a defined TG task in healthy athletes depended on footwear, sports-surface, and the specific athletic population. The study demonstrated a significant interaction ( F 2,104 = 3.35, p = 0.039) between groups (grass, hardwood court and artificial turf), and times were faster wearing footwear compared to barefoot ( F 2,138 = 26.31, p = 0.001). In contrast to the footwear conditions, there was no statistical difference between the barefoot conditions on any of the sport-surfaces. These findings suggest that clinicians should standardise footwear and the testing surface at baseline in order to accurately assess motor performance tests when SRC is suspected.

Assessment of global motor performance and gross and fine motor skills of infants attending day care centers

To analyze the global motor performance and the gross and fine motor skills of infants attending two public child care centers full-time. This was a longitudinal study that included 30 infants assessed at 12 and 17 months of age with the Motor Scale of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). This scale allows the analysis of global motor performance, fine and gross motor performance, and the discrepancy between them. The Wilcoxon test and Spearman's correlation coefficient were used. Most of the participants showed global motor performance within the normal range, but below the reference mean at 12 and 17 months, with 30% classified as having "suspected delays" in at least one of the assessments. Gross motor development was poorer than fine motor development at 12 and at 17 months of age, with great discrepancy between these two subtests in the second assessment. A clear individual variability was observed in fine motor skills, with weak linear correlation between the first and the second assessment of this subtest. A lower individual variability was found in the gross motor skills and global motor performance with positive moderate correlation between assessments. Considering both performance measurements obtained at 12 and 17 months of age, four infants were identified as having a "possible delay in motor development". The study showed the need for closer attention to the motor development of children who attend day care centers during the first 17 months of life, with special attention to gross motor skills (which are considered an integral part of the child's overall development) and to children with suspected delays in two consecutive assessments.

Force Sensing System for Automated Assessment of Motor Performance

Force Sensing System for Automated Assessment of Motor Performance

The first third-generation Alzheimer mouse, PLB1: Motor performance and anxiety assessment

The first third-generation Alzheimer mouse, PLB1: Motor performance and anxiety assessment

Deficits in motor co‐ordination and attention at 3 years of age predict motor deviations in 6.5‐year‐old children who needed neonatal intensive care

A total of 189 children without major impairments who needed neonatal intensive care (NIC) were followed up at ages 3 and 6.5 years. To determine the prevalence of different motor deviations at age 6.5 years and the co-occurrence of attention deficits; also, to analyse the predictive ability of motor co-ordination and attention assessments at age 3 years for motor deviations at 6.5 years. A combined assessment of motor performance and behaviour (CAMPB) was used at the 3-year examination. The Test of Motor Impairment (TOMI) and the Motor-Perceptual Development (MPU) were used together with the criteria of the diagnostic and statistical manual of mental disorders (DSM-IV-TR) to define motor deviations. At 6.5 years 64% of the children showed a motor deviation either as a delay according to MPU, a problem according to TOMI or Developmental Coordination Disorder (DCD) according to DSM-IV-TR. Higher proportions of children with attention deficit (50%) were found in the DCD group. The predictive ability of CAMPB was analysed in two ways: when all children with either a co-ordination or attention deficit, or both, at 3 years were considered to be at risk for motor deviations at 6.5 years, the sensitivity reached 78% and the specificity was 42%. But when only the 3 year olds with a combined deficit were considered to be at risk, the sensitivity was 37% and the specificity 89%; however, a positive predictive value of 86% was reached. At 6.5 years of age a majority of NIC children with no major impairments showed motor deviations. To fulfil the DCD criteria in DSM-IV-TR, a strict definition of motor deviations is recommended. Attention deficits are more prevalent among children with DCD. Deficits in motor co-ordination and/or attention in 3-year-old children are strong predictors of motor deviations and, especially, of DCD at 6.5 years of age.

Motor Assessment in Developmental Coordination Disorder: From Identification to Intervention

A description of Developmental Coordination Disorder (DCD) is included in the Diagnostic Manual of the American Psychiatric Association fourth edition (DSM‐IV‐TR). The major feature of this condition is impairment in motor skill, which has a negative impact on the performance of everyday life tasks. The present review outlines major issues concerning the assessment of motor performance in DCD. First, the psychometric principles of reliability and validity are considered, together with a discussion of test norms. This is followed by a review of 5 major purposes of assessment: screening and identification, measurement of motor performance, making a diagnosis, understanding the nature and mechanisms of the condition, and planning for intervention. In each case, the relevant assessment tools are identified and their application discussed. The article concludes with recommendations for future work, which include the need to refine the DCD diagnostic criteria in order to offer a more principled approach to the selection of assessment techniques.

Interrater Reliability of the Movement Assessment Battery for Children

The Movement Assessment Battery for Children (M-ABC) is a widely used, standardized assessment of motor performance in children. The total score obtained on this test often is used to identify children who are either definitely impaired or at risk for motor impairment. The purpose of this study was to determine the interrater reliability of data for the M-ABC when scored by pediatric physical therapists working in routine clinical settings. For 9 children who were referred to clinical settings for an assessment of possible movement difficulties, performance on the appropriate age band of the M-ABC was videotaped. The 9 children, one at each age from 4 through 12 years, represented all ages covered by the test. The videotaped performances were rated according to the test instructions by 131 pediatric physical therapists with a range of experience and by an expert rater who developed the Dutch version of the test. The average agreement between therapists in their classification of the children was very high. The kappa coefficients for the 9 videos ranged from .95 to 1.00. Errors made by the therapists could be classified as those that might be common to all tests and those that are specific to the M-ABC.

Partial depletion of dopamine in substantia nigra impairs motor performance without altering striatal dopamine neurotransmission

Previous data indicate that the release of somatodendritic dopamine in substantia nigra influences motor activity and coordination, but the relative importance of somatodendritic dopamine release vs. terminal striatal dopamine release remains to be determined. We utilized simultaneous measurement of dopamine neurotransmission by microdialysis and motor performance assessment by rotarod test to investigate the effects of local dopamine depletion in rats. The vesicular monoamine transporter inhibitor tetrabenazine (100 microm) was administered locally in substantia nigra as well as in striatum. Nigral tetrabenazine administration decreased nigral dopamine dialysate concentrations to 7% of baseline and whole-tissue dopamine content by 60%. Nigral dopamine depletion was associated with a reduction in motor performance to 73 +/- 6% of pretreatment value, but did not alter dialysate dopamine concentrations in the ipsilateral striatum. Striatal tetrabenazine administration decreased striatal dopamine dialysate concentrations to 5% of baseline and doubled the somatodendritic dopamine response to motor activity, but it was not associated with changes in motor performance or dopamine content in striatal tissue. Simultaneous treatment of substantia nigra and striatum reduced motor performance to 58 +/- 5% of the pretreatment value. The results of this study indicate that partial depletion of nigral dopamine stores can significantly impair motor functions, and that increased nigral dopamine release can counteract minor impairments of striatal dopamine transmission.

Are Models of Disability Useful in Real Cases? Pediatric Case Examples Realized in Research, Clinical Practice, and Education

Conceptual models are useful devices for organizing complex material and examining interrelationships among variables. For example, speakers at the 1990 II STEP Conference presented a systems model of motor control, the dynamical systems model as used in studying infant motor development, and the World Health Organization model as a systematic approach to the description of impairments, functional limitations, and disability. The purpose of this perspective is to provide examples of the usefulness of models of disability in organizing research, educational materials, and measurement in clinical practice. The disability model of the National Center for Medical Rehabilitation Research was used: (1) to design a measurement strategy for assessing effects of spasticity reduction in a child with cerebral palsy, (2) to develop a new assessment of functional motor performance in infants, and (3) as the conceptual framework for a comprehensive reference book for the practice of pediatric physical therapy (the current edition has been reformatted to conform to the International Classification of Function, Disability and Health). Similar models of the dimensions of disability have guided extensive development of tests designed by physical therapists for assessing function and quality of life in children with neurologic conditions.

Associations of motor co‐ordination and attention with motor‐perceptual development in 3‐year‐old preterm and full‐term children who needed neonatal intensive care

Children who have needed neonatal intensive care (NIC) are considered to be at risk for deficits such as developmental co-ordination disorder and attention-deficit/hyperactivity disorder. By assessing motor-perceptual development, motor co-ordination and attention already at 3 years of age, it might be possible to identify such deficits earlier than they are today. To investigate the motor-perceptual development in a group of 202 NIC children but had no major impairments, to describe associations of deficits in co-ordination and attention with motor-perceptual delays, and to estimate the prevalence of NIC children with combined deficits together with a motor-perceptual delay. Co-ordination and attention in children born very preterm (n = 57), moderately preterm (n = 75) and full-term (n = 70) were observed according to a model for Combined Assessment of Motor Performance and Behaviour while they were assessed using a developmental scale, Motor-Perceptual Development, 0-7 years, MPU. In two out of 14 MPU areas, a larger proportion of very preterm than of moderately preterm and full-term children had marked developmental delay. Overall, the proportion of NIC children having a motor-perceptual delay increased with increasing incoordination and especially increasing lack of attention. Twenty-one (11%) of the NIC children had different motor-perceptual delays combined with pronounced incoordination and pronounced lack of attention. Deficits in co-ordination and attention were associated with motor-perceptual delays in areas important for daily living and development of academic skills. Therefore, to find children at risk for developmental co-ordination disorder and attention-deficit/hyperactivity disorder, assessments of co-ordination and attention should be added to assessments of motor-perceptual development in 3-year-old NIC children.

Review of Three Tests of Motor Proficiency in Children

The present purpose is to provide clinicians, occupational and physical therapists, and educators with a comparative analysis of three tests of motor proficiency. The Bruininks-Oseretsky Test of Motor Proficiency, Movement Assessment Battery for Children, and Tufts Assessment of Motor Performance were developed to assess the motor skills of children with developmental delays. The selection criteria, interrater reliability, reproducibility, and recommended use of each test are reported here. Recommendations for use of each test include standardization of the sample population to ensure its appropriateness.

Reliability of concentric and eccentric torque during isokinetic knee extension in post-stroke hemiparesis

Emerging evidence on the velocity-dependent nature of force impairment in post-stroke hemiparesis has emphasized the complexity of strength and motor performance assessments in this clinical population. The need to establish reliability and responsiveness of muscle performance measures across a broad range of concentric and eccentric movement speeds is therefore clear, as these metrics will provide benchmarks both for making clinical inference and evaluating meaningful clinical change following interventions. Isokinetic knee extensor strength was tested at 14 angular velocities in 17 adults with chronic post-stroke hemiparesis (>18 months), and 13 non-disabled controls. Identical tests were conducted on two occasions separated by two days. Test-retest reliability of maximal isokinetic torque was evaluated using intraclass correlation. Absolute reliability was assessed using standard error of measurement from which smallest real differences were derived. Overall, intraclass correlation coefficients were excellent for both hemiparetic (0.891) and control (0.937) groups. Intraclass correlation coefficients for each criterion speed were also high for both groups (>0.86). Measurement error relative to the mean torque varied between 14.1% and 26.3% for hemiparetic subjects and 6.0-18.1% for controls. The smallest real difference relative to mean torque was 39.0-72.7% and 16.6-50.2% for hemiparetic and control subjects, respectively. Isokinetic knee extension torque can be measured reliably in persons with chronic post-stroke hemiparesis and in non-disabled controls across a full functional range of concentric and eccentric speeds. Established measurement error and smallest real differences will aid interpretation of longitudinal observations of muscle performance in this clinical population.

THE BRIEF ASSESSMENT OF MOTOR FUNCTION (BAMF): CONTENT VALIDITY AND RELIABILITY OF THE FINE MOTOR SCALE

Purpose/Hypothesis: The BAMF consists of 5 hierarchical 0-10 scales designed for rapid assessment of motor performance, independent of age. BAMF items are structured to reliably assess demonstrated motor capability, not impairment or disability. The Lower Extremity Scale has been validated and published. Content validity is completed for the two Oral Motor Scales: Articulation and Deglutition, their reliability trials are in progress. This abstract reports content validity and reliability determinations for the Fine Motor Scale (FMS). A companion abstract for this meeting reports content validity and reliability for the Upper Extremity Gross Motor Scale. Number of Subjects: 28 Occupational Therapists participated as Expert Panel Members to evaluate the content of the FMS. All have PhD, DSc or ScD degrees; 90% have more than 25 years of experience. For reliability, a convenience sample of ten children (ages 19 mo to 15 years; 3 males, 7 females) with a range of diagnoses including Proteus, Sheldon-Freeman, Smith-Lemli-Opitz, and Smith-Magenis syndromes, was selected to represent a broad range of skill levels. Materials/Methods: After agreeing to participate, Expert Panel members were sent a questionnaire via email composed of 6 standard questions for each of the 0-10 FMS items. Response range was 1 = Disagree to 4 = Agree. Completion of the questionnaire was necessary for inclusion on the Expert Panel. Respondents were invited, not required, to provide additional written comments on the questionnaire. Means, medians and ranges were used to describe central tendency and range of responses. For reliability, 3 occupational and 2 physical therapists rated the videotaped motor performances of 10 children whose FMS scores ranged from 0-10. The Kappa Statistic was used to evaluate reliability. Results: Expert panel members agreed that all items should be included (means 3.43–3.89, range 1–4, medians 4.00); all items are functionally relevant (means 2.93–3.82, ranges 1–4, medians 2.5–4), and all items are easily discriminated (means 3.32–4.0; ranges 1–4, medians 4.00). Eighty-six written comments were used to modify the content of the FMS in addition to the quantitative data. Kappa values for interrater and intrarater reliability were 0.978 and 1.00, respectively. Conclusions: Twenty-eight experts in occupational therapy provided quantitative and qualitative feedback to establish content validity of the BAMF FMS. Kappa values for interrater and intrarater reliability indicate this is a highly reliable instrument for baseline and screening purposes when rapid motor performance assessment is desired. Clinical Relevance: Motor skill assessments normed to nondisabled children are valuable for obtaining intervention services. However, children with motor limitations are only described by these scales according to their relative deficits, using numbers which do not indicate what the child can actually do. The BAMF FMS was designed for very rapid screening and longitudinal assessment of children's capability, in a format that links immediately to a specific fine motor level.

Nigral dopamine release – preclinical studies of its implication in motor functions

Since the discovery of nigral somatodendritic dopamine release thirty years ago, the physiological function and relevance of this phenomenon have been debated. Autoinhibitory functions, as well as modulation of GABA-ergic, glutamatergic and serotonergic transmission in substantia nigra (SN) pars reticulata have been described, but the physiological importance of these mechanism for motor functions has been difficult to determine. We have previously described a method for combining microdialysis dopamine measurements in SN and the striatum of awake rats with reverse dialysis of drugs during simultaneous motor performance assessments on an accelerating rod. To compare the importance of physiological nigral and striatal dopamine release, this method was used to induce a local pharmacological depletion of dopamine in SN or striatum by reverse dialysis of tetrabenazine (TBZ) in either or both of the regions. The extent of local depletion was evaluated by measuring dopamine in the dialysates ([DA]out)and by post mortem biochemistry of the dialysed regions. Local treatment with TBZ reduced [DA]out by over 90% in the treated region. Motor performance was, however, only significantly deteriorated by nigral or dual TBZ treatment. Furthermore, [DA]out was increased in SN during rotarod activity and striatal TBZ-treatment. Whereas striatal tissue content of dopamine was not affected by local TBZ treatment, nigral dopamine content was decreased by 50% by treatment in SN. For this reason it is not possible to justly compare the motor performance effects of nigral and striatal TBZ-treatment. Nevertheless, the results strengthen the idea that nigral dopamine release is physiologically important, and we suggest that it has a permissive role in basal ganglia output, which is important to consider when developing new treatments for movement disorders.

Ultraschallgestützte Analyse von Gang- und Handmotorik schizophrener Patienten

Neurological signs and disturbed psychomotor performance are consistently confirmed by clinical studies on schizophrenic patients. They could either be caused by the illness itself or could occur as side-effects of antipsychotic medication. Based on the clinical observation, differential diagnosis between catatonic symptoms of schizophrenia and extrapyramidal side-effects often remains unclear. Apart from their diagnostic value, motor disturbances can also be predictive parameters for prognosis of the disease and clinical response to antipsychotic treatment. Motor disturbances are mainly assessed by use of clinical ratings. In the last years, new approaches like infrared or ultrasonic movement analysis systems have been introduced to objectively determine motor disturbances in schizophrenic patients. Ultrasonic movement analysis systems calculate the three-dimensional positions of tiny markers, which are attached to moving body parts, with high spatial and temporal resolution. Thus, key parameters of gait and hand-movements can be determined exactly. Results of several studies using these new methods indicate that schizophrenia causes a primary disturbance of motor performance. Treatment with conventional antipsychotics intensifies many of the disabling motor deficiencies, whereas the influence of atypical antipsychotics on motor performance is either not detectable or much smaller. All in all, most results of studies using objective methods for the assessment of motor performance underline the advantages of treatment with atypical antipsychotics compared to conventional antipsychotics, particularly with regard to the patient's motor performance.

Constraint-induced movement therapy for recovery of upper-limb function following traumatic brain injury

A volunteer sample of 22 participants with chronic traumatic brain injury (TBI) (onset >1 year) and relative hemiplegia that revealed moderate disability in the more-affected upper limb (UL) participated. Constraint-induced (CI) movement therapy (CI therapy) was employed for a 2-week period; treatments included massed practice, shaping of the more-affected UL, behavioral contracts, and other behavioral techniques for affecting transfer to a real-world setting. We used the Wolf Motor Function Test, the Fugl-Meyer Motor Performance Assessment, and the Motor Activity Log to measure outcomes. All outcome measures improved significantly as a result of the intervention. More-adherent participants had more improvement compared with less-adherent participants. These preliminary results suggest that CI therapy may be effective for improving UL motor function following chronic TBI.

Quality of motor performance in preterm and full-term 3-year-old children.

A combined assessment of motor performance and behaviour (CAMPB) was introduced previously for use in a longitudinal study of children who needed neonatal intensive care (NIC) and were born very preterm (n = 68), moderately preterm (n = 81) and full-term (n = 77) and in a reference group of neonatally healthy full-term children (n = 72). Aim To follow up the quality of motor performance at 3 years of age in the above groups of children. A detailed assessment of motor performance and an assessment of co-ordination were performed according to the CAMPB protocol. The results were compared between the different groups of children, and the relation between the two ways of assessing quality of motor performance was examined. The detailed assessment showed that the very preterm children had a significantly higher total score of deviations than any of the other gestational age groups of children. Also, some types of deviations were much more frequently observed in the very preterm children than in the other three groups. Some types of deviations were more often seen in children with pronounced incoordination than in children with no incoordination. The results from the two ways of assessing motor performance were strongly correlated. At 3 years of age, NIC children born very preterm have a lower quality of motor performance than NIC children born at a higher gestational age and healthy children born at term. The two ways of assessing quality of motor performance proved useful in identifying children with deviations indicating minor motor impairments.

Assessment of Reactive Motor Performance with Event-Related Brain Potentials: Attention Processes in Elite Table Tennis Players

Motor readiness, visual attention, and reaction time (RT) were assessed in 15 elite table tennis players (TTP) and 15 controls (C) during Posner’s cued attention task. Lateralized readiness potentials (LRP) were derived from contingent negative variation (CNV) at Sites C3 and C4, elicited between presentation of directional cueing (S1) and the appearance of the imperative stimulus (S2), to assess preparation for hand movement while P1 and N1 component amplitudes were derived from occipital event-related potentials (ERPs) in response to S2 to assess visual attention. Both groups had faster RT to validly cued stimuli and slower RT to invalidly cued stimuli relative to the RT to neutral stimuli that were not preceded by directional cueing, but the groups did not differ in attention benefit or cost. However, TTP did have faster RT to all imperative stimuli; they maintained superior reactivity to S2 whether preceded by valid, invalid, or neutral warning cues. Although both groups generated LRP in response to the directional cues, TTP generated larger LRP to prepare the corresponding hand for movement to the side of the cued location. TTP also had an inverse cueing effect for N1 amplitude (i.e., amplitude of N1 to the invalid cue > amplitude of N1 to the valid cue) while C visually attended to the expected and unexpected locations equally. It appears that TTP preserve superior reactivity to stimuli of uncertain location by employing a compensatory strategy to prepare their motor response to an event associated with high probability, while simultaneously devoting more visual attention to an upcoming event of lower probability.