Internal representation of movement in children with developmental coordination disorder : a mental rotation task

Recent studies show that children with developmental coordination disorder (DCD) have difficulties in generating an accurate visuospatial representation of an intended action, which are shown by deficits in motor imagery. This study sought to test this hypothesis further using a mental rotation paradigm. It was predicted that children with DCD would not conform to the typical pattern of responding when required to imagine movement of their limbs. Participants included 16 children with DCD and 18 control children; mean age for the DCD group was 10 years 4 months, and for controls 10 years. The task required children to judge the handedness of single-hand images that were presented at angles between 0° and 180° at 45° intervals in either direction. Results were broadly consistent with the hypothesis above. Responses of the control children conformed to the typical pattern of mental rotation: a moderate trade-off between response time and angle of rotation. The response pattern for the DCD group was less typical, with a small trade-off function. Response accuracy did not differ between groups. It was suggested that children with DCD, unlike controls, do not automatically enlist motor imagery when performing mental rotation, but rely on an alternative object-based strategy that preserves speed and accuracy. This occurs because these children manifest a reduced ability to make imagined transformations from an egocentric or first-person perspective.

Procedural learning in children with developmental coordination disorder

Despite the fact that developmental coordination disorder (DCD) is characterised by a deficit in the ability to learn or automate motor skills, few studies have examined motor learning over repeated trials. In this study we examined procedural learning in a group of 10 children with DCD (aged 8–12 years) and age-matched controls without DCD. The learning task was modelled on that of Nissen and Bullemer [Cognitive Psychology 19 (1987) 1]. Children performed a serial reaction time (SRT) task in which they were required to learn a spatial sequence that repeated itself every 10 trials. Children were not aware of the repetition. Spatial targets were four (horizontal) locations presented on a computer monitor. Children responded using four response keys with the same horizontal mapping as the stimulus. They were tested over five blocks of 100 trials each. The first four blocks presented the same repeating sequence, while the fifth block was randomised. Procedural learning was indexed by the slope of the regression of RT on blocks 1–4. Results showed that most children displayed strong procedural learning of the sequence, despite having no explicit knowledge about it. Overall, there was no group difference in the magnitude of learning over blocks of trials – most children performed within the normal range. Procedural learning for simple sequential movements appears to be intact in children with DCD. This suggests that cortico-striatal circuits that are strongly implicated in the sequencing of simple movements appear to be function normally in DCD.

Rules and resources: a structuration approach to understanding the coordination of childrens`s inpatient health care

Aim. This paper presents findings from a multi-method study exploring the process of care coordination in children's inpatient health care.

Background. Existing work on care coordination is typified by 'black-box' type studies that measure inputs to and outcomes of care coordination roles and practices, without addressing the process of coordination.

Method. Using questionnaires, interviews and observation to collect data in multiple sites in the United Kingdom and Denmark between 1999 and 2005, the study gathered the perceptions of staff and compared these with observed practice. Giddens' structuration theory was used to provide an analytical and explanatory framework.

Findings. Current care coordination practice is diverse and inconsistent. It involves a wide range of clinical and non-clinical staff, many of whom perceive a lack of clarity about who should perform specific coordination activities. Staff draw upon a wide range of different material and non-material resources in coordinating care, the use of which is governed by largely tacit and informal rules.

Conclusions. Care coordination can be usefully conceptualized as a 'structurated' process – one that is continually produced and reproduced by staff using rules and resources to 'instantiate' or bring about care coordination through action. Potentially negative implications of this are manifested in diversity and inconsistency in care coordination practice. However, positive aspects such as the opportunity this provides to tailor care to the needs of the individual patient can be realized.

Integration and coordination of care

The health care systems in Australia are under pressure from workforce shortages, increasing costs and an ageing population with a high prevalence of chronic disease. There is a well-established description of inequity in health outcomes among rural and remote populations. Most of the inequity appears to be due to poorer access to services than higher levels of health risk factors, such as cholesterol, blood pressure or obesity. Over the last 15 years, the science of improvement has led to quality improvement techniques, such as collaboratives, managed clinical networks and collaborative care, all of which have been tried successfully in Australia. Each of these offers ways to reduce the inequity in health outcomes attributed to rurality or remoteness.

Energetics of interlimb coordination

While the traditional dependent variables of motor skill learning are accuracy and consistency of movement outcome, there has been increasing interest in aspects of motor performance that are described as reflecting the ‘energetics’ of motor behaviour. One defining characteristic of skilled motor performance is the ability to complete the task with minimum energy expenditure (Sparrow & Newell, 1998). A further consideration is that movements also have costs in terms of cognitive ‘effort’ or ‘energy’. The present project extends previous work on energy expenditure and motor skill learning within a coordination dynamics framework. From the dynamic pattern perspective, a coordination pattern lowest on the 11KB model potential curve (Haken, Kelso & Bunz, 1985) is more stable and least energy is required to maintain pattern stability (Temprado, Zanone, Monno & Laurent, 1999). Two experiments investigated the learning of stable and unstable coordination patterns with high metabolic energy demand. An experimental task was devised by positioning two cycle ergometers side-by-side, placing one foot on each, with the pedals free to move independently at any metronome-paced relative phase, Experiment 1 investigated practice-related changes to oxygen consumption, heart rate, relative phase, reaction time and muscle activation (EMG) as participants practiced anti-phase, in-phase and 90°-phase cycling. Across six practice trials metabolic energy cost reduced and AE and VE of relative phase declined. The trend in the metabolic and reaction time data and percent co-contraction of muscles was for the in-phase cycling to demonstrate the highest values, anti-phase the lowest and 90°-phase cycling in-between. It was found that anti- and in-phase cycling were both kinematically stable but anti-phase coordination revealed significantly lower metabolic energy cost. It was, therefore, postulated that of two equally stable coordination patterns, that associated with lower metabolic energy expenditure would constitute a stronger attractor. Experiment 2 was designed to determine whether a lower or higher energy-demanding coordination pattern was a stronger attractor by scanning the attractor layout at thirty-degree intervals from 0° to 330°. The initial attractor layout revealed that in-phase was most stable and accurate, but the remaining coordination patterns were attracted to the low energy cost anti-phase cycling. In Experiment 2 only 90°- phase cycling was practiced with a post-test attractor layout scan revealing that 90°-phase and its symmetrical partner 270°-phase had become attractors of other coordination patterns. Consistent with Experiment 1, practicing 90°-phase cycling revealed a decline in AE and VE and a reduction in metabolic and cognitive cost. Practicing 90°-phase cycling did not, however, destabilise the in-phase or anti-phase coordination patterns either kinematically or energetically. In summary, the findings suggest that metabolic and mental energy can be considered different representations of a ‘global’ energy expenditure or ‘energetic’ phenomenon underlying human coordination. The hypothesis that preferred coordination patterns emerge as stable, low-energy solutions to the problem of inter-and intra-limb coordination is supported here in showing that the low-energy minimum of coordination dynamics is also an energetic minimum.

Assessment of movement participation for children with developmental coordination disorders

The Caregiver Assessment of Movement Participation was developed to identify children of 5-10 years old for movement participation difficulties in home contexts. Its psychometric properties were investigated including its usefulness as a screening instrument using both classical test theory methods and Rasch analysis. Results confirmed its validity and reliability.

Improving the coordination of care for low back pain patients by creating better links between acute and community services

This paper reports on the development of a care-pathway to improve service linkages between the acute setting and community health services in the treatment of low back pain. The pathway was informed by two processes: (1) a literature review based on best-practice guidelines in the assessment, treatment and continuity of care for low back pain patients; and (2) consultation with staff and key stakeholders. Stakeholders from both the acute and community sectors comprised the Working Group, who identified central areas of concern to be addressed in the care-pathway, with the goal of preventing chronicity of low back pain and reducing emergency department presentations. The main outcomes achieved include: the development of a new care-coordinator role, which would support a greater focus on integration between acute and community sectors for low back pain patients; identifying the need to screen at-risk patients; implementation of the SCTT (Service Coordination Tool Templates) tool as a system of referral across the acute and community settings; and agreement on the need to develop an evidence-based self-management program to be offered to low back pain patients. The benefits and challenges of implementing this care pathway are discussed.

Effective coordination of vertical IS standardisation initiatives

This paper investigates vertical IS standardisation initiatives from an Actor Network Theory (ANT) perspective. It describes the standardisation process as a series of translations of interests. The ANT lens provides an insight into how participating organisations attempt to align the interests of other organisations. The contributions of this paper are: (i) a deeper understanding of the vertical IS standardisation process; (ii) actions participating organisations can take to effectively coordinate vertical IS standardisation initiatives.

Screening children with developmental coordination disorder : the development of the caregiver assessment of movement participation

This study investigated the psychometric properties of the Caregiver Assessment of Movement Participation (CAMP), which was developed to measure and identify children with movement participation problems in home contexts. The test-retest reliability, as well as the concurrent and contrast-group validity of the 35-item parent-proxy CAMP, was examined on 312 children aged 5 to 8 years using intraclass correlation, factor analysis, and the Rasch model. Initial findings on the CAMP appeared to support its validity. Testing on other properties from a practical perspective, such as finding the best rating scale structure and cutpoints, are recommended before using the instrument for child health surveillance screening.

Psychometric properties of the caregiver assessment of movement participation scale for screening children with development coordination disorders

Using Rasch analysis, the psychometric properties of a newly developed 35-item parent-proxy instrument, the Caregiver Assessment of Movement Participation (CAMP), designed to measure movement participation problems in children with Developmental Coordination Disorder, were examined. The CAMP was administered to 465 school children aged 5–10 years. Thirty of the 35 items were retained as they had acceptable infit and outfit statistics. Item separation (7.48) and child separation (3.16) were good; moreover, the CAMP had excellent reliability (Reliability Index for item = 0.98; Person = 0.91). Principal components analysis of item residuals confirmed the unidimensionality of the instrument. Based on category probability statistics, the original five-point scale was collapsed into a four-point scale. The item threshold calibration of the CAMP with the Movement Assessment Battery for Children Test was computed. The results indicated that a CAMP total score of 75 is the optimal cut-off point for identifying children at risk of movement problems.