http://hdl.handle.net/1956/942 Search the Channel search http://bora.uib.no/simple-search http://hdl.handle.net/1956/1936 Title: Children with developmental problems and disorders : selected aspects of motor and multidisciplinary assessment and intervention <br/> <br/>Authors: Iversen, Synnøve <br/> <br/>Abstract: The general aim of this thesis was to apply a multidisciplinary approach to selected clinical aspects of children with developmental problems and disorders, in order to contribute to the development of assessment and intervention strategies. Motor coordination difficulties were particularly focused. The following aspects were investigated in the separate studies: - Behaviour, cognitive, linguistic and motor skills were assessed in 6-year old children considered at risk with regard to inclusion in ordinary schooling due to behavioural and emotional difficulties. - Incidence, severity and types of motor coordination difficulties in 6-year-old children with behavioural and emotional difficulties were compared to age and gender matched controls. - Incidence, severity and types of motor coordination difficulties in a group of 10-12 year old children with dyslexia and a group consisting of teacher referred poor readers, were compared to a control group, which comprised teacher referred good readers. - A participatory multidisciplinary team approach was developed and implemented at school start at 27 schools in two regions in Norway in order to promote health and improve services for all children, but with a particular focus on children with developmental problems and disorders. - Mid-childhood effects of a high-intensity, task specific school-based intervention approach were compared with traditional municipal physiotherapy intervention for 6-year old children with motor coordination difficulties. The results from the evaluation of the 6-year-old children considered at risk with respect to ordinary school inclusion highlighted the importance of multidisciplinary assessment of young children with behavioural and emotional problems. While the most severe problems were found in social interaction and attention, the children also scored below average on cognitive and linguistic measures. Severe motor problems were found in more than half of the group. The following in-depth investigation of motor coordination difficulties revealed that 62.1 % in the high-risk group and 20.7 % in the control group showed borderline or definite motor coordination difficulties at or below the 15th centile when assessed with the Movement Assessment Battery for Children (M-ABC) (Henderson and Sugden, 1992). In the high-risk group 55.2 % fulfilled the criteria for developmental coordination disorder (DCD), compared to 3.4 % of the controls. The high-risk group showed a mixed profile, with significant difficulties within all sub-areas of the M-ABC. Investigation of motor profiles for children in the high-risk group with specific types of behavioural and emotional problems showed a significant relationship between attention problems and manual dexterity difficulties, and continuous, precise fine motor movements were particularly difficult. More than 50 % of the children with dyslexia as well as the group comprising teacher referred poor readers showed definite motor coordination difficulties at or below the 5th centile, compared to 13.6 % of the controls. Children in both groups performed significantly worse than controls within the sub-area of manual dexterity and balance, but not in ball-skills. Continuous precise fine motor movements stood out as particularly difficult for both groups of poor readers. The participatory multidisciplinary team approach implemented at school start was reported to improve multidisciplinary teamwork and professional relations. An increased focus on general developmental and health care issues was also reported, as well as improved health and educational services to vulnerable children, including children with developmental problems and disorders. Local creativity and ownership within supportive administrative structures were evaluated as promoting factors, while available time and professional resources from the supportive municipal services stood out as main constraints. The construction of learning partnerships based on face-to-face interaction appeared to be a particular strength of the approach. The evaluation of possible mid-childhood effects of two different types of intervention approaches applied at the age of six for children with motor coordination difficulties (DCD), revealed no significant differences with respect to total impairment and subscale scores at the MABC. At the levels of activity and participation the parents representing the high-intensity, task specific approach reported an overall more favourable situation. Their children were physically active, with frequent use of targeted motor skills learned during intervention. The majority of children from both groups displayed comorbid learning difficulties and attention deficits at follow-up, and the parents considered their children vulnerable and worried about future social functioning. The studies demonstrated that children with developmental problems and disorders represent a complex, variable and vulnerable group. Although some pure cases of developmental disorders were identified, the majority of children evaluated presented with concomitant difficulties, highlighting a need for coordinated municipal multidisciplinary health and educational services. http://hdl.handle.net/1956/1719 Title: Methodological considerations of clinical studies on low back pain <br/> <br/>Authors: Torstensen, Tom Arild http://hdl.handle.net/1956/1559 Title: Dysleksi og motorikk : en undersøkelse av motoriske vansker hos barn med dysleksi <br/> <br/>Authors: Berg, Karin <br/> <br/>Abstract: Movement competence plays an important role in a child’s development. Motor difficulties seem often to appear in parallel with dyslexia in children, according to both the literature and professionals working with these children. At the same time it has been pointed out that many dyslexic children have perfectly normal motor skills. The intention of this study was to examine what type of motor difficulties a group of dyslexic children had, and how many of these children exhibited these difficulties. Twenty children with dyslexia between the ages of 10 to 12 years were tested with Movement Assessment Battery for Children (MABC-test) and 9 separate tests. A comparison group, consisting of 28 children of ages 9 and 11 years, were assessed only on the 9 separate tests. The study is a pilot study of an exploratory type. The findings are discussed in terms of an information processing model and a dynamic system/pattern theory. In addition they are also compared to other research/studies of dyslexic children’s motor skills. The results showed that 60% of the children with dyslexia had clear motor difficulties according to MABC-test. The difficulties showed up primarily in the sub-tests for fine motor skills, especially the one concerned with hand-eye coordination. Several children had also problems with combined hand-hand coordination and hand-eye coordination. Both the sub-tests required a stable tracking ability of the eyes and a stable fine motor coordination. The hand-eye coordination sub-test also required continually finger movements. The dyslexic group had significantly greater problems than the comparison group in mastering the 9 separate tests judged with the Total score. The dyslexic group did not score significantly different from the comparison group of the separate tests judged separately. The biggest differences between the groups were on the tests requiring dynamic balance with mobility and anticipation/feed forward mechanisms. One of these tests, consisting of a combination of 3 different hopping sequences, showed close to significant differences between the groups. The children’s difficulties can be related to a possible deficit in underlying fast motor timing. Some researchers have suggested that children with dyslexia are showing a mild dysfunction in the cerebellum and/or in the magnocellular system. This study do not answer whether the motor difficulties, are related to such deficits or not, but the results do not contradict such an explanation. The study does not give an answer to whether the observed motor difficulties assessed, can be observed in the children’s everyday situations. A new study could concentrate on this area.; ; God motorisk kompetanse er av stor betydning for barns utvikling. Motoriske vansker synes ofte å opptre parallelt med dysleksi hos barn i følge både faglitteratur og fagfolk i praksisfeltet. Samtidig understrekes det av andre at mange barn med dysleksi har helt normal motorikk. Hensikten med denne studien var å undersøke hvilke typer motoriske vansker en gruppe barn med dysleksi hadde, og hvor stor andel av barna som hadde disse vanskene sammenlignet med jevnaldrende uten dysleksi. Tyve barn med dysleksi i alderen 10 til 12 år ble testet med Movement Assessment Battery for Children (MABC-test) og 9 Enkelttester. En sammenligningsgruppe på 28 barn, 9 og 11 år, ble testet kun med de 9 Enkelttestene. Undersøkelsen er en pilotundersøkelse av eksplorerende art. Funnene drøftes i forhold til en informasjons-prosesseringsmodell og dynamisk system/mønsterteori, og i forhold til andre forskningsundersøkelser av dyslektiske barns motoriske ferdigheter. Resultatene viste at 60% av barna med dysleksi hadde sikre motoriske vansker i følge norm for MABC-test. Vanskene viste seg først og fremst på det finmotoriske området, og spesifikt hadde alle, bortsett fra 1 barn, vansker med øye-håndkoordineringsoppgaven. Flere hadde også vansker med en kombinert hånd-håndkoordinerings- og øye-håndkoordineringsoppgave. Begge oppgavene stilte store krav til stabile følgebevegelser med øynene og presis og stabil finmotorikk. Oppgaven som flest hadde vansker med, krevde i tillegg kontinuerlige fingerbevegelser. Dysleksigruppen hadde signifikant større vansker enn sammenligningsgruppen med raskt å mestre utførelsen av de 9 Enkelttestene bedømt ut fra Totalskåre. Ingen av Enkelttestene vurdert hver for seg, ga signifikante forskjeller mellom gruppene. De største forskjellene mellom gruppene var på testene som innebar dynamisk balanse med forflytning og som stilte krav til rask antesipering eller feedforwardfunksjon. Den største, og nær signifikante forskjellen, var på en dynamisk balanseoppgave sammensatt av 3 ulike hoppesekvenser. Vanskene som framkom ved begge undersøkelsesinstrumenter, kan være forenlig med vansker med underliggende rask motorisk timing. Om vanskene kan knyttes til en svikt i cerebellumfunksjoner og i det magnocellulære systemet, som andre forskere har foreslått er tilstede hos barn med dysleksi, svarer ikke undersøkelsen på, men resultatene er ikke uforenlige med en slik tolkning. Undersøkelsen svarer ikke på om de motoriske vanskene som ble avslørt, gjenspeiler motoriske vansker i barnas hverdag. Nye undersøkelser bør derfor konsentreres om dette.