Search Results (302)

Background and Objectives: Psychomotor developmental delay is a frequent comorbidity in children with congenital heart defects (CHD), especially after surgical correction of the CHD and exposure to risk factors such as anesthesia, cardiopulmonary bypass and postoperative complications. Yet psychomotor delay is present in these patients before surgical correction but is under-recognized. Evidence focusing solely on unrepaired CHD remains limited. Materials and Methods: This prospective cross-sectional study evaluated 153 and included 77 children under 6 years of age with unrepaired CHD, stratified into cyanotic (n = 31) and non-cyanotic (n = 46) CHD, admitted to a pediatric cardiology department over a period of 5 years. Psychomotor development was assessed using the Denver Developmental Screening Test II (DDST-II), standardized for pediatric population. Associations with clinical, perinatal, and demographic factors were analyzed using univariate and multivariate methods. Results: Developmental delay was identified in 97% of cyanotic and 54% of non-cyanotic patients. Compared to healthy norms, CHD patients had significantly lower global developmental scores (p = 0.03). Gross motor and personal-social domains were most frequently affected. Prenatal CHD diagnosis correlated with better global developmental scores (p = 0.012), and breastfeeding was associated with improved outcomes compared with formula or mixed feeding (p = 0.008). Conclusions: Infants and young children with CHD are at increased risk of early psychomotor developmental delay, particularly in the gross motor and personal–social domains, even before exposure to surgical or intensive care damaging factors. Systematic psychomotor surveillance, integration of protective factors such as prenatal diagnosis and breastfeeding, and timely access to multidisciplinary interventions are essential to optimize long-term outcomes in this vulnerable population. Full article

Background and Objectives: Evidence on motor performance in children with autism spectrum disorder (ASD) is scarce and inconsistent. The association of motor impairments with autism severity and intelligence remains insufficiently studied. We aimed to examine motor performance parameters in children with ASD compared with typically developing (TD) peers. Materials and Methods: In this cross-sectional study, a convenience sample of 26 children with ASD, aged 4–10 years, was recruited from specialized centers in KSA, alongside 27 age- and sex-matched TD children. For the ASD group, severity (Childhood Autism Rating Scale, CARS-2) and intelligence quotient (Stanford–Binet Intelligence Scale, SB5) were extracted from medical records. CARS-2 score was utilized to categorize children with ASD into two groups (mild-to-moderate and severe groups). All study children were assessed for gross and fine motor skills using the Movement Assessment Battery for Children-2 (MABC-2), balance, muscle strength, endurance, and flexibility. Results: ASD groups recorded significantly lower scores in all MABC-2 component areas when compared to the TD group (p < 0.001). Aiming and catching percentile was significantly lower in the severe ASD group compared to the mild-to-moderate group (p = 0.05). Furthermore, children with ASD exhibited increased hypermobility, predominantly at the elbow joints, reduced grip strength, shorter distance in the modified 6 min walk test, and lower standing long-jump performance (p < 0.001) when compared to TD group; however, no significant difference was recorded between the ASD groups. Spearman correlation revealed that aiming and catching was negatively correlated with autism severity (CARS-2) (r = −0.38, p = 0.05) and positively with IQ (r = 0.51, p = 0.03). Aiming and catching was positively correlated with grip strength (r = 0.55, p = 0.003), endurance (r = 0.58, p = 0.002), and jump distance (r = 0.44, p = 0.03), while balance was positively correlated with grip strength (r = 0.44, p = 0.02). Conclusions: Children with ASD exhibit significant impairments in gross and fine motor performance compared with TD peers, accompanied by hypermobility, reduced strength, and diminished endurance. Notably, aiming and catching ability correlated with both IQ and autism severity as well as specific motor parameters, suggesting its potential as a clinical marker of motor–cognitive interaction in ASD. Full article

Background/objectives: Communication difficulties are highly prevalent among children with cerebral palsy (CP) and have a significant impact on participation, psychosocial development, and quality of life. The Communication Function Classification System (CFCS) was developed to provide a standardized framework for describing functional communication performance across five ordinal levels. While the CFCS has been validated internationally, evidence on its psychometric properties in Italian pediatric populations remains limited. The objective of this study was to examine the inter-rater and intra-rater reliability of the Italian version of the CFCS and to explore construct validity through a single association with the Gross Motor Function Classification System Expanded and Revised (GMFCS E&R). Methods: A cross-sectional study was conducted with 66 children with CP (mean age 8.8 years, SD = 4.9) recruited from the Bambino Gesù Children’s Hospital in Rome. Two trained raters independently classified each child using the CFCS and GMFCS E&R, with CFCS reassessments performed after 14–20 days to evaluate intra-rater stability. Agreement was assessed using linear weighted Cohen’s Kappa (κᵂ) coefficients, and construct validity was analyzed using Spearman rho correlation (r) between CFCS and GMFCS E&R levels. Results: The CFCS demonstrated almost very good agreement for both inter-rater and intra-rater reliability, with κᵂ values exceeding 0.90. Construct validity was supported by a strong and statistically significant correlation with GMFCS E&R (r = 0.82, p < 0.01), indicating that greater motor impairment was associated with more severe communication limitations. Conclusions: The Italian version of the CFCS is a highly reliable classification system and shows evidence of construct validity based on a single convergent association in children with CP. These findings support its use for descriptive and classificatory purposes in clinical and research contexts, while further studies are needed to examine additional psychometric properties. Full article

Early identification of motor difficulties is essential in infancy and early childhood, and current American Academy of Pediatrics recommendations emphasize that motor surveillance should accompany routine clinical visits. One standardized tool widely used for evaluating motor development is the Peabody Developmental Motor Scales–Second Edition (PDMS-2). This review summarizes the theoretical foundations and psychometric properties of the PDMS-2, the principles of administering and scoring the assessment, and evidence from validation and standardization studies conducted in different countries. A non-systematic literature search was conducted in PubMed, Scopus, and Google Scholar (2000–February 2025) using the terms “PDMS-2” OR “Peabody Developmental Motor Scales Second Edition” combined with “reliability”, “validity”, “norms”, “reference”, or “standardization”. Original and review articles published in English were included without geographical restrictions. The PDMS-2 is widely applied in both clinical and research contexts. It has been used as an outcome measure in randomized controlled trials, interventional, and observational studies involving preterm infants, children with genetic syndromes, metabolic disorders, cerebral palsy, congenital heart defects, HIV, oncological conditions, and typically developing children. Key strengths of the PDMS-2 include its broad age range, the ability to assess both gross and fine motor skills, and its quantitative scoring system, which supports diagnosis, therapeutic planning, and monitoring of developmental change. Although the tool has been validated and standardized in multiple countries, additional work is still needed to establish normative data for underrepresented populations. Full article

Fundamental movement skills (FMS) and behavioral self-regulation (SR) are important for lifelong physical activity (PA). While physical literacy (PL) mediates child PA, its broader developmental impact in early childhood education (ECE) remains underexplored. The Active Start feasibility study examined a 10-week PL-based intervention’s effects on FMS (stationary, locomotion, object control), total motor competency and behavioral SR, as well as sex-based differences, among 3–5-year-olds in Somerville, Massachusetts childcare centers. Children (mean age = 3.8 years, 55% boys) were randomized by childcare center (two per condition) into intervention (n = 39) or control (n = 35) groups. Outcomes were measured at baseline and final using the Peabody Developmental Motor Scales for FMS and motor competency and the Head–Toes–Knees–Shoulders task for SR. Intervention effects were assessed using linear mixed-effects and zero-inflated mixed-effects hurdle models, with interactions examining sex-based differences in program effectiveness. Stationary skills had a net average improvement of 2.3 points in the intervention group compared to the control (p < 0.01). No significant treatment effects were observed for locomotor, object control, total motor competency or behavioral SR skills (p > 0.05). The treatment effects did not significantly differ by sex. PL-based ECE interventions may enhance stability skills in motor development, but further research in larger samples is needed to determine broader impacts on early childhood development. Full article

Stroke-induced motor impairment necessitates objective and quantitative assessment tools for rehabilitation planning. In this study, a gesture-specific framework based on high-density surface electromyography (HD-sEMG) was developed to characterize neuromuscular dysfunction using eight macroscopic features and two microscopic motor unit decomposition features. HD-sEMG recordings were collected from stroke patients (n = 11; affected and unaffected sides) and healthy controls (n = 8; dominant side) during seven standardized hand gestures. Feature-level comparisons revealed hierarchical abnormalities, with the affected side showing significantly reduced activation/coordination relative to healthy controls, while the unaffected side exhibited intermediate deviations. For each gesture, dedicated K-nearest neighbors (KNN) models were constructed for clinical validation. For Brunnstrom stage classification, wrist extension yielded the best performance, achieving 92.08% accuracy and effectively discriminating severe (Stage 4), moderate (Stage 5), and mild (Stage 6) impairment as well as healthy controls. For fine motor recovery prediction, the thumb–index–middle finger pinch provided the optimal regression performance, predicting Upper Extremity Fugl–Meyer Assessment (UE-FMA) scores with R = 0.86 and RMSE = 3.24. These results indicate that gesture selection should be aligned with the clinical endpoint: wrist extension is most informative for gross recovery staging, whereas pinch gestures better capture fine motor control. Overall, the proposed HD-sEMG framework provides an objective approach for monitoring post-stroke recovery and supporting personalized rehabilitation assessment. Full article

Background/Objectives: This study aimed to analyze the influence of sex, the presence of siblings, and the duration of exposure to technology on the development of gross and fine motor skills in children aged between 24 and 48 months, using the PDMS-2 battery as the assessment instrument. Methods: The sample comprised 193 children, distributed across three age groups: 24 months (N = 22), 36 months (N = 78), and 48 months (N = 93). The assessed skills included Postural Control, Locomotion, Object Manipulation, Fine Grasping, and Visual–Motor Integration, grouped into the domains of Gross Motor and Fine Motor development. Statistical analysis was conducted using the non-parametric Mann–Whitney and Kruskal–Wallis tests, complemented by the epsilon squared (ε²) effect size measure. Results: The results revealed statistically significant differences between sexes, with girls demonstrating superior performance in Fine Motor and Visual–Motor Integration tasks, particularly at 36 and 48 months (p < 0.05; ε² up to 0.22). The presence of siblings showed a positive impact only at 36 months, while the duration of exposure to technology did not present a significant association with motor performance at any age group. Conclusions: The Total Motor Quotient (TMQ) varied according to the variables analyzed, reinforcing the notion that motor development is multifactorial and sensitive to familial and social contexts. These findings highlight the importance of considering both environmental and biological factors when designing motor intervention strategies in early childhood. Full article

Objective: This systematic review examined whether siblings act as facilitators or barriers to children’s motor competence and physical fitness. Methods: Following PRISMA guidelines, systematic searches were conducted in four databases (Web of Science, Scopus, SPORTDiscus, and MEDLINE/PubMed) up to September 2025. Results: Seventeen studies (total n = 116,827) met eligibility criteria. Eleven studies were rated fair quality and the remainder poor. Twelve studies assessed motor competence, four assessed physical fitness, and one addressed both. Children with older siblings often showed better coordination and motor skills, whereas some evidence indicated earlier gross motor development in only children and no consistent differences in fine motor skills. The presence of younger siblings was associated with lower motor skill scores in infants, while older siblings were linked to higher scores. Across motor competence outcomes, the available evidence is concentrated in object control and fine/hand motor skills, with comparatively fewer data on locomotor and stability domains. Regarding physical fitness, siblings generally exerted a positive influence across several dimensions, but these findings are based on a small number of studies, and results for cardiorespiratory fitness are conflicting. Conclusions: Given the heterogeneity in ages and measurement tools, along with the predominance of methodological constraints, readers should interpret the findings with caution. In summary, the available evidence suggests that having siblings may be associated with higher motor competence and some aspects of physical fitness, yet the certainty of evidence is limited by heterogeneity (age ranges and measurement tools) and methodological constraints. Full article

Background/Objectives: The study aims to experiment with a teaching methodology based on the application of some principles of Nonlinear Pedagogy (NLP) in order to understand its effectiveness not only on motor development but also on attention and processing speed. Methods: A between-subjects quasi-experimental design involved 165 children (mean age = 7.21 ± 0.93 years), assigned to an experimental (n = 98; 45% Male and 55% Female) and control group (n = 67; 42% Male and 58% Female) over 16 weeks (32 sessions). The experimental group followed Physical Education (PE) lessons grounded on NLP principles, while control group followed traditional PE lessons. Divided attention and visual processing speed were assessed using the Witty SEM test with 2 difficulty levels, and the motor skills were assessed through Test of Gross Motor Development-3 and used as covariate. Results: Significant interactions emerged for Divided Attention (p = 0.014, d = 58 for level 1; p = 0.014, d = 42 for level 2). The visual processing speed also showed significant interaction (p < 0.001, d = 0.88 for level 1; p < 0.001, d = 1.11 for level 2). Conclusions: Findings from this preliminary study indicate a significant relationship between NLP-based teaching and improvements in attention and visual processing speed. The NLP intervention group outperformed the control group in both domains, supporting the effectiveness of this pedagogical approach within primary school PE settings. These promising results encourage further investigation with larger samples and over longer intervention periods. Full article

Background/Objectives: The Test of Gross Motor Development (TGMD-2) totals assume equal weighting of the 12 locomotor (LOC) and object control (OC) skills, yet validation studies indicate differential contributions. The study compared equal- and differential-weighted scores for LOC and OC skills, with three fitness and two physical activity (PA) outputs during guided active play (GAP). Methods: Children’s (n = 82; 7.6 ± 1.5 years) TGMD-2 LOC and OC differential factor weights were estimated with Exploratory Factor Analysis (EFA) and compared to equal weights with multiple linear regression (two, five, and eight predictors) and Chi-square analyses. Predictor variables included fitness, BMI, sex, age stages, and PA assessed by energy expenditure (PAEE) and intensity (MVPA) estimated using accelerometry during 1 h GAP. Results: EFA supported a two-factor structure (variance explained = 51.1%) with ≥0.500 loadings for 9/12 skills. Differential- and equal-weighted LOC and OC scores showed varied contributions from individual skills. Multiple linear regression analysis showed similar explained variances (R²) of 53% (PAEE), 40% (MVPA), 31% (OC), and 14% (LOC) for equal or differential scores with eight predictors. Although β coefficients varied, going from two, five, and eight predictors, the impact of equal and differential weights was comparable. Chi-square analysis indicated high OC associated with MVPA (X² (4) = 9.42, p ≤ 0.05), LP, and STR with PAEE. Conclusions: TGMD-2 outputs with equal- and differential-weighted scores are adequate for clinical/educational use, which show similar relationships with PA and HRF variables. Differential-weighted TGMD-2 scores comprise different contributions of movement skills and may hold promise for intervention studies focused on varied or target tasks and movement abilities. Full article

Background/Objectives: The developmental gymnastics (DG) exercise programme is a specialised form of gymnastics that focuses on the physical, cognitive, and motor development of individuals, particularly children. This 36-week study aimed to investigate the effect of DG on the gross motor skills (GMS) of preschoolers. Methods: This randomised controlled trial included 300 preschool children (5.1 ± 0.83 years), of whom 220 completed the 36-week programme (EG = 99, CG = 121). The children were randomly assigned to either an experimental group or a control group following standard physical activities. Attrition was mainly due to illness or attendance below 80%. Analyses were adjusted for age and BMI to control for confounding variables. Children in the CG participated in three organised extracurricular physical activities per week. In contrast, those in the EG engaged in 60 min of the designated exercise programme twice a week. We employed the Test of Gross Motor Development-2 (TGMD-2) to evaluate gross motor skills (GMS). Results: The mixed ANCOVA models revealed that EG showed greater improvement in all locomotor skills tests compared with the CG, with mean differences in TGMD-2 total scores of +3.28 points (p = 0.0002, partial η² = 0.24). Effect sizes ranged from small to large (partial η² = 0.05–0.19; Cohen’s d = 0.6–1.4), indicating meaningful practical improvements in gross motor competence. In the combined sample, both groups demonstrated similar improvements in all tests of object control skills. However, gender-specific differences were observed in the improvement of underhand roll, stationary dribble performance, and the total score of object control skills. Girls in the CG showed more improvement in underhand roll performance than girls in the EG. In contrast, boys in the EG demonstrated greater improvements in stationary dribble performance (4%) and the total score for object control skills (3%) compared to boys in the CG. Conclusions: The results of this study indicate that the nine-month DG programme was associated with significant improvements in GMS in preschool children. These findings highlight the value of structured gymnastics as a sustainable component of preschool curricula. Trial Registration Number: NCT06315036. Full article

This paper deals with the mechanical design and kinematic analysis of an autonomous wrist for space assembly (AWSA) whose actuators are activated by DC motors and ball screw drives. This robotic wrist was developed and built as a prototype to investigate in-space robotic operations, including maintaining and repairing spacecraft of the US National Aeronautics and Space Administration (NASA), such as the International Space Station (ISS) or satellites. Despite its disadvantages, such as a small workspace and low maneuverability, a parallel structure instead of a serial structure was selected for the design of the AWSA due to several advantages it has over a serial robot manipulator (SRM), including higher payload, greater stiffness, and better stability. The present paper also introduces a hybrid concept for robotic space operations, which combines an SRM performing gross motion and a parallel robot manipulator (PRM) performing fine motion. It then discusses the design and construction of the DC motor actuators and ball screw drives and presents the kinematic equations developed for the AWSA. This paper provides a closed-form solution to the inverse kinematics of the AWSA and a numerical solution using the Newton–Raphson method for its forward kinematics. Full article

The school-age period is a crucial time for the integrated development of cognitive and motor functions. Literature highlights that physical activity enhances executive functions, including visuospatial working memory (VSWM). In light of this evidence, this study investigated the effects of a school-based coordinative motor intervention on VSWM and gross motor skills in primary school children. An experimental research trial was conducted involving 184 children aged 9–10 years (mean age = 9.5 years, SD = 0.50 years), with 51.1% girls, divided into an experimental group (EG; n = 110), and a control group (CG; n = 74). Randomisation was performed at the class level via sealed envelope extraction by an independent researcher, ensuring allocation concealment. Outcome assessors were blinded to group assignment. VMWM was assessed using BVS-Corsi-2, and gross motor skills were evaluated via the TGMD-3. The EG showed significant improvements in VSWM (Corsi Forward: p < 0.001, d = 1.12; Corsi Backward: p < 0.001, d = 1.40) and gross motor skills, including Total Gross Motor: p < 0.001, d = 1.58, as well as in locomotion (p < 0.001, d = 2.11) and ball skills score (p < 0.001, d = 1.34). These findings strongly endorse incorporating cognitively demanding physical activities into standard school programmes to support children’s overall development and demonstrate the practicality of implementing such programmes within existing educational settings. Full article

Background: Cochlear implants (CIs) are transformative neuroprosthetics that restore speech perception for individuals with severe-to-profound hearing loss. However, temporal envelope cues are well-represented within the signal processing, while spectral envelope cues are poorly accessed by CI users, resulting in substantial deficits compared to normal-hearing individuals. This profoundly impairs the perception of complex auditory stimuli like music and vocal prosody, significantly impacting users’ quality of life, social engagement, and artistic expression. Methods: This narrative review synthesizes research on CI signal-processing limitations, perceptual and production challenges in music and singing, the role of the auditory–motor feedback loop, and strategies for improvement, including rehabilitation, technology, and the influence of neuroplasticity and sensitive developmental periods. Results: The degraded signal causes marked deficits in pitch, timbre, and vocal emotion perception. Critically, this impoverished input functionally breaks the high-fidelity auditory–motor feedback loop essential for vocal control, transforming it from a precise fine-tuner into a gross error detector sensitive only to massive pitch shifts (~6 semitones). This neurophysiological breakdown directly causes pervasive pitch inaccuracies and melodic distortion in singing. Despite these challenges, improvements are possible through advanced sound-processing strategies, targeted auditory–motor training that leverages neuroplasticity, and capitalizing on sensitive periods for auditory development. Conclusions: The standard CI signal creates a fundamental neurophysiological barrier to singing. Overcoming this requires a paradigm shift toward holistic, patient-centered care that moves beyond speech-centric goals. Integrating personalized, music-based rehabilitation with advanced CI programming is essential for improving vocal production, fostering musical engagement, and ultimately enhancing the overall quality of life for CI users. Full article

Background/Objectives: Children with cerebral palsy (CP) commonly present impairments in gross motor function and limitations in activities of daily living (ADLs), which negatively impact independence and quality of life. Identifying effective rehabilitation strategies is essential to promote functional development. To evaluate the effectiveness of occupational therapy (OT) interventions on gross motor function and independence in ADLs among children with CP. Methods: Seven electronic databases were searched through August 2025. The review protocol was registered in PROSPERO (CRD42025634706) and conducted in accordance with PRISMA guidelines. Methodological quality and certainty of evidence were assessed using the Oxford Centre for Evidence-Based Medicine scale, the Risk of Bias 2 (RoB 2) tool, and GRADEpro. Randomized controlled trials reporting OT interventions targeting gross motor and ADL outcomes were included. Results: Of 594 identified records, 14 studies met the inclusion criteria. Meta-analysis indicated that OT interventions significantly improved gross motor function (GMFM-66; ES = 0.32 [0.01–0.63], p = 0.04), mobility (PEDI-Mobility; ES = 0.46 [0.05–0.87], p = 0.02), and occupational performance (COPM-Performance; ES = 2.63 [1.14–4.11], p = 0.001) and satisfaction (COPM-Satisfaction; ES = 2.17 [0.82–3.51], p = 0.002). No significant changes were observed in self-care (PEDI-Self-Care; ES = 0.19 [−0.14–0.53], p = 0.26). Conclusions: Evidence suggests that OT interventions effectively enhance gross motor function, mobility, and occupational performance in children with CP. These results support the integration of OT within pediatric rehabilitation programs to optimize functional outcomes. Full article