Developmental coordination disorder: a focus on handwriting

Background. Developmental coordination disorder (DCD), is the term used to refer to children who present with motor coordination difficulties, unexplained by a general-medical condition, intellectual disability or known neurological impairment. Difficulties with handwriting are often included in descriptions of DCD, including that provided in DSM-5 (APA, 2013). However, surprisingly few studies have examined handwriting in DCD in a systematic way. Those that are available, have been conducted outside of the UK, in alphabets other than the Latin based alphabet. In order to gain a better understanding of the nature of 'slowness' so commonly reported in children with DCD, this thesis aimed to examine the handwriting of children with DCD in detail by considering the handwriting product, the process, the child's perspective, the teacher's perspective and some popular clinical measures including strength, visual perception and force variability. Compositional quality was also evaluated to examine the impact of poor handwriting on the wider task of writing. Method. Twenty-eight 8-14 year-old children with a diagnosis of DCD participated in the study, with 28 typically developing age and gender matched controls. Participants completed the four handwriting tasks from the Detailed Assessment of Speed of Handwriting (DASH) and wrote their own name; all on a digitising writing tablet. The number of words written, speed of pen movements and the time spent pausing during the tasks were calculated. Participants were also assessed in spelling, reading, receptive vocabulary, visual perception, visual motor integration, grip strength and the quality of their composition. Results. The findings confirmed what many professionals report, that children with DCD produce less text than their peers. However, this was not due to slow movement execution, but rather a higher percentage of time spent pausing, in particular, pauses over 10 seconds. The location of the pauses within words indicated a lack of automaticity in the handwriting of children with DCD. The DCD group scored below their peers on legibility, grip strength, measures of visual perception and had poorer compositional quality. Individual data highlighted heterogeneous performance profiles in children with DCD and there was little agreement/no significant association between teacher and therapist's measures of handwriting. Conclusions. A new model incorporating handwriting within the broader context of writing was proposed as a lens through which therapists can consider handwriting in children with DCD. The model incorporates the findings from this thesis and discusses avenues for future research in this area

An examination of writing pauses in the handwriting of children with Developmental Coordination Disorder.

This article has been made available through the Brunel Open Access Publishing Fund.Difficulties with handwriting are reported as one of the main reasons for the referral of children with Developmental Coordination Disorder (DCD) to healthcare professionals. In a recent study we found that children with DCD produced less text than their typically developing (TD) peers and paused for 60% of a free-writing task. However, little is known about the nature of the pausing; whether they are long pauses possibly due to higher level processes of text generation or fatigue, or shorter pauses related to the movements between letters. This gap in the knowledge-base creates barriers to understanding the handwriting difficulties in children with DCD. The aim of this study was to characterise the pauses observed in the handwriting of English children with and without DCD. Twenty-eight 8-14 year-old children with a diagnosis of DCD participated in the study, with 28 TD age and gender matched controls. Participants completed the 10 min free-writing task from the Detailed Assessment of Speed of Handwriting (DASH) on a digitising writing tablet. The total overall percentage of pausing during the task was categorised into four pause time-frames, each derived from the literature on writing (250 ms to 2 s; 2-4 s; 4-10 s and >10 s). In addition, the location of the pauses was coded (within word/between word) to examine where the breakdown in the writing process occurred. The results indicated that the main group difference was driven by more pauses above 10 s in the DCD group. In addition, the DCD group paused more within words compared to TD peers, indicating a lack of automaticity in their handwriting. These findings may support the provision of additional time for children with DCD in written examinations. More importantly, they emphasise the need for intervention in children with DCD to promote the acquisition of efficient handwriting skill

Real‐life experience in switching to new extended half‐life products at European haemophilia centres

The concept of replacement therapy in haemophilia is changing significantly thanks to the switch from standard products to extended half‐life products. These novel drugs are showing beneficial effects overcoming current prophylaxis limitations by reducing the infusion frequency, maintaining a higher trough level to ensure a lower risk of bleeding, and making treatment significantly less distressing to patients by improving the quality of life. Real‐life data on the efficacy of novel drugs and their impact on routine management of haemophilia A and B patients are still limited. This manuscript reports the results of a European survey conducted by the European Association for Haemophilia and Allied Disorders (EAHAD) at the beginning of 2018 on the clinical management of patients using extended half‐life recombinant FVIII and FIX fusion products, since at the time of the survey none of the PEGylated products were available yet. We report data on the efficacy of these novel drugs by 33 European haemophilia centres that have already switched to extended half‐life fusion products, showing a significant reduction in the number of infusions and a satisfactory trough levels in the clinical care of haemophilia patients, with a greater impact for haemophilia B

Direct replacement of oral sodium benzoate with glycerol phenylbutyrate in children with urea cycle disorders

Long-term management of urea cycle disorders (UCDs) often involves unlicensed oral sodium benzoate (NaBz) which has a high volume and unpleasant taste. A more palatable treatment is licenced and available (glycerol phenylbutyrate [GPB], Ravicti) but guidance on how to transition patients from NaBz is lacking. A retrospective analysis of clinical and biochemical data was performed for eight children who transitioned from treatment with a single ammonia scavenger, NaBz, to GPB at a single metabolic centre; UCDs included arginosuccinic aciduria (ASA) (n = 5), citrullinaemia type 1 (n = 2) and carbamoyl phosphate synthetase I deficiency (CPS1) (n = 1). Patients transitioned either by gradual transition over 1–2 weeks (n = 3) or direct replacement of NaBz with GPB (n = 5). Median initial dose of GPB was 8.5 mL/m2/day based on published product information; doses were revisited subsequently in clinic and titrated individually (range 4.5–11 mL/m2/day). Pre-transition and post-transition mean ammonia levels were 37 μmol/L (SD 28 μmol/L) and 29 μmol/L (SD 22 μmol/L), respectively (p = 0.09), and mean glutamine levels were 664 μmol/L (SD 225 μmol/L) and 598 μmol/L (SD 185 μmol/L), respectively (p = 0.24). There were no reductions in levels of branched chain amino acids. No related adverse drug reactions were reported. Patients preferred GPB because of its lower volume and greater palatability. Direct replacement of NaBz with GPB maintained metabolic control and was simple for the health service and patients to manage. A more cautious approach with additional monitoring would be warranted in brittle patients and patients whose ammonia levels are difficult to control

Children and Young People’s Perspectives and Experiences of a Community Wheelchair Basketball Club and its Impact on Daily Life

Introduction: Although the benefits of physical activity are widely recognised, levels of inactivity are considerably higher for children and young people with disabilities than those without. Young people with disabilities struggle to access inclusive opportunities and there is a lack of research surrounding users’ experiences of disability sport more generally. This research aimed to explore members’ experiences of a community-based wheelchair basketball club and its impact on daily life. Method: Semi-structured interviews were conducted with eleven disabled and able-bodied members of the club (aged 6-25) to gain an in-depth understanding of their experiences. Findings: Inductive thematic analysis identified an overarching theme of ‘wheelchair basketball elicits strong emotions’ and four main themes of ‘positive social interactions’, ‘benefitting health and independence’, ‘changing perceptions of disability’ and ‘a meaningful occupation that opens doors’. Participants reported positive experiences of wheelchair basketball which improved their physical and mental health whilst increasing opportunities for socialisation and encouraging acceptance of disability. Conclusion: The findings have implications at individual, organisational and societal levels and provide some justification for the role of occupational therapy in disability sport. The findings demonstrate the potential for inclusive community sports clubs to improve health and social outcomes for individuals, regardless of disability.Sport England (A Wheelchair Basketball Club for West London

Handwriting and typing: Occupational therapy practice when supporting adolescents with handwriting difficulties

While most children have developed effective handwriting by secondary school age, some have handwriting difficulties that hamper academic progress. Occupational therapists play a role in assessment and planning support, which may include introducing typing as an alternative. However, there is limited understanding regarding how decisions are made about recommending typing. This study explored the support provided to adolescents with handwriting difficulties by occupational therapists, and the contextual factors that influence their decision-making.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by a research priority grant awarded by the UK Occupational Therapy Research Foundation to MP (Principal Investigator), Brunel University London

The Development of a Novel Interprofessional Education Curriculum for third year medical and pharmacy students

Abstract Introduction: The Liaison Committee on Medical Education and the Accreditation Council for Pharmacy Education, agencies responsible for the accreditation of medical and pharmacy schools respectively, require interprofessional education (IPE) to be integrated into both curricula. Institutions are given the autonomy to design and implement this requirement, however research is equivocal in regards to when and how best to implement IPE. The development of a new IPE curriculum is often met with a number of challenges, such as a lack of faculty support and resources. Methods: This study describes a newly created pilot IPE curriculum developed with minimal existing organizational IPE structure and resources, led by faculty champions from two complementary healthcare professions, Internal Medicine and Pharmacy. The validated 10-item Student Perceptions of Interprofessional Clinical Education- Revised (SPICE-R) instrument was used to assess the medical and pharmacy students’ attitudes towards interprofessional healthcare teams and the team approach to patient care. Results: Overall, students demonstrated a statistically significant increase in their perception of interprofessional healthcare teams and team approach to patient care. Conclusion: Prior to this IPE curriculum no formal IPE curriculum existed in this setting. This IPE curriculum was successfully implemented with minimal existing resources, the use of faculty champions and student’s perception of IPE improved using the validated SPICE-R instrument. IPE curriculum integration at our institution is in various stages of development. As IPE integration moves forward this pilot can serve as one example of how IPE could be implemented

Grip strength and pen pressure are not key contributors to handwriting difficulties in children with Developmental Coordination Disorder

Copyright © The Author(s) 2020. Introduction Children with developmental coordination disorder have significant difficulties with handwriting. Factors such as hand grip strength and pen pressure are often assumed by clinicians to play a role, although empirical evidence is lacking. The aim of this study was to measure grip strength and pen pressure to examine their relationships with handwriting performance in children with developmental coordination disorder. Method Sixteen 8–14-year-old children with developmental coordination disorder were compared with 20 typically developing age- and gender-matched controls. Palmar, pinch and tripod grip strength were measured using hand dynamometers. The mean pressure exerted on a writing tablet by the pen was obtained during a handwriting task. Group comparisons were made and correlations conducted between grip strength and pen pressure and a range of handwriting product and process measures. Results There were no group differences on the three measures of grip strength. However, the developmental coordination disorder group exerted less pressure on the writing surface compared to typically developing peers. There were no significant correlations between grip strength or pen pressure and handwriting performance in children with developmental coordination disorder. Conclusion Clinicians should be cautious when using measures of grip strength or pen pressure to inform them about aspects of handwriting skill in children with developmental coordination disorder.UK Occupational Therapy Research Foundation (UKOTRF) Research Development Grant (2016)

Bench test results on a new technique for far-infrared polarimetry

The results of bench tests performed on a new method of combined interferometry/polarimetry for the magnetic-field reconstruction of tokamak plasmas is presented. In particular, the sensitivity obtained in the polarimetric measurement shows the feasibility of Faraday rotation determination approaching a precision of ±0.2°. The method is based on an optically pumped far-infrared laser with a rotating polarization where both the interferometric and polarimetric information is determined from phase measurements. Specific sources that introduce disturbances in the optical arrangement and that can limit the attainment of the polarimetric precision, mentioned above, are discussed