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  • 1. Artzi, M.
    et al.
    Shiran, S. I.
    Weinstein, M.
    Myers, V.
    Tarrasch, R.
    Schertz, M.
    Fattal-Valevski, A.
    Miller, E.
    Gordon, A. M.
    Green, Dido
    Department Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
    Ben Bashat, D.
    Cortical reorganization following injury early in life2016In: Neural Plasticity, ISSN 2090-5904, E-ISSN 1687-5443, article id 8615872Article in journal (Refereed)
    Abstract [en]

    The brain has a remarkable capacity for reorganization following injury, especially during the first years of life. Knowledge of structural reorganization and its consequences following perinatal injury is sparse. Here we studied changes in brain tissue volume, morphology, perfusion, and integrity in children with hemiplegia compared to typically developing children, using MRI. Children with hemiplegia demonstrated reduced total cerebral volume, with increased cerebrospinal fluid (CSF) and reduced total white matter volumes, with no differences in total gray matter volume, compared to typically developing children. An increase in cortical thickness at the hemisphere contralateral to the lesion (CLH) was detected in motor and language areas, which may reflect compensation for the gray matter loss in the lesion area or retention of ipsilateral pathways. In addition, reduced cortical thickness, perfusion, and surface area were detected in limbic areas. Increased CSF volume and precentral cortical thickness and reduced white matter volume were correlated with worse motor performance. Brain reorganization of the gray matter within the CLH, while not necessarily indicating better outcome, is suggested as a response to neuronal deficits following injury early in life.

  • 2. Bundy, A.
    et al.
    Green, Dido
    Group Approaches in Childhood2017In: Cognitive Orientation to Daily Occupational Performance in Occupational Therapy: Using the CO-OP Approach (TM) to Enable Participation Across the Lifespan / [ed] D. Dawson, S. Mcewen, & H. Polatajko, American Occupational Therapy , 2017Chapter in book (Other academic)
  • 3. Bundy, Anita C.
    et al.
    Green, Dido
    Viewing children through multiple lenses2015In: Sensory integration: Theory and practice / [ed] A. C. Bundy & S. J. Lane, Philadelphia: F. A. Davis , 2015, 3Chapter in book (Other academic)
  • 4.
    Cohen-Holzer, Marilyn
    et al.
    Pediatric and Adolescent Rehabilitation Center, Alyn Hospital, Jerusalem, Israel.
    Katz-Leurer, Michal
    Pediatric and Adolescent Rehabilitation Center, Alyn Hospital, Jerusalem, Israel.
    Meyer, Shirley
    Pediatric and Adolescent Rehabilitation Center, Alyn Hospital, Jerusalem, Israel.
    Green, Dido
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. Center for Rehabilitation, Oxford Brookes University, Oxford, United Kingdom.
    Parush, Shula
    School of Occupational Therapy, Faculty of Medicine of Hadassah and the Hebrew University of Jerusalem, Jerusalem, Israel.
    The effect of bimanual training with or without constraint on hand functions in children with unilateral cerebral palsy: A non-randomized clinical trial2017In: Physical & Occupational Therapy in Pediatrics, ISSN 0194-2638, E-ISSN 1541-3144, Vol. 37, no 5, p. 516-527Article in journal (Refereed)
    Abstract [en]

    Aim:

    To compare the effect of bimanual training with or without constraint on manual functions in children with unilateral cerebral palsy (UCP).

    Methods:

    Seventeen children aged 6–11 years with UCP participated in one of two intensive therapeutic camps: bimanual (n = 9) incorporating one hour of constraint (“Hybrid”) or Bimanual (n = 8). Each camp met for 2 weeks, 5 days per week for 6 hours each day. The Assisting Hand Assessment (AHA) and the Jebsen Taylor Test of Hand Function (JTTHF) examined bimanual and unimanual functions pre, post- and 3-months post-intervention.

    Results:

    A significant improvement was noted in AHA scores for both groups between the pre-, post- and three months post-intervention [Hybrid (F2; 16 = 85.5, p < 0.01); Bimanual (F2; 16 = 15.4, p < 0.01)] with no significant differences between groups over time (F2; 30 = 0.74, p = 0.48). For the JTTHF, a significant improvement was noted in the affected hand following the Hybrid program (F2; 30 = 7.45, p = 0.01), while following the Bimanual program a significant difference was noted only in the less-affected hand (F2; 16 = 6.02, p < 0.01].

    Conclusion:

    Both interventions Hybrid and Bimanual were similarly effective for improving use of the affected hand in bimanual tasks. The unique contribution of each intervention, the Hybrid program on the affected and the Bimanual on the less-affected side, warrants further examination.

  • 5. Farr, W.
    et al.
    Green, Dido
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. Centre for Rehabilitation, Oxford Brookes University, United Kingdom.
    Male, I.
    Morris, C.
    Bailey, S.
    Gage, H.
    Speller, S.
    Colville, V.
    Jackson, M.
    Bremner, S.
    Memon, A.
    Therapeutic potential and ownership of commercially available consoles in children with cerebral palsy2017In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 80, no 2, p. 108-116Article in journal (Refereed)
    Abstract [en]

    Introduction:

    We conducted a survey amongst families of children with cerebral palsy to ascertain the ownership and therapeutic use and potential of commercial games consoles to improve motor function.

    Method:

    Three hundred families in South East England were identified through clinical records, and were requested to complete an anonymised questionnaire.

    Results:

    A total of 61 families (20% response) returned a completed questionnaire with 41 (68%) identified males and 19 (32%) identified females with cerebral palsy, with a mean age of 11 years 5 months (SD 3Y 7M). The large majority of families, 59 (97%), owned a commercial console and the child used this for 50-300 minutes a week. Returns by severity of motor impairment were: Gross Motor Function Classification System I (22%), II (32%), III (13%), IV (15%), V (18%). Consoles were used regularly for play across all Gross Motor Function Classification System categories.

    Conclusion:

    The potential of games consoles, as home-based virtual reality therapy, in improving the motor function of children with cerebral palsy should be appropriately tested in a randomised controlled trial. Wide ownership, and the relative ease with which children engage in the use of commercially-based virtual reality therapy systems, suggests potential as a means of augmenting therapy protocols, taking advantage of interest and participation patterns of families.

  • 6.
    Farr, W. J.
    et al.
    Sussex Community NHS Foundation Trust, Brighton, West Sussex, UK.
    Male, I.
    Sussex Community NHS Foundation Trust, Brighton, West Sussex, UK.
    Green, Dido
    Department of Rehabilitation, Oxford Brookes University, Oxford, UK.
    Morris, C.
    Medical School, University of Exeter, Exeter, UK.
    Gage, H.
    School of Economics, University of Surrey, Surrey, UK.
    Bailey, S.
    Medical School. University of Exeter, Exeter, UK.
    Speller, S.
    Sussex Community NHS Foundation Trust, Brighton, West Sussex, UK.
    Colville, V.
    Sussex Community NHS Foundation Trust, Brighton, UK.
    Jackson, M.
    Sussex Community NHS Foundation Trust, Brighton, UK.
    Bremner, S.
    Brighton and Sussex Medical School, Brighton, UK.
    Memon, A.
    Brighton and Sussex Medical School, Brighton, UK.
    Current issues and challenges in research on virtual reality therapy for children with neurodisability2017In: Rehabilitation: Innovations and Challenges in the Use of Virtual Reality Technologies / [ed] W. Powell, A. Rizzo, P. M. Sharkey, & J. Merrick, Nova Science Publishers, Inc., 2017, p. 9-26Chapter in book (Refereed)
  • 7.
    Farr, W. J.
    et al.
    Sussex Community NHS Foundation Trust, Brighton, West Sussex, UK.
    Male, I.
    Sussex Community NHS Foundation Trust, Brighton, West Sussex, UK.
    Green, Dido
    Department of Rehabilitation, Oxford Brookes University, Oxford, UK.
    Morris, C.
    Medical School, University of Exeter, Exeter, UK.
    Gage, H.
    School of Economics, University of Surrey, Surrey, UK.
    Bailey, S.
    Medical School. University of Exeter, Exeter, UK.
    Speller, S.
    Sussex Community NHS Foundation Trust, Brighton, West Sussex, UK.
    Colville, V.
    Sussex Community NHS Foundation Trust, Brighton, UK.
    Jackson, M.
    Sussex Community NHS Foundation Trust, Brighton, UK.
    Bremner, S.
    Brighton and Sussex Medical School, Brighton, UK.
    Memon, A.
    Brighton and Sussex Medical School, Brighton, UK.
    Current issues and challenges in research on virtual reality therapy for children with neurodisability2016In: Proceedings of the 11th International Conference in Disability, Virtual Reality and Associated Technologies, Los Angeles, California, USA, 20-22 September, 2016, 2016Conference paper (Refereed)
    Abstract [en]

    A PICO (population, intervention, comparison, outcome) approach is adopted to discuss issues and challenges in virtual reality therapy research in community health settings. Widespread variation within and between populations, e.g. co-morbid conditions, complicates treatment fidelity and applicability. Interventions require flexible dose and frequency to fit into children’s family circumstances, with clearly employed specialist paediatric research staff. Comparisons require adaptation to digital technology, and keep pace with development. Outcomes may overstate the impact of virtual reality therapy and technological novelty, while not fully unpacking hidden digital effects. A wide set of agreed, flexible, and patient-centred outcome measures are required to establish positive clinical baseline.

  • 8. Farr, William
    et al.
    Green, Dido
    Male, Ian
    Morris, Christopher
    Bailey, Sarah
    Gage, Heather
    Speller, Sandra
    Colville, Val
    Jackson, M.
    Bremner, Stephen
    Memon, Anjum
    Feasibility of an RCT to evaluate home-based virtual reality therapy in children with cerebral palsy2017Conference paper (Refereed)
  • 9.
    Farr, William
    et al.
    Sussex Community NHS Trust.
    Male, Ian
    Sussex Community NHS Trust.
    Green, Dido
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. Oxford Brookes University.
    Morris, Christopher
    University of Exeter Medical School.
    Gage, Heather
    University of Surrey.
    Bailey, Sarah
    University of Exeter Medical School.
    Speller, Sandra
    Sussex Community NHS Trust.
    Colville, Val
    Sussex Community NHS Trust.
    Jackson, Mandy
    Sussex Community NHS Trust.
    Bremner, Stephen
    Brighton and Sussex Medical School.
    Memon, Anjum
    Brighton and Sussex Medical School.
    Methodological issues of using placebos in interventions based on digital technology2017In: Journal of Mobile Technology in Medicine, ISSN 1839-7808, Vol. 6, no 2, p. 56-63Article in journal (Refereed)
    Abstract [en]

    Background/Aims: Use of placebo is the ideal for comparison in clinical trials to reduce biases. With digital technology being used more frequently in healthcare interventions, how do we determine the placebo effect where interventions exploit technology? If placebo in medicine is traditionally defined by a lack of pharmacological agents, how might we begin to move towards controlling for effects of digital technology?

    Method: This paper explores the traditional placebo effect and discusses its impact in healthcare contexts with digital technology with reference to a particular trial. Different meanings of placebo in the context of evaluating technology suggest new challenges and positive consequences.

    Results: Methodological considerations are discussed, which enabled the development of a placebo-controlled evaluation of a digital technology in healthcare and rehabilitation.

    Conclusion: Digital placebo was controlled in our trial by employing technology across all groups in the absence of evidence-based practice and shows how to control for unknown and hidden effects of technology.

  • 10.
    Green, Dido
    Centre for Rehabilitation, Oxford Brookes University, Oxford, United Kingdom.
    Are proprioceptive functions affected in Duchenne muscular dystrophy?2014In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 56, no 9, p. 805-806Article in journal (Refereed)
  • 11.
    Green, Dido
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. Centre for Rehabilitation, Oxford Brookes University, Oxford, United Kingdom.
    Challenges in combining upper limb and lower limb interventions in protocols for children with brain injury2017In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 59, no 3, p. 335-335Article in journal (Other academic)
  • 12.
    Green, Dido
    Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
    Developmental coordination disorder in children with ADHD and physical therapy intervention2010In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 52, no 3, p. 308-308Article in journal (Other academic)
  • 13.
    Green, Dido
    NIHR GSTFT/KCL Biomedical Research Centre, Newcomen Centre, Guy's Hospital, London, United Kingdom.
    Hand function and fine motor activities2009In: Finnie's Handling the Young Child with Cerebral Palsy at Home / [ed] Eva Bower, Elsevier, 2009, 4, p. 243-268Chapter in book (Other academic)
  • 14.
    Green, Dido
    Department of Occupational Therapy, School of Health Professions, Sackler School of Medicine, Ramat Aviv, Israel.
    Limitations of meta-analyses2012In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 42, no 8, p. 1774-1775Article in journal (Other academic)
  • 15.
    Green, Dido
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Prognostication and the unpredictable nature of HIV encephalopathy with bilateral lower limb spasticity2018In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749Article in journal (Other academic)
  • 16.
    Green, Dido
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    The Tyneside Pegboard Test: balancing clinical utility against ecological validity2018In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 60, no 3, p. 224-224Article in journal (Other academic)
  • 17.
    Green, Dido
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Time and relativity in therapeutic rehabilitation2017In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 59, no 2Article in journal (Other (popular science, discussion, etc.))
  • 18.
    Green, Dido
    Centre for Rehabilitation, Oxford Brookes University, Oxford, United Kingdom.
    Translating evidence into practice2014In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 56, no 12, p. 1132-1133Article in journal (Other (popular science, discussion, etc.))
  • 19.
    Green, Dido
    et al.
    Newcomen Centre, Guy's Hospital, London, United Kingdom.
    Baird, G.
    Barnett, A. L.
    Henderson, L.
    Huber, J.
    Henderson, S. E.
    The severity and nature of motor impairment in Asperger's syndrome: A comparison with Specific Developmental Disorder of Motor Function2002In: Journal of Child Psychology and Psychiatry and Allied Disciplines, ISSN 0021-9630, E-ISSN 1469-7610, Vol. 43, no 5, p. 655-668Article in journal (Refereed)
    Abstract [en]

    Background:

    The aims of this study were to measure objectively the extent and severity of motor impairment in children with Asperger's syndrome and to determine whether the motor difficulties experienced by such children differed in any way from those classified as having a Specific Developmental Disorder of Motor Function (SDD-MF). Criteria derived from ICD 10-R were used to identify 11 children with Asperger's syndrome and a matched group of 9 children with a Specific Developmental Disorder of Motor Function. Children in both groups were required to have a verbal IQ of 80 or greater on the WISC IIIR.

    Method:

    The Autism Diagnostic Interview (Revised; Lord, Rutter, & LeCouteur, 1994) was used to identify features of AS in the first group and to exclude them in the latter. The Movement Assessment Battery for Children (Henderson & Sugden, 1992) provided a standardised test of motor impairment. A Gesture Test based on that by Cermak, Coster, and Drake (1980) was used to assess the child's ability to mime the use of familiar tools and to imitate meaningless sequences of movements.

    Results:

    All the children with Asperger's syndrome turned out to meet our criterion for a diagnosis of motor impairment, five of the six most severely motor impaired children in the whole study being from this group. Performance of the Asperger group was also slightly poorer on the Gesture Test. The profile of performance on each test was examined in detail but no evidence of group differences in the pattern of impairment was found.

    Conclusions:

    This study is consistent with others suggesting a high prevalence of clumsiness in Asperger's syndrome. Our findings also attest to the widespread prevalence of motor impairment in developmental disorders and the problems such co-morbidity poses for attempts to posit discrete and functionally coherent impairments underlying distinct syndromes.

  • 20.
    Green, Dido
    et al.
    Newcomen Centre, Guy's Hospital, London, United Kingdom.
    Baird, G.
    Sugden, D.
    A pilot study of psychopathology in Developmental Coordination Disorder2006In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 32, no 6, p. 741-750Article in journal (Refereed)
    Abstract [en]

    Background:

    This paper explores the prevalence of emotional and behavioural disorders in children referred to a Community Paediatric Occupational Therapy service for assessment and treatment of problems with development of motor skills.

    Methods:

    Parents of 47 children from a clinical sample of children who had been identified with Developmental Coordination Disorder (DCD) returned the Strengths and Difficulties Questionnaire (SDQ) - a brief measure of the pro-social behaviour and psychopathology that can be completed by parents, teachers or youths.

    Results:

    Significant emotional and behavioural problems were reported by 29 parents (62%) with a further six (13%) reporting problems in the borderline range. Seven children (15%) were without significant problems in one or more area although only four of these (9%) were outside the borderline range for all of the sub-domains of the SDQ.

    Discussion:

    A significant proportion of children with DCD were reported by their parents to be at risk of psychopathology. Further research is needed to understand the relationship between motor difficulties and emotional and behavioural symptoms; however, it is recommended that interventions for children with DCD should support mental health and behavioural problems as well as motor development.

  • 21.
    Green, Dido
    et al.
    Newcomen Centre, Guy's Hospital, London, United Kingdom.
    Beaton, L.
    Moore, D.
    Warren, L.
    Wick, V.
    Sanford, J. E.
    Santosh, P.
    Clinical incidence of sensory integration difficulties in adults with learning disabilities and illustration of management2003In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 66, no 10, p. 454-463Article in journal (Refereed)
    Abstract [en]

    This project investigated the prevalence of sensory processing problems in a clinical group and also examined the clinical effectiveness of a specialised therapeutic technique, sensory integrative therapy (SIT), in the treatment of maladaptive behaviours in two adults with learning disabilities. The Sensory Integration Inventory - Revised for Individuals with Developmental Disabilities (SII-R, Reisman and Hanschu 1992) was used to identify two clients suspected of having poor sensory processing. A single-subject experimental design (ABAB) was used to assist the objective measurement of the effects of SIT. The results suggest that the SII-R has some limitations in identifying clients who would benefit from SIT. One client (Ms D) was seen to instigate more positive interactions with her environment during and following the treatment phases; however, the overhabituated behaviours of the other client (Mr K) showed little response to SIT. These results are discussed in the form of a practitioner's update, with respect to the indicators of sensory processing dysfunction and the potential therapeutic benefits of SIT as an adjunct to therapeutic interventions for individuals with learning disabilities.

  • 22.
    Green, Dido
    et al.
    Newcomen Centre, Guy's Hospital, London, United Kingdom.
    Bishop, T.
    Wilson, B. N.
    Crawford, S.
    Hooper, R.
    Kaplan, B.
    Baird, G.
    Is questionnaire-based screening part of the solution to waiting lists for children with developmental coordination disorder?2005In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 68, no 1, p. 2-10Article in journal (Refereed)
    Abstract [en]

    This study was undertaken to determine whether questionnaire-based screening could be part of the solution to a long waiting list of referrals for occupational therapy assessment by identifying the requirement for clinical assessments. The performance of two questionnaires - the Developmental Coordination Disorder Questionnaire (DCDQ) completed by parents and the Checklist of the Movement Assessment Battery for Children (C-ABC) completed by teachers - was compared with a more traditional clinical assessment for the identification of DCD in children already referred to occupational therapy. It was found that the parent report was quite reliable in the identification of DCD if no other developmental problem was present. However, there was little benefit to using the teacher report to screen children. Several confounding variables, including an unequal proportion of children with DCD in the sample and the inclusion of children who were younger than the age range of the DCDQ, may have influenced how well the questionnaires performed. Although questionnaires cannot replace a full clinical assessment, the results showed that there may be some value in including the parent report in the identification of DCD.

  • 23.
    Green, Dido
    et al.
    Newcomen Centre, Guy's Hospital, London, United Kingdom.
    Chambers, M. E.
    Sugden, D. A.
    Does subtype of developmental coordination disorder count: Is there a differential effect on outcome following intervention?2008In: Human Movement Science, ISSN 0167-9457, E-ISSN 1872-7646, Vol. 27, no 2, p. 363-382Article in journal (Refereed)
    Abstract [en]

    It is well known that developmental coordination disorder (DCD) is a heterogeneous condition in which children frequently present with co-occurring conditions in addition to their motor difficulties. This study considered whether there would be a differential effect of a group treatment program on subtypes of perceptual and movement problems or associated co-occurring conditions. A subset of children (n = 43) from a larger clinical sample (n = 100) with DCD participated in a 2 frac(1, 4) year cross-over intervention study which followed the cognitive orientation to daily occupational performance (CO-OP) approach. Original subtypes were determined by contrasting the current sample with previously published subtyping studies in DCD [Hoare, D. (1994). Subtypes of developmental coordination disorder. Adapted Physical Activity Quarterly, 11, 158-169; Macnab, J. J., Miller, L. T., & Polatajko, H. J. (2001). The search for subtypes of DCD: Is cluster analysis the answer? Human Movement Science, 20, 49-72]. No advantage was conferred to any subtype although children with more profound and complex difficulties at initial assessment, despite progress following intervention, were most likely to have continuing difficulties at the end of the project.

  • 24.
    Green, Dido
    et al.
    Centre for Rehabilitation, Oxford Brookes University, Marston Road Campus, Jack Straw’s Lane, Oxford, United Kingdom.
    Chandler, S.
    Charman, T.
    Simonoff, E.
    Baird, G.
    Brief Report: DSM-5 Sensory Behaviours in Children With and Without an Autism Spectrum Disorder2016In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 46, no 11, p. 3597-3606Article in journal (Refereed)
    Abstract [en]

    Atypical responses to sensory stimuli are a new criterion in DSM-5 for the diagnosis of an autism spectrum disorder (ASD) but are also reported in other developmental disorders. Using the Short Sensory profile (SSP) and Autism Diagnostic Interview-Revised we compared atypical sensory behaviour (hyper- or hypo-reactivity to sensory input or unusual sensory interests) in children aged 10–14 years with (N = 116) or without an ASD but with special educational needs (SEN; N = 72). Atypical sensory behaviour was reported in 92 % of ASD and 67 % of SEN children. Greater sensory dysfunction was associated with increased autism severity (specifically restricted and repetitive behaviours) and behaviour problems (specifically emotional subscore) on teacher and parent Strengths and Difficulties Questionnaires but not with IQ.

  • 25.
    Green, Dido
    et al.
    Guy's ad St Thomas' NHS Foundation Trust, London, United Kingdom.
    Charman, T.
    Pickles, A.
    Chandler, S.
    Loucas, T.
    Simonoff, E.
    Baird, G.
    Impairment in movement skills of children with autistic spectrum disorders2009In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 51, no 4, p. 311-316Article in journal (Refereed)
    Abstract [en]

    Aim:

    We undertook this study to explore the degree of impairment in movement skills in children with autistic spectrum disorders (ASD) and a wide IQ range.

    Methods:

    Movement skills were measured using the Movement Assessment Battery for Children (M-ABC) in a large, well defined, population-derived group of children (n = 101: 89 males, 12 females; mean age 11 y 4 mo, SD 10 mo; range 10 y-14 y 3 mo) with childhood autism and broader ASD and a wide range of IQ scores. Additionally, we tested whether a parent-completed questionnaire, the Developmental Coordination Disorder Questionnaire (DCDQ), was useful in identifying children who met criteria for movement impairments after assessment (n = 97 with complete M-ABCs and DCDQs).

    Results:

    Of the children with ASD, 79% had definite movement impairments on the M-ABC; a further 10% had borderline problems. Children with childhood autism were more impaired than children with broader ASD, and children with an IQ less than 70 were more impaired than those with IQ more than 70. This is consistent with the view that movement impairments may arise from a more severe neurological impairment that also contributes to intellectual disability and more severe autism. Movement impairment was not associated with everyday adaptive behaviour once the effect of IQ was controlled for. The DCDQ performed moderately well as a screen for possible motor difficulties.

    Interretation:

    Movement impairments are common in children with ASD. Systematic assessment of movement abilities should be considered a routine investigation.

  • 26.
    Green, Dido
    et al.
    Centre for Rehabilitation, Oxford Brookes University, Marston Road Campus, Jack Straw s Lane, Oxford, United Kingdom.
    Lim, M.
    Lang, B.
    Pohl, K.
    Turk, J.
    Sensory Processing Difficulties in Opsoclonus-Myoclonus Syndrome2016In: Journal of Child Neurology, ISSN 0883-0738, E-ISSN 1708-8283, Vol. 31, no 8, p. 965-970Article in journal (Refereed)
    Abstract [en]

    Opsoclonus-myoclonus syndrome is a rare but serious neurological condition resulting in loss of control of eye movements, often accompanied by difficulties in posture and movement control with reports of sensory sensitivities potentially impacting on behavior. This pilot study characterizes the presence of atypical sensory behaviors in opsoclonus-myoclonus syndrome through questionnaire survey of a cohort of families. The Short Sensory Profile, Vineland Adaptive Behavior Scale, and Developmental Behaviour Checklist were distributed to 30 families; 16 were returned anonymously. Atypical sensory behaviors were identified in a large proportion (62.5%). Children reported as being more anxious showed greater sensitivity to auditory stimuli, U(14) 11, P =.026. This is consistent with recent recognition of more extensive disease neurocognitive effects in Opsoclonus-myoclonus syndrome. Further research is needed to increase understanding of the complex pathology of this disease and to provide indicators for sensory and behavioral as well as pharmacological interventions.

  • 27.
    Green, Dido
    et al.
    Newcomen Centre, Guy's Hospital, London, United Kingdom.
    Lingam, R.
    Mattocks, C.
    Riddoch, C.
    Ness, A.
    Emond, A.
    The risk of reduced physical activity in children with probable Developmental Coordination Disorder: A prospective longitudinal study2011In: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 32, no 4, p. 1332-1342Article in journal (Refereed)
    Abstract [en]

    The aim of the current study was to test the hypothesis that children with probable Developmental Coordination Disorder have an increased risk of reduced moderate to vigorous physical activity (MVPA), using data from a large population based study. Prospectively collected data from 4331 children (boys = 2065, girls = 2266) who had completed motor coordination testing at 7 years and accelerometry at 12 years were analysed from the Avon Longitudinal Study of Parents and Children (ALSPAC). Probable DCD (p-DCD) was defined, using criteria based on the DSM IV classification, as those children below the 15th centile of the ALSPAC Coordination Test at seven years who had a functional impairment in activities of daily living or handwriting, excluding children with a known neurological diagnosis or IQ < 70. Secondary exposure variables consisted of subtests from the ALSPAC Coordination test (manual dexterity, ball skills and balance). Objective measurement of the average daily minutes of MVPA was recorded as ≥3600 counts per minute (cpm) using actigraph accelerometry. Boys with p-DCD were less physically active than boys without DCD (mean difference in MVPA 4.36. cpm, t= 2.69; p= 0.007). For boys, targeting skill (bean bag toss) was related to increased MVPA, after adjustment for confounding factors including neonatal, family and environmental factors as well as Body Mass Index at age seven and 12 years (β= 0.76, t= 3.37, p< 0.001, CI 0.32-1.20). There was no difference in level of MVPA in girls with and without p-DCD (mean difference 1.35. min, t= 0.97, p= 0.31), which may reflect the low levels of MVPA of girls in this cohort. Our findings suggest that the presence of movement difficulties, particularly poor targeting (bean bag toss/ball skills), at a young age is a potential risk factor for reduced MVPA in boys.

  • 28.
    Green, Dido
    et al.
    Department of Occupational Therapy, School of Health Professions, Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
    Meroz, A.
    Margalit, A. E.
    Ratzon, N. Z.
    A validation study of the Keyboard Personal Computer Style instrument (K-PeCS) for use with children2012In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 43, no 6, p. 985-992Article in journal (Refereed)
    Abstract [en]

    This study examines a potential instrument for measurement of typing postures of children. This paper describes inter-rater, test-retest reliability and concurrent validity of the Keyboard Personal Computer Style instrument (K-PeCS), an observational measurement of postures and movements during keyboarding, for use with children. Two trained raters independently rated videos of 24 children (aged 7-10 years). Six children returned one week later for identifying test-retest reliability. Concurrent validity was assessed by comparing ratings obtained using the K-PECS to scores from a 3D motion analysis system. Inter-rater reliability was moderate to high for 12 out of 16 items (Kappa: 0.46 to 1.00; correlation coefficients: 0.77-0.95) and test-retest reliability varied across items (Kappa: 0.25 to 0.67; correlation coefficients: r = 0.20 to r = 0.95). Concurrent validity compared favourably across arm pathlength, wrist extension and ulnar deviation. In light of the limitations of other tools the K-PeCS offers a fairly affordable, reliable and valid instrument to address the gap for measurement of typing styles of children, despite the shortcomings of some items. However further research is required to refine the instrument for use in evaluating typing among children.

  • 29.
    Green, Dido
    et al.
    Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
    Schertz, M.
    Gordon, A. M.
    Moore, A.
    Schejter Margalit, T.
    Farquharson, Y.
    Ben Bashat, D.
    Weinstein, M.
    Lin, J. -P
    Fattal-Valevski, A.
    A multi-site study of functional outcomes following a themed approach to hand-arm bimanual intensive therapy for children with hemiplegia2013In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 55, no 6, p. 527-533Article in journal (Refereed)
    Abstract [en]

    Aim:

    This study investigated the effects of a theme-based ('magic') variation of the hand-arm bimanual intensive therapy programme, in two different countries, in improving activity performance for children with hemiplegia, including those with severe movement restrictions.

    Method:

    Twenty-three children with spastic hemiplegia (13 males, 10 females; mean age 10y 7mo, range 7-15y; Manual Ability Classification System level I, two; level II, 13; level III, eight), participated in one of three, 2-week, summer camps. A within-participant experimental design was used with the Assisting Hand Assessment and Children's Hand Experience Questionnaire as primary outcome measures. Evaluations occurred immediately before the first day, on the last day, and 3 months after intervention. Two groups underwent additional assessments 2 weeks before the camp.

    Results:

    Significant intervention effects were seen on the Assisting Hand Assessment (p=0.002) and on the Children's Hand Experience Questionnaire (p<0.001), the latter maintained at follow-up. The affected hand was reported to be used in 25% of bimanual activities before the camp, progressing to 93% after camp, and decreasing to 86% at follow-up. Severity of impairment did not influence progress.

    Interpretation:

    This themed approach to intensive intervention showed positive results in bimanual use, with improvements in independence sustained at follow-up. Although children across camps and motor severity made progress, some questions remain about intensity and duration of intervention to optimize longer-term outcomes.

  • 30.
    Green, Dido
    et al.
    Department of Paediatric Neurosciences, Newcomen Centre, Guy’s Hospital, London, UK.
    Wilson, B. N.
    The importance of parent and child opinion in detecting change in movement capabilities2008In: Canadian Journal of Occupational Therapy / Revue Canadienne d`Ergotèrapie, ISSN 0008-4174, Vol. 75, no 4, p. 208-219Article in journal (Refereed)
    Abstract [en]

    Background:

    Children and parents can make valid judgments about movement difficulties, which aids in the screening and assessment of Developmental Coordination Disorder (DCD). When considering therapy outcomes, child and family-centred practice supports the inclusion of parent and child perspectives to reflect progress made in meaningful daily contexts.

    Purpose:

    This paper describes an evaluation of the use of questionnaires for parents and children to measure change in motor performance.

    Methods:

    Questionnaires were administered to 43 children with DCD and their parents five times over two-and-a-quarter years in conjunction with other clinical measures.

    Findings:

    Parent report, using the Developmental Coordination Disorder Questionnaire, correlated significantly with clinical measures of motor skill, whilst parent and child perceptions differed. Children's confidence and resilience may influence their opinions of their ability.

    Implications:

    These results raise questions of whose perspective of progress is most valid and relevant - the therapist's, child's or parent's?

  • 31.
    Green, Dido
    et al.
    Tel Aviv University, Tel Aviv, Israel.
    Wilson, P. H.
    Use of virtual reality in rehabilitation of movement in children with hemiplegia - A multiple case study evaluation2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 7, p. 593-604Article in journal (Refereed)
    Abstract [en]

    Purpose:

    To evaluate the feasibility and therapeutic effect of engaging children of differing neuromotor and cognitive ability in a virtual reality (VR) tabletop workspace designed to improve upper-limb function.

    Method:

    Single-subject experimental design with multiple baselines was employed. Four children with hemiplegia participated in VR-based training between nine and 19, 30-minute sessions, over three-four weeks. Outcomes were assessed from the perspective of the International Classification of Functioning, Disability and Health; considering body function, activity performance and participation. Upper-limb performance was assessed using system-measured variables (speed, trajectory and accuracy) and standardized tests. Trend analyses were employed to determine trends on system variables between baseline phase and treatment phases. Standardised measures were compared between pre- and post-training.

    Results:

    Two children made progress across system variables with some translation to daily activities. Performance of the other two children was more variable, however, they engaged positively with the system by the end of the treatment phase.

    Conclusions:

    The VR (RE-ACTION) system shows promise as an engaging rehabilitation tool to improve upper-limb function of children with hemiplegia, across ability levels. Trade-offs between kinematic variables should be considered when measuring improvements in movement skill. Larger trials are warranted to evaluate effects of augmented feedback, intensity and duration of training, and interface type to optimise the system's effectiveness.

    Implications for Rehabilitation:

    The RE-ACTION system shows promise as a relatively low-cost solution to support therapies for upper-limb function and activity participation for children with hemiplegia and associated conditions. The combination of goal-directed tasks, augmented feedback, and engaging exploratory environments is a potentially quite powerful rehabilitation solution for children. Increased task engagement supported positive outcomes of the International Classification of Functioning, Disability and Health - Children and Youth version, including body function and activity levels as well as enhanced participation. Larger experimental trials are required to test the capacity of the system to progress the skills of children with multiple disabilities.

  • 32.
    Green, Dido
    et al.
    Department of Occupational Therapy, Sackler School of Medicine, Tel Aviv University, Israel.
    Wilson, P. H.
    Validation of the Elements/RE-ACTION System for use with children: Evaluation of performance across developmental stages2011In: 2011 International Conference on Virtual Rehabilitation, ICVR 2011, 2011Conference paper (Refereed)
    Abstract [en]

    The aim of this study was to ascertain the feasibility of using the Elements virtual reality (VR) System for children and determine the construct validity of the assessment mode of the system. These technologies were adapted for use with children, called the Re-Action system, to support motor learning. A mixed-approach design was used. Construct validity was evaluated by contrasting performance on system variables across different developmental stages (Kindergarten, Primary Education, Middle Education and Secondary Education). Four system-generated measures were recorded automatically by the Re-Action system: object placement accuracy, movement speed, movement efficiency, and response errors. These measures were obtained during goal based tasks ranging from predictable to random targets. Children's perceptions of the system were measured via the Short Feedback Questionnaire-Children (SFQ-C) to ascertain the levels of engagement of the children in the system which might support motivation and compliance. Seventy-three children aged between 4 and 16 years undertook 15 minutes of interaction with the system. Differences between developmental stages were identified on randomly presented stimuli indicating that the RE-ACTION system has some sensitivity to developmental trends in performance capacity. Subjective data from the SFQ-C revealed high levels of enjoyment and satisfaction with the tasks. These findings support an earlier case study evaluation of the Re-Action system for use with children with hemiplegia and suggest that the paediatric adaptation of the Elements System has the potential to support understanding of motor learning through childhood. The assessment mode of the system appears to be a valid movement assessment tool for children of different ages with the potential for documenting change as a result of development or intervention.

  • 33.
    Green, Dido
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Ziviani, Jenny
    The arts and children’s occupational opportunities2017In: Occupation-centred practice with children: a practical guide for occupational therapists / [ed] Sylvia Rodger, Ann Kennedy-Behr, Chichester: John Wiley & Sons, 2017, 2, p. 311-328Chapter in book (Other academic)
  • 34. Gringras, P.
    et al.
    Green, Dido
    Centre for Rehabilitation, Oxford Brookes University, Oxford, United Kingdom.
    Wright, B.
    Rush, C.
    Sparrowhawk, M.
    Pratt, K.
    Allgar, V.
    Hooke, N.
    Moore, D.
    Zaiwalla, Z.
    Wiggs, L.
    Weighted blankets and sleep in autistic children - A randomized controlled trial2014In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 134, no 2, p. 298-306Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To assess the effectiveness of a weighted-blanket intervention in treating severe sleep problems in children with autism spectrum disorder (ASD).

    METHODS:

    This phase III trial was a randomized, placebo-controlled crossover design. Participants were aged between 5 years and 16 years 10 months, with a confirmed ASD diagnosis and severe sleep problems, refractory to community-based interventions. The interventions were either a commercially available weighted blanket or otherwise identical usual weight blanket (control), introduced at bedtime; each was used for a 2-week period before crossover to the other blanket. Primary outcome was total sleep time (TST) recorded by actigraphy over each 2-week period. Secondary outcomes included actigraphically recorded sleeponset latency, sleep efficiency, assessments of child behavior, family functioning, and adverse events. Sleep was also measured by using parent-report diaries.

    RESULTS:

    Seventy-three children were randomized and analysis conducted on 67 children who completed the study. Using objective measures, the weighted blanket, compared with the control blanket, did not increase TST as measured by actigraphy and adjusted for baseline TST. There were no group differences in any other objective or subjective measure of sleep, including behavioral outcomes. On subjective preference measures, parents and children favored the weighted blanket.

    CONCLUSIONS:

    The use of a weighted blanket did not help children with ASD sleep for a longer period of time, fall asleep significantly faster, or wake less often. However, the weighted blanket was favored by children and parents, and blankets were well tolerated over this period.

  • 35. Hammond, J.
    et al.
    Jones, V.
    Hill, E. L.
    Green, Dido
    Centre for Rehabilitation, Oxford Brookes University, Oxford, United Kingdom.
    Male, I.
    An investigation of the impact of regular use of the Wii Fit to improve motor and psychosocial outcomes in children with movement difficulties: A pilot study2014In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 40, no 2, p. 165-175Article in journal (Refereed)
    Abstract [en]

    Background:

    Children with Developmental Co-ordination Disorder (DCD) experience poor motor and psychosocial outcomes. Interventions are often limited within the healthcare system, and little is known about how technology might be used within schools or homes to promote the motor skills and/or psychosocial development of these children. This study aimed to evaluate whether short, regular school-based sessions of movement experience using a commercially available home video game console (Nintendo's Wii Fit) would lead to benefits in both motor and psychosocial domains in children with DCD.

    Methods:

    A randomized crossover controlled trial of children with movement difficulties/DCD was conducted. Children were randomly assigned to an intervention (n = 10) or comparison (n = 8) group. The intervention group spent 10min thrice weekly for 1 month using Wii Fit during the lunch break, while the comparison group took part in their regular Jump Ahead programme. Pre- and post-intervention assessments considered motor proficiency, self-perceived ability and satisfaction and parental assessment of emotional and behavioural problems.

    Results:

    Significant gains were seen in motor proficiency, the child's perception of his/her motor ability and reported emotional well-being for many, but not all children.

    Conclusions:

    This study provides preliminary evidence to support the use of the Wii Fit within therapeutic programmes for children with movement difficulties. This simple, popular intervention represents a plausible method to support children's motor and psychosocial development. It is not possible from our data to say which children are most likely to benefit from such a programme and particularly what the dose and duration should be. Further research is required to inform across these and other questions regarding the implementation of virtual reality technologies in therapeutic services for children with movement difficulties.

  • 36. Jaber, Manar
    et al.
    Farr, William
    Morris, Christopher
    Bremner, Stephen
    Male, Ian
    Green, Dido
    Barriers and facilitators to physical activity participation and engagement in wii-fit home-therapy programmes for children with cerebral palsy2017Conference paper (Refereed)
  • 37. Martini, R.
    et al.
    Mandich, A.
    Green, Dido
    Oxford Brookes University, Centre for Rehabilitation, Oxford, United Kingdom.
    Implementing a modified cognitive orientation to daily occupational performance approach for use in a group format2014In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 77, no 4, p. 214-219Article in journal (Refereed)
    Abstract [en]

    Cognitive orientation to daily occupational performance is an intervention approach that is often used with children with developmental coordination disorder, and is usually implemented using an individual intervention format. This practice analysis describes two experiences of the cognitive orientation to daily occupational performance approach, modified for use in a group format: An intensive day-camp, and a weekly after-school club. The group format provided children with various opportunities (for example, helping other children and realizing that different 'plans' work for different people) and challenges (for example, maintaining both children's engagement during problem solving and heterogeneity in children's breakdowns). Cognitive orientation to daily occupational performance in a group format is feasible and has the potential to encourage skill acquisition for a greater number of children with developmental coordination disorder.

  • 38.
    Neil, Louise
    et al.
    Centre for Research in Autism and Education (CRAE), UCL Institute of Education, University College London, London, UK.
    Green, Dido
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. Centre for Rehabilitation, Oxford Brookes University, Oxford, United Kingdom.
    Pellicano, Elizabeth
    School of Psychology, University of Western Australia, Perth, Australia.
    The psychometric properties of a new measure of sensory behaviors in autistic children2017In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 47, no 4, p. 1261-1268Article in journal (Refereed)
    Abstract [en]

    Unusual reactions to sensory input became part of the diagnostic criteria for autism spectrum disorder in the DSM-5. Measures accurately assessing these symptoms are important for clinical decisions. This study examined the reliability and validity of the Sensory Behavior Questionnaire, a parent-report scale designed to assess frequency and impact of sensory behaviors in autistic children. The scale demonstrated excellent internal consistency and concurrent validity, and was a better predictor of autistic symptoms than the Short Sensory Profile within a group of 66 school-age autistic children. The scale also successfully discriminated between autistic and typical children of similar age and ability. The Sensory Behavior Questionnaire has potential as a measure of sensory behaviors in children on the autism spectrum.

  • 39. Rudisch, J.
    et al.
    Butler, J.
    Izadi, H.
    Zielinski, I. M.
    Aarts, P.
    Birtles, D.
    Green, Dido
    Department of Sport and Health Sciences, Oxford Brookes University, Oxford, United Kingdom.
    Kinematic parameters of hand movement during a disparate bimanual movement task in children with unilateral Cerebral Palsy2016In: Human Movement Science, ISSN 0167-9457, E-ISSN 1872-7646, Vol. 46, p. 239-250Article in journal (Refereed)
    Abstract [en]

    Children with unilateral Cerebral Palsy (uCP) experience problems performing tasks requiring the coordinated use of both hands (bimanual coordination; BC). Additionally, some children with uCP display involuntary symmetrical activation of the opposing hand (mirrored movements). Measures, used to investigate therapy-related improvements focus on the functionality of the affected hand during unimanual or bimanual tasks. None however specifically address spatiotemporal integration of both hands. We explored the kinematics of hand movements during a bimanual task to identify parameters of BC. Thirty-seven children (aged 10.9. ±. 2.6. years, 20 male) diagnosed with uCP participated. 3D kinematic motion analysis was performed during the task requiring opening of a box with their affected- (AH) or less-affected hand (LAH), and pressing a button inside with the opposite hand. Temporal and spatial components of data were extracted and related to measures of hand function and level of impairment. Total task duration was correlated with the Jebsen-Taylor Test of Hand Function in both conditions (either hand leading with the lid-opening). Spatial accuracy of the LAH when the box was opened with their AH was correlated with outcomes on the Children's Hand Use Experience Questionnaire. Additionally, we found a subgroup of children displaying non-symmetrical movement interference associated with greater movement overlap when their affected hand opened the box. This subgroup also demonstrated decreased use of the affected hand during bimanual tasks. Further investigation of bimanual interference, which goes beyond small scaled symmetrical mirrored movements, is needed to consider its impact on bimanual task performance following early unilateral brain injury.

  • 40.
    Rudisch, Julian
    et al.
    Department of Sport and Health Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom.
    Butler, Jenny
    Department of Sport and Health Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom.
    Izadi, Hooshang
    Department of Mechanical Engineering and Mathematical Sciences, Faculty of Technology Design and Environment, Oxford Brookes University, Oxford, United Kingdom.
    Birtles, Deirdre
    School of Psychology, University of East London, London, United Kingdom.
    Green, Dido
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. Department of Sport and Health Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom.
    Developmental characteristics of disparate bimanual movement skills in typically developing children2018In: Journal of motor behavior, ISSN 0022-2895, E-ISSN 1940-1027, Vol. 50, no 1, p. 8-16Article in journal (Refereed)
    Abstract [en]

    Mastery of many tasks in daily life requires role differentiated bimanual hand use with high spatiotemporal cooperation and minimal interference. The authors investigated developmental changes in the performance of a disparate bimanual movement task requiring sequenced movements. Age groups were attributed to changes in CNS structures critical for bimanual control such as the corpus callosum (CC) and the prefrontal cortex; young children (5–6 years old), older children (7–9 years old), and adolescents (10–16 years old). Results show qualitative changes in spatiotemporal sequencing between the young and older children which typically marks a phase of distinct reduction of growth and myelination of the CC. Results show qualitative changes in spatiotemporal sequencing between the young and older children, which coincides with distinct changes in the growth rate and myelination of the CC. The results further support the hypothesis that CC maturation plays an important role in the development of bimanual skills.

  • 41. Schertz, M.
    et al.
    Shiran, S. I.
    Myers, V.
    Weinstein, M.
    Fattal-Valevski, A.
    Artzi, M.
    Ben Bashat, D.
    Gordon, A. M.
    Green, Dido
    Tel Aviv University, Tel Aviv, Israel.
    Imaging Predictors of Improvement from a Motor Learning-Based Intervention for Children with Unilateral Cerebral Palsy2016In: Neurorehabilitation and Neural Repair, ISSN 1545-9683, E-ISSN 1552-6844, Vol. 30, no 7, p. 647-660Article in journal (Refereed)
    Abstract [en]

    Background:

    Motor-learning interventions may improve hand function in children with unilateral cerebral palsy (UCP) but with inconsistent outcomes across participants. Objective. To examine if pre-intervention brain imaging predicts benefit from bimanual intervention.

    Method:

    Twenty children with UCP with Manual Ability Classification System levels I to III, aged 7-16 years, participated in an intensive bimanual intervention. Assessments included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF) and Children's Hand Experience Questionnaire (CHEQ) at baseline (T1), completion (T2) and 8-10 weeks post-intervention (T3). Imaging at baseline included conventional structural (radiological score), functional (fMRI) and diffusion tensor imaging (DTI).

    Results:

    Improvements were seen across assessments; AHA (P = 0.04), JTTHF (P <.001) and CHEQ (P < 0.001). Radiological score significantly correlated with improvement at T2; AHA (r =.475) and CHEQ (r =.632), but negatively with improvement on unimanual measures at T3 (JTTFH r = -.514). fMRI showed negative correlations between contralesional brain activation when moving the affected hand and AHA improvements (T2: r = -.562, T3: r = -0.479). Fractional Anisotropy in the affected posterior limb of the internal capsule correlated negatively with increased bimanual use on CHEQ at T2 (r = -547) and AHA at T3 (r = -.656).

    Conclusions:

    Children with greater structural, functional and connective brain damage showed enhanced responses to bimanual intervention. Baseline imaging may identify parameters predicting response to intervention in children with UCP.

  • 42. Schertz, M.
    et al.
    Zuk, L.
    Green, Dido
    Tel Aviv University, Faculty of Medicine, Department of Occupational Therapy, Ramat Aviv, Israel.
    Long-term neurodevelopmental follow-up of children with congenital muscular torticollis2013In: Journal of Child Neurology, ISSN 0883-0738, E-ISSN 1708-8283, Vol. 28, no 10, p. 1215-1221Article in journal (Refereed)
    Abstract [en]

    Congenital muscular torticollis is a common condition, but long-term neurodevelopmental follow-up is lacking. This study reports on neurodevelopmental outcome of 68 children, aged 7 to 9 years, with a history of congenital muscular torticollis, excluding children with torticollis due to other conditions. Thirty-eight children were examined for presence of neurodevelopmental disorders. Telephone interview data were available for an additional 30 children. Of those examined, 22/38 (57.9%) had or were at risk for a developmental disorder (attention-deficit hyperactivity disorder (ADHD), developmental coordination disorder, language impairment, autistic spectrum disorder) on at least 1 of the assessments administered, 23/38 (60.5%) had received developmental treatment during childhood. One child, based on a telephone interview, had a history of developmental treatment. Therefore, 30/68 (44.1%) children of the total sample demonstrated a developmental delay/disorder, currently (22/68) or previously (8/68). Our findings suggest congenital muscular torticollis to be a significant risk factor for later neurodevelopmental conditions with disorders presenting at different stages of development.

  • 43. Shiran, S. I.
    et al.
    Weinstein, M.
    Sirota-Cohen, C.
    Myers, V.
    Ben Bashat, D.
    Fattal-Valevski, A.
    Green, Dido
    Tel Aviv Sourasky Medical Center, Dana-Dwek Hospital, Tel Aviv, Israel.
    Schertz, M.
    MRI-based radiologic scoring system for extent of brain injury in children with hemiplegia2014In: American Journal of Neuroradiology, ISSN 0195-6108, E-ISSN 1936-959X, Vol. 35, no 12, p. 2388-2396Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE:

    Brain MR imaging is recommended in children with cerebral palsy. Descriptions of MR imaging findings lack uniformity, due to the absence of a validated quantitative approach. We developed a quantitative scoring method for brain injury based on anatomic MR imaging and examined the reliability and validity in correlation to motor function in children with hemiplegia.

    MATERIALS AND METHODS:

    Twenty-seven children with hemiplegia underwent MR imaging (T1, T2-weighted sequences, DTI) and motor assessment (Manual Ability Classification System, Gross Motor Functional Classification System, Assisting Hand Assessment, Jebsen Taylor Test of Hand Function, and Children's Hand Experience Questionnaire). A scoring system devised in our center was applied to all scans. Radiologic score covered 4 domains: number of affected lobes, volume and type of white matter injury, extent of gray matter damage, and major white matter tract injury. Inter- and intrarater reliability was evaluated and the relationship between radiologic score and motor assessments determined.

    RESULTS:

    Mean total radiologic score was 11.3 ± 4.5 (range 4 -18). Good inter- (p = 0.909, P < .001) and intrarater (p = 0.926, P =<.001) reliability was demonstrated. Radiologic score correlated significantly with manual ability classification systems (p = 0.708, P < .001), and with motor assessments (assisting hand assessment [p = <0.753, P < .001]; Jebsen Taylor test of hand function [p = 0. 766, P < .001]; children's hand experience questionnaire [p=<0. 716, P < .001]), as well as with DTI parameters.

    CONCLUSIONS:

    We present a novel MR imaging- based scoring system that demonstrated high inter- and intrarater reliability and significant associations with manual ability classification systems and motor evaluations. This score provides a standardized radiologic assessment of brain injury extent in hemiplegic patients with predominantly unilateral injury, allowing comparison between groups, and providing an additional tool for counseling families.

  • 44. Skidmore, E.
    et al.
    McEwen, S.
    Green, Dido
    Van den Houten, J.
    Dawson, D.
    Polatajko, H.
    Essential Elements and Key Features2017In: Cognitive Orientation to Daily Occupational Performance in Occupational Therapy: Using the CO-OP Approach (TM) to Enable Participation Across the Lifespan / [ed] D. Dawson, S. Mcewen, & H. Polatajko, American Occupational Therapy , 2017Chapter in book (Other academic)
  • 45.
    Smits-Engelsman, Bouwien C.M.
    et al.
    Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
    Jover, Marianne
    PsyCLE, Aix Marseille Université, Aix en Provence, France.
    Green, Dido
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. Centre for Rehabilitation, Oxford Brookes University, Oxford, United Kingdom.
    Ferguson, Gillian
    Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
    Wilson, Peter
    School of Psychology, Australian Catholic University, Australia.
    DCD and comorbidity in neurodevelopmental disorder: How to deal with complexity?2017In: Human Movement Science, ISSN 0167-9457, E-ISSN 1872-7646, Vol. 53, p. 1-4Article in journal (Other academic)
  • 46.
    Vinçon, Sabine
    et al.
    Clinic for Child Neurology and Social Pediatrics, Child Centre Maulbronn, Maulbronn, Germany.
    Green, Dido
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. Department of Sport and Health Sciences, Oxford Brookes University, Oxford, United Kingdom.
    Blank, Rainer
    Clinic for Child Neurology and Social Pediatrics, Child Centre Maulbronn, Maulbronn, Germany.
    Jenetzky, Ekkehart
    Clinic for Child Neurology and Social Pediatrics, Child Centre Maulbronn, Maulbronn, Germany.
    Ecological validity of the German Bruininks-Oseretsky Test of Motor Proficiency – 2nd Edition2017In: Human Movement Science, ISSN 0167-9457, E-ISSN 1872-7646, Vol. 53, p. 45-54Article in journal (Refereed)
    Abstract [en]

    The diagnosis of Developmental Coordination Disorder (DCD) is based on poor motor coordination in the absence of other neurological disorders. In order to identify the presence of movement difficulties, a standardised motor assessment is recommended to determine the extent of movement problems which may contribute to deficits in daily task performance. A German version of the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (German BOT-2) was recently published. This study aimed to determine the ecological validity of the German BOT-2 by considering the relationship between assessment of fundamental motor skills with the BOT-2 and performance of everyday motor activities as evaluated by parents. This study used data obtained from the German BOT-2 standardisation study (n = 1.177). Subtests were compared with theoretically corresponding tasks via parental ratings of overall fine and gross motor abilities and performance in six typical motor activities. Non-parametric Jonckheere Terpstra test was used to identify differences in ordered contrasts. Subtests reflecting ‘Strength’, ‘Running Speed and Agility’, ‘Upper-Limb Coordination’, ‘Balance’, and ‘Fine Motor Precision’ were associated with parental evaluation of gross motor skills (p < 0.001). The subtest ‘Fine Motor Integration’ significantly correlated with parental ratings of females’ fine motor skills. Parental ratings of males’ fine motor skills were associated with three further subtests. Regarding everyday motor activities, the first three fine motor BOT-2 subtests were associated with parent evaluations of drawing, writing and arts and crafts (p < 0.001). Gross motor subtests of ‘Bilateral Coordination’ and ‘Balance’ showed no relationship to bike riding or performance in sports. Subtests of ‘Upper-Limb Coordination’ and ‘Strength’ showed significant correlations with sports, ball games and cycling. The results of this study suggest that the closer the proximity in the nature of the motor skills assessed in the German BOT-2 to daily motor tasks, the stronger the relationship between the clinical test and parental report of everyday performance of their child. The body functions tested in the German BOT-2, and hypothesized to underpin certain skills, were not automatically relevant for specific activities undertaken by German children. Future research should investigate the relationships of the various BOT-2 constructs for diagnosis of DCD.

  • 47. Weinstein, M.
    et al.
    Green, Dido
    Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
    Geva, R.
    Schertz, M.
    Fattal-Valevski, A.
    Artzi, M.
    Myers, V.
    Shiran, S.
    Gordon, A. M.
    Gross-Tsur, V.
    Bashat, D. B.
    Interhemispheric and intrahemispheric connectivity and manual skills in children with unilateral cerebral palsy2014In: Brain Structure and Function, ISSN 1863-2653, E-ISSN 1863-2661, Vol. 219, no 3, p. 1025-1040Article in journal (Refereed)
    Abstract [en]

    This study investigated patterns of motor brain activation, white matter (WM) integrity of inter- and intrahemispheric connectivity and their associations with hand function in children with unilateral cerebral palsy (CP-U). Fourteen CP-U (mean age 10.6 ± 2.7 years) and 14 typically developing children (TDC) underwent magnetic resonance imaging. CP-U underwent extensive motor evaluation. Pattern of brain activation during a motor task was studied in 12 CP-U and six TDC, by calculating laterality index (LI) and percent activation in the sensorimotor areas (around the central sulcus), and quantifying the activation in the supplementary motor area (SMA). Diffusivity parameters were measured in CP-U and eight other TDC for the corpus callosum (CC), affected and less affected cortico-spinal tracts (CST), and posterior limb of the internal capsule (PLIC). Abnormal patterns of brain activation were detected in areas around the central sulcus in 9/12 CP-U, with bilateral activation and/or reduced percent activation. More activation in areas around the central sulcus of the affected hemisphere was associated with better hand function. CP-U demonstrated more activation in the SMA when moving the affected hand compared to the less affected hand. CP-U displayed reduced WM integrity compared to TDC, in the midbody and splenium of the CC, affected CST and affected PLIC. WM integrity in these tracts was correlated with hand function. While abnormal pattern of brain activation was detected mainly when moving the affected hand, the integrity of the CC was correlated with function of both hands and bimanual skills. This study highlights the importance of interhemispheric connectivity for hand function in CP-U, which may have clinical implications regarding prognosis and management.

  • 48. Weinstein, M.
    et al.
    Myers, V.
    Green, Dido
    Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
    Schertz, M.
    Shiran, S. I.
    Geva, R.
    Artzi, M.
    Gordon, A. M.
    Fattal-Valevski, A.
    Ben Bashat, D.
    Brain Plasticity following Intensive Bimanual Therapy in Children with Hemiparesis: Preliminary Evidence2015In: Neural Plasticity, ISSN 2090-5904, E-ISSN 1687-5443, Vol. 2015, article id 798481Article in journal (Refereed)
    Abstract [en]

    Neuroplasticity studies examining children with hemiparesis (CH) have focused predominantly on unilateral interventions. CH also have bimanual coordination impairments with bimanual interventions showing benefits. We explored neuroplasticity following hand-Arm bimanual intensive therapy (HABIT) of 60 hours in twelve CH (6 females, mean age 11 ± 3.6 y). Serial behavioral evaluations and MR imaging including diffusion tensor (DTI) and functional (fMRI) imaging were performed before, immediately after, and at 6-week follow-up. Manual skills were assessed repeatedly with the Assisting Hand Assessment, Children's Hand Experience Questionnaire, and Jebsen-Taylor Test of Hand Function. Beta values, indicating the level of activation, and lateralization index (LI), indicating the pattern of brain activation, were computed from fMRI. White matter integrity of major fibers was assessed using DTI. 11/12 children showed improvement after intervention in at least one measure, with 8/12 improving on two or more tests. Changes were retained in 6/8 children at follow-up. Beta activation in the affected hemisphere increased at follow-up, and LI increased both after intervention and at follow-up. Correlations between LI and motor function emerged after intervention. Increased white matter integrity was detected in the corpus callosum and corticospinal tract after intervention in about half of the participants. Results provide first evidence for neuroplasticity changes following bimanual intervention in CH.

  • 49.
    Weinstein, Maya
    et al.
    Centre for Rehabilitation, Oxford Brookes University, Oxford, UK.
    Green, Dido
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. Centre for Rehabilitation, Oxford Brookes University, Oxford, UK.
    Rudisch, Julian
    Centre for Rehabilitation, Oxford Brookes University, Oxford, UK.
    Zielinski, Ingar M.
    Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
    Benthem-Muñiz, Marta
    Department of Neuroimaging, King's College London, London, UK.
    Jongsma, Marijtje L. A.
    Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
    McClelland, Verity
    Department of Basic and Clinical Neuroscience, King's College London, UK.
    Steenbergen, Bert
    Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
    Shiran, Shelly
    Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
    Ben Bashat, Dafna
    The Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
    Barker, Gareth J.
    Department of Neuroimaging, King's College London, London, UK.
    Understanding the relationship between brain and upper limb function in children with unilateral motor impairments: A multimodal approach2018In: European journal of paediatric neurology, ISSN 1090-3798, E-ISSN 1532-2130, Vol. 22, no 1, p. 143-154Article in journal (Refereed)
    Abstract [en]

    Atypical brain development and early brain injury have profound and long lasting impact on the development, skill acquisition, and subsequent independence of a child. Heterogeneity is present at the brain level and at the motor level; particularly with respect to phenomena of bilateral activation and mirrored movements (MMs). In this multiple case study we consider the feasibility of using several modalities to explore the relationship between brain structure and/or activity and hand function: Electroencephalography (EEG), both structural and functional Magnetic Resonance Imaging (sMRI, fMRI), diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), Electromyography (EMG) and hand function assessments.

    Methods: 15 children with unilateral CP (ages: 9.4 ± 2.5 years) undertook hand function assessments and at least two additional neuroimaging and/or neurophysiological procedures: MRI/DTI/fMRI (n = 13), TMS (n = 11), and/or EEG/EMG (n = 8). During the fMRI scans and EEG measurements, a motor task was performed to study cortical motor control activity during simple hand movements. DTI tractography analysis was used to study the corpus-callosum (CC) and cortico-spinal tracts (CST). TMS was used to study cortico-spinal connectivity pattern.

    Results: Type and range of severity of brain injury was evident across all levels of manual ability with the highest radiological scores corresponded to children poorer manual ability. Evidence of MMs was found in 7 children, mostly detected when moving the affected hand, and not necessarily corresponding to bilateral brain activation. When moving the affected hand, bilateral brain activation was seen in 6/11 children while 3/11 demonstrated unilateral activation in the contralateral hemisphere, and one child demonstrated motor activation predominantly in the supplementary motor area (SMA). TMS revealed three types of connectivity patterns from the cortex to the affected hand: a contralateral (n = 3), an ipsilateral (n = 4) and a mixed (n = 1) connectivity pattern; again without clear association with MMs. No differences were found between children with and without MMs in lesion scores, motor fMRI laterality indices, CST diffusivity values, and upper limb function. In the genu, midbody, and splenium of the CC, higher fractional anisotropy values were found in children with MMs compared to children without MMs. The EEG data indicated a stronger mu-restoration above the contralateral hemisphere in 6/8 children and above the ipsilateral hemisphere in 2/8 children.

    Conclusion: The current results demonstrate benefits from the use of different modalities when studying upper-limb function in children with CP; not least to accommodate to the variations in tolerance and feasibility of implementation of the differing methods. These exposed multiple individual brain-reorganization patterns corresponding to different functional motor abilities. Additional research is warranted to understand the transactional influences of early brain injury, neuroplasticity and developmental and environmental factors on hand function in order to develop targeted interventions. 

  • 50. Wilson, B. N.
    et al.
    Crawford, S. G.
    Green, Dido
    Guy’s & St Thomas’ Foundation Trust & Kings College London Biomedical Research Centre, Strand, London, UK.
    Roberts, G.
    Aylott, A.
    Kaplan, B. J.
    Psychometric properties of the revised Developmental Coordination Disorder Questionnaire2009In: Physical & Occupational Therapy in Pediatrics, ISSN 0194-2638, E-ISSN 1541-3144, Vol. 29, no 2, p. 184-204Article in journal (Refereed)
    Abstract [en]

    The Developmental Coordination Disorder Questionnaire (DCDQ) is a parent-completed measure designed to identify subtle motor problems in children of 8 to 14.6 years of age. The purpose of this study was to extend the lower age range to children aged 5 to 7 years, revise items to ensure clarity, develop new scoring, and evaluate validity of the revised questionnaire. Additional items with improved wording were generated by an expert panel. Analyses of internal consistency, factor loading, and qualitative/quantitative feedback from researchers, clinicians, and parents were used to select 15 items with the strongest psychometric properties. Internal consistency was high (alpha = .94). The expanded questionnaire was completed by the parents of 287 children, aged 5-15 years, who were typically developing. Logistic regression modeling was used to generate separate cutoff scores for three age groups (overall sensitivity = 85%, specificity = 71%). The revised DCDQ was then compared to other standardized measures in a sample of 232 children referred for therapy services. Differences in scores between children with and without DCD (p < .001) provide evidence of construct validity. Correlations between DCDQ scores and Movement Assessment Battery for Children (r = .55) and Test of Visual-Motor Integration (r = .42) scores support concurrent validity. The results provide evidence that the revised DCDQ is a valid clinical screening tool for DCD.

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