Neuro Week 3

What does skilled movement emerge from (4 things)

Brain and body maturation

sensory information and feedback

goal-directed practice

task and environmental demands

What is early learning like

Movement is variable, slow and attention-demanding

What happens with practice

Errors refine the motor plan

successful solutions become more stable

performance requires less conscious control

What shapes motor development outcomes

Brain development or injury, sensory feedback, cognition, fatigue and environment

What are the characteristics of early walking in a child who has recently begun walking

A wide base of support, outward-pointing feet, short steps and relatively limited movement at the hip, knee and ankle. The arms are held in a high-guard position to improve balance

How does gait change as postural control and coordination develop

The gait gradually becomes narrower, smoother and more efficient

What is feedforward control

Predicts the movement and its likely sensory consequences before feedback arrives

What is feedback control

Compares the actual outcome with the goal and corrects error

What do efficient skilled actions depend on

Both feedforward and feedback control working together

What is predictive control in motor development

Less efficient anticipation of movement consequences may increase reliance on late feedback.

What is sensorimotor integration

Visual, proprioceptive and tactile information may be weighted or combined less efficiently

What is timing and sequencing in motor development

Movement components may be less stable across time and practice

What is automaticity in motor development

Skills may continue to demand conscious attention after repeated practice

When does performance change

Performance changes when the individual, task or environment changes

What are the four interacting cortical representations in motor control

PPC – task state (What is happening in the task?)

PM – task action (What action will achieve the goal?)

S1 – body state (Where is the body, and what can it currently do?)

M1 – body action (What motor commands are required?)

What does PPC stand for

Posterior parietal cortex – represents task state

What does PM stand for

Premotor cortex – represents task action

What does S1 stand for

Primary somatosensory cortex – represents body state

What does M1 stand for

Primary motor cortex – represents body action

What does the basal ganglia evaluate

Expected reward, effort, cost and action value

What does the cerebellum do in motor control

Predicts future states and updates representations from prediction errors

What does coordination between cortical layers do

Translates an abstract goal into an achievable bodily movement

What is a limitation of this model

It is a computational framework, not a complete anatomical wiring diagram

What is Developmental Coordination Disorder (DCD)

A common neurodevelopmental disorder affecting the acquisition and execution of coordinated motor skills

what happens to individuals with DCD

Motor performance is substantially below that expected for age and opportunities to learn

How may movements appear in DCD

Movements may be slow, inaccurate, inconsistent or unusually effortful

What do DCD difficulties interfere with

Daily living, education, play, sport and social participation

Is DCD homogeneous

No. DCD is highly heterogeneous and commonly co-occurs with ADHD, autism and learning difficulties

Is DCD explained by low intelligence, poor motivation or another neurological condition

no

When do DCD symptoms begin and how long do they persist

Symptoms begin during development and often persist into adolescence and adulthood

Does DCD have a single known cause

No. DCD has no single known cause. It most likely develops through several interacting biological and developmental influences

Is there a genetic component to DCD

Yes. Motor coordination difficulties can run in families, although no specific "DCD gene" has been identified

What are the strongest and most consistently identified early-life risk factors for DCD

Premature birth and low birthweight

What prenatal and neonatal complications are risk factors for DCD

Placental problems, neonatal illness, respiratory complications and prolonged hospital admission may disrupt early brain development

What brain differences are associated with DCD

Differences in the maturation and connectivity of cerebellar, parietal, frontal and sensorimotor networks may impair motor learning and coordination

Can environmental influences cause DCD

Environmental influences (opportunities for movement, physical activity, healthcare, early intervention) may modify severity and functional impact but are unlikely to cause it independently

What is Criterion A for DCD diagnosis

Motor skills substantially below expectation

What is Criterion B for DCD diagnosis

Persistent functional interference

motor difficulties significantly affect age-appropriate self-care, school or work productivity, play, leisure, sport or broader participation – not simply performance on a motor test

What is Criterion C for DCD diagnosis

Developmental onset – symptoms begin in the early developmental period

What is Criterion D for DCD diagnosis

Alternative explanations excluded – deficits are not better explained by intellectual disability, visual impairment, cerebral palsy, neuromuscular disease or another neurological condition. With intellectual disability, motor skill must be below that expected for mental age

What is included in the developmental and medical history for DCD

Motor milestones, onset and course, learning opportunities, current concerns and strengths, family context, school reports and relevant medical history

What is included in standardised motor assessment for DCD

Age-appropriate testing such as the MABC-2 or BOT-2 (characterises fine motor, ball-skill and balance performance) and supports Criterion A

What is included in the functional impact assessment for DCD

Interview, observation and questionnaires such as the DCDQ, plus evidence from home, education, work, play and leisure, establish Criterion B

What is included in the clinical examination and differential assessment for DCD

Vision, neurological and musculoskeletal assessment exclude other causes. ADHD, autism, language and learning disorders may co-occur and should be assessed rather than treated as automatic exclusions

How may fine-motor difficulty appear in DCD

Slow handwriting, poor manipulation or effortful self-care

How may gross-motor difficulty appear in DCD

Balance problems, running difficulties, jumping difficulties, catching problems or difficulty learning sport skills

When does performance worsen in DCD

with novelty, speed, distraction, fatigue or dual-task demands

What does the pattern of DCD reflect

The pattern reflects the child, the task and the environment – there is no one universal deficit

Does DCD frequently overlap with other conditions

yes

How does ADHD affect the presentation of DCD

ADHD may increase variability, distractibility and difficulty sustaining deliberate motor strategies

How does autism affect the presentation of DCD

Autism may alter sensory experience, predictability needs and participation contexts

How do language and learning disorders affect the presentation of DCD

Language and learning disorders can complicate instructions, academic performance and access to intervention

Does co-occurrence invalidate DCD

No. Co-occurrence does not invalidate DCD; it changes the functional profile and support needs

Does DCD imply low intelligence, above-average intelligence or unusually high empathy

No. DCD does not imply low intelligence, above-average intelligence or unusually high empathy. These traits vary across individuals and are not defining diagnostic features

What did resting-state fMRI show about children with DCD

less functional connectivity with the sensorimotor network than typically developing peers

What brain regions showed differences in DCD

the posterior cingulate cortex, precuneus, and posterior middle temporal gyrus

What may weaker cross-network communication contribute to in DCD

inefficient integration and motor learning in DCD

What may DCD reflect at the network level

altered communication across distributed networks, not just in one isolated motor region

What neuroimaging methods have reported group-level differences in DCD

Functional MRI, structural MRI and diffusion imaging

What motor-control systems are repeatedly involved in DCD

The cerebellum, basal ganglia, parietal cortex and frontal regions, including medial OFC and DLPFC

What functions do these systems support

Prediction and error correction, action selection, sensory integration, movement planning and monitoring

Is there a diagnostic neural signature for DCD

No. Small, heterogeneous samples and different tasks produced overlapping – but not identical – patterns across studies

How is DCD better understood

as atypical development of distributed motor-control networks than failure of a single 'motor centre'

What is fractional anisotropy (FA)

A measure of white matter integrity based on the directionality of water diffusion

What is axial diffusivity

A measure of diffusion parallel to axons, reflecting axonal integrity

What is neural efficiency

The ability of the brain to perform a task successfully while using its neural resources effectively

what happens to prefrontal activity in DCD

appears to translate into performance less effectively when movement is required—especially when attention is shared

What does SPECT measure

Regional cerebral blood flow at rest, used as an indirect marker of regional neural function

What is CO-OP

Cognitive Orientation to Daily Occupational Performance – a therapy approach for DCD

what did resting-state fMRI show after CO-OP treatment

CO-OP increased DMN-right pACC connectivity; movement quality tracked DMN-cerebellar connectivity

What connectivity increased three months after CO-OP

Dorsal-attention connectivity with the left precentral gyrus

What did CO-OP strengthen

connectivity among networks supporting self-regulation, goal-directed attention and motor execution

What does the retained follow-up pattern help with

It may help sustain learning and transfer strategies to new motor tasks

What does motor learning do to functional brain networks

Motor learning can reshape functional brain networks

What other therapies are mentioned for DCD

Action observation and motor imagery (AOMI), quiet eye training, virtual reality (VR – with translatability issues), and transcranial direct current stimulation (tDCS – changes in neuroplasticity, no convincing benefit)

What is cerebral palsy (CP)

An early-onset, lifelong neurodevelopmental condition in which impaired development of movement and posture limits activity

what does cerebral palsy (CP) result from

a non-degenerative brain malformation or injury during early development

Is CP a single disease

No. CP is a broad-spectrum condition with multiple possible lesions or pathways

What are the 4 motor patterns in CP

spastic, dyskinetic, ataxic or mixed

What body regions and degree of motor limitation vary in CP

vary widely; people may walk independently, use mobility aids or use wheeled mobility

What associated features may be involved in CP

Sensation, vision, cognition, communication, epilepsy, feeding, pain and secondary musculoskeletal health

Does motor impairment define intellect or potential in CP

no

Does CP have a single cause

no

What is the nature of the brain disturbance in CP

CP follows a non-progressive disturbance of the developing brain

When may the disturbance in CP arise

before, around or after birth, and its pathway is not always identifiable

What developmental/genetic causes of CP exist

Brain malformations and pathogenic genetic variants can alter the formation and organisation of motor networks

What prematurity/low birthweight causes of CP exist

Prematurity and low birthweight are major risk factors, partly through vulnerability to white-matter injury, intraventricular haemorrhage and periventricular infarction

What vascular/hypoxic causes of CP exist

Fetal or perinatal stroke and hypoxic-ischaemic encephalopathy can permanently disrupt descending motor and sensorimotor pathways

What infection/inflammation causes of CP exist

Maternal-fetal infection, neonatal meningitis or encephalitis, and severe jaundice may injure the immature brain

What postnatal acquired causes of CP exist

Early-life trauma, stroke or severe oxygen deprivation can also produce CP when injury occurs during brain development

Are causal pathways certain in CP

No. Causal pathways are uncertain. Multiple biological and clinical factors may interact, and most infants exposed to an individual risk factor do not develop CP

What are the effects of brain disruption before 24 weeks of gestation

Disruption of proliferation, migration or cortical formation is more likely to produce congenital brain malformations

What happens between 24-34 weeks of gestation

Periventricular white matter is especially vulnerable.

Injury may involve the corticospinal tract and internal capsule, particularly after very preterm birth

What happens after 34 weeks / at birth

Cortical-subcortical and deep-grey structures become more prominent targets, including injury associated with stroke or hypoxic-ischaemic encephalopathy

What happens in early postnatal life

Acquired stroke, infection, trauma or severe oxygen deprivation can affect different structures while motor networks are still developing

What can early injury do to corticospinal organisation

Early injury can alter corticospinal competition and produce different motor-network wiring patterns, particularly in unilateral CP

How should the motor type in CP be described

spastic, dyskinetic, ataxic or mixed. More than one motor pattern may coexist

How should topography be described in CP

Describe unilateral or bilateral involvement. Limb-based terms may supplement this description but do not indicate everyday function

What is GMFCS

Gross Motor Function Classification System

what do GMFCS levels I–V describe

usual self-initiated sitting, transfers and mobility, including typical use of mobility devices