Statement of the Problem Children with bilateral cerebral palsy (BCP) oftentimes have difficulty coordinating their hands to perform bimanual tasks. However, the characteristics of bimanual coordination in children with BCP have not yet been explored. Furthermore, although intensive motor learning-based interventions such as Hand-Arm Bimanual Intensive Training Including the Lower Extremities, (HABIT-ILE) are aimed at improving bimanual function in children with BCP, there is no evidence, to date, that bimanual coordination improves in these children following interventions such as HABIT-ILE. Since the Both Hands Assessment (BoHA) is the only validated measure of bimanual performance in children with BCP, this study also sought to determine whether the kinematic measure of bimanual coordination used in this study as well as the BoHA are both responsive to change following HABIT-ILE. Methods Vicon motion capture was used to collect 3-D kinematic data during a drawer-opening task to compare bimanual coordination in 14 children with BCP with that of 14 typically developing children (TDC) using speed and hand constraints. Children with BCP classified at Manual Ability Classification System (MACS) levels I to III were also evaluated on the Box and Blocks Test (BBT), a test of unimanual dexterity, and the BoHA. The BoHA uses video analysis to evaluate spontaneous use of both hands during a board game. Correlations between temporal measures of bimanual coordination and these clinical measures of hand function and asymmetry were also examined. A subset of 6 children with BCP were evaluated on the drawer-opening task and the BoHA pre- and post-HABIT-ILE to determine the effect of HABIT-ILE on both bimanual coordination and performance and to compare the responsiveness to change between these two measures. Results Compared to TDC, children with BCP performed the bimanual task more slowly (p < 0.001) and sequentially, as evidenced by greater time differences between the two hands completing the two components of the task (p < 0.05). Performing the task at a faster speed facilitated bimanual coordination, particularly in children with BCP (p < 0.05). The use of the less affected hand to initiate the more complex component of the task under speeded conditions also had a greater facilitatory effect on bimanual coordination in children with BCP (p = 0.02). Bimanual coordination measures correlated significantly with clinical measures of hand function and asymmetry. For instance, faster task completion times correlated with higher BBT scores (Spearman’s rho ranged from r = -0.74 to r = -0.82). Following HABIT-ILE, children with BCP improved on several temporal measures of bimanual coordination (r = -0.64; p = 0.03) and the BoHA (r = -0.61; p = 0.03). Conclusion This study found significant differences in bimanual coordination between children with BCP and TDC. It also highlighted the facilitatory effect of faster speeds and hand role on bimanual coordination. Correlations between temporal measures of bimanual coordination and clinical measures of hand function suggest that children with BCP with lesser impairment of both hands are better able to coordinate their hands to perform bimanual tasks. Following HABIT-ILE, children with BCP improved significantly on several temporal measures of bimanual coordination as well as the BoHA. Thus, this study demonstrated that both a kinematic measure of bimanual coordination as well as a measure that relies on video analysis of bimanual performance were both responsive to change following HABIT-ILE.

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Tesis (MA)--Stellenbosch University, 1994. / ENGLISH ABSTRACT: Visual-motor integration plays an important role in the development of a child. Developmental deficits in this area can, for example, be detrimental to a child's school-readiness or scholastic achievements. Visual-motor integration problems should be diagnosed as early as possible so that remediation can take place. The American Beery Developmental Test for Visual-Motor Integration (VMI) is widely used as a screening technique for visual-motor abilities by psychologists, occupational therapists, educators and remedial teachers in South Africa. In order to determine whether this American standardised test offers valid results for a group of South African subjects, the results of children in the VMI:1982 and VMI:1989 were compared to their results in the South African Copying Test. A sample of 40 pre-school children from a pre-primary school in Stellenbosch were selected. Only children with normal visual acuity, who had not undergone an occupational therapy evaluation, or school readiness test, during the previous three months, were included in the sample. A significant relationship was found between the results of the VMI:1982 and VMI:1989. The results of both the VMI:1982 and VMI:1989 correlated significantly with the results of the Copying Test. Performance in the tests correlated with chronological age as well as teacher evaluation of ability development. lt was concluded that the VMI may be regarded as a valid test of visual-motor integration in the group of subjects studied. lt is recommended that future studies including children from all cultural groups in South Africa should also be undertaken. / AFRIKAANSE OPSOMMING: Visueel-motoriese integrasie speel 'n belangrike rol in die ontwikkeling van die kind. Ontwikkelingsagterstande in hierdie area kan byvoorbeeld 'n kind se skoolgereedheid of skolastiese prestasie nadelig be"invloed. Probleme ten opsigte van visueel-motoriese integrasie behoort so vroeg as moontlik opgespoor te word sodat remediering kan geskied. Die Amerikaanse BeeryOntwikkelingstoets vir Visueei-Motoriese lntegrasie {VMI) word in Suid-Afrika wyd deur sielkundiges, arbeidsterapeute, opvoedkundiges en remedierende onderwysers benut vir die evaluering van visueel-motoriese vaardighede. Om te bepaal of hierdie Amerikaans gestandaardiseerde toets geldige resultate vir 'n groep SuidAfrikaanse toetslinge !ewer, is die prestasies van kinders in die VMI:1982, sowel as die VMI:1989 met hul prestasies in die Suid-Afrikaanse Natekentoets vergelyk. 'n Steekproef van 40 voorskoolse kinders uit 'n pre-primere skool op Stellenbosch is gekies. Slegs kinders met normale gesigskerpte, en diegene wat nie gedurende die vorige drie maande 'n arbeidsterapie- of skoolgereedheidsevaluering ondergaan het nie, is by die ondersoek ingesluit. Beduidende korrelasies is tussen die VMI:1982-resultate en VM1:1989-resultate bevind. Die resultate van beide die VMI:1982 en VMI:1989 het beduidend met die van die Natekentoets gekorreleer. Prestasie in die toetse het met kronologiese ouderdom, sowel as onderwyser-beoordelings van vaardigheidsontwikkeling, gekorreleer. Daar is tot die gevolgtrekking gekom dat die VMI wel geldige resultate in die geval van hierdie spesifieke ondersoekgroep gelewer het. Verdere navorsing, wat oak kinders uit alle kultuurgroepe in Suid-Afrika insluit, word aanbeveel.

Fifty-one subjects each performed two trials which consisted of traversing a horizontal ladder. Film records were made of each trial using a high-speed camera. Absolute and relative temporal and kinematic parameters were obtained from the film records. The conclusions were that there was no age related interaction or differences in preferred rung spacing or contact/airborne times. A Chi-Square analysis did show a preference for a specific gait pattern for the six year old age group.

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