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Motor skill disorder — Clinical Guidelines

Overview

Motor skill disorders encompass a range of conditions affecting the development and execution of motor abilities, impacting various aspects of physical function and coordination. These disorders can manifest in both children and adults, often requiring targeted interventions for improvement. 2 28 29

Diagnosis

Clinical Assessment: Evaluation of motor performance through standardized tests and observational methods. 2 29

Psychomotor Assessments: Utilization of specific motor skill tests to identify deficits in coordination, strength, and dexterity. 2 30 33

Grading Systems: Use of scales like the American College of Graduate Medical Education (ACGME) milestones for surgical skills to quantify proficiency levels. 9

Management

Intervention Programs: Participation in structured motor skill intervention programs, such as the Children's Health Activity Motor Program (CHAMP), which shows promise in improving perceived motor competence. 2

Simulation Training: Implementation of simulation-based training for procedural skills like nasolaryngoscopy, bronchoscopy, and flexible cystoscopy to enhance proficiency and safety. 1 3 5 16 17 21

Cognitive Training: Incorporation of cognitive training methods, including mental practice and action observation, to augment motor skill acquisition. 4 13 28

Virtual Reality (VR): Utilization of VR simulators for skill acquisition in procedures such as endoscopy and robotic surgery to provide realistic training environments. 16 17 27

Special Populations

Pediatrics: Tailored motor skill interventions, such as CHAMP, are effective in improving motor competence in preschoolers. 2

Elderly: Specific attention to visuospatial aptitude and manual dexterity training may be beneficial, though direct evidence is limited in this population. 9 15

Comorbidities: No specific evidence provided in abstracts regarding unique management approaches for motor skill disorders in the presence of comorbidities. 2 3 4

Key Recommendations

Implement structured motor skill intervention programs, such as CHAMP, for children to enhance perceived motor competence. (Evidence: Moderate) 2

Utilize simulation and virtual reality training tools to improve procedural skills in medical trainees, ensuring proficiency and safety. (Evidence: Strong) 1 5 16 17

Incorporate cognitive training methods, including mental practice and action observation, to complement physical training for motor skill acquisition. (Evidence: Moderate) 4 13

References

1 Clements AC, Fernández-Penny FE, Bindschadler M, Le H, Meyer TK, Friedman SD et al.. Metrics of Proficiency in a 3D-Printed Spatially-Calibrated Flexible Nasolaryngoscopy Trainer. The Laryngoscope 2026. link 2 George-Komi L, Palmer KK, Palmer SA, Nunu MA, Robinson LE. Sex Differences in Perceived Motor Competence After the Children's Health Activity Motor Program Intervention. Journal of sport & exercise psychology 2023. link 3 Voduc N, Adamson R, Kashgari A, Fenton M, Porhownick N, Wojnar M et al.. Development of Learning Curves for Bronchoscopy: Results of a Multicenter Study of Pulmonary Trainees. Chest 2020. link 4 Gould SJ. Action-Observation in Fine Motor Learning Applying Neuropsychology Principles to Enhance Academic Teaching in the Field of Rheumatology A Pilot Study. Bulletin of the Hospital for Joint Disease (2013) 2020. link 5 Nitsche JF, Knupp RJ, Tooze JA, Sun CH, Jin S, Brost BC. Using Simulation to Define the Learning Curve for the Digital Cervical Examination. Obstetrics and gynecology 2019. link 6 Gilmour-White JA, Picton A, Blaikie A, Denniston AK, Blanch R, Coleman J et al.. Does access to a portable ophthalmoscope improve skill acquisition in direct ophthalmoscopy? A method comparison study in undergraduate medical education. BMC medical education 2019. link 7 Joshi K, Hernandez J, Martinez J, AbdelFattah K, Gardner AK. Should they stay or should they go now? Exploring the impact of team familiarity on interprofessional team training outcomes. American journal of surgery 2018. link 8 Shah M, Aydin A, Moran A, Khan MS, Dasgupta P, Ahmed K. The role of cognitive training in endourology: a randomised controlled trial. Actas urologicas espanolas 2018. link 9 Hinchcliff E, Green I, Destephano C, Cox M, Smink D, Kumar A et al.. Visuospatial Aptitude Testing Differentially Predicts Simulated Surgical Skill. Journal of minimally invasive gynecology 2018. link 10 Kwok J, Liao W, Baxter S. Evaluation of an online peer fundus photograph matching program in teaching direct ophthalmoscopy to medical students. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 2017. link 11 Fent G, Gosai J, Purva M. A randomized control trial comparing use of a novel electrocardiogram simulator with traditional teaching in the acquisition of electrocardiogram interpretation skill. Journal of electrocardiology 2016. link 12 Kowalewski TM, Sweet R, Lendvay TS, Menhadji A, Averch T, Box G et al.. Validation of the AUA BLUS Tasks. The Journal of urology 2016. link 13 Conlin A, Lea J, Bance M, Chadha N, Kilty S, Kozak F et al.. Mental practice in postgraduate training: a randomized controlled trial in mastoidectomy skills. Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 2016. link 14 White LW, Kowalewski TM, Dockter RL, Comstock B, Hannaford B, Lendvay TS. Crowd-Sourced Assessment of Technical Skill: A Valid Method for Discriminating Basic Robotic Surgery Skills. Journal of endourology 2015. link 15 Tang CG, Hilsinger RL, Cruz RM, Schloegel LJ, Byl FM, Rasgon BM. Manual dexterity aptitude testing: a soap carving study. JAMA otolaryngology-- head & neck surgery 2014. link 16 Zhang Y, Liu JS, Wang G, Yu CF, Zhu H, Na YQ. Effectiveness of the UroMentor virtual reality simulator in the skill acquisition of flexible cystoscopy. Chinese medical journal 2013. link 17 Vaccaro CM, Crisp CC, Fellner AN, Jackson C, Kleeman SD, Pavelka J. Robotic virtual reality simulation plus standard robotic orientation versus standard robotic orientation alone: a randomized controlled trial. Female pelvic medicine & reconstructive surgery 2013. link 18 Lee HH, Song KY, Park CH, Jeon HM. Training of surgical endoscopists in Korea: assessment of the learning curve using a cumulative sum model. Journal of surgical education 2012. link 19 Jenison EL, Gil KM, Lendvay TS, Guy MS. Robotic surgical skills: acquisition, maintenance, and degradation. JSLS : Journal of the Society of Laparoendoscopic Surgeons 2012. link 20 Smith SE, Tallentire VR, Spiller J, Wood SM, Cameron HS. The educational value of using cumulative sum charts. Anaesthesia 2012. link 21 Giglioli S, Boet S, De Gaudio AR, Linden M, Schaeffer R, Bould MD et al.. Self-directed deliberate practice with virtual fiberoptic intubation improves initial skills for anesthesia residents. Minerva anestesiologica 2012. link 22 Asman P, Lindén C. Internet-based assessment of medical students' ophthalmoscopy skills. Acta ophthalmologica 2010. link 23 Furnée EJ, van Empel PJ, Mahdavian Delavary B, van der Peet DL, Cuesta MA, Meijerink WJ. Evaluation of a technical skills training program in surgical residents. Journal of laparoendoscopic & advanced surgical techniques. Part A 2009. link 24 Mackel TR, Rosen J, Pugh CM. Markov model assessment of subjects' clinical skill using the E-Pelvis physical simulator. IEEE transactions on bio-medical engineering 2007. link 25 Gupta RR, Lam WC. Medical students' self-confidence in performing direct ophthalmoscopy in clinical training. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 2006. link 26 Hilmi OJ, White PS, McGurty DW, Oluwole M. Bronchoscopy training: is simulated surgery effective?. Clinical otolaryngology and allied sciences 2002. link 27 Berg D, Raugi G, Gladstone H, Berkley J, Weghorst S, Ganter M et al.. Virtual reality simulators for dermatologic surgery: measuring their validity as a teaching tool. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 2001. link 28 Henatsch HD, Langer HH. Basic neurophysiology of motor skills in sport: a review. International journal of sports medicine 1985. link 29 Shea JB, Hunt JP. Motor control. Clinics in sports medicine 1984. link 30 Mosher RE, Schutz RW. The development of a test of overarm throwing: an application of generalizability theory. Canadian journal of applied sport sciences. Journal canadien des sciences appliquees au sport 1983. link 31 Peltenburg AL, Erich WB, Bernink MJ, Huisveld IA. Selection of talented female gymnasts, aged 8 to 11, on the basis of motor abilities with special reference to balance: a retrospective study. International journal of sports medicine 1982. link 32 Singer RN. Cognitive processes, learner strategies, and skilled motor behaviors. Canadian journal of applied sport sciences. Journal canadien des sciences appliquees au sport 1980. link 33 Pytel JL. The relation of kinematic factors to the acquisition of skill on a novel task. Canadian journal of applied sport sciences. Journal canadien des sciences appliquees au sport 1980. link 34 Kirby TJ. Dexterity testing and residents' surgical performance. Transactions of the American Ophthalmological Society 1979. link

Motor skill disorder