Motor competence: Test of Gross Motor Development – third

Qualitative aspects of the children’s MC were evaluated using the TGMD-3 (Ulrich 2019). The TGMD-3 is a direct observation assessment tool that measures the performance of 13 motor skills subdivided into two divergent skill categories;

LM skills, in total six skills, and BS, in total seven skills. These 13 skills comprise the sum of the TGMD-3 gross motor index, which is the most reliable score of the test (Ulrich 2019) and therefore is utilised in this study with its raw scores.

According to the author, the test can be used to identify children who are significantly behind their peers in MC, to plan programmes to improve motor skills in children showing delays and to assess changes as a function of increasing age, experience, instruction or intervention from three to 10 years old.

The qualitative aspects of each skill and their scoring are reported in more detail below. First is a summary of six LM skills evaluated by points with their performance criteria, as follows:

1. Run (0-8 points) for 15 metres, with criteria such as 1) arms move in opposition to legs with elbows bent, 2) brief period where both feet are off the ground, 3) narrow foot placement landing on heel or toes (not flat-footed), 4) non-support leg bent about 90 degrees so foot is close to buttocks;

2. Gallop (0-8 points) for seven metres, with criteria such as 1) arms flexed and swinging forward, 2) a step forward with the lead foot followed by the trailing foot landing beside or a little behind the lead foot (not in front of the lead foot), 3) brief period where both feet come off the ground, 4) maintains a rhythmic pattern for four consecutive gallops;

3. Hop (0-8 points) for a minimum of five metres, with criteria such as 1) non-hopping leg swings forward in pendular fashion to produce force, 2) foot of non-hopping leg remains behind hopping leg (does not cross in front of), 3) arms flex and swing forward to produce force, 4) hops four consecutive times on the preferred foot before stopping;

4. Skip (0-6 points) for a minimum of nine metres, with criteria such as 1) a step forward followed by a hop on the same foot, 2) arms are flexed and move in opposition to legs to produce force, 3) completes four continuous rhythmical alternating skips;

61 5. Horizontal jump (0-8 points), with criteria such as 1) prior to take off, both knees are flexed and arms are extended behind the back, 2) arms extend forcefully forward and upward, reaching above the head, 3) both feet come off the ground together and land together, 4) both arms are forced downward during landing;

6. Slide (0-8 points) for a minimum of seven metres, with criteria for the preferred side (first three criteria) and for non-preferred side (fourth criterion) including 1) body is turned sideways so shoulders remain aligned with the line on the ground, 2) a step sideways with the lead foot followed by a slide with the trailing foot where both feet come off the ground briefly, 3) four continuous slides (preferred side), 4) four continuous slides (non-preferred side).

Each child performed each skill twice, and his/her evaluation score was the sum of the received points during these two performances. These two trials were observed and analysed by an educated observer (DN or PMH) based on the fulfilment of the given criteria (three to four criteria for one skill), who accordingly evaluated each skill (zero points if the given criteria were not fulfilled, one point if they were met). Consequently, the maximum total of points in LM skills was 46 points. The same protocol was followed in BS; a summary of the seven skills follows:

7. Two-hand strike of a stationary ball (0-10 points) replaced at the child’s waist level, with criteria such as 1) child’s preferred hand grips bat above non-preferred hand, 2) child’s non-preferred hip/shoulder faces straight ahead, 3) hip and shoulder rotation during swing, 4) steps with non-preferred foot, 5) hits ball, sending it straight ahead;

8. One-hand forehand strike (0-8 points) from waist height off the bounce, with criteria such as 1) child takes a backswing with the paddle when the ball is bounced, 2) steps with non-preferred foot, 3) strikes the ball towards the wall, 4) paddle follows through towards non-preferred shoulder;

9. One-hand stationary dribble (0-6 points), with criteria such as 1) contacts ball with one hand at about waist level, 2) pushes the ball with fingertips (not slapping at the ball), 3) maintains control of the ball for at least four consecutive bounces without moving the feet to retrieve the ball;

10. Two-hand catch (0-6 points) from four metres distance, with criteria such as 1) child’s hands are positioned in front of the body with the elbows flexed, 2) arms extend reaching for the ball as it arrives, 3) ball is caught by hands only;

11. Kicking a stationary ball (0-8 points), which is replaced in six metres and the child runs from two metres towards the stationary ball and kicks it. The performance criteria for the kick include 1) rapid, continuous approach to the ball, 2) child takes an elongated stride or leap just prior to ball contact, 3) non-kicking foot placed close to the ball, 4) kicks ball with insteps or inside of preferred foot (not the toes);

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12. Overhand throw (0-8 points) with a tennis ball onto a wall with a distance of six metres, with criteria such as 1) windup is initiated with a downward movement of a hand and arm, 2) rotates hip and shoulder to a point where the non-throwing side faces the wall, 3) steps with the foot opposite the throwing hand towards the wall, 4) throwing hand follows through after the ball’s release across the body towards the hip of the non-throwing side;

13. Underhand throw (0-8 points) with a tennis ball onto a wall with a distance of four metres, with criteria such as 1) preferred hand swings down and back, reaching behind the trunk, 2) steps forward with the foot opposite the throwing hand, 3) ball is tossed forward, hitting the wall without a bounce, 4) hand follows through after ball release to at least chest level.

As each child performed each skill twice, his/her evaluation score was the sum of the received points during these two performances. The maximum total points for BS was 54 points. Finally, the TGMD-3 gross motor index, which is the sum of the LM skills and BS, has a theoretical maximum of 100 points (Appendix 6).

In the measurements, according to the manual’s instructions, each child had three trials. The first was a practise trial, where child could have a try at the given task after researcher had demonstrated the task. Children completed the practise trial together in a queue or side by side, depending on the space. Afterwards, each child completed the two sequential trials in turn. The proper assessment trials were done one by one. During the data collection, the children completed the assessments in groups of three to five children. One session with each group took approximately 45 to 60 minutes.

Before starting the data collection, two observers were trained to observe the children’s performance, and both (DN & PMH) passed Ulrich’s official TGDM-3 reliability test performed via video-analysis. However, as the majority of the data were analysed based on live observation in Skilled Kids, we also video-analysed the performances at the beginning of the data collection to be sure that the measurements were observed in reliable manner and to assure that the interrater reliability between the observers was appropriate. Therefore, during autumn 2015, all the assessments were observed live (DN) and additionally video observed (PMH). The results and evaluations were compared (n = 167) and analysed to obtain reliability for the observation. To determine interrater reliability between the two observers, both coded the same performance for the 167 children. Interrater reliability was calculated based on a two-way random model of consistency for single measures. Interrater reliability between the observers for the TGMD-3 gross motor index was 0.88 (95% CI = 0.85–0.92). This is considered to be excellent (Nunnaly & Bernstein 1994). To conclude, overall, the TGMD-3 has been demonstrated to have good to excellent intrarater and interrater reliability (Ulrich 2019), and it has been found to be valid and reliable both internationally (Cools et al. 2009) and nationally (Rintala et al. 2017).

63 4.6.2 Motor competence: Körperkoordinationstest für Kinder (KTK)

To have complementary information about the gross motor coordination, balance and body control of children aged five to seven years in the Skilled Kids study, participants also completed the Körperkoordinationstest für Kinder (KTK) assessment (Kiphard & Schilling 2007). In this product-oriented assessment tool, evaluation is based on the total score of the four items included in the test battery.

As the test is result-based, the theoretical total maximum points cannot be specified. However, in this study sample, the maximum value of one child was 197 points.

According to the authors, KTK is suitable for typically developed children as well as for identifying motor problems and impairments in children until the age of 14. Contrary to the TGMD-3, it is not based on single movement skills, and therefore, it is not quickly learned (Cools et al. 2009). The four test items include the following:

1. Walking backwards eight steps on balance beams (length 3 m, height 5 cm) with divergent widths of 6.0 cm, 4.5 cm and 3.0 cm. The first of the three trials was performed from the widest beam. The maximum for each trial was eight successful steps, resulting an overall maximum score of 24 points per width (3 × 8 points). The maximum score for walking backwards including all widths was 72 points (3 × 24 points);

2. Hopping for height on one leg over an increasing obstacle (width 60 cm, depth 20 cm, height 5 cm each). The first, second and third trial of each height gave three, two or one point(s), respectively. The maximum score for one leg was 39 points, thus the theoretical maximum for both legs was 78 points;

3. Jumping laterally from side to side for 15 seconds over a thin wooden lath (60 cm × 4 cm × 2 cm) on a jumping base (100 cm × 60 cm). There were two trials, and the sum of the number of correct jumps in two trials was the scoring of this item;

4. Shifting between two platforms (size 25 cm × 25 cm, height 5.7 cm) as quickly as possible for 20 seconds. Transitions were performed in the same direction with the two given trials. The result was the sum of the number of points in the two trials.

Each skill was performed and observed carefully following the manual’s instructions by experienced observers (DN, AS, VN & PMH). During the data collection, each child completed the assessment within a group of three to five children. For one child, the test took approximately 20 to 30 minutes. Finally, the sum of these latter scores yielded the total sum score for the KTK test (Appendix 7). The raw score was used in the present analysis, as recommended (Bardid, Huyben et al. 2016; Iivonen et al. 2015).

With this study sample, we did not specifically analyse the intrarater reliability between the observers, as KTK is considered to be highly reliable

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internationally, most likely because it is result-based. KTK’s test‐retest reliability coefficient for the total score is 0.97, and the subtests range between 0.80 and 0.96 (Kiphard & Schilling 2007).

4.6.3 Perceived motor competence: The Pictorial Scale of Perceived