Feasibility of the Circuit Checklist as an easy gross motor assessment for preschool children using recorded videos: a pilot study 

Feasibility of the Circuit Checklist as an easy gross motor assessment for preschool children using recorded videos: a pilot study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Feasibility of the Circuit Checklist as an easy gross motor assessment for preschool children using recorded videos: a pilot study Hala Zeidan, Anuradhi Bandara, Keisuke Irie, Kohei Mukaiyama, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4416101/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Motor development of children is variable. Equally, motor impairments are also variable, making screening and assessments of motor abilities and motor delays difficult, especially during early childhood development in a school setting. Several assessment methods for motor function exist from performance tests to questionnaires, done by therapists, teachers, or parents. However, such assessments may be expensive, time consuming for the teachers and the children, difficult to conduct in a group setting, and the results are controversial. Purpose To test the feasibility of a Circuit Checklist for gross motor assessment in a school setting. Methods We enchained exercises into a circuit play and created a detailed checklist of these movements and tested the motor function of children in a special needs’ classroom. Then we calculated its concurrent validity with the Gross Motor Score (GMS) of Movement Assessment Battery for Children − 2nd edition (MABC-2) using Pairwise correlation, test-retest reliability using test-retest correlation, inter-rater reliability between two testers using inter-rater correlation, and the internal consistency of the circuit checklist items using Cronbach’s alpha. Results We found that seven circuit movements and their checklist items are valid and have a moderate correlation of 0.6421 with GMS of MABC-2, a high degree of precision in the estimates of inter-rater reliability (range: 0.589–0.856), and a moderate internal consistency (Cronbach’s Alpha: 0.666). Conclusion This Circuit Checklist could be a useful first step tool to screen motor impairments of preschool children, in a school setting. Ultimately, the checklist items would be useful to create a motion capture screening tool more practically used in classrooms. pediatric motor ability coordination pediatric motor screening circuit checklist MABC-2 Figures Figure 1 INTRODUCTION Motor development starts as early as in the fetal stage and continues until preschool age [ 1 ], during that, basic motor skills and behavior significantly develop [ 1 , 2 ], and become specialized complex and functional skills by the age of eight [ 1 , 2 ]. Basic movement skills and fitness components need to be developed equally during early stages of growth [ 3 , 4 ]. It is favorable to accomplish these skills by school age as development slows down as inactivity increases, while the child carries over the base of motor skills learned in preschool [ 2 ]. At this age, physical exercises including variable activities of different intensities are recommended, since it also affects both the physical and mental well-being [ 4 ]. However, motor skills mastery is variable between children because of the complexity of motor skills and the neural control mechanism, developmental delays, or impairments, and the environment [ 1 ]. Children’s morphological growth is reported to mask both the improvement and deterioration of motor efficiency [ 2 ], and it is difficult to judge whether the child is having motor difficulties because of impairment or lack of experience [ 1 ]. In all cases, prevention measures are encouraged to start at early age [ 1 , 5 ], before entering school where motor demands increase [ 1 ]. If left without appropriate support, these motor impairments will affect the child’s life into adulthood [ 1 , 6 ]. Individuals with motor impairments, especially those with Developmental Coordination Disorder (DCD), are reported to participate less in or withdraw from physical activities, have lower physical fitness and obesity, higher risk of cardiovascular problems [ 1 , 6 ] and cardiorespiratory diseases [ 1 ]. Motor impairments also have secondary effects that involve social and emotional health, academic and daily life function, decreased self-perception and self-worth, increased levels of anxiety and depression – as young as the age of four [ 1 ]. Therefore, early identification and interventions are necessary for such children to improve and prevent secondary health and social problems [ 6 ], inactivity and academic problems [ 7 ]. However, identification is still complicated, delayed or ignored because of lack of awareness, the variability of motor development [ 1 ] and DCD disorder [ 7 ]. Knowing and following up the level of physical function is a priority for public health [ 4 ] and teachers in the educational setting are the first wall of defense for identification of motor impairments and prevention from secondary impairments. There are several standardized assessment methods to measure motor abilities of preschool children, such as: Movement Assessment Battery for Children − 2nd edition (MABC-2), Bruininks-Oseretsky Test for Motor Proficiency – 2nd edition, McCarron Assessment of Neuromuscular Development, Peabody Developmental Motor Scales – 2nd edition [ 1 , 8 ], among others. However, these are conducted individually and are time consuming for the child and the teacher (especially for children with special needs [ 9 ]), expensive [ 1 , 8 ], and may be difficult to score or interpret by the teachers [ 1 ]. Among these tests, MABC-2 is the one widely used as a gold standard test for motor coordination and performance [ 1 , 10 , 11 ]. There are also questionnaires designed for the parents or the teachers to assess preschool children, such as: Developmental Coordination disorder Questionnaire [ 12 ], Five to Fifteen Questionnaire [ 12 ], MABC-2 Checklist [ 13 ], among others. However, although parents and teachers are a reliable source to assess children’s motor ability, correlation between their results and motor test results are controversial and may be inadequate for diagnosis [ 12 ]. Assessment methods like observational tests are reported to be effective and inexpensive pre-screening tools for difficulties in movement coordination, that can be done at school [ 7 , 14 ]. Meanwhile, summed up and standardized scores of test items do not allow for specific determination of the deficit or delay the child may have [ 1 ]. What’s more, misleading results may appear when the assessment tool used are not appropriate for the purpose of the assessment, or when the children lack experience in doing the test movement, lack motivation and cooperation to do the test or when they are having a bad day [ 1 ]. Therefore, the goal of this pilot study is to create an observational tool based on the biomechanical steps of the movements assessed, and on motor developmental milestones, in a playful group setting. This tool would be for teachers working in special needs’ classrooms to help them specifically recognize and appropriately help their students at an early age if needed. It would also allow the teachers to refer the parents to further professional assessments. It would also serve as a base method for the development of a digitalized version of the assessment based on motion capture. METHODS This was a pilot study aiming to test the feasibility of a new gross motor screening method and which was approved by the ethical committee of Kyoto University, Japan (approval number: R-2929). Children (n = 32) were recruited from special-needs support classrooms belonging to the same company in Osaka, Japan, between June 2021 to December 2021. Written letters explaining the purpose of the study with a consent form were sent to the parents and the children. The children with written consent from their parents were included in the study. Children with physical dependence or with difficulties comprehending the contents of the tests, or children who refused to do or continue the assessments on the test days were the exclusion criteria from the analysis as it may affect the results. Circuit Checklist The new assessment consisted of a circuit and a checklist sheet. The circuit consisted of 12 sections and 98 checklist items: 1) waiting for turn (2 items), 2) obstacle run (6 items), 3) ball catch (9 items), 4) ball kick (8 items), 5) walking backwards (4 items), 6) wheelbarrow (9 items), 7) bean bag grasp (3 items), 8) bean bag throw (11 items, repeated twice), 9) jumping on foot shapes (13 items), 10) long jump (5 items), 11) balance on one leg (7 items, tested on both legs), 12) rules (3 items). The circuit’s setting and description are attached in the appendix. These exercises and their grading were based on practice inside the classroom, previous studies [ 10 , 11 , 13 , 15 , 16 ] and the developmental milestones [ 17 ]. It was designed by a PhD holder physiotherapist working with special needs children. The checklist sheet was represented as a table containing 12 sections and their checklist items representing the description of the movement chaining from a biomechanical point of view. A demonstration was first given by the physiotherapist and the teacher before starting the assessment of each child one at a time. A video recording using a mobile phone was taken for each child. The physiotherapist later observed each video on a computer and marked the checklist sheet. A (✔) was marked for accomplish items, and ( x ) was marked for unaccomplished items. The number of (✔) were calculated as the total Circuit Checklist score. The same videos were also observed and marked by another physiotherapist for inter-rater reliability of the checklist. Further, six children were tested again using the same Circuit Checklist two weeks after the first trial for test-retest reliability. Movement Assessment Battery for Children − 2nd edition MABC-2 consists of tests in three areas. The first is manual dexterity skills (MD) containing three tests. The second is aiming and catching skills (A&C) containing two tests assessing throwing and catching abilities. The third is balance skills (BAL) containing three tests assessing static and dynamic balance. The detailed rules of the tests and the scoring methods are carefully explained in the MABC-2 Manual [ 15 ]. As the Circuit Checklist contains gross motor skills only, making MD outside the scope of the checklist’s aim, the Gross Motor Score (GMS) from MABC-2 was calculated by combining the standard score (SS) from each item of A&C and BAL tests multiplied by 3 and divided by 5: (A&C SS + BAL SS)*3/5 (Fig. 1). This calculation method was used in a previous study [ 18 ]. [Figure 1] FIGURE 1 Movement Assessment Battery for Children – 2nd edition’s components and scoring method, and its gross motor score’s calculation method. Gross motor score is calculated using the standard scores from Aiming & Catching and Balance tests and multiplying it by 3 and dividing by 5. Statistical methods JMP Pro 17 (SAS Institute Inc., Cary, NC, USA) was used to test for correlation of the movement sections of the checklist in the first step and concurrent validity of the total checklist score, in relation to GMS, by Pairwise correlation and Spearman’s correlation. IBM SPSS version 28.0 (IBM Corp., Armonk, NY, USA) was used to test for test-retest reliability using the intra-class correlation coefficient for each movement section; inter-rater reliability using inter-rater correlation coefficient computed for each movement section, and internal consistency of the movement sections by Cronbach’s alpha. The data of 32 children were analyzed for validity with MABC-2 and inter-rater reliability, and six children for intra-rater reliability. RESULTS Demographics The 32 children’s age ranged between 3 to 7 years old (4.5 ± 1.16; 3 years old = 7; 4 years old = 10; 5 years old = 7, 6 years old = 7; 7 years old = 1). Their average body weight was 17.98 ± 3.72 kilograms, their bogy height 1.08 ± 0.12 meters and their average BMI was 15.28 ± 1.38 kg/m2. MABC-2 total score’s average was 60.81 ± 14.58 and the Gross Motor score average was 38.31 ± 7.6, while the total checklist score’s averages were 26.75 ± 5.17 for the first tester and 24.03 ± 5.25 for the second tester. Correlation of the circuit movements to GMS and reduction of movements and items The correlation between the scores of each of the 12 movement sections (Table 1) and the checklist items and the GMS of the main tester were analyzed. This was done to reduce the number of items that may not correlate with GMS and affect the assessment, as a first step of the analysis in this study. The movement sections “Wheelbarrow”, “Jumping on foot shapes” and “Balance on one leg (longest)” had a significantly positive correlation with GMS. The movement sections “Waiting for turn”, “Obstacles run”, “Walking backwards”, “Beanbag grasp”, “Beanbag throw (1 st time)”, “Balance on one leg (best)” and “Rules” had lower correlations and were reduced from the checklist, keeping seven movement sections for further analysis. TABLE 1 First Circuit Checklist movement sections and the number of checklist items, and pairwise correlation results between these movement sections and GMS Movement Section Number of checklist items Correlation to GMS Significance 1) Waiting for turn 2 items -0.0025 0.9892 2) Obstacles run 6 items 0.0934 0.6112 3) Ball catch 9 items 0.2085 0.2520 4) Ball kick 8 items 0.2321 0.2011 5) Walking backwards 4 items 0.0058 0.9749 6) Wheelbarrow 9 items 0.6328 <0.0001* 7) Beanbag grasp 3 items -0.0675 0.7134 8) Beanbag throw (1 st time) 11 items -0.0495 0.7880 8) Beanbag throw (2 nd time) 11 items 0.0141 0.9388 9) Jumping on foot shapes 13 items 0.4238 0.0157* 10) Long jump 5 items -0.0308 0.8671 11) Balance on one leg (longest) 7 items 0.3803 0.0318* 11) Balance on one leg (best) 7 items 0.2730 0.1305 12) Rules 3 items -0.0735 0.6892 Total Circuit Checklist score 98 items 0.6107 <0.0001* Correlation between the first Circuit Checklist’s movement sections and concurrent validity the total Circuit Checklist score, compared to gross motor score, were analyzed using Pairwise correlation. *p<0.05. GMS, gross motor score. Table 2 shows the final seven movement sections and their detailed checklist items that were modified and included in the second part of the analysis of this study. “Wheelbarrow” had a positive strong linear correlation to GMS; “Jumping on foot shapes” and “balance on one leg (longest)” had a positive moderate correlation to GMS; “Ball catch” had a positive weak correlation to GMS and the other movement sections had none to very weak correlation to GMS. [Table 2] TABLE 2 Final Circuit Checklist movement sections and pairwise correlation results between these movement sections and GMS Movement Section Correlation to GMS Checklist item contents 1) Ball catch 0.3079 (p=0.0865) Got ready to catch the ball Caught the ball without trapping it with the body and did not lose it Looked at the ball and followed its trajectory, and did not close their eyes or move their head when catching or trying to catch the ball Moved their limbs to adjust their body position to the ball’s trajectory Did not lose balance when catching the ball or when trying to catch the ball 2) Ball kick 0.2731 (p=0.1305) Used the right amount of force Did not lose balance nor trunk stability The ball was directed to the goal Took a moment to look at the goal and the ball before kicking the ball No fidgeting, no excessive or exaggerated movements 3) Wheelbarrow 0.7178 (p<0.0001*) The child was held at the ankles Kept elbows extended The fingers were pointed towards the goal Kept trunk straight and away from ground Kept the knees extended Kept the neck extended looking ahead and did not keep looking at the hands Did not tire halfway, nor took a few seconds break Did not complain about the exercise being difficult (including sounds) Reached the goal 4) Bean bag throw 0.0268 (p=0.8842) Did not step closer to the goal Looked at the goal before throwing and while throwing the bean bag Posture was stable while throwing Used the right amount of force The bean bag reached the goal or its borders without skimming the floor first 5) Jumping on foot shapes 0.5151 (p=0.0026*) Cards 1 and 2: the right foot and the left foot took off and landed at the same time when jumping twice on both feet Cards 3 and 4: successively hopped twice on the right leg with the left leg raised above ground Cards 6 and 7: successively hopped twice on the left leg with the right leg raised above ground Switched feet smoothly between the cards Did not mistake any of the foot shapes Did not skip any of the cards Tracked/looked at the next foot shape Jumped once on each card Cards 9 and 10: flipped the body 180° while jumping and stepped on the correct card at landing 6) Long jump 0.0213 (p=0.9078) Card 10 and 11: The right foot and the left foot took off and landed at the same time Reached the goal or its borders Arms and legs were coordinated Did not lose balance on landing 7) Balance on one leg (longest) 0.5086 (p=0.0030*) Please record the number of seconds for each side (In relation to age and motor milestones: 2 to 3 years old: 2s, 4 to 5 years old: 10s, 6 years and above: 30s) Kept initial posture The trunk, the feet and the ankles were stable Did not move the arms to adjust or maintain balance Did not support the free leg on the test leg nor held it with their hand Total Circuit Checklist score 0.6421 (p<0.0001*) Items reduced to 42 items Correlation between the final Circuit Checklist’s movement sections and concurrent validity the total Circuit Checklist score, compared to gross motor score, were analyzed using Pairwise correlation. The numbers between brackets are previous studies’ references. *p<0.05. GMS, gross motor score. °, degrees. s, seconds. Concurrent validity of the Circuit Checklist total score and GMS from MABC-2 The concurrent validity of the modified and final circuit checklist total score and gross motor score was 0.6421 (p<0.0001*) using Pairwise correlation and 0.6538 (p<0.0001*) using Spearman’s correlation, indicating a moderate correlation. Test-retest reliability Test-rest reliability results of the seven movement sections are shown in Table 3. The intra-class correlation coefficient values ranged from -0.029 to 0.915, with “Jumping on foot shapes” showing the strongest correlation and “Balance on one leg (longest)” showing a negative correlation that was not statistically significant. TABLE 3 Test-retest reliability results for the final remaining movement sections Movement section n Test-Retest Correlation (ICC) 95% CI Lower bound Upper bound 1) Ball catch 6 0.615 -0.315 0.937 2) Ball kick 6 0.384 -0.676 0.888 3) Wheelbarrow 6 0.524 -0.189 0.910 4) Bean bag throw 6 0.375 -0.363 0.872 5) Jumping on foot shapes 6 0.915 0.568 0.987 6) Long jump 6 0.681 -0.186 0.949 7) Balance on one leg (longest) 6 -0.029 -1.084 0.777 Test-retest reliability was calculated using intra-class correlation coefficient. *p<0.05. n, number of participants. ICC, intra-class correlation coefficient. CI, confidence interval. Inter-rater reliability Inter-rate reliability results of the seven movement sections are shown in Table 4. Inter-rater correlation coefficient values were computed for each movement section, which ranged from 0.589 to 0.856. “Ball catch”, “Ball kick”, “Long jump” and “Balance on one leg (longest)” demonstrated the strongest inter-rater reliability, with values of 0.856, 0.710, 0.782, and 0.711, respectively. “Wheelbarrow”, “Bean bag throw” and “Jumping on foot shapes” showed moderate inter-rater reliability, with values ranging from 0.589 to 0.696. TABLE 4 Inter-rater reliability between the two testers’ results for the final remaining movement sections Movement section n Inter-rater Correlation 95% CI Lower bound Upper bound 1) Ball catch 32 0.856 0.694 0.931 2) Ball kick 32 0.710 0.415 0.857 3) Wheelbarrow 32 0.598 0.181 0.803 4) Bean bag throw 32 0.589 0.080 0.810 5) Jumping on foot shapes 32 0.696 -0.153 0.896 6) Long jump 32 0.782 0.546 0.895 7) Balance on one leg (longest) 32 0.711 0.051 0.889 Inter-rater reliability between the two testers was calculated using inter-rater correlation coefficient. *p<0.05. n, number of participants. CI, confidence interval. Internal consistency of the remaining Movement Sections Cronbach's alpha of the internal consistency of the checklist yielded a value of 0.666, and the Cronbach’s Alpha based on standardized items a value of 0.664, indicating moderate internal consistency. The corrected item-total correlations (Table 5) showed that the item with the highest correlation was "Wheelbarrow" and the item with the lowest correlation was "Long jump". When examining the impact of deleting each item, "Wheelbarrow" had the greatest impact on reliability, resulting in a Cronbach's alpha of 0.532 if that item were deleted, while "Long jump" had the least impact, resulting in a Cronbach's alpha of 0.685 if that item was deleted. TABLE 5 Corrected item-total correlation of the final remaining movement sections Movement Section Corrected Item-Total Correlation Cronbach's Alpha if Item Deleted 1) Ball catch 0.528 0.587 2) Ball kick 0.294 0.651 3) Wheelbarrow 0.700 0.532 4) Bean bag throw 0.265 0.658 5) Jumping on foot shapes 0.473 0.622 6) Long jump 0.117 0.685 7) Balance on one leg (longest) 0.330 0.643 Corrected item-total correlation of the final Circuit Checklist movement sections was analyzed using Cronbach’s Alpha. Discussion In this study, we have tested the feasibility of a new assessment checklist in the form of a circuit-play based on a biomechanical perspective and tested its validity with MABC-2 and its reliability. There were 12 movement sections in the first step of the analysis reduced to seven movement sections and further tested in the second step of this study’s analysis. The final circuit movement sections were seven exercises as follows: 1) Ball catch, 2) Ball kick, 3) Wheelbarrow, 4) Bean bag throw, 5) Jumping on foot shapes, 6) Long jump, 7) Balance on one leg (longest), which can be chaining one after the other in a small classroom. These seven movements forming a circuit play, and their checklist items, appear to be a future potential tool to screen children with motor difficulties at early stage in a school setting. We have chosen a playful circuit style in this study as this kind of activity combines a succession of movements. We based the circuit’s movements on movements from previous assessments and the environment of the children [ 10 , 11 , 13 , 15 – 17 , 19 – 26 ]. Circuits are usually used in training exercises and formed of successive sections where the child trains a specific function in each section, as in explosive strength, speed, and aerobic endurance [ 3 ]. When the child finishes the task of one section, they move to the next one [ 4 ], which made us choose it as method to assess several movements at once in a group setting. Meanwhile, children usually master the exercises from their environment [ 19 ] therefore we considered it a good tool for screening motor impairment. Although the first version of the circuit checklist’s total score had a moderate correlation of 0.6107 (p < 0.0001*) with GMS, the total of 98 items is too long for teachers to assess. Therefore, we reduced the checklist items and movements that did not correlate with GMS, which resulted in keeping seven movements and 42 checklist items. Items were reduced by half and had a slightly higher moderate correlation of 0.6421 (p < 0.0001*) to GMS. We compared the circuit checklist’s validity to MABC-2’s GMS that contains aiming and catching exercises and balance exercises measuring mainly coordination and performance [ 10 , 15 ]. We assume that this is the reason why the movement sections “Waiting for turn” and “Rules” that may rely mainly on social behavioral skills [ 23 ], attention [ 27 ] and executive function [ 28 ]; and “Obstacles run”, “Walking backwards” and “Beanbag grasp” that may reply mainly on spatiotemporal adjustment [ 16 ] and the sensory system rather than visual coordination [ 16 , 29 ] did not correlate with GMS. Consequently, “Jumping on foot shapes” and “Balance on one leg (longest)” are similar to the “One-Leg Balance” and “Jumping on Mats” from MABC-2, and our checklist items are similar to the test fail criteria in MABC-2, which explains the correlation to GMS. Although “Ball catch” and “Beanbag throw” are two exercises similar to “Catching beanbag” and “Throwing Beanbag onto mat”, they had lower correlations with GMS explained by the difference in assessment frequency where MABC-2 graded the performance of 10 trials in total, but the circuit checklist graded the performance of one trial in total. What’s more, “Ball kick” and “Wheelbarrow” were two exercises different from MABC-2 contents but were exercises performed habitually in the classroom and enjoyed by the children, therefore included in the circuit checklist. Wheelbarrow exercise is a multi-joint task presenting a greater challenge [ 24 ] than simpler movements, and movement of children with DCD has been showed to be impaired because of trunk muscle timing and recruitment compared to typically developing children [ 24 ], which could have reflected the child’s coordination skills in our method. Considering the concurrent validity of the circuit checklist’s total score, the latter positively and moderately correlated with GMS from MABC-2, which is a fair result considering the sample size and the difficulty to make a test that is practical and motivational for young children in a group setting, where all the tested items are valid and reliable [ 21 ]. In this study, the test-retest reliability of the seven movement sections ranged from − 0.029 to 0.915. These findings suggest that some movements demonstrate stronger test-retest reliability than others, and that the reliability of some movements such as “Balance on one leg (longest)” may be questionable given the wide confidence intervals. A previous study about considerations when development of new test items suggested that exercise items related to stability would not have high reliability [ 21 ]. This could explain the wide confidence interval of “Balance on one leg (longest)” especially that the children had only one trial on both legs, where the longest balance time was picked for analysis. Also, caution should be taken when interpreting these results due to the small sample size (n = 6) and the characteristics of the children (with special needs). Future studies with a larger sample size of typically developing children are needed to confirm these findings and provide more reliable estimates of test-retest reliability. As for inter-rater reliability , the confidence intervals for all movement sections were relatively narrow, indicating a high degree of precision in the estimates of inter-rater reliability. These findings suggest that the seven movement sections demonstrate good to excellent inter-rater reliability, with some items showing stronger reliability than others. Overall, these results suggest that the seven movement sections may be a useful tool for assessing the construct of interest and that it can be reliably applied by different raters. Including a teacher’s analysis of the circuit checklist is a future direction of this new assessment method to check for inter-rater reliability in between a multidisciplinary team. Meanwhile, it is important to note that these findings may be limited by the specific context and sample used in this study. Therefore, caution should be taken when generalizing these results to other settings or populations. In this study, the overall results of internal consistency suggest that while the checklist has moderate internal consistency, some items may have weaker relationships with the total score, which could be explored further in future research. Implications for education and clinical practice Teachers are expected to recognize the motor difficulties of their students [ 7 ], especially when the general support is not sufficient, and the student needs intensified support or special support [ 7 ], at an early age [ 14 ]. They are also required to support independence and social participation [ 14 ]. Meanwhile, their involvement in teaching gross motor skills is necessary before the end of childhood [ 30 ] to prepare children in early development for school readiness – where more complicated motor skills are required. Therefore, a checklist detailing the movement steps, conducted in the form of play would help the teachers pinpoint the motor difficulty of their pre-school students and modify the play exercises to suit their needs. This pilot study has some limitations. The test-rest reliability data were taken from 6 children only, which is a low number. That is due to the classroom circumstances and the absence of the children on the re-test days. Also, it was done by recruiting children from a habilitation facility without trial on children from the community. In the future, testing the CC reliability between a multidisciplinary team, setting CC cut offs, and including typically developing children a clinical sample of children with DCD and test the correlation of the Circuit Checklist with purely gross motor tests like the Test of Gross Motor Development [ 11 ] and the elements of movement functions one by one. Assessing the engagement of the child would also be beneficiary to determine whether the child is using their full ability. CONCLUSION We conclude that the seven movements and their detailed checklist items, that this study has introduced, could be a useful first step screening for motor impairment and discoordination in pre-school children. Ultimately, we aim to use the results in this study to program an automated AI screening tool using motion capture in the classroom. Declarations Ethics approval and consent to participate This was a pilot study aiming to test the feasibility of a new gross motor screening method and which was approved by the ethical committee of Kyoto University, Japan (approval number: R-2929). Informed consent was obtained from the parents of the children. Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Competing interests The authors have no completing interests to declare. Funding Not applicable Authors' contributions H.Z. designed the circuit checklist, analyzed the data and wrote the main manuscript. A.B. participated in the data collection and statistical analysis. K.M. applied for the ethical committee of Kyoto University. R.Y. helped with the measurements. K.I. and T.A. supervised and monitored the work. All authors reviewed, read and approved the final manuscript. References Piek JP, Hands B, Licari MK. Assessment of motor functioning in the preschool period. Neuropsychol Rev. 2012. 10.1007/s11065-012-9211-4 . Krneta Z, Casals C, Bala G, Madić D, Pavlović S, Drid P. Can kinesiological activities change pure motor development in preschool children during one school year? Coll Antropol. 2015;39(1):35–40. Kaur G, Goswami J. Effects of circuit training program on aerobic capacity, speed and explosive strength performance of school children. Int J Yogic Hum Mov Sports Sci. 2019;4(1):1185–9. Popović B, Cvetković M, Mačak D, Šćepanović T, Čokorilo N, Belić A, et al. Nine Months of a structured multisport program improve physical fitness in preschool children: a quasi-experimental study. Int J Environ Res Public Health. 2020. 10.3390/ijerph17144935 . De Toia D, Klein D, Weber S, Wessely N, Koch B, Tokarski W, et al. Relationship between anthropometry and motor abilities at pre-school age. Obes Facts. 2009. 10.1159/000228155 . Ferguson GD, Jelsma D, Jelsma J, Smits-Engelsman BC. The efficacy of two task-orientated interventions for children with Developmental Coordination Disorder: Neuromotor Task Training and Nintendo Wii Fit Training. Res Dev Disabil. 2013. 10.1016/j.ridd.2013.05.007 . Asunta P, Viholainen H, Ahonen T, Cantell M, Westerholm J, Schoemaker MM, et al. Reliability and validity of the Finnish version of the motor observation questionnaire for teachers. Hum Mov Sci. 2017. 10.1016/j.humov.2016.12.006 . Cools W, De Martelaer K, Samaey C, Andries C. Movement skill assessment of typically developing preschool children: A review of seven movement skill assessment tools. J Sports Sci Med. 2009;8(2):154–68. PMID: 24149522. Hu X, Wang H, Han ZR, Zhao Y, Ke L. The influence of visual supports and motivation on motor performance of the MABC-2 for Chinese school - aged children with autism spectrum disorder. Sci Rep. 2021. 10.1038/s41598-021-95155-8 . Brown T. Movement Assessment Battery for Children: Second Edition (MABC-2). In: Volkmar FR, editor. Encyclopedia of Autism Spectrum Disorders. Cham: Springer; 2021. https://doi.org/10.1007/978-3-319-91280-6_1922 . Logan SW, Robinson LE, Rudisill ME, Wadsworth DD, Morera M. The comparison of school-age children’s performance on two motor assessments: the Test of Gross Motor Development and the Movement Assessment Battery for Children. Phys Educ Sport Pedagogy. 2014. 10.1080/17408989.2012.726979 . Bolk J, Farooqi A, Hafstrom M, Aden U, Serenius F. Developmental coordination disorder and its association with developmental comorbidities at 6.5 years in apparently healthy children born extremely preterm. JAMA Pediatr. 2018;172(8):765–74. Schoemaker MM, Niemeijer AS, Flapper BCT, Smits-Engelsman BCM. Validity and reliability of the movement assessment battery for children-2 checklist for children with and without motor impairments. Dev Med Child Neurol. 2012. 10.1111/j.1469-8749.2012.04226.x . Nakajima A, Otaki M, Kajita H, Morikawa T, Nakamae T, Kato M. Assessment methods used by occupational therapists working in special needs schools in Japan. Kobe Gakuin Gen Rehabilitation Res. 2016;11(2):135–45. Henderson SE, Sugden DA, Barnett A. The Movement Assessment Battery for Children. 2nd ed. London: Pearson Education Inc; 2007. Luecha T, Takesue S, Yeoh WL, Loh PY, Muraki S. Backward Walking Styles and Impact on Spatiotemporal Gait Characteristics. Healthc (Basel). 2022. 10.3390/healthcare10122487 . Gerber RJ, Wilks T, Erdie-Lalena C. Developmental milestones: motor development. Pediatr Rev. 2012. 10.1542/pir.31-7-267 . Irie K, Mukaiyama K, Yamashita R, Zeidan H, Bandara A, Nagai-Tanima M, et al. Investigation subtypes of motor skills and activities of daily living among young children with motor delay. Occup Ther Int. 2023;2023:4031372. https://doi.org/10.1155/2023/403137 . Buzescu R, Nechita F, Cioroiu SG. The Relationship between Neuromuscular Control and Physical Activity in the Formation of the Visual-Psychomotor Schemes in Preschools. Sensors. 2021;21(1):224. https://doi.org/10.3390/s21010224 . Donath L, Faude O, Hagmann S, Roth R, Zahner L. Fundamental movement skills in preschoolers: a randomized controlled trial targeting object control proficiency. Child Care Health Dev. 2015;41(6):1179–87. https://doi.org/10.1111/cch.12232 . Ikeda T, Aoyagi O. Relationship between test characteristics and movement patterns, physical fitness, and measurement characteristics: suggestions for developing new test items for 2- to 6-year-old children. Hum Perform Meas. 2008;5:9–22. Jahedi S, Hosseiny S, Sharifi A, Ghagarieh M. Effect of self-monitoring strategy instruction on modify behavior of hyperactive disorder in early childhood of Shiraz city. Adv Environ Biol. 2013;7(2):330–2. ISSN 1995 – 0756. Miles CAL, Wood G, Vine SJ, Vickers JN, Wilson MR. Quiet eye training facilitates visuomotor coordination in children with developmental coordination disorder. Res Dev Disabil. 2015;40:31–41. https://doi.org/10.1016/j.ridd.2015.01.005 . Kane K, Barden J. Contributions of trunk muscles to anticipatory postural control in children with and without developmental coordination disorder. Hum Mov Sci. 2012;31(3):707–20. https://doi.org/10.1016/j.humov.2011.08.004 . Sember V, Fratina R, Dolenec M, Prevc P, Tomazin K. Effects of Creeping Exercise on Upper Limb Strength. S Afr J Res Sport Phys Educ Recreat. 2021;43(2). Van der Beld WA, Van der Sanden GAC, Sengers RCA, Verbeek ALM, Gabreels FJM. Validity and reproducibility of a new diagnostic motor performance test in children with suspected myopathy. Dev Med Child Neurol. 2006;48:20–7. Van der Fels IMJ, te Wierike SCM, Hartman E, Elferink-Gemser MT, Smith J, Visscher C. The relationship between motor skills and cognitive skills in 4–16 year old typically developing children: A systematic review. J Sci Med Sport. 2015;18(6):697–703. http://dx.doi.org/10.1016/j.jsams.2014.09.007 . McClelland MM, Cameron CE. Developing together: The role of executive function and motor skills in children’s early academic lives. Early Child Res Q. 2019;46:142–51. https://doi.org/10.1016/j.ecresq.2018.03.014 . Veldman SLC, Jones RA, Okely AD. Efficacy of gross motor skill interventions in young children: an updated systematic review. BMJ Open Sport Exerc Med. 2016. 10.1136/bmjsem-2015-000067 . Wang J, Yuan W, An R. Effectiveness of backward walking training on spatial-temporal gait characteristics: A systematic review and meta-analysis. Hum Mov Sci. 2018;60:57–71. https://doi.org/10.1016/j.humov.2018.05.007 . Additional Declarations No competing interests reported. Supplementary Files Appendix.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4416101","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":308415182,"identity":"2c47519a-9fcf-4f99-a639-6265b90c6574","order_by":0,"name":"Hala Zeidan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYBACAwbmBhDNw3CAgfExWIgZIoJHCyNcC7MxiM/AzEicFgagFjZpsBYGAlrM2Q82fmD4YyPDd/zsseqCij/R/O1ALT8qtuHUYtmT2CzBwJPGI3kmL+32jDMGuTMOMzYw9py5jdthBxIbpP9IHOYxOJBjdpu3zSC3AaiFmbENj5bzD5t/MBj85zE4/8asGKRlPkEtNxLbJBgSDvAY3MgxYwZp2UBYy8M2C4YDyTySN94YS/OcMc7dCNRyEK9fzicfvsHwx86e73yO4WeeCrnceecPH3zwowK3FuzgAInqR8EoGAWjYBSgAQC861lrXUl+VQAAAABJRU5ErkJggg==","orcid":"","institution":"Kyoto University","correspondingAuthor":true,"prefix":"","firstName":"Hala","middleName":"","lastName":"Zeidan","suffix":""},{"id":308415183,"identity":"f7ff56a6-4491-4976-9e7c-f89bc6a1e714","order_by":1,"name":"Anuradhi Bandara","email":"","orcid":"","institution":"Kyoto University","correspondingAuthor":false,"prefix":"","firstName":"Anuradhi","middleName":"","lastName":"Bandara","suffix":""},{"id":308415184,"identity":"e25d1f85-f0fa-4682-8bc4-eecaa56c5bc7","order_by":2,"name":"Keisuke Irie","email":"","orcid":"","institution":"Kyoto University","correspondingAuthor":false,"prefix":"","firstName":"Keisuke","middleName":"","lastName":"Irie","suffix":""},{"id":308415185,"identity":"71546cb9-2207-4c9e-bdcb-7321e2dba3f7","order_by":3,"name":"Kohei Mukaiyama","email":"","orcid":"","institution":"Kyoto University","correspondingAuthor":false,"prefix":"","firstName":"Kohei","middleName":"","lastName":"Mukaiyama","suffix":""},{"id":308415186,"identity":"de72541c-d507-4d2c-b203-81882163129f","order_by":4,"name":"Reika Yamashita","email":"","orcid":"","institution":"Kyoto University","correspondingAuthor":false,"prefix":"","firstName":"Reika","middleName":"","lastName":"Yamashita","suffix":""},{"id":308415187,"identity":"df3ed905-3354-44f6-82b6-523ad0587ddf","order_by":5,"name":"Tomoki Aoyama","email":"","orcid":"","institution":"Kyoto University","correspondingAuthor":false,"prefix":"","firstName":"Tomoki","middleName":"","lastName":"Aoyama","suffix":""}],"badges":[],"createdAt":"2024-05-14 03:10:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4416101/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4416101/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57729368,"identity":"96325f7e-a181-4f4c-9fee-fa3167f772b1","added_by":"auto","created_at":"2024-06-04 21:52:43","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":364684,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMovement Assessment Battery for Children – 2nd edition’s components and scoring method, and its gross motor score’s calculation method. Gross motor score is calculated using the standard scores from Aiming \u0026amp; Catching and Balance tests and multiplying it by 3 and dividing by 5.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4416101/v1/c2a59b68ff8b9c8ee13c11f9.jpeg"},{"id":75745909,"identity":"14345586-3b48-442c-bce2-a7ad271586fc","added_by":"auto","created_at":"2025-02-07 18:01:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1866093,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4416101/v1/9e5be6bd-f412-42e0-9ed0-46f12ceb759a.pdf"},{"id":57728289,"identity":"c9d705f3-6b9f-4b8b-bc79-0ea1e23bd613","added_by":"auto","created_at":"2024-06-04 21:44:43","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":2924522,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-4416101/v1/0cadc3e4380229c45b2b3e9b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Feasibility of the Circuit Checklist as an easy gross motor assessment for preschool children using recorded videos: a pilot study ","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMotor development starts as early as in the fetal stage and continues until preschool age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], during that, basic motor skills and behavior significantly develop [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and become specialized complex and functional skills by the age of eight [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Basic movement skills and fitness components need to be developed equally during early stages of growth [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. It is favorable to accomplish these skills by school age as development slows down as inactivity increases, while the child carries over the base of motor skills learned in preschool [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. At this age, physical exercises including variable activities of different intensities are recommended, since it also affects both the physical and mental well-being [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, motor skills mastery is variable between children because of the complexity of motor skills and the neural control mechanism, developmental delays, or impairments, and the environment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Children\u0026rsquo;s morphological growth is reported to mask both the improvement and deterioration of motor efficiency [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and it is difficult to judge whether the child is having motor difficulties because of impairment or lack of experience [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In all cases, prevention measures are encouraged to start at early age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], before entering school where motor demands increase [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIf left without appropriate support, these motor impairments will affect the child\u0026rsquo;s life into adulthood [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Individuals with motor impairments, especially those with Developmental Coordination Disorder (DCD), are reported to participate less in or withdraw from physical activities, have lower physical fitness and obesity, higher risk of cardiovascular problems [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and cardiorespiratory diseases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Motor impairments also have secondary effects that involve social and emotional health, academic and daily life function, decreased self-perception and self-worth, increased levels of anxiety and depression \u0026ndash; as young as the age of four [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Therefore, early identification and interventions are necessary for such children to improve and prevent secondary health and social problems [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], inactivity and academic problems [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, identification is still complicated, delayed or ignored because of lack of awareness, the variability of motor development [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and DCD disorder [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Knowing and following up the level of physical function is a priority for public health [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and teachers in the educational setting are the first wall of defense for identification of motor impairments and prevention from secondary impairments.\u003c/p\u003e \u003cp\u003eThere are several standardized assessment methods to measure motor abilities of preschool children, such as: Movement Assessment Battery for Children \u0026minus;\u0026thinsp;2nd edition (MABC-2), Bruininks-Oseretsky Test for Motor Proficiency \u0026ndash; 2nd edition, McCarron Assessment of Neuromuscular Development, Peabody Developmental Motor Scales \u0026ndash; 2nd edition [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], among others. However, these are conducted individually and are time consuming for the child and the teacher (especially for children with special needs [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]), expensive [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and may be difficult to score or interpret by the teachers [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Among these tests, MABC-2 is the one widely used as a gold standard test for motor coordination and performance [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are also questionnaires designed for the parents or the teachers to assess preschool children, such as: Developmental Coordination disorder Questionnaire [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], Five to Fifteen Questionnaire [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], MABC-2 Checklist [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], among others. However, although parents and teachers are a reliable source to assess children\u0026rsquo;s motor ability, correlation between their results and motor test results are controversial and may be inadequate for diagnosis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Assessment methods like observational tests are reported to be effective and inexpensive pre-screening tools for difficulties in movement coordination, that can be done at school [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Meanwhile, summed up and standardized scores of test items do not allow for specific determination of the deficit or delay the child may have [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. What\u0026rsquo;s more, misleading results may appear when the assessment tool used are not appropriate for the purpose of the assessment, or when the children lack experience in doing the test movement, lack motivation and cooperation to do the test or when they are having a bad day [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Therefore, the goal of this pilot study is to create an observational tool based on the biomechanical steps of the movements assessed, and on motor developmental milestones, in a playful group setting. This tool would be for teachers working in special needs\u0026rsquo; classrooms to help them specifically recognize and appropriately help their students at an early age if needed. It would also allow the teachers to refer the parents to further professional assessments. It would also serve as a base method for the development of a digitalized version of the assessment based on motion capture.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis was a pilot study aiming to test the feasibility of a new gross motor screening method and which was approved by the ethical committee of Kyoto University, Japan (approval number: R-2929). Children (n\u0026thinsp;=\u0026thinsp;32) were recruited from special-needs support classrooms belonging to the same company in Osaka, Japan, between June 2021 to December 2021. Written letters explaining the purpose of the study with a consent form were sent to the parents and the children. The children with written consent from their parents were included in the study. Children with physical dependence or with difficulties comprehending the contents of the tests, or children who refused to do or continue the assessments on the test days were the exclusion criteria from the analysis as it may affect the results.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eCircuit Checklist\u003c/h2\u003e \u003cp\u003eThe new assessment consisted of a circuit and a checklist sheet. The circuit consisted of 12 sections and 98 checklist items: 1) waiting for turn (2 items), 2) obstacle run (6 items), 3) ball catch (9 items), 4) ball kick (8 items), 5) walking backwards (4 items), 6) wheelbarrow (9 items), 7) bean bag grasp (3 items), 8) bean bag throw (11 items, repeated twice), 9) jumping on foot shapes (13 items), 10) long jump (5 items), 11) balance on one leg (7 items, tested on both legs), 12) rules (3 items). The circuit\u0026rsquo;s setting and description are attached in the appendix. These exercises and their grading were based on practice inside the classroom, previous studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and the developmental milestones [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It was designed by a PhD holder physiotherapist working with special needs children.\u003c/p\u003e \u003cp\u003eThe checklist sheet was represented as a table containing 12 sections and their checklist items representing the description of the movement chaining from a biomechanical point of view. A demonstration was first given by the physiotherapist and the teacher before starting the assessment of each child one at a time. A video recording using a mobile phone was taken for each child. The physiotherapist later observed each video on a computer and marked the checklist sheet. A (✔) was marked for accomplish items, and (\u003cb\u003ex\u003c/b\u003e) was marked for unaccomplished items. The number of (✔) were calculated as the total Circuit Checklist score. The same videos were also observed and marked by another physiotherapist for inter-rater reliability of the checklist. Further, six children were tested again using the same Circuit Checklist two weeks after the first trial for test-retest reliability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMovement Assessment Battery for Children \u0026minus;\u0026thinsp;2nd edition\u003c/h2\u003e \u003cp\u003eMABC-2 consists of tests in three areas. The first is manual dexterity skills (MD) containing three tests. The second is aiming and catching skills (A\u0026amp;C) containing two tests assessing throwing and catching abilities. The third is balance skills (BAL) containing three tests assessing static and dynamic balance. The detailed rules of the tests and the scoring methods are carefully explained in the MABC-2 Manual [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. As the Circuit Checklist contains gross motor skills only, making MD outside the scope of the checklist\u0026rsquo;s aim, the Gross Motor Score (GMS) from MABC-2 was calculated by combining the standard score (SS) from each item of A\u0026amp;C and BAL tests multiplied by 3 and divided by 5: (A\u0026amp;C SS\u0026thinsp;+\u0026thinsp;BAL SS)*3/5 (Fig.\u0026nbsp;1). This calculation method was used in a previous study [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e[Figure 1]\u003c/h2\u003e \u003cp\u003e \u003cb\u003eFIGURE 1 Movement Assessment Battery for Children \u0026ndash; 2nd edition\u0026rsquo;s components and scoring method, and its gross motor score\u0026rsquo;s calculation method. Gross motor score is calculated using the standard scores from Aiming \u0026amp; Catching and Balance tests and multiplying it by 3 and dividing by 5.\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical methods\u003c/h2\u003e \u003cp\u003eJMP Pro 17 (SAS Institute Inc., Cary, NC, USA) was used to test for correlation of the movement sections of the checklist in the first step and concurrent validity of the total checklist score, in relation to GMS, by Pairwise correlation and Spearman\u0026rsquo;s correlation. IBM SPSS version 28.0 (IBM Corp., Armonk, NY, USA) was used to test for test-retest reliability using the intra-class correlation coefficient for each movement section; inter-rater reliability using inter-rater correlation coefficient computed for each movement section, and internal consistency of the movement sections by Cronbach\u0026rsquo;s alpha. The data of 32 children were analyzed for validity with MABC-2 and inter-rater reliability, and six children for intra-rater reliability.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eDemographics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 32 children\u0026rsquo;s age ranged between 3 to 7 years old (4.5\u0026nbsp;\u0026plusmn;\u0026nbsp;1.16; 3 years old = 7; 4 years old = 10; 5 years old = 7, 6 years old = 7; 7 years old = 1). Their average body weight was 17.98\u0026nbsp;\u0026plusmn;\u0026nbsp;3.72 kilograms, their bogy height 1.08\u0026nbsp;\u0026plusmn;\u0026nbsp;0.12 meters and their average BMI was 15.28\u0026nbsp;\u0026plusmn;\u0026nbsp;1.38 kg/m2. MABC-2 total score\u0026rsquo;s average was 60.81\u0026nbsp;\u0026plusmn;\u0026nbsp;14.58 and the Gross Motor score average was 38.31\u0026nbsp;\u0026plusmn;\u0026nbsp;7.6, while the total checklist score\u0026rsquo;s averages were 26.75\u0026nbsp;\u0026plusmn;\u0026nbsp;5.17 for the first tester and 24.03\u0026nbsp;\u0026plusmn;\u0026nbsp;5.25 for the second tester.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation of the circuit movements to GMS and reduction of movements and items\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe correlation between the scores of each of the 12 movement sections (Table 1) and the checklist items and the GMS of the main tester were analyzed. This was done to reduce the number of items that may not correlate with GMS and affect the assessment, as a first step of the analysis in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe movement sections \u0026ldquo;Wheelbarrow\u0026rdquo;, \u0026ldquo;Jumping on foot shapes\u0026rdquo; and \u0026ldquo;Balance on one leg (longest)\u0026rdquo; had a significantly positive correlation with GMS. The movement sections \u0026ldquo;Waiting for turn\u0026rdquo;, \u0026ldquo;Obstacles run\u0026rdquo;, \u0026ldquo;Walking backwards\u0026rdquo;, \u0026ldquo;Beanbag grasp\u0026rdquo;, \u0026ldquo;Beanbag throw (1\u003csup\u003est\u003c/sup\u003e time)\u0026rdquo;, \u0026ldquo;Balance on one leg (best)\u0026rdquo; and \u0026ldquo;Rules\u0026rdquo; had lower correlations and were reduced from the checklist, keeping seven movement sections for further analysis.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 1 First Circuit Checklist movement sections and the number of checklist items, and pairwise correlation results between these movement sections and GMS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\"\u003e\n \u003cp\u003eMovement Section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\"\u003e\n \u003cp\u003eNumber of checklist items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\"\u003e\n \u003cp\u003eCorrelation to GMS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\"\u003e\n \u003cp\u003eSignificance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e1) Waiting for turn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e2 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e-0.0025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0.9892\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e2) Obstacles run\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e6 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e0.0934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0.6112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e3) Ball catch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e9 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e0.2085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0.2520\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e4) Ball kick\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e8 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e0.2321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0.2011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e5) Walking backwards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e4 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e0.0058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0.9749\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e6) Wheelbarrow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e9 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e0.6328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e7) Beanbag grasp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e3 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e-0.0675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0.7134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e8) Beanbag throw\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; (1\u003csup\u003est\u003c/sup\u003e time)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e11 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e-0.0495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0.7880\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e8) Beanbag throw\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; (2\u003csup\u003end\u003c/sup\u003e time)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e11 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e0.0141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0.9388\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e9) Jumping on foot\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;shapes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e13 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e0.4238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0.0157*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e10) Long jump\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e5 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e-0.0308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0.8671\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e11) Balance on one leg\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; (longest)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e7 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e0.3803\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0.0318*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e11) Balance on one leg\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; (best)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e7 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e0.2730\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0.1305\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\" valign=\"top\"\u003e\n \u003cp\u003e12) Rules\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\" valign=\"top\"\u003e\n \u003cp\u003e3 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\" valign=\"top\"\u003e\n \u003cp\u003e-0.0735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\" valign=\"top\"\u003e\n \u003cp\u003e0.6892\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.602564102564102%\"\u003e\n \u003cp\u003eTotal Circuit Checklist score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.314102564102566%\"\u003e\n \u003cp\u003e98 items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.80128205128205%\"\u003e\n \u003cp\u003e0.6107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.28205128205128%\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation between the first Circuit Checklist\u0026rsquo;s movement sections and concurrent validity the total Circuit Checklist score, compared to gross motor score, were analyzed using Pairwise correlation. *p\u0026lt;0.05. GMS, gross motor score.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 shows the final seven movement sections and their detailed checklist items that were modified and included in the second part of the analysis of this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Wheelbarrow\u0026rdquo; had a positive strong linear correlation to GMS; \u0026ldquo;Jumping on foot shapes\u0026rdquo; and \u0026ldquo;balance on one leg (longest)\u0026rdquo; had a positive moderate correlation to GMS; \u0026ldquo;Ball catch\u0026rdquo; had a positive weak correlation to GMS and the other movement sections had none to very weak correlation to GMS. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[Table 2]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTABLE 2 Final Circuit Checklist movement sections and pairwise correlation results between these movement sections and GMS\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.00163132137031%\"\u003e\n \u003cp\u003eMovement Section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.774877650897228%\"\u003e\n \u003cp\u003eCorrelation to GMS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.223491027732464%\"\u003e\n \u003cp\u003eChecklist item contents\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.00163132137031%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e1) Ball catch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.774877650897228%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e0.3079 (p=0.0865)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.223491027732464%\" valign=\"top\"\u003e\n \u003cp\u003eGot ready to catch the ball\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eCaught the ball without trapping it with the body and did not lose it\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eLooked at the ball and followed its trajectory, and did not close their eyes or move their head when catching or trying to catch the ball\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eMoved their limbs to adjust their body position to the ball\u0026rsquo;s trajectory\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eDid not lose balance when catching the ball or when trying to catch the ball\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.00163132137031%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e2) Ball kick\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.774877650897228%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e0.2731 (p=0.1305)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.223491027732464%\" valign=\"top\"\u003e\n \u003cp\u003eUsed the right amount of force\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eDid not lose balance nor trunk stability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eThe ball was directed to the goal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eTook a moment to look at the goal and the ball before kicking the ball\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eNo fidgeting, no excessive or exaggerated movements\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.00163132137031%\" rowspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e3) Wheelbarrow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.774877650897228%\" rowspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e0.7178 (p\u0026lt;0.0001*)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.223491027732464%\" valign=\"top\"\u003e\n \u003cp\u003eThe child was held at the ankles\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eKept elbows extended\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eThe fingers were pointed towards the goal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eKept trunk straight and away from ground\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eKept the knees extended\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eKept the neck extended looking ahead and did not keep looking at the hands\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eDid not tire halfway, nor took a few seconds break\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eDid not complain about the exercise being difficult (including sounds)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eReached the goal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.00163132137031%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e4) Bean bag throw\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.774877650897228%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e0.0268 (p=0.8842)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.223491027732464%\" valign=\"top\"\u003e\n \u003cp\u003eDid not step closer to the goal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eLooked at the goal before throwing and while throwing the bean bag\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003ePosture was stable while throwing\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eUsed the right amount of force\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eThe bean bag reached the goal or its borders without skimming the floor first\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.00163132137031%\" rowspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e5) Jumping on foot shapes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.774877650897228%\" rowspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e0.5151 (p=0.0026*)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.223491027732464%\" valign=\"top\"\u003e\n \u003cp\u003eCards 1 and 2: the right foot and the left foot took off and landed at the same time when jumping twice on both feet\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eCards 3 and 4: successively hopped twice on the right leg with the left leg raised above ground\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eCards 6 and 7: successively hopped twice on the left leg with the right leg raised above ground\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eSwitched feet smoothly between the cards\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eDid not mistake any of the foot shapes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eDid not skip any of the cards\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eTracked/looked at the next foot shape\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eJumped once on each card\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eCards 9 and 10: flipped the body 180\u0026deg;\u0026nbsp;while jumping and stepped on the correct card at landing\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.00163132137031%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e6) Long jump\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.774877650897228%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e0.0213 (p=0.9078)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.223491027732464%\" valign=\"top\"\u003e\n \u003cp\u003eCard 10 and 11: The right foot and the left foot took off and landed at the same time\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eReached the goal or its borders\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eArms and legs were coordinated\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eDid not lose balance on landing\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.00163132137031%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e7) Balance on one leg (longest)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.774877650897228%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e0.5086 (p=0.0030*)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.223491027732464%\" valign=\"top\"\u003e\n \u003cp\u003ePlease record the number of seconds for each side\u003c/p\u003e\n \u003cp\u003e(In relation to age and motor milestones: 2 to 3 years old: 2s, 4 to 5 years old: 10s, 6 years and above: 30s)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eKept initial posture\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eThe trunk, the feet and the ankles were stable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eDid not move the arms to adjust or maintain balance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eDid not support the free leg on the test leg nor held it with their hand\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.00163132137031%\" valign=\"top\"\u003e\n \u003cp\u003eTotal Circuit Checklist score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.774877650897228%\" valign=\"top\"\u003e\n \u003cp\u003e0.6421 (p\u0026lt;0.0001*)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.223491027732464%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eItems reduced to 42 items\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCorrelation between the final Circuit Checklist\u0026rsquo;s movement sections and concurrent validity the total Circuit Checklist score, compared to gross motor score, were analyzed using Pairwise correlation. The numbers between brackets are previous studies\u0026rsquo; references. *p\u0026lt;0.05. GMS, gross motor score. \u0026deg;, degrees. s, seconds.\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConcurrent validity of the Circuit Checklist total score and GMS from MABC-2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe concurrent validity of the modified and final circuit checklist total score and gross motor score was 0.6421 (p\u0026lt;0.0001*) using Pairwise correlation and 0.6538 (p\u0026lt;0.0001*) using Spearman\u0026rsquo;s correlation, indicating a moderate correlation.\u0026nbsp;\u003cbr\u003e\u003cbr\u003e\u003cstrong\u003eTest-retest reliability\u003c/strong\u003e\u003cbr\u003eTest-rest reliability results of the seven movement sections are shown in Table 3. The intra-class correlation coefficient values ranged from -0.029 to 0.915, with \u0026ldquo;Jumping on foot shapes\u0026rdquo; showing the strongest correlation and \u0026ldquo;Balance on one leg (longest)\u0026rdquo; showing a negative correlation that was not statistically significant.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 3 Test-retest reliability results for the final remaining movement sections\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.303754266211605%\" rowspan=\"2\"\u003e\n \u003cp\u003eMovement section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.726962457337883%\" rowspan=\"2\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.2320819112628%\" rowspan=\"2\"\u003e\n \u003cp\u003eTest-Retest Correlation (ICC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.737201365187715%\" colspan=\"2\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eLower bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eUpper bound\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.35042735042735%\" valign=\"top\"\u003e\n \u003cp\u003e1) Ball catch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.743589743589743%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.273504273504273%\" valign=\"top\"\u003e\n \u003cp\u003e0.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e-0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.35042735042735%\" valign=\"top\"\u003e\n \u003cp\u003e2) Ball kick\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.743589743589743%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.273504273504273%\" valign=\"top\"\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e-0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.888\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.35042735042735%\" valign=\"top\"\u003e\n \u003cp\u003e3) Wheelbarrow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.743589743589743%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.273504273504273%\" valign=\"top\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e-0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.910\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.35042735042735%\" valign=\"top\"\u003e\n \u003cp\u003e4) Bean bag throw\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.743589743589743%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.273504273504273%\" valign=\"top\"\u003e\n \u003cp\u003e0.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e-0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.872\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.35042735042735%\" valign=\"top\"\u003e\n \u003cp\u003e5) Jumping on foot\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; shapes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.743589743589743%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.273504273504273%\" valign=\"top\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.987\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.35042735042735%\" valign=\"top\"\u003e\n \u003cp\u003e6) Long jump\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.743589743589743%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.273504273504273%\" valign=\"top\"\u003e\n \u003cp\u003e0.681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e-0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.949\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.35042735042735%\" valign=\"top\"\u003e\n \u003cp\u003e7) Balance on one leg\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; (longest)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.743589743589743%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.273504273504273%\" valign=\"top\"\u003e\n \u003cp\u003e-0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e-1.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.777\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTest-retest reliability was calculated using intra-class correlation coefficient. *p\u0026lt;0.05. n, number of participants. ICC, intra-class correlation coefficient. CI, confidence interval.\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInter-rater reliability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInter-rate reliability results of the seven movement sections are shown in Table 4.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eInter-rater correlation coefficient values were computed for each movement section, which ranged from 0.589 to 0.856. \u0026ldquo;Ball catch\u0026rdquo;, \u0026ldquo;Ball kick\u0026rdquo;, \u0026ldquo;Long jump\u0026rdquo; and \u0026ldquo;Balance on one leg (longest)\u0026rdquo; demonstrated the strongest inter-rater reliability, with values of 0.856, 0.710, 0.782, and 0.711, respectively. \u0026ldquo;Wheelbarrow\u0026rdquo;, \u0026ldquo;Bean bag throw\u0026rdquo; and \u0026ldquo;Jumping on foot shapes\u0026rdquo; showed moderate inter-rater reliability, with values ranging from 0.589 to 0.696.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 4 Inter-rater reliability between the two testers\u0026rsquo; results for the final remaining movement sections \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.03071672354949%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMovement section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.484641638225256%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.747440273037544%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eInter-rater Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.737201365187715%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eLower bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eUpper bound\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.0940170940171%\" valign=\"top\"\u003e\n \u003cp\u003e1) Ball catch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.495726495726496%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.77777777777778%\" valign=\"top\"\u003e\n \u003cp\u003e0.856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.931\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.0940170940171%\" valign=\"top\"\u003e\n \u003cp\u003e2) Ball kick\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.495726495726496%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.77777777777778%\" valign=\"top\"\u003e\n \u003cp\u003e0.710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.0940170940171%\" valign=\"top\"\u003e\n \u003cp\u003e3) Wheelbarrow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.495726495726496%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.77777777777778%\" valign=\"top\"\u003e\n \u003cp\u003e0.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.803\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.0940170940171%\" valign=\"top\"\u003e\n \u003cp\u003e4) Bean bag throw\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.495726495726496%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.77777777777778%\" valign=\"top\"\u003e\n \u003cp\u003e0.589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.810\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.0940170940171%\" valign=\"top\"\u003e\n \u003cp\u003e5) Jumping on foot shapes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.495726495726496%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.77777777777778%\" valign=\"top\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e-0.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.896\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.0940170940171%\" valign=\"top\"\u003e\n \u003cp\u003e6) Long jump\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.495726495726496%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.77777777777778%\" valign=\"top\"\u003e\n \u003cp\u003e0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.0940170940171%\" valign=\"top\"\u003e\n \u003cp\u003e7) Balance on one leg (longest)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.495726495726496%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.77777777777778%\" valign=\"top\"\u003e\n \u003cp\u003e0.711\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.316239316239315%\" valign=\"top\"\u003e\n \u003cp\u003e0.889\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eInter-rater reliability between the two testers was calculated using inter-rater correlation coefficient. *p\u0026lt;0.05. n, number of participants. CI, confidence interval.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInternal consistency of the remaining Movement Sections\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCronbach\u0026apos;s alpha of the internal consistency of the checklist yielded a value of 0.666, and the Cronbach\u0026rsquo;s Alpha based on standardized items a value of 0.664, indicating moderate internal consistency. The corrected item-total correlations (Table 5) showed that the item with the highest correlation was \u0026quot;Wheelbarrow\u0026quot; and the item with the lowest correlation was \u0026quot;Long jump\u0026quot;. When examining the impact of deleting each item, \u0026quot;Wheelbarrow\u0026quot; had the greatest impact on reliability, resulting in a Cronbach\u0026apos;s alpha of 0.532 if that item were deleted, while \u0026quot;Long jump\u0026quot; had the least impact, resulting in a Cronbach\u0026apos;s alpha of 0.685 if that item was deleted. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 5 Corrected item-total correlation of the final remaining movement sections\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.673611111111114%\" valign=\"top\"\u003e\n \u003cp\u003eMovement Section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.8125%\" valign=\"top\"\u003e\n \u003cp\u003eCorrected Item-Total Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.51388888888889%\" valign=\"top\"\u003e\n \u003cp\u003eCronbach\u0026apos;s Alpha if Item Deleted\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.673611111111114%\" valign=\"top\"\u003e\n \u003cp\u003e1) Ball catch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.8125%\" valign=\"top\"\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.51388888888889%\" valign=\"top\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.673611111111114%\" valign=\"top\"\u003e\n \u003cp\u003e2) Ball kick\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.8125%\" valign=\"top\"\u003e\n \u003cp\u003e0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.51388888888889%\" valign=\"top\"\u003e\n \u003cp\u003e0.651\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.673611111111114%\" valign=\"top\"\u003e\n \u003cp\u003e3) Wheelbarrow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.8125%\" valign=\"top\"\u003e\n \u003cp\u003e0.700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.51388888888889%\" valign=\"top\"\u003e\n \u003cp\u003e0.532\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.673611111111114%\" valign=\"top\"\u003e\n \u003cp\u003e4) Bean bag throw\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.8125%\" valign=\"top\"\u003e\n \u003cp\u003e0.265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.51388888888889%\" valign=\"top\"\u003e\n \u003cp\u003e0.658\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.673611111111114%\" valign=\"top\"\u003e\n \u003cp\u003e5) Jumping on foot shapes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.8125%\" valign=\"top\"\u003e\n \u003cp\u003e0.473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.51388888888889%\" valign=\"top\"\u003e\n \u003cp\u003e0.622\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.673611111111114%\" valign=\"top\"\u003e\n \u003cp\u003e6) Long jump\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.8125%\" valign=\"top\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.51388888888889%\" valign=\"top\"\u003e\n \u003cp\u003e0.685\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.673611111111114%\" valign=\"top\"\u003e\n \u003cp\u003e7) Balance on one leg (longest)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.8125%\" valign=\"top\"\u003e\n \u003cp\u003e0.330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.51388888888889%\" valign=\"top\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCorrected item-total correlation of the final Circuit Checklist movement sections was analyzed using Cronbach\u0026rsquo;s Alpha.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we have tested the feasibility of a new assessment checklist in the form of a circuit-play based on a biomechanical perspective and tested its validity with MABC-2 and its reliability. There were 12 movement sections in the first step of the analysis reduced to seven movement sections and further tested in the second step of this study\u0026rsquo;s analysis. The final circuit movement sections were seven exercises as follows: 1) Ball catch, 2) Ball kick, 3) Wheelbarrow, 4) Bean bag throw, 5) Jumping on foot shapes, 6) Long jump, 7) Balance on one leg (longest), which can be chaining one after the other in a small classroom. These seven movements forming a circuit play, and their checklist items, appear to be a future potential tool to screen children with motor difficulties at early stage in a school setting.\u003c/p\u003e \u003cp\u003eWe have chosen a \u003cb\u003eplayful circuit style\u003c/b\u003e in this study as this kind of activity combines a succession of movements. We based the circuit\u0026rsquo;s movements on movements from previous assessments and the environment of the children [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20 CR21 CR22 CR23 CR24 CR25\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Circuits are usually used in training exercises and formed of successive sections where the child trains a specific function in each section, as in explosive strength, speed, and aerobic endurance [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. When the child finishes the task of one section, they move to the next one [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], which made us choose it as method to assess several movements at once in a group setting. Meanwhile, children usually master the exercises from their environment [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] therefore we considered it a good tool for screening motor impairment.\u003c/p\u003e \u003cp\u003eAlthough the first version of the circuit checklist\u0026rsquo;s total score had a moderate correlation of 0.6107 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*) with GMS, the total of 98 items is too long for teachers to assess. Therefore, \u003cb\u003ewe reduced the checklist items\u003c/b\u003e and movements that did not correlate with GMS, which resulted in keeping seven movements and 42 checklist items. Items were reduced by half and had a slightly higher moderate correlation of 0.6421 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*) to GMS.\u003c/p\u003e \u003cp\u003eWe compared the circuit checklist\u0026rsquo;s validity to MABC-2\u0026rsquo;s GMS that contains aiming and catching exercises and balance exercises measuring mainly coordination and performance [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. We assume that this is the reason why the movement sections \u0026ldquo;Waiting for turn\u0026rdquo; and \u0026ldquo;Rules\u0026rdquo; that may rely mainly on social behavioral skills [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], attention [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and executive function [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]; and \u0026ldquo;Obstacles run\u0026rdquo;, \u0026ldquo;Walking backwards\u0026rdquo; and \u0026ldquo;Beanbag grasp\u0026rdquo; that may reply mainly on spatiotemporal adjustment [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and the sensory system rather than visual coordination [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] did not correlate with GMS. Consequently, \u0026ldquo;Jumping on foot shapes\u0026rdquo; and \u0026ldquo;Balance on one leg (longest)\u0026rdquo; are similar to the \u0026ldquo;One-Leg Balance\u0026rdquo; and \u0026ldquo;Jumping on Mats\u0026rdquo; from MABC-2, and our checklist items are similar to the test fail criteria in MABC-2, which explains the correlation to GMS. Although \u0026ldquo;Ball catch\u0026rdquo; and \u0026ldquo;Beanbag throw\u0026rdquo; are two exercises similar to \u0026ldquo;Catching beanbag\u0026rdquo; and \u0026ldquo;Throwing Beanbag onto mat\u0026rdquo;, they had lower correlations with GMS explained by the difference in assessment frequency where MABC-2 graded the performance of 10 trials in total, but the circuit checklist graded the performance of one trial in total. What\u0026rsquo;s more, \u0026ldquo;Ball kick\u0026rdquo; and \u0026ldquo;Wheelbarrow\u0026rdquo; were two exercises different from MABC-2 contents but were exercises performed habitually in the classroom and enjoyed by the children, therefore included in the circuit checklist. Wheelbarrow exercise is a multi-joint task presenting a greater challenge [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] than simpler movements, and movement of children with DCD has been showed to be impaired because of trunk muscle timing and recruitment compared to typically developing children [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], which could have reflected the child\u0026rsquo;s coordination skills in our method.\u003c/p\u003e \u003cp\u003eConsidering the \u003cb\u003econcurrent validity\u003c/b\u003e of the circuit checklist\u0026rsquo;s total score, the latter positively and moderately correlated with GMS from MABC-2, which is a fair result considering the sample size and the difficulty to make a test that is practical and motivational for young children in a group setting, where all the tested items are valid and reliable [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, the \u003cb\u003etest-retest reliability\u003c/b\u003e of the seven movement sections ranged from \u0026minus;\u0026thinsp;0.029 to 0.915. These findings suggest that some movements demonstrate stronger test-retest reliability than others, and that the reliability of some movements such as \u0026ldquo;Balance on one leg (longest)\u0026rdquo; may be questionable given the wide confidence intervals. A previous study about considerations when development of new test items suggested that exercise items related to stability would not have high reliability [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This could explain the wide confidence interval of \u0026ldquo;Balance on one leg (longest)\u0026rdquo; especially that the children had only one trial on both legs, where the longest balance time was picked for analysis. Also, caution should be taken when interpreting these results due to the small sample size (n\u0026thinsp;=\u0026thinsp;6) and the characteristics of the children (with special needs). Future studies with a larger sample size of typically developing children are needed to confirm these findings and provide more reliable estimates of test-retest reliability.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAs for inter-rater reliability\u003c/b\u003e, the confidence intervals for all movement sections were relatively narrow, indicating a high degree of precision in the estimates of inter-rater reliability. These findings suggest that the seven movement sections demonstrate good to excellent inter-rater reliability, with some items showing stronger reliability than others. Overall, these results suggest that the seven movement sections may be a useful tool for assessing the construct of interest and that it can be reliably applied by different raters. Including a teacher\u0026rsquo;s analysis of the circuit checklist is a future direction of this new assessment method to check for inter-rater reliability in between a multidisciplinary team. Meanwhile, it is important to note that these findings may be limited by the specific context and sample used in this study. Therefore, caution should be taken when generalizing these results to other settings or populations.\u003c/p\u003e \u003cp\u003eIn this study, the overall results of \u003cb\u003einternal consistency\u003c/b\u003e suggest that while the checklist has moderate internal consistency, some items may have weaker relationships with the total score, which could be explored further in future research.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eImplications for education and clinical practice\u003c/h2\u003e \u003cp\u003eTeachers are expected to recognize the motor difficulties of their students [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], especially when the general support is not sufficient, and the student needs intensified support or special support [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], at an early age [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. They are also required to support independence and social participation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Meanwhile, their involvement in teaching gross motor skills is necessary before the end of childhood [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] to prepare children in early development for school readiness \u0026ndash; where more complicated motor skills are required. Therefore, a checklist detailing the movement steps, conducted in the form of play would help the teachers pinpoint the motor difficulty of their pre-school students and modify the play exercises to suit their needs.\u003c/p\u003e \u003cp\u003eThis pilot study has some limitations. The test-rest reliability data were taken from 6 children only, which is a low number. That is due to the classroom circumstances and the absence of the children on the re-test days. Also, it was done by recruiting children from a habilitation facility without trial on children from the community. In the future, testing the CC reliability between a multidisciplinary team, setting CC cut offs, and including typically developing children a clinical sample of children with DCD and test the correlation of the Circuit Checklist with purely gross motor tests like the Test of Gross Motor Development [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and the elements of movement functions one by one. Assessing the engagement of the child would also be beneficiary to determine whether the child is using their full ability.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eWe conclude that the seven movements and their detailed checklist items, that this study has introduced, could be a useful first step screening for motor impairment and discoordination in pre-school children. Ultimately, we aim to use the results in this study to program an automated AI screening tool using motion capture in the classroom.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a pilot study aiming to test the feasibility of a new gross motor screening method and which was approved by the ethical committee of Kyoto University, Japan (approval number: R-2929). Informed consent was obtained from the parents of the children.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no completing interests to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH.Z. designed the circuit checklist, analyzed the data and wrote the main manuscript. A.B. participated in the data collection and statistical analysis. K.M. applied for the ethical committee of Kyoto University. R.Y. helped with the measurements. K.I. and T.A. supervised and monitored the work. All authors reviewed, read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePiek JP, Hands B, Licari MK. Assessment of motor functioning in the preschool period. Neuropsychol Rev. 2012. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11065-012-9211-4\u003c/span\u003e\u003cspan address=\"10.1007/s11065-012-9211-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrneta Z, Casals C, Bala G, Madić D, Pavlović S, Drid P. Can kinesiological activities change pure motor development in preschool children during one school year? Coll Antropol. 2015;39(1):35\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaur G, Goswami J. Effects of circuit training program on aerobic capacity, speed and explosive strength performance of school children. Int J Yogic Hum Mov Sports Sci. 2019;4(1):1185\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePopović B, Cvetković M, Mačak D, Šćepanović T, Čokorilo N, Belić A, et al. Nine Months of a structured multisport program improve physical fitness in preschool children: a quasi-experimental study. Int J Environ Res Public Health. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph17144935\u003c/span\u003e\u003cspan address=\"10.3390/ijerph17144935\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Toia D, Klein D, Weber S, Wessely N, Koch B, Tokarski W, et al. Relationship between anthropometry and motor abilities at pre-school age. Obes Facts. 2009. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000228155\u003c/span\u003e\u003cspan address=\"10.1159/000228155\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerguson GD, Jelsma D, Jelsma J, Smits-Engelsman BC. The efficacy of two task-orientated interventions for children with Developmental Coordination Disorder: Neuromotor Task Training and Nintendo Wii Fit Training. Res Dev Disabil. 2013. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ridd.2013.05.007\u003c/span\u003e\u003cspan address=\"10.1016/j.ridd.2013.05.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsunta P, Viholainen H, Ahonen T, Cantell M, Westerholm J, Schoemaker MM, et al. Reliability and validity of the Finnish version of the motor observation questionnaire for teachers. Hum Mov Sci. 2017. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.humov.2016.12.006\u003c/span\u003e\u003cspan address=\"10.1016/j.humov.2016.12.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCools W, De Martelaer K, Samaey C, Andries C. Movement skill assessment of typically developing preschool children: A review of seven movement skill assessment tools. J Sports Sci Med. 2009;8(2):154\u0026ndash;68. PMID: 24149522.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu X, Wang H, Han ZR, Zhao Y, Ke L. The influence of visual supports and motivation on motor performance of the MABC-2 for Chinese school - aged children with autism spectrum disorder. Sci Rep. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-021-95155-8\u003c/span\u003e\u003cspan address=\"10.1038/s41598-021-95155-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown T. Movement Assessment Battery for Children: Second Edition (MABC-2). In: Volkmar FR, editor. Encyclopedia of Autism Spectrum Disorders. Cham: Springer; 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/978-3-319-91280-6_1922\u003c/span\u003e\u003cspan address=\"10.1007/978-3-319-91280-6_1922\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLogan SW, Robinson LE, Rudisill ME, Wadsworth DD, Morera M. The comparison of school-age children\u0026rsquo;s performance on two motor assessments: the Test of Gross Motor Development and the Movement Assessment Battery for Children. Phys Educ Sport Pedagogy. 2014. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/17408989.2012.726979\u003c/span\u003e\u003cspan address=\"10.1080/17408989.2012.726979\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBolk J, Farooqi A, Hafstrom M, Aden U, Serenius F. Developmental coordination disorder and its association with developmental comorbidities at 6.5 years in apparently healthy children born extremely preterm. JAMA Pediatr. 2018;172(8):765\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchoemaker MM, Niemeijer AS, Flapper BCT, Smits-Engelsman BCM. Validity and reliability of the movement assessment battery for children-2 checklist for children with and without motor impairments. Dev Med Child Neurol. 2012. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1469-8749.2012.04226.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1469-8749.2012.04226.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakajima A, Otaki M, Kajita H, Morikawa T, Nakamae T, Kato M. Assessment methods used by occupational therapists working in special needs schools in Japan. Kobe Gakuin Gen Rehabilitation Res. 2016;11(2):135\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHenderson SE, Sugden DA, Barnett A. The Movement Assessment Battery for Children. 2nd ed. London: Pearson Education Inc; 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuecha T, Takesue S, Yeoh WL, Loh PY, Muraki S. Backward Walking Styles and Impact on Spatiotemporal Gait Characteristics. Healthc (Basel). 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/healthcare10122487\u003c/span\u003e\u003cspan address=\"10.3390/healthcare10122487\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGerber RJ, Wilks T, Erdie-Lalena C. Developmental milestones: motor development. Pediatr Rev. 2012. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/pir.31-7-267\u003c/span\u003e\u003cspan address=\"10.1542/pir.31-7-267\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrie K, Mukaiyama K, Yamashita R, Zeidan H, Bandara A, Nagai-Tanima M, et al. Investigation subtypes of motor skills and activities of daily living among young children with motor delay. Occup Ther Int. 2023;2023:4031372. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1155/2023/403137\u003c/span\u003e\u003cspan address=\"10.1155/2023/403137\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuzescu R, Nechita F, Cioroiu SG. The Relationship between Neuromuscular Control and Physical Activity in the Formation of the Visual-Psychomotor Schemes in Preschools. Sensors. 2021;21(1):224. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/s21010224\u003c/span\u003e\u003cspan address=\"10.3390/s21010224\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonath L, Faude O, Hagmann S, Roth R, Zahner L. Fundamental movement skills in preschoolers: a randomized controlled trial targeting object control proficiency. Child Care Health Dev. 2015;41(6):1179\u0026ndash;87. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/cch.12232\u003c/span\u003e\u003cspan address=\"10.1111/cch.12232\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIkeda T, Aoyagi O. Relationship between test characteristics and movement patterns, physical fitness, and measurement characteristics: suggestions for developing new test items for 2- to 6-year-old children. Hum Perform Meas. 2008;5:9\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJahedi S, Hosseiny S, Sharifi A, Ghagarieh M. Effect of self-monitoring strategy instruction on modify behavior of hyperactive disorder in early childhood of Shiraz city. Adv Environ Biol. 2013;7(2):330\u0026ndash;2. ISSN 1995\u0026thinsp;\u0026ndash;\u0026thinsp;0756.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiles CAL, Wood G, Vine SJ, Vickers JN, Wilson MR. Quiet eye training facilitates visuomotor coordination in children with developmental coordination disorder. Res Dev Disabil. 2015;40:31\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ridd.2015.01.005\u003c/span\u003e\u003cspan address=\"10.1016/j.ridd.2015.01.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKane K, Barden J. Contributions of trunk muscles to anticipatory postural control in children with and without developmental coordination disorder. Hum Mov Sci. 2012;31(3):707\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.humov.2011.08.004\u003c/span\u003e\u003cspan address=\"10.1016/j.humov.2011.08.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSember V, Fratina R, Dolenec M, Prevc P, Tomazin K. Effects of Creeping Exercise on Upper Limb Strength. S Afr J Res Sport Phys Educ Recreat. 2021;43(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan der Beld WA, Van der Sanden GAC, Sengers RCA, Verbeek ALM, Gabreels FJM. Validity and reproducibility of a new diagnostic motor performance test in children with suspected myopathy. Dev Med Child Neurol. 2006;48:20\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan der Fels IMJ, te Wierike SCM, Hartman E, Elferink-Gemser MT, Smith J, Visscher C. The relationship between motor skills and cognitive skills in 4\u0026ndash;16 year old typically developing children: A systematic review. J Sci Med Sport. 2015;18(6):697\u0026ndash;703. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.jsams.2014.09.007\u003c/span\u003e\u003cspan address=\"10.1016/j.jsams.2014.09.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcClelland MM, Cameron CE. Developing together: The role of executive function and motor skills in children\u0026rsquo;s early academic lives. Early Child Res Q. 2019;46:142\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ecresq.2018.03.014\u003c/span\u003e\u003cspan address=\"10.1016/j.ecresq.2018.03.014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVeldman SLC, Jones RA, Okely AD. Efficacy of gross motor skill interventions in young children: an updated systematic review. BMJ Open Sport Exerc Med. 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjsem-2015-000067\u003c/span\u003e\u003cspan address=\"10.1136/bmjsem-2015-000067\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Yuan W, An R. Effectiveness of backward walking training on spatial-temporal gait characteristics: A systematic review and meta-analysis. Hum Mov Sci. 2018;60:57\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.humov.2018.05.007\u003c/span\u003e\u003cspan address=\"10.1016/j.humov.2018.05.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"pediatric motor ability, coordination, pediatric motor screening, circuit checklist, MABC-2","lastPublishedDoi":"10.21203/rs.3.rs-4416101/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4416101/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMotor development of children is variable. Equally, motor impairments are also variable, making screening and assessments of motor abilities and motor delays difficult, especially during early childhood development in a school setting. Several assessment methods for motor function exist from performance tests to questionnaires, done by therapists, teachers, or parents. However, such assessments may be expensive, time consuming for the teachers and the children, difficult to conduct in a group setting, and the results are controversial.\u003c/p\u003e\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo test the feasibility of a Circuit Checklist for gross motor assessment in a school setting.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe enchained exercises into a circuit play and created a detailed checklist of these movements and tested the motor function of children in a special needs\u0026rsquo; classroom. Then we calculated its concurrent validity with the Gross Motor Score (GMS) of Movement Assessment Battery for Children \u0026minus;\u0026thinsp;2nd edition (MABC-2) using Pairwise correlation, test-retest reliability using test-retest correlation, inter-rater reliability between two testers using inter-rater correlation, and the internal consistency of the circuit checklist items using Cronbach\u0026rsquo;s alpha.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe found that seven circuit movements and their checklist items are valid and have a moderate correlation of 0.6421 with GMS of MABC-2, a high degree of precision in the estimates of inter-rater reliability (range: 0.589\u0026ndash;0.856), and a moderate internal consistency (Cronbach\u0026rsquo;s Alpha: 0.666).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis Circuit Checklist could be a useful first step tool to screen motor impairments of preschool children, in a school setting. Ultimately, the checklist items would be useful to create a motion capture screening tool more practically used in classrooms.\u003c/p\u003e","manuscriptTitle":"Feasibility of the Circuit Checklist as an easy gross motor assessment for preschool children using recorded videos: a pilot study ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-04 21:44:38","doi":"10.21203/rs.3.rs-4416101/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7c346e78-bc68-429c-83cf-b8f32b520151","owner":[],"postedDate":"June 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-07T17:53:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-04 21:44:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4416101","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4416101","identity":"rs-4416101","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}