DSM 5- Difficulty with activities that require
motor coordination
DSM 5- what does DCD impacts
Impacts Academic achievement or activities of daily living
DSM 5- DCD has to be diagnosed when what is ruled out?
Other medical conditions like neurological brain bleed or genetic disorder
Prevalence and Associated Ages
5-8% at school age (5-11 years) for general population due to kids at that age historically given challenges like handwriting, socializing and playing with other kids.
DCD occur with other other disorders (3)
- ADHD
- ASD
- RD (reading disability)
Etiology
• Multiple brain regions and neural networks implicated
– Cerebellum
– Different activation and more activation (FMRI studies on DCD kids have regions lit up that TD kids do not That means they have a hard time from explicit to implicit, making them seem like they are staring over again in a complex motor skill.)
Clinical presentation of DCD: development to adulthood
Decreased participation in motor play, leading to depression as adults and cardiovascular problems. They have attention system deficits like for dual tasking
Clinical presentation of DCD: Handwriting and how you can improve patients
DCD patient’s handwriting are cramped together and their “in air transitions” are all over the place. AS a PT, you can improve handwriting by improving their UE strength/proximal stability, fine motor skills.
Clinical presentation of DCD: Playing skills
• Limited ball playing skills
• Poor targeting skill associated with less moderate to vigorous activity
less running so they get picked to play with less
Clinical presentation of DCD: Other areas of difficulty
• Performance IQ (i.e. Block Design) < verbal IQ
• Executive function deficits
– Specific difficulties with reaction time
• Slow, less accurate performance
( messy eating)
DCD Individuals’ performance with
intra-task variability
DCD kids don’t get consistent with more practice
Children with DCD engage in less moderate-vigorous physical activity (MVPA), results to…
higher BMIs, less strength
– Parental activity patterns and parental perception of child’s motor abilities associated with less MVPA in DCD
– When parents perceived their child’s motor abilities as inferior, children with DCD were less likely to participate in MVPA
Impact of coordination difficulties on Life Domains
Coordination differences leads to play differences, leading to difficulty in self care activity, then less peer relations leading to negative self perception, then to negative emotional health
Diagnostic measures and their ages (2)
• Movement Assessment Battery for Children – 2nd Edition
(MABC-2)
– 3 years to 16 years
• Bruininks-Oseretzky Test of Motor Proficiency, 2nd version
(BOTMP2)
– 4 years to 21 years
Developmental Coordination Disorder Questionnaire (DCDQ): age and things they look for
– 5-15 years
– Your child throws a ball in a controlled and accurate fashion.
– Your child catches a small ball (e.g., tennis ball size) thrown from a distance of 6 to 8 feet (1.8 to
2.4 meters).
– Your child hits an approaching ball or birdie with a bat or racquet accurately.
– Your child jumps easily over obstacles found in garden or play environment.
Children Participation Questionnaire (CPQ): age and things they look for
– 4 to 6 years
– education, social participation, play, leisure, activities of daily living and
instrumental activities of daily living
– frequency of participation, degree of assistance required, child’s pleasure
in participating, and parental satisfaction from child’s participation
DCDDaily: Age and what they look for
– 5 to 8 years
– Self care and self-maintenance, productivity and school, leisure and play
DCD child’s gait vs TD (typically developed) child’s
DCD child have more hip flexion and knee flexion to adapt to decreased balance and strength.
DCD child have greater reliance on visual feedback with gait as they walk much slower with no vision
TD child more plantarflexion during toe off
DCD children’s attention system
Lack ability to do dual tasks . They cannot drive as adults
DCD children’s posture and muscle tone
Usually more flexed forward posture
Low muscle tone
DCD children’s cardiovascular endurance
Needing a long break
PT intervention: Task training (2)
• Task Specific Training
– Neuromotor Task Training
• Dual Task – consider attentional requirements in all
interventions
PT intervention: Cognitive Orientation to Daily Occupational Performance (CO-OP), what does it based on, how to help child problem solve.
- Based on model of learning
- Explicit problem solving (give child internal cues to many ways to slave the task.
- Goal–Plan—Do—Check (access the problem solving, if goal achieved, then make new goal)
PT intervention: Group vs. Individual Sports
Individual sport will last longer as not everyone will have time to play with you and helps child to engage at that as adults.
In group sport, it is better for kid to participate in positions of least attentional demand like being a soccer goalie.
PT intervention: what other trainings to consider (2)
- Fitness Training
* Gait Training
Samantha is a 7-year-old girl with a diagnosis of DCD. She has a hard time playing group sports during recess and is feeling left out.
STG?
In 3 months, Sam will be able to pass the ball with her teammates with accuracy ten out of ten times to participate with her classmates.
