DCD lecture Flashcards
DCD is suspected when
- motor impairment or skill delay impacting age-appropriate activities
- Sufficient opportunities have been provided to learn a motor skill
- A motor impairment cannot be explained by another diagnosis
what are the 4 DSM-5-TR Criteria
- Motor Performance Deficits
- Participation and ADL Deficits
- Early onset
- No Exclusionary Conditions
what is the requirement to receive a diagnosis of developmental coordination disorder?
- All 4 DSM-5-TR criteria must be met
Motor Performance Deficits
- Learning and performance of motor coordination activities are not meeting the expectation of child’s chronological age and opportunities
Participation and ADL Deficits
- Motor difficulties have a significant impact on:
Self care activities
Academic Achievement
Leisure
Play
No Exclusionary Conditions
- Motor challenges are not better explained by: intellectual impairments, visual impairment, neurologic and genetic conditions
Frequently associated conditions of DCD
- ADHD
- ASD (Autism Spectrum Disorder)
- Speech impairments
- Learning or intellectual disability
- a person with one of these diagnoses has a 50% likelihood of also having DCD
Common Secondary impairments of DCD
- Increased sedentary activities
- Decreased cardiovascular health
- Social isolation
- Academic and behavioral challenges
- Higher rates of mental health
When is the most appropriate to screen for DCD?-
- starting around age 5
Clues when screening for DCD
- Birth weight < 1500g (3.3lbs)
- Birth prior to 32 weeks gestation
- ADD, ADHD, ASD, intellectual or learning Disability
- Hypotonicity or joint laxity
- Balance deficits
Factors associated with increased risk for DCD
- Birth weight < 1500g (3.3lbs)
- Birth prior to 32 weeks gestation
- ADD, ADHD, ASD, intellectual or learning Disability
Factors that are commonly observed in children with DCD
- Hypotonicity or joint laxity
- Balance deficits
Factors that can be causes of coordination impairment but are not DCD symptoms
- head injury
- headaches or blurred vision
- global developmental delayed
- deterioration of previously learned skills
- changes in muscle toe
- social delays
Possible Screening tools for DCD
MABC-2-C (Movement assessment battery)
DCDQ’07 ( Developmental coordination disorder questionnaire)
What is MABC-2
- takes account of behavioral difficulty
- Break tasks down to stability vs. mobility
- Predictable vs. unpredictable settings
What information should we gather in the history for suspecting DCD
- Prematurity
- Cos-existing conditions
- Birth weight
- frequent falls
- onset of noticeable symptoms
- family hx of ASD< DCD, ADHD
- Timing of developmental milestones
- School performance and services
what system review informations are to rule out other causes of coordination impairments?
- Atypical or asymmetrical muscle tone
- Headaches or pain
- Signs of trauma (head)
- Acute changes in cognition
- Acute changes In visual function or previous history of visual impairments
What system reviews information are to determine if secondary impairments of DCD are also present?
- Bruising or abrasions from falls
- Endurance at home and school (keeping up with peers, fatigue, etc)
Common Findings of Observation
- Decreased coordination (Jerky) movements
- Increased time to complete tasks
- Asymmetrical movement patterns
- Impaired motor sequencing and timing
-Increased step width - Double limb stance and stride time variability
- immature movement patterns compared to peers
- Delayed hopping, jumping, and ball skills
DCDQ’07 vs. MABC-2
DCDQ:
- Caregiver report
- Ages 5-15 years
- Evaluates gross and fine motor skills that require increased coordination
MABC-2
- Norm referenced
- ages 3-16 years, 11 months
- checklist for age 5-12 years, 0 months
what percentile of MABC-2 would indicate kids at probably DCD/significant movement difficulty?
5th percentile or lower
What percentile on MABC-2 indicate kids at risk for DCD?
5th - 15th percentile
Test & measures for DCD
- cardiorespiratory fitness
- muscle tone
- joint laxity
- Coordination
First- Choice Intervention
- Task oriented combined with body functions & structure interventions
Task-Oriented
- intended to improve acquisition and execution of a specific functional motor task
- can have gradual increases in task-demand
Body Function & Structures
- Addressing underlying impairments suspected to contribute to functional deficits
- ineffective when done without task approach
Types of task-oriented intervention
- Motor skill training
- neuromotor task training
- motor imagery
Types of Body functions & structures
- proximal stability training
- cardiorespiratory training
- Functional Movement: Power training program
Task-Oriented: Motor skill training
- Require practice and repetition of voluntary movements to accomplish a task
- Complexity and difficulty are modified over time
- Land based
Goals of Task-Oriented: Motor skill training
- resolve, reduce, or prevent impairments
- develop effective and efficient strategies to accomplish functional tasks
- adapt functional tasks to environmental conditions
Task-Oriented: Neuromotor Task Training
- Breaks down both the cognitive and motor control processes present during a task
- Decreases environmental and task demands to promote success, then increases until skill is generalizable
*45-60 minute sessions, 2x/week, 9 weeks
Task-Oriented: Motor Imagery 6-step Protocol
- Visual imagery exercises
- Relaxation and mental preparation
- Visual modeling of fundamental motor skills
- Mental rehearsal of skills from an external perspective
- Mental Rehearsal of skills from an internal perspective
- Overt practice with repetitions of the skill and mental rehearsal between each skill
Frequency of Task-Oriented: Motor Imagery
60 minutes 1x/week suggested
Body Function/ structure: Proximal Stability
- Strengthening of abs and lumbopelvic regions
- Proximal stability training alone improved strength but not sensory organization
- Improvements were significant for both motor skills and sensory organization when task oriented training was added
Frequency of Body Function/ structure: Proximal Stability
60 minutes, 1x/week, 8 weeks
Body Function/ Structure: Cardiorespiratory has significant improvements in?
- MABC-2 Composite score
- Cardiovascular endrurance testing
Frequency of Body Function/ Structure: Cardiorespiratory
50 minutes, 3x/week, 16 weeks
Body Function / Structure: Functional Movement-Power training
90 minutes, 2x/week, 12 weeks
Overall Intervention Dosage
- 2-5 times per week of skill practice in an episode of care
- 1-2 direct PT sessions per week + 1-3 home or school based practice sessions
- 9 week episode of care on average for measurable, long term change
CanChild MATCH Framework
- modify the task
- alter expectations
- teach strategies
- change the environment
- Help by understanding
