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Neuro Rehab 1 > Developmental Coordination Disorder > Flashcards

Developmental Coordination Disorder Flashcards

1
Q

what are 5 co-existing conditions

A

ADHD
LD - learning disabilities
ASD - autism
sensory differences
behavioral/mental health concerns

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2
Q

when is DCD typically diagnosed

A

@5yo or later

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3
Q

what is DCD categorized as

A

neurodevelopmental
motor disorder

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4
Q

what are 2 risk factors of DCD

A

prematurity (<32wks)
low birth weight (<3.3lb)

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5
Q

causality of DCD

A

unknown

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6
Q

pathology of DCD

A

unknown
different brain activity noted:
- primary sensory motor cortex
- post sup temporal gyrus
- cerebellum
- supplemental motor area

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7
Q

where there is different brain activity noted, what are those regions associated with

A

timing, motor control, spatial and error processing

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8
Q

where in the action planning system is there a breakdown in DCD

A

thought that could be right from beginning have altered receiving info from environment
- could be any process w/i system
- could be issue w action aspect (ie speed, force, distance)

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9
Q

what are 8 BSF impairments of DCD

A
  1. impaired coordination
  2. poor spatial organization
  3. poor feedback and feed-forward motor control
  4. poor short and long-term memory
  5. neuro “soft signs” = low tone, persistent primitive reflexes, immature movement
  6. dec strength
  7. slow movement (reaction time & movement time)
  8. “fixing”
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10
Q

what ab motor planning is disrupted when a motor task is unsuccessful in DCD

A

knowledge of performance
- will repeat motor task same way even if wasn’t successful

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11
Q

what is the “fixing” BSF impairment noted in DCD

A

stiffen more prox ms groups during movements
- movements never get more fluid w experience and KR/KP as TD do

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12
Q

what results from poor memory seen in DCD

A

focusing on navigating environment and concomitant ADHD possible

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13
Q

what are 5 activity limitations of DCD

A

awkward slow gait (falls, trips)
dec balance (eps high level skills)
poor quality GM skills
FM skills
delay in skill acquisition in some

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14
Q

how may fine motor skills be an activity limitation in DCD

A

poor handwriting
drop things
poor ADLs (zippers, tying shoes)

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15
Q

what gross motor skills may have poor quality in DCD

A

hopping
skipping

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16
Q

how can the environment impact DCD

A

more difficulty in complex environment
- ie speed needed, navigate space

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17
Q

what are 3 ways DCD may have participation limitations

A

school setting
- phys ed
- “disruptive”
time - never enough
frustration - self, peers, teachers

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18
Q

what is the significance of a school environment for a child w DCD

A

this is where you see kids fall behind
in a school environment - more complex tasks, follow rules, navigate socially, competition in phys ed, fall out of chairs
- concentrating on one task so hard, forget where body is in space
- never have enough time to do things w the quality/completedness that is needed

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19
Q

what are 4 secondary complications (BSF and activity and participation limitations)

A
  1. dec strength/power
  2. withdrawal from physical activity
  3. dec physical fitness
  4. affects participation in sports, leisure, opportunities for social interaction, sense of self worth

limit ROM
dec performance in school

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20
Q

what are 4 co-existing or secondary to DCD dx

A

depression
unmotivated
low self-esteem, self-worth
anxiety
- play
- academics
- vocation
- social

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21
Q

what are the 4 criteria that must be met to be dx w DCD

A
  1. motor performance deficits
  2. participation and ADL deficits
  3. early onset
  4. no exclusionary conditions
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22
Q

who makes the DCD dx

A

physician
psychologist

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23
Q

who of the interprofessional team is key for managing DCD

A

PT

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24
Q

how is the criteria of motor performance deficits defined for a DCD dx

A

learning and execution of coordinated motor skills is below age level GIVEN CHILD’S OPPORTUNITY FOR SKILL LEARNING

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25
Q

describe what exclusionary conditions mean as a criteria for a DCD dx

A

motor coordination difficulties not better explained by intellectual delay, visual impairment, or other neurological conditions that affect movement

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26
Q

what are conditions to r/o in order to dx w DCD (7)

A
  1. other neuro disorder (ie TBI, mild CP)
  2. ASD/related conditions
  3. regression of skill***
  4. orthopedic disorders
  5. primary sensory impairments
  6. comprehension difficulties
  7. genetic condition/syndrome
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27
Q

what is a critical thing to r/o before a DCD dx and what would that thing r/o be more indicative of

A

regression of skill
- NMD (ie duchenne’s)

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28
Q

prognosis for DCD

A

will not outgrow, chronic condition
- intervention leads to more positive outcomes

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29
Q

what is DCD prognosis correlated to (3)

A
  1. poor academic achievement
  2. poor social and physical competence
  3. “antisocial” functioning in adolescents and young adults
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30
Q

what is very important and influential in how PT should practice and manage DCD

A

CPGs

31
Q

what is the order that a PT exam should go thru in assessing DCD

A

activity based assessment
- PMH/systems review
- participation
- observe movement
- activity limitations w standard measures
- BSF impairments

32
Q

what should be covered in PMH (6)

A
  1. reason for referral
  2. onset of sx, when first noticed
  3. other concerns, co-existing dx
  4. developmental hx - all domains, milestones
  5. education/intervention hx - what does family know
  6. participation hx - has the child had opportunities, likes/dislikes
33
Q

what is covered in systems review (9 - have an idea)

A
  1. ms tone
  2. fall hx, toe walking
  3. gower’s sign, waddling gait
  4. pain
  5. endurance at home, school, community
  6. acute changes in cog function** (**not consistent w DCD)
  7. behavioral regulation & attention
  8. interaction abilities - peers & adults
  9. vision screen
34
Q

what are 4 standardized participation measures (yes you need to know this)

A
  1. Canadian Occupational Performance Measure (COPM)
  2. Goal Attainment Scale (GAS)
  3. Perceived Efficacy and Goal Setting Program (PEGS)
  4. Children’s Assessment of Participation & Enjoyment (CAPE)
35
Q

what DSM V criteria does the standardize participation measures address

A

2: participation & ADL deficits

36
Q

how is motor performance assessed

A

observation - movement analysis

37
Q

what ab movement analysis is observed (7)

A
  1. movement thru space
  2. skills in different environments
  3. large, whole body movement & postural control
  4. UE: skilled tasks
  5. (B) movements (ie crossing midline)
  6. simple vs complex movements
  7. speed component
38
Q

what DSM V criteria does movement analysis address

A

1: motor deficits

39
Q

what are 2 activity limitation questionnaires that are reliable and valid for pt population

A
  1. Developmental Coordination Disorder Questionnaire 2007 (DCDQ’07)
  2. Movement Assessment Battery for Children 2nd Edition Checklist (MABC-2-C)
40
Q

what are 2 not valid for DCD population but still used activity limitation questionnaires

A

interviews
others that may be applicable for individual children (ie school function assessment)

41
Q

what DSM V criteria does activity limitation questionnaires address

A

2: participation and ADL deficits

42
Q

what is the purpose of the DCDQ’07 and what ICD area does this cover

A

screen motor coordination in children (ages 5-15yo)
- from parent perspective

activity limitations

43
Q

what is the gold standard objective measure for DCD population in assessing motor performance

A

MABC-2

44
Q

how are motor skills assessed

A

performance outcome measures

45
Q

what are 2 objective motor performance measures

A
  1. Movement Assessment Battery for Children 2nd ed (MABC-2)
  2. Bruininks-Oseretsky Test for Motor Proficiency 2nd Ed (BOT-2)
46
Q

describe the MABC-2: ages, domains, etc.

A

gold standard for assessing motor performance in DCD

ages 3-16
domains:
- manual dexterity
- aiming and catching
- balance

norm referenced

47
Q

what are the norm referenced outcomes of the MABC-2 that assess motor performance in DCD

A

> 15th percentile = no movement difficulty
5-15 percentile = at risk
<5th percentile = significant movement difficulty

48
Q

when would you use the BOT-2 over the MABC-2

A

if child too old for MABC-2

49
Q

describe the BOT-2: ages, domains, etc.

A

motor performance assessment
ages: 4-21
- if children too old for gold standard MABC-2

areas examined:
- fine manual control
- manual coordination
- body coordination
- strength and agility

norm referenced

50
Q

describe how BSF impairments are assessed

A

based on observational movement analysis

51
Q

what about the BSF impairments thru observation should be considered

A

consider examination of components of fitness
- cardiorespiratory endurance
- strength, power, ms endurance
- postural control

52
Q

what are 3 general goals of PT interventions

A
  1. learning
  2. prevent secondary impairments
  3. inc participation and confidence
53
Q

what else should be provided as interventions outside of PT (2)

A

care coordination & education
direct services

54
Q

what should be provided as part of care coordination and education (3)

A

family-centered approach
- education
- activity selection
- lifestyle

education
- teachers, coaches
- community programs

anticipate problems, give choices, set up for success

55
Q

what are we educating the family on to set the child up for success

A

how to get better at anticipating problems
- anything that is new will be more challenging
- activities that require cont adaptation and hand eye coordination

56
Q

what are alternative activities for DCD and why are these better for that population (5)

A

swimming
track/field
individual activities:
- biking
- martial arts
- yoga

while activities are new, have repetitive nature to set child up for success

57
Q

what are 2 ideal “first-choice” strategies for PT interventions

A

task-specific training
BSF

58
Q

how can task-specific training be applied (4)

A

motor skill training
neuromotor task training
cog orientation to daily occ performance
motor imagery

59
Q

how a BSF strategy of PT intervention be applied (3)

A

core stability training
cardiorespiratory training
functional movement - power training program

60
Q

what are factors to implement/consider when using a task-specific training strategy (7)

A
  1. environment
  2. part -> whole
  3. verbal instruction
  4. positioning
  5. modeling
  6. freq practice (to inc confidence)
  7. consistent feedback
61
Q

what is a cognitive approach to a PT intervention

A

use cognitive strategies to form a mental plan of action that helps person to learn, problem solve, and perform

very deliberate engagement of child in problem-solving

62
Q

what are the benefits to using a cognitive approach in PT interventions (3)

A

improve:
- learning
- problem solving
- task performance

63
Q

what is the evidence say about task-oriented approaches to PT and what does recent evidence support

A

addressing impairments doesn’t translate into improved activity or participation for DCD pt population

recent evidence supports move to “top-down” approaches

64
Q

what are the advantages to using a task oriented approach to a chronic condition like DCD

A

children need to be able to learn to learn
- generalize learning
- approach new motor tasks w same effective strategies

65
Q

what are the benefits to using a motor learning approach in this population

A

greater potential to inc function and participation

66
Q

what is the CPG for addressing the BSF impairments and 3 recommended PT interventions per this CPG

A

strong role for prevention/alleviation of secondary complications
- trunk/prox stability
- functional strength/power
- cardiorespiratory training

67
Q

dosage and setting for a PT intervention

A

time: 100min/wk
practice time: 2-5x/wk (PT or supplemental activities)
duration: ~9wks depending on STG

setting: individual, small group suggested

68
Q

what are supplemental activities in the home and community

A

soccer
taekwondo

69
Q

what are considerations of soccer as a supplemental activity and how is this best managed

A

requires:
- speed, power, endurance, agility, coordination

best if by trained coach

70
Q

what are considerations of taekwondo as a supplemental activity? what is the evidence? how is this activity best managed?

A

requires: balance, strength
evidence: BSF vs activity/performance

best if taught by certified instructor

71
Q

what is the key in deciding supplemental activities outside of PT

A

shared decision making with child/family

72
Q

what are supplemental activities that should be decided upon together w the family

A

individual type sports
active video games

73
Q

evidence on active video games as a supplemental activity?

A

insufficient evidence on improving participation and motor outcomes
- some detrimental effect as less time outside

74
Q

what are the 3 take home important implications for PT

A
  1. w children and early dx/management
  2. w adults in context of PT for “other” issues
  3. w advocacy and awareness

Neuro Rehab 1 (27 decks)

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