Developmental Coordination Disorder Flashcards
what are 5 co-existing conditions
ADHD
LD - learning disabilities
ASD - autism
sensory differences
behavioral/mental health concerns
when is DCD typically diagnosed
@5yo or later
what is DCD categorized as
neurodevelopmental
motor disorder
what are 2 risk factors of DCD
prematurity (<32wks)
low birth weight (<3.3lb)
causality of DCD
unknown
pathology of DCD
unknown
different brain activity noted:
- primary sensory motor cortex
- post sup temporal gyrus
- cerebellum
- supplemental motor area
where there is different brain activity noted, what are those regions associated with
timing, motor control, spatial and error processing
where in the action planning system is there a breakdown in DCD
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)
what are 8 BSF impairments of DCD
- impaired coordination
- poor spatial organization
- poor feedback and feed-forward motor control
- poor short and long-term memory
- neuro “soft signs” = low tone, persistent primitive reflexes, immature movement
- dec strength
- slow movement (reaction time & movement time)
- “fixing”
what ab motor planning is disrupted when a motor task is unsuccessful in DCD
knowledge of performance
- will repeat motor task same way even if wasn’t successful
what is the “fixing” BSF impairment noted in DCD
stiffen more prox ms groups during movements
- movements never get more fluid w experience and KR/KP as TD do
what results from poor memory seen in DCD
focusing on navigating environment and concomitant ADHD possible
what are 5 activity limitations of DCD
awkward slow gait (falls, trips)
dec balance (eps high level skills)
poor quality GM skills
FM skills
delay in skill acquisition in some
how may fine motor skills be an activity limitation in DCD
poor handwriting
drop things
poor ADLs (zippers, tying shoes)
what gross motor skills may have poor quality in DCD
hopping
skipping
how can the environment impact DCD
more difficulty in complex environment
- ie speed needed, navigate space
what are 3 ways DCD may have participation limitations
school setting
- phys ed
- “disruptive”
time - never enough
frustration - self, peers, teachers
what is the significance of a school environment for a child w DCD
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
what are 4 secondary complications (BSF and activity and participation limitations)
- dec strength/power
- withdrawal from physical activity
- dec physical fitness
- affects participation in sports, leisure, opportunities for social interaction, sense of self worth
limit ROM
dec performance in school
what are 4 co-existing or secondary to DCD dx
depression
unmotivated
low self-esteem, self-worth
anxiety
- play
- academics
- vocation
- social
what are the 4 criteria that must be met to be dx w DCD
- motor performance deficits
- participation and ADL deficits
- early onset
- no exclusionary conditions
who makes the DCD dx
physician
psychologist
who of the interprofessional team is key for managing DCD
PT
how is the criteria of motor performance deficits defined for a DCD dx
learning and execution of coordinated motor skills is below age level GIVEN CHILD’S OPPORTUNITY FOR SKILL LEARNING
describe what exclusionary conditions mean as a criteria for a DCD dx
motor coordination difficulties not better explained by intellectual delay, visual impairment, or other neurological conditions that affect movement
what are conditions to r/o in order to dx w DCD (7)
- other neuro disorder (ie TBI, mild CP)
- ASD/related conditions
- regression of skill***
- orthopedic disorders
- primary sensory impairments
- comprehension difficulties
- genetic condition/syndrome
what is a critical thing to r/o before a DCD dx and what would that thing r/o be more indicative of
regression of skill
- NMD (ie duchenne’s)
prognosis for DCD
will not outgrow, chronic condition
- intervention leads to more positive outcomes
what is DCD prognosis correlated to (3)
- poor academic achievement
- poor social and physical competence
- “antisocial” functioning in adolescents and young adults
what is very important and influential in how PT should practice and manage DCD
CPGs
what is the order that a PT exam should go thru in assessing DCD
activity based assessment
- PMH/systems review
- participation
- observe movement
- activity limitations w standard measures
- BSF impairments
what should be covered in PMH (6)
- reason for referral
- onset of sx, when first noticed
- other concerns, co-existing dx
- developmental hx - all domains, milestones
- education/intervention hx - what does family know
- participation hx - has the child had opportunities, likes/dislikes
what is covered in systems review (9 - have an idea)
- ms tone
- fall hx, toe walking
- gower’s sign, waddling gait
- pain
- endurance at home, school, community
- acute changes in cog function** (**not consistent w DCD)
- behavioral regulation & attention
- interaction abilities - peers & adults
- vision screen
what are 4 standardized participation measures (yes you need to know this)
- Canadian Occupational Performance Measure (COPM)
- Goal Attainment Scale (GAS)
- Perceived Efficacy and Goal Setting Program (PEGS)
- Children’s Assessment of Participation & Enjoyment (CAPE)
what DSM V criteria does the standardize participation measures address
2: participation & ADL deficits
how is motor performance assessed
observation - movement analysis
what ab movement analysis is observed (7)
- movement thru space
- skills in different environments
- large, whole body movement & postural control
- UE: skilled tasks
- (B) movements (ie crossing midline)
- simple vs complex movements
- speed component
what DSM V criteria does movement analysis address
1: motor deficits
what are 2 activity limitation questionnaires that are reliable and valid for pt population
- Developmental Coordination Disorder Questionnaire 2007 (DCDQ’07)
- Movement Assessment Battery for Children 2nd Edition Checklist (MABC-2-C)
what are 2 not valid for DCD population but still used activity limitation questionnaires
interviews
others that may be applicable for individual children (ie school function assessment)
what DSM V criteria does activity limitation questionnaires address
2: participation and ADL deficits
what is the purpose of the DCDQ’07 and what ICD area does this cover
screen motor coordination in children (ages 5-15yo)
- from parent perspective
activity limitations
what is the gold standard objective measure for DCD population in assessing motor performance
MABC-2
how are motor skills assessed
performance outcome measures
what are 2 objective motor performance measures
- Movement Assessment Battery for Children 2nd ed (MABC-2)
- Bruininks-Oseretsky Test for Motor Proficiency 2nd Ed (BOT-2)
describe the MABC-2: ages, domains, etc.
gold standard for assessing motor performance in DCD
ages 3-16
domains:
- manual dexterity
- aiming and catching
- balance
norm referenced
what are the norm referenced outcomes of the MABC-2 that assess motor performance in DCD
> 15th percentile = no movement difficulty
5-15 percentile = at risk
<5th percentile = significant movement difficulty
when would you use the BOT-2 over the MABC-2
if child too old for MABC-2
describe the BOT-2: ages, domains, etc.
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
describe how BSF impairments are assessed
based on observational movement analysis
what about the BSF impairments thru observation should be considered
consider examination of components of fitness
- cardiorespiratory endurance
- strength, power, ms endurance
- postural control
what are 3 general goals of PT interventions
- learning
- prevent secondary impairments
- inc participation and confidence
what else should be provided as interventions outside of PT (2)
care coordination & education
direct services
what should be provided as part of care coordination and education (3)
family-centered approach
- education
- activity selection
- lifestyle
education
- teachers, coaches
- community programs
anticipate problems, give choices, set up for success
what are we educating the family on to set the child up for success
how to get better at anticipating problems
- anything that is new will be more challenging
- activities that require cont adaptation and hand eye coordination
what are alternative activities for DCD and why are these better for that population (5)
swimming
track/field
individual activities:
- biking
- martial arts
- yoga
while activities are new, have repetitive nature to set child up for success
what are 2 ideal “first-choice” strategies for PT interventions
task-specific training
BSF
how can task-specific training be applied (4)
motor skill training
neuromotor task training
cog orientation to daily occ performance
motor imagery
how a BSF strategy of PT intervention be applied (3)
core stability training
cardiorespiratory training
functional movement - power training program
what are factors to implement/consider when using a task-specific training strategy (7)
- environment
- part -> whole
- verbal instruction
- positioning
- modeling
- freq practice (to inc confidence)
- consistent feedback
what is a cognitive approach to a PT intervention
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
what are the benefits to using a cognitive approach in PT interventions (3)
improve:
- learning
- problem solving
- task performance
what is the evidence say about task-oriented approaches to PT and what does recent evidence support
addressing impairments doesn’t translate into improved activity or participation for DCD pt population
recent evidence supports move to “top-down” approaches
what are the advantages to using a task oriented approach to a chronic condition like DCD
children need to be able to learn to learn
- generalize learning
- approach new motor tasks w same effective strategies
what are the benefits to using a motor learning approach in this population
greater potential to inc function and participation
what is the CPG for addressing the BSF impairments and 3 recommended PT interventions per this CPG
strong role for prevention/alleviation of secondary complications
- trunk/prox stability
- functional strength/power
- cardiorespiratory training
dosage and setting for a PT intervention
time: 100min/wk
practice time: 2-5x/wk (PT or supplemental activities)
duration: ~9wks depending on STG
setting: individual, small group suggested
what are supplemental activities in the home and community
soccer
taekwondo
what are considerations of soccer as a supplemental activity and how is this best managed
requires:
- speed, power, endurance, agility, coordination
best if by trained coach
what are considerations of taekwondo as a supplemental activity? what is the evidence? how is this activity best managed?
requires: balance, strength
evidence: BSF vs activity/performance
best if taught by certified instructor
what is the key in deciding supplemental activities outside of PT
shared decision making with child/family
what are supplemental activities that should be decided upon together w the family
individual type sports
active video games
evidence on active video games as a supplemental activity?
insufficient evidence on improving participation and motor outcomes
- some detrimental effect as less time outside
what are the 3 take home important implications for PT
- w children and early dx/management
- w adults in context of PT for “other” issues
- w advocacy and awareness
