Developmental Coordination Disorder Flashcards
what was DCD previously called?
clumsy child, development clumsiness, developmental apraxia, motor coordination problem, dyspraxia, perceptual motor dysfunction
Prevalence of development coordination disorder
3-5%
- 5-6% of school age children
- M:F ratio is 2:1
Who has a higher risk of development coordination disorder?
children born weighting less than 3.3lbs or before 32 weeks gestation
pathophysiology of DCD
- dysfunction of cortical networks
- changes in white matter
- less activation in areas associated with timing, motor control, spatial. and error processing
DCD and coexisting conditions
- LD: learning disabilities
- ADHD: attention deficit hyperactivity disorder
- Sensory integration/ Sensory motor disorder
- Autism spectrum disorder
Percent of children with DCD who have epilepsy
25%
How is DCD diagnosed?
through classification in the Diagnostic and Statistical Manual of Mental Disorders - 5th Edition
- Neurodevelopmental Disorder
- Subcategory: motor disorder
- 4 criteria
DSM-V Diagnostic Category
- Acquisition and execution of coordinated motor skill are substantially below what is expected for age
- Motor skill deficit interferes with academic achievement, ADL, leisure and play
- Onset of symptoms is in early development
- Deficits are not better explained by intellectual disability, visual impairment, or a neuron condition such as CP, MD, or a degenerative disorder
Common characteristics of DCD
- delayed motor development
- clumsiness
- balance and coordination problems
- handwriting problems
- hypotonia/joint laxity
- overweight or obese
- low fitness level
multi-system involvement
motor –> information processing –> psychosocial –> repeat
DCD involves…
social, concentration, organization, fine motor, communication, gross motor
Difficulties with motor skills
- Difficulty with ADLs (utensils for eating, dressing)
- Difficulty with handwriting or drawing
- Difficulties with balance and coordination
- Poor praxis
- Low muscle tone
- lower level of fitness than age-matched peers
Information processing/sensory issues
- impaired ability to judge distance
- poor body awareness
- poor timing
- short and long term memory issues related to sequencing motor tasks
- perceptual deficits
- slower response times
psychosocial difficulties
- learning difficulties
- reading problems
- behavior problems
- poor interactive play skills
- lower self esteem
- lower self worth
- increased anxiety
Standards for Screening and Examination of DCD
- European Academy of Childhood Disability Guidelines
- Academy of Pediatric PT CPG
Screening and Exam for DCD includes…
- history and systems review
- screening
- appropriate referrals for red flags that indicate concerns for medical, development, or other exclusionary conditions
Possible Coexisting Conditions
- ASD
- Attention Hyperactivity Disorder
- Learning Disability
- Communication Disorder
Differential Diagnosis
- CP
- Genetic Disorders
- Visual Impairments
- Neurodegenerative disorders
- TBI
Development Coordination Disorder Questionnaire
- screening tool for DCD
- Parent questionnaire
- age rage expanded: 5 years to 15 years
- high sensitivity and specificity
comprehensive examination DCD
- participation and quality of life
- movement analysis and observation
- activity limitations
- motor performance
- body structures and function
Assessment of participation
- COPM
- CAPE/PAC
-PEGs - PEM-CY
- PODCI (does not include child preference)
Standardized tests for Assessment of Motor Performance
- M-ABC2: screening tools, identification of motor impairment
- BOT-2: identification, more in depth diagnostics, and qualification for school services
Movement ABC-2
- Age range: 3-16 yo
- Time to administer: 15-20 mins
- 3 age bands (3-6, 7-10, 11-16)
- 8 items in 3 categories: manual dexterity (3), aiming and catching (2), balance (3)
MABC-2 Categorization of children with DCD
- 5th percentile > significant movement difficulty = probably DCD
- 5th to 15th percentiles at risk of having movement difficulty = at risk for DCD
- no difference in literature on the treatment of these different groups
BOT-2
- evaluates higher level motor skills
- age range: 4 years - 21yo,11mo
- norm referenced
- sex specific or combined norms
BOT-2 subscales bs subtests
- fine motor control: fine motor precision, fine motor integration
- manual coordination: manual dexterity, upper limb coordination
- body coordination: bilateral coordination, balance
- strength and agility: running speed and agility, strength
Goal setting
- Should be established with child priorities in mind
- PEGS
- COPM
- GAS
Task oriented interventions
- neuromotor task training
- cognitive orientation to daily performance
- Wii Fit training
Body oriented interventions
- strengthening exercises
- endurance exercises
- coordination exercises
Individual or group therapy?
- Individual for children < 5-6 years
- Group for > 6 years based on ability to attend and follow directions
what are the most effective approach for interventions?
body oriented and task oriented
neuromotor task training
- based on motor control and motor learning principles
- considered motor teaching and motivation principles
- Addresses how to instruct child, hot to practice skill and how to provide feedback
Cognitive orientation to daily performance
- client centered, performance based, problem solving approach
- enables skill acquisition through a process of strategy use and guided discovery
- focused on only 3 motor skills during 10 intervention sessions
- parent involvement - celebrate success, support
fitness, recreation and physical activity recommendations
- incorporate child and family priorities and participation
- focus on individual activities where child can be successful and develop life long habits (swimming, skiing, bicycling, hiking, skating, yoga, etc)
- include aerobic exercise
- provide HEP: strengthening, balance, endurance
What od children with DCD have?
altered white matter
what are essential for success?
child goals
