Developmental Coordination Disorder Flashcards
HALLMARK DCD DIAGNOSIS
A. Learning and execution of coordinated motor skills is below age level given the child’s opportunity for skill learning
B. Motor difficulties significantly interfere with ADL’s, academic productivity, prevocational and vocational activities, leisure and play.
C. Onset is in the early developmental period.
D. Motor coordination difficulties are not better explained by intellectual delay, visual impairment, or other neurological conditions that affect movement
OTHER TERMS FOR DCD
- Clumsy child syndrome
- Developmental clumsiness
- Dyscoordination
- Developmental apraxia or dyspraxia * Motor apraxia or dyspraxia
- Sensory-Based Motor Disorder (SBMD)
–> dyspraxia
–> postural disorders
ETIOLOGY
5-10%
2:1 boys: girls
RISKS: more prevalence in very low birth weight, premature infants (<32 weeks)
common comorbid conditions
- Attention deficit disorder (~50%)
- Learning disability
- Speech/language impairments
- Sensory differences
- Autism Spectrum disorder (new with DSM-5)
PATHOPHYS OF DCD
Multiple brain areas involved
-cerebellar lobe, inferior parietal
lobe, middle occipital gyrus, and thalamus showed less activation
POOR INTERNAL MODELS (CEREBELLUM)
–> learning new every time
No meds have proven effective
MED MANAGEMENT: rehab team examination and
intervention, including psychology, OT, Speech, and some possible
medical management for co-existing conditions like ADD
Common BSF impairments
- Poor strength
- Poor coordination and motor planning
- Joint laxity
- Poor visual perception
- Poor or slower processing
- Poor sequencing
- Poor feedback and feedforward
Common activity limitations
- Awkward gait
- Delayed or poor quality of motor skills
Common participation restrictions
- Difficulties at school and home (takes more time, messy)
- Longer term social-emotional and fitness consequences
5 MAIN CHARACTERISTICS OF DCD
Communication issues
gross motor skill delay
social implications
ADL limitations
–> tying shoes, driving
school challenges
Prognosis and Functional Consequences
● Don’t usually outgrow DCD, but learn to adapt
● Poor fitness
● Obesity
● Decreased physical activity (encourage individual sports)
● Poor self-esteem and self-worth
● Emotional and behavioral problems
● Impaired academic achievement
● At risk for being bullied
Movement observation drives examination–> how can you do this in exam and why is it important?
Observe a few basic tasks such as ball throwing/catching, going up and down stairs
Children with DCD present with a variety of co-morbidities and body structure and function impairments, so observation is important to hypothesize about other tests and measures to consider
DCD DIAGNOSIS SPECIFIC TESTS
DCD-Q’07:
-age 5-15 years
-parent report
-screening of participation and ADLs
–> throwing ball, cutting, clumsy, fatigues easily, run and stop
-15 items, 5 point scale
-high SN and SP, and validity
-available free online
Movement Assessment Battery for Children-2
-Near Gold Standard to identify and evaluate movement deficits and contribute to a diagnosis of
DCD: examination for children
- age 3-16 years
-3 sections, 8 items for each of 3 age bands
–> manual dexterity, ball skills, static and dynamic balance
-higher scores are better
< 5th% on MABC-2 - probable for DCD
-5-15% –> suspect for DCD
Possible impairments to examine based on OMA
- Strength * Coordination/Balance
- Joint laxity/flexibility
- Posture
- Timing and sequencing
- Feedback and feed-forward motor control
- Cardiopulmonary fitness
INTERVENTION Action statements from CPG
-task/activity-oriented approaches PLUS body function/structure interventions–> most effective
—> motor learning, motor planning strategies, feedback, self-assessment of movements
-individual PT for children <5-6 years
-individual or group > 6 years based on ability to attend and follow directions
Example of self-assessment of movements during task-oriented interventions
-how did that go for you?
-what do you think you could do differently to improve?
