Developmental Coordination Disorder Flashcards
DSM IV Definition
Performance in ADL’s (that require motor performance) is substantially below that expected for a person’s chronological age and measured intelligence
May be manifested by marked delays in achieving motor milestones, dropping things, “clumsiness”, poor handwriting and poor performance in sports
ICD-9 dx code for DCD
Disturbances described previously significantly interfere with academic achievement and/or ADLs
Disturbance not due to a medical condition (CP, MD) and does not meet the criteria for PDD
Motor difficulties are greater than expected in the presence of intellectual disability
DCD Incidence
5-10% of children in school
Greater in boys than girls
90% of children with learning disorders are thought to have motor coordination problems
Increased…
Pre-term infants
Greater degrees of prematurity
Pre or perinatal influences or risk factors
Associated disorders
Phonological disorder
Expressive language disorder
Mixed receptive/expressive Language disorder
ADD/ADHD
Phonological disorder
Making sounds
Expressive language disorder
Coordinating speech and language for communication
ADD/ADHD
Individuals with ADD/ADHD may fall, bump into things, knock things over due to distractibility and impulsivity; however, if criteria for both disorders are met, both diagnoses can be given
Action Planning System Processes
Process 1 - Interprets and integrates
Process 2 - Decides on a plan of action
Process 3 - Organizes plan into motor components
Process 4 - Message sent to mm, mm contract
Process 1 - Interprets and integrates
Child may experience difficulty interpreting info received from vision, tactile, balance, proprioception, and mm movement
Process 2 - Decides on a plan of action
Child may have difficulty choosing type of motor action that is appropriate for the situation
In order to select an action the child must consider the context n which the action takes place
(i.e. when approaching a curb, child has to figure out that stepping up a curb is like climbing stairs)
Process 3 - Organizes plan into motor components
Child may have difficulty forming a plan of action in the proper SEQUENCE
Child must organize the motor requirements of a task into a sequence of commands (motor program) that tells the mm how to perform the required action
(i.e. when the child approaches a set of stairs, he must shift weight onto one foot to lift the other)
Process 4 - Message sent to mm, mm contract
Messages sent to the mm must specify speed, force, direction, distance to be moved
When children move in response to stimuli moving in time or space (catching a ball) the messages must also change
A child may have difficulty monitoring this information or modifying the messages in order to guide the movement while it is taking place
Overall hypotheses DCD
Child has difficulty with analyzing sensory input…
Using info to choose a plan of action
Sequencing the movement required for the task
Sending the right message to produce a coordinated action
Integrating all of the above to control movement while it is happening (feedforward)
Apraxia
Loss of praxis
Usually seen in adults
Neurologic basis for problem as evidences on CT or MRI
Basis not usually tied to somatosensory dysfunction
Rx is based on use of automatic activities
Dyspraxia
Dysfunctional praxis
Usually seen in children
Neurologic basis for problems NOT usually noted in CT or MRI
Thought to have tactile proprioceptive basis
Learning activities for first time; cannot build on previously learned activities
Developmental Dyspraxia
Poor motor planning
Decrease sense of body and what body can do
Clumsiness makes child appear messy or accident prone
Problems with ADLs
May learn splinter skills, but cannot generalize
Dose things in an inefficient way
Has low mm tone that makes them appear weak
Must give full attn to task
Difficulty with total flexion and extension patterns
Decreased rotation
Weight shifting problems
Developmental dyspraxia gait deviations
Toe walking - sensation
Foot slap - sensation
High stepping
Shuffling
