L12: Developmental Coordination Disorder Flashcards
What is DCD?
- Marked impair in development of motor, postural and/or fine motor coordination that interferes w/ academic achieve. or ADLs
DSM-V Criteria for DCD
KEY WORDS: Interferes with, NOT explained by another condition**
- Execution of motor skills is substantially BELOW expected (clumsy, slow, inacc.) and interferes w/ ADLs, productivity, play
- Onset is EARLY in dev. and are NOT explained by known neuro/visual/intellectual condition
DCD Etiology
Unknown;
ASD and ADHD may have genetic link
Genetic links to DCD
ASD and ADHD
Etiology DCD:
Speculated possible causes:
- abnorm NT/receptors
- CB or BG probs
- Mild CP
- natal insult
-
Impaired feed-forward mech.
- This is like reaching up high in cabinet and setting feet so you don’t fall
- Or setting body posture before a dynamic task
DCD Incidence
- Bw 6-12; 2:1 boys:girls
- Found w/ more complicated pre and post-natal courses
DCD Co-Existing disorders:
- ASD, ADHD
- Dyslexia, speech/lang impairment, benign epilepsy***, jt hypERmobility syndrome
Prognosis:
W/OUT interventions
- Diffs in adulthood→ incd risk for:
- poor social, academic, physical competence as well as behavioral, dec self-esteem, mental health
- inactive→ obesity, CV probs
- poor social, academic, physical competence as well as behavioral, dec self-esteem, mental health
Clinical Characteristics:
BSF
- HypOtonia
- Primitive reflex persist.
- Immature balance rxns
- Dec proprio
- Diff w/ 2-3step commands
- Dec energy, strength, endurance
- Behavioral probs (class clown/aggressive)
- Slow rxn times
- Variability doing same activity
- Dec motor plan/coord
- Inc attn during motor tasks
- Awkard mvmts
- Poor memory
- Dec handwriting/drawing
- Diff dressing, gripping
Clinical Characteristics:
Psychosocial
- Learning disability
- lower intelligence risk
- reading probs
Clinical Characteristics:
Activity Limits:
- Selfcare/ADLs
- Fine/Gross motor
- handwriting
- bike, jumping J’s, throw/kick
- grasp
- time mgmt
Clinical Characteristics:
Participation
- Sports
- Gym
- Playground
Clinical Characteristics:
Personal Factors
- Self-imposed restrictions***
- dec activity lvls
- depression/isolation
Clinical Characteristics:
Environmental Factors
- Performance gym/sports
- parental limits 2* fear of injury
PT’s Role in DCD
- R/O motor diff’s caused by other dx’s (CP, MD, BI, FAS, etc.)
-
TEST
- tone, strength, coord, balance, endurance, object manip, ROM, posture, functional mobility
- Clinical observation of mvmt and motor planning is KEY
- tone, strength, coord, balance, endurance, object manip, ROM, posture, functional mobility
-
Childs self perception/QoL + Parents perception of Diff’s
- BOTH esp important in DCD****
DCD Red Flags:
CALL MD:
- recent head trauma
-
regression of motor skills
- RED FLAG FOR ANY DX***
- h/o HA, eye pain, blurred vision
- sig. gait abnorms
- asymmetric tone/strength
- dysarthria (diff swallowing)
- Gower’s sign→ diff floor to stand
- inc/fluctuating mm tone
DCD Red Flags
Reqs further consideration:
- Neurocutaneous skin lesion
- Avoid eye contact/won’t engage
- Dysmorphic features
- untreated visual probs (strabismus)
PT Dx and Standardized Testing:
GOLD STANDARD FOR DCD****
Movement Assessment Battery for Children
Mvmt-ABC******
PT Dx and Standardized testing for DCD
- Mvmt-ABC== GOLD STANDARD***
- USED MOST FREQ.
- BOT-2, Peabody, TGMD-2, DCDQ, Strengths/Difficulties Questionnaire
- DCDQ’07—– 5-15yo ***
PT Tx for DCD
DIRECT INTERVENTIONS: Bottom-UP
*Isolated impairment
- Addresses BSF that may be underlying cause of difficulty
- Strength, ROM, balance, body awareness
- building blocks of motor skills
- perceptual motor training, sensory integration, NDT
PT Tx for DCD
DIRECT INTERVENTION: Top-Down
*Giving context to what you are doing
- Interventions must be contextually based w/ focus on every day situations
PT Tx for DCD
More guidelines
- Simple and concise, yet frequent verbal cueing
- Task specific, cognitive approaches
- Encourage community participation, healthy lifestyle, family edu.
- Start w/ 1:1 playground and work up to busier times, small group @ gym focused on FUN!!
