" A LITTLE MISS CLUMSY - INTRODUCTION TO DEVELOPMENTAL COORDINATION DISORDER" By Dr. Vandana Patel

“Developmental Coordination Disorder (DCD) is a term used to describe children who exhibit motor coordination skills below that expected for their chronological age and intellect and which are not attributable to medical disorders.” 

                                                                                                            - American Psychiatric Association (APA), 2000.

Diagnostic criteria:

DSM-5 

1. Acquisition and execution of coordinated motor skills are below what would be expected at a given chronological age and opportunity for skill learning and use; difficulties are manifested as clumsiness (e.g. dropping or bumping into objects) and as slowness and inaccuracy of performance of motor skills (e.g. catching an object, using scissors, handwriting, riding a bike, or participating in sports)
2. The motor skills deficit significantly or persistently interferes with activities of daily living appropriate to the chronological age (e.g. self-care and self-maintenance) and impacts academic/school productivity, pre-vocational and vocational activities, leisure, and play
3. The onset of symptoms is in the early developmental period.
4. The motor skills deficits cannot be better explained by intellectual disability or visual impairment and are not attributable to a neurological condition affecting movement (e.g. cerebral palsy, muscular dystrophy, or a degenerative disorder)  

-Amanda Kirby et al, DSM V, APA, 2013

Epidemiology: 

Lingham R, 2009 and Rainer Blank, 2011.

Etiology:

Clinical features:

PRESCHOOL

•       Delay in gross and fine motor development

•       Bump into obstacles

•       Frequent falling

•       Eating habits

•       Have difficulty in pencil grip or using scissors

•       Weak in building blocks and jigsaw puzzles

•       Fail to judge distance 

•       Difficulty in playing physical games & difficulty in learning new physical activities

•       Fall over easily when walking or running

•       poor skills in handling pencil

•       Slow at copying and writing

•       Messy and untidy handwriting 

•       handicrafts

•       Dressed shabbily

•       Easily drop objects or spill drinks

       

     

                     

Neuronal correlation of DCD:

Damage to the parietal lobe, cerebellum, corpus callosum and basal ganglia are the probable reasons for DCD.

Parietal lobe:

- Poor visual spatial processing 

- Motor imagery

- Facial emotion recognition 

Cerebellum: 

-Finger-to-nose touching  rapid alternating hand movements

-Timing of muscle recruitment

-Poor anticipatory postural activity

-Poor motor adaptation attributed to cerebellum

Corpus callosum:

-Inter-sensory & intra-sensory modality matching in children with and without

 eye–hand coordination problems

-Corpus callosum is smaller as in ADHD

Basal Ganglia:

-Weak evidence

-‘‘Soft’’ neurological signs of basal ganglia dysfunction had difficulty in modulating

force of movement.

Impairments in children with DCD:

                                                      

Physical therapy assessment: 

Chief complaints:

• ·         Academic failure?

• ·         Difficulty in performing complex or fine movements?

• ·         Parental observation

• ·         Co-existence of ADHD, learning difficulty?

• ·         Family member having a similar diagnosis

• ·         Difficulty in interacting with or coping with peer group?

• ·         Reading difficulty?

History of present illness:

x        Antenatal, natal and postnatal history?

x        Is the child preterm?

x        Is he developing normally?

x        Is there any family member exhibiting same issues?

x        Since when is child presenting these signs?

x        Does he/she have any visual or movement problems?

x        What does your child’s progress report say?

x        Is he able to tie shoe lace? Is he able to write and read?

x        Is he responding sluggish?

x        Are there any behavioral problems?

On Observation:

•       Child’s behavior

•    Gait

•    Posture

•    Fine motor activities

•    Writing

•    Dysmorphic features

 On Examination:

                                

Physical therapy Management:

   SENSORY INTEGRATION

 i.  Aimed to improve Sensory System Modulation (SSM) & Functional Support Capabilities (FSC) which form End Product Ability (EPA)

ü.  Organizes the sensory system by providing vestibular, proprioceptive, auditory, and tactile inputs

iii.   “Praxis”- contributing in movement performance

         Ability to start/ stop/ sequencing or organizing cognitive actions

TASK SPECIFIC TRAINING

                                                                                                                        Mia Pless, 2000

NEUROMOTOR TASK TRAINING

ü  Task-oriented approach focusing directly on teaching the skills a child needs in daily life

ü  NTT has assessment within a functional setting

ü  Determine extent to which motor tasks are performed below expected level.

ü  Determine which cognitive and motor control process are involved resulting in deficient motor performance

STRENGTH TRAINING

•    To improve neural pathways and motor unit recruitment

•    Active heavy muscle work will facilitate proprioceptive awareness

•    Blocked repetitions of isolated joint movements helps during cognitive stage of learning

•    Core strengthening for more stability

METRONOME TRAINING

•    The Interactive Metronome is a PC-based, noninvasive technique that requires participants to practice timing and rhythmicity of varied movements of the hands and feet in synchrony with auditory cues

•    Intended to improve timing, sequencing, rhythmicity of movements

VIRTUAL REALITY

•      Provides both cognitive and motor control challenges

•      Targets balance, posture, coordination and cognition

•      Motor learning, repetition, augmented feedback, variability

•      Negative – positive impact

PHYSICAL FITNESS TRAINING

•      Swimming

•      Walking

•      Cycling

•      Aerobics / Dance

•      Rock Climbing

•      Yoga

•      Non competitive sports

HANDWRITING TRAINING

•      Pencil grasps

•      Broader surcease to narrower surface

•      Clear and one or two word instructions

•      Gross to precise grasp

AQUATIC THERAPY

•      Properties of water can be used to develop postural control strategies

•      Improving balance, reduce postural sway

•      Improve neuro-motor impairments

•      Improve motor skills

ROLE OF PARENTS

•    Encourage the child to participate in games and sports that are interesting to him/her and which provide practice in, and exposure to, motor activities

•    Introduce the child to new sports activities or a new playground on an individual basis

•    Ask the child simple questions to ensure comprehension

•    Private lessons may be helpful at certain points in time to teach the child specific skills

•    Encourage the child to interact with peers through other activities that are likely to be successful (cubs, music, drama, or art)

•    Not to compare with other children without DCD

•    Acceptance of the fact

•    Not to overload the child to the limit where he/she will not be able to reach

•    Be patient and interact with them instead of reacting

ENVIRONMENTAL MODIFICATIONS

CLASSROOM

•           One-on-one teaching

•          Step-by-step instructions

•          Separate time to copy notes

•          Extra time at lunch break

•          Non-competitive sport participation

HOME

•          Color coding drawer 

•          Easy arrangement for dressing

•          Tool modification for easy use

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