Pediatric PT--Developmental Coordination Disorder

Task-specific approaches, like Neuromotor Task Training, work on tasks that the child needs or wants to perform with a goal to:

"teach culturally normative tasks in mechanically efficient ways"

The School Functional Assessment has three parts that measure what?

1) Participation Scale: evaluates child's participation in six school-related settings 2) Task Support Scale: examines the amount of assistance and/or the types of adaptations required for the child to perform essential school tasks 3) child's mobility and ability to maintain and change positions, manipulate objects, and move on rec equipment p. 518

In the past, treatment interventions used with children with DCD were aimed at changing body structure and functional impairments. What are these 4 "bottom-up" methods?

1) Perceptual-motor training 2) Process-oriented approach 3) Sensory integration (SI) 4) Neurodevelopmental therapy (NDT) p. 516

Interventions that target transfer and generalization of new skills and emphasize motor learning are likely to be most effective for treatment of DCD. What motor learning principles should be used?

1) frequent practice 2) practice in variable environments 3) consistent provision of feedback p.516

"Declarative knowledge" that children with DCD lack related to motor tasks include what 3 concepts?

1) how to approach a task 2) how to determine what is required for the task 3) how to develop strategies to use when learning and performing a task p.517

The "top-down" interventions for treating children with DCD focus on motor learning principles in combination with other theories that emphasize the role of cognitive processes in the learning of new movement skills, incorporating which 2 ideas?

1) task-specific interventions 2) cognitive approaches p.516

What three systems are considered during task performance?

1) the child 2) the task itself 3) the environment p. 516

What 3 other conditions have shown strong associations with DCD? (If a child has any of these conditions, the likelihood of DCD is at least 50%)

1. ADHD 2. speech/articulation difficulties 3. language-based learning disabilities (esp. reading disability) p. 500

What 3 conditions signal that DCD is present?

1. motor impairment and/or motor skill delay significantly impacts a child's ability to perform age-appropriate complex motor activities 2. adequate opportunities for experience and practice have been provided 3. no other explanation can be offered for the motor impairment p. 499

What 14 (yes, 14) conditions would usually cause you not to consider DCD?

1. recent head injury or trauma 2. progressive deterioration in previously acquired skills 3. increasing or fluctuating muscle tone 4. Hx of headache, eye pain, blurred vision 5. global developmental delays 6. asymmetrical tone or strength 7. musculoskeletal abnormality 8. neurocutaneous lesion 9. avoidance of eye contact, unwillingness to engage socially 10. Gower's sign 11. ataxia, dysarthria 12. absence of DTRs 13. dysmorphic features 14. untreated visual impairment p. 500

What 4 criteria must be met for a diagnosis of DCD?

1. the motor impairment must be substantial and discrepant from other abilities 2. it must have an impact on academic achievement or ADLs 3. it must not meet the criteria for a pervasive developmental disorder and must not be due to a general medical condition 4. it must not be greater than what would be accounted for by any cognitive impairments that may be present pp. 499-500

What age range is appropriate for the DCDQ (DCDQ'07)?

5-15 years old p 512

What percentage of school-age children have DCD?

5-6% p. 498

What types of activities are appropriate for adolescents and adults with DCD?

Activities with minimized competition and need for quick motor response. They should be involved with leisure activities like swimming, cycling, choir. Job should minimize need for changing motoric and environmental expectations. p. 520, 521

What is the test that is reported to be the most frequently used assessment with school age children from 4.5-14.5 years old?

Bruininks-Oseretsky of Motor Proficiency (BOTMP) p 513

Which outcome measure is best suited for use with children older than 8 to identify areas of functional difficulty in order to set goals and measure effectiveness of intervention for DCD?

Canadian Occupational Performance Meaure (COPM) p. 518

What scale is used by teachers of children in the 4-8 years of age range?

Children Activity Scale for Teachers (ChAS-T) p 512 (not validated though)

What is a self reporting scale that children aged 9-16 can use?

Children's Self-Perceptions of Adequacy in, and Predilection for, Physical Activity Scale (CSAPPA) P 512

Evidence shows that which approach has been shown to be effective and demonstrated some generalization and transfer of skills in children with DCD?

Cognitive Orientation to Daily Occupational Performance (CO-OP) p.517

What type of motor skill do they have difficulty with?

Coordination difficulty when skill have to be purposely learned (e.g., catching and kicking a ball) and especially if it requires greater precision, continuous adaptability and hand eye coordination (e.g., basketball, football, baseball, hockey) p. 520

What is ADHD associated with DCD called?

DAMP (dysfunction of attention, motor control, and perception) p. 519

What is a DCD screening tool that parents can do?

Developmental Coordination Disorder Questionnaire (DCDQ) revised in 2007 to the DCDQ'07 p 512

A child with DCD will be slow to react to a ball because of ______? Clumsiness Difficulty attending to body position Difficulty correcting errors Weakness

Difficulty correcting errors p.509

Although no specific pathologic process or single neuroanatomic site has been definitively associated with DCD, what is the speculated underlying mechanism of DCD?

Diffuse areas of the brain are affected, resulting in variable expression of the disorder and the different profiles seen (with strong association between motor, attention, and perceptual processes) p505

More recent interventions for DCD emphasizes that the intervention must be contextually based with intervention occurring in everyday situations and being of significance to the individual child, reflecting the beliefs of which group?

Dynamic systems theorists p. 516

What are some specific strategies to help child with DCD in PE?

Emphasize fun, effort and participation and not proficiency; noncompetitive games; divide into smaller groups; use DCD child as model when giving instruction to class; modify equipment p. 519, 520

True or False: The widely accepted test for diagnosing DCD is the DCDQ'07?

False p 513 - there is no widely accepted standard for assessing DCD

Which outcome measure establishes 5 possible levels of specific functional attainment for a child to create a criterion-referenced individualized measurement?

Goal Attainment Scaling (GAS) p. 518

What does the evidence show about the effectiveness of the task-oriented approach?

Good evidence to support that children learn the tasks that are taught, but not much evidence for transfer or generalization. p. 516

What is a weakness of the DCDQ?

It does not measure difficulties in skill directly as other tests do. p 512

What is a weakness of the Bruininks-Oseretsky of Motor Proficiency (BOTMP)?

It does not measure impairments in quality of movement, it only measures can the child perform the activity p 513

What is a weakness of the MABC test?

It has poor sensitivity, which translates into fewer children with CDC are identified p 512

What are the secondary impairments related to primary motor coordination difficulties that are often precursors for participation restrictions in physical activities, reduced social interaction, and diminished fitness across the life span?

Lack of energy, fatigue, and decreased strength, power, and endurance p505

What are 2 tests that the DCDQ has been validated against?

Movement Assessment Battery for Children (MABC) & Bruininks-Oseretsky of Motor Proficiency (BOTMP) The DCDQ also sensitive and specific for diagnosis of CDC. p 512

The hallmark signs of a DCD child's movement include what deficits?

Movements are inaccurate and lack fluency

What are three types of screening tools that can be used for DCD?

Parent Child report Teacher p 513

Which outcome measure is best suited for use with children younger than 8 to identify areas of functional difficulty in order to set goals and measure effectiveness of intervention for DCD?

Perceived Efficacy and Goal Setting system (PEGS) p. 518

What are the three subscales of the CSAPPA?

Perceived adequacy Predilection to physical activity Enjoyment of PE class p 512

Which of the following are soft signs often seen in kids with DCD? Poor visual perception Decreased ROM High tone Auditory deficits

Poor visual perception

What is often the first activity limitation that educators identify in a child with DCD?

Poor written communication P.510

What associated behaviors might children with DCD exhibit?

Quiet and withdrawn at school, avoidance of schoolwork or PE with "off-task" behaviors or illness, disruption of teacher and/or classmates, low frustration tolerance, decreased motivation, and poor self-esteem (which leads to giving up on tasks easily and decreased task initiation and completion at home and in school) p505

What does the research show about the "bottom-up" interventions for treating children with DCD?

Research shows that they have produced minimal change in functional outcomes and offer no clear advantage of one approach over another. p. 516

What do parents of a child with DCD identify as something they are concerned about?

Restricted participation P.508

In the school playground, what activities should DCD child be guided to?

Running or playing tag instead of ball games p. 520

What is the first step in identifying potential DCD?

Screening tools p 513

What do children with DCD have the most difficult with?

Skills that have to be taught (especially those requiring accuracy, refined eye-hand coordination, and constant monitoring of feedback) p506

In examining a child with DCD, what information should be included?

Standardized tests, functional task analysis, & examination of tasks in natural environments p 513

What activities are well suited for DCD child and why?

Swimming, skating, skiing, cycling because they contain repetitive sequencing and do not require constant monitoring of feedback during performance. They can do these for the rest of their life. p. 520

What approaches are used to target intervention at the level of activity limitation?

Task-specific and cognitive approaches (implement strategies that emphasize participation without risk of injury and prevent physical effects of inactivity) p. 519

What can PE teachers do to help DCD children?

Teachers can learn to "MATCH" tasks that fit needs of DCD child. (Modify task, Alter expectations, Teach strategies, Change environment, Help by understanding) p. 519

What scale is used by teachers of children in the 5-11 year old age range?

The Motor Observation Scale for Teachers (MOQ-T) p 512 (not validated though)

What test that we have learned in class can be used as a pre-intervention and post-intervention measure to evaluate change?

The Peabody Developmental Motor Scales-Second Edition (PDMS-2) p 513

What are the hypotheses for the underlying mechanism of DCD?

The dual-task paradigm: There is a lack of automatization of motor actions in children with DCD when attentional demands increase, meaning that performance of one task will be negatively affected by the second if both tasks need to make use of the same "pool" of resources (visual and cognitive), indicating pathology in the cerebellum. The efference-copy-deficit hypothesis: motor imagery deficits are related to difficulties in generating efference copies of motor commands through feed forward models, indicating the possible involvement of the posterior parietal cortex. Impaired internal models: the cerebellum has inadequate forward modeling of movements and is unable to form, access, or update its internal models, resulting in poor "online" error correction, along with input from mirror neurons in the posterior parietal cortex (cerebellum communicates with mirror neurons to code and update movement) (All suggest complex and shared interplay occurrence between different neuroanatomic regions of the brain when learning, executing, and correcting movements) p505

What does the DCDQ test measure?

The functional impact of poor coordination p 512

What is the 'gold standard' when for testing DCD?

There is no gold standard p 513

Why are fine motor activities often difficult in children with DCD?

They have trouble with sequencing skills; difficulty correctly sequencing the steps and often forget steps and have to start all over (even if it is a skill they have practiced many times before). Includes self-care and academic activities such as tying shoes and writing homework or art and craft projects. p506

Why are gross motor activities difficult in children with DCD?

They lack good balance and postural control, as well as flexibility and adaptability, resulting in poorly coordinated running, skipping, hopping, jumping, management of stairs (especially maneuvering around others), throwing, catching, and kicking. p506-507

Children with ADHD but not DCD will appear clumsy? True or False

True p. 519

True or False: secondary impairments in children with DCD are preventable.

True p505

Children with DCD tend to rely predominantly on which type of information? Somatosensory Vestibular Visual Auditory

Visual

Compared to their peers, children with DCD have lower or decreased ________, _________, _________.

activity level, anaerobic power, muscle strength p. 519

The way cognitive intervention approaches are applied will depend on what factor

age of the child p. 517

A child's total score on the BOT-2 falls within the expected level for his age, and he shows some difficulty in only the gross motor skills area of the test. As the PT administering the exam, you would: a. Immediately refer the patient to the primary care physician because you suspect this child has a neuromuscular problem. b. Administer another exam to assess whether or not the child has developmental coordination disorder. c. Continue working with the patient to improve his performance of gross motor tasks. d. Discharge the patient because he does not need PT; he'll catch up to his peers with more practice.

b. Administer another exam to assess whether or not the child has developmental coordination disorder. p. 514 - the BOT-2 may not be the most appropriate test to clinically assess a child as having DCD. Using only the total score may under-identify children with DCD.

Which assessment tool is best for identifying children with DCD? a. The BOT-2 because it has an expanded age range from 4-21 years and instructions/items have been modified to allow for greater flexibility b. The MABC because it is backed by evidence to demonstrate good test-retest reliability despite omitting tasks related to handwriting c. The MABC-2 because it includes qualitative descriptors of motor behavior that therapists can focus on during administration of each test item d. The VABS because it includes examination of motor coordination in the context of functional tasks and the child's natural environment

b. The MABC because it is backed by evidence to demonstrate good test-retest reliability despite omitting tasks related to handwriting p. 514

What is the ratio of boys to girls who are affected by DCD?

commonly accepted as 2:1 recent studies suggest closer to 1:1 p. 499

What neurologic or medical disorder is DCD associated with?

currently, none p. 499

Cognitive approaches are based on the premise that children with DCD are deficient in what type of knowledge?

declarative p. 517

For older children, cognitive intervention should include?

encouraging them to think independently through motor problems p.517

If a child is diagnosed with developmental coordination disorder (DCD) how long is it expected to last?

for life p. 498

For younger children, cognitive intervention should include which two approaches?

participatory or consultative to identify motor problems and select strategies p. 517

What type of motor skills develop relatively spontaneously for DCD child?

sitting, grasping, crawling (early milestone) p. 520

What population has a substantially higher than average prevalence of DCD?

the preterm population, especially those with low birth weight p. 499

What is a weakness of standardized tests for very young children?

they only measure the achievement of developmental skills and do not focus on impairment in the qualitative aspects of movement. p 513