Developmental Coordination Disorder
8:00 am- 10:00 am Saturday October 8th, 2021
Mica Mitchell, PT, DPT, C/NDT & Shanna Thurman, PT, MPT, DPT, C/NDT
Biography
Mica Mitchell, PT, PT, C/NDT Board Certified Clinical Specialist in Pediatric Physical Therapy
Assistant Professor of Physical Therapy
Shanna Thurman, PT, MPT, DPT, C/NDT Adjunct Professor of Physical Therapy
Story Time
• Ella has balance difficulties, as well as not being about to run or jump, which concerns her mother.
• Mother states that MDs have speculated on a diagnosis of CP but this diagnosis was not confirmed.
• Ella was born at 28 weeks gestational age due to pre-eclampsia.
• Mom states that Ella used to fall a lot but now does not fall as much anymore and when she staggers she is able to regain her balance to prevent falls usually.
• Mother states Ella was receiving PT services through Early Intervention Program but was discharged when she started to walk around 20 months of age.
• Ella is attending Pre-K this fall.
• Mother would like Ella to be able to jump, run, and increase her balance abilities for increased safety and function.
Story Time Questions
• What elements should be included in the evaluation?
• What other information is needed to enhance interaction with patient?
• If this patient qualifies for PT services, what would the intervention consist of?
• Who else should be a part of this patient’s intervention team?
Objectives
• Define developmental coordination disorder (DCD)
• Explain the criteria for DCD diagnosis
• Describe the elements of examination for a patient at risk of or diagnosed with DCD
• Create interventions for a patient at risk for or diagnosed with DCD
Developmental Coordination Disorder (DCD)
Characteristics include poor motor coordination and delayed development of motor skills, not explained by other conditions
DCD
• Defined in 2015 with diagnostic criteria
• Medical Diagnosis: physician, psychologist, psychiatrist
• Neurodevelopmental disorder
• ~5-6% of school-aged children
• 1.7 to 2.8 times more likely in boys than in girls
• Diagnosis typically made ≥5 year old
DCD
• Born weighing less than 1500 g OR less than 32 weeks gestation
• 2 times more likely to receive a DCD diagnosis
• Children with DCD have been shown to have dysfunction of cortical networks compared to peers without DCD.
• Primary sensorimotor cortex, posterior superior temporal gyrus, cerebellum, and supplementary motor area
DCD- Associated Conditions
• Neuromaturational dysfunction
• Hypotonia
• Joint laxity
• Balance deficits
• Overweight or obese Pathways.org
DCD Also Know As
• Clumsy Child Syndrome
• Developmental Dyspraxia
• Sensory Integration disorder
• Perceptual-motor difficulties
• Minor neurological dysfunction
Diagnostic Criteria DCD Diagnosis Criteria A
A. The acquisition and execution of coordinated motor skills are substantially below that expected given the individual’s chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness (eg, dropping or bumping into objects) as well as slowness and inaccuracy of performance of motor skills (eg, catching an object, using scissors or cutlery, handwriting, riding a bike, or participating in sports).
DCD Diagnosis Criteria B
B. The motor skills deficit in criterion A significantly and persistently interferes with activities of daily living appropriate to chronological age (eg, self-care and self-maintenance) and affects academic/school productivity, prevocational and vocational activities, leisure, and play.
DCD Diagnosis Criteria C
C. Onset of symptoms is in the early developmental period.
DCD Diagnosis Criteria D
D. The motor skills deficits are not better explained by intellectual disability (intellectual developmental disorder) or visual impairment and are not attributable to a neurological condition affecting movement (eg, cerebral palsy, muscular dystrophy, and degenerative disorder).
Interdisciplinary Team
• Child
• Family
• Primary physician
• Medical Specialists
• Psychologist
• OT
• Others
Physical Therapy Evaluation
• History
• Systems review
• Examination
• Activity Limitations questionnaires
• Standardized outcome measures
• Examine body functions and structures
Coexisting Conditions with DCD
• Attention deficit disorder (ADD)
• Attention-deficit hyperactivity disorder (ADHD)
• Autism spectrum disorder (ASD)
• Sensory differences
• Learning disabilities
• Anxiety
• Depression
DCD Differential Diagnosis
• Cerebral Palsy
• Congenital Syndromes
• Genetic disorders
• Malignancies
• Musculoskeletal disorders
• Neurodegenerative disorders
• Toxic and teratogenic disorders
• Traumatic brain injuries
• Visual Impairments
Participation Outcome Measures
• Canadian Occupational Performance Measure (COPM)
• Goal Attainment Scale (GAS)
• Perceived Efficacy and Goal Setting Program
• Children’s Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC)
Motor Performance
• Movement Analysis
• Clinical Observation
Activity Limitations
• Questionnaires
• DCDQ’07
• Movement Assessment Battery for Children- Second Edition Checklist (MABC-2-C)
• Interviews
Gross Motor Outcome Measures
• Movement Assessment Battery for Children- Second Edition (MABC-2)
• Bruininks-Oseretsky Test of Motor Performance- 2nd Edition (BOT-2)
Body Functions and Structures Outcome Measures
• Identify Impairments
• Strength
• Power
• Balance
• Cardiorespiratory fitness/endurance
Body Functions and Structures Outcome Measures
• Six-minute walk test (6MWT)
• 20 meter shuttle run test (20mSRT)
• Progressive Aerobic Cardiovascular Endurance Run (PACER)
• Functional Strength Measure (FSM)
• Hand-held dynamometer
• Muscle Power Sprint Test (MPST)
• Sensory Organization Test (SOT)
Interventions
• Combination
• Task-oriented
• Body structure and function
• Characteristics of interventions
• Small groups or 1-on-1
• Education
• Supplemental activities
Task Oriented Interventions
• Motor Skills Training
• Neuromotor Task Training
• Cognitive Orientation to daily Occupational Performance (CO-OP)
• Motor Imagery
Task Oriented Intervention
• Principles of task oriented intervention
• Part to whole practice
• Multiple repetitions
• Task- specific practice in variable environments
• Adapt training based in progress
• Facilitate self-discovery using creative methods
• Feedback provision
Body Functions and Structures Intervention
• Core Stability Training
• Cardiorespiratory Training
• Functional Movement-Power Training Program
Supplemental Activities
•Soccer training
•Taekwondo
•Other physical activities
Intervention Dosage
• Opportunities for practice in home and school environment
• Supplemental activities in the community
• Ex: High frequency
Discharge
• Communication
• Recommendations
• Follow-up
Story Time Revisited
Case Study
• Ethan comes to the clinic with concerns of inability to perform stairs and other age appropriate tasks.
• Ethan’s growth capacity is 6 ft based on doctor’s assessment; however presently he is overweight.
• Ethan currently in the 7th grade and attends Middle School.
• Mom has Ethan in karate and in Cross Fit.
• Parents report Ethan has difficulty performing the following tasks: jumping, running, bicycle riding, stair negotiation, especially descending.
• Mother reports that he tends to scoot down on his bottom at the beginning of stairs and walks when there are only ~4 steps remaining to go down.
• Ethan does have endurance and core strength deficits according to his mom.
• He is also receiving OT services to address hand-eye coordination.
• Parents reported that Ethan has always been slower than his friends and not able to keep up with them on playground even when he was little.
• Ethan reports that he has trouble with negotiating stairs, inclines and performing half kneel to stand independently. In addition, the patient reports difficulty negotiating a decline surface, stating that he sometimes requires help and would have to walk at a slow pace.
Case Study Questions
• What elements should be included in the evaluation?
• What other information is needed to enhance interaction with patient?
• If this patient qualifies for PT services, what would the intervention consist of?
• Who else should be a part of this patient’s intervention team?
https://pediatricapta.org/clinical-practice-guidelines
Take Away
Conference Survey Contact Information
Mica Mitchell, PT, PT, C/NDT Board Certified Clinical Specialist in Pediatric Physical Therapy
Assistant Professor of Physical Therapy
Shanna Thurman, PT, MPT, DPT, C/NDT Adjunct Professor of Physical Therapy
[email protected] @isthurman [email protected]
@micamitchellPT
References
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2. Supplemental Digital Content (available at: http://links.lww.com/PPT/A305)
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https://apps.who.int/iris/handle/10665/43737. Published 2007.
References
11. McDougall J, King G. Goal Attainment Scaling: Description, Utility, Applications in Pediatric Physical Therapy Services. 2nd ed. London, Canada: Thames Valley Children’s Centre; 2007. https://f1000.com/work/item/7553956/resources/6942375/pdf.
12. Wilson BN. The Developmental Coordination Disorder Questionnaire 2007 (DCDQ’07) Administration Manual for the DCDQ’07 with Psychometric Properties.
http://www.dcdq.ca. Published 2012.
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Medicine. 2016;95(16):e3492. doi:10.1097/MD.0000000000003492.
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17. Academy of Pediatric Physical Therapy. Resource/Fact Sheet List of Pediatric Assessment Tools Categorized by ICF Model. https://pediatricapta.org/fact-sheets/.
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19. Smits-Engelsman BCM, Reynders K, Schoemaker M. Children With Developmental Coordination Disorder (DCD): Symptomatology, Diagnostics and Treatment.
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20. Sylvia Schell, Kayla Roth, Holly Duchow. (2020) Developmental Coordination Disorder in Alberta: A Journey into Knowledge Translation. Physical & Occupational Therapy In Pediatrics 40:3, pages 294-310.
