Knowledge to Practice in Developmental Coordination Disorder: Impact of an Evidence-Based Online Module on Physical Therapists’ Self-Reported Knowledge,Skills, and Practice

ABSTRACT

Aims: To evaluate the impact of an evidence-based online module on Developmental Coordination Disorder (DCD) on self-reported physical therapist (PT) knowledge, skills, and practice. Methods: Fifty PTs completed a questionnaire before and after the completion of the online module, with 41 PTs completing the same questionnaire 2 months later. The questionnaires included items rated using a 7-point Likert Scale and short open-ended questions. Results: There was a significant effect of Time for 17 out of 18 items on self-reported knowledge, and all 19 items for self-reported skills. Post-hoc analyses indicated that mean scores at Time 2 and Time 3 were higher than the mean scores at Time 1. Forty-six (92%) participants reported an increase in their confidence to provide evidence-based services. Forty-three (86%) participants indicated their intentions to modify their evaluative practices (e.g., involving children in goal setting) and their management of DCD (e.g., using the best practice principles, providing resources to families). At the 2-month follow-up, 19 (46%) participants had returned to the module to review information (e.g., video, resources) or to download handouts. Conclusions: The online DCD module appears to be an effective knowledge translation strategy to increase PTs’ self-reported knowledge and skills, and to support evidence-informed practice.     

Ecosystemic Needs Assessment for Children with Developmental Coordination Disorder in Elementary School: Multiple Case Studies

ABSTRACT

This study explored the needs of children with developmental coordination disorder (DCD) from an ecosystemic viewpoint as part of a theory-driven program evaluation process. A multiple case study needs assessment was conducted. Participants included ten children with DCD, their parents (n = 12), teachers (n = 9), and service providers (n = 6). Data collection involved semi-structured interviews, validated questionnaires, and a review of the children's records. The results support the relevance of using an ecosystemic model to assess the needs of children with DCD in their life and social contexts. More specifically, the results highlight the need to provide additional services at school, such as occupational therapy and special education, as well as information and training regarding DCD for parents and teachers. The results also point to the relevant variables to consider in an intervention program based on theory-driven evaluations. This study shows how employing an ecosystemic frame of reference provides a better understanding of the needs of children with DCD. Future research should document the ecosystemic profiles and evolution of the needs of children with DCD with a larger sample from diverse socioeconomic backgrounds using a longitudinal study design.     

Adaptation and Extension of the European Recommendations (EACD) on Developmental Coordination Disorder (DCD) for the UK context

ABSTRACT

Background: Developmental Coordination Disorder (DCD) affects the learning and performance of everyday motor skills. It commonly co-occurs with other developmental disorders and a range of associated psycho-social impairments. Recent evidence-based guidelines on diagnosis, assessment, and intervention provide valuable information for practitioners. However these are directed primarily at German-speaking countries and focus on work with children. Aim: The aim of this project was to consider the application of these guidelines in the UK and to extend them for use with adults with DCD. Methods: Individuals with DCD, parents, and professionals from a wide range of disciplines were invited to two workshops to discuss and debate the guidelines, to adapt them for the UK and produce dissemination materials. Results: A working definition of DCD was agreed, minor revisions were made to the guidelines to reflect the UK context, an extension for adults was compiled and a series of leaflets was produced to disseminate this information to health and education professionals, parents, and employers. Conclusions: This work will raise awareness of the condition across different professional groups. It provides information to help those working with children and adults with DCD in the UK to assist in the process of diagnosis, assessment, and intervention.     

Exploring the Role of Physiotherapists in the Care of Children with Autism Spectrum Disorder

Aims: Children with autism spectrum disorder (ASD) are less likely to participate in physical activity than their age related peers, and it has been suggested that physiotherapists (PT) could potentially facilitate their participation. Currently, no research has examined PTs’ potential role in enhancing physical activity (PA) participation. The purpose of this qualitative study was to examine PTs experiences and perspectives of working with children with ASD, and to explore potential directions for PTs to potentially increase PA. Methods: Ten pediatric PTs in Canada were interviewed, and data were analyzed using thematic analysis. Results: Three themes were identified: the role of PT, perceived lack of expertise, confidence and training, and structural and systemic barriers. The accounts highlight the social and institutional complexity and constraints in PTs potential promotion of PA for children with ASD. Participants supported a primarily consultative role whereby PTs could educate and partner with parents, teachers, and community service providers to enhance gross motor development and individualize PA needs. Conclusions: These findings indicate how PTs might be involved in enhancing PA among children with ASD.     

Health Promotion in a Low-income Primary School: Children with and Without DCD Benefit,but Differently

ABSTRACT

Poor motor performance and reduced physical fitness are characteristic of children with Developmental Coordination Disorder (DCD). These features have also been identified more frequently among children living in low socio-economic circumstances. Aims: To evaluate the outcomes of a nine-week health promotion program (HPP) on the motor performance and fitness levels of children (6–10 years) with and without DCD attending a low-income primary school. Methods: The HPP was designed and implemented by undergraduate physiotherapy students using guidelines from the World Health Organization School Health Initiative and their physiotherapy curriculum. Children with DCD (n = 22) and a control group without DCD (n = 19) participated in the evaluation. Motor skill, functional strength, aerobic capacity, and anaerobic power were measured at baseline and after nine weeks. Results: Both groups of children improved on all measures at the conclusion of the HPP. Children with DCD showed greater improvement than the control group in motor performance and the control group showed greater improvement on one of the anaerobic fitness outcomes. Conclusions: A school-based HPP that focuses on increasing opportunities for physical activity may be effective in improving motor performance in children with DCD and can increase fitness levels in general.     

A Service Delivery Model for Children with DCD Based on Principles of Best Practice

ABSTRACT

Aims. In this perspective article, we propose the Apollo model as an example of an innovative interdisciplinary, community-based service delivery model for children with Developmental Coordination Disorder (DCD) characterized by the use of graduated levels of intensity and evidence-based interventions that focus on function and participation. Methods. We describe the context that led to the creation of the Apollo model, describe the approach to service delivery and the services offered. Results. The Apollo model has 5 components: first contact, service delivery coordination, community-, group-, and individual-interventions. This model guided the development of a streamlined set of services offered to children with DCD, including early-intake to share educational information with families, community interventions, inter-disciplinary and occupational therapy groups, and individual interventions. Following implementation of the Apollo model, wait-times decreased and the number of children receiving services increased, without compromising service quality. Conclusions. Lessons learned are shared to facilitate development of other practice models to support children with DCD.     

Current Therapeutic Management of Perinatal Stroke with a Focus on the Upper Limb: A Cross-Sectional Survey of UK Physiotherapists and Occupational Therapists

Aim: To determine current UK pediatric physiotherapist (PT) and occupational therapist (OT) management of perinatal stroke. Design: Web-based cross-sectional survey. Methods: Participants were members of the Association of Paediatric Chartered Physiotherapists and Occupational Therapists specialist section: children young people and families working with infants. Items covered prioritization of referrals, assessments, therapy approaches aimed at the upper limb, and parental support. Results: 179 therapists responded. 87.2% of PTs and 63.0% of OTs managed infants with perinatal stroke. Infants with clinical signs of motor dysfunction at referral were prioritized for early initial assessment. The most frequently used assessments were the Alberta Infant Motor Scale (AIMS) and Bayley Scales of Infant Development (BSID). Of PTs and OTs, 41.9 and 40.0% used no standardized assessments. Frequently used therapy interventions were Bobath/Neurodevelopmental Therapy (NDT), positioning aids and passive movements. 88.1% of therapists would choose a bilateral rather than unilateral (affected side) therapy approach for infants with perinatal stroke aged up to 6 months. Of PTs and OTs, 56.9 and 57.1% provided psychological support to families. Conclusions: Assessment and provision of therapy services following perinatal stroke is variable. Increased use of standardized assessments and centralized data collection regarding service provision for high-risk infants is recommended.     

Comparing Activity Patterns,Biological, and Family Factors in Children with and Without Developmental Coordination Disorder

ABSTRACT

The association between motor proficiency and moderate to vigorous physical activity (MVPA) suggests children with developmental coordination disorder (DCD) may be susceptible to inactivity-related conditions such as cardiovascular diseases. The aim of this study was to compare children with and without DCD on physical activity patterns, activity types, body composition, strength, and cardiovascular fitness. Additionally, factors potentially influencing MVPA were also explored. Eighteen children (7–11 years) with and without DCD (n = 9/group) participated. Motor coordination, physical activity, strength, cardiovascular fitness, body mass index (BMI), and family factors were measured. Children with DCD participated in significantly less MVPA and had higher BMIs and decreased strength and cardiovascular fitness. Strength, activity type, and family factors correlated significantly with MVPA for children with DCD. The results suggest that strength, activity types, parent perception of their child's motor abilities, and parent activity participation should be considered to maximize health benefits associated with MVPA for children with DCD.     

Cognitive dysfunction is worse among pediatric patients with bipolar disorder Type I than Type II

Background: Impaired profiles of neurocognitive function have been consistently demonstrated among pediatric patients with bipolar disorder (BD), and may aid in the identification of endophenotypes across subtypes of the disorder. This study aims to determine phenotypic cognitive profiles of patients with BD Type I and II. Methods: Subjects (N = 79) consisted of BD I (n = 27) and BD II (n = 19) patients and demographic and intellectually matched healthy controls (HC; n = 33) that completed a battery of neurocognitive tasks. Results: Bipolar disorder Type I patients performed significantly more poorly compared to HC on all domains of cognitive function including attention, executive function, working memory, visual memory, and verbal learning and memory. BD I patients also performed more poorly compared to BD II patients on all domains of cognitive functioning with the exception of working memory, whereas BD II patients did poorly relative to HC only on verbal learning and memory. Conclusions: Findings from the current study indicate that BD I patients are characterized by more severe cognitive impairment relative to BD II patients who show an intermediate pattern of performance between BD I patients and HC. Verbal learning and memory may effectively differentiate pediatric BD patients and controls, regardless of the subtype of BD, and may serve as a cognitive endophenotype for the disorder. Additionally, these findings move us closer to developing effective cognitive interventions tailored to specific subtypes of pediatric BD patients.     

Adaptation and Preliminary Testing of the Developmental Coordination Disorder Questionnaire (DCDQ) for Children in India

Aims: While Developmental Coordination Disorder (DCD) has gained worldwide attention, in India it is relatively unknown. The revised DCD Questionnaire (DCDQ′07) is one of the most utilized screening tools for DCD. The aim of this study was to translate the DCDQ′07 into the Hindi language (DCDQ-Hindi) and test its basic psychometric properties. Methods: The DCDQ′07 was translated following guidelines for cross cultural adaptation of instruments. Parents of 1100 children (5–15 years) completed the DCDQ-Hindi, of which 955 were considered for data analysis and 60 were retested randomly after 3 weeks for test–retest reliability. Results: The DCDQ-Hindi showed high internal consistency (α = .86) and moderate test–retest reliability (.73). Confirmatory factor analysis showed equivalence to the DCDQ′07. The% probable DCD using DCDQ′07 cutoff scores (≤57) ranged from 22% to 68%. Using more stringent cutoffs (≤36) it ranged from 5% to 9%. Significant difference was seen for gender (p < .05) in subset 1(gross-motor skills) total scores. Conclusions: The DCDQ-Hindi reveals promise for initial identification of Hindi speaking Indian children with DCD. Based on more stringent cut-off scores, the “probable prevalence” of children with risk of DCD in India appears to be around 6–7%. Research with larger sample and comparison with the MABC-2 or equivalent is needed.     

Motor Planning and Gait Coordination Assessments for Children with Developmental Coordination Disorder

Aims: The purposes were to examine construct validity of the Motor Planning Maze Assessment (Maze) and three items from the Functional Gait Assessment (FGA) that were modified for children (pediatric modified FGA, pmFGA), by comparing performance of children with DCD and age matched peers with typical development (TD); the construct validity of total scores of the Dynamic Gait Index (DGI) and the FGA. Methods: Twenty pairs of children with DCD and TD, age from 5 to 12 years, participated in this study. Children in both groups were tested on the Maze, pmFGA, DGI, and FGA. Paired t-tests and agreement tables were used to compare the motor performances between two groups. Results: The DCD group showed higher summary scores in the Maze (p < 0.001) and demonstrated significantly fewer steps (p ≤ 0.001) while doing the pmFGA items than the TD group. However, the FGA quality scores demonstrated minimal differences between the two groups on all three items. Children with DCD showed significantly lower DGI and FGA total scores (p < 0.001) than the TD group. Conclusion: The Maze, DGI, and FGA tests are easily applied in clinical settings and can differentiate motor planning and gait coordination between children with DCD and with TD.     

Self-Regulatory Skill Among Children with and without Developmental Coordination Disorder: An Exploratory Study

Aim: Children with developmental coordination disorder (DCD) experience difficulty learning and performing everyday motor tasks due to poor motor coordination. Recent research applying a cognitive learning paradigm has argued that children with DCD have less effective cognitive and metacognitive skills with which to effectively acquire motor skills. However, there is currently limited research examining individual differences in children's use of self-regulatory and metacognitive skill during motor learning. This exploratory study aimed to compare the self-regulatory performance of children with and without DCD. Methods: Using a mixed methods approach, this study observed and compared the self-regulatory behavior of 15 children with and without DCD, aged between 7 and 9 years, during socially mediated motor practice. Observation was conducted using a quantitative coding scheme and qualitative analysis of video-recorded sessions. This paper will focus on the results of quantitative analysis, while data arising from the qualitative analysis will be used to support quantitative findings. Results: In general, findings indicate that children with DCD exhibit less independent and more ineffective self-regulatory skill during motor learning than their typically developing peers. In addition, children with DCD rely more heavily on external support for effective regulation and are more likely to exhibit negative patterns of motivational regulation. Conclusions: These findings provide further support for the notion that children with DCD experience difficulty effectively self-regulating motor learning. Implications for practice and directions for future research are discussed.     

Effectiveness of a Summer Camp Intervention for Children with Developmental Coordination Disorder

ABSTRACT

Background: Developmental coordination disorder (DCD) significantly affects a child's motor abilities and negatively impacts their self-efficacy and participation in physical activity. Using a task-specific approach and cognitive strategies in a group setting, we designed a summer camp intervention for children with DCD. Aims: Our purpose was to examine the effectiveness of the summer camp in meeting child-chosen functional motor goals and increasing self-efficacy and participation. Methods: This mixed methods study examined performance and satisfaction of child-chosen goals, self-efficacy, and participation of 11 children before and after the camp. Survey and interview data from three children and nine parents were collected to supplement quantitative findings. Results: Statistically significant improvement in performance and satisfaction of child-chosen goals was noted. While no measureable changes in self-efficacy and participation were observed, parents and children reported positive benefits to camp participation, including the confidence to try new activities, being with other children with DCD, and learning more about the disorder. Conclusion: The intensive, group-based summer camp may offer a valuable alternative to improve the functional skills of children with DCD, while providing other notable benefits.     

Development and Pilot Testing of the Challenge Module: A Proposed Adjunct to the Gross Motor Function Measure for High-Functioning Children with Cerebral Palsy

ABSTRACT

The aim was to develop a Challenge Module (CM) as a proposed adjunct to the Gross Motor Function Measure for children with cerebral palsy who have high-level motor function. Items were generated in a physiotherapist (PT) focus group. Item reduction was based on PTs’ ratings of item importance and safety via online surveys. The proposed CM items were pilot-tested with children in Gross Motor Function Classification System Level I. The focus group identified 35 items for consideration. The first item-reduction survey (n = 86 PT respondents) resulted in 20 items. A second survey yielded two additional items. Seven pilot-test participants (6–14 years) had a CM total mean score of 74.5% (SD = 19.4). Three easy items were subsequently removed and two items combined. Of seven additional items suggested by the children during testing, two were accepted in a third item-reduction survey. The final result was a 20-item CM to evaluate advanced motor skills. The CM requires refinement through Rasch scaling and formal validation.     

Is Group-Based or Individual-Based Intervention more Effective for Quality of Life Outcomes in Children with Developmental Coordination Disorder? A Systematic Review

Aims: To examine whether group-based or individual-based treatment programs are more effective for quality of life (QOL) outcomes in children with developmental coordination disorder (DCD). Methods: A systematic search of the literature was conducted, in accordance with the PRISMA guidelines. Quality of the papers was assessed using the Modified Downs and Black Checklist. Peer-reviewed clinical experimental studies of children diagnosed with DCD with any QOL related outcome measure were included, of all years, languages, and approaches of intervention. Results: Sixteen studies were identified for inclusion, of mixed methodological qualities (predominantly low). Improvement of QOL with both group-based and individual-based interventions were shown, though large degrees of heterogeneity were observed in study designs, participants, modes of interventions, durations, and outcome measures utilized. Conclusions: The effectiveness of group-based versus individual-based interventions on QOL of children with DCD is unclear. There is a pressing need for a high quality, powered trials, utilizing the randomized control trial paradigm, comparing both intervention approaches with standardized treatment approaches and outcome measures to determine and compare the effect on QOL of children with DCD.     

Trouble du déficit de l’attention/hyperactivité avec ou sans troubles associés : mise en évidence de différences attentionnelles et exécutives

Background

Children with attention-deficit hyperactivity disorder (ADHD) manifest deficits in attentional and executive domains. Yet, although ADHD is often associated with other neurodevelopmental syndromes such as developmental dyslexia (DD) and developmental coordination disorder (DCD), very few studies exploring the impact of these associated disorders on cognitive abilities of children with ADHD are available. Whether and how these comorbid disorders may influence attentional and executive abilities among ADHD patients remained to be explored.

Diagnosis of vascular rings and slings using an interleaved 3D double-slab FISP MR angiography technique

Background: Congenital upper airway obstruction and dysphagia may be caused by vascular rings and slings. Often, invasive and radiation-dependent diagnostic procedures are needed to clarify the diagnosis. Objective: To evaluate the diagnostic utility of high-resolution, free-breathing three-dimensional double-slab fast imaging with steady precession magnetic resonance angiography (3D FISP MRA) in infants and children with respiratory upper airway obstruction and/or dysphagia for detection or exclusion of vascular rings and slings. Materials and methods: Eleven patients (median age 1.3 years; range 5.1 months to 15.8 years) were investigated prospectively with 3D FISP MRA and spin-echo techniques. Additional diagnostic data were available from surgery (n=7), cardiac catheterization (n=5), CT (n=2), barium swallow (n=3) and bronchoscopy/oesophagoscopy (n=4). Results: In one case, diagnosis was missed with low-resolution spin-echo sequences, but high-resolution 3D FISP MRA revealed a double aortic arch. 3D FISP MRA accurately found (n=8) or excluded (n=3) vascular rings or slings in all patients. Using a five-level grading system for 3D FISP MRA image quality (1=non-diagnostic; 5=excellent), the mean grade was 4.3±0.7 with no significant grade difference between two independent observers (P=0.81). Conclusions: High-resolution 3D FISP MRA accurately defined or excluded vascular rings and slings in patients with respiratory symptoms and/or dysphagia. This technique may provide a non-invasive, radiation-free alternative without contrast agents for diagnosis of vascular rings and slings in free-breathing infants and children.Electronic supplementary material is available for this article at