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.     

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.     

Effect of Hippotherapy on Motor Proficiency and Function in Children with Cerebral Palsy Who Walk

Aims: To evaluate the effects of hippotherapy on physical capacities of children with cerebral palsy. Methods: Thirteen children (4–12 years old) with cerebral palsy classified in Gross Motor Function Classification System Level I or II were included in this prospective quasi-experimental ABA design study. Participants received 10 weeks of hippotherapy (30 min per week). Gross motor function and proficiency were measured with the Bruininks–Oseretski Motor Proficiency short form [BOT2-SF]) and the Gross Motor Function Measure-88 [GMFM-88] (Dimension D and E) twice before the program (T1 and T1′), immediately after (T2), and 10 weeks following the end of the program (T3). Results: Mean scores for dimensions D and E of the GMFM-88 Dimension scores (p = .005) and three out of the eight items of the BOT2-SF (fine motor precision (p = .013), balance (p = .025), and strength (p = .012) improved between baseline and immediately after intervention; mean scores immediately following and 10 weeks following intervention did not differ. Conclusions: Hippotherapy provided by a trained therapist who applies an intense and graded session for 10 weeks can improve body functions and performance of gross motor and fine motor activities in children with cerebral palsy.     

Effect of Touch Screen Tablet Use on Fine Motor Development of Young Children

Aim: To investigate the effects of touch-screen tablet use on the fine motor development of preschool children without developmental delay. Methods: 40 children who used a touch-screen tablet more 60 minutes per week for at least 1 month received a 24-week home fine motor activity program using a touch-screen-tablet. 40 children matched for age (mean = 61.0 months) and sex who did not meet the criteria for previous tablet use received a 24-week program consisting of manual play activities. Motor performance was measured using the Bruininks–Oseretsky Test of Motor Proficiency. The two-factor mixed design ANOVA was used to compare performance of the touch-screen tablet and non-touch-screen tablet groups. Results: Pretest analysis showed no group differences in motor performance and pinch strength. At posttest, children in the nontouch-screen-tablet group made significantly greater changes in fine motor precision (p < 0.001), fine motor integration (p = 0.008), and manual dexterity (p = 0.003). Conclusion: Using a touch screen tablet extensively might be disadvantageous for the fine motor development of preschool children.     

The Association of Motor Skills and Adaptive Functioning in XXY/Klinefelter and XXYY Syndromes

Aims: Klinefelter (XXY) and XXYY syndromes are genetic disorders in males characterized by additional sex chromosomes compared to the typical male karyotype of 46, XY. Both conditions have been previously associated with motor delays and motor skills deficits. We aimed to describe and compare motor skills in males with XXY and XXYY syndromes, and to analyze associations with age, cognitive abilities, and adaptive functioning. Methods: Sixty-four males with XXY and 46 males with XXYY, ages 4–20 were evaluated using the Beery Test of Visual Motor Integration and the Bruininks-Oseretsky Test of Motor Proficiency – 2nd Edition assessments, Vineland–2 adaptive scales, and cognitive testing. Results: Motor coordination impairments were found in 39% of the males with XXY and 73% of the males with XXYY. Both groups showed strengths in visual perceptual skills. Males with XXYY had lower mean scores compared to males with XXY across all assessments. Fine motor dexterity and coordination deficits were common. There was a positive correlation between VMI scores and adaptive functioning. Conclusion: Occupational and physical therapists should be aware of the motor phenotype in XXY and XXYY both to aid in diagnosis of unidentified cases and to guide intervention.     

Effect of Group Setting on Gross Motor Performance in Children 3–5 Years Old with Motor Delays

Aims: The purpose of this study was to evaluate differences in gross motor performance of children 3–5 years of age with motor delays when assessed individually compared to assessment in a group setting among peers with typical development (TD). Methods: Twenty children with motor delays and 42 children with TD were recruited from a preschool program. A within-subject repeated measures design was used; each child with delay was tested both in an individual setting and in a group setting with two to four peers with TD. Testing sessions were completed 4–8 days apart. Ten different motor skills from the Peabody Developmental Motor Scales-2 were administered. Performance of each item was videotaped and scored by a blinded researcher. Results: Overall gross motor performance was significantly different (p < .05) between the two settings, with 14 of 20 children demonstrating better performance in the group setting. In particular, children performed better on locomotion items (p < .05). Conclusions: The higher scores for locomotion in the group setting may be due to the influence of competition, motivation, or modeling. Assessing a child in a group setting is recommended as part of the evaluation process.     

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.     

Responsiveness of the Test of Basic Motor Skills of Children with Down Syndrome

The aim of this study was to examine the responsiveness of the Test of Basic Motor Skills for Children with Down Syndrome (BMS). Forty-one children with Down Syndrome, 3 to 36 months of age, participated in the study. Gross motor skills were assessed three times using the BMS and the Gross Motor Function Measure (GMFM) before and after a baseline period of 2 weeks (T1-T2) and after a period of 16 weeks (T2-T3). Internal and external responsiveness of the BMS was analyzed using Guyatt's Responsiveness Index (GRI) and 2 × 2 repeated measures. Change in BMS scores was compared to change in GMFM scores and parent and physiotherapist ratings of change. The responsiveness of the BMS was large (GRI = 2.55). A significant Time × Age interaction [F(1,37) = 8.87, p < .01] indicated that BMS scores increased more for children ≤ 2 years compared with children 2 to 3 years of age. The difference in GRI between the BMS and GMFM was 0.75 (95% CI ?0.25–1.75), indicating that the BMS and GMFM did not significantly differ in responsiveness. The Time × Measure interaction was not significant, indicating that the increase in mean BMS and GMFM scores did not differ. Change in BMS scores were correlated with parent ratings of change (r = 0.65, p < .001) but not physiotherapist ratings (r = 0.36, p = .23). The results provide evidence that the BMS is responsive to change in gross motor development in children with Down Syndrome from 3 to 36 months of age.     

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.     

Active Video Gaming for Children with Cerebral Palsy: Does a Clinic-Based Virtual Reality Component Offer an Additive Benefit? A Pilot Study

Aims: To compare changes in gross motor skills and functional mobility between ambulatory children with cerebral palsy who underwent a 1-week clinic-based virtual reality intervention (VR) followed by a 6-week, therapist-monitored home active video gaming (AVG) program and children who completed only the 6-week home AVG program. Methods: Pilot non-randomized controlled trial. Five children received 1 hour of VR training for 5 days followed by a 6-week home AVG program, supervised online by a physical therapist. Six children completed only the 6-week home AVG program. The Gross Motor Function Measure Challenge Module (GMFM-CM) and Six Minute Walk Test (6MWT) evaluated change. Results: There were no significant differences between groups. The home AVG-only group demonstrated a statistically and clinically significant improvement in GMFM-CM scores following the 6-week AVG intervention (median difference 4.5 points, interquartile range [IQR] 4.75, p = 0.042). The VR + AVG group demonstrated a statistically and clinically significant decrease in 6MWT distance following the intervention (median decrease 68.2 m, IQR 39.7 m, p = 0.043). All 6MWT scores returned to baseline at 2 months post-intervention. Conclusion: Neither intervention improved outcomes in this small sample. Online mechanisms to support therapist-child communication for exercise progression were insufficient to individualize exercise challenge.     

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.     

Factors Associated with Enhanced Gross Motor Progress in Children with Cerebral Palsy: A Register-Based Study

Aim: To examine associations between interventions and child characteristics; and enhanced gross motor progress in children with cerebral palsy (CP). Methods: Prospective cohort study based on 2048 assessments of 442 children (256 boys, 186 girls) aged 2–12 years registered in the Cerebral Palsy Follow-up Program and the Cerebral Palsy Register of Norway. Gross motor progress estimates were based on repeated measures of reference percentiles for the Gross Motor Function Measure (GMFM-66) in a linear mixed model. Mean follow-up time: 2.9 years. Results: Intensive training was the only intervention factor associated with enhanced gross motor progress (mean 3.3 percentiles, 95% CI: 1.0, 5.5 per period of ≥3 sessions per week and/or participation in an intensive program). Gross motor function was on average 24.2 percentiles (95% CI: 15.2, 33.2) lower in children with intellectual disability compared with others. Except for eating problems (–10.5 percentiles 95% CI: –18.5, –2.4) and ankle contractures by age (–1.9 percentiles 95% CI: –3.6, –0.2) no other factors examined were associated with long-term gross motor progress. Conclusions: Intensive training was associated with enhanced gross motor progress over an average of 2.9 years in children with CP. Intellectual disability was a strong negative prognostic factor. Preventing ankle contractures appears important for gross motor progress.     

Development of Child and Family-Centered Engagement Guidelines for Clinical Administration of the Challenge to Measure Advanced Gross Motor Skills: A Qualitative Study

Aims: This article describes a qualitative study aimed at producing child-centered guidelines for the administration of a measure of children's advanced gross motor skills, the Challenge. The purpose of the guidelines is to promote collaborative interpretation and application of results. Methods: The study was conducted in three Canadian cities and included 31 children with cerebral palsy (GMFCS Level I or II) ages 8 to 18 and one parent/caregiver per child (N = 62 participants). Following Challenge administration, each child and one of their caregivers took part in separate qualitative interviews. Analyses were oriented to exploring understandings of the purposes of testing, impressions of the child's performance, and perceptions of how results might inform activity choices and interventions. Results: Three themes were generated: investments in doing well; I know my child/myself; and caregivers' interpretations of child's performance. Themes were then integrated with principles of child and family-centered care to develop The Challenge Engagement Guidelines directed at reducing test anxiety and enhancing shared decision making. Conclusions: The Guidelines are the first of their kind to integrate child and family-centered principles into the administration protocol of a motor measure. Although developed for the Challenge, the principles have applicability to other rehabilitation measures.     

Effects of Aquatic Intervention on Gross Motor Skills in Children with Cerebral Palsy: A Systematic Review

Aims: To review the literature on the effects of aquatic intervention on gross motor skills for children with cerebral palsy (CP). Data sources: Six databases were searched from inception to January 2016. Review methods: Aquatic studies for children aged 1–21 years with any type or CP classification and at least one outcome measuring gross motor skills were included. Information was extracted on study design, outcomes, and aquatic program type, frequency, duration, and intensity. Quality was rated using the Centre of Evidence-Based Medicine: Levels of Evidence and the PEDro scale. Results: Of the 11 studies which met inclusion criteria, only two used randomized control trial design, and the results were mixed. Quality of evidence was rated as moderate to high for only one study. Most studies used quasi-experimental designs and reported improvements in gross motor skills for within group analyses after aquatic programs were held for two to three times per week and lasting for 6–16 weeks. Participants were classified according to the Gross Motor Function Classification System (GMFCS) levels I–V, and were aged 3–21 years. Mild to no adverse reactions were reported. Conclusions: Evidence on aquatic interventions for ambulatory children with CP is limited. Aquatic exercise is feasible and adverse effects are minimal; however, dosing parameters are unclear. Further research is needed to determine aquatic intervention effectiveness and exercise dosing across age categories and GMFCS levels.     

Developmental Progression of Motor Skills in Children Prenatally Exposed to Cocaine

This study tested the motor development of 73 infants who were prenatally exposed to cocaine using the Peabody Developmental Motor Scales at 6, 12, 18, and 24 months of age. Repeated measures MANOVA found a main effect for age with scores decreasing as children increased in age. The significant interactive effect between age and skill type indicated that fine motor quotient scores decreased more than the comparable gross motor scores. T-tests showed significant differences between the two skill types: fine motor skills were higher at the first two testing periods and lower at the last two periods. This article discusses the nature of the delays at specified age periods and the implications for future assessment and programming.     

Preliminary Efficacy of a Friendly Constraint-Induced Therapy (Friendly-CIT) Program on Motor and Psychosocial Outcomes in Children with Cerebral Palsy

Aims: Constraint-induced therapy (CIT) is effective, but concerns have been repeatedly raised regarding the generalizability, feasibility, and potentially intrusive nature of restraining a child's unimpaired upper limb. We examined the feasibility and efficacy of friendly-CIT, which uses home-based model, a caregiver-determined schedule, and gentle restraint, in children with cerebral palsy. Methods: In a one-group pre-post intervention trial, 15 children (median of age = 8 years, 4 months) participated in 8 weeks of friendly-CIT (36 hours). Motor and psychosocial outcomes were investigated. Results: Participants showed significant improvement on the manual dexterity subtest of the Bruininks-Oseretsky Test of Motor Proficiency (p = 0.004); the how often (p = 0.01) and how well (p = 0.02) scales of the Revised Pediatric Motor Activity Log; and the functional skills score on the Chinese version of the Pediatric Evaluation of Disability Inventory (p = 0.002). For psychosocial outcomes, children with CP consistently demonstrated high engagement and increased playfulness (p < 0.0001) during the 8-week intervention. Parents showed no change in stress status and high satisfaction with friendly-CIT. Conclusion: Friendly-CIT is feasible and promising for improving a child's motor and psychosocial outcomes without increasing parental stress.     

Exploring the Use of Cognitive Intervention for Children with Acquired Brain Injury

ABSTRACT

Introduction: Children with acquired brain injury (ABI) often experience cognitive, motor, and psychosocial deficits that affect participation in everyday activities. Cognitive Orientation to Daily Occupational Performance (CO-OP) is an individualized treatment that teaches cognitive strategies necessary to support successful performance. Objective: This study explores the use of CO-OP with children with ABI. Method: Children with ABI, experiencing school and self-care difficulties, were identified from a previous study. Six children, aged 6–15 years, completed 10 weekly intervention sessions with occupational therapists. Children and parents rated the child's performance of challenging everyday tasks and their satisfaction with this performance. Task performance was also evaluated objectively through videotape analysis. Results: Participants showed significant improvement in their ability to perform child-chosen tasks and maintained this performance 4 months later. However, they had difficulty applying the executive problem-solving strategy and discovering cognitive strategies on their own. Issues related to the use of CO-OP with this population are discussed.