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Developmental Developmental Coordination Coordination

Disorder (DCD)Disorder (DCD)Clinical Science IIIClinical Science III

Karen R. Voogt, DPTKaren R. Voogt, DPT

Fall 2011Fall 2011

DCDDCD Children also described as “low Children also described as “low

tone”, “mild motor” problemstone”, “mild motor” problems Also labeled:Also labeled:

clumsy child syndromeclumsy child syndrome physically awkwardphysically awkward perceptual motor dysfunctionperceptual motor dysfunction developmental dyspraxiadevelopmental dyspraxia sensory integrative dysfunctionsensory integrative dysfunction

DCD Definition from DSM DCD Definition from DSM IVIV

““Chronic and usually permanent Chronic and usually permanent condition characterized by condition characterized by impairment of motor performance impairment of motor performance that is sufficient to produce that is sufficient to produce functional motor performance functional motor performance deficits that are not explicable by the deficits that are not explicable by the child's age or intellect, or by other child's age or intellect, or by other diagnosable neurological or spatial-diagnosable neurological or spatial-temporal organizational problems.”temporal organizational problems.”

DCD Other CriteriaDCD Other Criteria

Motor development must differ Motor development must differ from their development in other from their development in other areas and the motor problems areas and the motor problems must have an impact on must have an impact on academics and/or daily life academics and/or daily life activities.activities.

DCDDCD

Many achieve motor skills at Many achieve motor skills at typical timestypical times

May not generalize to other May not generalize to other settingssettings

Motor difficulties continue to Motor difficulties continue to be present into adolescence be present into adolescence and adulthoodand adulthood

DCD and Other Co-DCD and Other Co-MorbiditiesMorbidities

Can range from mild to severeCan range from mild to severe Gross and fine motor problemsGross and fine motor problems Learning disabilitiesLearning disabilities Speech and articulation difficultiesSpeech and articulation difficulties Attention deficit disorderAttention deficit disorder

DCD PathophysiologyDCD Pathophysiology

No specific pathologic process or single No specific pathologic process or single neuroanatomic site has been definitively neuroanatomic site has been definitively associated with DCD.associated with DCD.

DCD is not related to muscle pathology, DCD is not related to muscle pathology, peripheral sensory abnormality, or central peripheral sensory abnormality, or central nervous system damage that produces nervous system damage that produces spasticity, athetosis, or ataxia.spasticity, athetosis, or ataxia.

Possible frontal and parietal lobe area Possible frontal and parietal lobe area lesionslesions

Relationships Among Relationships Among Body Structures and Body Structures and

Function, Activity, and Function, Activity, and Participation for a Participation for a

Child with DCDChild with DCD

See HandoutSee Handout

DCD PathophysiologyDCD Pathophysiology

Associated with prematurity, Associated with prematurity, low birth weightlow birth weight

Prenatal, perinatal or Prenatal, perinatal or neonatal risk factorsneonatal risk factors

Impairments of Impairments of Body Functions Body Functions

Identified in Identified in Children with Children with

DCDDCDSee HandoutSee Handout

Diagnosis of DCDDiagnosis of DCD

Usually not made until later in school age when Usually not made until later in school age when child learns and performs skills that require child learns and performs skills that require adaptation in speed, timing, force or distance of adaptation in speed, timing, force or distance of the movementthe movement

Slowness of movementSlowness of movement Decreased reaction time and movement timeDecreased reaction time and movement time Rely on use of vision more heavilyRely on use of vision more heavily Decreased strength and powerDecreased strength and power Poor hand-eye coordinationPoor hand-eye coordination

DCD Secondary DCD Secondary Impairments/SequelaeImpairments/Sequelae

Decreased participation in sport and Decreased participation in sport and leisure activitiesleisure activities

Decreased opportunities for social Decreased opportunities for social interactioninteraction

Decreased physical fitness across Decreased physical fitness across the lifespan the lifespan

Sedentary lifestyle health risksSedentary lifestyle health risks

DCD Role of FeedbackDCD Role of Feedback

Studies demonstrate children with DCD do Studies demonstrate children with DCD do not interpret and utilize sensory feedback not interpret and utilize sensory feedback or feedback from task performance in the or feedback from task performance in the same manner as other children same manner as other children

NO internal representation of the motor NO internal representation of the motor action (efferent copy)action (efferent copy) May be responsible for slow, uncoordinated May be responsible for slow, uncoordinated

movementmovement Don’t learn from their mistakesDon’t learn from their mistakes Perform like earlier learning stagesPerform like earlier learning stages No pre-movement preparation or “postural No pre-movement preparation or “postural

biasing”biasing”

DCD “Fixing” StrategyDCD “Fixing” Strategy

Freezing or fixing of joints during Freezing or fixing of joints during task performancetask performance

Deliberate stabilization of joints Deliberate stabilization of joints Movements are stiff, awkward, Movements are stiff, awkward,

clumsy in appearanceclumsy in appearance

““Fixing”Fixing”

Stabilize so another part can be Stabilize so another part can be moved with better controlmoved with better control

Controls excess degrees of freedomControls excess degrees of freedom Less efficient, causes fatigueLess efficient, causes fatigue Challenged in timing, duration and Challenged in timing, duration and

sequencingsequencing

Treatment InterventionTreatment Intervention

Determine what sports/leisure Determine what sports/leisure activities will be successful activities will be successful Address specific necessary skillsAddress specific necessary skills

Prevent long term effects of Prevent long term effects of inactivityinactivity

Address physical impairments Address physical impairments (low tone)(low tone)

Treatment InterventionsTreatment Interventions

Children with DCD have difficulty with Children with DCD have difficulty with activities that require:activities that require: PrecisionPrecision Continuous adaptabilityContinuous adaptability Eye-hand coordinationEye-hand coordination Variable environmentVariable environment Constant monitoring of feedback during task Constant monitoring of feedback during task

performanceperformance High level of unpredictability High level of unpredictability Ex: hockey, baseball, basketball, footballEx: hockey, baseball, basketball, football

Treatment InterventionTreatment Intervention

Children with DCD may be successful Children with DCD may be successful with:with: Sequence of movements that are Sequence of movements that are

repetitiverepetitive Swimming, skating, skiing, bicyclingSwimming, skating, skiing, bicycling Lifestyle sportsLifestyle sports

Intervention Intervention