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A SYSTEMATIC REVIEW OF INTERVENTIONS UTILIZED IN THE MANAGEMENT OF INDIVIDUALS WITH DEVELOPMENTAL COORDINATION DISORDER

Abigail Bissonette, SPT; Haley Brandt, SPT; Susan Christensen, SPT, CSCS; Alyson Cybulski, SPT; Sara Girolami, SPT; Jacob McDonald, SPT; Caitlin Schober, SPT; Dr. Ann Franz, Ph.D., P.T., CSCS

WHAT IS DCD?

Developmental Coordination Disorder (DCD) is

characterized by difficulty in movement skills (gross

and fine motor) that are not primarily due to any

physical, neurological, or behavioral disorders.

Children with DCD struggle with learning and

performing everyday tasks in their environment that

negatively affect their everyday life. If cognitive

impairments are present in children with DCD, motor

impairments must be greater than in children of the

same age without DCD with cognitive impairments.

A physician makes the diagnosis after all other

possible explanations for the motor difficulties are

ruled out and if all of the above characteristics are

present.

PURPOSE

Interventions Review Findings

Task-oriented Effective for children with DCD. More effective than

process-oriented and traditional therapy

CO-OP More effective than current treatment approaches.

NTT The task that is trained is improved.

MIT Seems to work for some children, but needs more research.

Traditional therapy Effective for children with DCD. More effective than

process-oriented.

PMT Not an effective approach with small effect size (0.082)

Body Functions &

Structure

May be effective, but less that task-oriented approaches

Gross Motor &

Strength

May help, and often used in therapy

Parent/Teacher

Guided

No clear evidence for efficacy, but should educate parents

to assist in interventions at home.

Process-oriented Not recommended for improving motor performance in

children DCD

SIT Inconclusive evidence about effectiveness of SIT compared

to other treatments or no treatments.

Kinaesthetic

Training

Moderate evidence that kinaesthetic training may help

improve kinaesthetic acuity.

INCLUSION/EXCLUSION CRITERIA

SYSTEMATIC REVIEWS

The purpose of this review is to evaluate the efficacy of therapeutic interventions for children with DCD to improve motor performance based on currently available research.

RESULTS AND FUTURE RESEARCHIntervention should be aimed at task-oriented functional activities that are meaningful and relevant to the child’s daily life, with involvement from parents and teachers. Moreover, our review demonstrated that a variety of interventions are beneficial in improving a child’s motor performance.

Improvements in Study Design:• Consistent and Functional Outcome Measures

•M-ABC, BOT, DCD-Q

• Interventions that are generalizable to functional tasks•Task-oriented approach, sports- or ADL-specific interventions

• Long-term studies > 3 months• Larger sample size to better generalize results to children with DCD• Increased rigor in sampling (Inclusion and exclusion criteria)

•Consistent diagnostic criteria for DCD

• Determine optimal duration, intensity, and frequency to standardize recommendations• Interventions grouped by age, subtype, and/or comorbidities

Inclusion Criteria: Birth to 21 years old, English, Past 20 years, Human

Exclusion Criteria: Surgical procedures, Medical procedures

Search Terms: DCD, Birth-21 years, Intervention, Treatment, Developmental Delay, Group Therapy, Physical Activity, Motor Performance, Sensory Integration, Neuromotor task training, Task-oriented approach, Physical therapy

Search Engines/Databases: PubMed, Google Scholar, PEDro, TRIP

Intervention

CategoryArticle

Type of

StudyParticipant Characteristics Interventions Outcome Measures Results

Cognitive Approach

Hyland (2012) RCT n = 39; Dx: DCD Analyzed 39 video-taped sessions to evaluate children’s use of DPA, a self-regulation technique, during CO-OP,

task-specific, and conventional therapy approaches

Pre- and post-test comparison use of DPA for each type of therapy +

Wilson (2002) RT n = 54; Dx: Probable

DCD

MIT: n = 18; 60 min 1x/wk x 5wks individual treatment

Traditional-PMT: n = 18; 60 min 1x/wk x 5wks individual treatment

Wait-List Control: n = 18; no intervention

M-ABC* =

Cosper (2009) Cohort

Study

n = 12; Dx: DCD Interactive Metronome Training: n = 12, 1hr/wk x 15 individual treatment: Repetitive pattern motor activities

timed to beats

BOT-2*, GDS Continuous Performance Test (sustained attention) +

Leemrijse (2000) RT with 6

single cases

n=6; Dx: DCD Experimental Group 1: n = 3; 12-18 wks of LBD, 12-18 wks SI

Experimental Group 2: n = 3; 12-18 wks of SI, 12-18 wks LBD

M-ABC* (LBD), Praxis Tests of the SIPT* (LBD), Rhythm IntegratedTM* (LBD), VAS

(parent worry)* (LBD & SI)

+

LBD>SI

Group

Pless (2000) Research

Report

n = 37; Dx: DCD and

Probable DCD

Group Motor Skill Interventions: n = 17; 1x/wk x10 wks

Control: n = 20; no motor skill intervention

M-ABC checklist and motor portion +

Hung (2012) RCT Pilot n = 23; Dx: DCD Group-Based: n = 12, 4-6 children:1 therapist; 45 min/wk x 8 wks; HEP: 20 min/d

Individual-Based: n = 11; 45 min/wk x 8 wks; HEP x 20 min/d

M-ABC* =

Zwicker (2014) RT n = 11; Dx: DCD Group-Based: 6hrs/d x 2-wk summer camp sessions M-ABC-2, DCD-Q, COPM*, PEGS, CSAPPA, CAPE, parent survey +

Dunford (2011) Repeated

Measure

n = 8; Dx: DCD Group CO-OP: 50 min x 8 sessions x 2 wks M-ABC*, Harter, COPM* +

NTT

Niemeijer (2006) Pilot Study n =19; Dx: DCD NTT: 1x/wk x 9 wks M-ABC* (adjusting body positioning and explaining why), TGMD-2* (giving

clues, explaining why, providing rhythm, and asking about understanding)

+

Niemeijer (2007) RCT n =39; Dx: DCD NTT: n = 26; 1x/wk x 9 wks

Control: n = 13; 9 wks no training

M-ABC*, TGMD-2* +

Ferguson (2013) Quasi-

experimenta

l design

n= 46; Dx: Probable DCD NTT: n = 27; 45-60 min, 2x/wk x 9 wks: Workstations included soccer, netball, tagging games, indigenous games.

Wii: n = 19; 30 min, 3x/wk x 6 wks: Choice of 18 games mimicking cycling, soccer, skateboarding, skiing. Play at

least 2x.

M-ABC-2* (NTT), Functional Strength Measure* (total & 6/9 items NTT; 1 item

for Wii), Hand-held dynamometer, Muscle Power Sprint Test* (NTT & Wii),

Metre Shuttle Run Test* (NTT)

+

NTT>Wii

Task Specific

Fong (2012) RCT n = 62; Dx: DCD TKD training: n = 21; 1 hr/wk x 12 wks; Home practice: 45-60 min, 6 d/wk, parent activity log

Control: DCD n = 23; non-DCD n=18

SOT*, UST* +

Fong (2013) RCT n = 62; Dx: DCD TKD training: n = 21; 1 hr/wk x 12 wks; Home practice: 45-60 min, 6 d/wk, parent activity log

Control: DCD n = 23; non-DCD n=18

Isokinetic concentric strength (Cybex Norm isokinetic dynamometer)*, UST*,

MCT

+

Hillier (2010) Pilot Study n = 13; Dx: DCD Aquatic Therapy: 30 min, 1x/wk x 6 sessions

Control: no intervention

M-ABC, PSPCSA, Parent Questionnaire +

Tsai (2009) RT n = 43; Dx: DCD Table Tennis: 50 min, 3x/wk x 10 wks M-ABC-2*, reaction times and error responses* +

Traditional Physical

Therapy

Giagazoglou

(2015)

Cohort

Study

n = 20; Dx: Probable

DCD

Experimental Group: n = 10; 45 min, 3x/wk x12 wks: Balance training circuit with 15 min on trampoline

Control: n = 10; no intervention

BCTC*, TBCT*, Balance Testing on EPS pressure platform* +

Kane (2009) Case Report n = 5; Dx: DCD 55 min, 2x/wk x 6 sessions: Aerobic warm-up, core stability exercises, task-specific intervention per child’s sports

goals

DCD-Q, Leisure section of Canadian occupational and performance model,

BOTMP, CSAPPA, therapist-derived measure of core stability, child-chosen goals

and perceived competency for each goal

+

Menz (2013) Case Report n = 1; Dx: Probable DCD 60 min, 2x/wk x 24 sessions: Progressive strength training using universal exercise unit BOT-2*, COPM*, DCDQ*, TGMD-2, Monkey bars +

Kaufman (2007) Case Report n = 1; Dx: DCD 20-30 min, 2x/wk x 12 wks: Progressive strength training using body weight and weights HDD, BOT-MP, Proprioceptive test, parent and teacher report +

Watemberg

(2007)

RT n = 28; Dx: DCD Physical Therapy: n = 14; 1hr, 2x/wk x 4 wks in groups of 4-5 children; HEP: 30min/d

Control: n = 14; no intervention

M-ABC* +

Virtual Reality

Hammond (2014) Pilot Study n = 18; Dx: DCD and

Probable DCD

Wii Fit: 10 min, 3x/wk x 1 month

Control: Jump Ahead program

DCD-Q, BOT-2*, CSQ: Ability, Satisfaction, SDQ +

Jelsma (2014) RT n = 48; Dx: Probable

DCD

Wii Fit: 30 min, 3x/wk x 6 wks M-ABC-2*, BOT-2,* Wii Fit ski slalom test*, Enjoyment Scale +

Ashkenazi (2013) Pilot Study n = 9; Dx: Probable DCD Sony PlayStation 2 Eye toy: 60 min, 1x/wk x 10 sessions: Also included goal-directed, task-oriented approach M-ABC*, DCD-Q*, Parent’s subjective reports, Walk and talk test, 6-minute walk

test

+

Ashkenazi, T., Weiss, P. L., Orian, D., & Laufer, Y. (2013). Low-cost virtual reality intervention program for children with developmental coordination disorder: A pilot feasibility study. Pediatric Physical Therapy, 25(4), 467-473

Barnhart, B. H., Davenport, M., Epps, S. B., & Nordquist, V. M. (2003). Developmental coordination disorder. Physical Therapy, 83(8), 722-731.

Blank, R., Smits-Engelsman, B., Polatajko, H., & Wilson, P. (2012). European Academy for Childhood Disability (EACD): Recommendations on the definition, diagnosis, and intervention of developmental coordination disorder. Developmental Medicine & Child Neurology, 54(1), 54-

93.

Cosper, S. M., Lee, G. P., Peters, S. B., & Bishop, E. (2009). Interactive metronome training in children with attention deficit and developmental coordination disorders. International Journal of Rehabilitation Research, 32(4), 331-336.

Dunford, C. (2011). Goal-oriented group intervention for children with developmental coordination disorder. Physical & Occupational Therapy in Pediatrics, 31(3), 288-300.

Ferguson, G. D., Jelsma, D., Jelsma, J., & Smits-Engelsman, B. C. (2013). The efficacy of two task-orientated interventions for children with developmental coordination disorder: Neuromotor task training and Nintendo Wii Fit training. Research in Developmental Disabilities, 34(9),

2449-2461.

Fong, S. S, Chung, J. W., Chow, L. P., Ma, A. W., & Tsang, W. W. (2013). Differential effect of taekwondo training on knee muscle strength and reactive and static balance control in children with developmental coordination disorder: A randomized controlled trial. Research in

Developmental Disabilities, 34(5), 1446-1455.

Fong, S. S., Tsang, W. W., & Ng, G. Y. (2012). Taekwondo training improves sensory organization and balance control in children with developmental coordination disorder: A randomized controlled trial. Research in Developmental Disabilities, 33(1), 85-95.

Giagazoglou, P., Sidiropoulou, M., Mitsiou, M., Arabatzi, F., & Kellis, E. (2015). Can balance trampoline training promote motor coordination and balance performance in children with developmental coordination disorder? Research in Developmental Disabilities, 36, 13-19.

Hammond, J., Jones, V., Hill, E. L., Green, D., & Male, I. (2012). An investigation of the impact of regular use of the Wii Fit to improve motor and psychosocial outcomes in children with movement difficulties: A pilot study. Child: Care, Health and Development, 40(2), 165-175.

Hillier, S., McIntyre, A., & Plummer, L. (2010). Aquatic physical therapy for children with developmental coordination disorder: A pilot randomized controlled trial. Physical & Occupational Therapy in Pediatrics, 30(2), 111-124.

Hung, W. W. Y., & Pang, M. Y. C. (2012). Effects of group-based versus individual-based exercise training on motor performance in children with developmental coordination disorder: A randomized controlled pilot study. Journal of Rehabilitation Medicine, 42, 122-128.

Hyland, M. Polatajko, H. J. (2011). Enabling children with developmental coordination disorder to self-regulate through the use of dynamic performance analysis: Evidence from the CO-OP approach. Human Movement Science, 31(2012), 987-998.

Jelsma, D., Geuze, R., Mombarg, R., & Smits-Engelsman, B. (2014). The impact of Wii Fit intervention on dynamic balance control in children with probable developmental coordination disorder and balance problems. Human Movement Science, 33, 404-418.

Kane, K., & Bell, A. (2009). A core stability group program for children with developmental coordination disorder: 3 clinical case reports. Pediatric Physical Therapy, 21(4), 375-382.

Kaufman, L. B., & Schilling, D. L. (2007). Implementation of a strength training program for a 5-year-old child with poor body awareness and developmental coordination disorder. Physical Therapy, 87(4), 455-467.

Leemrijse, C., Meijer, O. G., Vermeer, A., Adér, H. J., & Diemel, S. (2000). The efficacy of Le Bon Départ and sensory integration treatment for children with developmental coordination disorder: A randomized study with six single cases. Clinical Rehabilitation, 14(3), 247-259.

Menz, S. M., Hatten, K., & Grant-Beuttler, M. (2013). Strength training for a child with suspected developmental coordination disorder. Pediatric Physical Therapy, 25(2), 214-223.

Niemeijer A. S., Smits-Engelsman B. C., & Schoemaker M. M. (2006). Are teaching principles associated with improved motor performance in children with developmental coordination disorder? A pilot study. Physical Therapy. 86(9), 1221-1230.

Niemeijer A. S., Smits-Engelsman B. C., & Schoemaker M. M. (2007). Neuromotor task training for children with developmental coordination disorder: A controlled trial. Developmental Medicine & Child Neurology, 49(6), 406-411.

Pless M., Carlsson, M., Sundelin, C., & Persson, K. (2000). Effects of group motor skill intervention on five to six year old children with developmental coordination disorder. Pediatric Physical Therapy, 12(4), 183-189.

Smits-Engelsman, B., Blank, R., Van Der Kaay, A., Mosterd-Van Der Meijs, R., Vlugt-Van Den Brand, E., Polatajko, H., & Wilson, P. (2013). Efficacy of interventions to improve motor performance in children with developmental coordination disorder: A combined systematic review

and meta-analysis. Developmental Medicine & Child Neurology, 55(3), 229-237.

Tsai, C. L. (2009). The effectiveness of exercise intervention on inhibitory control in children with developmental coordination disorder: Using a visuospatial attention paradigm as a model. Research in Developmental Disabilities, 30, 1268-1280.

Watemberg, N., Waiserberg, N., Zuk, L., & Lerman-Sagie, T. (2007). Developmental coordination disorder in children with attention-deficit-hyperactivity disorder and physical therapy intervention. Developmental Medicine & Child Neurology, 49, 920-925.

Wilson, P. H., Thomas, P. R., & Madruff, P. (2002). Motor imagery training ameliorates motor clumsiness in children. Journal of Child Neurology, 17(7), 491-498.

Zwicker, J., Rehal, H., Sodhi, S., Karkling, M., Paul, A., Hilliard, M., & Jarus, T. (2014). Effectiveness of a summer camp intervention for children with developmental coordination disorder. Physical & Occupational Therapy in Pediatrics. Advanced online publication. Retrieved from

http://informahealthcare.com/potp. DOI: 10.3109/01942638.2014.957431.

REFERENCES

ABBREVIATIONSTreatment Approaches: Cognitive Orientation to daily Occupational Performance (CO-OP); Dynamic Performance Analysis (DPA); Le Bon Départ (LBD); Motor Imagery Training (MIT);

Neuromotor Task Training (NTT); Perceptual Motor Training (PMT); Sensory Integration Training (SIT); Taekwondo (TKD). Study Types: Randomized Control Trial (RCT); Randomized Trial

(RT). Diagnoses: Attention Deficit Disorder (ADD); Attention Deficit Hyperactivity Disorder (ADHD); Pervasive Developmental Disorder (PDD). Outcome Measures: Body Coordination Test

for Children (BCTC); Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2; BOTMP); Children’s Assessment of Participation and Enjoyment (CAPE); Canadian Occupational Performance

Measure (COPM); Children’s Self-Perceptions of Adequacy and Predilection for Physical Activity (CSAPPA); Coordination Skills Questionnaire (CSQ); Developmental Coordination Disorder

Questionnaire (DCD-Q); Hand Held Dynamometer (HDD); Movement Assessment Battery for Children (M-ABC); Motor Control Test (MCT); Perceived Efficacy and Goal Setting in Children

with Disabilities (PEGS); Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PSPCSA); Strengths and Difficulties Questionnaire (SDQ); Sensory

Organization Test (SOT); Trampoline Body Coordination Test (TBCT); Test of Gross Motor Development (TGMD-2); Unilateral Stance Test (UST); Visual Analog Scale (VAS)