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Developmental Coordination Disorder (DCD). Robyn Smith Department of Physiotherapy University Free State 2012. Developmental Coordination Disorder (DCD). The many names for DCD. Known as the child with minimal motor problems - PowerPoint PPT Presentation

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Attention Deficit Hyperactivity Disorder (ADHD) & Developmental Coordination disorder (DCD)

Developmental Coordination Disorder (DCD)Robyn SmithDepartment of PhysiotherapyUniversity Free State2012

6/12/2012 2:30 PM 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

1Developmental Coordination Disorder (DCD)The many names for DCDKnown as the child with minimal motor problems

DCD has been labeled in many ways terms often used interchangeably probably the clumsy child is the term most frequently used to describe this group of children.

Minimal Brain Dysfunction (MBD)

Also know as developmental dysplasia, minimal brain dysfunction, developmental dyspraxia.

What characterises children with DCD?This is a group of children with minor motor problems who are:

often missed or incorrectly diagnosed as having ADHD.

Because the minor extent of the motor problem theyfly under the radar until more complex motor activitiesare required e.g. playground activities and sport

Motor control deficit Difficulty in learning to moveLack of success Deprived movement environmentWithdrawal from demanding situationsWhat is the impact of a minimal motor deficit?Introduction to DCDThese children often develop a poor self image as a result of their underperformance compared to their peers.

minor motor problems have major effects on activities of daily living!!!

6How common in DCD?The incidence is believed to be approximately 10% of school going children.

Signs and symptoms of DCDPerformance of daily activities that require motor co-ordination is significantly below that expected level for chronological age and intelligence that interferes with academic achievements and ADL activities,

it is not associated with any medical, neurological or muscular illness,

it is not necessarily associated with ADHD,

When associated with mental retardation the motor difficulties are more severe.

8Causes of DCDNeonatal causes:Neonatal asphyxialow birth weight prematurity and sepsis

Genetic factors (25-40 %)

Poor childhood nutrition

Prolonged hospitalisation

Psycho-social, cultural and socio economic factors are also ?? as possible causes of DCD

9Typical complains lodged by parentsAs a baby

Delayed achievement of motor milestones, feeding problems, anddelayed acquisition of language

At home

Child struggles with ADL activities including dressing, tying shoe laces, using cutlery and bathingOften accidentally wet their bed

Typical complains lodged by parents and teachers

At school NB!!! often the most complaints arise in area of scholastic or classroom performance

Work very slowly in classPoor posture at desk, often writes lying on armUntidy, write with very light /very hard pressure with a pencilDraw and colour in poorly for their ageGeneral perception problems (usually referred to OT)11Typical complains lodged by parents and teachers:Outdoor activities

Performs poorly at gross motor activities, clumsy, tend to bump into objects, trip and fall frequentlyBattle with actives requiring balance and coordination e.g. jumping, skipping, running, climbing, swingingAvoids the jungle gym activities on playgroundDoes not want to ride a bike, or participate in sport or any ball activities

Typical complains lodged by parents and teachersSocial behaviour

Insecure, shy and withdrawn Generally poor socialisation skills (often seem not to have friends)

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What do most parents or teachers do with a child with balance and coordination problems?They send to Monkeynastix !!!!What do most parents or teachers do with a child with balance and coordination problems?Children with DCD are often referred to activities such as Monkeynastix to address their gross motor skills and co-ordination.

However these activities focus on splinter skills e.g. teaching the child to jump through hoop.

This however does not address the underlying problems or causes.value of physiotherapy cannot be replaced.

What is the role of Physiotherapy in these children ??Typical problems that would require physiotherapy intervention1. Delayed acquisition of motor milestones (developmental delay)

2. Abnormalities in muscle tone and joint and soft tissue mobility.

Generally have low tone around the shoulder and pelvic girdle and trunk. Stiffness and shortening of certain muscles may occur as a result of fixing patterns used for stability e.g. mm. pectoralis, hamstrings, iliopsoas and gastrognemius and soleus. The spine is usually stiff and immobile with a flattened/increased lumbar lordosis, thoracic kyphosis and hyper-extension of the neck (poking chin)

17Typical problems that would require physiotherapy intervention3. Poor central control due to underlying low tone and muscle weakness

Poor rotation, tend to move in straight linesPoor posture e.g. slumped posture, lying arms during class

Typical problems that would require physiotherapy intervention4. Poor weight bearing on, and weight transfer over the arms and legs e.g. closed chain positions and activities 5. Poor balance e.g. cannot walk on straight line, or stand one foot

6. Poor eye-hand and eye foot co-ordination during ball activities Typical problems that would require physiotherapy intervention7. Poor spatial and directional awareness e.g. child battles to move in different directions e.g. forward, backwards and to sides. Battle to stay within the lines when writing or colouring in

8. Poor symmetrical /bilateral integration e.g. battle to jump forwards, sides and backwards with both feet, battle to stick objects with both hands on a wall simultaneously, battle to do scissor jumps and star jumps, battle to catch and throwing a ball with both hands

Typical problems that would require physiotherapy intervention9. Children often battle with activities requiring them to cross the midline, do not want to reach across the midline.

10. Sensory integration problems e.g. hypo- or hypersensitive

Physiotherapy interventionAs physiotherapist our extensive knowledge of normal development, normal movement patterns and components of movements are imperative in us being able to identify and address the child underlying problems

Need address the cause and not the symptom!!!!

Children are often only referred to physiotherapy from the age of 3-4 years, often only at school going age

Not all children require physiotherapy, often structured exercise and sport will be enough to address the coordination issues

Treatment of the motor problems in a child with DCDAddress the following aspects during your treatment:

Developmental delay through appropriate stimulation and facilitation Low muscle tonePoor central control due to underlying low tone and muscle weakness (activities requiring rotation NB)Posture correctionJoint and soft tissue immobility and tightness Poor weight bearing on, and weight transfer over the arms and legs in closed chain positions and activities

Treatment of the motor problems in a child with DCDBalance activitiesCo-ordination and ball activities Spatial and directional awareness including activities with direction changesBilateral integration e.g. jumping with two feet catching both handsActivities requiring them to cross the midlineObstacle course ReferencesSheperd, RB. 2002. Minimal brain dysfunction: learning disability attention deficit disorder, clumsiness in Physiotherapy in paediatrics. 3rd ed. pp154-164

Peters, JM & Markee, A. 2007. Developmental Coordination disorder in Physiotherapy for children. Poutney, T (ed). Pp 123-138

Du Randt, R. 2008. Physiotherapy for Developmental Coordination (lecture notes, unpublished)

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