Developmental Coordination Disorder (DCD)

Robyn SmithDepartment of Physiotherapy

University Free State2012

Developmental Coordination Disorder (DCD)

The many names for DCD• Known 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

move

Lack of success

Deprived movement

environment

Withdrawal from demanding situations

What is the impact of a minimal motor deficit?

Introduction to DCD• These 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!!!

How common in DCD?

• The incidence is believed to be approximately 10% of school going children.

Signs and symptoms of DCD

• Performance 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.

Causes of DCD• Neonatal causes:

– Neonatal asphyxia– low 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

Typical complains lodged by parentsAs a baby

– Delayed achievement of motor milestones, – feeding problems, and– delayed acquisition of language

At home

– Child struggles with ADL activities including dressing, tying shoe laces, using cutlery and bathing

– Often 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 class– Poor posture at desk, often writes lying on arm– Untidy, write with very light /very hard pressure

with a pencil– Draw and colour in poorly for their age– General perception problems (usually referred to

OT)

Typical complains lodged by parents and teachers:

Outdoor activities

– Performs poorly at gross motor activities, clumsy, tend to bump into objects, trip and fall frequently

– Battle with actives requiring balance and coordination e.g. jumping, skipping, running, climbing, swinging

– Avoids the jungle gym activities on playground– Does not want to ride a bike, or participate in sport or any ball

activities

Typical complains lodged by parents and teachers

Social behaviour

– Insecure, shy and withdrawn – Generally poor socialisation skills (often seem not

to have friends)

>

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 intervention

1. 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)

Typical problems that would require physiotherapy intervention

3. 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 intervention

4. 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 intervention

7. 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 intervention

9. 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 intervention • As 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 DCD

• Address the following aspects during your treatment:

• Developmental delay through appropriate stimulation and facilitation

• Low muscle tone• Poor central control due to underlying low tone and muscle

weakness (activities requiring rotation NB)• Posture correction• Joint 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 DCD

• Balance activities• Co-ordination and ball activities • Spatial and directional awareness including

activities with direction changes• Bilateral integration e.g. jumping with two feet

catching both hands• Activities requiring them to cross the midline• Obstacle course

References• Sheperd, 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)