Improving the motor coordination of children with Developmental Coordination Disorder

using Soft Play Equipment

Lois AddySenior Lecturer

Terminology• Clumsy child syndrome• Dyspraxia• Sensory integrative dysfunction• Minimal brain dysfunction• Perceptual-motor disorder• Motor learning difficulties• Congenital maladroit• Developmental apraxia• Minimal cerebral palsy• Executive apraxia• Deficit of attention, motor and perception (DAMP)

Gillberg (1996) • Developmental Coordination Disorder (DCD)

Definition of DCD

‘Performance in daily living activities that require motor coordination is substantially below that expected, given the person’s chronological

age and measured intelligence.’

DSM-IV (2000)

Revised criterion A

Observed poor performance in (culturally exposed) fundamental motor skills evident in a variety of environments– Walking Reaching & grasping– Running Object manipulation– Hopping Object propulsion– Skipping Object reception– Climbing

APA wish to include specific skills which are universally

affected:

Catching

Throwing

Kicking

Running

Jumping

Hopping

Cutting

Colouring

Printing

Writing.Handwriting

APA diagnostic criteria (2000)Criterion BThe disturbance in criterion A significantly interferes with academic achievements or activities for daily living.

The disturbance in criterion A significantly interferes with educational progress and/or activities of daily living

NB: leads to reduced participation in– Self-care activities– School/class/desk/work related activities – Play & leisure activities

APA diagnostic criteria (2000)

Criterion C

The disturbance is not due to a general medical condition (i.e. cerebral palsy, hemiplegia or muscular dystrophy) and does not meet criteria for pervasive development disorder.

Suggest: ‘the disturbance is not due to a general neurological condition’.

Symptoms

I move with all the grace of a pregnant penguin let loose in

an opium factory. I have difficulty running (my arms

tend to flap about, and I invariably end up tripping over

my own ski-sized feet)

The so-called ‘pure’ DCD with only motor difficulties is the exception rather than the

rule. Ref: Peters & Henderson (2008).

2 ways of helping children with motor

coordination problems

Teaches a specific skill without emphasising the underlying processes.

The skill is sub-divided, instructed, and rehearsed until it has been mastered.

Top-downThe physical task-centred

approach

2. Bottom-up

Process-orientated approach

Identifies the underlying processes involved in acquiring a specific skill; and then focuses on developing these skills to provide the foundation from which other skills are built.

The process-orientated approach is based on the premise that age-appropriate reflexes, postural reactions, and perceptuo-motor abilities all underlie functional motor skills and conceptual development (Pless and Carlsson, 2000).

Sensory Integration System

Sensory Integration

System

Fidget toys

Children with clinically identified Sensory Modulation Disorders respond

physiologically differently to sensory stimuli (including tactile stimuli) than

typically developing children; these differences have ramifications for

functional behaviour.

McIntosh et al (1999)Rotz R, Wright SD (2005)

Poor Figure-Ground Discrimination: Distractibility The child has difficulty blocking out unnecessary input from the environment.

• Auditorily Distractible Means paying attention to all sounds, not just appropriate ones, e.g., voices in halls, ringing of telephone.

• Visually Distractible Means paying attention to all things seen rather than the appropriate items, e.g., clouds, rug, pictures.

Spatial Relationships

The ability to perceive the position of two or more objects in relation to self and in relation to each other.

Remediation

environment

task

person

Provide the input that the body is craving for

Provide tasks which extend the child’s motor control through carefully graded activities Provide an

environment which can provide sensory integration

EvidenceBundy, A. C., Shia, S., Long Qi, L., & Miller, L.J. (2007). How does sensoryprocessing affect play? American Journal of Occupational Therapy. 61, 201-208.

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

Miller, L.J., Schoen, S.A., James, K. & Schaaf, R.C. (2007). Lessons learned: Apilot study of occupational therapy effectiveness for children withsensory modulation disorder. American Journal of OccupationalTherapy, 61, 161-169.

Parham, L. D., Cohn, E. S., Spitzer, S., Koomar, J. A., Miller, L. J., Burke, J. P., et al. (2007). Fidelity in sensory integration intervention research. American Journal of Occupational Therapy, 61, 216–227.

PilotSample Group: 3 children with

coordination difficultiesInclusion criteria: 6-10 years old, not

currently receiving occupational therapy or physiotherapy

Ethical approval obtainedPre and post assessment using the

Movement Assessment Battery for Children – Second Edition (MABC-2)

Permission from parents and children

MABC-2 Range

Child’s Score Total Test Score Percentile Range Description

Red Zone Up to and including 56

At or below the 5th percentile

Denotes a significant movement difficulty

Amber Zone Between 57 and 67 Inclusive

Between the 5th and 15th percentile

Suggests the child is ‘at risk’ of having a movement difficulty; monitoring required

Green Zone Any score above 67

Above the 15th percentile

No movement difficulty detected

Interpretation

Traffic Light system for test total

8 week intervention programme:Activities introduced (a few!)

• Circuit Crawling • Pushing and pulling activities• Crab football• Crab walking races• Wheelbarrows• Hand-eye coordination• Strength and endurance i.e. rope climbing,

spinning, swinging, monkeys• Squashing and rolling activities

Focus: Static and dynamic resistance activities

• Run around circuit as fast as possible x2.• On hands and knees (starting at dining tables) crawl around

circuit, the winner is the person who comes last.• Push adult around course (adult providing some resistance).• Commando crawl around course• Wheelbarrow backward and forward along toddler flat mat.• Time circuit, try to beat previous time.• Go round circuit backwards• Hide and Seek• Crab penalty goals• Intersperse with fine motor activities (workbook)

Components Component Score

Standard Score

Percentile

Manual Dexterity 18 5 5Aiming and Catching 11 5 5Balance 22 6 9Total Test Score 51 5 5

Components Component Score

Standard Score

Percentile

Manual Dexterity 21 6 9Aiming and Catching 21 11 63Balance 22 6 9Total Test Score 64 7 16

Child 1:Age: 8.5Primary area of concern: Aiming and Catching, and Manual Dexterity

Components Component Score

Standard Score

Percentile

Manual Dexterity 29 10 50Aiming and Catching 11 5 5Balance 17 5 5Total Test Score 57 6 9

Components Component Score

Standard Score

Percentile

Manual Dexterity 25 8 25Aiming and Catching 13 6 9Balance 25 8 25Total Test Score 63 7 16

Child 2: Age: 6.10Primary area of concern: Aiming and Catching, and Balance

Components Component Score

Standard Score

Percentile

Manual Dexterity 21 6 9Aiming and Catching 22 12 75Balance 17 5 5Total Test Score 60 6 9

Components Component Score

Standard Score

Percentile

Manual Dexterity 13 4 2Aiming and Catching 23 12 75Balance 27 8 25Total Test Score 63 7 16

Child 3 Age: 6.4 years Primary area of control: Balance (Core Stability)

Directed activities, utilising the soft play environment, can improve the motor skills of children with DCD

However…only a small number of children were involved in this pilot project.

Conclusion

Children did not feel stigmatised by the environment

Parents were comfortable with the setting Parking was easier than at a hospital/school Parents obtained ideas of what to do to

enhance their child’s development using play-based activities

Parents and children supported each other. Parents returned to the soft play centre to

practice skills

Positive Feedback

Parents and children always used restaurant facilities.

Other children joined in activities, spontaneously, and parents asked if they could be part of the project.

The play environment was perceived as being more than a play centre, it was seen as having therapeutic value by those involved in the project and others who observed the activities.

Overt link between development and play

Commercial Benefits

Consider providing a dedicated time for children with motor difficulties to access the play environment.

Disseminate project findings to occupational therapists and physiotherapists across the UK to encourage similar, and/or larger scale projects.

Create list of activity ideas for other parents/carers to use.

Future Recommendations

Consider the inclusion of selected activities which will encourage key skills. For example:

Improve hand-eye coordination through fixed table top games i.e. magnetic mazes, electronic tracking games.

Improved ball skills ie Mookie Reflex Swingball soccer, wind tunnel ball balancers

THANK YOU TO JANICE DUNPHY, DIRECTOR OF CREEPY CRAWLIES, YORK AND ALL HER FANTASTIC STAFF FOR

MAKING THIS PROJECT POSSIBLE

FOR FURTHER INFO. CONTACT: LOISMA@TALKTALK.NET