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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