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D e v e lo p m e n t aD e v e lo p m e n t al C o o r d in a t io n l C o o r d in a t io n

D is o r d e r D is o r d e r ( D C D )( D C D )Clinical Science IIIClinical Science III

Karen R. Voogt, DPTKaren R. Voogt, DPTFall 2011Fall 2011

D C DD C D Children also described as “low tone”, Children also described as “low tone”,

“mild motor” problems“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

D C D D e f in i t io n f r o m D C D D e f in i t io n f r o m D S M IVD S M IV

““Chronic and usually permanent condition Chronic and usually permanent condition characterized by impairment of motor characterized by impairment of motor performance that is sufficient to produce performance that is sufficient to produce functional motor performance deficits that functional motor performance deficits that are not explicable by the child's age or are not explicable by the child's age or intellect, or by other diagnosable intellect, or by other diagnosable neurological or spatial-temporal neurological or spatial-temporal organizational problems.”organizational problems.”

D C D O t h e r C r i t e r iaD C D O t h e r C r i t e r ia

Motor development must differ from Motor development must differ from their development in other areas and their development in other areas and the motor problems must have an the motor problems must have an impact on academics and/or daily life impact on academics and/or daily life activities.activities.

D C DD C D

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 be Motor difficulties continue to be present into adolescence and present into adolescence and adulthoodadulthood

D C D a n d O t h e r C o -D C D a n d O t h e r C o -M o r b id i t ie sM o r b id i t ie s

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

D C D D C D P a t h o p h y s io lo g yP a t h o p h y s io lo g y

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 lesionsPossible frontal and parietal lobe area lesions

R e la t io n s h ip s R e la t io n s h ip s A m o n g B o d y A m o n g B o d y

S t r u c t u r e s a n d S t r u c t u r e s a n d F u n c t io n , A c t iv i t y , F u n c t io n , A c t iv i t y , a n d P a r t ic ip a t io n a n d P a r t ic ip a t io n

f o r a C h i ld w it h f o r a C h i ld w it h D C DD C D

See HandoutSee Handout

D C D D C D P a t h o p h y s io lo g yP a t h o p h y s io lo g y

Associated with prematurity, low Associated with prematurity, low birth weightbirth weight

Prenatal, perinatal or neonatal Prenatal, perinatal or neonatal risk factorsrisk factors

Im p a ir m e n t s Im p a ir m e n t s o f B o d y o f B o d y

F u n c t io n s F u n c t io n s Id e n t i f ie d in Id e n t i f ie d in

C h i ld r e n w it h C h i ld r e n w it h D C DD C DSee HandoutSee Handout

D ia g n o s is o f D C DD ia g n o s is o f D C D

Usually not made until later in school age when child Usually not made until later in school age when child learns and performs skills that require adaptation in learns and performs skills that require adaptation in speed, timing, force or distance of the movementspeed, timing, force or distance of the 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

D C D S e c o n d a r y D C D S e c o n d a r y Im p a ir m e n t s /S e q u e la eIm p a ir m e n t s /S e q u e la e 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 the Decreased physical fitness across the

lifespan lifespan Sedentary lifestyle health risksSedentary lifestyle health risks

D C D R o le o f D C D R o le o f F e e d b a c kF e e d b a c k

Studies demonstrate children with DCD do not Studies demonstrate children with DCD do not interpret and utilize sensory feedback or interpret and utilize sensory feedback or feedback from task performance in the same feedback from task performance in the same manner as other children manner as other children

NO internal representation of the motor action NO internal representation of the motor action (efferent copy)(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”

D C D “ F ix in g ” D C D “ F ix in g ” S t r a t e g yS t r a t e g y

Freezing or fixing of joints during task Freezing or fixing of joints during task performanceperformance

Deliberate stabilization of joints Deliberate stabilization of joints Movements are stiff, awkward, Movements are stiff, awkward,

clumsy in appearanceclumsy in appearance

““ F ix in g ”F ix in g ”

Stabilize so another part can be moved Stabilize so another part can be moved with better controlwith 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

Tr e a t m e n t Tr e a t m e n t In t e r v e n t io nIn t e r v e n t io n

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 inactivityPrevent long term effects of inactivity Address physical impairments (low Address physical impairments (low

tone)tone)

Tr e a t m e n t Tr e a t m e n t In t e r v e n t io n sIn t e r v e n t io n s

Children with DCD have difficulty with activities Children with DCD have difficulty with activities that require: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

Tr e a t m e n t Tr e a t m e n t In t e r v e n t io nIn t e r v e n t io n

Children with DCD may be successful Children with DCD may be successful with:with: Sequence of movements that are repetitiveSequence of movements that are repetitive Swimming, skating, skiing, bicyclingSwimming, skating, skiing, bicycling Lifestyle sportsLifestyle sports

In t e r v e n t io n In t e r v e n t io n