Transcript 4 DCD - Learning

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
• 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 they
fly under the radar until more complex motor activities
are required e.g. playground activities and sport
What is the impact of a minimal motor deficit?
Difficulty in
learning to
move
Deprived
movement
environment
Lack of
success
Motor control
deficit
Withdrawal from
demanding situations
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 parents
As 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 lines
Poor 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 123138
• Du Randt, R. 2008. Physiotherapy for Developmental
Coordination (lecture notes, unpublished)