dmd - 11/17/10
 Developmental
Coordina4on
 Disorder


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Unformatted text preview: 11/17/10
 Developmental
Coordina4on
 Disorder
 What
is
DCD?
 •  Children
who
appear
physically
and
 intellectually
normal,
yet
lack
the
motor
 competence
to
cope
with
the
demands
of
 everyday
living
 •  Poor
motor
coordina4on
 •  Developmental
Dyspraxia
 •  Developmental
Clumsiness
 What
is
DCD?
 •  Problems
in
voluntary
movement
planning
 (praxis)
 1
 11/17/10
 Occurrence
 •  About
5%
to
8%
of
all
children
 •  Occurs
2
to
3
4mes
more
oMen
in
boys
than
in
 girls
 Possible
Causes
of
DCD
 •  Unclear
 –  Con4nuum
of
CP
 –  Prenatal
or
neonatal
insult
 –  Neuronal
damage
at
the
cellular
level
 –  Abnormali4es
in
neurotransmiPer
or
receptor
systems
 –  Parts
of
the
nervous
system
which
play
a
dominate
role
in
motor
 control
 •  Basal
ganglia,
cerebellum,
motor
cortex
 •  Neuropathology
causes
 •  Children’s
difficul4es
with
coordina4on
can
result
from
a
 combina4on
of
one
or
more
impairments
in
 propriocep4on,
motor
programming,
4ming,
or
sequencing
 of
muscle
ac4vity.
 Problems
of
Children
with
DCD
 •  •  •  •  General
delay
in
motor
development
 Gross
Motor
problems
 Fine
Motor
problems
 Psychosocial
issues
 2
 11/17/10
 Gross
Motor
Problems
 •  Hypotonia,
persistence
of
primi4ve
reflexes,
 immature
balance
reac4ons
 •  Demonstrate
an
awkward
running
paPern,
fall
 frequently,
drop
items,
and
have
difficulty
 imita4ng
body
posi4ons
 •  Gross
motor
deficits
lead
to
performing
poorly
 in
spor4ng
events,
possibly
due
to
their
slow
 reac4on
and
movement
4mes
 •  Non‐par4cipa4on

decreased
muscle
force
 Fine
Motor
Problems
 •  Difficulty
with
handwri4ng
or
drawing
 •  Difficulty
planning
and
execu4ng
fine
motor
 skills,
such
as
gripping
and
dressing
 Psychosocial
Problems
 •  Adolescents
with
DCD
 –  Have
fewer
friends
 –  More
feelings
of
low
self‐worth
 –  More
anxiety
 3
 11/17/10
 •  An
individual
with
dcd
 Long
term
outcomes
of
DCD
 •  View
1:
mostly
confined
to
childhood
and
 decreases
with
age
(by
16‐20yrs)
 •  View
2:
Does
not
disappear
as
a
func4on
of
 age;
displaying
poorer
motor
performance
 into
adolescence.
 •  Poor
motor
coordina4on
as
having
effects
on
 children’s
learning
skills
and
interac4ons
with
 others
 Treatment
Goals
 •  Independence
 •  Increasing
self‐esteem
 4
 11/17/10
 Treatment
Approaches
 •  BoPom‐up
approaches
 –  Sensory‐integra4on
training
 –  Process‐oriented
treatment
approach
 –  Perceptual
motor
training
 •  Top‐down
approaches
 –  Cogni4ve/
problem‐solving
training
 –  Task‐specific
interven4on
 Sensory
integra4on
therapy
 •  Sensory
s4mula4on
 •  May
show
some
gains
in
motor
development
 Process‐oriented
treatment
 •  •  •  •  Kinesthe4c
training
ac4vi4es
 Posi4ve
reinforcement
 Desirable
ac4vi4es
 Somewhat
useful
 5
 11/17/10
 Perceptual
motor
training
 •  Wide
range
of
motor
experiences
 •  Ample
opportuni4es
to
prac4ce
motor
skills
 •  Some
motor
improvements
 Task‐specific
interven4on
 •  Direct
teaching
of
a
skill
 •  Motor
tasks
are
broken
down
into
steps,
with
 each
step
taught
independently
and
then
 organized
to
accomplish
an
en4re
task.
 •  Have
demonstrated
gains
in
motor
skills
 Cogni4ve/
problem‐solving
skills
 training
 •  Emphasizes
ac4ve
problem
solving
 •  •  •  •  Goal:
What
am
I
going
to
do?
 Plan:
How
am
I
going
to
accomplish
the
skill?
 Do
it:

Go
ahead
and
perform
the
skill
 Check:

How
well
did
my
plan
work?
 6
 11/17/10
 Motor
Problems
in
Children
with
 Au4sm
Spectrum
Disorders
(ASD)
 Characteris4cs
 •  Atypical
social
development
 •  Impaired
communica4on
skills
 •  Rigid
cogni4ve
and
behavioral
style
 Motor
Impairments
 •  Poor
performance
on
standardized
motor
skill
 assessments.
 •  Poor
balance
control
 •  Clumsiness
 •  Problems
with
motor
planning
 7
 11/17/10
 Neural
Correlates
of
Motor
 Func4oning
 •  Underlying
neurological
abnormali4es
may
 give
rise
to
atypical
motor
performance
 •  Mirror
neurons
and
imita4on
 Impaired
Imita4on
of
Body
 Movements
 •  Imitate
less
 •  Produce
poorer
approxima4ons
of
manual
and
 body
postures
 •  Commit
specific
types
of
errors
more
 frequently
 Levels
of
White
MaPer
 8
 11/17/10
 Perceptual‐Motor
Difficul4es
 •  Impairments
in
the
interac4on
of
visual
and
 propriocep4ve/kinesthe4c
input
in
the
control
 of
ac4ons
 •  “Visually”
driven
 •  Stereotypical
motor
behaviors
 •  Manipula4ng
objects
to
afford
close
visual
 scru4ny
 Sensory‐Integra4on
Therapy
 •  Rela4on
between
sensory
experiences
and
 motor
and
behavior
performance
 •  Use
of
planned
and
controlled
sensory
 experiences:
 –  Ves4bular
 –  Propriocep4ve
 –  Somatosensory
ac4vi4es
 •  Emphasis
on
the
produc4on
of
func4onal
and
 adap4ve
responses
to
sensory
s4muli
 Sensory‐Integra4on
Therapy
 •  Sensory‐Integra4on
Therapy
 9
 ...
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