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MOTOR  IMPAIRMENTS , ACTIVITY LIMITATIONS  AND PARTIC IPATION RES TR ICTIONS  AFFECTING CHILDREN WITH DEVELOPMENTAL COORDINATION DIS ORDER: A S YS TEMATIC  REVIEW JULY 23 2009 Paul Conzatti, Lawren De Marchi, Aylee Fox, Jordan Monks & Jonathan Yiu S upervisor: Jill Zwicker Presentation Outline 1. Introduction 2. Methods 3. Results 4. Discussion 5. Limitations 6. Conclusion and Implications 7. Acknowledgements Introduction Developmental Coordination Disorder  Definition: M A motor skill disorder characterized by a marked impairment in the development of motor coordination abilities that significantly interferes with performance of daily activities and/or academic achievement1  DS M-IV Diagnostic Criteria1: 1. Marked impairment in development of motor coordination 2. Interference with academic achievement or activities of daily living 3. Coordination difficulties not due to a general medical condition or a pervasive developmental disorder 4. If mental retardation is present, motor difficulties in excess of those expected Developmental Coordination Disorder  Pathophysiology: M Unclear M No hard neurological signs are present2 i Deficit may lie within the cerebellum3  S igns and S ymptoms: m Work at a slower pace, trading speed for accuracy4  Deficient at processing kinesthetic information but not visual information  Rely more on visual cues as opposed to proprioception5 u Difficulty maintaining postural stability6 a Deficits contribute to repeated failures, which can cause avoidance of physical activities and socializing with peers 7 International C lassification of Functioning, Disability and Health (ICF)8  Framework for the description of health and health-related states 8  S tructures the assessment of children with complex conditions  Holistic approach to the individual9  Health and health-related characteristics are described from the perspective of8,9: 1. Body Functions and S tructures  Physiological and psychological functions of body systems 1. Activities  Whole body activities or tasks 1. Participation  Involvement in a life s ituation International C lassification of Functioning, Disability and Health (ICF)8 WHO, 2007 Literature Review and Rationale  Prevalence: M 6-13%  of school aged children display characteristics consistent with DCD children10  Physiotherapy intervention: t Motor impairment changes can occur7  Focus on impairments at BFS  level e A more significant role can be played at the activity and participation levels 7 Are the foci of physiotherapy interventions a reflection of current literature? No systematic review exists with the purpose of summarizing available literature regarding the presentation of DCD using a structured framework such as the ICF Question  What motor impairments, activity limitations and participation restrictions are common in children with Developmental Coordination Disorder? Purpose 1. S ummarize the existing literature to produce a comprehensive list of characteristics of children with DCD 2. Classify the motor impairments, activity limitations and participation restrictions affecting children with DCD according to the ICF framework 3. Highlight gaps in the research regarding the presentation of children with DCD in order to direct future investigations Methods S earch S trategy  Comprehensive literature searches: t MEDLINE, EMBAS E, C INAHL, PEDro, PsychINFO, OTseeker and ER IC  Examples of Primary MeS H term: a “developmental coordination disorder” o “motor skills  disorder” o “motor performance” e “motor dysfunction” n “developmental disorder”  Examples of S econdary terms relating to the ICF: n “body functions and structures” n “activity” n “participation” S tudy S election: Inclusion  S tudy types: M S ystematic reviews w Randomized control trials o Clinical controlled trials l Cohort comparisons n Case studies n Pilot studies  Intervention and Descriptive studies:  If baseline outcome measures could be classified as a characteristic of children with DCD S tudy S election: Inclusion  English language  Published post 1994 9 Year which the nomenclature of DCD was standardized 11  S ubjects: M Both male and female m Aged 2-18 m DS M-IV diagnosed for DCD S tudy S election: Exclusion  S tudy types: M Books M Narrative reviews s Theses s Dissertations s Letters to the editor d Commentaries  S ubjects: M Participants with other significant neurological disorders, medical disorders or intellectual disabilities  Exception of those diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) or Learning Disability (LD) in conjunction with DCD Potentially relevant citations retrieved from electronic literature search (n = 4250) Abstracts  put forward to review (n = 1002) Full-text articles  put forward to review (n = 278) S tudies  included in sys tematic review (n = 27) Citations  excluded based on inclus ion and exclus ion criteria (n = 3248) Abstracts  excluded based on inclus ion and exclus ion criteria (n = 633) Additional abstracts  were excluded because publication dates  prior to the year 1994, the official year that DCD was  defined by the DS M IV (n = 101) S tudies  excluded after full-text review (n = 199) Additional s tudies  were excluded as  the participants  were not DCD diagnosed us ing the DS M IV criteria (n = 52)   Figure 1.  Flow Chart Results S tudy S tudy Quality ( /6) S tudy Des ign Age Range or Mean (S D)    S ample S ize  DCD (N) Control (N) Outcome Measure BODY FUNCTIONS  & S TRUCTURES Cherng et al. (2007) 2 Cohort comparison DCD: 5.5 (0.9)y Control: 5.4 (0.9)y 20 20 COP sway area de Castelnau et al. (2007) 2 Cohort comparison 8-13y 24 60 Continuous Performance Test & S ynchronization – S yncopation Test ACTIVITIES  & PARTICIPATION Astill (2007) 2 Cohort comparison 8.6 (1.0)y 5 (7- 8y) 5 (9- 10y) 5 (7- 8y) 5 (9- 10y) Ball catching scale Cantin et al. (2007) 2 Cohort comparison DCD: 9.1 (1.2)y Control: 10.0 (1.3)y 9 11 PAT Table 1. Example of Description of S tudies Results  27 included studies i 19 at the Body Functions and S tructures (BFS ) level n 9 at the Activity and Participation levels  Amalgamated due to high degree of overlap t 1 study was classified under both Body Functions and S tructures and Activity and Participation Results  3 Qualitative studies u Related to the Activities and Participation level c Unable to be subcategorized based on the ICF criteria c Not included in the Results (Table 2)  Reviewed in Discussion Results  ICF subcategories  S ome studies fall within 2 subcategories  Body Functions and S tructures level:  12 at Neuromusculoskeletal and Movement related Functions  6 at S ensory Functions and Pain  8 at Mental Functions  1 at Functions of the Heart and Respiration Results  Activity and Participation level:  4 at Functions of Mobility  3 at Functions of S elf Care  2 at Community S ocial and C ivic Life  1 at Learning and Applying Knowledge  1 at General Tasks and Demands Representation of Included Studies Based on ICF Classification 0 2 4 6 8 10 12 14 Se ns or y F un cti on s a nd  Pa in Me nta l F un cti on s Fu nc tio ns  of  th e H ea rt a nd  R es pir ati on Ne uro mu sc ulo sk ele tal  an d M ov em en t R ela ted  Fu nc t... Mo bil ity Co mm un ity  So cia l a nd  C ivi c L ife  Le ar nin g a nd  A pp lyi ng  K no wl ed ge  Se lf C ar e Ge ne ral  Ta sk s a nd  D em an ds Qu ali tat ive  S tud ies N um be r o f S tu di es        Body Functions and S tructures        Activities and Participation        Qualitative S tudies Figure 2. Included Studies Based on ICF Classification S tudy ICF Class ification Sample S ize DCD (N)  Control (N) Measure Variable DCD Outcomes Mean (S D) Control Outcomes Mean (SD) BODY FUNCTIONS  & STRUCTURES Cherng et al. (2007) S ensory functions and pain Hearing and vestibular functions S eeing and related functions 20 20 Centre of Pressure S way Area 1. Eyes open, fixed foot support (mm) 2. Eyes closed, fixed foot support (mm) 3. Unreliable vision, fixed foot support (mm) 4. Eyes open, compliant foot support (mm) 5. Eyes closed, compliant foot support (mm) 6. Unreliable vision, compliant foot support (mm) 1. 668.95 (383.15)** 2. 1051.07 (1001.09)** 3. 755.15 (462.57)** 4. 2136.29 (1881.96)** 5. 3786.88 (3705.17)** 6. 2616.69 (1413.57)** 1. 381.84 (234.11)** 2. 437.85 (180.65)** 3. 431.15 (158.95)** 4. 781.04 (520.84)** 5. 1414.92 (790.61)** 6. 1413.89 (1056.98)** ACTIVITIES  & PARTICIPATION Cantin et al. (2007) Mobility   Carrying, moving and handling objects 9 11 Prism Adaptation Test 1. Baseline throwing accuracy (cm) 2. Performance coefficient (PC) (cm): 3. After- adaptation affect (yes or no) 4. Adaptation prism phase (throws) 5. Adaptation after prism phase (throws) 1. 30.0 (8.2)* 2. 17.8 (6.7)** 3. 7 yes, 2 no 4. 10.4 (8.9) 5. 10.3 (8.2) 1. 15.7 (5.1)* 2. 8.2 (2.5)** 3. 11 yes 4. 9.8 (5.2) 5. 8.0 (4.1) Table 2. Example of Study Outcomes Discussion Discussion  What motor impairments, activity limitations and participation restrictions are common in children with Developmental Coordination Disorder? • Neuromusculosketetal and Movement Related Functions • Mental Functions • S ensory Functions and Pain • Functions of the cardiovascular, haematological, immunological and respiratory systems Body Functions and S tructures BFS : Neuromusculosketelal and Movements Related Functions  Ball catching tasks 12,13 s 2 studies  Video analysis of ball catching strategy  Positions of the fingers and wrist  Trajectory of the ball and velocity  Acceleration values of limbs during catch u Results:  Different and unstable catching profile compared to controls13  S lower moment of completion, smaller max hand aperture, slower max closing velocity12 c Analysis:  Children with DCD have multiple deficits that contribute to problems with purposeful motor tasks BFS : Neuromusculosketelal and Movements Related Functions  Movement Duration during Motor Tasks n 3 studies 14-16  Measured time to complete pointing tasks  Results:  2 out of 3 studies showed significantly slower movement duration in DCD children compared to controls  All 3 showed significantly slower imagined movement times (discussed in mental functions) n Analysis:  S uggests that children with DCD have slower movement duration  Involuntary Movement Functions 3,17 m 2 studies  Timing and amplitude of postural activity using a force plate  EMG activity of postural muscles p Results:  S ignificant slower onset of postural muscles17  Prolonged onset of postural activity with varied weight lifting3 o Analysis:  Confirmed deficits in involuntary movement functions (postural control) BFS : Neuromusculosketelal and Movements Related Functions BFS : Neuromusculosketelal and Movements Related Functions  Coordination Task18 k 1 study  Clapping and marching task to a metronome beat: timing deviation between limbs n Results:  S ignificant difference in variability of relative phasing between DCD and controls e Analysis:  Children with DCD have difficulties with both the coordination and control of the perception-action coupling of this task BFS : Neuromusculosketelal and Movements Related Functions  S tandardized Assessment Tools 19,20 e 2 studies  Measures of motor performance  Neurodevelopmental Physiotherapy Assessment (NDPA)  Movement Assessment Battery for Children (MABC) e Results:  Children with DCD scored significantly poorer than control children in both measures  Deficits listed in the analysis were found in 95%  of subjects i Analysis:  DCD children displayed deficits in gross and fine motor skills, proprioception, stability, balance, postural control, tactile sense and motor planning 20 BFS : Mental Functions  Perceived Competence e 3 studies 19-21  Perceived Motor Competence S cale  Pictorial S cale of Perceived Competence and S ocial Acceptance o Results:  2 of 3 studies found no significant deficits in self perceived competence  in DCD children  1 study did not compare data to controls, therefore conclusions unable to be drawn w Analysis:  Although children with DCD have deficits in several areas of function including motor skills, they may not have an accurate self-perception of these deficits BFS : Mental Functions  Imagined Movements and S equences 14-16 t 3 studies  Timing of imagined movements during pointing tasks e Results:  Magnitude of slowing between real and imagined movements was not proportional  DCD children did not demonstrate variance with imagined movement amongst varying target width compared to controls who did show variance t Analysis:  DCD children have an inability to generate internal representations of volitional movements BFS : Mental Functions  Attentional Tasks 22,23 s 2 studies  COVAT (Covert orienting of visuo-spatial attention task): Measured reaction time  Continuous Performance Test: Measured %  of correct responses r Results:  Although 1 study found significantly s lower reaction times in DCD children compared to controls, the other study did not find a significant difference e Analysis:  Inconclusive evidence that children with DCD have deficits in attentional tasks BFS : S ensory Functions and Pain  Postural Control and Balance3,24-28  6 studies  Center of pressure sway area  Postural S way O Results:  All studies found deficits in postural stability  3 studies found increased deficits under conditions where vestibular input was relied upon  Analysis:  Children with DCD have problems with postural adaptations to different movements and sensory conditions BFS : Functions of the Cardiovascular, Haematological, Immunological and Respiratory systems  Ventilatory Function19 t 1 study  Forced Vital Capacity (FVC) a Results:  Found DCD children to have a mean FVC at the lower end of normal range for their age and height f Analysis:  No clear conclusions can be made about the cardiovascular fitness of DCD children from this s ingle study • Mobility • Community S ocial and C ivic Life • S elf Care • Learning and Applying Knowledge • General Tasks and Demands Activity and Participation Activity and Participation: Mobility  Ball Handling S kills 29,30 i 2 studies  Catching and throwing o Results:  Decreased completed catches, catching accuracy and score on catching scale in children with DCD e Analysis:  DCD children had significant impairments in ball handling skills  compared to controls  Correlates with the BFS  findings  Children with DCD have motor impairments that result in difficulties with activities such as ball catching and throwing Activity and Participation: Mobility  Perceived E fficacy and Goal S etting31,32 c 2 studies  PEGS  (Perceived E fficacy and Goal S etting)  Perceived efficacy in different activities related to mobility31  COPM (Canadian Occupational Performance Measure)  Identification of client-centered goals 32 Activity and Participation: Mobility t Results:  Areas of concern identified by both children and parents/teachers  Pencil skills  Gross motor function/sports  Academic/school activities  Identified goals related to:  Mobility (carrying, moving and handling of objects)  Printing, Lego™ , cutting, colouring  Analysis:  S cores were not compared with controls, however, these scores can be used to identify areas needing improvement and future goals Activity and Participation: Community S ocial and C ivic Life  Perceived S elf E fficacy31,32 f 2 studies  PEGS  Perceived efficacy in different activities related to recreation and leisure  COPM  Identification of client-centered goals f Results:  Goals included leisure activities:  S occer, biking, basketball b Analysis:  S cores were not compared with controls, however, these scores can be used to identify areas needing improvement and future goals Activity and Participation: S elf Care  3 studies 20,31,32  PEGS : Multiple activities related to self care  COPM: Identification of client centered goals  PEDI (Pediatric Evaluation of Disability Inventory): Participation in Activities of Daily Living  Results:  Children with DCD showed significantly lower mean functional self- care skills than the normative mean20  Fine manipulation skills  Organizing and sequencing of functional tasks such as dressing, grooming and bathing  Analysis: M Motor deficits at the BFS  level affect activities of self care Activity and Participation: Learning and Applying Knowledge  Copying Task33 M 1 study  ActiveCube S ystem  S imilarity (copying) task i Results:  Child with DCD had significant difficulty with copying task compared to control a Analysis:  S tudy only contained 3 DCD and 3 controls; however, only reported data for 1 DCD and 1 control, therefore conclusions are unable to be drawn Activity and Participation: General Tasks and Demands  Time to Complete Copying Task33  1 study  ActiveCube S ystem  Time to complete task  Results:  DCD child took less time than the control child  However, the DCD child only completed 3 of the 6 steps required to fully complete the task e Analysis:  Few conclusions can be drawn regarding this study due to the lack of available data, small sample size and lack of related studies Qualitative S tudies Qualitative S tudies  3 studies 34-36  Not subcategorized according to the levels of the ICF e 1 study  Qualitative interviews with parents of children with DCD  Aimed at studying the importance of participation  Results:  DCD children experience motor-based activity restrictions  Analysis:  Far-reaching negative consequences on the children’s Activity and Participation  Parents felt that treatments aimed at Activity and Participation were necessary for the management of their child’s disorder Qualitative S tudies  Gross motor skills:  Ball skills  Balance  Hopping  S kipping  Running  Biking  Fine motor skills:  Writing  Drawing  Dressing and tying shoelaces  2 multiple case studies s Investigated effectiveness of specific interventions for treatment of DCD e Results: e Baseline evaluations demonstrated problems with gross and fine motor skills, low self-esteem and decreased confidence in their own abilities a Analysis: a Motor deficits at the Body Functions and Structures level affect Activities and Participation Limitations Limitations 1. Heterogeneity of DCD population and studies  Wide variety of deficits well documented in the literature  Numerous outcome measures used in application of assessing children with DCD  Diversity challenges ability to compare individual studies 1. Articles published prior to 1994 excluded  Earlier articles may still provide valuable data despite the differing terminology 1. S tudies excluded if diagnostic criteria did not indicate DS M-IV diagnosis  Other valid forms of diagnosing DCD children  1. Absence of a grey literature search  Appropriate studies may have been overlooked 1. ICF amalgamates the Activity and Participation categories due to high degree of association  Presents a limitation when assessing children with DCD  Generalizes their deficits Limitations Conclusion and Implications Body Functions and S tructures Impairments Neuromusculoskeletal and movement related functions Ball catching Onset of postural muscles Coordination ?  Movement duration S ensory functions and pain Balance Postural control Mental functions Perceived competence Imagined movements ?  Reaction time during attentional tasks Functions of the heart and respiration ?  Fitness Activities  and Participation Impairments Functions of mobility Ball handling skills Pencil skills, Gross motor function, Academic activities Functions of self care Fine motor manipulation Dressing, Grooming, Bathing Community social and civic life S occer, Basketball, Biking Learning and applying knowledge Copying tasks General tasks and demands No conclusive data Qualitative studies Gross and fine motor skills (Hopping, S kipping, Running, Biking) Low self esteem Decreased confidence in abilities Figure 3. Impairments Based on ICF Classification Conclusion  Body Functions and S tructures level n Impairments in various motor skills a Vast majority of the studies at this level  Activity and Participation level t Motor deficits impact activity and participation  Nature and magnitude of impacts remain unclear This review highlights that current research is focused to impairments at the Body Functions and S tructures level, thereby, under-representing the Activity and Participation level Implications  Vital for physiotherapists to consider all levels of the ICF t Improve function and health related quality of life when activity and participation are the foci of treatment7  This S ystematic Review can help inform assessments and treatments of children with DCD f Provides a more structured, holistic picture of the DCD child s Future research needed using ICF model to guide physiotherapy practice • S upervisor • Ms. Jill Zwicker • UBC Faculty Members • Dr. Darlene Reid • Dr. E lizabeth Dean • UBC Librarian • Ms. Charlotte Beck Acknowledgments References 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington: American Psychiatric Association; 1994. 2. Hillier S . Intervention for children with developmental coordination disorder: a systematic review. INTERNET J ALLIED HEALTH S CI PRACT 2007 07;5(3):1-11. 3. Jucaite A, Fernell E , Forssberg H, Hadders-Algra M. Deficient coordination of associated postural adjustments during a lifting task in children with neurodevelopmental disorders. Developmental Medicine & Child Neurology 2003 Nov;45(11):731-742. 4. Missiuna C, Pollock N. Beyond the norms: Need for multiple sources of data in the assessment of children. Physical and Occupational Therapy in Pediatrics 1995;15(4):57-71. 5. S myth TR  GD. Information processing deficits in clumsy children. Aust.J.Psychol. 1986;38:13-22. 6. Volman MJM GR. Relative phase stability of bimanual and visuomanual rhythmic coordination patterns in children with a developmental coordination disorder. Hum Movement S ci 1998;17:541-572. 7. Missiuna C, R ivard L, Bartlett D. Early identification and risk management of children with developmental coordination disorder. Pediatric Physical Therapy 2003 Mar;15(1):32-38. 8. World Health Organization. International classification of functioning, disability and health: children & youth version: ICF-CY. Geneva: World Health Organization; 2007. 9. Watter P, Rodger S , Marinac J, Woodyatt G, Ziviani J,Ozanne A. Multidisciplinary assessment of children with developmental coordination disorder: using the ICF framework to inform assessment. Phys.Occup.Ther.Pediatr. 2008;28(4):329-350. References 1. Hadders-Algra M. The neuronal group selection theory: promising principles for understanding and treating developmental motor disorders. Developmental Medicine & Child Neurology 2000 Oct;42(10):707-715. 2. Polatajko HJ, Cantin N. Developmental coordination disorder (dyspraxia): an overview of the state of the art. S emin.Pediatr.Neurol. 2005 Dec;12(4):250-258. 3. Deconinck FJA, De Clercq D, S avelsbergh GJP, Van Coster R , Oostra A, Dewitte G, et al. Adaptations to task constraints in catching by boys with DCD. Adapted Physical Activity Quarterly 2006 Jan;23(1):14-30. 4. Utley A, Astill S L. Developmental sequences of two-handed catching: how do children with and without developmental coordination disorder differ? . Physiotherapy Theory & Practice 2007 Mar-Apr;23(2):65-82. 5. Lewis M, Vance A, Maruff P, Wilson P, Cairney S . Differences in motor imagery between children with developmental coordination disorder with and without the combined type of ADHD. Dev.Med.Child Neurol. 2008;50(8):608-612. 6. Maruff P, Wilson P, Trebilcock M, Currie J. Abnormalities of imaged motor sequences in children with developmental coordination disorder. Neuropsychologia 1999 Oct;37(11):1317-1324. 7. Wilson PH, Maruff P, Ives S , Currie J. Abnormalities of motor and praxis imagery in children with DCD. Human Movement S cience 2001 Mar;20(1-2):135-159. 8. Johnston LM, Burns YR , Brauer S G, R ichardson CA. Differences in postural control and movement performance during goal directed reaching in children with developmental coordination disorder. Human Movement S cience 2002 Dec;21(5-6):583-601. 9. Whitall J, Getchell N, McMenamin S , Horn C, Wilms-Floet A, C lark JE . Perception-action coupling in children with and without DCD: Frequency locking between task-relevant auditory signals and motor responses in a dual-motor task. Child: Care, Health & Development 2006 Nov;32(6):679-692. References 1. Peters JM, Wright AM. Development and evaluation of a group physical activity programme for children with developmental co-ordination disorder: An interdisciplinary approach. Physiotherapy Theory and Practice 1999;15(4):203-216. 2. Rodger S , Watter P, Marinac J, Woodyatt G, Ziviani J, Ozanne A. Assessment of children with Developmental Coordination Disorder (DCD): motor, functional, self-efficacy and communication abilities. NZ J PHYS IOTHER 2007 11;35(3):99-109. 3. Pless M, Carlsson M, S undelin C, Persson K. Pre-school children with developmental co-ordination disorder: S elf- perceived competence and group motor skill intervention. Acta Paediatrica, International Journal of Paediatrics 2001;90(5):532-538. 4. Wilson PH, Maruff P, McKenzie BE. Covert orienting of visuospatial attention in children with developmental coordination disorder. Developmental Medicine & Child Neurology 1997 Nov;39(11):736-745. 5. de Castelnau P, Albaret JM, Chaix Y, Zanone PG. Developmental coordination disorder pertains to a deficit in perceptuo-motor synchronization independent of attentional capacities. Human Movement S cience 2007 Jun;26(3):477-490. 6. Cherng RJ, Hsu YW, Chen YJ, Chen JY. S tanding balance of children with developmental coordination disorder under altered sensory conditions. Human Movement S cience 2007 Dec;26(6):913-926. 7. Grove CR , Lazarus JA. Impaired re-weighting of sensory feedback for maintenance of postural control in children with developmental coordination disorder. Human Movement S cience 2007 Jun;26(3):457-476. 8. Inder JM, S ullivan S J. Does an educational kinesiology intervention alter postural control in children with a developmental coordination disorder?  CLIN KINES IOL 2004 12;58(4):9-26. 9. Inder JM, S ullivan S J. Motor and postural response profiles of four children with developmental coordination disorder. Pediatric Physical Therapy 2005;17(1):18-29. References 1. Laufer Y, Ashkenazi T, Josman N. The effects of a concurrent cognitive task on the postural control of young children with and without developmental coordination disorder. Gait Posture 2008 Feb;27(2):347-351. 2. Astill S . Can children with developmental coordination disorder adapt to task constraints when catching two- handed? . Disability & Rehabilitation 2007 Jan 15;29(1):57-67. 3. Cantin N, Polatajko HJ, Thach WT, Jaglal S . Developmental coordination disorder: exploration of a cerebellar hypothesis. Human Movement S cience 2007 Jun;26(3):491-509. 4. Dunford C, Missiuna C, S treet E , S ibert J. Children's perceptions of the impact of developmental coordination disorder on activities of daily living. British Journal of Occupational Therapy 2005 May;68(5):207-214. 5. Taylor S , Fayed N, Mandich A. CO-OP intervention for young children with developmental coordination disorder. OTJR  Occupation, Participation and Health 2007 S ep;27(4):124-130. 6. Jacoby S , Josman N, Jacoby D, Koike M, Itoh Y, Kawai N, et al. Tangible user interfaces: Tools to examine, assess, and treat dynamic constructional processes in children with developmental coordination disorders. International Journal on Disability and Human Development 2006 Jul;5(3):257-263. 7. Mandich AD, Polatajko HJ, Rodger S . R ites of passage: understanding participation of children with developmental coordination disorder. Human Movement S cience 2003 Nov;22(4-5):583-595. 8. Miyahara M, Wafer A. C linical intervention for children with developmental coordination disorder: A multiple case study. Adapted Physical Activity Quarterly 2004 Jul;21(3):281-300. 9. Miyahara M, Leeder T, Francis G, Inghelbrecht A. Does an instruction of a verbal labeling strategy for hand movements improve general motor coordination as well as the gestural performance?  A test of the relationship between developmental coordination disorder and dyspraxia. C linical Case S tudies 2008 Jun;7(3):191-207. Questions Figure 3. Impairments Based on ICF Classification Body Functions and S tructures Impairments Neuromusculoskeletal and movement related functions Ball catching Onset of postural muscles Coordination ?  Movement duration S ensory functions and pain Balance Postural control Mental functions Perceived competence Imagined movements ?  Reaction time during attentional tasks Functions of the heart and respiration ?  Fitness Activities  and Participation Impairments Functions of mobility Ball handling skills Pencil skills, Gross motor function, Academic activities Functions of self care Fine motor manipulation Dressing, Grooming, Bathing Community social and civic life S occer, Basketball, Biking Learning and applying knowledge Copying tasks General tasks and demands No conclusive data Qualitative studies Gross and fine motor skills (Hopping, S kipping, Running, Biking) Low self esteem Decreased confidence in abilities Appendix A: S ample S earch S trategy from Embase Database 1. “developmental coordination disorder”.ti,ab. 2. “developmental co-ordination disorder”.ti,ab. 3. exp Developmental Coordination Disorder/ 4. dcd.ti,ab. 5. dcd.mp. 6. 1 or 2 or 3 or 4 or 5 7. exp Motor Performance/ 8. exp Motor Dysfunction/ 9. 7 or 8 10. exp Developmental Disorder/ 11. 9 and 10 12. 6 or 11 13. exp Psychomotor Performance/ 14. exp “Movement (Physiology)”/ 15. exp VIS UOMOTOR  COORDINATION/ or exp EYE  HAND COORDINATION/ or exp COORDINATION/ or exp MOTOR  COORDINATION/ 16. exp GAIT DIS ORDER/ or exp GAIT/ 17. exp BALANCE  IMPAIRMENT/ or exp BALANCE  DIS ORDER/ 18. exp Body Equilibrium/ 19. exp Proprioception/ or exp Body Equilibrium/ or exp Body Posture/ 20. exp Developmental S tability/ 21. exp Physical Disability/ 22. exp Motor Performance/ 23. exp Task Performance/ 24. exp Motor Activity/ 25. exp S ensorimotor Function/ 26. exp Visuomotor Coordination/ 27. exp Psychomotor Disorder/ 28. exp Object Manipulation/ 29. 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 30. exp Daily Life Activity/ or exp ADL DIS ABILITY/ 31. adl*.mp. 32. exp EXERCIS E/ 33. exp Physical Activity/ 34. exp Human Activities/ 35. exp LE IS URE/ 36. activit*.mp. 37. 30 or 31 or 32 or 33 or 34 or 35 or 36 38. exp S PORT/ 39. exp PLAY/ 40. exp RECREATION/ 41. exp Patient Participation/ 42. participat*.mp. 43. 38 or 39 or 40 or 41 or 42 44. 29 or 37 or 43 45. 12 and 44 46. limit 45 to (English and (child or preschool child <1 to 6 years> or school child <7 to 12 years> or adolescent <13 to 17 years>))

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{[{ mDataHeader[type] }]} {[{ month[type] }]} {[{ tData[type] }]}

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