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Motor Impairments, Activity Limitations and Participation Restrictions Affecting Children with Developmental.. Conzatti, Paul; De Marchi, Lawren; Fox, Aylee; Monks, Jordan; Yiu, Jonathan; Zwicker, Jill 2009

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M O TO R IM P AIR M E NTS , AC TIVITY LIM ITATIO NS AND P AR TIC IP ATIO N R E S TR IC TIO NS AFFE C TING C HILD R E N WITH D E VE LO P M E NTAL C O O R D INATIO N D IS O R D E R : A S YS TE M ATIC R E VIE W JULY 23 2009  P aul C onzatti, Lawren D e M archi, Aylee Fox, Jordan M onks & Jonathan Yiu S upervis or: Jill Zwicker  P resentation O utline 1. 2. 3. 4. 5. 6. 7.  Introduction M ethods R esults D iscussion Limitations C onclusion and Implications Acknowledgements  Introduction  D evelopmental C oordination D isorder   D efinition: M  A motor s kill dis order characterized by a marked impairment in the development of motor coordination abilities that s ignificantly interferes with performance of daily activities and/or academic achievement1    D S M -IV D iagnostic C riteria1:  1.  M arked impairment in development of motor coordination Interference with academic achievement or activities of daily living C oordination difficulties not due to a general medical condition or a pervas ive developmental disorder If mental retardation is pres ent, motor difficulties in exces s of thos e expected  2. 3. 4.  D evelopmental C oordination D isorder     P athophysiology: M  Unclear  M  No hard neurological signs are present2  i  D eficit may lie within the cerebellum3  S igns and S ymptoms: m  Work at a slower pace, trading speed for accuracy4 D eficient at processing kinesthetic information but not visual information  R ely more on visual cues as opposed to proprioception5  u  D ifficulty maintaining postural stability6  a  D eficits contribute to repeated failures, which can cause avoidance of physical activities and socializing with peers 7  International C lassification of Functioning, D isability and Health (IC F)8    Framework for the description of health and health-related states 8    S tructures the assessment of children with complex conditions  Holis tic  approach to the individual9  International C lassification of Functioning, D isability and Health (IC F)8    Health and health-related characteristics are described from the perspective of8,9: 1.  B ody Functions and S tructures   1.  Activities   1.  P hys iological and ps ychological functions of body s ys tems Whole body activities or tas ks  P articipation   Involvement in a life s ituation  WHO, 2007  Literature R eview and R ationale   P revalence: M    6-13% of school aged children display characteristics consistent with D C D children10  P hysiotherapy intervention: t  M otor impairment changes can occur7 Focus on impairments at B FS 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 D C D using a structured framework such as the IC F  Q uestion   What motor impairments, activity limitations and participation restrictions are common in children with D evelopmental C oordination D isorder?  P urpose 1.  2.  3.  S ummarize the exis ting literature to produce a comprehensive lis t of characteris tics of children with D C D C lassify the motor impairments, activity limitations and participation res trictions affecting children with D C D according to the IC F framework Highlight gaps in the research regarding the pres entation of children with D C D in order to direct future inves tigations  M ethods  S earch S trategy   C omprehens ive literature searches: t    E xamples of P rimary M eS H term: a o o e n    M E D LINE , E M B AS E , C INAHL, P E D ro, P sychINFO , O Ts eeker and E R IC “developmental coordination dis order” “motor s kills dis order” “motor performance” “motor dys function” “developmental disorder”  E xamples of S econdary terms relating to the IC F: n n n  “body functions and s tructures ” “activity” “participation”  S tudy S election: Inclusion   S tudy types: M w o l n n    S ys tematic reviews R andomized control trials C linical controlled trials C ohort comparis ons C as e s tudies P ilot s tudies  Intervention and D escriptive studies: If bas eline outcome meas ures could be classified as a characteris tic of children with D C D  S tudy S election: Inclusion   E nglish language    P ublished post 1994 9  Year which the nomenclature of D C D was standardized 11    S ubjects: M m m  Both male and female Aged 2-18 D S M -IV diagnos ed for D C D  S tudy S election: E xclusion   S tudy types : M M s s s d    Books Narrative reviews Thes es D is s ertations Letters to the editor C ommentaries  S ubjects : M  P articipants with other s ignificant neurological dis orders , medical dis orders or intellectual dis abilities   E xception of thos e diagnos ed with Attention D eficit Hyperactivity D is order (AD HD ) or Learning D is ability (LD ) in conjunction with D C D  Fig ure 1. Flow C hart  Potentially relevant citations retrieved from electronic literature s earch (n = 4250)  C itations excluded bas ed on inclus ion and exclus ion criteria (n = 3248) Abs tracts put forward to review (n = 1002) Abs tracts excluded bas ed on inclus ion and exclus ion criteria (n = 633) Additional abs tracts were excluded becaus e publication dates prior to the year 1994, the official year that DC D was defined by the DS M IV (n = 101) Full-text articles put forward to review (n = 278) S tudies excluded after full-text review (n = 199) Additional s tudies were excluded as the participants were not DC D diag nos ed us ing the DS M IV criteria (n = 52) S tudies included in s ys tematic review (n = 27)  R esults  Table 1. Example of Des cription of S tudies S tudy  S tudy S tudy Quality Des ig n ( /6)  Ag e R ang e or Mean (S D)  S ample S ize  Outcome Meas ure  DC D (N) C ontrol (N)  B ODY FUNC TIONS & S TR UC TUR E S C herng et al. (2007)  2  C ohort DCD: C ontrol: comparison 5.5 (0.9)y 5.4 (0.9)y  20  20  C O P sway area  de C astelnau et al. (2007)  2  C ohort 8-13y comparison  24  60  C ontinuous P erformance Test & S ynchronization – S yncopation Tes t  AC TIVITIE S & PAR TIC IPATION Astill (2007)  2  C ohort 8.6 (1.0)y comparison  C antin et al. (2007)  2  C ohort DCD: C ontrol: comparison 9.1 (1.2)y 10.0 (1.3)y  5 (78y) 5 (910y) 9  5 (7- B all catching scale 8y) 5 (910y) 11 P AT  R esults   27 included s tudies i  19 at the B ody Functions and S tructures (B FS ) level  n  9 at the Activity and P articipation levels  Amalgamated  t  due to high degree of overlap  1 study was clas s ified under both B ody Functions and S tructures and Activity and P articipation  R esults   3 Qualitative studies u c  c  R elated to the Activities and P articipation level Unable to be s ubcategorized bas ed on the IC F criteria Not included in the R es ults (Table 2)  R eviewed  in D is cus sion  R esults   IC F subcategories     S ome s tudies fall within 2 s ubcategories  Body Functions and S tructures level:  12  at Neuromusculoskeletal and M ovement related Functions  6 at S ensory Functions and P ain  8 at M ental Functions  1 at Functions of the Heart and R espiration  R esults   Activity and P articipation level:    4 3 2 1 1       at Functions of M obility at Functions of S elf C are at C ommunity S ocial and C ivic Life at Learning and Applying Knowledge at G eneral Tas ks and D emands  N eu ro m us cu l  ns or y Fu n  ct ct io io ns os ns ke an of le M d th ta e Pa e nt la H a in nd l ea Fu rt M nc an ov tio em d ns R en es tR pi ra el tio at ed n C om Fu m nc un t.. Le ity . ar So ni ci ng M al ob an an ili d ty d Ap C iv pl ic yi ng Li fe Kn G ow en le er dg al e Ta S sk el s fC an ar d e D em Q ua an lit ds at iv e St ud ie s  Fu n  Se  Number of Studies  Figure 2. Included Studies Based on ICF Classification Representation of Included Studies Based on ICF Classification  14  12  B ody Functions and S tructures  10  Activities and P articipation  8  Q ualitative S tudies  6  4  2  0  Table 2. Example of Study Outcomes S tudy  IC F C las s ification  S ample S ize Meas ure DC D (N) C ontrol (N) B ODY FUNC TIONS & S TR UC TUR ES C herng et al. S ens ory functions 20 20 C entre of (2007) and pain P ress ure S way Hearing and Area vestibular functions S eeing and related functions  AC TIVITIES & PAR TIC IPATION C antin et al. M obility 9 (2007) C arrying, moving and handling objects  11  P ris m Adaptation Test  Variable  DC D Outcomes Mean (S D)  1. E yes open, 1. 668.95 (383.15)** fixed foot 2. 1051.07 (1001.09)** support (mm) 3. 755.15 (462.57)** 2. E yes 4. 2136.29 (1881.96)** clos ed, fixed 5. 3786.88 (3705.17)** foot support 6. 2616.69 (1413.57)** (mm) 3. Unreliable vision, fixed foot support (mm) 4. E yes open, compliant foot support (mm) 5. E yes clos ed, compliant foot support (mm) 6. Unreliable vision, compliant foot support (mm) 1. 30.0 (8.2)* 1. Baseline throwing 2. 17.8 (6.7)** accuracy (cm) 3. 7 yes, 2 no 2. 4. 10.4 (8.9) P erformance 5. 10.3 (8.2) coefficient (P C ) (cm): 3. Afteradaptation affect (yes or no) 4. Adaptation pris m phase (throws ) 5. Adaptation after pris m  C ontrol Outcomes Mean (S D) 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)**  1. 15.7 (5.1)* 2. 8.2 (2.5)** 3. 11 yes 4. 9.8 (5.2) 5. 8.0 (4.1)  D iscussion  D iscussion   What motor impairments, activity limitations and participation restrictions are common in children with D evelopmental C oordination D isorder?  B ody Functions and S tructures •  Neuromusculosketetal and M ovement R elated Functions  •  M ental Functions  •  S ens ory Functions and P ain  •  Functions of the cardiovascular, haematological, immunological and respiratory systems  B FS : Neuromusculosketelal and M ovements R elated Functions   Ball catching tasks 12,13 s  2 studies      u  R esults:    c  Video analysis of ball catching strategy P ositions of the fingers and wrist Trajectory of the ball and velocity Acceleration values of limbs during catch  D ifferent and unstable catching profile compared to controls 13 S lower moment of completion, smaller max hand aperture, slower max closing velocity12  Analysis:   C hildren with D C D have multiple deficits that contribute to problems with purposeful motor tasks  B FS : Neuromusculosketelal and M ovements R elated Functions   M ovement D uration during M otor Tasks n  3 studies 14-16   M easured time to complete pointing tas ks  R esults:    n  2 out of 3 studies s howed significantly slower movement duration in D C D children compared to controls All 3 showed significantly slower imagined movement times (discussed in mental functions)  Analysis:   S uggests that children with D C D have s lower movement duration  B FS : Neuromusculosketelal and M ovements R elated Functions   Involuntary M ovement Functions 3,17 m  2 studies    p  o  Timing and amplitude of postural activity using a force plate E M G activity of postural muscles  R esults:   S ignificant slower onset of postural muscles 17    P rolonged onset of postural activity with varied weight lifting 3  Analysis:   C onfirmed deficits in involuntary movement functions (postural control)  B FS : Neuromusculosketelal and M ovements R elated Functions   C oordination Tas k18 k  1 study   n  R esults:   e  C lapping and marching task to a metronome beat: timing deviation between limbs  S ignificant difference in variability of relative phasing between D C D and controls  Analysis:   C hildren with D C D have difficulties with both the coordination and control of the perception-action coupling of this task  B FS : Neuromusculosketelal and M ovements R elated Functions   S tandardized Asses sment Tools 19,20 e  2 studies   M easures of motor performance    e  R esults:    i  Neurodevelopmental P hys iotherapy As sess ment (ND P A) M ovement Asses sment B attery for C hildren (M AB C )  C hildren with D C D scored s ignificantly poorer than control children in both measures D eficits listed in the analysis were found in 95% of subjects  Analysis:   D C D children displayed deficits in gross and fine motor skills, proprioception, stability, balance, postural control, tactile sense and motor planning 20  BFS : M ental Functions   P erceived C ompetence e  3 studies 19-21    o  R esults:     w  P erceived M otor C ompetence S cale P ictorial S cale of P erceived C ompetence and S ocial Acceptance  2 of 3 studies found no significant deficits in self perceived competence in D C D children 1 study did not compare data to controls, therefore conclusions unable to be drawn  Analysis:   Although children with D C D have deficits in s everal areas of function including motor skills, they may not have an accurate self-perception of these deficits  BFS : M ental Functions   Imagined M ovements and S equences 14-16 t  3 studies   e  R esults:     t  Timing of imagined movements during pointing tasks  M agnitude of slowing between real and imagined movements was not proportional D C D children did not demonstrate variance with imagined movement amongst varying target width compared to controls who did s how variance  Analysis:   D C D children have an inability to generate internal representations of volitional movements  BFS : M ental Functions   Attentional Tas ks 22,23 s  2 studies    r  R esults:   e  C O VAT (C overt orienting of visuo-s patial attention task): M easured reaction time C ontinuous P erformance Test: M easured % of correct responses  Although 1 study found s ignificantly s lower reaction times in D C D children compared to controls, the other study did not find a significant difference  Analysis:   Inconclusive evidence that children with D C D have deficits in attentional tasks  BFS : S ensory Functions and P ain   P ostural C ontrol and Balance3,24-28 6 studies    O  C enter of pressure sway area P ostural S way  R esults:    All studies found deficits in postural stability 3 studies found increased deficits under conditions where vestibular input was relied upon  Analysis:   C hildren with D C D have problems with postural adaptations to different movements and sensory conditions  B FS : Functions of the C ardiovascular, Haematological, Immunological and R espiratory systems    Ventilatory Function19 t  1 study   a  R esults:   f  Forced Vital C apacity (FVC )  Found D C D children to have a mean FVC at the lower end of normal range for their age and height  Analys is:   No clear conclus ions can be made about the cardiovas cular fitnes s of D C D children from this s ingle s tudy  Activity and P articipation • • • • •  M obility C ommunity S ocial and C ivic Life S elf C are Learning and Applying Knowledge G eneral Tasks and D emands  Activity and P articipation: M obility   Ball Handling S kills 29,30 i  2 studies   o  R esults:   e  C atching and throwing  D ecreas ed completed catches , catching accuracy and score on catching s cale in children with D C D  Analysis:   D C D children had s ignificant impairments in ball handling s kills compared to controls    C orrelates with the B FS findings C hildren with D C D have motor impairments that result in difficulties with activities such as ball catching and throwing  Activity and P articipation: M obility   P erceived E fficacy and Goal S etting 31,32 c  2 studies     P E G S (P erceived E fficacy and G oal S etting)  P erceived efficacy in different activities related to mobility31 C O P M (C anadian O ccupational P erformance M eas ure)  Identification of client-centered goals 32  Activity and P articipation: M obility t  R esults:   Areas of concern identified by both children and parents/teachers       P encil skills G ross motor function/s ports Academic/school activities  Identified goals related to:   M obility (carrying, moving and handling of objects)  P rinting, Lego™ , cutting, colouring  Analysis:   S cores were not compared with controls , however, thes e s cores can be us ed to identify areas needing improvement and future goals  Activity and P articipation: C ommunity S ocial and C ivic Life   P erceived S elf E fficacy31,32 f  2 studies     f  R esults:   b  PEGS  P erceived efficacy in different activities related to recreation and leisure COPM  Identification of client-centered goals  G oals included leisure activities:  S occer, biking, basketball  Analys is:   S cores were not compared with controls, however, these scores can be used to identify areas needing improvement and future goals  Activity and P articipation: S elf C are   3 studies 20,31,32       R esults:     P E G S : M ultiple activities related to self care C O P M : Identification of client centered goals P E D I (P ediatric E valuation of D isability Inventory): P articipation in Activities of D aily Living  C hildren with D C D showed significantly lower mean functional selfcare skills than the normative mean20  Fine manipulation skills  O rganizing and sequencing of functional tasks s uch as dressing, grooming and bathing  Analysis: M  M otor deficits at the B FS level affect activities of self care  Activity and P articipation: Learning and Applying Knowledge   C opying Task33 M  1 study   i  R esults:   a  ActiveC ube S ystem  S imilarity (copying) task  C hild with D C D had significant difficulty with copying task compared to control  Analysis:   S tudy only contained 3 D C D and 3 controls; however, only reported data for 1 D C D and 1 control, therefore conclusions are unable to be drawn  Activity and P articipation: General Tasks and D emands   Time to C omplete C opying Tas k33 1 study   ActiveC ube S ystem  Time to complete task  R esults:   D C D child took les s time than the control child   e  However, the D C D child only completed 3 of the 6 steps required to fully complete the task  Analysis:   Few conclus ions can be drawn regarding this s tudy due to the lack of available data, s mall s ample size and lack of related s tudies  Q ualitative S tudies  Q ualitative S tudies   3 studies 34-36   e  Not subcategorized according to the levels of the IC F  1 study   Q ualitative interviews with parents of children with D C D     R es ults :     Aimed at studying the importance of participation  D C D children experience motor-bas ed activity restrictions  Analys is:     Far-reaching negative consequences on the children’s Activity and P articipation P arents felt that treatments aimed at Activity and P articipation were necessary for the management of their child’s disorder  Q ualitative S tudies   2 multiple case s tudies s  e  Inves tigated effectiveness of specific interventions for treatment of DCD R es ults: e  Baseline evaluations demonstrated problems with gross and fine motor skills, low self-esteem and decreased confidence in their own abilities   a  Gros s motor skills:  B all skills  B alance  Hopping  S kipping  R unning  B iking    Fine motor skills :  Writing  D rawing  D ress ing and tying s hoelaces  Analysis: a  Motor deficits at the Body Functions and Structures level affect Activities and Participation  Limitations  Limitations 1.  Heterogeneity of D C D population and studies      1.  Wide variety of deficits well documented in the literature Numerous outcome measures used in application of ass ess ing children with D C D D iversity challenges ability to compare individual studies  Articles published prior to 1994 excluded   E arlier articles may still provide valuable data despite the differing terminology  Limitations 1.  S tudies excluded if diagnostic criteria did not indicate D S M -IV diagnosis   1.  Absence of a grey literature search   1.  O ther valid forms of diagnosing D C D children  Appropriate s tudies may have been overlooked  IC F amalgamates the Activity and P articipation categories due to high degree of association   P resents a limitation when asses sing children with  C onclusion and Implications  Figure 3. Impairments Based on ICF Classification B ody Functions and S tructures Impairments  Neuromusculoskeletal and movement related functions S ens ory functions and pain M ental functions  Functions of the heart and respiration  Activities and Participation Impairments  Functions of mobility  B all catching Ons et of postural muscles C oordination ? M ovement duration B alance P os tural control P erceived competence Imagined movements ? R eaction time during attentional tas ks ? Fitnes s  B all handling s kills P encil skills, Gros s motor function, Academic activities Functions of self care Fine motor manipulation D ressing, Grooming, Bathing C ommunity s ocial and civic life S occer, Bas ketball, Biking Learning and applying knowledge C opying tas ks General tas ks and demands No conclus ive data Qualitative studies Gross and fine motor skills (Hopping, S kipping, R unning, B iking)  C onclusion   B ody Functions and S tructures level n a    Impairments in various motor skills Vast majority of the s tudies at this level  Activity and P articipation level t  M otor deficits impact activity and participation   Nature and magnitude of impacts remain unclear  This review highlights that current research is focused to impairments at the B ody Functions and S tructures level, thereby, under-representing the Activity and P articipation level  Implications   Vital for physiotherapists to consider all levels of the IC F t    Improve function and health related quality of life when activity and participation are the foci of treatment7  This S ystematic R eview can help inform assessments and treatments of children with D C D f  s  P rovides a more structured, holistic picture of the D C D child Future research needed using IC F model to guide physiotherapy practice  Acknowledgments •  S upervisor •  •  •  M s. Jill Zwicker  UBC Faculty M embers •  D r. D arlene R eid  •  D r. E lizabeth D ean  UBC Librarian •  M s. C harlotte B eck  R eferences 1.  2.  3.  4.  5. 6.  7.  8.  9.  American P sychiatric Association. D iagnostic and statistical manual of mental disorders. 4th ed. Washington: American P sychiatric Association; 1994. Hillier S . Intervention for children with developmental coordination disorder: a systematic review. INTE R NE T J ALLIE D HE ALTH S C I P R AC T 2007 07;5(3):1-11. Jucaite A, Fernell E , Forssberg H, Hadders-Algra M . D eficient coordination of associated postural adjustments during a lifting task in children with neurodevelopmental disorders. D evelopmental M edicine & C hild Neurology 2003 Nov;45(11):731-742. M issiuna C , P ollock N. Beyond the norms: Need for multiple sources of data in the assessment of children. P hysical and O ccupational Therapy in P ediatrics 1995;15(4):57-71. S myth TR G D . Information processing deficits in clumsy children. 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D ev.M ed.C hild Neurol. 2008;50(8):608-612. M aruff P , Wilson P , Trebilcock M , C urrie J. Abnormalities of imaged motor sequences in children with developmental coordination disorder. Neuropsychologia 1999 Oct;37(11):1317-1324. Wilson P H, M aruff P , Ives S , C urrie J. Abnormalities of motor and praxis imagery in children with D C D . Human M ovement S cience 2001 M ar;20(1-2):135-159. Johnston LM , B urns YR , Brauer S G , R ichardson C A. D ifferences in postural control and movement performance during goal directed reaching in children with developmental coordination disorder. Human M ovement S cience 2002 D ec;21(5-6):583-601. Whitall J, G etchell N, M cM enamin S , Horn C , Wilms-Floet A, C lark JE . P erception-action coupling in children with and without D C D : Frequency locking between task-relevant auditory signals and motor responses in a dual-motor task. C hild: C are, Health & D evelopment 2006 Nov;32(6):679-692.  R eferences 1.  2.  3.  4.  5.  6.  7.  8.  9.  P eters JM , Wright AM . D evelopment and evaluation of a group physical activity programme for children with developmental co-ordination disorder: An interdisciplinary approach. P hysiotherapy Theory and P ractice 1999;15(4):203-216. R odger S , Watter P , M arinac J, Woodyatt G , Ziviani J, O zanne A. Assessment of children with D evelopmental C oordination D isorder (D C D ): motor, functional, self-efficacy and communication abilities. NZ J P HYS IO THE R 2007 11;35(3):99-109. P less M , C arlsson M , S undelin C , P ersson K. P re-school children with developmental co-ordination disorder: S elfperceived competence and group motor skill intervention. Acta P aediatrica, International Journal of P aediatrics 2001;90(5):532-538. Wilson P H, M aruff P , M cKenzie B E . C overt orienting of visuospatial attention in children with developmental coordination disorder. D evelopmental M edicine & C hild Neurology 1997 Nov;39(11):736-745. de C astelnau P , Albaret JM , C haix Y, Zanone P G . D evelopmental coordination disorder pertains to a deficit in perceptuo-motor synchronization independent of attentional capacities. Human M ovement S cience 2007 Jun;26(3):477-490. C herng R J, Hsu YW, C hen YJ, C hen JY. S tanding balance of children with developmental coordination disorder under altered sensory conditions. Human M ovement S cience 2007 D ec;26(6):913-926. G rove C R , Lazarus JA. Impaired re-weighting of sensory feedback for maintenance of postural control in children with developmental coordination disorder. Human M ovement S cience 2007 Jun;26(3):457-476. Inder JM , S ullivan S J. D oes an educational kinesiology intervention alter postural control in children with a developmental coordination disorder? C LIN KINE S IO L 2004 12;58(4):9-26. Inder JM , S ullivan S J. M otor and postural response profiles of four children with developmental coordination disorder. P ediatric P hysical Therapy 2005;17(1):18-29.  R eferences 1.  2.  3.  4.  5.  6.  7.  8.  9.  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. G ait P osture 2008 Feb;27(2):347-351. Astill S . C an children with developmental coordination disorder adapt to task constraints when catching twohanded? . D isability & R ehabilitation 2007 Jan 15;29(1):57-67. C antin N, P olatajko HJ, Thach WT, Jaglal S . D evelopmental coordination disorder: exploration of a cerebellar hypothesis. Human M ovement S cience 2007 Jun;26(3):491-509. D unford C , M issiuna C , S treet E , S ibert J. C hildren's perceptions of the impact of developmental coordination disorder on activities of daily living. B ritish Journal of O ccupational Therapy 2005 M ay;68(5):207-214. Taylor S , Fayed N, M andich A. C O -O P intervention for young children with developmental coordination disorder. O TJR O ccupation, P articipation and Health 2007 S ep;27(4):124-130. 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 D isability and Human D evelopment 2006 Jul;5(3):257-263. M andich AD , P olatajko HJ, R odger S . R ites of passage: understanding participation of children with developmental coordination disorder. Human M ovement S cience 2003 Nov;22(4-5):583-595. M iyahara M , Wafer A. C linical intervention for children with developmental coordination disorder: A multiple case study. Adapted P hysical Activity Q uarterly 2004 Jul;21(3):281-300. M iyahara M , Leeder T, Francis G , Inghelbrecht A. D oes 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 C ase S tudies 2008 Jun;7(3):191-207.  Q uestions  Figure 3. Impairments Based on ICF Classification B ody Functions and S tructures Impairments  Neuromusculoskeletal and movement related functions S ens ory functions and pain M ental functions  Functions of the heart and respiration  Activities and Participation Impairments  Functions of mobility  B all catching Ons et of postural muscles C oordination ? M ovement duration B alance P os tural control P erceived competence Imagined movements ? R eaction time during attentional tas ks ? Fitnes s  B all handling s kills P encil skills, Gros s motor function, Academic activities Functions of self care Fine motor manipulation D ressing, Grooming, Bathing C ommunity s ocial and civic life S occer, Bas ketball, Biking Learning and applying knowledge C opying tas ks General tas ks and demands No conclus ive data Qualitative studies Gross and fine motor skills (Hopping, S kipping, R unning, B iking)  Appendix A: S ample S earch S trateg y from Embas e Databas e 1. “developmental coordination disorder”.ti,ab. 2. “developmental co-ordination disorder”.ti,ab. 3. exp D evelopmental C oordination D is order/ 4. dcd.ti,ab. 5. dcd.mp. 6. 1 or 2 or 3 or 4 or 5 7. exp M otor P erformance/ 8. exp M otor D ys function/ 9. 7 or 8 10. exp D evelopmental D isorder/ 11. 9 and 10 12. 6 or 11 13. exp P sychomotor P erformance/ 14. exp “M ovement (P hys iology)”/ 15. exp VIS UOM OTOR C O OR D INATIO N/ or exp E YE HAND C O OR D INATIO N/ or exp C OO R D INATIO N/ or exp M O TO R C OO R DINATIO N/ 16. exp GAIT D IS O R DE R / or exp GAIT/ 17. exp B ALANC E IM P AIR M E NT/ or exp B ALANC E D IS OR D E R / 18. exp B ody E quilibrium/ 19. exp P roprioception/ or exp B ody E quilibrium/ or exp B ody P osture/ 20. exp D evelopmental S tability/ 21. exp P hysical D isability/ 22. exp M otor P erformance/ 23. exp Tas k P erformance/ 24. exp M otor Activity/ 25. exp S ensorimotor Function/ 26. exp Vis uomotor C oordination/ 27. exp P sychomotor D is order/ 28. exp Object M anipulation/ 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 D aily Life Activity/ or exp AD L D IS AB ILITY/ 31. adl*.mp. 32. exp E X E R C IS E / 33. exp P hysical Activity/ 34. exp Human Activities/ 35. exp LE IS UR E / 36. activit*.mp. 37. 30 or 31 or 32 or 33 or 34 or 35 or 36 38. exp S P O R T/ 39. exp P LAY/ 40. exp R E C R E ATION/ 41. exp P atient P articipation/ 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 (E nglish and (child or pres chool child <1 to 6 years> or school child <7 to 12 years > or adoles cent <13 to 17 years>))  

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