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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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MOTOR IMPAIRMENTS, ACTIVITY LIMITATIONS AND PARTICIPATION RESTRICTIONS AFFECTING CHILDREN WITH DEVELOPMENTAL COORDINATION DISORDER: A SYSTEMATIC REVIEWJULY 23 2009 Paul Conzatti, Lawren De Marchi, Aylee Fox, Jordan Monks & Jonathan YiuSupervisor: Jill ZwickerPresentation OutlineIntroductionMethodsResultsDiscussionLimitationsConclusion and ImplicationsAcknowledgements IntroductionDevelopmental Coordination DisorderDefinition: 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 achievement1DSM-IV Diagnostic Criteria1:Marked impairment in development of motor coordinationInterference with academic achievement or activities of daily livingCoordination difficulties not due to a general medical condition or a pervasive developmental disorderIf mental retardation is present, motor difficulties in excess of those expectedDevelopmental Coordination DisorderPathophysiology:UnclearNo hard neurological signs are present2Deficit may lie within the cerebellum3Signs and Symptoms: Work at a slower pace, trading speed for accuracy4Deficient at processing kinesthetic information but not visual informationRely more on visual cues as opposed to proprioception5Difficulty maintaining postural stability6Deficits contribute to repeated failures, which can cause avoidance of physical activities and socializing with peers7International Classification of Functioning, Disability and Health (ICF)8Framework for the description of health and health-related states8Structures the assessment of children with complex conditionsHolistic approach to the individual9Health and health-related characteristics are described from the perspective of8,9:Body Functions and Structures Physiological and psychological functions of body systemsActivities Whole body activities or tasksParticipation Involvement in a life situationInternational Classification of Functioning, Disability and Health (ICF)8WHO, 2007Literature Review and RationalePrevalence: 6-13% of school aged children display characteristics consistent with DCD children10Physiotherapy intervention:Motor impairment changes can occur7Focus on impairments at BFS levelA more significant role can be played at the activity and participation levels 7Are 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 ICFQuestion What motor impairments, activity limitations and participation restrictions are common in children with Developmental Coordination Disorder?PurposeSummarize the existing literature to produce a comprehensive list of characteristics of children with DCDClassify the motor impairments, activity limitations and participation restrictions affecting children with DCD according to the ICF frameworkHighlight gaps in the research regarding the presentation of children with DCD in order to direct future investigationsMethodsSearch StrategyComprehensive literature searches:MEDLINE, EMBASE, CINAHL, PEDro, PsychINFO, OTseeker and ERICExamples of Primary MeSH term: “developmental coordination disorder”“motor skills disorder”“motor performance”“motor dysfunction”“developmental disorder”Examples of Secondary terms relating to the ICF:“body functions and structures”“activity” “participation” Study Selection: Inclusion Study types: Systematic reviewsRandomized control trials Clinical controlled trials Cohort comparisonsCase studies Pilot studies Intervention and Descriptive studies:If baseline outcome measures could be classified as a characteristic of children with DCDStudy Selection: InclusionEnglish language Published post 1994Year which the nomenclature of DCD was standardized 11Subjects: Both male and femaleAged 2-18 DSM-IV diagnosed for DCDStudy Selection: ExclusionStudy types: BooksNarrative reviewsThesesDissertationsLetters to the editor CommentariesSubjects: 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 DCDPotentially 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)Studies included in systematic review (n = 27)Citations excluded based on inclusion and exclusion criteria (n = 3248)Abstracts excluded based on inclusion and exclusion criteria (n = 633)Additional abstracts were excluded because publication dates prior to the year 1994, the official year that DCD was defined by the DSM IV (n = 101)Studies excluded after full-text review (n = 199)Additional studies were excluded as the participants were not DCD diagnosed using the DSM IV criteria (n = 52)  Figure 1.  Flow ChartResultsStudyStudy Quality ( /6)Study DesignAge Range or Mean (SD)   Sample Size DCD (N)     Control (N)Outcome MeasureBODY FUNCTIONS & STRUCTURESCherng et al. (2007)2Cohort comparisonDCD: 5.5 (0.9)yControl: 5.4 (0.9)y2020COP sway areade Castelnau et al. (2007)2Cohort comparison8-13y2460Continuous Performance Test &Synchronization – Syncopation TestACTIVITIES & PARTICIPATIONAstill (2007)2Cohort comparison8.6 (1.0)y5 (7-8y)5 (9-10y)5 (7-8y)5 (9-10y)Ball catching scaleCantin et al. (2007)2Cohort comparisonDCD:9.1 (1.2)yControl: 10.0 (1.3)y911PATTable 1. Example of Description of StudiesResults27 included studies19 at the Body Functions and Structures (BFS) level 9 at the Activity and Participation levelsAmalgamated due to high degree of overlap1 study was classified under both Body Functions and Structures and Activity and ParticipationResults3 Qualitative studiesRelated to the Activities and Participation levelUnable to be subcategorized based on the ICF criteriaNot included in the Results (Table 2)Reviewed in DiscussionResultsICF subcategoriesSome studies fall within 2 subcategoriesBody Functions and Structures level:12 at Neuromusculoskeletal and Movement related Functions6 at Sensory Functions and Pain8 at Mental Functions 1 at Functions of the Heart and Respiration ResultsActivity and Participation level:4 at Functions of Mobility3 at Functions of Self Care2 at Community Social and Civic Life1 at Learning and Applying Knowledge  1 at General Tasks and Demands       Body Functions and Structures       Activities and Participation       Qualitative StudiesFigure 2. Included Studies Based on ICF ClassificationStudyICF ClassificationSample SizeDCD (N)  Control (N)MeasureVariableDCD OutcomesMean (SD)Control OutcomesMean (SD)BODY FUNCTIONS & STRUCTURESCherng et al. (2007)Sensory functions and pain Hearing and vestibular functionsSeeing and related functions2020Centre of Pressure Sway Area1. 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 & PARTICIPATIONCantin et al. (2007)Mobility                    Carrying, moving and handling objects911Prism Adaptation Test1. 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 no4. 10.4 (8.9)5. 10.3 (8.2)1. 15.7 (5.1)*2. 8.2 (2.5)**3. 11 yes4. 9.8 (5.2) 5. 8.0 (4.1)Table 2. Example of Study OutcomesDiscussionDiscussionWhat motor impairments, activity limitations and participation restrictions are common in children with Developmental Coordination Disorder?Neuromusculosketetal and Movement Related FunctionsMental FunctionsSensory Functions and PainFunctions of the cardiovascular, haematological, immunological and respiratory systemsBody Functions and StructuresBFS: Neuromusculosketelal and Movements Related FunctionsBall catching tasks12,132 studiesVideo analysis of ball catching strategyPositions of the fingers and wristTrajectory of the ball and velocityAcceleration values of limbs during catchResults:Different and unstable catching profile compared to controls13Slower moment of completion, smaller max hand aperture, slower max closing velocity12Analysis: Children with DCD have multiple deficits that contribute to problems with purposeful motor tasksBFS: Neuromusculosketelal and Movements Related FunctionsMovement Duration during Motor Tasks3 studies14-16Measured time to complete pointing tasksResults:2 out of 3 studies showed significantly slower movement duration in DCD children compared to controlsAll 3 showed significantly slower imagined movement times (discussed in mental functions)Analysis: Suggests that children with DCD have slower movement durationInvoluntary Movement Functions3,172 studiesTiming and amplitude of postural activity using a force plateEMG activity of postural musclesResults:Significant slower onset of postural muscles17Prolonged onset of postural activity with varied weight lifting3Analysis: Confirmed deficits in involuntary movement functions (postural control)BFS: Neuromusculosketelal and Movements Related FunctionsBFS: Neuromusculosketelal and Movements Related FunctionsCoordination Task181 studyClapping and marching task to a metronome beat: timing deviation between limbsResults:Significant difference in variability of relative phasing between DCD and controlsAnalysis: Children with DCD have difficulties with both the coordination and control of the perception-action coupling of this taskBFS: Neuromusculosketelal and Movements Related FunctionsStandardized Assessment Tools19,202 studiesMeasures of motor performanceNeurodevelopmental Physiotherapy Assessment (NDPA)Movement Assessment Battery for Children (MABC)Results:Children with DCD scored significantly poorer than control children in both measuresDeficits listed in the analysis were found in 95% of subjects Analysis: DCD children displayed deficits in gross and fine motor skills, proprioception, stability, balance, postural control, tactile sense and motor 	planning 20BFS: Mental FunctionsPerceived Competence3 studies19-21Perceived Motor Competence ScalePictorial Scale of Perceived Competence and Social AcceptanceResults:2 of 3 studies found no significant deficits in self perceived competence  in DCD children1 study did not compare data to controls, therefore conclusions unable to be drawnAnalysis: Although children with DCD have deficits in several areas of function including motor skills, they may not have an accurate self-perception of these deficitsBFS: Mental FunctionsImagined Movements and Sequences14-163 studiesTiming of imagined movements during pointing tasksResults:Magnitude of slowing between real and imagined movements was not proportionalDCD children did not demonstrate variance with imagined movement amongst varying target width compared to controls who did show varianceAnalysis: DCD children have an inability to generate internal representations of volitional movementsBFS: Mental FunctionsAttentional Tasks22,232 studiesCOVAT (Covert orienting of visuo-spatial attention task): Measured reaction timeContinuous Performance Test: Measured % of correct responsesResults:Although 1 study found significantly slower reaction times in DCD children compared to controls, the other study did not find a significant differenceAnalysis: Inconclusive evidence that children with DCD have deficits in attentional tasksBFS: Sensory Functions and PainPostural Control and Balance3,24-286 studiesCenter of pressure sway areaPostural SwayResults:All studies found deficits in postural stability3 studies found increased deficits under conditions where vestibular input was relied uponAnalysis: Children with DCD have problems with postural adaptations to different movements and sensory conditionsBFS: Functions of the Cardiovascular, Haematological, Immunological and Respiratory systemsVentilatory Function191 study Forced Vital Capacity (FVC)Results:Found DCD children to have a mean FVC at the lower end of normal range for their age and height Analysis: No clear conclusions can be made about the cardiovascular fitness of DCD children from this single studyMobilityCommunity Social and Civic LifeSelf CareLearning and Applying KnowledgeGeneral Tasks and DemandsActivity and Participation Activity and Participation: MobilityBall Handling Skills29,302 studiesCatching and throwingResults:Decreased completed catches, catching accuracy and score on catching scale in children with DCDAnalysis: DCD children had significant impairments in ball handling skills compared to controlsCorrelates with the BFS findings Children with DCD have motor impairments that result in difficulties with activities such as ball catching and throwingActivity and Participation: MobilityPerceived Efficacy and Goal Setting31,322 studiesPEGS (Perceived Efficacy and Goal Setting)Perceived efficacy in different activities related to mobility31COPM (Canadian Occupational Performance Measure)Identification of client-centered goals32Activity and Participation: MobilityResults:Areas of concern identified by both children and parents/teachers Pencil skillsGross motor function/sports Academic/school activitiesIdentified goals related to:Mobility (carrying, moving and handling of objects) Printing, Lego™, cutting, colouringAnalysis:Scores were not compared with controls, however, these scores can be used to identify areas needing improvement and future goalsActivity and Participation: Community Social and Civic LifePerceived Self Efficacy31,322 studiesPEGSPerceived efficacy in different activities related to recreation and leisureCOPMIdentification of client-centered goalsResults:Goals included leisure activities:Soccer, biking, basketballAnalysis:Scores were not compared with controls, however, these scores can be used to identify areas needing improvement and future goalsActivity and Participation: Self Care3 studies20,31,32PEGS: Multiple activities related to self careCOPM: Identification of client centered goalsPEDI (Pediatric Evaluation of Disability Inventory): Participation in Activities of Daily LivingResults:Children with DCD showed significantly lower mean functional self-care skills than the normative mean20Fine manipulation skillsOrganizing and sequencing of functional tasks such as dressing, grooming and bathingAnalysis: Motor deficits at the BFS level affect activities of self careActivity and Participation: Learning and Applying KnowledgeCopying Task331 studyActiveCube SystemSimilarity (copying) taskResults:Child with DCD had significant difficulty with copying task compared to controlAnalysis: Study only contained 3 DCD and 3 controls; however, only reported data for 1 DCD and 1 control, therefore conclusions are unable to be drawnActivity and Participation: General Tasks and DemandsTime to Complete Copying Task331 studyActiveCube SystemTime to complete taskResults:DCD child took less time than the control childHowever, the DCD child only completed 3 of the 6 steps required to fully complete the taskAnalysis: Few conclusions can be drawn regarding this study due to the lack of available data, small sample size and lack of related studiesQualitative StudiesQualitative Studies3 studies34-36Not subcategorized according to the levels of the ICF1 studyQualitative interviews with parents of children with DCDAimed at studying the importance of participationResults:DCD children experience motor-based activity restrictionsAnalysis: Far-reaching negative consequences on the children’s Activity and ParticipationParents felt that treatments aimed at Activity and Participation were necessary for the management of their child’s disorderQualitative StudiesGross motor skills:Ball skillsBalanceHoppingSkippingRunning Biking Fine motor skills:WritingDrawingDressing and tying shoelaces2 multiple case studies Investigated effectiveness of specific interventions for treatment of DCDResults:Baseline evaluations demonstrated problems with gross and fine motor skills, low self-esteem and decreased confidence in their own abilitiesAnalysis:Motor deficits at the Body Functions and Structures level affect Activities and ParticipationLimitationsLimitationsHeterogeneity of DCD population and studiesWide variety of deficits well documented in the literatureNumerous outcome measures used in application of assessing children with DCDDiversity challenges ability to compare individual studiesArticles published prior to 1994 excludedEarlier articles may still provide valuable data despite the differing terminologyStudies excluded if diagnostic criteria did not indicate DSM-IV diagnosisOther valid forms of diagnosing DCD children Absence of a grey literature searchAppropriate studies may have been overlookedICF amalgamates the Activity and Participation categories due to high degree of associationPresents a limitation when assessing children with DCDGeneralizes their deficitsLimitationsConclusion and ImplicationsBody Functions and Structures ImpairmentsNeuromusculoskeletal and movement related functionsBall catchingOnset of postural musclesCoordination? Movement durationSensory functions and painBalancePostural controlMental functionsPerceived competenceImagined movements? Reaction time during attentional tasksFunctions of the heart and respiration? FitnessActivities and Participation ImpairmentsFunctions of mobilityBall handling skillsPencil skills, Gross motor function, Academic activitiesFunctions of self careFine motor manipulationDressing, Grooming, BathingCommunity social and civic lifeSoccer, Basketball, BikingLearning and applying knowledgeCopying tasksGeneral tasks and demandsNo conclusive dataQualitative studiesGross and fine motor skills (Hopping, Skipping, Running, Biking)Low self esteemDecreased confidence in abilitiesFigure 3. Impairments Based on ICF ClassificationConclusionBody Functions and Structures levelImpairments in various motor skillsVast majority of the studies at this levelActivity and Participation levelMotor deficits impact activity and participationNature and magnitude of impacts remain unclearThis review highlights that current research is focused to impairments at the Body Functions and Structures level, thereby, under-representing the Activity and Participation levelImplicationsVital for physiotherapists to consider all levels of the ICF Improve function and health related quality of life when activity and participation are the foci of treatment7This Systematic Review can help inform assessments and treatments of children with DCDProvides a more structured, holistic picture of the DCD childFuture research needed using ICF model to guide physiotherapy practice SupervisorMs. Jill Zwicker UBC Faculty MembersDr. Darlene ReidDr. Elizabeth Dean UBC LibrarianMs. Charlotte BeckAcknowledgments ReferencesAmerican Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington: American Psychiatric Association; 1994.Hillier S. Intervention for children with developmental coordination disorder: a systematic review. INTERNET J ALLIED HEALTH SCI PRACT 2007 07;5(3):1-11.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.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.Smyth TR GD. Information processing deficits in clumsy children. Aust.J.Psychol. 1986;38:13-22.Volman MJM GR. Relative phase stability of bimanual and visuomanual rhythmic coordination patterns in children with a developmental coordination disorder. Hum Movement Sci 1998;17:541-572.Missiuna C, Rivard L, Bartlett D. Early identification and risk management of children with developmental coordination disorder. Pediatric Physical Therapy 2003 Mar;15(1):32-38.World Health Organization. International classification of functioning, disability and health: children & youth version: ICF-CY. Geneva: World Health Organization; 2007.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.ReferencesHadders-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.Polatajko HJ, Cantin N. Developmental coordination disorder (dyspraxia): an overview of the state of the art. Semin.Pediatr.Neurol. 2005 Dec;12(4):250-258.Deconinck FJA, De Clercq D, Savelsbergh 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.Utley A, Astill SL. 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.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.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.Wilson PH, Maruff P, Ives S, Currie J. Abnormalities of motor and praxis imagery in children with DCD. Human Movement Science 2001 Mar;20(1-2):135-159.Johnston LM, Burns YR, Brauer SG, Richardson CA. Differences in postural control and movement performance during goal directed reaching in children with developmental coordination disorder. Human Movement Science 2002 Dec;21(5-6):583-601.Whitall J, Getchell N, McMenamin S, Horn C, Wilms-Floet A, Clark 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.ReferencesPeters 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.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 PHYSIOTHER 2007 11;35(3):99-109.Pless M, Carlsson M, Sundelin C, Persson K. Pre-school children with developmental co-ordination disorder: Self-perceived competence and group motor skill intervention. Acta Paediatrica, International Journal of Paediatrics 2001;90(5):532-538.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.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 Science 2007 Jun;26(3):477-490.Cherng RJ, Hsu YW, Chen YJ, Chen JY. Standing balance of children with developmental coordination disorder under altered sensory conditions. Human Movement Science 2007 Dec;26(6):913-926.Grove CR, Lazarus JA. Impaired re-weighting of sensory feedback for maintenance of postural control in children with developmental coordination disorder. Human Movement Science 2007 Jun;26(3):457-476.Inder JM, Sullivan SJ. Does an educational kinesiology intervention alter postural control in children with a developmental coordination disorder? CLIN KINESIOL 2004 12;58(4):9-26.Inder JM, Sullivan SJ. Motor and postural response profiles of four children with developmental coordination disorder. Pediatric Physical Therapy 2005;17(1):18-29.ReferencesLaufer 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.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.Cantin N, Polatajko HJ, Thach WT, Jaglal S. Developmental coordination disorder: exploration of a cerebellar hypothesis. Human Movement Science 2007 Jun;26(3):491-509.Dunford C, Missiuna C, Street E, Sibert 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.Taylor S, Fayed N, Mandich A. CO-OP intervention for young children with developmental coordination disorder. OTJR Occupation, Participation and Health 2007 Sep;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 Disability and Human Development 2006 Jul;5(3):257-263.Mandich AD, Polatajko HJ, Rodger S. Rites of passage: understanding participation of children with developmental coordination disorder. Human Movement Science 2003 Nov;22(4-5):583-595.Miyahara M, Wafer A. Clinical intervention for children with developmental coordination disorder: A multiple case study. Adapted Physical Activity Quarterly 2004 Jul;21(3):281-300.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. Clinical Case Studies 2008 Jun;7(3):191-207.QuestionsFigure 3. Impairments Based on ICF ClassificationBody Functions and Structures ImpairmentsNeuromusculoskeletal and movement related functionsBall catchingOnset of postural musclesCoordination? Movement durationSensory functions and painBalancePostural controlMental functionsPerceived competenceImagined movements? Reaction time during attentional tasksFunctions of the heart and respiration? FitnessActivities and Participation ImpairmentsFunctions of mobilityBall handling skillsPencil skills, Gross motor function, Academic activitiesFunctions of self careFine motor manipulationDressing, Grooming, BathingCommunity social and civic lifeSoccer, Basketball, BikingLearning and applying knowledgeCopying tasksGeneral tasks and demandsNo conclusive dataQualitative studiesGross and fine motor skills (Hopping, Skipping, Running, Biking)Low self esteemDecreased confidence in abilitiesAppendix A: Sample Search Strategy from Embase Database1. “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 57. exp Motor Performance/8. exp Motor Dysfunction/9. 7 or 810. exp Developmental Disorder/11. 9 and 1012. 6 or 1113. exp Psychomotor Performance/14. exp “Movement (Physiology)”/15. exp VISUOMOTOR COORDINATION/ or exp EYE HAND COORDINATION/ or exp COORDINATION/ or exp MOTOR COORDINATION/16. exp GAIT DISORDER/ or exp GAIT/17. exp BALANCE IMPAIRMENT/ or exp BALANCE DISORDER/18. exp Body Equilibrium/19. exp Proprioception/ or exp Body Equilibrium/ or exp Body Posture/20. exp Developmental Stability/21. exp Physical Disability/22. exp Motor Performance/23. exp Task Performance/24. exp Motor Activity/25. exp Sensorimotor 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 2830. exp Daily Life Activity/ or exp ADL DISABILITY/31. adl*.mp.32. exp EXERCISE/33. exp Physical Activity/34. exp Human Activities/35. exp LEISURE/36. activit*.mp.37. 30 or 31 or 32 or 33 or 34 or 35 or 3638. exp SPORT/39. exp PLAY/40. exp RECREATION/41. exp Patient Participation/42. participat*.mp.43. 38 or 39 or 40 or 41 or 4244. 29 or 37 or 4345. 12 and 4446. 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>)) Deficits are not consistent with the child’s intellectual abilities Not caused by obvious medical/neurological conditions that could explain the coordination deficits.**Pilot studies rationale: activity and participation, all encompassing*School aged*More research is necessary to determine the mechanisms responsible for these deficits.Possible explanations: difficulties in spatial orientation and timing, inability to find appropriate motor solutions (Astill)*More research is needed to confirm this finding and identify potential mechanisms.Possible Explanations: deficit in generating forward models of an efference copy leading to deficits in purposive behavior, occurs in parietal lobe (lewis)Although DCD children were slower, the main purpose of these studies was to look at imagined movement.*fBut more research is needed to draw a more definite conclusion.Possible explanations: Decreased ability to stabilize trunk may lead to further deficits when controlling the body in space (Johnston), disturbed temporal coordination of central motor program - cerebellum? (Jucaite)*This measure indicated the stability or tightness of coupling between metronome and clap or step within trials*Further research is needed as the mechanisms are unclear. Possible Explanations: deficit in generating forward models of an efference copy leading to deficits in purposive behavior, occurs in parietal lobe (lewis*Talk about link between mental functions and reaction time, challenging ability to keep attention*The exact conditions and significance of these impairments remain unclear.*Drawing conclusions based on these studies is limited due to small sample sizes and lack of controls.***For the purposes of this review, reported outcome measures have been classified according to the most appropriate, but not necessarily sole, suitable category. *Holistic approach to assessing and treating children with DCD* 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. 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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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