The Effects of Attentional Focus Instruction on the Performance of a Whole-Body Coordination Task in Children With Developmental Coordination Disorder

An external focus promotes motor learning of an aiming task in individuals with hearing impairments

Research has shown that external relative to internal focus (IF) instructions may improve motor performance as well as cognitive function (e.g., attentional stability and task-focus). The aim of the study was to examine the influence of attentional focus instructions on skill acquisition and learning of an aiming task in individuals with hearing impairments. The participants (N = 39, Mage = 17.87 ± 1.88 years) performed a bowling task with their dominant hand to knock down as many pins as possible. On day 1, they were randomly divided into three attentional focus groups; IF (focus on your throwing hand), external focus (EF) (focus on the pins), and control (no-focus) instructions. Each participant performed 36 trials, divided into 3 blocks of 12 trials. Attentional focus instructions were given before each block, with a brief reminder provided after each 3 trials. On day 2, retention and transfer (further distance) tests were performed. Results showed that while there were no significant differences between groups in the pre-test, the EF group outperformed both IF and control groups in retention and transfer tests. No significant difference was found between the control and IF. The findings suggest that the advantages of the external relative to the IF and no-focus instructions may generalize to individuals with hearing impairments.

Which outcomes are key to the pre-intervention assessment profile of a child with developmental coordination disorder? A systematic review and meta-analysis

BACKGROUND

Purpose of this study was to determine what key aspects of function should be incorporated to make up a pre-intervention assessment profile of a child with Developmental Coordination Disorder (DCD); more specifically, what aspects of functioning are implicated in DCD and what is their relative impact?

METHODS

A systematic review and meta-analysis were conducted, for which Pubmed, Web of Science, Scopus and Proquest were searched (last update: April 2023, PROSPERO: CRD42023461619). Case-control studies were included to determine point estimates for performances on field-based tests in different domains of functioning. Risk of bias was assessed, and level of evidence estimated. Random-effect meta-analyses were performed to calculate the pooled standardized mean differences for domains of functioning and subgrouping was done for clinically relevant subdomains. Heterogeneity was determined with I2.

RESULTS

121 papers were included for analyses. Data of 5 923 children with DCD were included (59.8% boys) and 23 619 Typically Developing (TD) children (45.8% boys). The mean (SD) age of the DCD group was 10.3y (1.2) and 9.3y (1.3) for the TD children. Moderate evidence was found for motor performance, executive functions, sensory processing and perceptions, cognitive functions and sports and leisure activities to be affected in children with DCD.

CONCLUSION

Differences between the two groups varied per domain of functioning. This emphasizes the diversity present within children with DCD and provides a rationale for explaining the heterogeneity in this patient group. Yet, results highlight the potential involvement of all these domains and call for clinicians to be alert not only to examine motor skill difficulties but also other aspects of function. Results indicate the need to develop an individualized pre-intervention multi-dimensional assessment profile for each child with DCD. It also supports the important role that clinicians play in an interdisciplinary team to tackle the difficulties encountered by children with DCD.

The effect of a visual illusion and self-controlled practice on motor learning in children at risk for developmental coordination disorder

Numerous efforts have been made to test the OPTIMAL theory of motor learning in healthy children and adult populations. However, only a small number of studies have tested this theory in children with cognitive-motor disorders, such as developmental coordination disorder (DCD). The present study aims to examine the individual and additive effects of a visual illusion and self-controlled practice on a golf putting task in children at risk for DCD based on the OPTIMAL theory. Forty children at risk for DCD (mean age = 8.57 ± 1.05 years) were randomly assigned to four experimental groups (1-small visual illusion + self-controlled practice; 2-big visual illusion + self-controlled practice; 3-small visual illusion + yoked; 4-big visual illusion + yoked). Following 12 pretest trials of a golf putting task, the participants completed 5 blocks of 12 trials of practice on the first day. A retention test (12 trials) and a transfer dual-task test (12 trials) were conducted on the second day. The results indicated that in retention test the big visual illusion + self-controlled practice group was significantly better than the small visual illusion + yoked group (p = 0.01), while there was not any other significant difference between groups at retention test as well as between all groups at practice phase and transfer test (p > 0.05 for all comparisons). In other words, an additive effect has been observed just in the retention test but not the practice phase as well as transfer test. In general, the results of this study support the OPTIMAL theory of motor learning in children at risk for DCD and suggests to all educators who work with these children to use the combination of the visual illusion with self-controlled practice to improve the motor learning of children at risk for DCD.

Evaluating the influence of feedback on motor skill learning and motor performance for children with developmental coordination disorder: a systematic review

Introduction

Children with developmental coordination disorder (DCD) have difficulties with learning and performing physical tasks. It is well known that task-specific practice is effective in improving motor skills. Additional feedback during practice may function as a quality improvement mechanism and therefore enhance motor skill outcomes.

Aims

To investigate the effect of different forms of feedback on motor learning and motor performance in children with DCD.

Methods

A systematic review was conducted (registration CRD42020175118) to investigate the effectiveness of different types of feedback, compared to other forms of feedback, or no additional feedback, on motor learning and motor performance outcomes in children with DCD. The search was run across six electronic databases (last search January 2024). Two reviewers independently screened studies for inclusion, assessed the quality of included studies, and extracted relevant data. A narrative synthesis was performed and included studies that assessed motor learning and/or performance outcomes following an intervention that delivered a specific form of feedback in comparison to another form of feedback or no specific feedback.

Results

14 articles from 13 trials were included in this review. Feedback was delivered by providing various forms of feedback, including: knowledge of results, focus of attention and augmented feedback delivered via technology. No significant differences were found between different forms of feedback for motor learning or performance outcomes for children with DCD. Interventions that used technology (with augmented feedback) to deliver the intervention were found to be as effective as traditional therapy. All groups who participated in therapy, regardless of the presence or type of feedback received, improved in overall scores on a motor performance outcome assessment.

Conclusion

Despite the clear rationale for using feedback-oriented interventions for children with DCD, there is surprisingly limited and low-quality research. There is no clear evidence that one form of feedback is more effective than another, although it appears that feedback delivered via technology may be as effective as feedback delivered in traditional therapy interventions for children with DCD. Further exploration is required from appropriately powered and well-designed trials.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=175118, identifier (CRD42020175118).

How do paediatric physical therapists teach motor skills to children with Developmental Coordination Disorder? An interview study

BACKGROUND

When teaching motor skills, paediatric physical therapists (PPTs) use various motor learning strategies (MLSs), adapting these to suit the individual child and the task being practised. Knowledge about the clinical decision-making process of PPTs in choosing and adapting MLSs when treating children with Developmental Coordination Disorder (DCD) is currently lacking. Therefore, this qualitative study aimed to explore PPTs' use of MLSs when teaching motor skills to children with DCD.

METHODS

Semi-structured individual and group interviews were conducted with PPTs with a wide range of experience in treating children with DCD. A conventional content analysis approach was used where all transcripts were open-coded by two reviewers independently. Categories and themes were discussed within the research group. Data were collected until saturation was reached.

RESULTS

Twenty-six PPTs (median age: 49 years; range: 26-66) participated in 12 individual interviews and two focus-group interviews. Six themes were identified: (1) PPTs treated children in a tailor-made way; (2) PPTs' teaching style was either more indirect or direct; (3) PPTs used various strategies to improve children's motivation; (4) PPTs had reached the optimal level of practice when children were challenged; (5) PPTs gave special attention to automatization and transfer during treatment; and (6) PPTs considered task complexity when choosing MLSs, which appeared determined by task constraints, environmental demands, child and therapist characteristics.

CONCLUSION

PPTs' clinical decision-making processes in choosing MLSs appeared strongly influenced by therapist characteristics like knowledge and experience, resulting in large variation in the use of MLSs and teaching styles to enhance motivation, automatization, and transfer. This study indicates the importance of the level of education on using MLSs to teach children motor skills, and clinical decision-making. Future research should focus on implementing this knowledge into daily practice.

Therapists' Use of Instructions and Feedback in Motor Learning Interventions in Children with Developmental Coordination Disorder: A Video Observation Study

AIM

This qualitative study explored therapists' use of instructions and feedback when teaching motor tasks to children with developmental coordination disorder (DCD) as a first step in developing practical recommendations.

METHODS

A conventional content analysis approach was used to analyze videotaped treatment sessions of physical therapists using a newly developed analysis plan. Inductive coding was used to code purposively selected video segments. The codes were sorted into categories to identify key themes. Analyses were performed independently by two researchers until data saturation was reached.

RESULTS

Ten video-taped sessions were analyzed and 61 segments were coded. Three key themes were identified: (1) therapists' intention with the instructions and feedback was to motivate or to provide information; (2) the preferred therapists' teaching style was either direct or indirect; and (3) parameters to shape specific instructions and feedback were the focus of attention, modality, information content, timing and frequency.

CONCLUSION

Therapists used numerous instructions and feedback with different information content, often shaped by multiple focuses and/or modalities to motivate children or to provide specific information about task performance. Although therapists adapted instructions and feedback to child and task, future research should explore how characteristics of child and task can guide therapists' clinical decision-making.

Behavioral and Neuroimaging Research on Developmental Coordination Disorder (DCD): A Combined Systematic Review and Meta-Analysis of Recent Findings

AIM

The neurocognitive basis of Developmental Coordination Disorder (DCD; or motor clumsiness) remains an issue of continued debate. This combined systematic review and meta-analysis provides a synthesis of recent experimental studies on the motor control, cognitive, and neural underpinnings of DCD.

METHODS

The review included all published work conducted since September 2016 and up to April 2021. One-hundred papers with a DCD-Control comparison were included, with 1,374 effect sizes entered into a multi-level meta-analysis.

RESULTS

The most profound deficits were shown in: voluntary gaze control during movement; cognitive-motor integration; practice-/context-dependent motor learning; internal modeling; more variable movement kinematics/kinetics; larger safety margins when locomoting, and atypical neural structure and function across sensori-motor and prefrontal regions.

INTERPRETATION

Taken together, these results on DCD suggest fundamental deficits in visual-motor mapping and cognitive-motor integration, and abnormal maturation of motor networks, but also areas of pragmatic compensation for motor control deficits. Implications for current theory, future research, and evidence-based practice are discussed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, identifier: CRD42020185444.