Brain functional connectivity in children with developmental coordination disorder following rehabilitation intervention

Changes in cortical grey matter volume with Cognitive Orientation to daily Occupational Performance intervention in children with developmental coordination disorder

Introduction

Cognitive Orientation to daily Occupational Performance (CO-OP) is a cognitive-based, task-specific intervention recommended for children with developmental coordination disorder (DCD). We recently showed structural and functional brain changes after CO-OP, including increased cerebellar grey matter. This study aimed to determine whether CO-OP intervention induced changes in cortical grey matter volume in children with DCD, and if these changes were associated with improvements in motor performance and movement quality.

Methods

This study is part of a randomized waitlist-control trial (ClinicalTrials.gov ID: NCT02597751). Children with DCD (N = 78) were randomized to either a treatment or waitlist group and underwent three MRIs over 6 months. The treatment group received intervention (once weekly for 10 weeks) between the first and second scan; the waitlist group received intervention between the second and third scan. Cortical grey matter volume was measured using voxel-based morphometry (VBM). Behavioral outcome measures included the Performance Quality Rating Scale (PQRS) and Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2). Of the 78 children, 58 were excluded (mostly due to insufficient data quality), leaving a final N = 20 for analyses. Due to the small sample size, we combined both groups to examine treatment effects. Cortical grey matter volume differences were assessed using a repeated measures ANOVA, controlling for total intracranial volume. Regression analyses examined the relationship of grey matter volume changes to BOT-2 (motor performance) and PQRS (movement quality).

Results

After CO-OP, children had significantly decreased grey matter in the right superior frontal gyrus and middle/posterior cingulate gyri. We found no significant associations of grey matter volume changes with PQRS or BOT-2 scores.

Conclusion

Decreased cortical grey matter volume generally reflects greater brain maturity. Decreases in grey matter volume after CO-OP intervention were in regions associated with self-regulation and motor control, consistent with our other studies. Decreased grey matter volume may be due to focal increases in synaptic pruning, perhaps as a result of strengthening networks in the brain via the repeated learning and actions in therapy. Findings from this study add to the growing body of literature demonstrating positive neuroplastic changes in the brain after CO-OP intervention.

Effects of a highly intensive balance therapy camp in children with developmental coordination disorder - An intervention protocol

BACKGROUND

Children with Developmental Coordination Disorder (DCD) often (<87 %) experience postural control problems, impacting all levels of the International Classification of Functioning, Disability and Health (ICF) including their daily participation, self-esteem and mental health. Due to the multisystemic nature of postural control, comprehensive therapy should target all systems which is currently not the case. Highly intensive therapy is effective and commonly used in pediatric populations, but has not been explored yet to train postural control in children with DCD.

AIMS

To investigate the effects of a highly intensive functional balance therapy camp at all ICF levels in children with DCD.

METHODS AND PROCEDURES

The effects on postural control, muscle activity, brain alterations, self-perceived competence, self-identified goals, gross motor activities and participation are evaluated. Participants are assessed pre- and post-intervention, including a 3 months follow-up. Forty-eight children with DCD, aged 6-12 years old, receive 40 h of comprehensive balance training. This intervention is fun, individually tailored, targets all postural control systems, implements different motor learning strategies and includes both individual and group activities.

CONCLUSION

Novel insights into the effects of a highly intensive comprehensive balance therapy camp designed for children with DCD will be gained at all levels of the ICF.

Functional connectivity during tic suppression predicts reductions in vocal tics following behavior therapy in children with Tourette syndrome

BACKGROUND

Comprehensive Behavioral Intervention for Tics (CBIT) is recommended as a first-line treatment for Tourette syndrome in children and adults. While there is strong evidence proving its efficacy, the mechanisms of reduction in tic severity during CBIT are still poorly understood. In a recent study, our group identified a functional brain network involved in tic suppression in children with TS. We reasoned that voluntary tic suppression and CBIT may share some mechanisms and thus we wanted to assess whether functional connectivity during tic suppression was associated with CBIT outcome.

METHODS

Thirty-two children with TS, aged 8 to 13 years old, participated in a randomized controlled trial of CBIT v. a treatment-as-usual control condition. EEG was recorded during tic suppression in all participants at baseline and endpoint. We used a source-reconstructed EEG connectivity pipeline to assess functional connectivity during tic suppression.

RESULTS

Functional connectivity during tic suppression did not change from baseline to endpoint. However, baseline tic suppression-related functional connectivity specifically predicted the decrease in vocal tic severity from baseline to endpoint in the CBIT group. Supplementary analyses revealed that the functional connectivity between the right superior frontal gyrus and the right angular gyrus was mainly driving this effect.

CONCLUSIONS

This study revealed that functional connectivity during tic suppression at baseline predicted reduction in vocal tic severity. These results suggest probable overlap between the mechanisms of voluntary tic suppression and those of behavior therapy for tics.

A systematic review of behavioral and neurobiological profiles associated with coexisting attention-deficit/hyperactivity disorder and developmental coordination disorder

Attention-deficit/hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) co-occur in approximately 50% of cases. This study aimed to characterize the behavioral, cognitive, and neurobiological profiles of co-occurring ADHD and DCD diagnoses by mapping, synthesizing, and providing a critical appraisal of the existing literature. A systematic search was conducted across four databases (MEDLINE, PsycINFO, Embase, and Scopus) to identify studies comparing a coexisting ADHD+DCD diagnosis to ADHD and DCD alone. From 2353 screened articles, 15 behavioral and 10 neuroimaging studies were included. Collectively, these studies suggest that the comorbid ADHD+DCD presentation constitutes a more severe phenotype characterized by neurocognitive differences associated with both conditions. Despite sharing some common neural features, our findings support the separate etiology hypothesis indicating that neural network alterations in individuals with ADHD+DCD represent a unique neural pattern rather than a sum of ADHD and DCD characteristics. Considering the heterogeneity inherent to both ADHD and DCD, future studies should involve rigorous and comprehensive assessment procedures to delineate how different subtypes of each diagnosis relate to distinct performance characteristics.

Motor learning in developmental coordination disorder: behavioral and neuroimaging study

Developmental coordination disorder (DCD) is characterized by motor learning deficits that are poorly understood within whole-body activities context. Here we present results of one of the largest non-randomized interventional trials combining brain imaging and motion capture techniques to examine motor skill acquisition and its underpinning mechanisms in adolescents with and without DCD. A total of 86 adolescents with low fitness levels (including 48 with DCD) were trained on a novel stepping task for a duration of 7 weeks. Motor performance during the stepping task was assessed under single and dual-task conditions. Concurrent cortical activation in the prefrontal cortex (PFC) was measured using functional near-infrared spectroscopy (fNIRS). Additionally, structural and functional magnetic resonance imaging (MRI) was conducted during a similar stepping task at the beginning of the trial. The results indicate that adolescents with DCD performed similarly to their peers with lower levels of fitness in the novel stepping task and demonstrated the ability to learn and improve motor performance. Both groups showed significant improvements in both tasks and under single- and dual-task conditions at post-intervention and follow-up compared to baseline. While both groups initially made more errors in the Stroop task under dual-task conditions, at follow-up, a significant difference between single- and dual-task conditions was observed only in the DCD group. Notably, differences in prefrontal activation patterns between the groups emerged at different time points and task conditions. Adolescents with DCD exhibited distinct prefrontal activation responses during the learning and performance of a motor task, particularly when complexity was increased by concurrent cognitive tasks. Furthermore, a relationship was observed between MRI brain structure and function measures and initial performance in the novel stepping task. Overall, these findings suggest that strategies that address task and environmental complexities, while simultaneously enhancing brain activity through a range of tasks, offer opportunities to increase the participation of adolescents with low fitness in physical activity and sports.

Cognitive Orientation to Daily Occupational Performance: A Randomized Controlled Trial Examining Intervention Effects on Children with Developmental Coordination Disorder Traits

Children with traits of developmental coordination disorder (DCD-t) may experience occupational performance problems that go unrecognized and therefore may not be adequately supported. The cognitive orientation to daily occupational performance (CO-OP) approach has been effective in interventions for developmental coordination disorder (DCD). Based on an open-label, randomized controlled trial design, this study evaluated the effects of CO-OP on the occupational performance and motor skills of older kindergarten children with DCD-t using the School Assessment of Motor and Process Skills (S-AMPS) and the Movement Assessment Battery for Children, Second Edition. Children with a total DCDQ score of less than 40 or M-ABC2 scores in the 5th to 16th percentile were considered to have DCD-t. Furthermore, children with DCD-t and S-AMPS process skills less than 0.7 were considered to have DAMP (Deficits in Attention, Motor control and Perception)-t. After 3 months of CO-OP intervention, the performance and motor skills of children with DCD-t improved significantly. However, there were no significant changes noted in the motor skills of children with DAMP-t, although their occupational performance improved. These results suggest that CO-OP is effective even for older kindergarten children with DCD-t. However, further improvement of the CO-OP approach or a different strategy is required for children with ADHD comorbidity.

Direct machine learning reconstruction of respiratory variation waveforms from resting state fMRI data in a pediatric population

In many functional magnetic resonance imaging (fMRI) studies, respiratory signals are unavailable or do not have acceptable quality due to issues with subject compliance, equipment failure or signal error. In large databases, such as the Human Connectome Projects, over half of the respiratory recordings may be unusable. As a result, the direct removal of low frequency respiratory variations from the blood oxygen level-dependent (BOLD) signal time series is not possible. This study proposes a deep learning-based method for reconstruction of respiratory variation (RV) waveforms directly from BOLD fMRI data in pediatric participants (aged 5 to 21 years old), and does not require any respiratory measurement device. To do this, the Lifespan Human Connectome Project in Development (HCP-D) dataset, which includes respiratory measurements, was used to both train a convolutional neural network (CNN) and evaluate its performance. Results show that a CNN can capture informative features from the BOLD signal time course and reconstruct accurate RV timeseries, especially when the subject has a prominent respiratory event. This work advances the use of direct estimation of physiological parameters from fMRI, which will eventually lead to reduced complexity and decrease the burden on participants because they may not be required to wear a respiratory bellows.

Perspective: Acknowledging complexity to advance the understanding of developmental coordination disorder

Developmental Coordination Disorder (DCD) is a heterogeneous neurodevelopmental disorder known for primary symptoms of motor learning and execution difficulties. Recent research has consistently suggested DCD symptoms span broadly beyond motor difficulties, yet a majority of research and practice approaches the investigation, diagnosis, and treatment of DCD with a reductionist framework. Therefore, this paper suggests the paradigm of complexity theory as a means for better conceptualization, assessment, and treatment of DCD. First, the perspective of complexity theory and its relevance to DCD is described. Then, examples from recent research which attempt to acknowledge and capture the complex nature of DCD are highlighted. Finally, suggestions for considering and measuring complexity of DCD in future research and practice are provided. Overall, the perspective of complexity can propel the research forward and improve the understanding of DCD relevant to assessment and treatment. The complexity paradigm is highly relevant to describing the evolving and multidimensional picture of DCD, understanding heterogeneous symptom profiles, making connections to interconnected secondary symptoms, and beyond.

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.

White Matter Changes With Rehabilitation in Children With Developmental Coordination Disorder: A Randomized Controlled Trial

Background and Objectives: Children with developmental coordination disorder (DCD) have difficulty learning motor skills, which can affect their participation in activities of daily living and psychosocial well-being. Over 50% of children with DCD also have attention deficit hyperactivity disorder (ADHD), which further exacerbates their motor problems and impact on quality of life. A rehabilitation approach known as Cognitive Orientation to Occupational Performance uses problem-solving strategies to help children learn motor skills they wish to achieve. While this cognitive approach has been effective for children with DCD, few studies have examined the effectiveness of this approach for children with co-occurring ADHD. Further, the underlying mechanism and neural basis of this intervention are largely unknown.

Methods: In this randomized waitlist-controlled trial, we used MRI to examine white matter microstructure after intervention in 8–12-year-old children with DCD (n = 28) and with DCD and co-occurring ADHD (n = 25). Children in both groups were randomized to either a treatment group or waitlist group at their first MRI. The treatment group began the intervention after their MRI scan and returned for a post-treatment scan at 3 months, and follow-up scan at 6 months; the waitlist group waited 3 months before their second MRI, received the intervention, and then had a post-treatment scan. Each child received intervention once weekly for 10 weeks. Diffusion tensor imaging was used to acquire white matter diffusion parameters and was analyzed using tract-based spatial statistics (TBSS).

Results and Conclusion: Children with DCD showed significant improvement in white matter microstructure in the bilateral anterior thalamic radiation, bilateral sensorimotor tract, bilateral cingulum, fornix, splenium and body of corpus callosum, right inferior fronto-occipital fasciculus, and white matter pathways to bilateral inferior gyri, right middle frontal gyrus, frontal medial cortex, and left cuneus. We suggest that these rehabilitation-induced neural changes in children with DCD occurred in regions associated with attention, self-regulation, motor planning, and inter-hemispheric communication, which positively affected brain connectivity and motor function. In contrast, children with DCD and co-occurring ADHD did not show any brain changes following the intervention. Modifications to the treatment protocol might help address the attentional and self-regulatory needs of children with a dual diagnosis.

Clinical Trial Registration: ClinicalTrials.gov ID: NCT02597751.