Development and evaluation of a group physical activity programme for children with developmental co-ordination disorder: An interdisciplinary approach

Description of School-Based Physical Therapy Services and Outcomes for Students with Down Syndrome

Students with Down syndrome (DS) receive school-based physical therapy (SBPT), however little data exists regarding services and outcomes. Using a prospective observational cohort study our aim was to explore SBPT activities and interventions, and students' goal achievement of 46 students with DS, tracked by 17 physical therapists (PTs). PTs provided on average 24.0 min/week direct service and 11.6 min/week services on behalf of the student. The most frequent activities employed were physical education/recreation, mobility, and sitting/standing/transitions. The most frequent interventions implemented were neuromuscular, mobility, and musculoskeletal. Although students individually met 69.5% of their primary outcome goals, their achievement could not be explained by total minutes of either direct and minutes on behalf of SBPT, nor minutes spent in most frequent activity.

Is Group-Based or Individual-Based Intervention more Effective for Quality of Life Outcomes in Children with Developmental Coordination Disorder? A Systematic Review

Aims: To examine whether group-based or individual-based treatment programs are more effective for quality of life (QOL) outcomes in children with developmental coordination disorder (DCD). Methods: A systematic search of the literature was conducted, in accordance with the PRISMA guidelines. Quality of the papers was assessed using the Modified Downs and Black Checklist. Peer-reviewed clinical experimental studies of children diagnosed with DCD with any QOL related outcome measure were included, of all years, languages, and approaches of intervention. Results: Sixteen studies were identified for inclusion, of mixed methodological qualities (predominantly low). Improvement of QOL with both group-based and individual-based interventions were shown, though large degrees of heterogeneity were observed in study designs, participants, modes of interventions, durations, and outcome measures utilized. Conclusions: The effectiveness of group-based versus individual-based interventions on QOL of children with DCD is unclear. There is a pressing need for a high quality, powered trials, utilizing the randomized control trial paradigm, comparing both intervention approaches with standardized treatment approaches and outcome measures to determine and compare the effect on QOL of children with DCD.

Physical activity and fitness in children with developmental coordination disorder: a systematic review

Developmental coordination disorder (DCD) is a neurodevelopmental condition characterized by poor motor proficiency that interferes with a child's activities of daily living. Activities that most young children engage in such as running, walking, and jumping are important for the proper development of fitness and overall health. However, children with DCD usually find these activities challenging. A systematic review of the literature was conducted to synthesize the recent available data on fitness and physical activity in children with DCD, and to understand the extent of the differences between children with DCD and their typically developing peers. Systematic searches of electronic databases and reference lists identified 40 peer-reviewed studies meeting the inclusion criteria. These studies were reviewed in terms of: (a) study design, (b) population, (c) assessment tools, (d) measures, and (e) fitness and physical activity outcomes. It has been demonstrated that body composition, cardiorespiratory fitness, muscle strength and endurance, anaerobic capacity, power, and physical activity have all been negatively associated, to various degrees, with poor motor proficiency. However, differences in flexibility were not conclusive as the results on this parameter are mixed. Studies' limitations and the impact of results on future work are discussed.

Understanding teachers' perceptions of the motor difficulties of children with developmental coordination disorder (DCD)

BACKGROUND

Children with developmental coordination disorder (DCD) are often identified by classroom teachers and the identification process relies heavily on teachers' perceptions. The literature would suggest that teachers' perceptions may be influenced by a child's gender, behaviour and the type of motor problem they demonstrate. To date, the influence of these factors on teachers' perceptions of children with DCD has not been empirically tested.

AIM

This study investigated whether child gender, behaviour and type of motor problem influenced teachers' ratings of concern and importance of intervening for children with motor difficulties.

SAMPLE

One hundred and forty-seven teachers of children from 6 to 9 years of age participated in this study.

METHOD

Hypothetical case scenarios were developed that experimentally manipulated the factors of child gender (male/female), behaviour (disruptive/non-disruptive) and type of motor problem (fine motor/gross motor). Teachers were given two case scenarios of the same gender (that varied by behaviour) and rated: (a) their degree of concern about children's motor problems and (b) how important they thought it was for the child to receive intervention for that problem.

RESULTS

The effect of child gender on teachers' perceptions depends upon the type of motor problem. While child behaviour had a marginal influence on teachers' perceptions, interestingly, teachers appeared to recognize motor problems only in the absence of disruptive behaviour. The type of motor problem demonstrated also influenced teachers' perceptions.

CONCLUSION

This study provides preliminary insight into factors that influence teachers' perceptions of children with DCD with clear implications for the classroom identification of children with DCD.

Increased physical work loads in modern work--a necessity for better health and performance?

Shifting workforce proportions to sedentary occupations and technology developments in traditionally physically demanding occupations have resulted in low physical workloads for many workers. Insufficient physical stress is known to have detrimental short- and long-term effects on health and physical capacity. It is argued herein that many modern workers are at risk of insufficient physical workload. Further, it is argued that the traditional physical ergonomics paradigm of reducing risk by reducing physical loads ('less is better') is not appropriate for many modern occupations. It is proposed that a new paradigm is required, where 'more can be better'. The potential for work to be seen as an arena for improving physical health and capability is discussed and the types of changes to work that may be required are outlined. The paper also discusses challenges and responsibilities presented by this new paradigm for ergonomists, employers, health and safety authorities and the community. The majority of workers in affluent communities now face the significant threat to health of insufficient physical workload. Ergonomics can design work to a prescription that can not only reduce injury risk but enhance health and capacity. However, this will require a change in paradigm.

Effect of sensorimotor groups on gross motor acquisition for young children with Down syndrome

PURPOSE

To examine whether participation in sensorimotor groups and individual intervention resulted in greater improvements in motor skill acquisition than solely individual intervention for young children with Down syndrome.

METHODS

Ten children with Down syndrome, 13 to 29 months of age, participated. Children in both groups received individual intervention, and children in the intervention group participated in 10 weekly sensorimotor groups. All children were assessed at 3 points using the Gross Motor Function Measure and Goal Attainment Scaling.

RESULTS

Children in the intervention group demonstrated significant improvement compared with children in the control group at the p < 0.10 level in lying and rolling, crawling and kneeling, and total score domains of the Gross Motor Function Measure and in Goal Attainment Scaling.

CONCLUSIONS

Participation in sensorimotor groups and individual intervention resulted in greater improvement in motor skill acquisition than solely individual intervention for young children with Down syndrome. Additional research to support these exploratory findings is needed.

The effect of different intervention programmes on the self-concept and motor proficiency of 7- to 9-year-old children with DCD

BACKGROUND

The self-concept of children is influenced by developmental co-ordination disorder (DCD). The aim was to determine the most effective method in enhancing motor proficiency and self-concept of 7- to 9-year-old children with DCD.

METHODS

Teachers at nine different schools identified 201 possible DCD candidates. The Movement Assessment Battery for Children identified 58 with DCD (36 boys and 22 girls). Self-concept and anxiety were determined by the Tennessee Self-Concept Scale (Child Form) and Child Anxiety Scale respectively. The children were randomly grouped into four experimental groups [motor intervention (MI), self-concept (SC) enhancing intervention, psycho-motor intervention (P-MI) and a control group (CG)]. A two-way analysis of variance (anova) with a group factor and a repeated measures over time followed by a Bonferroni post hoc analysis and separate one-way anovas followed by a Tukey post hoc analysis were conducted to determine between-group and within-group differences at the pre-, post- and re-tests. Effect sizes (d) were calculated to determine the practical significance of statistical differences (P < 0.05).

RESULTS

After completion of the intervention programmes, no significant improvement in motor proficiency was found in the SC group, while the MI, P-MI and CG groups improved significantly (P < 0.01). No further improvements were found after the retention period in all the groups. From the pre-test to retest 2, the MI, P-MI and CG improved (P < 0.01), while the SC showed lower (P > 0.05) motor proficiency. A tendency of lower anxiety (P > 0.05) was found in the SC, while the total self-concept of the P-MI showed the biggest improvement (P < 0.05).

CONCLUSION

Motor proficiency and self-concept of children with DCD benefit from intervention, but both should be addressed for optimal benefits.

Use of groups in pediatric physical therapy: survey of current practices

PURPOSE

This nationwide survey study aimed to examine the use of groups in pediatric physical therapy, including characteristics, effectiveness, and financial considerations of group intervention.

METHODS

Questionnaires were mailed to 500 randomly selected members of the American Physical Therapy Association Section on Pediatrics. Respondents reported on the characteristics of children typically included in group intervention, types of activities used, effectiveness at meeting goals, billing methods, and documentation practices.

RESULTS AND CONCLUSIONS

The response rate was 285 (57%). Only 41.4% of respondents reported using groups. Characteristics of group intervention were variable among respondents, and considerable differences in billing practices and perceived effectiveness were noted. Commonly reported characteristics included use of small groups of young children with developmental delay and use of task specific developmental activities. Perceived benefits and limitations of group intervention were also reported. Implications for further research into the use of groups were explored.

Parental questions about developmental coordination disorder: A synopsis of current evidence

In recent years, knowledge about developmental coordination disorder (DCD) has accumulated very rapidly. Considerable progress has been made in the understanding of DCD, but recent studies have not been compiled in a way that makes them easily accessible to practicing paediatricians. In the present paper, the literature is reviewed and organized around the questions commonly raised by parents of children with DCD when they meet with their paediatrician. Parents express concern and seek information about their child's movement difficulties. They want to know what causes their child's lack of coordination and whether DCD is the correct diagnosis. Are other developmental disorders involved? What can they do to help their child's daily frustrations? The present review addresses frequently asked questions through a critical appraisal of current research literature. Paediatricians who are familiar with the research evidence will be better able to recognize these children and to share information with parents.

Developmental coordination disorder (dyspraxia): an overview of the state of the art

A large number of school-aged children present with motor-based performance problems that have significant negative effects on their ability to participate fully in the daily activities of home, school, and play. These children have a neurodevelopmental disorder most commonly known as developmental coordination disorder (DCD). These children are frequently brought to the attention of the family doctor and referred to health care professionals in search of answers and services. Therapists treating these children have a large number of intervention approaches at their disposal. This paper presents an overview of these approaches and a review of the available evidence. The evidence for the older, deficit-oriented approaches remains inconclusive, at best; whereas the task-oriented approaches, seem to be better supported. While more work is needed to validate the use of the task-oriented approaches, the results suggest that a shift in perspective from a deficit-oriented to a task-oriented perspective would be appropriate.

Provision for children with developmental co-ordination disorder (DCD): audit of the service provider

BACKGROUND

The aim of this study was to conduct an audit of parent/carer satisfaction with the service provided for children presenting with movement difficulties [developmental co-ordination disorder (DCD)/dyspraxia] at the out-patient physiotherapy clinic of a specialist tertiary referral paediatric hospital.

METHOD

A postal questionnaire was used to obtain objective and subjective data on the service offered. Factual information on aspects such as waiting time for first appointment, type of intervention offered, etc. was checked against clinical records. Satisfaction with the service was assessed using ratings and open-ended comment.

RESULTS

Forty-five families completed the questionnaire. The results showed that the service was generally rated highly. The opportunity to discuss the child's problems and its implications was considered valuable. Among families offered 1 : 1 intervention, a statistically significant correlation emerged between the number of sessions attended and perceived effectiveness. Among families offered a home programme, perceived effectiveness was related to the number of times per week the child practised the programme.

CONCLUSIONS

This study showed that many children from mainstream schools with co-ordination problems continued to find it difficult to obtain a clear diagnosis. Once a referral and assessment had been achieved, however, parents/carers were shown to be satisfied with the package offered by this service provider.

Motor performance checklist for 5-year-olds: a tool for identifying children at risk of developmental co-ordination disorder

OBJECTIVE

The aim of this study was to further evaluate the 'Motor Performance Checklist for 5-year-olds', an instrument which had been piloted with some success and reported via this journal in 1996.

METHOD

Both validity and reliability in identifying children in most need of paediatric occupational therapy services was assessed. The Motor Performance Checklist was compared against a chosen 'gold standard' test, The Bruininks-Oseretsky test of Motor Proficiency, in a group of 141 5-year-old children.

RESULTS

Correlations of 0.72 and 0.85 were found between the tests. The checklist was found to have a sensitivity of 83% and a specificity of 98%. Positive predictive validity was found to be 72% and negative predictive validity 99%. Interrater reliability ranged between 0.79 and 0.99 and intrarater reliability was 0.77.

CONCLUSIONS

These results indicate that the Motor Performance Checklist has the potential to assist in identifying children in most need of referral to community occupational therapy services.