Navigating through apertures: perceptual judgements and actions of children with Developmental Coordination Disorder

Children with developmental coordination disorders: a review of approaches to assessment and intervention

Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder characterized by deficits in motor skills, with gross and fine motor dysfunction being the main symptom. This condition greatly impairs children's daily life, learning, and social interaction. Symptoms typically appear during preschool or school age, and if left untreated, they can persist into adulthood. Thus, early assessment and intervention are crucial to improve the prognosis. This study aims to review the existing literature on DCD, providing a comprehensive overview of the assessment for children with DCD in terms of body functions and structures, activities and participation, and environmental factors within the framework of the International Classification of Functioning, Disability, and Health - Children and Youth (ICF-CY). Additionally, specific rehabilitation interventions will be described, offering valuable insights for the clinical assessment and intervention of children with DCD.

Moving With Confidence: How Does Anxiety Impede Performance in Individuals With Developmental Coordination Disorder (DCD)?

Purpose of Review

It is well-established that anxiety levels are higher among people with developmental coordination disorder (DCD) compared to their peers. However, it is unclear whether this anxiety influences movement and behaviour. The purpose of this paper is to review studies demonstrating the influence of anxiety on movement and/or behaviour in non-DCD and DCD populations.

Recent Findings

When considering non-DCD literature, many studies have illustrated the influence of anxiety on movement. Only two papers were found which explicitly aimed to consider the influence of anxiety on movement in a DCD population. These findings are described and explored against a backdrop of the wider research field.

Summary

This paper has highlighted the potential role of anxiety in constraining movement patterns in DCD. While a great deal more evidence is needed before definitive conclusions, there is emerging evidence that motor behaviour may be related to task-specific anxiety in children with DCD.

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.

Perception of Affordances for Vertical and Horizontal Jumping in Children: Gymnasts Versus Non-Athletes

Purpose: We investigated the perception of affordances for vertical jumping-and-reaching and horizontal jumping by children. Method: In the horizontal task, children were asked to judge their ability in the standing long jump. In the vertical task, children were asked to judge the height of a ball that they could run to, jump up, and reach with their fingertips. Following judgments, children performed both types of jumps. We compared gymnasts (children with at least 2 years of gymnastics training; 7.92 ± 0.91 years) versus children with no competitive athletic experience (7.74 ± 0.86 years). Results: As expected, actual ability was greater in gymnasts than in non-athletes, for both types of jump (each p < .001). We separately analyzed Constant Error and Absolute Error of judgments (relative to actual performance). Results revealed that gymnasts tended toward underestimation, while non-athletes tended toward overestimation. Absolute error differed between tasks for the non-athletes (p < .001), but for the gymnasts the difference between conditions was not significant (p = .25). Absolute error differed between groups for vertical jump-and-reach (p < .01) but not for horizonal jump (p = .17). Conclusions: Gymnastics experience was associated with a generalized tendency for children to underestimate their jumping ability. In addition, gymnastics experience was associated with judgment accuracy that was consistent across tasks. The results reveal that gymnastics training is associated with changes in athletic ability, but also with changes in the perception of affordances.

To step or to spring: the influence of state anxiety on perceptual judgements and executed action

Emotional state, in particular anxiety, has been shown to constrain perceptual judgement of action capabilities. However, whether anxiety also constrains actual behaviour is unknown. The current study, therefore, aimed to determine whether state anxiety constrained firstly perceptual judgements of action capabilities and secondly actual behaviour. To do this, we asked participants to make perceptual judgements and perform action behaviours in relation to crossing ground-based apertures representing puddles. State anxiety was measured in 30 participants using the State-Trait Anxiety Inventory. The critical ratio of aperture size relative to leg length at which participants' behaviour choice would switch between a step and a spring was calculated. In a perceptual judgement task, participants judged the ratio at which they would choose to switch. In a subsequent executed action task, the ratio at which they actually switched was measured. Perceptual critical ratio could be predicted via state anxiety and age, while action critical ratio was not predicted by either. Therefore, this study has demonstrated that state anxiety and age both constrain perceptual judgement of action capabilities, as shown in previous studies. However, this does not seem to result in a change in emergent behaviour. This highlights the importance of measuring emergent behaviour rather than inferring it from perceptual judgements even when they are couched in terms of action.

Developmental coordination disorder

Developmental coordination disorder (DCD) is a neurodevelopmental disorder that affects children's ability to execute coordinated motor actions, resulting in slow, clumsy, or inaccurate motor performances and learning difficulties (of new motor tasks or to adapt previously learned gestures to a modified or additional constraint). In the course of development, children with DCD exhibit a diversity of motor signs, including fine and gross motor problems with impaired postural control and balance, and sensorimotor coordination or motor learning difficulties. The prevalence ranges between 1.8% and 8%, depending on the diagnostic criteria used, based on the cutoff of motor scores from standardized scales. Four main hypotheses have been postulated to explain DCD in terms of deficits in visuospatial functions, procedural learning, internal modeling, or executive functions. Neuroimaging studies are scarce but have highlighted several brain regions, including the parietal, frontal, and cerebellar cortices. Meta-analyses have supported task-oriented approaches as effective therapies to improve motor performance in children with DCD.

Visual detection of affordances for aperture negotiation in people with Parkinson disease

BACKGROUND

An essential requirement for the guidance of action in cluttered environments is that people can accurately perceive what actions are afforded by particular surroundings given the person's action capabilities. Research has shown that healthy young individuals turn their shoulders when walking through a doorway when the aperture is less than a certain percentage of their shoulder width and that they are able to detect this critical width with visual inspection. These findings imply that movements are constrained by perception of the environment in body-scaled unit.

OBJECTIVES

The present work examined whether the visual affordance of doorway passability is altered in people with Parkinson disease (PD).

METHODS

People with PD, healthy age-matched controls, and young adults (16 participants per group) walked through a series of apertures scaled to shoulder width. Participants also had to visually judge a series of apertures to determine if they could walk through the gap with their normal gait pattern. Finally, participants had to estimate their eye height.

RESULTS

Statistical analysis revealed that people with PD initiated shoulder turning to go through the doorway at larger apertures (A) relative to their shoulder (S) width (A/S = 1.61) in comparison to healthy age-matched participants (A/S = 1.41) and young adults (A/S = 1.26). In comparison to healthy participants, People with PD also judged wider apertures as impassable. Individuals with PD were less accurate in their estimation of eye height (Error = 10.1%) than the healthy older (Error = 6.29%) and younger adults (Error = 4.79%).

CONCLUSIONS

PD significantly impacted the affordances for aperture negotiation. Such altered perceptual affordances may contribute to gait pattern changes in people with PD when walking through doorways. These findings suggest that some of the motor symptoms in PD might have a perceptual underpinning.

Physical Growth, Body Scale, and Perceptual-Motor Development

In this chapter we consider from the theoretical framework of the ecological approach to perception and action, the relations between physical growth and body scale in the context of children's perceptual-motor development. Body scale and the timescale of its change through growth are shown to relate to the emergence and dissolution of the fundamental skills in infancy, the perception of what an environment affords functionally for action, together with the emergent pattern of movement coordination. A central issue in typical and atypical motor development is the mapping of the timescale of adaptive change in the acquisition of perceptual-motor skill to the accompanying timescale of change in physical growth.

Understanding the Functional Mobility of Adults with Developmental Coordination Disorder (DCD) Through the International Classification of Functioning (ICF)

PURPOSE OF REVIEW

This phenomenological study explored the lived experience of six adults with developmental coordination disorder (DCD) and its potential impact on functional mobility. Utilising the International Classification of Functioning (World Health Organisation, 2001), the data derived from interviews were analysed to consider how persistent motor impairments impact on activity engagement and participation.

RECENT FINDINGS

Much of the research evidence pertaining to DCD focuses on children. However, there is increasing acknowledgment that for some, the motor impairments synonymous with DCD continue into adulthood.

SUMMARY

The findings from this study suggest that for this group of participants, functional mobility can be compromised, restricting activity and participation. At a body structure/function level, participants identified additional impairments that moved beyond mobility, suggesting that the secondary consequences of fatigue and anxiety were disabling. However, personal factors were seen to mitigate some difficulties encountered to allow participants to remain actively engaged in a range of adult roles.

When an object appears unexpectedly: foot placement during obstacle circumvention in children and adults with Developmental Coordination Disorder

Adjustments to locomotion to avoid an obstacle require a change to the usual pattern of foot placement, i.e. changes to step length and/or step width. Previous studies have demonstrated a difficulty in individuals with Developmental Coordination Disorder (DCD) in controlling stability while both stepping over and while circumventing an obstacle. In a previous study, we have considered the way in which individuals with DCD prepare for the possibility of an obstacle appearing (Wilmut and Barnett in Exp Brain Res 235:1531-1340, 2017). Using a parallel data set from this same task on the same individuals, the aim of the current study was to investigate the exact nature of changes in foot placement during obstacle avoidance, as this was not clear from previous work. Children and adults aged from 7 to 34 years of age took part in the study. Forty-four met the criteria for a diagnosis of DCD and there were 44 typically developing (TD) age and gender-matched controls. Participants walked at a comfortable pace down an 11 m walkway; on 6 out of 36 trials a 'gate' closed across their pathway which required circumvention. These 6 'gate close' trials were analysed for this study. The number and magnitude of step length and step width adjustments were similar across the DCD and TD groups, however, the younger children (7-11 years) made a greater number of early adjustments compared to the older children and adults (12-34 years of age). In contrast the adults made a greater number of adjustments later in the movement compared to the children. In terms of foot placement adjustments a clear preference was seen across all participants to use adjustments which resulted in reducing step length, stepping away from the obstacle and a combination of these. Apart from subtle differences, the individuals with DCD make step placements to circumvent an obstacle in line with their peers. It is suggested that the choice of foot placement strategy in individuals with DCD, although in line with their peers, may not be optimal for their level of motor ability.

When an object appears unexpectedly: anticipatory movement and object circumvention in individuals with and without Developmental Coordination Disorder

Obstacles often appear unexpectedly in our pathway and these require us to make adjustments to avoid collision. Previous research has demonstrated that healthy adults will make anticipatory adjustments to gait where they have been told there is the possibility of an obstacle appearing. One population that may find this type of anticipatory movement difficult is individuals with Developmental Coordination Disorder (DCD). The current study considered how individuals with and without DCD adjust to the possibility of an obstacle appearing which would require circumvention. Fortyfour individuals with DCD and 44 age-matched controls (aged from 7 to 34 years of age) walked down an 11 m walkway under three conditions. Initially they were told this was a clear pathway and nothing in the environment would change (1, no possibility of an obstacle, no obstacle). They then performed a series of trials in which a gate may (2, possibility of an obstacle, obstacle) or may not (3, possibility of an obstacle, no obstacle) partially obstruct their pathway. We found that all participants increased medio-lateral trunk acceleration when there was the possibility of an obstacle but before the obstacle appeared, in addition the typical adults and older children also increased step width. When describing circumvention we found that the younger children showed an increase in trunk velocity and acceleration in all three directions compared to older children and adults. We also found that the individuals with DCD adjusted their path sooner and deviated more than their peers. The degree of adjustment to step width in anticipation of an obstacle was related to later medio-lateral velocity and timing of the deviation. Therefore, the lack of 'readying' the system where there is the possibility of an obstacle appearing seen in the individuals with DCD and the younger typical children may explain the increased medio-lateral velocity seen during circumvention.

Developmental coordination disorder and its cause: The road less travelled

We critically review the research literature that seeks to focus on the possible cause of children diagnosed with developmental coordination disorder (DCD). In so doing we contrast the traditional information processing (IP) approach as a model to explain the causal factors that account for the motor deficits present in children with DCD, with a dynamical systems (DS) account which argues that coordination deficits in children with DCD is less to do with problems of poor internal models (a cornerstone of IP theory) and more with a degrading of perception-action coupling. We review and comment on the extant empirical data and conclusions of both approaches. We conclude that the data for an IP explanation is weak and a reconsideration of DCD is in order with respect to the underlying cause of this issue.