The efficacy of Le Bon Départ and Sensory Integration treatment for children with developmental coordination disorder: a randomized study with six single cases

Auditory-Perceptual and Auditory-Motor Timing Abilities in Children with Developmental Coordination Disorder: A Scoping Review

Developmental coordination disorder (DCD) remains largely underdiagnosed and masked by other co-occurring conditions. The aim of this study was to (1) provide the first review of research regarding auditory-motor timing and synchronization abilities in children with DCD and (2) examine whether reduced motor performance may be associated with difficulties in auditory perceptual timing. The scoping review was carried out across five major databases (MEDLINE, Embase, PsycINFO, CINAHL, and Scopus) in accordance with the PRISMA-ScR guidelines. Studies were screened by two independent reviewers against the inclusion criteria, without publication date restrictions. From an initial return of 1673 records, 16 articles were included in the final review and synthesized based on the timing modality studied (i.e., auditory-perceptual, motor, or auditory-motor). Results suggest that children with DCD have difficulties with rhythmic movements both with and without external auditory cues and further indicate that variability in and slowness of motor response are key characteristics of DCD, regardless of the experimental task. Importantly, our review highlights a significant gap in the literature regarding auditory perceptual abilities in DCD. In addition to testing auditory perception, future studies should compare the performance of children with DCD on paced and unpaced tasks to determine whether auditory stimuli contribute to a more or less stable performance. This knowledge may inform future therapeutic interventions.

Inferior Auditory Time Perception in Children With Motor Difficulties

Accurate time perception is crucial for hearing (speech, music) and action (walking, catching). Motor brain regions are recruited during auditory time perception. Therefore, the hypothesis was tested that children (age 6-7) at risk for developmental coordination disorder (rDCD), a neurodevelopmental disorder involving motor difficulties, would show nonmotor auditory time perception deficits. Psychophysical tasks confirmed that children with rDCD have poorer duration and rhythm perception than typically developing children (N = 47, d = 0.95-1.01). Electroencephalography showed delayed mismatch negativity or P3a event-related potential latency in response to duration or rhythm deviants, reflecting inefficient brain processing (N = 54, d = 0.71-0.95). These findings are among the first to characterize perceptual timing deficits in DCD, suggesting important theoretical and clinical implications.

Motor skill intervention for pre-school children: A scoping review

Background

There is a high prevalence of motor skill difficulties amongst pre-school children living in low socio-economic areas. Motor skill impairment can affect these children’s school readiness and academic progress, social skills, play and general independence.

Objectives

This scoping review investigates the key elements of existing motor skill interventions for pre-school children.

Method

We gathered information through structured database searches from Cinahl, Eric, PubMed, Cochrane, ProQuest, Psych Net, PEDro and Scopus, using a keyword string. The PRISMA-SCR design was used to identify 45 eligible studies. All included studies investigated a motor skill intervention with well-defined outcome measures for children aged 4–7 years with motor skill difficulties. Studies that exclusively focused on children with neurological conditions such as cerebral palsy, physical disabilities or medical/physical deteriorating conditions were excluded. Information was charted on MS Excel spreadsheets. Fundamental concepts were categorised into common key themes and were converted into a proposed framework.

Results

Fifteen intervention approaches were identified. Treatment is mostly managed by occupational therapists and physiotherapists. Evidence supports individual and group treatment with a child-centred, playful approach in a school or therapeutic setting. Whilst session information varied, there is moderate evidence to suggest that a 15-week programme, with two weekly sessions, may be feasible.

Conclusion

Children with motor skill difficulties need therapeutic intervention. This study identified the key elements of existing therapy intervention methods and converted it into a proposed framework for intervention planning. It is a first step towards addressing motor skill difficulties amongst pre-school children in low socio-economic areas.

Is auditory perceptual timing a core deficit of developmental coordination disorder?

Time is an essential dimension for perceiving and processing auditory events, and for planning and producing motor behaviors. Developmental coordination disorder (DCD) is a neurodevelopmental disorder affecting 5-6% of children that is characterized by deficits in motor skills. Studies show that children with DCD have motor timing and sensorimotor timing deficits. We suggest that auditory perceptual timing deficits may also be core characteristics of DCD. This idea is consistent with evidence from several domains, (1) motor-related brain regions are often involved in auditory timing process; (2) DCD has high comorbidity with dyslexia and attention deficit hyperactivity, which are known to be associated with auditory timing deficits; (3) a few studies report deficits in auditory-motor timing among children with DCD; and (4) our preliminary behavioral and neuroimaging results show that children with DCD at age 6 and 7 have deficits in auditory time discrimination compared to typically developing children. We propose directions for investigating auditory perceptual timing processing in DCD that use various behavioral and neuroimaging approaches. From a clinical perspective, research findings can potentially benefit our understanding of the etiology of DCD, identify early biomarkers of DCD, and can be used to develop evidence-based interventions for DCD involving auditory-motor training.

Reaction to the sensory integration therapy in children with postural stability deficits

BACKGROUND

The goal was to examine the influence of sensory integration therapy (SIT) on one leg standing in children with deficits of the postural stability.

METHODS

28 children 4-6 year old that could not stand on one leg for more than 20 seconds were randomly divided into control "C" and experimental "E" groups. Group "C" participated in standard classes in the kindergarten. Group "E" participated in sensory integration therapy (SIT) for 2 weeks, 5 times a week (additionally to the standard classes).

RESULTS

Results of the experiment show that the skill of standing on one leg has significantly improved (P<0.01) in the group that underwent additional therapy. The change in time of standing on the right leg with eyes open in the E group was statistically and significantly higher than the changes observed in the same time in group C (F=22.5, P=0.001' η²=0.44). Similarly, significant changes in time of standing on the right leg with eyes closed were observed in group E. The foregoing changes were bigger in group E than in group C (F=16. 1, P=0.004, η²=0.36). The analysis post hoc revealed that while there were no significant differences between the two groups on the pretest (P>0.05), there were significant differences between groups in right leg standing test with eyes open or closed on posttest. (P<0.05). Similar results were observed during on the one, left leg standing. The time of one leg standing with both eyes open and closed improved more significantly in group E than in group C (F=20.4, P=0.001, η²=0.42 respectively for the test with eyes open and F=7.4, P=0.010, η²=0.21 for the test with eyes closed). The analysis post hoc revealed that while there were no significant differences between the two groups on the pretest (P>0.05), there were significant differences between groups in left leg standing test with eyes open or closed on posttest (P<0.05).

CONCLUSIONS

Research conducted show that there is a positive influence of SIT on children with low level of postural stability. Its significant improvement in children with low levels of postural stability is important not only for the current functioning of those children but for their future - by protecting them from falling down and from injuries.

A systematic review of high quality randomized controlled trials investigating motor skill programmes for children with developmental coordination disorder

OBJECTIVE

To identify effective motor training interventions for children with developmental coordination disorder from research graded as high quality (using objective criteria) for the purpose of informing evidence-based clinical practice.

DATA SOURCES

We followed the guidance for conducting systematic reviews issued by the Centre for Reviews and Dissemination. Six OvidSP electronic databases (AMED, All EBM reviews (including Cochrane), Embase, Ovid MEDLINE, PsychARTICLES Full Text, PsycINFO) were searched systematically. We aimed to retain only randomized control trials and systematic reviews of randomized control trials, defined as the highest level of evidence by the Oxford Centre for Evidence-Based Medicine. We searched reference lists of retained articles to identify further appropriate articles.

REVIEW METHODS

Two reviewers critically appraised and categorized articles by effect size (including confidence intervals), inclusion of power calculations and quality using the Physiotherapy Evidence Database (PEDro) scale. Only studies scoring seven or more on the PEDro scale (classed by the PEDro as high reliability) were retained.

RESULTS

No systematic reviews met our criteria for inclusion from 846 articles yielded by the systematic search. Nine randomized control trials investigating 15 interventions to improve motor skills met our inclusion criteria for 'high quality'. Nevertheless, not all included studies were adequately powered for determining an effect.

CONCLUSION

Large effect sizes associated with 95 % confidence intervals suggest that 'Neuromotor Task Training', 'Task-oriented Motor Training' and 'Motor Imagery + Task Practice Training' are the most effective reported interventions for improving motor skills in children with developmental coordination disorder.

Systematic review of sensory integration therapy for individuals with disabilities: Single case design studies

Sensory integration therapy (SIT) is a controversial intervention that is widely used for people with disabilities. Systematic analysis was conducted on the outcomes of 17 single case design studies on sensory integration therapy for people with, or at-risk of, a developmental or learning disability, disorder or delay. An assessment of the quality of methodology of the studies found most used weak designs and poor methodology, with a tendency for higher quality studies to produce negative results. Based on limited comparative evidence, functional analysis-based interventions for challenging behavior were more effective that SIT. Overall the studies do not provide convincing evidence for the efficacy of sensory integration therapy. Given the findings of the present review and other recent analyses it is advised that the use of SIT be limited to experimental contexts. Issues with the studies and possible improvements for future research are discussed including the need to employ designs that allow for adequate demonstration of experimental control.

Feasibility study of a single-blind randomised controlled trial of an occupational therapy intervention

BACKGROUND

Several factors facilitate or hinder efficacy research in occupational therapy. Strategies are needed, therefore, to support the successful implementation of trials.

AIM

To assess the feasibility of conducting a randomised controlled trial (RCT). The main feasibility objectives of this study were to assess the process, resources, management, and scientific basis of a trial RCT.

MATERIAL AND METHODS

A total of 10 occupational therapists, between the ages of 30 and 55 (M 43.4; SD 8.3) with seven to 26 years' (M 14.3; SD 6.1) experience, participated in this study. Qualitative data collected included minutes of meetings, reports, and field notes. The data were analysed based on the principles of content analysis, using feasibility objectives as the main categories.

RESULTS

Data analysis revealed strengths in relation to retention and inclusion criteria of participants, the study protocol, study organisation, and the competence of researchers. Weaknesses were found related to recruitment, randomisation, data collection, time for training and communication, commitment, and design.

CONCLUSION

The findings indicated that there are several factors which had a considerable impact on the implementation of an RCT in practice. However, it was useful to assess methods and procedures of the trial RCT as a basis to refine research plans.

Deficient motor timing in children with neurofibromatosis type 1

Neurofibromatosis type 1 (NF1) is one of the most common single-gene disorders affecting fine and visual-motor skills. This case-control study investigated motor timing as a possible related performance deficit in children with NF1. A visual-motor reaction time (VRT) test was administered in 20 NF1 children (mean age 9 years 7 months) and 20 age- and gender-matched typically developing (TD) children. Copying and tracing performance were evaluated using the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI). Children with NF1 responded with an increased reaction time (RT) to temporally predictive stimuli compared to TD children, whereas RT at unpredictive stimuli did not differ between groups. Motor timing indexed by the RT decrease at predictive stimuli significantly associated with the Beery VMI copy and tracing outcomes. Deficient motor timing as an actual symptom may add to further research on the pathogenesis of NF1-associated motor impairment and the development of more effective treatment.

Efficacy of interventions to improve motor performance in children with developmental coordination disorder: a combined systematic review and meta-analysis

AIM

The aim of this study was to review systematically evidence about the efficacy of motor interventions for children with developmental coordination disorder (DCD), and to quantify treatment effects using meta-analysis.

METHOD

Included were all studies published between 1995 and 2011 that described a systematic review, (randomized) clinical trial, or crossover design about the effect of motor intervention in children with DCD. Studies were compared on four components: design, methodological quality, intervention components, and efficacy. Twenty-six studies met the inclusion criteria for the review. Interventions were coded under four types: (1) task-oriented intervention, (2) traditional physical therapy and occupational therapy, (3) process-oriented therapies, and (4) chemical supplements. For the meta-analysis, effect sizes were available for 20 studies and their magnitude (weighted Cohen's d [d(w) ]) was compared across training types.

RESULTS

The overall effect size across all intervention studies was d(w) =0.56. A comparison between classes of intervention showed strong effects for task-oriented intervention (d(w) =0.89) and physical and occupational therapies (d(w) =0.83), whereas that for process-oriented intervention was weak (d(w) =0.12). Of the chemical supplements, treatment with methylphenidate was researched in three studies (d(w) =0.79) and supplementation of fatty acids plus vitamin E in one study (no effect). The post hoc comparison between treatment types showed that the effect size of the task-oriented approach was significantly higher than the process-oriented intervention (p=0.01) and comparison (p=0.006). No significant difference in the magnitude of effect size between traditional physical and occupational therapy approaches and any of the other interventions emerged.

INTERPRETATION

In general, intervention is shown to produce benefit for the motor performance of children with DCD, over and above no intervention. However, approaches from a task-oriented perspective yield stronger effects. Process-oriented approaches are not recommended for improving motor performance in DCD, whereas the evidence for chemical supplements for children with DCD is currently insufficient for a recommendation.

Examining the Evidence for Interventions with Children with Developmental Coordination Disorder

Introduction:

This paper presents the results of a critical review of the literature regarding the evidence for the effectiveness of a selection of interventions in terms of improving occupational performance in children with developmental coordination disorder (DCD).

Method:

The inclusion criteria for articles reviewed were as follows: be about children whose primary diagnosis was DCD; present actual research into the effectiveness of an intervention or interventions; consider interventions that fit with occupational therapy practice (although it was not necessary for the intervention to be carried out by an occupational therapist); be published in peer-reviewed journals; and be available in the English language. The literature search was conducted by applying Boolean logic to the following databases: EMBASE, PsycINFO, CINAHL and ERIC. All articles that had the potential to fit the inclusion criteria were collected and screened for suitability. Reference lists of pertinent articles were also checked for further literature. The publication date of articles ranged from 1984 to 2011. Nineteen articles were deemed suitable for further appraisal and were appraised using the Critical Appraisal Skills Programme.

Findings:

The findings indicated that, of those interventions reviewed, the most effective in improving occupational performance was the Cognitive Orientation to Daily Occupational Performance approach.

Systematic review of the research evidence examining the effectiveness of interventions using a sensory integrative approach for children

Twenty-seven studies were systematically reviewed to identify, evaluate, and synthesize the research literature on the effectiveness of sensory integration (SI) intervention on the ability of children with difficulty processing and integrating sensory information to engage in desired occupations and to apply these findings to occupational therapy practice. Results suggest the SI approach may result in positive outcomes in sensorimotor skills and motor planning; socialization, attention, and behavioral regulation; reading-related skills; participation in active play; and achievement of individualized goals. Gross motor skills, self-esteem, and reading gains may be sustained from 3 mo to 2 yr. Findings may be limited by Type II error because of small sample sizes, variable intervention dosage, lack of fidelity to intervention, and selection of outcomes that may not be meaningful to clients and families or may not change with amount of treatment provided. Replication of findings with methodologically and theoretically sound studies is needed to support current findings.

Sensory processing disorder: any of a nurse practitioner's business?

PURPOSE

Children who exhibit the confusing symptom patterns associated with sensory processing deficits are often seen first by primary care providers, including family and pediatric nurse practitioners (NPs). The purpose of this article is to alert NPs to the state of the science for these disorders and to the roles NPs could play in filling the knowledge gaps in assessment, treatment, education, and research.

DATA SOURCES

Literature searches using PubMed and MedLine databases and clinical practice observations.

CONCLUSIONS

Sensory integration disorders have only begun to be defined during the past 35 years. They are not currently included in the DSM IV standard terminology, and are not yet substantively incorporated into most health disciplines' curricula or practice, including those of the NP.

IMPLICATIONS FOR PRACTICE

NPs are in a unique position to test hypothesized terminology for Sensory Processing Disorder (SPD) by contributing precise clinical descriptions of children who match as well as deviate from the criteria for three proposed diagnostic groups: Sensory Modulation Disorder (SMD), Sensory Discrimination Disorder (SDD), and Sensory-Based Motor Disorder (SBMD). Beyond the SPD diagnostic debate, for children with sensory deficit patterns the NP role can incorporate participating in interdisciplinary treatment plans, refining differential diagnoses, providing frontline referral and support for affected children and their families, and making both secondary prevention and critical causal research possible through validation of consistently accepted diagnostic criteria.

Interrater reliability of the Movement Assessment Battery for Children

BACKGROUND AND PURPOSE

The Movement Assessment Battery for Children (M-ABC) is a widely used, standardized assessment of motor performance in children. The total score obtained on this test often is used to identify children who are either definitely impaired or at risk for motor impairment. The purpose of this study was to determine the interrater reliability of data for the M-ABC when scored by pediatric physical therapists working in routine clinical settings.

SUBJECTS AND METHODS

For 9 children who were referred to clinical settings for an assessment of possible movement difficulties, performance on the appropriate age band of the M-ABC was videotaped. The 9 children, one at each age from 4 through 12 years, represented all ages covered by the test. The videotaped performances were rated according to the test instructions by 131 pediatric physical therapists with a range of experience and by an expert rater who developed the Dutch version of the test.

RESULTS

The average agreement between therapists in their classification of the children was very high. The kappa coefficients for the 9 videos ranged from .95 to 1.00.

DISCUSSION AND CONCLUSION

Errors made by the therapists could be classified as those that might be common to all tests and those that are specific to the M-ABC.

Multidisciplinary assessment of children with developmental coordination disorder: using the ICF framework to inform assessment

The aim of this study was to describe relationships in young children with motor coordination problems between measures of motor, functional, self-efficacy, and communication administered by a multidisciplinary team and the fit of these measures within the framework of the International Classification of Functioning, Disability and Health (ICF) (World Health Organisation, 2001). Sixty children, 40 males and 20 females, with mean age 72.5 months (SD= 11.4 months) referred to a university physiotherapy clinic met the inclusion criteria for developmental coordination disorder (DCD). Each measure provided a different perspective of performance when considered within the framework of the ICF. The findings suggest caution when using the Movement Assessment Battery for Children (M-ABC) for the purpose of diagnosis with young referred children, since 25 of the 60 children scored > 15th percentile, despite demonstrating motor deficits at home and school. Further research is needed to address assessment at the participation level. Viewing children from the multiple perspective of each discipline highlights the range of challenges faced by children with DCD.

Improvements in performance following optometric vision therapy in a child with dyspraxia

SS, an 8-year-old boy with dyspraxia, presented for behavioural optometry assessment. He had been diagnosed with a subtle form of dyspraxia by his paediatric occupational therapist, based on poor proprioception, delayed bilateral integration and poor visual perception. A full visual assessment was carried out. SS was given a programme of reflex inhibition exercises for 3 months. Then, a programme of optometric vision therapy (OVT) exercises was prescribed at home and in practice for a period of 8 months. SS was assessed using a battery of occupational therapy Sensory Integration and Praxis Tests (SIPT) before optometric intervention, and after OVT. There were significant improvements in fusional reserves, accommodative facility and oculomotor control of pursuit and saccadic eye movements. His reading level had changed by 4 years in 11 months. The SIPT results showed improvements in the visual and motor/visual perception subtests, confirming the significant changes in visual perceptual performance. Consideration is given to treatment modalities for dyspraxia, and the studies confirming their effectivity of approach. This case study provides evidence supporting the use of OVT eye exercises in dyspraxia, ocular motility, accommodative dysfunction, learning difficulties and sports performance. The need for further research and inter-professional working is discussed.

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.