Aim
These international clinical practice recommendations (CPR) for developmental coordination disorder (DCD), initiated by the European Academy of Childhood Disability (EACD), aim to address key ...questions on the definition, diagnosis, assessment, intervention, and psychosocial aspects of DCD relevant for clinical practice.
Method
Key questions in five areas were considered through literature reviews and formal expert consensus. For recommendations based on evidence, literature searches on ‘mechanisms’, ‘assessment’, and ‘intervention’ were updated since the last recommendations in 2012. New searches were conducted for ‘psychosocial issues’ and ‘adolescents/adults’. Evidence was rated according to the Oxford Centre for Evidence‐Based Medicine (level of evidence LOE 1–4) and transferred into recommendations. For recommendations based on formal consensus, two meetings of an international, multidisciplinary expert panel were conducted with a further five Delphi rounds to develop good clinical practice (GCP) recommendations.
Results
Thirty‐five recommendations were made. Eight were based on the evidence from literature reviews (three on ‘assessment’, five on ‘intervention’). Twenty‐two were updated from the 2012 recommendations. New recommendations relate to diagnosis and assessment (two GCPs) and psychosocial issues (three GCPs). Additionally, one new recommendation (LOE) reflects active video games as adjuncts to more traditional activity‐oriented and participation‐oriented interventions, and two new recommendations (one GCP, one LOE) were made for adolescents and adults with DCD.
Interpretation
The CPR–DCD is a comprehensive overview of DCD and current understanding based on research evidence and expert consensus. It reflects the state of the art for clinicians and scientists of varied disciplines. The international CPR–DCD may serve as a basis for national guidelines.
What this paper adds
Updated international clinical practice guidelines on developmental coordination disorder (DCD).
Refined and extended recommendations on clinical assessment and intervention for DCD.
A critical synopsis of current research on mechanisms of DCD.
A critical synopsis of psychosocial issues in DCD, with implications for clinical practice.
The first international recommendations to consider adolescents and adults with DCD.
Resumen
Recomendaciones internacionales para la práctica clínica sobre la definición, diagnóstico, evaluación, intervención y aspectos psicosociales del trastorno del desarrollo de la coordinación
Objetivo
Estas recomendaciones internacionales para la práctica clínica (RPC) sobre el trastorno del desarrollo de la coordinación (TDC), iniciadas por la Academia Europea de Discapacidad Infantil (EACD), tienen como objetivo abordar preguntas clave sobre la definición, diagnóstico, evaluación, intervención y aspectos psicosociales de TDC relevantes para la práctica clínica.
Método
Las preguntas clave en cinco áreas fueron tratadas a través de revisiones bibliográficas y consenso formal de expertos. Para las recomendaciones basadas en la evidencia, las búsquedas en la literatura sobre “mecanismos”, “evaluación” e “intervención” se actualizaron desde las últimas recomendaciones en 2012. Se realizaron nuevas búsquedas para “problemas psicosociales” y “adolescentes / adultos”. La evidencia se calificó de acuerdo con la gradación del Centro de Oxford para Medicina Basada en la Evidencia (nivel de evidencia LOE 1–4) y en ello se basaron las recomendaciones. Para recomendaciones basadas en el consenso formal, se llevaron a cabo dos reuniones de un panel multidisciplinario internacional de expertos con cinco rondas Delphi adicionales para desarrollar recomendaciones de buena práctica clínica (BPC).
Resultados
Se realizaron 35 recomendaciones. Ocho de ellas se basaron en la evidencia de las revisiones de la literatura (tres en “evaluación”, cinco en “intervención”). Veintidós fueron actualizadas a partir de las recomendaciones de 2012. Las nuevas recomendaciones se relacionan con el diagnóstico y la evaluación (dos BPC) y las cuestiones psicosociales (tres BPC). Además, una nueva recomendación (LOE) trata acerca de los videojuegos activos como complemento de las intervenciones más tradicionales orientadas a la actividad y la participación, y se hicieron dos nuevas recomendaciones (una BCP, una LOE) para adolescentes y adultos con TDC.
Interpretación
Estas recomendaciones internacionales para la práctica clínica sobre TDC aportan una visión general completa sobre TDC y el conocimiento actual basado en evidencia de investigación y consenso de expertos. Brinda actualización para clínicos y científicos de diversas disciplinas. Las recomendaciones internacionales para la práctica clínica TDC pueden servir como base para recomendaciones nacionales.
Recomendações internacionais para a prática clínica na definição, diagnóstico, avaliação, intervenção e aspectos psicossociais do transtorno do desenvolvimento da coordenação
Objetivo
Essas recomendações internacionais para a prática clínica (RPC) no transtorno do desenvolvimento da coordenação (TDC), iniciadas pela Academia Européia de Deficiência Infantil (EACD), objetiva direcionar questões chave na definição, diagnóstico, avaliação, intervenção e aspectos psicossociais do TDC relevantes para a prática clínica.
Métodos
Questões chave em cinco áreas foram consideradas através de revisões da literatura e consensos formais de especialistas. Para recomendações baseadas em evidências, buscas na literatura em “mecanismos”, “avaliação” e “intervenção” foram atualizadas desde as últimas recomendações de 2012. Novas buscas foram conduzidas para “problemas psicossociais” e “adolescentes/adultos”. Evidências foram classificadas de acordo com o Centro Oxford para Medicina Baseada em Evidência (nível de evidência NE 1‐4) e transferidas em recomendações. Para recomendações baseadas em consensos formais, dois encontros de um painel de especialistas internacional e multidisciplinar foram conduzidos com posteriormente cinco sessões Delphi para desenvolver recomendações de boa prática clínica (BPC).
Resultados
Trinta e cinco recomendações foram feitas. Oito foram baseadas em evidências de revisões da literatura (três em “avaliação”, cinco em “intervenção). Vinte e duas foram atualizadas das recomendações de 2012. Novas recomendações são relacionadas com diagnóstico e avaliação (duas BPC) e problemas psicossociais (três BPCs). Adicionalmente, uma nova recomendação (NE) se refere a jogos de videogame ativos como adjuntos à mais tradicional terapia orientada à tarefa e intervenção orientada à participação, e duas novas recomendações (uma BPC, um NE) foram feitas para adolescentes e adultos com TDC.
Interpretação
A RPC‐TDC apresenta uma visão geral do TDC e o conhecimento atual baseado em evidências de pesquisas e consenso de especialistas. Reflete o estado de arte dos clínicos e cientistas de disciplinas variadas. A RPC‐TDC internacional deverá servir como uma base para as diretrizes nacionais.
What this paper adds
Updated international clinical practice guidelines on developmental coordination disorder (DCD).
Refined and extended recommendations on clinical assessment and intervention for DCD.
A critical synopsis of current research on mechanisms of DCD.
A critical synopsis of psychosocial issues in DCD, with implications for clinical practice.
The first international recommendations to consider adolescents and adults with DCD.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
A pocket version of these guidelines is available as Appendix S1 (https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.14132#support-information-section)
Transfer of motor skills is the ultimate goal of motor training in rehabilitation practice. In children with Developmental Coordination Disorder (DCD), very little is known about how skills are ...transferred from training situations to real life contexts. In this study we examined the influence of two types of practice on transfer of motor skills acquired in a virtual reality (VR) environment.
One hundred and eleven children with DCD and their typically developing (TD) peers, aged 6-10 years (M = 8.0 SD = 1.0) were randomly assigned to either variable (n = 56) or repetitive practice (n = 55). Participants in the repetitive practice played the same exergame (ski slalom) twice weekly for 20 minutes, over a period of 5 weeks, while those in the variable group played 10 different games. Motor skills such as balance tasks (hopping), running and agility tasks, ball skills and functional activities were evaluated before and after 5 weeks of training.
ANOVA repeated measures indicated that both DCD and TD children demonstrated transfer effects to real life skills with identical and non-identical elements at exactly the same rate, irrespective of the type of practice they were assigned to.
Based on these findings, we conclude that motor skills acquired in the VR environment, transfers to real world contexts in similar proportions for both TD and DCD children. The type of practice adopted does not seem to influence children's ability to transfer skills acquired in an exergame to life situations but the number of identical elements does.
Aim Developmental coordination disorder (DCD) is a significant disorder of childhood, characterized by core difficulties in learning fine and/or gross motor skills, and the attendant psychosocial ...problems. The aim of the meta‐analysis presented here (the first on DCD since 1998) was to summarize trends in the literature over the past 14 years and to identify and describe the main motor control and cognitive deficits that best discriminate children with DCD from those without.
Method A systematic review of the literature published between January 1997 and August 2011 was conducted. All available journal papers reporting a comparison between a group of children with DCD and a group of typically developing children on behavioural measures were included.
Results One hundred and twenty‐nine studies yielded 1785 effect sizes based on a total of 2797 children with DCD and 3407 typically developing children. Across all outcome measures, a moderate to large effect size was found, suggesting a generalized performance deficit in children with DCD. The pattern of deficits suggested several areas of pronounced difficulty, including internal (forward) modelling, rhythmic coordination, executive function, gait and postural control, catching and interceptive action, and aspects of sensoriperceptual function.
Interpretation The results suggest that the predictive control of action may be a fundamental disruption in DCD, along with the ability to develop stable coordination patterns. Implications for theory development and intervention are discussed.
Aim
To better understand the neural and performance factors that may underlie developmental coordination disorder (DCD), and implications for a multi‐component account.
Method
A systematic review of ...the experimental literature published between June 2011 and September 2016 was conducted using a modified PICOS (population, intervention, comparison, outcomes, and study type) framework. A total of 106 studies were included.
Results
Behavioural data from 91 studies showed a broad cluster of deficits in the anticipatory control of movement, basic processes of motor learning, and cognitive control. Importantly, however, performance issues in DCD were often shown to be moderated by task type and difficulty. As well, we saw new evidence of compensatory processes and strategies in several studies. Neuroimaging data (15 studies, including electroencephalography) showed reduced cortical thickness in the right medial orbitofrontal cortex and altered brain activation patterns across functional networks involving prefrontal, parietal, and cerebellar regions in children with DCD than those in comparison groups. Data from diffusion‐weighted magnetic resonance imaging suggested reduced white matter organization involving sensorimotor structures and altered structural connectivity across the whole brain network.
Interpretation
Taken together, results support the hypothesis that children with DCD show differences in brain structure and function compared with typically developing children. Behaviourally, these differences may affect anticipatory planning and reduce automatization of movement skill, prompting greater reliance on slower feedback‐based control and compensatory strategies. Implications for future research, theory development, and clinical practice are discussed.
RESUMEN
Hallazgos cognitivos y de neuroimágenes en niños con TDC (trastornos del desarrollo de la coordinación): nuevas perspectivas en base a una revisión sistemática de investigaciones recientes
Objetivo
Mejorar la comprensión de los factores neuronales y de funcionamiento que pueden ser la base de los TDC (trastornos del desarrollo de la coordinación) y sus implicaciones para una descripción multifactorial.
MetodoSe realizó una revisión sistemática de la literatura científica publicada entre Junio de 2011 y Septiembre de 2016 utilizando un marco PICOS modificado (población, intervención, comparación, resultados y tipo de estudio). Se incluyeron un total de 106 estudios.
Resultados
Los datos de comportamiento motor de 91 estudios mostraron un amplio conjunto de déficits en el control anticipatorio del movimiento, en los procesos básicos de aprendizaje motor y en el control cognitivo. Es importante destacar que los problemas de rendimiento motor en TDC a menudo se ven moderados por el tipo de tareas y la dificultad de las mismas. Asimismo, en varios estudios vimos nuevos indicios de estrategias y procesos compensatorios. Los datos de neuroimagen (15 estudios, incluyendo electroencefalografía) mostraron un grosor cortical reducido en la corteza orbitofrontal medial derecha y patrones alterados de activación cerebral a lo largo de redes funcionales que implican regiones prefrontales, parietales y cerebelares en niños con TDC con respecto a los grupos control. Los datos de resonancia magnética por difusión (DTI) sugirieron una reducción de la organización de la materia blanca que involucra estructuras sensoriomotoras y una conectividad estructural alterada a través de toda la red cerebral.
Interpretación
Tomados en conjunto, los resultados apoyan la hipótesis de que los niños con TDC muestran diferencias en la estructura y función cerebral en comparación con los niños con un desarrollo típico. En lo que hace a comportamiento motor, estas diferencias pueden afectar la planificación anticipada y dificultar la automatización de las habilidades motoras, lo que lleva a una mayor dependencia de un control motor basado en sistemas de retroalimentación más lenta y de estrategias compensatorias. Se discuten las implicaciones para la investigación futura, el desarrollo teórico y la práctica clínica.
RESUMO
Achados cognitivos e de neuroimagem em desordem do desenvolvimento da coordenação: novas descobertas a partir de uma revisão sistemática de estudos recentes
Objetivo
Compreender melhor of fatores neurais e de desemppenho que podem explicar a desordem do desenvolvimento da coordenação (DDC), e implicações para uma causa multi‐componentes.
Método
Uma revisão sistemática da literatura experimental publicada entre Junho de 2011 e Setembro de 2016 foi conduzida seguindo uma estrutura PICOS (população, intervenção, comparação, resultados e tipo do estudo) modificada. Um total de 106 estudos foi incluído.
Resultados
Dados comportamentais de 91 estudos mostraram um amplo grupo de deficits em controle antecipatório do movimento, processos básicos de aprendizagem motora, e controle cognitivo. No entanto, um achado importante foi que as dificuldades de desempenho em DDC foram frequentemente moderadas por tipo e dificuldade da tarefa. Também encontramos novas evidências de processos e estratégias compensatórios em vários estudos. Dados de neuroimagem (15 estudos, incluindo encefalografia) mostraram reduzida espessura cortical no córtex orbitofrontal medial direito, e padrões alterados de ativação cerebral em redes funcionais envolvendo regiões pré‐frontais, parietais e cerebelares em crianças com DDC do que nas crianças dos grupos de comparação. Dados de estudos com ressonância magnética por difusão sugerem reduzida organização da substância branca envolvendo estruturas sensório‐motoras, e alterada conectividade estrutural em toda a rede cerebral.
Interpretação
Juntos, os resultados dão suporte à hipótese de que crianças com DDC mostram diferenças na estrutura e função cerebral comparadas com crianças com desenvolvimento típico. Comportamentalmente, estas diferenças podem afetar o planejamento antecipatório e reduzir a automatização da habilidade motora, causando maior dependência em estratégias de controle mais lentas, baseadas no feedback, e estratégias compensatórias. Implicações para futuras pesquisas, desenvolvimento teórico e prática clínica são discutidas.
What this paper adds
A comprehensive systematic review of recent experimental research on developmental coordination disorder (DCD).
A current synthesis that informs international consensus guidelines on DCD.
Behavioural and neuroimaging findings are integrated with reference to current theory.
Evidence that motor control deficits in DCD depend on the nature of the task.
Evidence to show alterations of structural and functional neural connectivity in DCD.
Implications for clinical practice are provided, based on recent research.
What this paper adds
A comprehensive systematic review of recent experimental research on developmental coordination disorder (DCD).
A current synthesis that informs international consensus guidelines on DCD.
Behavioural and neuroimaging findings are integrated with reference to current theory.
Evidence that motor control deficits in DCD depend on the nature of the task.
Evidence to show alterations of structural and functional neural connectivity in DCD.
Implications for clinical practice are provided, based on recent research.
This article is commented on by Liégeois on page 1103 of this issue.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
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 dw) was compared across training types.
Results The overall effect size across all intervention studies was dw=0.56. A comparison between classes of intervention showed strong effects for task‐oriented intervention (dw=0.89) and physical and occupational therapies (dw=0.83), whereas that for process‐oriented intervention was weak (dw=0.12). Of the chemical supplements, treatment with methylphenidate was researched in three studies (dw=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.
Handwriting in Parkinson's disease (PD) features specific abnormalities which are difficult to assess in clinical practice since no specific tool for evaluation of spontaneous movement is currently ...available.
This study aims to validate the 'Systematic Screening of Handwriting Difficulties' (SOS-test) in patients with PD.
Handwriting performance of 87 patients and 26 healthy age-matched controls was examined using the SOS-test. Sixty-seven patients were tested a second time within a period of one month. Participants were asked to copy as much as possible of a text within 5 minutes with the instruction to write as neatly and quickly as in daily life. Writing speed (letters in 5 minutes), size (mm) and quality of handwriting were compared. Correlation analysis was performed between SOS outcomes and other fine motor skill measurements and disease characteristics. Intrarater, interrater and test-retest reliability were assessed using the intraclass correlation coefficient (ICC) and Spearman correlation coefficient.
Patients with PD had a smaller (p = 0.043) and slower (p<0.001) handwriting and showed worse writing quality (p = 0.031) compared to controls. The outcomes of the SOS-test significantly correlated with fine motor skill performance and disease duration and severity. Furthermore, the test showed excellent intrarater, interrater and test-retest reliability (ICC > 0.769 for both groups).
The SOS-test is a short and effective tool to detect handwriting problems in PD with excellent reliability. It can therefore be recommended as a clinical instrument for standardized screening of handwriting deficits in PD.
Although Developmental Coordination Disorder (DCD) is often characterized as a skill acquisition deficit disorder, few studies have addressed the process of motor learning. This study examined ...learning of a novel motor task; the Wii Fit ski slalom game. The main objectives were to determine: 1) whether learning occurs over 100 trial runs of the game, 2) if the learning curve is different between children with and without DCD, 3) if learning is different in an easier or harder version of the task, 4) if learning transfers to other balance tasks.
17 children with DCD (6-10 years) and a matched control group of 17 typically developing (TD) children engaged in 20 minutes of gaming, twice a week for five weeks. Each training session comprised of alternating trial runs, with five runs at an easy level and five runs at a difficult level. Wii scores, which combine speed and accuracy per run, were recorded. Standardized balance tasks were used to measure transfer.
Significant differences in initial performance were found between groups on the Wii score and balance tasks. Both groups improved their Wii score over the five weeks. Improvement in the easy and in the hard task did not differ between groups. Retention in the time between training sessions was not different between TD and DCD groups either. The DCD group improved significantly on all balance tasks.
The findings in this study give a fairly coherent picture of the learning process over a medium time scale (5 weeks) in children novice to active computer games; they learn, retain and there is evidence of transfer to other balance tasks. The rate of motor learning is similar for those with and without DCD. Our results raise a number of questions about motor learning that need to be addressed in future research.
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