DEVELOPMENTAL COORDINATION DISORDER: MORE THAN JUST A MOVEMENT PROBLEM. Professor Beth Hands

Transcription

1 DEVELOPMENTAL COORDINATION DISORDER: MORE THAN JUST A MOVEMENT PROBLEM Professor Beth Hands

2 WHAT IS DCD? Performance in daily activities that require motor coordination is substantially below that expected given the person s chronological age and measured intelligence This may be manifested by marked delays in achieving motor milestones (e.g., walking, crawling, sitting), dropping things, clumsiness, poor performance in sports, or poor handwriting. This disturbance significantly interferes with academic achievement or activities of daily living. The disturbance is not due to a general medical condition (e.g., cerebral palsy, hemiplegia, or muscular dystrophy) DSM5, 2013

3 HOW IS IT MANIFESTED? Poor fine motor skills (e.g., writing) Poor gross motor skills (e.g., running) Speech may lack fluency Abnormal muscle tone (hypo/hyper tonia) Poor body awareness (kinaesthesis) Difficulties with gross motor sequencing

4 DCD Prevalence estimates of between 5% and 19% depending on measure and age group Gender differences - findings are inconclusive but some suggestion of higher prevalence in boys

5 CONSEQUENCES. THE EVIDENCE Physical consequences Low physical fitness Social consequences Social isolation Psychological consequences Reduced self esteem Perceived motor competence

6 BACKGROUND TO THE AMPITUP PROGRAM Adolescents with DCD have low physical fitness Aerobic fitness Muscle strength Muscle endurance Flexibility Body composition (Hands & Larkin, 2006)

7 POSSIBLE REASONS? Long term limited participation in physical activity Inefficiency and inconsistency of movement patterns Movement overflow Early fatigue Low levels of motivation

8 A NEGATIVE CYCLE... Low Motor Competence Low Fitness Mediating Variables Individual: Genetic predisposition Self-perceptions Physical maturity Environment: Social pressures Physical constraints Hypoactivity Modifiable factors Hands and Larkin (2002)

9 THE AMPITUP PROGRAM 13 weeks/semester Twice per week 90 minutes per session 30 mins hydrotherapy pool/week Cardio Strength Flexibility Skill development 1:1 training

10 AMPITUP: YEARLY CYCLE AMPitup 13 weeks 8 week break AMPitup 13 weeks Pre Int 1 Post Int 1 Pre Int 2 Post Int 2 13 week break before commencing each new year

11 A TYPICAL AMPITUP SESSION 10 mins Warm up ergometer (bike, treadmill, cross trainer) 10 mins Mat work- balance, steps, fit balls, boxing 20 mins Strength and resistance (machines, weights) 10 mins Cardio ( ergometers, stairs ) 10 mins Strength and resistance ( machines, weights) 30 mins Hydrotherapy pool group work, strength, cardio OR 30 mins Mat work, cool down

12 PERCEIVED EXERTION RATING

13 DO ADOLESCENTS WITH DCD HAVE LOWER BONE MINERAL DENSITY MEASURES THAN TYPICALLY DEVELOPING ADOLESCENTS?

14 BACKGROUND Low bone strength, bone mass, and cortical thickness are related to increased fracture risk (Clark, Tobias & Ness; Davies, et al.,2005; Ma & Jones, 2003a). Risk factors for low BMD include low vitamin D, low calcium, obesity and low physical activity. Adolescents with motor difficulties (DCD) have low levels of physical activity and therefore may be at risk of low BMD and subsequently increased fracture risk.

15 BACKGROUND Limited research into the relationship between motor coordination and fracture incidence Low coordination was associated with wrist and forearm fractures in 321 children between 9-16 years (Ma, Morely & Jones; 2004). In a sample of 49 adolescents attending our clinic, 48.1% reported frequent falls and 22.4% have had one or more fractures.

16 Therefore exercise-induced gains in bone mass in children and adolescents may be critical (Kohrt, Bloomfield, Little, Nelson & Yingling, 2004).

17 PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY (PQCT) Minimal radiation exposure Tibia and Radius Measures volumetric bone mineral density 3D Bone geometry Bone strength -Stress Strain Index (SSI) and Fracture Risk Cortical and trabecular bone compartments, muscle mass

18 PQCT SCANS Radius 4% (Trabecular) Radius 66% (Cortical) Cortical Bone Trabecular Bone

19 PQCT NORMATIVE DATA Radius 4% trabecular Radius 4% total density Radius 66% cortical SSI 66%

20 Bone Mineral Density measures (N = 21) Site Measure Raw Score M (SD) Z-score M (SD) Radius 4% Trabecular density (mg/cm 3 ) (40.02) (1.29) 66% Cortical density (mg/cm 3 ) (73.84) (1.41) 66% SSI (45.23) (0.72) Tibia 4% Trabecular density (mg/cm 3 ) (35.64) (1.34) 66% Cortical density (mg/cm 3 ) (49.95) 0.01 (1.04) 66% SSI (427.21) (0.90)

21 SELF PERCEPTIONS AND DCD Can a 13 week individually tailored exercise intervention improve self-perceptions in the physical domain among adolescents with DCD?

22 PHYSICAL SELF PERCEPTION PROFILE (PSSP) AND PERCEIVED IMPORTANCE PROFILE (PIP) (FOX & CORBIN, 1990) PSPP: PIP: Comprising five 6 item subscales Four of these (sports competence (SC), physical conditioning (PC), attractiveness of body (AB), and physical strength (PS)) assess perceptions within specific sub domains. A fifth subscale measures global physical self worth (PSW), that reflects feelings of satisfaction with the physical self Participants also completed the Perceived Importance Profile which consists of four 2 item subscales that measure level of importance attached to each domain of PSW.

23 X X

24 16 14 CHANGES IN PHYSICAL SELF-PERCEPTIONS (N = 35) * * 12 Pre Post 10 8 Physical selfworth Physical condition Sport competence Attractive body Physical strength * p<.05

25 IMPORTANCE RATINGS (N = 35) Pre Post Physical condition Attractive body Physical strength Sport competence

26 PREDICTORS OF PHYSICAL SELF WORTH (PSW) Pre test: Attractive Body and Physical Strength were predictors of PSW (F=22.915, p<.001) Post test: Attractive Body, Physical Strength and Physical Condition were predictors of PSW (F=22.78, p<.001)

27 CONCLUSION The observed improvements in specific sub-domains of physical self-worth were directly related to the focus of the intervention. Participants showed increases in perceptions of physical condition (PC), and physical strength (PS) as well as actual improvements in fitness and strength. Changes in physical self perceptions can be facilitated by an individually tailored intervention in a supportive environment that focuses on fitness and strength, and that these can occur after a relatively short period of time. Results demonstrate the effectiveness of appropriate programs for adolescents with DCD when positive attitudes towards exercise are encouraged.

28 EXPERIENCES OF ADOLESCENTS WITH DCD WITH BULLYING To determine the prevalence of bullying among adolescents with DCD, identify the impact of the bullying and the type of coping strategies used.

29 PREVALENCE AND TYPE Prevalence 12/15 participants (80%) reported being bullied 75% of the males 86% of the females Type of bullying name calling exclusion being punched or pushed nasty stories spread.

30 COPING STRATEGIES Active strategies: told an adult (75%) told a friend (33%) made new friends (25%) Passive strategies: avoided or ignored bullies (43%) dealt by self (43%)

31 WHY WERE THEY BULLIED? Academic delay or learning difficulties Appearance lack of worldliness, new to school, perceived weakness, not athletic, not as psychologically able. Parents believed this contributed to low self esteem and social isolation...these other kids can kind of pick up on these children with learning difficulties, sweetness, innocence, lack of worldliness; because they do have quite a beautiful side to them. But some other kids can pick up on that and hone in on it and see it as a weakness, whereas it s actually a lovely quality.

32 MEASURING PHYSICAL FITNESS Children and adolescents with DCD have lower physical fitness (Cairney et al, 2007; Hands & Larkin, 2002, 2006). Most fitness tests require a reasonable level of coordination to perform. Potential confounders to the measurement of fitness in adolescents with DCD: Poor coordination (Hands & Larkin, 2002) Variable and inconsistent movement patterns (King et al, 2011; Smits-Engelman et al., 2001)

33 THE QUESTIONS: Are we using the right tests to measure physical fitness in children and adolescents with DCD? What tests are best able to detect change (improvement/regression)?

34 THE PARTICIPANTS Males Females Age (mths) MAND NDI (mean) BMI (wt/ht 2 ) Waist circumference (cm) Note: No significant group differences

35 RESULTS Pre Post LMM PWC170/kg MSFT (shuttles) Vertical jump (ins) SBJ (ins) Curl ups (n) Chest pass (cm) Grip strength (kg) Sit and reach (cm) Trunk lift (cm) Balance (secs) LMM adjusting for occasion, gender, age and number of sessions attended

36 MULTI STAGE FITNESS TEST Catley & Tomkinson, 2011

37 No. of shuttles LONGITUDINAL FITNESS MEASURES: MULTI STAGE FITNESS TEST Ollie Lauren Pre1 Post1 Pre2 Post2 Pre3 Post3

38 CURL-UPS Catley & Tomkinson, 2011

39 LONGITUDINAL FITNESS MEASURES: SBJ AND CURL UPS SBJ Curl ups Pre1 Post1 Pre2 Post2 Pre3 Post3 Ollie Lauren

40 SESSION X SESSION CHANGES Measured increases in work loads repetitions ergometer times

41 PARENTS TOLD US. 95% parents agreed or strongly their child had improved in both fitness and confidence Overall improvements in Weight loss Ability to focus on homework Improvement in school grades Greater level of cooperation In a recent cross country run, he did better than expected and attributed it to his training and increased fitness Scott is emotionally calm and co-operative on AMPitup nights Sally is less reluctant to run, jump, move around, since starting AMPitup

42 ARE WE USING THE RIGHT TESTS?

43 SO WE ADDED SOME OTHER TESTS.. Pre Post p Plank (secs) RM leg press (kg) RM chest press (kg)

44 CONCLUSIONS Tests differ in coordinative demands Strength measures require less coordination as the movement is constrained by equipment, however best aerobic fitness test still unclear. External cues cadence tapes, visual feedback, knowledge of results help, motivation Tests need a close alignment with exercise program same machinery, undertaken by known coach. Practice the test Inability to generalise to different setting

45 FUTURE DIRECTIONS Generalisability of improvement Transference into community facilities Young adults and DCD Impact of DCD on mental health