Neuroimaging and Occupational Therapy: Bridging the Gap to Advance Rehabilitation in Developmental Coordination Disorder

The Efficacy of Motor Imagery Additional to Task-Oriented Training for Children with Developmental Coordination Disorder: A Study Protocol for a Randomized Open-Label Controlled Trial

BACKGROUND

Developmental Coordination Disorder (DCD) affects school-age children and interferes with the practice of their daily activities. Task-oriented work and motor imagery have shown great efficacy in addressing this problem.

OBJECTIVE

This study presents a protocol that seeks to understand the effectiveness of a combined program of both modalities on the motor competence of children susceptible to the presence of DCD.

DESING

Randomised controlled trial.

METHODS

The participants are children susceptible to the presence of DCD (from 6 to 12 years old) distributed into an intervention group that received a total of 20 protocol sessions and a control group that continued with their usual school routine.

Combined action observation and motor imagery improves learning of activities of daily living in children with Developmental Coordination Disorder

Developmental coordination disorder (DCD) is characterised by poor motor coordination, which interferes with the ability to execute activities of daily living (ADLs). Combined action observation and motor imagery (AOMI) involves observing movement videos whilst imagining simultaneously the sensations of executing the same movement. Laboratory-based research indicates that AOMI can help improve movement coordination in children with DCD, but no previous research had investigated the efficacy of AOMI interventions for learning ADLs. This study investigated the efficacy of a home-based, parent-led, AOMI intervention for learning ADLs in children with DCD. Children with confirmed (n = 23) or suspected (n = 5) DCD (total sample n = 28), aged 7-12 years, were assigned to either an AOMI intervention or a control intervention (both n = 14). Participants attempted the following ADLs at pre-test (week 1), post-test (week 4), and retention test (week 6): shoelace tying, cutlery use, shirt buttoning, and cup stacking. Task completion times and movement techniques were recorded. The AOMI intervention produced significantly faster task completion times than the control intervention at post-test for shoelace tying, and significantly improved movement techniques for shoelace tying and cup stacking. Importantly, for children who could not tie shoelaces at pre-test (n = 9 per group), 89% of those following the AOMI intervention learnt the skill successfully by the end of the study, compared to only 44% of those following the control intervention. The findings indicate that home-based, parent-led, AOMI interventions can aid the learning of complex ADLs in children with DCD, and may be particularly effective for facilitating the learning of motor skills that do not currently exist within these children's motor repertoire.

Does the Degree and/or Direction of Handedness in Children With Developmental Coordination Disorder Influence Motor and Cognitive Performance? A Pilot Study

Research has shown that nonright-handedness in children with developmental coordination disorder (DCD) is associated with poorer motor and cognitive performance. This study investigated the influence of degree and direction of handedness on performance using the Home Handedness Questionnaire, the Hit-the-Dot test, the Movement Assessment Battery for Children, and the digital Trail-Making Test. Eighteen children with DCD and 21 typically developing children aged 8–12 years participated in this study. The distribution of degree and direction of handedness in the group of DCD children were not different from that found in the typically developing group. In the Hit-the-Dot test, typically developing children significantly performed better than children with DCD, no matter which hand was dominant or to which degree. A significant inconsistent-handed advantage in the subdomain balance was found for children with DCD. Inconsistent handedness also seems to be an advantage for children with DCD on the digital Trail-Making Test performance. The relationship between the subcategories of the Movement Assessment Battery for Children and the digital Trail-Making Test part B is stronger for consistent than for inconsistent handedness. Our findings suggest that children with DCD and inconsistent handedness might benefit from greater crosstalk across hemispheres. In addition, these predispositions can be reinforced or discouraged throughout development and via occupational therapy.

Influencing discussions and use of Neuroadvancements: Perspectives of Canadian occupational therapists

BACKGROUND: The early involvement of many actors including health professionals is identified in neuroethics and neurogovernance discussions as crucial in constructing conversations around awareness, reaction, and knowledge development pertaining to the ethical, legal, and societal consequences of neuroscientific or neurotechnological advancements (NA). Occupational Therapists (OTs) have a stake in NA; however, OTs are rarely mentioned within this context. Lifelong learning (LL) could be used to increase OTs knowledge on NA and its consequences. However, LL is rarely mentioned within neuroethics and neurogovernance discussions. OBJECTIVE: The study’s purpose is to understand the role of OTs as professionals and citizens in neuroethics and neurogovernance discussions and to examine the utility of LL processes put in place for OTs to empower OTs to contribute in a meaningful way to NA discussions. METHODS: 8 semi-structured interviews with OTs were conducted and analyzed using a directed content analysis. RESULTS: Although participants believed OTs can provide a holistic perspective to neurogovernance discussions, their knowledge on NA and its consequences is limited, and LL is not used as a tool to remain informed about such consequences. CONCLUSION: More education on NA and its consequences throughout their OT degree and through LL opportunities is warranted to facilitate their involvement.

Cerebellar and brainstem differences in children with developmental coordination disorder: A voxel-based morphometry study

Developmental coordination disorder (DCD) is a neurodevelopmental disorder that significantly impairs a child’s ability to learn motor skills and to perform everyday activities. The cause of DCD is unknown; however, evidence suggests that children with DCD have altered brain structure and function. While the cerebellum has been hypothesised to be involved in developmental coordination disorder, no studies have specifically examined cerebellar structure in this population. The purpose of our study was to examine cerebellar differences in children with DCD compared to typically-developing children. Using voxel-based morphometry, we assessed cerebellar morphology in children 8–12 years of age. Forty-six children (12 typically-developing and 34 with DCD) were investigated using high resolution T1-weighted images, which were then processed using the spatially unbiased atlas template of the cerebellum and brainstem (SUIT) toolbox for a region of interest-based examination of the cerebellum. Results revealed that children with DCD had reduced grey matter volume in several regions, namely: the brainstem, right/left crus I, right crus II, left VI, right VIIb, and right VIIIa lobules. Further, Pearson correlations revealed significant positive associations between the total motor percentile score on the Movement Assessment Battery for Children-2 and regions that had reduced grey matter volume in our cohort (brainstem, left crus I, right VIIb, and right VIIIa). These findings indicate that reductions in cerebellar grey matter volume are associated with poorer motor skills. Given the cerebellum’s involvement in internal models of movement, results of this study may help to explain why children with DCD struggle to learn motor skills.

Cerebellar Differences after Rehabilitation in Children with Developmental Coordination Disorder

Developmental coordination disorder (DCD) affects a child's ability to learn motor skills. Cognitive Orientation to daily Occupational Performance (CO-OP) is one of the recommended treatments to help achieve functional motor goals. The purpose of this study was to determine if CO-OP intervention induces functional improvements and structural changes in the cerebellum of children with DCD. Using a randomized waitlist-controlled trial, we investigated the effects of CO-OP intervention on cerebellar volume in 47 children with DCD (8-12 years old). Outcome measures included the Canadian Occupational Performance Measure, Performance Quality Rating Scale (PQRS), and Bruininks-Oseretsky Test of Motor Proficiency-2. The SUIT toolbox was used to carry out voxel-based morphometry using T1-weighted MRI scans. Children with DCD showed improved motor outcomes and increased gray matter volume in the brainstem, right crus II, bilateral lobules VIIIb, and left lobule IX following CO-OP. Significant associations were found between PQRS scores and regional gray matter changes in the brainstem, right crus II, right lobule VIIb, right and left lobule VIIIb, and vermis IX. Given the improved motor and brain outcomes with CO-OP, it is recommended that children with DCD be referred for this rehabilitation intervention.

Combined action observation and motor imagery: An intervention to combat the neural and behavioural deficits associated with developmental coordination disorder

Action observation (AO) and motor imagery (MI) have been used separately across different populations to alleviate movement impairment. Recently these two forms of covert motor simulation have been combined (combined action observation and motor imagery; AOMI), resulting in greater neurophysiological activity in the motor system, and more favourable behavioural outcomes when compared to independent AO and MI. This review aims to outline how some of the neural deficits associated with developmental coordination disorder (DCD) are evident during AO and MI, and highlight how these motor simulation techniques have been used independently to improve motor skill learning in children in this population. The growing body of evidence indicating that AOMI is superior to the independent use of either AO and MI is then synthesised and discussed in the context of children with DCD. To conclude, recommendations to optimise the delivery of AOMI for children with DCD are provided and future avenues for research are highlighted.

The prenatal, postnatal, neonatal, and family environmental risk factors for Developmental Coordination Disorder: A study with a national representative sample

Knowledge of obstetric and environmental influences on Developmental Coordination Disorder (DCD) helps provide increased understanding of the mechanisms underlying the disorder. However, the literature to date has not adequately examined the obstetric and environmental risk factors for DCD in a population-based sample. The current study was therefore conducted to explore the prenatal, perinatal, neonatal, and family environmental risk factors for DCD. A total of 2185 children aged 3-10 years from a national representative sample in China were included; the Movement Assessment Battery for Children-2 was used to assess motor function, and a questionnaire was completed by parents. DCD was identified in 156 children according to the DSM-5 criteria. Multilevel logistic regression was used, and comparisons were made between the DCD and non-DCD group. The results confirmed that male sex, BMI score, preterm birth, and some prenatal conditions are significant risk factors for DCD. Parents' education level and one-child status as two significant environmental risk factors for DCD appear largely independent of other risk factors in the Chinese population. This study provides an opportunity to explore the etiology of DCD and suggest potential assessment, monitoring and intervention programs for DCD that could be examined in the future.

Rehabilitation-induced brain changes detected through magnetic resonance imaging in children with neurodevelopmental disorders: A systematic review

AIM

The aim of this study was to systematically review evidence about rehabilitation-induced neuroplasticity measured by magnetic resonance imaging (MRI) in children with neurodevelopmental disorders.

METHOD

The following databases were searched: MEDLINE, EMBASE, CINAHL, and PsycINFO. Two independent reviewers screened articles according to inclusion criteria: (1) peer-review study published in a scientific journal; (2) studies that evaluated a rehabilitation-based intervention; (3) participants aged less than 19 years with a neurodevelopmental disorder; and (4) studies that used at least one MRI modality as an outcome measure. Twenty-seven studies met the criteria for the review and their quality was assessed by two independent reviewers using the Effective Public Health Practice Project Quality Assessment Tool.

RESULTS

Based on an assessment of bias and overall quality, 11% of the papers were rated as strong; 30% moderate; and 59% weak. Outcomes were categorized into structural connectivity, functional connectivity, cortical activation, and structural volume. Cortical activation and structural connectivity were the most commonly reported measures. Most studies were able to identify brain changes in children with neurodevelopmental disorders after therapy.

INTERPRETATIONS

Rehabilitation is shown to induce MRI-detectable neuroplastic changes in children with neurodevelopmental disorders. Structural connectivity might need greater intensity and/or duration of intervention to induce change.

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.