1
Q
DCD Definition by DSM-4? Manifested how?
A
- Performance in ADL’s (that require motor performance) is substantially below that expected for a person’s chronological age and measured intelligence.
- This may be manifested by marked delays in achieving motor milestones, dropping things, “clumsiness”, poor handwriting and poor performance in sports.
2
Q
DCD is diagnosed when? (3)
A
- The disturbances described previously significantly interfere with academic achievement and/or ADL’s
- The disturbance is not due to a medical condition (i.e. CP, MD,) and does not meet the criteria for PDD.
- Motor difficulties are greater than expected in the presence of intellectual disability
3
Q
Incidence greater in? 90% of kids are thought?
A
- Greater in boys than girls
- 90% of Children with learning disorders are thought to have motor coordination problems
4
Q
Incidence increased in? (4)
A
- incidence in pre-term infants
- prematurity risk of DCD
- incidence when there are pre or perinatal influences or risk factors
- Incidence greater in boys than girls (or boys may just be identified more as they may act out more in frustration)
5
Q
Associated Disorders? (4)
A
- Phonological disorder (speech impairment - difficult making the actual words)
- Expressive language disorder (putting the sounds together to make words)
- Mixed receptive/expressive
- Language Disorder
- ADD/ADHD
6
Q
Individuals with ADD/ADHD may ?
A
fall, bump into things, knock things over due to distractibility and impulsivity, however if criteria for both disorders are met, both diagnoses can be given.
7
Q
Hypothesis for Coordination Difficulties - process 1?
A
Child may experience difficutly interpreting info received from vision, tactile, balance, proprioception and muscle movement
8
Q
Hypothesis for Coordination Difficulties - process 2? (2)
A
- Child may have difficulty choosing the type of motor action that is appropriate for the situation
- In order to select an action the child must consider the context in which the action takes place
9
Q
Hypothesis for Coordination Difficulties - process 3? (2)
A
- Process 3: Child may have difficulty forming a plan of action in the proper SEQUENCE.
- Child must organize the motor requirements of a task into a sequence of commands (motor program) that tells the muscles how to perform the required action
i. e. when the child approaches a set of stairs, he must shift weight onto one foot to lift the other
10
Q
Hypothesis for Coordination Difficulties - process 4? (3)
A
- Messages sent to the muscles must specify speed, force, direction, distance to be moved.
- When children move in response to stimuli moving in time or space (catching a ball) the messages must also change.
- A child may have difficulty monitoring this information or modifying the messages in order to guide the movement while it is taking place
11
Q
Overall the child has difficulty with? (5) Result?
A
- analyzing sensory input
- Using information to choose a plan of action
- Sequencing the movement required for the task
- Sending the right message to produce a coordinated action
- Integrating all of the above to control movement while it is happening (feedforward)
- Result: child appears clumsy and awkward has difficulty learning and performing new tasks
12
Q
Apraxia characteristics? (5)
A
- Loss of Praxis
- Usually seen in adults
- Neurologic Basis for problem as evidences on CT or MRI
- Basis not usually tied to somatosensory dysfunction
- Rx is based on use of automatic activities
13
Q
Dyspraxia characteristics? (5)
A
- Dysfunctional Praxis
- Usually seen in children
- Neurologic basis for problems NOT usually noted on CT or MRI
- Thought to have tactile proprioceptive basis
- Learning activities for first time; cannot build on previously learn activities
14
Q
Developmental Dyspraxia characteristics? (1-8)
A
- Poor motor planning
- Decrease sense of body and what body can do
- Clumsiness makes child appear messy or accident prone
- Problems with ADL
- May learn splinter skills but cannot generalize
- Does things in an inefficient way
- Has low muscle tone that makes them appear weak
15
Q
Developmental Dyspraxia characteristics? (9-13)
A
Must give full attention to the task Difficulty with total flexion & extension patterns Decreased rotation Weight shifting problems Gait deviations
16
Q
Gait deviations can include? (4)
A
Toe Walking
Slaps foot down
High stepping
Shuffling (bc it increases sensory input)
17
Q
Developmental Dyspraxia characteristics? (14-22)
A
- Presence of developmental reflexes
- Vestibular impairment
- Oculomotor deficits
- Lack of cerebral dominance
- Somotoagnosia
- Heaviness when moved
- Visually directed action
- Problems with smooth control of movement
- Decreased postural reactions
18
Q
Developmental Dyspraxia characteristics? (23 - 29)
A
- Problems with unconscious movements
- Decreased thumb/finger movements
- Auditory language problems
- Poor proprioceptive set
- Fine motor problems including in-hand manipulation, writing
- Limited number of skills
- Difficulty organizing self
19
Q
Developmental Dyspraxia characteristics? (30 - 37)
A
- May have self-image problems (often starts around 6 yrs)
- Needs more protection than other children
- Has trouble growing up
- Emotionally labile
- Thinks own lack of control is due to someone else or the environment
- Emotionally sensitive
- Complains more about minor physical problems
- “Stubborn”
20
Q
Evaluation: Examination - Somotosensory? (4)
A
Vestibular
Tactile
Proprioception
Kinesthesia
21
Q
Evaluation: Examination - Sensory Integrative Function? (3)
A
- Sensory Integration and praxis test
- DeGangi-Berk test of sensory integration
- Test of Sensory Function in Infants
22
Q
Evaluation: Examination - Sensory Integrative Clinical Observations? 1-10
A
Tactile Defensiveness Muscle tone Eye Preference Eye Movements RAMP Movements Slow controlled movements* Equilibrium Reactions ATNR- quadruped STNR Prone Extension Supine Flexion
23
Q
Evaluation: Examination - Sensory Integrative Clinical Observations? 11-18
A
Diadokokinesia Thumb-finger touching Tongue to lip movement Cocontraction Gravitational Security Postural Background Movement Hopping, Skipping, Jumping Balance Beam
24
Q
Evaluation: Examination tests? (8)
A
Peabody Bruininks-Oseretsky Pedi Gubbay Test of Motor Proficiency School Functional Assessment DCD Questionnaire *Movement ABC Examination *Movement ABC Checklist
25
The Developmental Coordination Disorder Questionnaire is a ? Looks at? (3)
- Parent Questionnaire, 5 Level Likert Scale
- Gross motor and planning skills
- Fine motor skills
- Likes and general abilities
26
The Movement Assessment Battery for Children (Movement ABC; Henderson & Sugden, 1992) is a? It contains? (3) The test is given according to? Testing results in a?
- norm-based assessment of fine- and gross-motor performance for children ages 4 through 12.
- It contains items in three categories: manual dexterity, ball skills, and dynamic balance.
- The test is given according to four age bands, with test items changing depending on the age category.
- Testing results in a Total Impairment Score converted to a percentile. Percentile scores below 5% indicate a definite motor problem, whereas 5 to 15% is considered a Borderline Motor Problem.
27
The Movement ABC also contains a? The examiner is allowed to? For this reason, the Movement ABC is particularly?
- The Movement ABC also contains a checklist completed by a teacher or other professional to assess how the child performs motor activities in everyday situations and the child’s feelings toward motor tasks.
- The examiner is allowed to use any method to ensure understanding of the task, which results in a test that is more focused on motor tasks.
- For this reason, the Movement ABC is particularly suited for children who have difficulties with behavior, communication, intelligence, and/or attention
28
Characteristics of Treatment Procedures? (6) Shouldn't do?
- Active participation of the child
- Child Directed (if possible)
- Individualized treatment
- Purposeful Activity
- “Just Right Challenge”
- Need for an Adaptive response
- NDT
29
Levels of Adaptive Response? (6)
1) Response to passive stimuli
2) Hold on and stay
3) Alternating Contraction and relaxation of muscle groups
4) Move independently in a familiar way
5) Move through the environment in an unfamiliar way
6) Complete a complicated activity requiring an unfamiliar way, difficult timing or multiple adaptations
30
Characteristics of Treatment Procedures - Activities should be ? (3) Input is varied based on? ere is an implied or stated goal of? Should be administered by ?
- Activities should be rich in proprioceptive, vestibular and tactile input
- Input is varied based on child’s response
- There is an implied or stated goal of improving process and organization of sensation (not teaching specific skills)
- Should be administered by trained therapist
31
Behavioral Considerations During Treatment - protect? If need..? Provide? Identify? Use? What is that? (2)
- Protect the child’s self esteem
- If needed, let child avoid tasks that threaten
- Provide consistent positive and negative consequences to motivate
- Identify the end product
- Child should be aware where they are, when to go, when to stop, when session will be over
- Use Premack Principle
- Intersperse things you like with things you don’t like
- Stop before child fails, but ask child to go on
- Can we do a little more of this, if no, its ok
32
Therapist Responsibility - choose? Help? Offer? Break down? Make it?
- Choose the Skill
- Help child choose simple task
- Offer limited choices by structuring the environment
- Break down into smaller tasks
- Make it FUN for the child
33
Therapist Responsibility - modify? Use? Increase? Initially? Model? Use? (2)
- Modify the Environment
- Use sensory systems to help increase or decrease alertness and arousal
- Increase stimulation from environment
- Initially provide visual and auditory assists
- Model as needed and then reduce modeling
- Use spontaneous movement
- Use real life situations
34
Feedback? (4)
Immediate
Constant
Random
Delayed
35
Initial Activities - think? Do you need to? Can you?
- Think Vestibular!!
- Do you need to increase or decrease the child's level of arousal?
- Can you have the child or the parent or teacher do this prior to the session
36
Activities to Increase Arousal? (10)
```
Rolling
Rocking
Riding a tricycle
Rocking horse
Sit and Spin
Rocking chair
Swings
Scooters
Trampoline
Proprioceptive Input
```
37
To Increase Propriceptive Input:? (10)
```
Weighted Vests
Neoprene Suits
Weighted Shoes
Backpacks and Fanny packs
Sandbags in the lap
Theraband around chair
Ball Pits
Tactile Blankets
Weighted pencils
Move n Sit
```
38
To Increase Tactile Input? (7)
```
Pacifiers
Ball Pits
Textured Surfaces
Trapeze
Pounding Kneading
Chewing Gum
To decrease tactile defensiveness
```
39
To decrease tactile defensiveness? (3)
- Pressure on top of head during combing and brushing
- Pressure to hands during nail clipping
- Vibration: vibrating toothbrush, pens
40
Visual Input - to increase? (6)
- Mirrors
- Modeling
- Shading ie pastel colored paper not white
- Templates
- Increase natural light
- Designate boundaries for child; carpet squares, chalk marks, masking tape
41
Visual Input - to decrease? (4)
- Lower lights have more natural and less fluorescent
- Decrease distractions
- Eliminate art that hangs from ceiling
- Restrict visual area
42
Auditory Input - to increase? (6)
```
Headphones
Timers
Metronome
Clapping
Singing
Sit close to teacher
```
43
Auditory Input - to decrease? (5)
```
Headphones to muffle sound
Caps
Ear plugs
Give directions one at a time
Give more time for child to respond to request
```
44
Use of Total Body Patterns - flexion? (5)
```
Curling up
Sitting and holding against resistance
Sitting on ball or in net
T-stool
Scooter board in supine or sitting
```
45
Use of Total Body Patterns - extension? (7)
```
All Fours and rocking
Prone in net
Prone on ball/bolster
Wheelbarrow
Scooter board prone
Kneeling
Half kneeling
```
46
Use of Total Body Patterns - rotation? (4)
Ball sit to prone to sit
All fours to sit and reverse
Rolling up inclines
Kneeling to side sit
47
Use of Total Body Patterns - grading of movements? (4)
Squat to stand from various heights
Runner stance to partial stance
Hippity hop ball
Trampoline
48
Variables Affecting Response to Therapy? (2)
- Sequence & kind of sensory input
| - Therapist induced or child induced stimulation
49
Client variables? (4) Therapist variables? (3)
```
Client Variables
Age
Sex
Diagnosis
Severity
```
Therapist Variables
Sex
Personality
Expectations
Peds
flashcards
Decks in class (7)
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