Developmental Coordination Disorder and Ehlers Danlos (Walton)

What is DCD?

chronic condition characterized by motor impairments that interfere with ADLs or school progress

-delay in development of motor skills

-difficulty coordinating motor skills

What other conditions may occur simultaneously with DCD?

-ADHD

-ASD

-learning disabilities

-speech/language impairments

What age and gender are affected by DCD?

-5-6% of kids who are school age

-2 boys : 1 girl

How is a diagnosis of DCD made by the MD?

dx is made

-by ruling out movement problems from other physical, nuero, or behavioral disorder

-see if there are other disorders present along with DCD

What may be the first sign of DCD?

clumsiness and poor handwriting

What defines DCD according to the DSM?

a) motor development disorder

b) neurodevelopmental disorder

c) movement coordination disorder

d) psychological disorder

B) neurodevelopmental

What is the WHO criteria for DCD diagnosis?

-scoring 2 SDs below the mean on motor impairments tests

-interference with ADLs and academic performance

-excludes those with IQ below 70

What is the cause of DCD?

-unknown generally

-however, possible causes:

--NT abnormalities

--cerebellar, parietal lobe, corpus callosum, or basal ganglia circuitry problems

--prenatal, perinatal, or neonatal complications

--feed forward mechanism

Impairment in what structure may lead to issues with midline tasks in those with DCD?

corpus callosum

What are the 2 major hypotheses for DCD etiology?

-internal modeling deficit (IMD)

-mirror neuron system (MNS)

What are risk factors for DCD?

-male (2:1)

-small gestational age

-dx between 6-12

-premature birth

-genetic predisposition

-family hx

What are other disorders that are correlated to DCD?

-ADHD

-ASD

-dyslexia and other learning disabilities

-speech impairment (due to motor part of speech being impaired)

-benign epilepsy and joint hypermobility

What are physical characteristics of DCD?

-clumsy, awkward, bump into things, knock things over

-gross and fine motor skills are difficult

-delayed dressing, jumping, skipping, etc

-difficulty learning new skills, motor planning issues

-might seem the kid is defiant, but they simply can't do the thing

-bad handwriting

-coordination / baalance

-poor posture control (looks unsafe while doing dynamic things like stairs)

-hypotonia

-decreased body awareness

-slow reaction time

-difficulty with 2-3 step commands

-decreased energy

A kid with DCD may have proprioceptive and body awareness issues. How can treatment work on this?

use mirrors and external feedback devices

What are the emotional and behavioral characteristics of a kid with DCD?

-lack of interest in activities due to fatigue and failure

-decreased self esteem

-lack of motivation

-avoidance of socailization

-frustration with school

-aggression or humor to compensate for failure

-resistance to change in routine (due to effort expended for small tasks)

What are activity limitations in kids with DCD?

-planning and executing dressing, gripping

-self care, ADLs

-hand writing, fine motor grasp

-complete school work on time

-skipping, hopping, jumping

-delay in gross motor skills (bike riding, throwing, kicking)

What are participation restrictions for a kid with DCD?

-sports

-gym

-socialization in clubs and playground

What does a PT exam for DCD involve?

-history

-tone

-strength

-coordination (finger to nose)

-balance

-endurance

-object manipulation

-ROM (usually not issues)

-posture

-functional mobility

-complex movement (dual task)

What red flags that a more serious condition, outside of DCD is going on?

-recent head injury/trauma

-regression of motor skills

-h/o HA, eye pain, blurred vision

-gait abnormalities

-increased or fluctuating tone

-asymmetric tone or strength

-dysarthria

-Gower's sign

more consideration with:

-neurocutaneous skin lesions

-avoidance of eye contact, unwilling to engage

-dysmorphic featuers

-untreated visual impairments

What standardized tests can be used with DCD pts?

-movement ABC

-BOT 2

-peabody

-developmental coordination disorder questionnaire (DCDQ 070

-strengths and difficulties questionnaire

-developmental test of visual motor integration (VMI)

-DASH

What is the PT intervention for DCD like generally?

bottom up approach mostly

-address structure & function that may be underlying cause of difficulty (strength, ROM, balance, body awareness)

-emphasize building blocks of motor skills

-include perceptual motor training, sensory integration, and NDT

if top down approach, use interventions that are contextually based with everyday situations

What are examples of sensory integration exercises / activities?

-swinging

-sensory box with various tactile sensations/ textures

-pushing exercises

-deep pressure rolling (foam roller)

-joint compression

-weighted blankets

-dance

How can PT intervention assist in generalization of motor tasks?

-verbal cues

-positioning

-handling

-visual & observational learning

-practice in diff settings

-emphasize frequent practice

-task specific

What is the PT role in the treatment of DCD outside of treatment session?

-encourage community activities

-foster healthy lifestyle

-educate parents

-tips for playground

What is a method of encouraging exploration on playground or gym class for kid with DCD?

MATCH

-modify task

-adjust expectations

-teach strategies

-change environment

-help by understanding

What is the focus for DCD interventions?

-early incorporation of physical activity is important

-create a solid basis of motor skills and physical fitness

-task oriented training

-adapting task to child's skills

-positive meaningful feedback

What type of feedback should be given to a child with DCD?

positive meaningful feedback

-point out the good things instead of telling them what went wrong

-they already have self esteem problems due to being a failure at many motor things

-build them up!!! don't break them down

What is the prognosis for DCD?

-with or without intervention, CONTINUE to have difficulties with motor skills into adulthood

-decreased QOL

-poor social connections

-academic performance

-mental health issues

-sedentary lifestyle may cause obesity or poor CV health

What is Ehrler's Danlos Syndrome?

-genetic disorder that affects collagen formation and function

-13 variations

-affects every organ system and results in high mortality/morbidity

How many variants of EDS?

13 variants, classified into 6 types

What are s&s of EDS?

-joint hypermobility

-skin hyperextensibility

-tissue fragility

-delayed wound healing

-easy bruising

-club foot

-dysautonomia

-orthostatic intolerance

-diarrhea, incontinence

-postural control issues

-pain, fatigue

-smooth velvet skin textures

What are complications of other body systems as a result of EDS?

-arterial rupture

-organ rupture

-joint dislocation

-chronic pain

-fatigue

-recurrent fx

-hernias

-rectal prolapse

What should be monitored in a kid with EDS, before, during & after exercise? why?

monitor vitals due to cardio and pulmonary problems; look at glucose level due to glucose problems

What it PT management of EDS?

-treat what we can, like ST lesions and injuries

-relieve pain (ST work, gentile mobilization)

-educate on behavior modifications

-improve endurance and strength of postural and joint stabilizing muscles

-improve balance and coordination

-improve stamina and general fitness

-posture re-ed

What joints are affected with EDS?

technically all of them, but shoulder and hips more often

What is the first sign of EDS usually?

common and usual shoulder dislocation

T or F: EDS pts often will develop RA and chronic pain

False; OA and chronic pain

What is the skin texture of a pt with EDS?

smooth, velvet like texture

T or F: Pts with EDS can improve their postural control with core stabilization exercises

True

T or F: EDS has a certain set of signs and symptoms that will categorize it into a specific type

False; variety of s&s that make it more of a spectrum