Developmental coordination delay (DCD).
Developmental coordination delay (DCD).
There are many labels given to children with coordination difficulties. Some terms used are:
- Dyspraxia, clumsy child syndrome.
- Minor neurological dysfunction,
- Dyslexia (Coordination deficits may be present, but not associated with organisational problems),
- D.A.M.P (Deficits in attention motor control and perception).
DCD tends to be an umbrella term encompassing all of the above conditions.
Dyspraxia occurs in between 5 and 7% of the population, and is more common in boys than girls about 2 to 1. Children learn and develop through movement and play, social and emotional development occurs through interaction with others by gesture, play and speech.
A child that moves with ease and performs movements well tends to have confidence in himself and a positive self image is built.
He will practice skills that are difficult without a threat to his self confidence.
The child also judges his own motor performance by comparing himself with others.
A child with Dyspraxia finds he cannot succeed with activities and therefore develops low self esteem and low self confidence. He will eventually stop attempting new activities due to a fear of failure. This feeling can occur in school work and in PE.
The specific treatment programme of structured exercises I provide over 8 sessions will help to improve coordination, planning and muscle control.(it is based on the LEE Medical Programme originally designed by Michele Lee MCSP UK).
Please note: This programme will not help muscular Dystrophy patients there are other more suitable programmes for this condition.
There have been studies that have shown the majority of parent s knew there was a problem by the time their child was three but a formal diagnosis was not made until they were between 7 and 8 yrs of age. By this time the child was comparing himself to others and a poor self confidence had developed.
However this Therapeutic Treatment programme has a positive affects and rebuilds their self confidence rapidly by perfecting and improving their motor muscle movements so that they will reach the same miles stones as unaffected children by the time they are teenagers and will feel confident and able to participate in sports with their peers instead of dropping out most sporting activities
How you might notice your child has Dyspraxia:
- Delay in reaching milestones e.g. standing, walking and hopping. It is worth noting that some children never crawl, they bum shuffle!
- Poor writing and drawing abilities
- Unable to sit still
- Disorganised, messy, difficulty in planning activities properly.
- Frequently falls and trips
- Loner (gets on with younger or older kids more than his peers)
- Messy eater – spills drinks etc.
- Runs with hips flexed so appears to lean forwards and be more bent.
The role of the physiotherapist in Dyspraxia
The physiotherapist’s primary goal is to enable the child to be able to reach the age appropriate level of skills (milestones) and if these are noted delayed to be delayed at assessment to achieve these milestones through an appropriate individually tailored exercise programme. You might have noticed you child can’t stand on one leg without excessive wobbling were as other children of their age can, or he cannot walk up stairs without holding on to the banister and other can . With the specifically targeted exercise this programme provided this milestone can be reaches and by the time the child is a teenager he will have caught up with his peers.
An example of one milestone is throwing and catching a ball. However, as with all skills these improve as we develop and get older.
- At 2 yrs can throw football (big ball)
- At 3yrs throws and catches football
- At 4 yrs can use ball and bat
- At 5 yrs can play a variety of ball games (small and big balls)
- At 6 yrs bounces /throws and catches tennis ball with dominant hand.
- At 7 yrs throw, clap and catch between
- At 8 yrs throw,clap and clatch x2
- At 9 yrs throw,clapand catch x3
Kicking a ball is another milestone
- At 2 yrs walksinto ball and kicks it
- At 3 yrs kicks ball forceable
- At 4 yrs kicks ball with a skills improved
- At 5 yrs can trap and stop ball.
What does the physiotherapy assessment involve?
A hour long session initial assessment in which muscle tone (hyper mobility is very common in dyspraxia),Range of joint motion, coordination, balance, bilateral integrity, spatial awareness, hand/ eye coordination, foot/eye coordination, core strength are tested and areas were deficits were noted are addressed by appropriate home exercises. These are provided at the session and the child is sent home to perform these for either a week or two weeks and then returns and the next level of specific exercises are provided. The programme takes approximately 8 sessions on average and then a yearly follow up review.
However when a growth spurt occurs, top up sessions may be required as the child tends to get weaker and lacks stability around these times because the muscle are stretching to keep up with the bone growth and some may become week again and need to be targeted with the appropriate exercise.
The aim of the physiotherapy session is to teach the parent and child an affective tailor made home programme that works for them. The goals are set by the parent and child.
What do they want to achieve? E.g.
- I don’t want to fall over or trip as often.
- I don’t want to bump into objects as often.
- I want to improve at PE and sport so I can run and catch more effectively.
- I want to write more clearly.
Treatment is always more effective when it is part of a multidisciplinary team approach, with input from not only the physiotherapist but the school teacher, parent and occupational therapist (OT). This multi skilled approach allows the best possible outcome can be achieved.
At the end of the programme we try to find the best sporting activities suitable for that child so the child can continue to maintain the regained strength and coordination .It might be judo, swimming, rowing, horse riding, tennis, football etc etc.
Some other causes of dyspraxia:
Metabolic: 18 – 20 % due to a lack of essential fatty acids (EFA).
- Omega 3 (fish oils),
- Omega 6 (found in butter, cheeses)
Symptoms of EFA Deficiency:
- Dry skin.
- Course bumpy skin on arms
- Soft brittle nails (broken)
- Frequent urination and thirsty
- Dull dry hair
This can easily be treated by improving diet and supplementing diet .
Finally should you have any questions, concerns or ideas regarding DCD, please do not hesitate to contact me, telephone, email or snailmail. I will be happy to discuss the matter further.
Other useful Resources can be found at http://www.dyspraxia.ie/Galway