Efficacy of interventions to improve motor performance in children with DCD (2012) - Smits-Engelsman et. al. - Article

Summary of the article: Efficacy of interventions to improve motor performance in children with DCD: a combined systematic review and meta-analysis (2012) - Smits-Engelsman et. al.

Therapeutic approaches commonly used are physiotherapy, occupational therapy, medicine, education and diet. These approaches can be divided into three groups: process-oriented, task-oriented and conventional physical and occupational therapy.

Process-oriented approaches target the body functions needed to perform activities. This can be done by kinaesthetic therapy, perceptual training or combined. Both are bottom-up approaches. Improvement of body functions should lead to better skill performance.

Task-oriented approaches focuses on learning particular motor skills, and especially on task performances that are causing the child difficulty. Examples of the therapies used are Neuromotor Task Training (NTT), Cognitive Orientation to daily Occupational Performance (CO-OP) and imagery training.

NTT strongly focuses on task structure and scheduling as fundamental aspects for learning. It considers how environmental constraints can be manipulated to enhance the child’s mobility.

CO-OP is a good example of a top-down approach. It focuses on the use of cognitive strategies to facilitate skill acquisition, and uses a collaborative, problem solving approach adaptive from cognitive behavioral therapy.

Conventional physical and occupational therapy trains the most fundamental gross motor and fine motor skils. By combining underlying process-oriented approaches with direct training skills because of the underlying assumption that motor skills are developed in a sort of hierarchical fashion.

Although many different intervention strategies have been used and studied, it remains unclear which best improve motor performance or activities in children with DCD and alleviate the associated problems. Therefore, guidelines have been set that interventions should meet:

1. Activities should be functional based on goals that are relevant to daily living

2. Generalization and application in the context of everyday life should be enhanced

3. Interventions must be evidence-based and applicable to the understanding of children with DCD

The children in these particular studies were children any age with DCD or possible DCD. Children with one standard deviation below mean were defined as having poor motor performance and were also included. There were 20 eligible studies for the meta-analysis, and 26 studies met the inclusion criteria. A total of 912 children with DCD or motor impairments participated in the studies used, with an average sample size of 44 participants.

Based on these studies, there is strong evidence that children with DCD benefit the most from task-oriented approaches. Motor-training used in conventional physical and occupational therapies were also found to be effective. Process-orientated approaches showed conflicting results.

Task oriented approaches work on teaching essential activities of daily living and stimulate participation at school, home and sports. The effect of motor imagery training should be carefully considered, because there’s only one study available examining this therapy. Therefore, more research is needed. For sensory integration therapy or kinaesthetic training are no well-designed studies that provide support for their effectiveness.

The examined studies showed that parents and teachers are able to provide effective intervention for children with DCD when supported by a professional. Involvement of parents and teachers makes it more likely that learned skills will continue to be used after formal interventions.

Because ADHD and DCD often co-occur, it’s not clear whether methylphenidate can be used to improve motor performance in DCD without comorbidities.

Limitations to this meta-analysis are that most of the used studies didn’t control for all other factors that could have produced the observed results, and therefore have given moderate levels of evidence. Also, the scheduling of treatment was variable, from once a week to every day. Most studies compared one intervention with no intervention, instead of different forms of intervention. Unfortunately, few studies described the intervention in sufficient detail to help researchers and clinicians understand what part of the treatment made it successful. Few studies did a follow-up, so no statements about longer-term effectiveness can be made.