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Improving the motor coordination of children with Developmental Coordination Disorder using Soft          Play Equipment  ...
Terminology• Clumsy child syndrome• Dyspraxia• Sensory integrative dysfunction• Minimal brain dysfunction• Perceptual-moto...
Definition of DCD‘Performance in daily livingactivities that require motorcoordination is substantiallybelow that expected...
Revised criterion AObserved poor performance in (culturallyexposed) fundamental motor skills evidentin a variety of enviro...
APA wish to include specific skills which are universally           affected:Catching      CuttingThrowing      ColouringK...
APA diagnostic criteria (2000)Criterion BThe disturbance in criterion A significantly interferes withacademic achievements...
APA diagnostic criteria (2000)Criterion CThe disturbance is not due to a general medicalcondition (i.e. cerebral palsy, he...
Symptoms I move with all the grace of a pregnant penguin let loose in    an opium factory. I have  difficulty running (my ...
The so-called ‘pure’ DCD with only motor difficulties isthe exception rather than the            rule.Ref: Peters & Hender...
2 ways of helpingchildren with motor    coordination      problems
Top-down          The physical task-centred                 approachTeaches a specific skill without emphasising theunderl...
2. Bottom-up          Process-orientated approachIdentifies the underlying processes involved inacquiring a specific skill...
Sensory     SensoryIntegration   Integration  System     System
Fidget toys    Children with clinically identifiedSensory Modulation Disorders respond  physiologically differently to sen...
Poor Figure-Ground Discrimination: Distractibility The child has difficulty blocking out unnecessary           input from ...
Spatial RelationshipsThe ability to perceive the position of two ormore objects in relation to self and in relationto each...
Remediation                                       Provide the input that                                       the body is...
EvidenceBundy, A. C., Shia, S., Long Qi, L., & Miller, L.J. (2007). How does sensoryprocessing affect play? American Journ...
Pilot   Sample Group: 3 children with coordination    difficulties   Inclusion criteria: 6-10 years old, not currently  ...
MABC-2 Range        Interpretation        Traffic Light system for test totalChild’s Score       Total Test Score    Perce...
8 week intervention programme:            Activities introduced (a few!)• Circuit Crawling• Pushing and pulling activities...
Focus: Static and dynamic resistance activities• Run around circuit as fast as possible x2.• On hands and knees (starting ...
Child 1:Age: 8.5Primary area of concern: Aiming and Catching, and Manual DexterityComponents             Component       S...
Child 2:Age: 6.10Primary area of concern: Aiming and Catching, and BalanceComponents            Component      Standard   ...
Child 3Age: 6.4 yearsPrimary area of control: Balance (Core Stability)        Components               Component          ...
Directed activities, utilising thesoft play environment, canimprove the motor skills ofchildren with DCDHowever…only a sma...
Positive Feedback   Children did not feel stigmatised by the    environment   Parents were comfortable with the setting...
   Parents and children always used restaurant    facilities.   Other children joined in activities,    spontaneously, a...
   Consider providing a dedicated time for    children with motor difficulties to access the    play environment.   Diss...
   Consider the inclusion of selected activities    which will encourage key skills. For example:   Improve hand-eye coo...
THANK YOU TO JANICEDUNPHY, DIRECTOR OF  CREEPY CRAWLIES,  YORK AND ALL HERFANTASTIC STAFF FORMAKING THIS PROJECT      POSS...
LIW - Improving the motor coordination of children with Developmental Coordination Disorder using Soft Play Equipment (Loi...
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LIW - Improving the motor coordination of children with Developmental Coordination Disorder using Soft Play Equipment (Lois Addy)

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Directed activities, utilising the soft play environment, can improve the motor skills of children with DCD
Lois Addy research by York St John University (partnered by the PPA and Creepy Crawlies)

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LIW - Improving the motor coordination of children with Developmental Coordination Disorder using Soft Play Equipment (Lois Addy)

  1. 1. Improving the motor coordination of children with Developmental Coordination Disorder using Soft Play Equipment Lois Addy Senior Lecturer
  2. 2. Terminology• Clumsy child syndrome• Dyspraxia• Sensory integrative dysfunction• Minimal brain dysfunction• Perceptual-motor disorder• Motor learning difficulties• Congenital maladroit• Developmental apraxia• Minimal cerebral palsy• Executive apraxia• Deficit of attention, motor and perception (DAMP) Gillberg (1996)• Developmental Coordination Disorder (DCD)
  3. 3. Definition of DCD‘Performance in daily livingactivities that require motorcoordination is substantiallybelow that expected, given the person’s chronological age and measured intelligence.’ DSM-IV (2000)
  4. 4. Revised criterion AObserved poor performance in (culturallyexposed) fundamental motor skills evidentin a variety of environments– Walking Reaching & grasping– Running Object manipulation– Hopping Object propulsion– Skipping Object reception– Climbing
  5. 5. APA wish to include specific skills which are universally affected:Catching CuttingThrowing ColouringKicking Printing HandwritingRunning Writing.JumpingHopping
  6. 6. APA diagnostic criteria (2000)Criterion BThe disturbance in criterion A significantly interferes withacademic achievements or activities for daily living.The disturbance in criterion A significantly interferes witheducational progress and/or activities of daily livingNB: leads to reduced participation in – Self-care activities – School/class/desk/work related activities – Play & leisure activities
  7. 7. APA diagnostic criteria (2000)Criterion CThe disturbance is not due to a general medicalcondition (i.e. cerebral palsy, hemiplegia ormuscular dystrophy) and does not meet criteriafor pervasive development disorder.Suggest: ‘the disturbance is not due to a generalneurological condition’.
  8. 8. Symptoms I move with all the grace of a pregnant penguin let loose in an opium factory. I have difficulty running (my arms tend to flap about, and Iinvariably end up tripping over my own ski-sized feet)
  9. 9. The so-called ‘pure’ DCD with only motor difficulties isthe exception rather than the rule.Ref: Peters & Henderson (2008).
  10. 10. 2 ways of helpingchildren with motor coordination problems
  11. 11. Top-down The physical task-centred approachTeaches a specific skill without emphasising theunderlying processes.The skill is sub-divided, instructed, and rehearseduntil it has been mastered.
  12. 12. 2. Bottom-up Process-orientated approachIdentifies the underlying processes involved inacquiring a specific skill; and then focuses ondeveloping these skills to provide the foundationfrom which other skills are built.The process-orientated approach is based on thepremise that age-appropriate reflexes, posturalreactions, and perceptuo-motor abilities all underliefunctional motor skills and conceptual development(Pless and Carlsson, 2000).
  13. 13. Sensory SensoryIntegration Integration System System
  14. 14. Fidget toys Children with clinically identifiedSensory Modulation Disorders respond physiologically differently to sensory stimuli (including tactile stimuli) than typically developing children; these differences have ramifications for functional behaviour. McIntosh et al (1999) Rotz R, Wright SD (2005)
  15. 15. Poor Figure-Ground Discrimination: Distractibility The child has difficulty blocking out unnecessary input from the environment. • Auditorily Distractible Means paying attention to all sounds, not just appropriate ones, e.g., voices in halls, ringing of telephone. • Visually Distractible Means paying attention to all things seen rather than the appropriate items, e.g., clouds, rug, pictures.
  16. 16. Spatial RelationshipsThe ability to perceive the position of two ormore objects in relation to self and in relationto each other.
  17. 17. Remediation Provide the input that the body is craving forProvide tasks personwhich extend thechild’s motorcontrol throughcarefully gradedactivities task Provide an environment which can environment provide sensory integration
  18. 18. EvidenceBundy, A. C., Shia, S., Long Qi, L., & Miller, L.J. (2007). How does sensoryprocessing affect play? American Journal of Occupational Therapy. 61, 201-208.Kaufman L B, Schilling D L (2007) Implementation of a Strength Training Program for a5-Year-Old Child With Poor Body Awareness and Developmental CoordinationDisorder. Physical Therapy. 87 (4), 455-467Miller, L.J., Schoen, S.A., James, K. & Schaaf, R.C. (2007). Lessons learned: Apilot study of occupational therapy effectiveness for children withsensory modulation disorder. American Journal of OccupationalTherapy, 61, 161-169.Parham, L. D., Cohn, E. S., Spitzer, S., Koomar, J. A., Miller, L. J., Burke, J. P., et al. (2007).Fidelity in sensory integration intervention research. American Journal of OccupationalTherapy, 61, 216–227.
  19. 19. Pilot Sample Group: 3 children with coordination difficulties Inclusion criteria: 6-10 years old, not currently receiving occupational therapy or physiotherapy Ethical approval obtained Pre and post assessment using the Movement Assessment Battery for Children – Second Edition (MABC-2) Permission from parents and children
  20. 20. MABC-2 Range Interpretation Traffic Light system for test totalChild’s Score Total Test Score Percentile Range DescriptionRed Zone Up to and including At or below the 5th Denotes a 56 percentile significant movement difficultyAmber Zone Between 57 and 67 Between the 5th Suggests the child Inclusive and 15th percentile is ‘at risk’ of having a movement difficulty; monitoring requiredGreen Zone Any score above Above the 15th No movement 67 percentile difficulty detected
  21. 21. 8 week intervention programme: Activities introduced (a few!)• Circuit Crawling• Pushing and pulling activities• Crab football• Crab walking races• Wheelbarrows• Hand-eye coordination• Strength and endurance i.e. rope climbing, spinning, swinging, monkeys• Squashing and rolling activities
  22. 22. Focus: Static and dynamic resistance activities• Run around circuit as fast as possible x2.• On hands and knees (starting at dining tables) crawl around circuit, the winner is the person who comes last.• Push adult around course (adult providing some resistance).• Commando crawl around course• Wheelbarrow backward and forward along toddler flat mat.• Time circuit, try to beat previous time.• Go round circuit backwards• Hide and Seek• Crab penalty goals• Intersperse with fine motor activities (workbook)
  23. 23. Child 1:Age: 8.5Primary area of concern: Aiming and Catching, and Manual DexterityComponents Component Standard Percentile Score ScoreManual Dexterity 18 5 5Aiming and Catching 11 5 5Balance 22 6 9Total Test Score 51 5 5Components Component Standard Percentile Score ScoreManual Dexterity 21 6 9Aiming and Catching 21 11 63Balance 22 6 9Total Test Score 64 7 16
  24. 24. Child 2:Age: 6.10Primary area of concern: Aiming and Catching, and BalanceComponents Component Standard Percentile Score ScoreManual Dexterity 29 10 50Aiming and Catching 11 5 5Balance 17 5 5Total Test Score 57 6 9Components Component Standard Percentile Score ScoreManual Dexterity 25 8 25Aiming and Catching 13 6 9Balance 25 8 25Total Test Score 63 7 16
  25. 25. Child 3Age: 6.4 yearsPrimary area of control: Balance (Core Stability) Components Component Standard Percentile Score ScoreManual Dexterity 21 6 9Aiming and Catching 22 12 75Balance 17 5 5Total Test Score 60 6 9 Components Component Standard Percentile Score ScoreManual Dexterity 13 4 2Aiming and Catching 23 12 75Balance 27 8 25Total Test Score 63 7 16
  26. 26. Directed activities, utilising thesoft play environment, canimprove the motor skills ofchildren with DCDHowever…only a small number ofchildren were involved in this pilotproject.
  27. 27. Positive Feedback Children did not feel stigmatised by the environment Parents were comfortable with the setting Parking was easier than at a hospital/school Parents obtained ideas of what to do to enhance their child’s development using play-based activities Parents and children supported each other. Parents returned to the soft play centre to practice skills
  28. 28.  Parents and children always used restaurant facilities. Other children joined in activities, spontaneously, and parents asked if they could be part of the project. The play environment was perceived as being more than a play centre, it was seen as having therapeutic value by those involved in the project and others who observed the activities. Overt link between development and play
  29. 29.  Consider providing a dedicated time for children with motor difficulties to access the play environment. Disseminate project findings to occupational therapists and physiotherapists across the UK to encourage similar, and/or larger scale projects. Create list of activity ideas for other parents/carers to use.
  30. 30.  Consider the inclusion of selected activities which will encourage key skills. For example: Improve hand-eye coordination through fixed table top games i.e. magnetic mazes, electronic tracking games. Improved ball skills ie Mookie Reflex Swingball soccer, wind tunnel ball balancers
  31. 31. THANK YOU TO JANICEDUNPHY, DIRECTOR OF CREEPY CRAWLIES, YORK AND ALL HERFANTASTIC STAFF FORMAKING THIS PROJECT POSSIBLE FOR FURTHER INFO. CONTACT:LOISMA@TALKTALK.NET

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