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Children who have developmental coordination disorder (DCD) have previously been given a wide variety of diagnoses, including but not limited to developmental apraxia, motor impaired, clumsy child syndrome, perceptual motor difficulties, and sensory integrative dysfunction (Baxter, 2012; Blank, Smits-Engelsman, Polatajko, & Wilson, 2012; Sugden & Chambers, 2005; Barnhart, Davenport, Epps, & Nordquist, 2003;). Over the past several years, physicians, therapists, and school personnel have identified common characteristics that apply to most of these children. Common characteristics include but are not limited to low muscle tone, balance deficits, awkward running pattern, difficulty following two- to three-step motor commands, learning difficulties, poor interactive play skills, perceptual deficits, slower response time, and decreased fitness levels (Blank et al., 2012; Cairney Hay, Veldhuizen, & Faught, 2011; Sugden & Chambers, 2005). In 1994, the American Psychiatric Association (APA) identified a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic category for DCD for children who meet the following three qualifying conditions: (1) marked impairment in development of motor coordination, (2) impairment that interferes with academic achievement or activities of daily living (ADL), and (3) coordination difficulties that are not due to a general medical condition or pervasive developmental disorder (APA, 1994). In 2000, the DSM- IV was updated to include “If mental retardation is present, the motor difficulties are in excess of those usually associated with it,” (APA, 2000).
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The prevalence of DCD is estimated to be 5% to 6% of all school-age children (Blank et al., 2012; Pieters et al., 2012). Because of this high prevalence, physical therapists are called upon frequently to provide assessments and interventions for children with DCD.
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Children with DCD often exhibit multiple comorbidities (Pieters et al., 2012). Because of the complexity of DCD, physical therapists address not only impairments in strength, balance, and coordination, but also impairments in respiration and endurance (Cairney et al., 2011). Boys with DCD have been found to spend less time participating in activities that require moderate to vigorous physical activity and more time in low-intensity physical activities (Poulsen, Barker, & Ziviani, 2011; Poulsen, Ziviani, & Cuskelly, 2008). Parents of children with DCD have identified additional concerns as their children have matured. For example, early concerns in the areas of motor ability and play evolved into concerns with self-care, academic performance, and the inability to successfully participate in organized sports and social activities (Jarus, Lourie-Gelberg, Engel-Yeger, & Bart, 2011; Missiuna, Moll, King, King, & Law, 2007).
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This case study focuses on the physical therapy management of Mark, a 6-year-old boy who has DCD, over the course of a yearlong episode of care. It was determined that Mark's impairments of body structure and function and limitations in activities and participation would be best addressed by the Preferred Practice Pattern 5B: Impaired Neuromotor ...