Although some studies have shown that any intervention with children who have DCD would be better than no intervention, more attractive and motivational alternatives to conventional exercises should be encouraged.3 Group therapy is more time-efficient and cost-effective for the therapist. The parents of children with DCD emphasize the importance of their children being able to participate in organized physical activity groups and value therapy that improves their child’s perceptions of self-confidence and competence over those that focus only on improving motor abilities. These views have led to suggestions that therapeutic interventions should focus on enhancing the social, as well as the physical, skills of children with DCD.8
Two adequately powered studies demonstrated very large improvements with three interventions; one being the Neuromotor Task Training approach which consisted of practiced components of soccer, netball, variations of tagging games, and other popular games in workstations, under the guidance of therapists who manipulated aspects of the environment and tasks as needed. After nine weeks of training (two 45–60-minute sessions per week), the Neuromotor Task Training group showed a very large, statistically significant improvement on the MABC-2. Another effective treatment approach, ‘conventional’ motor training interventions (such as those commonly used by occupational therapists and physiotherapists), and finally motor imagery training combined with practicing motor tasks were deemed to be effective. All three of these motor intervention programs had features in common: A task-oriented approach was a key feature and, although two were group-based, they were tailored to the individual needs and particular interests of the children. The use of equipment, like hoops, ropes and ladders, and outdoor games, were also a core feature of the interventions.
Wii®, core stability training, self-concept training, Tai Kwon Do, table tennis and aquatic therapy are not supported by the available evidence, and on the basis of the empirical evidence, their usage is not recommended. Effect sizes for these interventions are negligible, small or there is stronger evidence for more effective interventions.9
Building on the task-oriented approach, researchers have developed an even more promising treatment strategy: ‘task-specific’ intervention to improve balance in children with DCD. This treatment exposes the children repeatedly to a given (balance) task under the right constraints (e.g., the child’s natural environment). Several studies have shown that task-specific intervention can improve the motor performance of children with DCD in hopping, skipping and various balance activities.4
Some authors propose that the use of Virtual Reality (VR) has a strong motivational factor for use in treatment. They report that the tasks are similar to a naturalistic situation and the feedback provided by the game is almost immediate. Additionally, a large amount of movement repetition elicited during VR practice and the adequately high degree of adherence to the VR activities should be considered important factors enhancing the success of these protocols. Despite the benefits of VR sited by the primary studies, individually, the evidence synthesis has shown that VR was not more effective than control interventions in improving the motor performance of children with DCD.3
A body of evidence has linked DCD to significant impairments in general visual-motor control and the processing of task-relevant, visual information; the ability to use predictive information to guide action; the pursuit tracking of objects; and the ability to maintain fixation on visual targets. Some of this research was laboratory-based. However, deficits in the control of vision have obvious implications on the production and control of coordinated movement in the ‘real world.’ The ability to maintain visual fixation on a target and track an object is fundamental for aiming and interception skills, which are the building blocks for activities in sports and with many playground games. Throwing and catching is a perfect example of a task where these visual abilities are critical, and it is not surprising that children with DCD struggle with this. Teaching participants to adopt the Quiet Eye strategy by observing video footage of their eye-movements (QE training; QET), improved catching techniques in children with average motor skill ability and in children with DCD. DCD children who were given a brief QET intervention experienced significant improvements in their catching coordination and catching kinematics, and the benefits were maintained after a 6-week detraining period. Results from the gaze and performance data revealed some important implications;
- All children improved on the interceptive motor task, stressing that DCD should be considered an impaired motor proficiency rather than a fundamental inability to learn motor skills.
- DCD children were able to demonstrate more functional eye movements in order to directly compensate for oculomotor atypicality’s.1
QET instructions resulted in more effective retention of interceptive skills than typical explicit instructions that focus on movement control.8
Many populations, such as those with DCD, demonstrate a high incidence of difficulty processing and integrating sensation.10 One study found that most children (88%) with developmental coordination disorder presented with some difficulties in sensory processing and integration that impacted their participation in activities of daily living.6 Jean Ayres articulated the importance of considering the sensory-motor factors that may be affecting participation in tasks such as activities of daily living. Studies indicate that sensory integration interventions may contribute to improved outcomes in the areas of reading and related skills, sensory-motor skills, motor planning, socialization, behavioral regulation, and attention, all clearly skills that individuals with DCD need in order to be successful in school and life.9