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The Bottom Line

	What problems did the researchers set out to study, and why?

 
In general, there has been a paucity of research on effective interventions for children with developmental coordination disorder (DCD). Recently, several intervention strategies using a "top-down" approach were described and found to be associated with positive treatment effects. One of these strategies—neuromotor task training (NTT)—incorporates motor learning principles and emphasizes direct teaching of task-specific activities. Because a variety of options can be used to accomplish effective teaching, little is known about which specific teaching principles are associated with the improvements seen in motor skills, so these authors explored the interaction between specific NTT teaching principles and improved motor skills.

	What types of patients participated in the study?

Top What problems did the... What types of patients... What new information does... How did the researchers... How might the results... What are the limitations...

 
Nineteen children (16 boys, 3 girls) with a diagnosis of DCD (according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed) who were referred for physical therapy because of motor coordination problems at home or school. The children were between the ages of 5 to 10 years (mean=7 y, 5 mo; SD=1.3 y). Participation in the study was limited to children who performed below the 15th percentile on the Movement Assessment Battery for Children (M-ABC) pretest assessment.

	What new information does this study offer?

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Children with DCD are heterogeneous with respect to the prevalence and severity of the motor impairments and functional limitations that characterize the disorder as well as the nonmotor impairments. Approaches to treatment have been equally diverse. These authors delineated which of the various teaching principles available to therapists using NTT were associated with the greatest gains in motor skills on the M-ABC or the Test of Gross Motor Development (TGMD-2). They found that improved motor skill performance was associated with specific clues on how to perform the task and guidance in terms of correcting posture. Improvements also were associated with principles that provided explanations for the execution of specific movements and with strategies in which the children were asked if they understood the movement requirements of the task.

	How did the researchers go about the study?

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All study participants received a 30-minute session of NTT once a week for 9 weeks. Posttest assessments using the M-ABC and TGMD-2 were done 1 or 2 weeks after the 9th session. Thirteen of the 19 study participants received an additional 9 sessions, after which a second posttest assessment was done. After participants had gone through at least 6 sessions, the researchers videotaped one of the 30-minute NTT interventions and analyzed the session using an observation system that quantified the type and frequency of the various motor teaching principles associated with NTT. These investigators developed and validated this observation system, called "motor teaching principles taxonomy" (MTPT), which essentially clusters 20 different principles for teaching motor skills into 3 mutually exclusive categories. Therapeutic success was measured by change scores on the M-ABC and TGMD-2 for each child. The change scores between and within children were analyzed with respect to their association with the teaching principles.

	How might the results of this study apply to patients who are treated by physical therapists from this point forward?

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At a minimum, this study reinforces the idea that children with DCD benefit from task-specific instruction. The NTT is a task-oriented, skill-based approach and relies on therapists applying effective teaching principles for giving instructions and providing feedback. By using the MTPT, they were able to parse the teaching principles used in NTT into component parts, giving physical therapists more insight into which might be more successful than others in achieving improved motor skills. Task-oriented approaches to motor learning and control, while having a strong theoretical basis, can be left to interpretation. By defining and categorizing intervention strategies, therapists can begin the challenging work of matching specific interventions to the various subtypes of DCD.

	What are the limitations of the study, and what further research is needed?

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As the authors acknowledged, this pilot study was done with a small sample and without a comparison group; all subjects received NTT, but there were differences in the type and frequency of the various motor teaching principles. No attempt was made to control for the variety of child-related factors that could have contributed to improved scores on the M-ABC and TGMD-2. Although a statistically significant improvement was found between pretest and posttest scores on both outcome measures, it is difficult to establish any causality with the teaching principles used in the NTT. Another limitation of the study was the uneven application of intervention sessions; subjects received either 9 or 18 sessions based on availability of reimbursement. The major limitation, however, is that the main result of the study was based on observation data from one treatment session. It is difficult to find clinical significance in the reported interactions between motor outcome and use of specific teaching principles from one 30-minute occurrence. %Further research is needed with a larger group of subjects and with a comparison group so that the improvements in motor performance can be linked to specific interventions. In addition, increasing the number of coded observations is necessary to establish a true correlation with the treatment outcomes. Finally, this field of study will benefit greatly from studies looking at motor skill retention over a longer period of time, so that treatment success can include permanent changes in motor behavior.

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Related Article

Are Teaching Principles Associated With Improved Motor Performance in Children With Developmental Coordination Disorder? A Pilot Study

Anuschka S Niemeijer, Marina M Schoemaker, and Bouwien CM Smits-Engelsman
Physical Therapy 2006 86: 1221-1230. [Abstract] [Full Text] [PDF]

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