Motor imagery training in children with Developmental Coordination Disorder

Background of the study:

Children with Developmental Coordination Disorder are impaired in the coordination of movements. Children with DCD may experience problems with both gross and fine movements. The prevalence of DCD is 5-10% of all children on primary schools. The motor problems that children with DCD experience have a negative impact on the functioning in daily life and academic achievement. The underlying cause of DCD is until present not yet known. A recent hypothesis, the 'internal modeling deficit' (IMD) hypothesis, states that children with DCD have problems in the generation of an accurate model for a movement.

Earlier studies have shown that children with DCD experience difficulties with motor imagery, motor planning and the online correction of movements. Current intervention programmes for children with DCD are mainly task specific training guided by a pediatric physiotherapist. A widely used training approach is the Cognitive Orientation to Daily Occupational Performance. Although this training seems to be effective to improve the performance of a certain task or movement, it is not aimed at the actual cause of the motor impairment. In addition, improvement on one task often does not transfer to other tasks.



By means of a Motor Imagery Training we want to study if it possible to improve the internal model for a movement in children with DCD, thereby probably improving also the motor abilities these children. This study is the first study that examines whether there is a causal relation between motor imagery capacities of children with DCD and their motor abilities.



Objective of the study:
Studying the effect of two intervention programs (1. Motor Imagery Training, 2. Cognitive Orientation to Daily Occupational Performance (CO-OP)) on the motor abilities, motor imagery and motor planning capacities in children with Developmental Coordination Disorder. These abilities will be tested before and after the training period.



Study design:
Children will be recruited through paediatric physiotherapists and occupational therapists in the Netherlands.
Chidren who sign up by the participating paediatric physiotherapsts and occupational therapists, will be invited to participate in this study.
First parents give their informed consent and then the motor capacities of these children will be tested with the mABC and interference with daily life will be tested with the DCDQ. If the children fullfill all the in- and exclusioncriteria, they will be randomly divided over the following two groups:



1. Motor Imagery training:

Before the start of the treatment sessions, children will participate in a pre measurement (duration: 1.5 hour) in which their motor ablities, their motor imagery, motor planning and online control abilities are tested. After this pre measurement, the treatment sessions (9 in total) can start. Next to the guided treatment, children are asked to perform some homework exercises, 4 times per week for 10 minutes. When children fulfilled the 9 treatment sessions, the motor abilities, motor imagery, planning and online control abilities are again tested during the post-measurement testing session.



2. CO-OP training:

Before the start of the treatment sessions, children will participate in a pre measurement (duration: 1.5 hour) in which their motor ablities, their motor imagery, motor planning and online control abilities are tested. After this pre measurement, the treatment sessions (9 in total) can start. Next to the guided treatment, children are asked to perform some homework exercises, 4 times per week for 10 minutes. When children fulfilled the 9 treatment sessions, the motor abilities, motor imagery, planning and online control abilities are again tested during the post-measurement testing session.

Before (T0) and after the treatment (T1) all tests will be assessed:

- mABC-2

- motor imagery: hand rotation task (reaction time and number of errors), visual guided pointing task (movement time)

- action planning: sword task, % of trials where children plan for end-state comfort (ESC)

- online control: double-step reaching task (movement time and errors)

- Video recordings of the trained motor skills

- Group 1: Motor Imagery Training

This group will receive 9 treatment sessions of 45 minutes. Because only motor imagery exercises will be to abstract for these children, we choose to combine the motor imagery with actual execution of the movement. This will be alternated, and children will also be asked to compare the imagery and the actual execution of the movement. Next to the guided treatment, children are asked to perform some homework exercises. They have to do the homework sessions 4 x per week 10 minutes per session.

- Group 2: Cognitive Orientation to Daily Occupational Performance (CO-OP)

Children in this group will be treated according to the CO-OP principles during 9 sessions of 45 minutes. CO-OP is expected to improve the knowledge of the task through cognitive strategy use. During a CO-OP intervention, a child learns a self-instruction strategy, which enables the child to identify why the performance was not succesful, and to invent and execute plans to correct his/her performance (the goal-plan-do-check strategy). Next to the guided treatment, children are asked to perform some homework exercises. They have to do the homework session 4 x per week 10 minutes per session.