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Developmental Dyspraxia: Sensory Considerations for Motor Skill Development

Noel Marie Spina, PT, DPT, PCS Lecturer

California State University, Long Beach Clinician

Children’s Hospital of Orange County Pediatric Therapy Network

[email protected]

Stefanie Bodison, OTD, OTR/L Assistant Professor of Research

USC Chan Division of Occupational Science & Occupational Therapy Faculty

Developmental Cognitive Neuroimaging Laboratory Keck School of Medicine at USC and Children’s Hospital Los Angeles

[email protected]

The speakers declare no conflicts of interest.

Bodison/Spina APTA CSM 2016 2

Acknowledgments Current Funding �  SC CTSI KL2 Award (NIH/NCRR/NCATS Grant #KL2TR000131) �  SC CTSI Pilot Award (NIH/NCRR/NCATS Grant #ULITR000130 )

Recent Past Funding �  T32 Award (NIH/NICHD/NCMRR Grant #1T32 HD64578-1A1)

Mentors �  Terence D. Sanger, MD, PhD �  Elizabeth Sowell, PhD �  Florence Clark, PhD, OTR/L �  Stewart Mostofsky, MD �  The children and the families under our care.


Developmental Cognitive Neuroimaging Laboratory

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Objectives �  Discuss current research findings describing developmental

dyspraxia in the pediatric special needs population. �  Utilizing a conceptual framework, explain the relationship between

pediatric motor disorders, sensory integration, and developmental dyspraxia in infants and children.

�  Identify the impact of developmental dyspraxia on the acquisition of complex motor skills and subsequent levels of participation in life roles.

�  Demonstrate an understanding of considerations relating to plans

of care and intervention strategies capable of addressing sensory-based impairments impacting the development of praxis in infants and children.


APTA Vision Statement

Transforming society by optimizing movement to improve the human experience.

APTA Guide to Practice


Principles to Achieve the Vision

Movement is key to optimal living and quality of life for all people that extends beyond health to every person's ability to participate in and contribute to society.



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Guiding Principles: Identity

� The physical therapist will be responsible for evaluating and managing an individual’s movement system across the lifespan.....

� The movement system is the core of

physical therapist practice, education, and research......



Movement = Action and Perception

Movement is Embodied (DST) �  Includes the sensory information that occurs before,

during, after the movement as well as the perception of the mover about what is happening

�  Perceptual information is a requisite for

guiding reach, mobility and balance control ◦  Balance control provides the basis for

intentional movement of the of the head, trunk and limbs

2011 Adolph and Berger


Movement encompasses a motor and a sensory event.


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Pediatric Motor Disorders � Developmental conditions that impact the

child’s ability to produce controlled, coordinated motor movements

�  Significantly impact the child’s development across multiple domains

� Disrupt the child’s daily routines and limit active participation in childhood occupations


Taxonomy of Pediatric Motor Disorders

References Sanger, T. D. (2003). Pediatric movement disorders. Current Opinion in Neurology, 16 (4),

529-535. Sanger, T. D.; Delgado, M. R.; Gaebler-Spira, D.; Hallett, M.; Mink, J. W. & the Taskforce on

Movement Disorders (2003). Classification and definition of disorders causing hypertonia in childhood. Pediatrics, 111 (1), e89-e97.

Sanger, T. D.; Chen D.; Delgado, M. R.; Gaebler-Spira, D.; Hallett, M.; Mink, J. W. & the

Taskforce on Movement Disorders (2006). Definition and classification of negative signs in childhood. Pediatrics, 118 (5), 2159-2167.

Sanger, T. D.; Chen, D.; Fehlings, D. L.; Hallett, M.; Lang, A. E.; Mink, J. W.; Singer, H.; Alter, K.;

Ben-Pazi, H.; Butler, E.; Chen, R.; Collins, A.; Dayanidhi, S.; Forssberg, H.; Fowler, E.; Gilbert, D. L.; Gorman, S. L.; Gormley, M. E.; Jinnah, H. A.; Kornblau, B.; Krosschell, K.; Lehman, R. K.; MacKinnon, C.; Malanga, C. J.; Mestermann, R.; Michaels, M. B.; Pearson, T. S.; Rose, J.; Russman, B.; Sternad, D.; Swoboda, K. & Valero-Cuevas, F. (2010). Definition and classification of negative motor signs in childhood. Movement Disorders, 25 (11), 1538-1549.


Developmental Dyspraxia

� The failure to have acquired the ability to perform age appropriate complex motor actions

� Estimated prevalence in 2% of the population, with 70% of those male


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� We theorize that the development of praxis naturally occurs as the typically developing child interacts with the environment.



�  Successful environmental interactions correlate with changes in brain structure and function, thereby providing the basis for the development of increasingly more complex skills.



� One theory about the difficulties seen in developmental dyspraxia relate to differences in sensorimotor integration.


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Sensorimotor Integration

�  Sensorimotor integration refers to the child’s ability to successfully transform sensory information into a motor response.

Mostofsky, S. H., & Ewen, J. B. (2011). Altered connectivity and action model formation in autism is autism. The Neuroscientist, 17(4), 437–448. Bodison/Spina APTA CSM 2016 16

Overarching Research Question

Is there a link between disordered

processing of sensory information in the brain and developmental dyspraxia?

And if so, what areas of the brain might

be involved?


Testing of This Hypothesis

� Phase 1: Development of a behavioral paradigm to explore the contribution of sensory input to motor performance.

� Phase 2: Ongoing research study using

advanced multimodal imaging techniques to explore the various regions associated with praxis


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Research Question #1 Related to Behavioral Paradigm

� What are the underlying sensorimotor problems in children who are suspected of having developmental dyspraxia



� Do dyspraxic children with ASD and DCD

have differing patterns of sensorimotor problems?



� Does the Test of Hand Gestures (TOHG)

provide us with insight about these differences?


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Identification of Populations

Current research identifying the presence of sensory integration challenges within pediatric populations demonstrating developmental dyspraxia


Participation

� Broadly defined as involvement in life situations and includes physical, social, and self-engagement in activities.

World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization; 2001


Participation Implications

The objectives of rehabilitation services are �  for children to participate in an ongoing way

in their community �  to have a sense of belonging and

contribution at each stage of their on-going development.

Law; Imms


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Participation as an Outcome

�  Participation is considered to be a key outcome of rehabilitation programs and services directed at assisting children and families to adapt to the challenges they face (King 2002)

�  Parents, youth and professionals consider enhanced participation in activities as one of the more important outcomes of intervention (Palisano et al)

25 Bodison/Spina APTA CSM 2016

Benefits of Participation

� Meaningful and intrinsically motivated leisure activities: ◦  foster mental and physical health benefits ◦  provide opportunities for social relationships ◦ may improve quality of life.

Specht



� Participation in family life and community activities enables children to: ◦  become self- determined ◦  learn skills ◦  form friendships ◦  express creativity ◦  determine meaning and purpose in life Dijkers


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�  For children with disabilities, participation

in activities is the context in which they learn skills, do tasks, develop friends and find satisfaction

Law


Health Promotion

Participation is essential to sustain health promotion action.

Rowland et al. 2015


Dimensions of Participation � Physical Engagement ◦  child’s involvement in the activity

�  Social Engagement ◦  child’s interpersonal interactions that occur

during the activity �  Self-Engagement ◦  child’s enjoyment in the moment and self-

understanding Palisano et al 2012


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Participation: Physical What do we know?

� Children with dyspraxia ◦ ASD ◦ DCD


Participation: Social What do we know



Participation: Self What do we know?


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Considerations: Plan of Care

� Considerations for plans of care designed to address developmental dyspraxia


Considerations: Strategies

� Considerations for sensory-based intervention strategies designed to address developmental dyspraxia


Lifespan

“The need is critical for youth with disabilities to participate in health promotion and fitness programs to develop active, healthy lifestyles into adulthood.

Rowland et al 2015


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References �  Ayres, A. J. (2011). Ayres dyspraxia monograph: 25th anniversary edition. Torrance, CA:

Pediatric Therapy Network.

�  Ayres, A. J. (1975). Sensorimotor foundations of academic ability. In W. M. Cruickshank & D. P. Hallahan (Eds.), Perceptual and Learning Disabilities in Children (vol. 2). New York, NY: Syracuse University Press.

�  Ayres, A. J. (2005). Sensory integration and the child: 25th anniversary edition. Los Angeles, CA: Western Psychological Services.

�  Bhat, A. N., Landa, R. J., & Galloway, J. C. C. (2011). Current perspectives on motor functioning in infants, children, and adults with autism spectrum disorders. Physical Therapy, 91, 1116-1129.

�  Bodison, S. C. (2015). Developmental dyspraxia and the play skills of children with autism. American Journal of Occupational Therapy, 69 (5) p 6905185060p1.

�  Bodison, S. & Mostofsky, S. (2014). Motor control and motor learning processes in autism spectrum disorders in Volkmar, F. R, Paul, R., Rogers, S. J., & Pelphrey, K. A. (eds) Handbook of Autism and Pervasive Developmental Disorders, fourth edition: Assessment, intervention, policy and the future, 354-377. New Jersey: Wiley & Sons, Inc.

�  Bult, M.K. (2011). What influences participation in leisure activities of children and youth with physical disabilities? A systematic review. Research in Developmental Disabilities, 32, 1521-1529.


References �  Camden, C. et al. (2014). Best practice principles for management of children with

developmental coordination disorder (DCD): results of a scoping review. Child: Care, Health and Development, 41 (1), 147-159.

�  Dijkers, M. P. (2010). Issues in the conceptualization and measurement of participation: An overview. Archives of Physical Medicine and Rehabilitation, 91 (9 Suppl), S5–S16.

�  Downey, R.; Rapport, M.J.K. (2012). Motor activity in children with autism: a review of current literature. Pediatric Physical Therapy, 24(1):2–20.

�  Dziuk, M. A., Larson, J. C., Apostu, A., Mahone, E. M., Denckla, M. B., & Mostofsky, S. H. (2007). Dyspraxia in autism: Association with motor, social, and communicative deficits. Developmental Medicine & Child Neurology, 49(10), 734–739.

�  EACD Recommendations. (2015). EACD Recommendations, 1–115.

�  Fournier, K. et al. (2010). Motor coordination in autism spectrum disorders: a synthesis and meta-analysis. Journal of Autism Developmental Disorders, 40, 1227-1240.

�  Kang, L.J. et al. (2014). A multidimensional model of optimal participation of children with physical disabilities. Disability and Rehabilitation, 36 (20), 1735-1741.

�  Lane, A., Harpster, K., Heathcock, J. (2012). Motor characteristics of young children referred for possible autism spectrum disorder. Pediatric Physical Therapy, 24, 21–29.


References �  Levac, D. et al. (2009). The application of motor learning strategies within

functionally based interventions for children with neuromotor conditions. Pediatric Physical Therapy, 21 (4), 345-355.

�  Law, M. (2002). Participation in the occupations of everyday life. American Journal of Occupational Therapy, 56 (6), 640-649.

�  MacNeil, L. K., & Mostofsky, S. H. (2012). Specificity of dyspraxia in children with autism. Neuropsychology, 26(2), 165.

�  Magalhaes, L.C., Cardoso, A.A., Missiuna, C. (2011). Activities and participation in children with developmental coordination disorder: A systematic review. Research in Developmental Disabilities, 32,1309–1316.

�  Mostofsky, S. et al. (2006). Developmental Dyspraxia is not limited to imitation in children with autism spectrum disorders. Journal of the International Neuropsychological Society, 12, 314-326.

�  Palisano, R.J. et al. (2011). Determinants of intensity of participation in leisure and recreational activities by youth with cerebral palsy. Archives of Physical Medicine and Rehabilitation, Vol 92.

�  Palisano, R.J. et al. (2012). Participation-based therapy for children with physical disabilities. Disability and Rehabilitation, 34, (12), 1041-1052.

�  Polatajko, H. J. & Cantin, N. (2006) Developmental Coordination Disorder (Dyspraxia): An Overview of the State of the Art. Seminar in Pediatric Neurology, 12 (4), 250-258.


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References �  Petrenchik TM, King GA. Pathways to positive development: Child- hood

participation in everyday places and activities. In Bazyk S, editor. Mental health promotion, prevention, and intervention in children and youth: A guiding framework for occupational therapy, Bethesda, MD: The American Occupational Therapy Association; 2011. pp 71–94.

�  Rahkonen, Petri et al. (2015). Atypical sensory processing is common in extremely low gestational age children. Acta Paediatrica. DOI: 10.1111/apa.12911.

�  Raz-Silibiger, S. et al. (2015). Relationship between motor skills, participation in leisure activities and quality of life of children with developmental coordination disorder: temporal aspects. Research in Developmental Disabilities, 38, 171–180.

�  Rivilis, I. et al. (2011). Physical activity and fitness in children with developmental coordination disorder: A systematic review. Research in Developmental Disabilities, 32, 894–910.

�  Rowland, J. et al. (2015). The scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities. Pediatric Physical Therapy, 27, 2–15.

�  Sanger, T. D. (2003). Pediatric movement disorders. Current Opinion in Neurology, 16 (4), 529-535.


References �  Sanger, T. D.; Chen, D.; Fehlings, D. L.; Hallett, M.; Lang, A. E.; Mink, J. W.; Singer, H.; Alter, K.; Ben-

Pazi, H.; Butler, E.; Chen, R.; Collins, A.; Dayanidhi, S.; Forssberg, H.; Fowler, E.; Gilbert, D. L.; Gorman, S. L.; Gormley, M. E.; Jinnah, H. A.; Kornblau, B.; Krosschell, K.; Lehman, R. K.; MacKinnon, C.; Malanga, C. J.; Mestermann, R.; Michaels, M. B.; Pearson, T. S.; Rose, J.; Russman, B.; Sternad, D.; Swoboda, K. & Valero-Cuevas, F. (2010). Definition and classification of negative motor signs in childhood. Movement Disorders, 25 (11), 1538-1549.

�  Specht J, King G, Brown E, Foris C. The importance of leisure in the lives of persons with congenital physical disabilities. Am J Occup Ther 2002;56:436-45.

�  Srinivasan, S., Pescatello, L., Bhat, A. (2014). Current perspectives on physical activity and exercise recommendations for children and adolescents with autism spectrum disorders. Physical Therapy, 94, 875-889.

�  Steinman, K.J., Mostofsky, S. H., & Denckla, M. B. (2010). Toward a Narrower, More Pragmatic View of Developmental Dyspraxia. Journal of Child Neurology, 25, 71-81.

�  World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization; 2001.

�  Zwaigenbaum, L. et al. (2009). Clinical Assessment and Management of Toddlers With Suspected Autism Spectrum Disorder: Insights From Studies of High-Risk Infants. Pediatrics, 123 (5), 1383-1391.

�  Zwicker, J. et al. (2012). Developmental coordination disorder: A review and update. European Journal of Paediatric Neurology, 16, 573-581.

�  Zwicker, J.G., Harris, S.R., Klassen, A.F., (2012). Quality of life domains affected in children with developmental coordination disorder: a systematic review. Child: care, health and development, 39 (4), 562-580.cch_1379.


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