Susan R. Harris

Developmental coordination disorder: A review and update

Present in approximately 5-6% of school-aged children, developmental coordination disorder (DCD) is a neuromotor disability in which a childs motor coordination difficulties significantly interfere with activities of daily living or academic achievement. These children typically have difficulty with fine and/or gross motor skills, with motor performance that is usually slower, less accurate, and more variable than that of their peers. In this paper, we review the history of various definitions leading up to the current definition of DCD, prevalence estimates for the disorder, etiology, common co-morbidities, the impact of DCD on the childs life, and prognosis. As well, we briefly describe current interventions for children with the disorder and results of recent neuroimaging studies of the brains of children with DCD, including research by the authors of this paper.

Quality of life of formerly preterm and very low birth weight infants from preschool age to adulthood: a systematic review.

OBJECTIVE. The goal of this systematic review was to synthesize studies that examined the health-related quality of life of preschool- and school-aged children, adolescents, and young adults who were born preterm and/or at very low birth weight. METHODS. We searched 7 databases up to September 2006 (Medline, PubMed, Embase, EBM Reviews, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, and the Educational Resource Information Center) as well as gray literature sources. We independently screened studies and included them only if a quality-of-life outcome measure was used and findings compared preterm, very low birth weight, or extremely low birth weight infants with term or normal birth weight peers. We independently assessed the methodologic quality of each study by using criteria adapted from the Centre for Reviews and Dissemination. RESULTS. Fifteen cohort or cross-sectional studies met the review criteria. In 6 studies of preschool-aged children, differences were found between study and control groups, suggesting that many preschool children born preterm or at very low birth weight perform more poorly than their peers in physical, emotional, and/or social functioning. Extremely low birth weight school-aged children had lower health utility scores compared with their peers, and similar results were found for adolescents. Parents of preterm and very low birth weight teens noted significantly poorer performance in their childs global health, behavior, and physical functioning, whereas the teenagers themselves did not. In young adulthood, differences in physical functioning remained, but subjective quality of life was similar to normal birth weight peers. CONCLUSIONS. The effects of preterm birth/very low birth weight on health-related quality of life seem to diminish over time, which possibly reflects issues related to a childs report versus a parent-proxy report, differing definitions of health-related quality of life, and adaptation of individuals over time, versus true change in health-related quality of life.

Single-subject research design: recommendations for levels of evidence and quality rating.

The aim of this article is to present a set of evidence levels, accompanied by 14 quality or rigor questions, to foster a critical review of published single‐subject research articles. In developing these guidelines, we reviewed levels of evidence and quality/rigor criteria that are in wide use for group research designs, e.g. randomized controlled trials, such as those developed by the Treatment Outcomes Committee of the American Academy for Cerebral Palsy and Developmental Medicine. We also reviewed methodological articles on how to conduct and critically evaluate single‐subject research designs (SSRDs). We then subjected the quality questions to interrater agreement testing and refined them until acceptable agreement was reached. We recommend that these guidelines be implemented by clinical researchers who plan to conduct single‐subject research or who incorporate SSRD studies into systematic reviews, and by clinicians who aim to practise evidence‐based medicine and who wish to critically review pediatric single‐subject research.

Brain activation associated with motor skill practice in children with developmental coordination disorder: an fMRI study.

Children with developmental coordination disorder (DCD) have difficulty in learning new motor skills. At present, it is not known whether these children employ a different set of brain regions than typically developing (TD) children during skilled motor practice. Using functional magnetic resonance imaging, we mapped brain activity associated with skilled motor practice of a trail‐tracing task in 7 children with DCD and 7 age‐matched controls (aged 8–12 years). We indexed change in motor performance as a reduction in tracing error from early practice to retention. Children with DCD showed less blood‐oxygen‐level‐dependent signal as compared to TD children in a network of brain regions associated with skilled motor practice: bilateral inferior parietal lobules (Brodmann Area (BA) 40), right lingual gyrus (BA 18), right middle frontal gyrus (BA 9), left fusiform gyrus (BA 37), right cerebellar crus I, left cerebellar lobule VI, and left cerebellar lobule IX. While no statistically significant differences were detected, effect size testing revealed that children with DCD demonstrated poorer tracing accuracy than TD children at retention (d = 0.48). Our results suggest that, compared to TD peers, children with DCD demonstrate under‐activation in cerebellar–parietal and cerebellar–prefrontal networks and in brain regions associated with visual‐spatial learning. These data suggest a neurobiological correlation with impaired learning of motor skills in children with DCD, which will need to be confirmed with a larger sample.

Health Care Communication Issues in Multiple Sclerosis: An Interpretive Description

Communication between persons with chronic illness and their professional health care providers is a critical element of appropriate health care. As the field of health care communication evolves, it becomes apparent that aspects of the illness experience shared by those affected by specific diseases might be a source of particular insight into what constitutes effective or appropriate communications. This interpretive description of health care communication issues in multiple sclerosis was based on qualitative secondary analysis of a set of in-depth interviews and focus groups conducted with 12 persons with longstanding MS experience. Analysis of their accounts illustrates an intricate interplay between common features within the disease trajectory and the communications that are perceived as helpful or unhelpful to living well with this chronic illness. From the analysis of these findings, the authors draw interpretations regarding what might be considered communication competencies for those who care for patients with this disease.

Case studies, single-subject research, and N of 1 randomized trials : Comparisons and contrasts

Case studies, single-subject research designs, and N of 1 randomized clinical trials are methods of scientific inquiry applied to an individual or small group of individuals. A case study is a form of descriptive research that seeks to identify explanatory patterns for phenomena and generates hypotheses for future research. Single-subject research designs provide a quasi-experimental approach to investigating causal relationships between independent and dependent variables. They are characterized by repeated measures of an observable and clinically relevant target behavior throughout at least one pretreatment (baseline) and intervention phase. The N of 1 clinical trial is similar to the single-subject research design through its use of repeated measures over time but also borrows principles from the conduct of large, randomized controlled trials. Typically, the N of 1 trial compares a therapeutic procedure with placebo or compares two treatments by administering the two conditions in a predetermined random order. Neither the subject nor the clinician is aware of the treatment condition in any given period of time. All three approaches are relatively easy to integrate into clinical practice and are useful for documenting individualized outcomes and providing evidence in support of rehabilitation interventions.

Quality of life domains affected in children with developmental coordination disorder: a systematic review

The quality of life (QOL) of children with developmental coordination disorder (DCD) is largely unknown, but evidence suggests that multiple QOL domains are affected by the disorder. While DCD is primarily considered a motor disorder, multiple studies have reported psychological and social concerns in children with this condition. Our primary aim was to present the current state of the evidence regarding the physical, psychological, and social QOL domains that can be affected in children with DCD. Systematic review of articles from seven databases through November 2010 (MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, CDSR, DARE) was conducted. Search terms included developmental coordination disorder, dyspraxia, quality of life, life satisfaction, well-being, activities of daily living, and participation. Two independent reviewers screened titles, abstracts, and full-text articles. Studies meeting the following criteria were selected: (1) sample comprised solely of individuals with coordination difficulties consistent with DCD; (2) outcome measures related to physical, psychological, or socials domains of QOL; and (3) articles published in English. Data were extracted by one author and verified by a second. Outcomes were categorized according to physical, psychological and social domains of QOL and study quality was rated by case definitions of DCD based on diagnostic criteria as per the Diagnostic and Statistical Manual - 4th edition. Forty-one articles were included. Most studies reported significantly poorer results in physical, psychological and social functioning in children with DCD compared with peers. Despite the impact of DCD on multiple domains, only one study used a QOL measure as an outcome. Although DCD impacts several QOL domains, the QOL of children with this disorder remains largely unknown. The next critical step is for clinicians and researchers to use QOL measures to gather information on how DCD may affect the QOL of children with this disorder.

Brain Activation of Children With Developmental Coordination Disorder is Different Than Peers

OBJECTIVES: Children with developmental coordination disorder (DCD) struggle to learn new motor skills, demonstrating more variable performance than typically developing (TD) children. The purpose of this study was to determine whether patterns of brain activity differed between children with and without DCD while performing a motor task. METHODS: Using functional MRI, we measured brain activation patterns in 7 children with DCD and 7 age-matched peers (aged 8–12 years) during a fine-motor, trail-tracing task. RESULTS: Despite similar levels of behavioral motor performance, different patterns of brain activity were noted between the 2 groups. The group with DCD showed significantly more activation than control subjects in left inferior parietal lobule, right middle frontal gyrus, right supramarginal gyrus, right lingual gyrus, right parahippocampal gyrus, right posterior cingulate gyrus, right precentral gyrus, right superior temporal gyrus, and right cerebellar lobule VI. These results suggest that the group with DCD relied on visuospatial processing to complete the task. The TD group demonstrated significantly more activation than the group with DCD in left precuneus, left superior frontal gyrus, right superior temporal gyrus/insula, left inferior frontal gyrus, and left postcentral gyrus; these regions have been associated with spatial processing, motor control and learning, and error processing. CONCLUSIONS: Children with DCD activate different brain regions from typical children when performing the same trail-tracing task. Despite the small sample size, our results contribute to a growing body of literature suggesting that children with DCD exhibit differences in neural networks and patterns of brain activation relative to same-age peers.

Effects of Exercise on Quality of Life in Women Living with Breast Cancer: A Systematic Review

Abstract:  The goal of this systematic review was to examine the effect of exercise on quality of life (QOL) in women living with breast cancer. Data bases searched were MEDLINE, EMBASE, CINAHL, PubMed, and PEDro. Keywords were “breast cancer and quality of life” in combination with “exercise” or “physical activity” (with associated Mesh terms). Limits were English or French language. Included studies were independently reviewed for methodological quality (van Tulder et al.) and assigned a level of evidence (Centre for Evidence‐Based Medicine). Nine relevant randomized controlled trials were included: four of moderate methodological quality and five of high methodological quality. There was strong evidence that exercise positively influences QOL in women living with breast cancer. Exercise can be an effective strategy to improve QOL in women living with breast cancer. Future research is necessary to determine optimal exercise types and parameters.

Effects of Pilates Exercises on Shoulder Range of Motion, Pain, Mood, and Upper-Extremity Function in Women Living With Breast Cancer: A Pilot Study

Background and Purpose: The purpose of this study was to examine the effects of Pilates exercises on shoulder range of motion (ROM), pain, mood, and upper-extremity (UE) function in women who had been treated for breast cancer. Participants: The participants were 4 women who had undergone axillary dissection and radiation therapy for stage I to IV breast cancer. Methods: A nonconcurrent, multiple-baseline, single-subject research design was used to examine the effects of Pilates exercises on the 4 outcomes. Results: Visual analyses of the data suggest a modest effect of the Pilates exercise program in improving shoulder abduction and external rotation ROM. Statistically significant improvement in shoulder internal and external rotation in the affected UE was shown for the one participant with pre-existing metastatic disease. The improving baselines seen for pain, mood, and UE function data made it impossible to assess the effects of Pilates exercises on those outcomes. No adverse events were experienced. Discussion and Conclusion: Pilates exercises may be an effective and safe exercise option for women who are recovering from breast cancer treatments; however, further research is needed.