KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION1. / Name of the Candidate And
Address
(in block letters): / PALLAVI PRAMOD HARDIKAR
941/14 SUDARSHAN SOC. MODEL COL. SHIVAJI NAGAR, CANAL ROAD, MAHARASHTRA, PUNE 411016.
2. / Name of the Institute : / LAXMI MEMORIAL COLLEGE OF PHYSIOTHERAPY, MANGALORE.
3. / Course of study and subject : / MASTERS OF PHYSIOTHERAPY (MPT)
2 YEARS DEGREE COURSE
PHYSIOTHERAPY IN PAEDIATRICS.
4. / Date of Admission to Course : / 18th March 2010.
5. / Title of the topic: /
“PREVALENCE OF DEVELOPMENTAL CO-ORDINATION DISORDER (DCD) IN ELEMENTARY SCHOOL GOING CHILDREN OF AGE GROUP BETWEEN 6 TO 7 YEARS IN MANGALORE.”
6. / Brief Resume of the Intended Work:6.1 NEED OF THE STUDY:
According to Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM4), Developmental Coordination Disorder (DCD) is defined, as a condition marked by a significant impairment in the development of motor coordination, which interferes with academic achievements and/or activities of daily living (ADL).
These difficulties are not due to a general medical condition (e.g. Cerebral Palsy.) and are in excess of any learning difficulties.1,2
Before the DSM era, children with DCD were described as ‘motor impairment’, ‘motor delayed’, ‘physically awkward’, ‘perceptuomotor dysfunction’/ ‘motor perceptual dysfunction(MPD)’, ‘developmentally agnostic/apractic’, or as ‘clumsy child syndrome’.3
Motor impairment compromises success in everyday activities and school progress. The condition is idiopathic and the child has no identifiable medical, cognitive, psychological, social, or other obvious condition or reason for the movement difficulty.4
Some studies have demonstrated that the children with DCD do not simply ‘grow out of’ their difficulties.
Without intervention difficulties persists into adulthood and are frequently accompanied by other problems, both at home and at school, so the early diagnosis can be helpful.
These children tend to avoid normal physical activity. This compromises fitness directly and in turn could make some children vulnerable to future disease including osteoporosis, cardiovascular conditions, obesity, musculoskeletal disorders, accidents, type 2DM, and mental health problems.4
A child who has attained all the normal developmental milestones at the correct age may also have certain motor deficit which may be asymptomatic at early stage of life, due to which the child slowly start adapting to these deficits. This adaptive behavior may show neuromotor disturbances in later stages. Parents and teachers are unaware of these integration deficits and neglect it.
So a screening program should be done to evaluate children having motor deficit and early intervention should given to avoid the risk of any neuromotor disturbance later.
By knowing the prevalence of DCD we can make teachers aware of the condition and its impact on children.
So, the early diagnosis of DCD can be helpful to prevent the future secondary complications and thus there exists a need and background for the genesis of this study.
HYPOTHESES:
• ALTERNATE HYPOTHESIS (H1): There may be a significant prevalence of DCD in elementary school going children of age group between 6 to 7 years.
• NULL HYPOTHESIS (HO): There may not be a any significant prevalence of DCD in elementary school going of age group between 6 to 7 years.
6.2 REVIEW OF LITERATURE:
Raghu Lingam et al did a study “ Prevalence of DCD using the DSM-IV at 7 years of age : A UK population based study” and found that 18 of 1000 seven year-olds have DCD acc to Strict DSM-IV criteria and that 49 of 1000 seven year-old have DCD or probable DCD.5
Mon-Williams et al in their study on validity and reliability of MABC and stated that “The Movement ABC has been evaluated and found useful for identifying children with DCD in Australia.”
Marina M. Schoemarker et al studied on Clinical And Research Diagnostic Criteria For DCD. The result suggest the usefulness of a distinction between clinical diagnostic criteria and research diagnostic criteria which helps to develop a unifying view on the use of diagnostic criteria for research and clinical practice.6
J. Visser, studied on A review of research on subtypes and co morbidities of DCD. The main massage of the paper was that, in order to understand the etiology and prognosis of DCD we need to have a better understanding of its nature. This requires an awareness of the existence of subtypes and co morbidities.7
Susan G. Grawford et al studied on” DCD and Associated Problems in Attention, Learning, and Psychological Dysfunction”. They found the Assessment of children with movement problems, regardless of the degree or severity of these problems should examine a wide range of functions in addition to motor functioning. Such an approach would assist in determining the types of intervention that would provide the most benefit to these children.8
Leslie Handerson et al studied on Reaction time and Movement time in children with DCD. In an aiming task, movement latency, movement duration and its variability were significantly prolonged in the DCD group. In a coincidence timing version of the task, absolute timing error was significantly greater in the DCD group.9
Christopher Gillberg M.D. et al studied on Natural Outcome of ADHD with DCD at age 22years. They found that childhood ADHD and DCD appear to be a most important predictor of poor psychosocial functioning in early adulthood. 10
Mary M. Smyth et al studied on Planning and Execution of Action in Children with and without DCD. The children in the DCD group performed less well on the majority of the proprioceptive tasks, but did not differ from controls in planning of grip selection. There was an improvement in grip planning with age. The results are contrasted with research indicating that people with autism do have a difficulty with planning grip selection. 11
Litsa M. A, Grunan, et al studied on DCD in Extremely Low Birth Weight Children at 9 years. ELBW children with DCD also had a significantly lower Performance IQ (PIQ) scores and were more likely (43%) to have a learning difficulty in arithmetic than ELBW children who did not have DCD. This study found that DCD is a common problem in school aged ELBW children.12
Patar H Wilson et al studied on Information Processing Deficits Associated with DCD. The findings support the notion that perceptual problems, particularly in the visual modality, are associated with difficulties in motor coordination.13
6.3 AIM & OBJECTIVES OF STUDY:
To find out the prevalence of developmental co-ordination disorder in elementary school going children of age group between 6-7 years in Mangalore.
`7.
/
MATERIALS AND METHODS:
• Paper.• Pencil.
• Ball and box.
• Pegs and Pegboard.
• MABC Scale.
• Questions Comprising the ADL Scale.
7.1 STUDY DESIGN: Non experimental study.
SOURCE OF DATA: 500 patients will be selected from schools in and around Mangalore.
SAMPLING TECHNIQUE: Simple randomize sampling.
STUDY DURATION: 3 months.
7.2 METHOD OF COLLECTION OF DATA :
• 500 children in the age group of 6 to 7 years of school going children will be selected.
• The procedure of the study will be explained in detail to the parents and the concerned teacher and a written consent form will be obtained.
Child will be screened for DCD using the DSM 4th edition criteria.
A. The impairment in motor coordination in these subjects will be screened using Movement Assessment Battery for Children. (MABC)15
• According to the MABC, the child taking part in the study is allowed only one attempt per item such as :
1) heel to toe walking,
2) placing pegs,
3) throwing ball into box and one hand catch.
• In the heel- to-toe walking test, the child will be asked to walk, heel to toe, along a straight line. The tester will record the largest number of consecutive correct steps taken to a maximum of 15.
• In the placing pegs task, the time taken for the child to insert 12 pegs into a peg board 1 at a time, using first their preferred then their non preferred hand, will be recorded.
• The testing of ball skills involved the child attempting to throw 10 single ball underarm into a box at a distance of 6 feet. The number of balls thrown into the box will be recorded.
• The performance of the subjects will be then evaluated and scoring will be done according to MABC.
B. Then the parents will be provided with the Questioners according to Questions Comprising the ADL Scale and using this disturbance in ADLs will be measured.1
• A 23-item measure of ADL was derived from the ALSPAC18 parent-completed questionnaire administered when the child was 6 years to 7 years of age. This scale included questions on key areas in which children with DCD struggle: self-care skills, play skills, and gross and fine motor skills including drawing and copying. Parents were asked to answer each question:
“yes can do” (2 marks);
“can do but not well” (1 mark);
“can not do as yet” (0 marks); or “has not had the opportunity to do.”
• A score was produced by adding the individual item scores (0 to 2) and dividing by the total number of items (23) minus the number of items the child had not had a chance to attempt.
INCLUSION CRITERIA:
• Children in the age group of 6 to 7 years.
• Both boys and girls.
• Co operative children.
• IQ more than 70 (according to DSM 4th edition)5
EXCLUSION CRITERIA:
• Any known psychological disorder.
• Any general medical condition(according to DSM 4th edition: CP, Muscular dystrophy, Muscular Impairments, Mental retardation).5
OUTCOME MEASURES :
Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM 4th edition.)2
STATISTICAL ANALYSIS:
Simple percentile study.
Chi square test.
RESEARCH QUESTION:
Is there any prevalence of DCD in elementary school going children of age group between 6 to 7 years in Mangalore?
7.3 Does the study require any investigations or interventions to be conducted on
Patients or other humans or animals? If so, please describe briefly.
YES, the children will be assessed during activities like 1) heal to toe walking, 2) placing pegs,3) throwing ball into box and one hand catch; using MABC scale.
7.4 Has ethical clearance been obtained from your institutions
Obtained
8. / List of References:
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition. Washington, DC: American Psychiatric Association; 1994.
2. American Psychiatric Association.DSM 4TH edition text revision. Washington, DC: American Psychiatric Association; 2000.
3. Why Bother about clumsiness? The implication of having DCD. Christopher Gillberg and Bjorn Kadesjo. Neural Plasticity Vol. 10, No. 1-2, 2003.
4. DCD Judith M Peters and Ann Markee. Chapter 9, page 123.
5. American Psychiatrc Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth edition. Washington, DC: American Psychiatric Association; 1994.
6. Human Movement Science. Vol. 20, Issue 1-2, March 2001, Pages 7-47.
7. Human Movement Science. Vol. 22, Issue 4-5, Nov. 2003, Pages 479-493.
8. Human Movement Science. Vol. 21, Issue 5-6, December 2002, Pages 905-918.
9. Journal of Child Psychology and Psychiatry. Vol. 33, Issue. 5, Pages 895-905. July 1992.
10. Journal of The American Academy of Child and Adolescent Psychiatry. Vol. 39, Issue 11, Pages 1424-1431(Nov.2000).
11. Journal of Child Psychology and Psychiatry. Vol. 38, Issue 8, Pages 1023-1037, Nov.1997.
12. Journal of developmental and Behavioral Pediatrics. Vol. 23, Issue 1, Pages 9-15. Feb.2002.
13. Journal Of Child Psychology and Psychiatry. Vol. 39, Issue 6, Pages 829-840, Sep. 1998
14. The American Journal of Occupational Therapy. Vol. 49, Issue 8, Pages 787-794.Sep.1995.
15. Henderson SE, SugdenDA. Movement Assessment Battery for Children Manual. Sidcup, United Kingdom: Psychological Corporation; 1992.
16. Developmental Medicine and Child Neurology. Vol. 40, Issue 6, Pages 388-395. June 1998.
17. Pediatrics: Official journal of the American academy of pediatrics. 2009.
18. Paediatrics and Perinatal Epidemiologi vol. 15, Issue 1, pages 74-87, Jan.2001.