What is dyspraxia?
Dyspraxia is a “loose” diagnosis that combines a co-ordination of movement type disorder with attention, anxiety and memory problems. Developmental coordination disorder (DCD), is the formally recognised diagnosis, a developmental condition in which a person’s gross and fine motor skills are affected. Often the terms are used interchangeably.
So dyspraxia a.k.a DCD results in difficulties with the organisation, planning and execution of physical movements required to carry out daily activities.
What are the criteria for a diagnosis ?
- The performance of coordinated motor skills are below that expected for the person’s given age; manifested by delay in achieving motor milestones such as crawling, walking etc., clumsiness, slowness and inaccuracy performing motor skills.
- The motor skills deficit significantly interferes with activities of daily living or academic achievement
- It is not as a result of any neurological or general medical condition
- The onset is in the early developmental period
Diagnosis is commonly made between the ages of 6 -12, by a paediatrician, and after ruling out any underlying neurological or physical conditions. Then onward referral is usually made to a chartered physiotherapist and occupational therapist, as needed.
Other characteristics of dyspraxia can include; lower muscular tone, poor posture and balance reactions, difficulty following motor commands, poor sporting performance, poor awareness of body position in space and frequent trips or falls.
Dyspraxia can impact a child in many ways, including socially and emotionally. They can present with increased anxiety and low self esteem.
These children can also have an increased risk for cardiovascular disease due to decreased levels of physical activity and lower levels of aerobic fitness.
How can Chartered Physiotherapy help?
For the treatment and management of dyspraxia, it is vital that a team based approach is taken, combining both an occupational therapist and a physiotherapist.
Physiotherapy has been proven to be an effective intervention with positive effects for patients with dyspraxia.
Firstly, a thorough assessment is carried out, to get a baseline measures of the patient’s functioning and difficulties.
The key areas that may be examined include;
- Balance in both sitting and standing
- Movement coordination
- Gait i.e how walking may be affected
- Muscle tone i.e do the muscles lack the tension or tone needed to effectively set the foundation for muscle function
- Muscle strength and functional ability
Questions may also be asked regarding specific tasks or daily activities that the child themselves finds most challenging.
Goals can then be created, through discussion between the physiotherapist, parents and child. Making sure that they are realistic and attainable.
Treatment can then revolve around these goals, prioritising to focus on 2-3 areas per session.
In the treatment of dyspraxia two main treatment approaches commonly used:
- Process-orientated approach, looks at the sensory modalities used for motor performance. It focuses on sensory integration and kinaesthesia training, developing the sensory parts involved in movement. Pin pointing certain areas such as memory, and the planning and formulation of motor (specific and controlled movement) programmes.
- Task-orientated approach, which uses practice and repetition to improve specific tasks. It breaks down tasks into smaller steps and uses a problem solving approach – how can we do this task differently? What can we change/make easier to have a more successful outcome.
There is little evidence that one technique is superior to the other, and therapists usually combine elements of both approaches.
Tailor-made programmes to target the patient's main areas of difficulty can include muscle strengthening, fine and gross motor skills, balls skills and coordination and functional activities needed for everyday tasks.
Manual techniques such as myofascial release and trigger point release may also be used to help normalise muscle tone and decrease any pain that may be caused by taut bands within the muscles.
As Chartered Physiotherapists, we can help to work with the child to explore new hobbies and help build their self-esteem towards physical activities by finding an activity that suits them and that will improve their cardiovascular fitness.
Physiotherapy treatment has been shown to improve patient’s self-confidence and willingness to try new activities and sports.
Children do not out grow dyspraxia, but with appropriate intervention it can be very well managed. Physiotherapy can help patients to overcome their activity limitations and facilitate their participation, and provide a long-term management programme with on-going review.
- Camden, C., Wilson, B., Kirby, A., Sugden, D. and Missiuna, C. (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), pp.147-159.
- Ganley, K. and Miles, C. (2013). Commentary on “Relationship Between Participation in Leisure Time Physical Activities and Aerobic Fitness in Children With DCD”. Pediatric Physical Therapy, 25(4), p.430.
- Gibbs, J., Appleton, J. and Appleton, R. (2007). Dyspraxia or developmental coordination disorder? Unravelling the enigma. Archives of Disease in Childhood, 92(6), pp.534-539.
- Lee, M. and Smith, G. (1998). The Effectiveness of Physiotherapy for Dyspraxia. Physiotherapy, 84(6), pp.276-284.
- Lee, M. and Smith, G. (2002). A Three Year Study on the Progress of Children Following Physiotherapy Treatment for Dyspraxia. Dyspraxia Foundation Professional Journal, (1), pp.9-23.
Mandich, A., Polatajko, H., Macnab, J. and Miller, L. (2001). Treatment of Children with Developmental Coordination Disorder. What is the Evidence?. Physical and Occupational Therapy in Pediatrics, 20(2-3), pp.51-68.
- Oudenampsen, C., Holty, L., Stuive, I., van der Hoek, F., Reinders-Messelink, H., Schoemaker, M., Kottink, A., van Weert, E. and Buurke, J. (2013). Relationship Between Participation in Leisure Time Physical Activities and Aerobic Fitness in Children With DCD. Pediatric Physical Therapy, 25(4), pp.422-429.
- Sugden, D. and Chambers, M. (2003). Intervention in children with Developmental Coordination Disorder: The role of parents and teachers. British Journal of Educational Psychology, 73(4), pp.545-561.