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How do fine and gross motor skills develop in preschool boys with Duchenne Muscular Dystrophy?
Jasmine Hoskens1, Ines Vandekerckhove2, Liesbeth De Waele3
1KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), Herestraat 49, Leuven 3000, Belgium; UHasselt, Faculty of Rehabilitation Sciences, Rehabilitation Research Centre (REVAL), Campus Diepenbeek, Agoralaan, Diepenbeek, Hasselt 3590, Belgium.
Insights
Boys with Duchenne Muscular Dystrophy (DMD) show deficits in fine and gross motor skills compared to peers. Cognition significantly impacts motor skill development, suggesting a broader psychomotor approach is needed for early intervention.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Boys with Duchenne Muscular Dystrophy (DMD) exhibit significant fine and gross motor impairments.
- Current early interventions for DMD predominantly focus on gross motor skills, potentially overlooking fine motor development.
Purpose of the Study:
- To investigate early motor development in preschool-aged boys diagnosed with DMD.
- To examine the influence of cognitive function on the motor skill progression in young boys with DMD.
Main Methods:
- A cohort of 17 boys with DMD (aged 11 months to 6 years) was assessed using the Bayley Scales of Infant and Toddler Development (Bayley-III), Peabody Developmental Motor Scales (PDMS-II), and Motor Function Measure (MFM-20).
- Longitudinal changes in fine and gross motor skills were analyzed using linear mixed-effects models (LMM), with cognitive function incorporated as a covariate.
Main Results:
- Boys with DMD demonstrated significantly lower scores in both fine and gross motor skills compared to typically developing peers (p<0.001).
- The trajectory of motor development varied across different subscales.
- Cognitive abilities were found to significantly influence various motor subscale outcomes (p=0.002-0.04).
Conclusions:
- Preschool boys with DMD do not reach the functional levels of their typically developing counterparts.
- Cognition plays a pivotal role in the developmental trajectory of motor skills in DMD.
- A comprehensive psychomotor approach, integrating both fine and gross motor skills and considering cognitive impact, is recommended for early intervention and future clinical trial designs.
Background:
Boys with Duchenne Muscular Dystrophy (DMD) experience both fine and gross motor problems. Nowadays, early intervention focuses almost exclusively on gross motor skills.
Aims:
We aimed to explore early motor development in preschool boys with DMD and investigate the influence of cognition.
Methods And Procedures:
Seventeen boys with DMD (11 months- 6 years) were compared to typically developing (TD) peers and followed-up with the Bayley Scales of Infant and Toddler Development (Bayley-III); Peabody developmental motor scales (PDMS-II) and Motor Function Measure (MFM-20). The longitudinal evolution of fine and gross motor skills was investigated using linear mixed effect models (LMM). Cognition was added to the LMM as a covariate.
Outcomes And Results:
Preschool boys with DMD scored lower compared to TD peers on both fine and gross motor skills (p<0.001). The evolution of motor development was subscale-dependent. A significant influence of cognition was found on different subscales (p= 0.002-0.04).
Conclusions And Implications:
Preschool boys with DMD do not achieve the same functioning level as TD boys. Cognition plays a crucial role in the evolution of motor skills. Our results suggest a shift to a broader psychomotor approach including both fine and gross motor skills, also considering the impact of cognition. WHAT THIS PAPER ADDS?: Our study provides a detailed mapping of early fine and gross motor development in preschool boys with Duchenne Muscular Dystrophy (DMD) and describes the influence of cognition on both fine and gross motor skills. Preschool boys with DMD do not achieve the same functioning level compared to typically developing boys. They score significantly lower on both fine and gross motor skills. The evolution of fine and gross motor development was subscale-dependent e.g. a negative-positive evolution was seen for grasping skills, with a tipping point around the age of four; stationary scaled scores decreased followed by a stabilization around the age four to five and locomotion scaled scores remained stable over time. Finally, we also found that cognition plays a crucial role in the evolution of both fine and gross motor skills. These new insights in the evolution of early motor development could be of added value for future clinical trials in young boys with DMD. Subsequently, increased alertness to early symptoms, e.g. developmental delay, may advance the age of diagnosis, as well as associated early intervention.
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