A continuum of balance performance between children with developmental coordination disorder, spastic cerebral palsy,
Charlotte Johnson1,2, Ann Hallemans3, Pieter Meyns4
1Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium - charlotte.johnson@uantwerpen.be.
Insights
Children with developmental coordination disorder (DCD) and cerebral palsy (CP) show significant balance deficits compared to typical development. While DCD and CP groups differ, both exhibit heterogeneity and rely on slower control mechanisms.
Area of Science:
- Pediatric neurology
- Motor control research
- Developmental disorders
Background:
- Balance deficits are common in developmental coordination disorder (DCD) and cerebral palsy (CP).
- Balance impairments in DCD are highly variable and less understood than in CP.
- Shared characteristics exist between DCD and CP balance deficits.
Purpose of the Study:
- To investigate the heterogeneity of balance performance in children with DCD.
- To compare balance performance in children with DCD against those with CP and typical development (TD).
Main Methods:
- Cross-sectional case-control study involving children aged 5-10.9 years.
- Participants included children with TD (N.=64), DCD (N.=39), and CP (N.=24).
- Balance was assessed using the extended Kids-Balance Evaluation Systems Test (Kids-BESTest), with ANCOVA and Tukey post-hoc analyses.
Main Results:
- Children with DCD and CP performed significantly worse than TD children across all balance domains.
- DCD children outperformed CP children on overall balance and most domains, but showed similar performance in stability limits and gait stability.
- Both DCD and CP groups demonstrated large effect sizes in balance deficits compared to TD.
Conclusions:
- A continuum of balance performance exists from TD to DCD and CP, marked by significant heterogeneity within DCD and CP groups.
- Children with DCD and CP struggle with anticipatory postural adjustments, reactive responses, and sensory integration, suggesting internal modeling deficits.
- Similar poor performance in stability limits/verticality for DCD and CP suggests potential sensory input/integration issues, necessitating tailored evaluations and treatments.
Background:
Balance deficits are one of the most common impairments in developmental coordination disorder (DCD) and cerebral palsy (CP), with shared characteristics between both groups. However, balance deficits in DCD are very heterogeneous, but unlike in CP, they are poorly understood.
Aim:
To unravel the heterogeneity of balance performance in children with DCD by comparing them with CP and typical development (TD).
Design:
Cross-sectional case-control study.
Setting:
Different outpatient settings and the community.
Population:
Children aged 5-10.9 years with TD (N.=64, boys: 34, mean [SD] age: 8.1 [1.6]), DCD (N.=39, boys: 32, mean [SD] age: 8.1 [1.5], formal diagnosis [N.=27]), and CP (N.=24, boys: 14, mean [SD] age: 7.5 [1.4], GMFCS level I [N.=14]/II [N.=10], unilateral [N.=13]/bilateral [N.=11]).
Methods:
We evaluated balance performance with the extended version of the Kids-Balance Evaluation Systems Test (Kids-BESTest). Between-group differences in domain and total scores (%) were assessed via ANCOVA (covariate: age), with Tukey post-hoc analyses (P≤0.01).
Results:
Children with DCD and CP performed poorer than TD children on total and domain scores with large effects (domains: η2=0.25-0.66 [P<0.001], total: η2=0.71 [P<0.001]). Still, post hoc comparisons revealed that DCD children scored significantly better than CP on the total score and four domains (P≤0.009), while performing similarly on tasks related to stability limits (P=0.999) and gait stability (P=0.012).
Conclusions:
There is a continuum of balance performance between children with TD, DCD and CP, but with great inter- and intra-individual heterogeneity in DCD and CP. DCD and CP children have difficulties with tasks requiring anticipatory postural adjustments, fast reactive responses, and with tasks that require complex sensory integration, suggesting an internal modeling deficit in both groups. This implies that these children must rely on slow conscious feedback-based control rather than fast feedforward control and fast automatic feedback. The performance of both DCD and CP children on their stability limits/verticality is similarly poor which further emphasizes a potential deficit in their sensory input and/or integration. Future research must focus on unraveling the control mechanisms, to further understand the heterogeneity of these balance deficits.
Clinical Rehabilitation Impact:
The heterogeneous balance performances in both children with DCD and CP underscore the importance of comprehensively evaluating balance deficits in both groups. This comprehensive assessment contributes to a better understanding of individual balance deficits, thereby facilitating more tailored treatment programs.
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