Baduanjin improves motor function and cortical activation in children with developmental coordination disorder: a randomized controlled trial

Children with developmental coordination disorder (DCD) exhibit significant deficits in both gross and fine motor functions. Baduanjin, a traditional Chinese mind-body exercise, has demonstrated potential in improving motor functions, including balance and neuromuscular coordination, in various rehabilitation settings. This study aims to investigate the effects of Baduanjin intervention on motor function in children with DCD, and further explore whether its potential benefits are mediated through improved cortical activation in motor-related brain regions, as reflected by cerebral hemodynamic responses.

This single-blind randomized controlled trial enrolled 40 children aged 5-10 years who met the DSM-5 diagnostic criteria for DCD and had an MABC-2 standard score of ≤ 7. Participants were randomly assigned, using a SAS 9.4-generated randomization sequence with sealed opaque envelopes for allocation concealment, to either an experimental group receiving Baduanjin training plus health education or a control group receiving health education alone. The intervention lasted 8 weeks, with five sessions per week, including two instructor-led hospital sessions and three parent-supervised home sessions. After the intervention, motor coordination and balance were assessed using the Movement Assessment Battery for Children-2 (MABC-2) and the ProKin 254 balance test system, respectively. In addition, functional near-infrared spectroscopy (fNIRS) was used to measure hemodynamic responses in motor-related cortical regions during functional tasks, to evaluate cortical activation and examine its associations with changes in motor function.

The per-protocol (PP) dataset included 36 participants, whereas the intention-to-treat (ITT) dataset included all 40 randomized children. Both PP and ITT analyses showed that the experimental group had significantly higher total MABC-2 scores than the control group (PP: P = 0.002; ITT: P = 0.001). Subscale analyses demonstrated significant improvements in aiming and catching (PP: P = 0.019; ITT: P = 0.005) and balance (PP: P = 0.008; ITT: P = 0.004). In addition, the experimental group showed significant improvements in key static balance parameters, including reduced sway area (PP and ITT: P < 0.001) and shorter sway path length (PP and ITT: P < 0.001). Dynamic postural stability also improved significantly (PP and ITT: P = 0.004). However, no statistically significant between-group differences were observed in manual dexterity (PP and ITT: P > 0.05). fNIRS results revealed that during the aiming and catching task, the experimental group exhibited significantly greater activation in the left premotor cortex and supplementary motor area (PMC + SMA) compared to the control group (CH31: FDR-adjusted P = 0.015; CH32: FDR-adjusted P = 0.041). In the one-leg balance task, the experimental group showed significantly enhanced activation in the left hemispheric regions, including the frontopolar area (FPA), dorsolateral prefrontal cortex (DLPFC), inferior frontal gyrus (IFG), primary motor cortex (M1), as well as the PMC + SMA (FDR-adjusted P = 0.018). No significant between-group differences in brain activation were observed during the manual dexterity task (FDR-adjusted P ≥ 0.05). Furthermore, correlation analysis indicated a significant positive association between improvements in motor performance and activation of motor-related brain regions in the experimental group.

Baduanjin training improved motor coordination and balance in children with DCD. The observed changes in activation within motor-related cortical regions provide preliminary support for a possible neurophysiological basis of these functional improvements, although the underlying mechanisms require further investigation.

ChiCTR, ChiCTR2300078980. Registered 22 December 2023, https//www.chictr.org.cn. The study protocol has been published (doi 10.1136/bmjopen2024084061).