The subtypes of developmental coordination disorder.

AIM: To identify subtypes in a large group of children clinically diagnosed with developmental coordination disorder (DCD) based on their pattern of motor, cognitive, and visual-motor abilities. METHOD: Standardized scores for verbal IQ, total IQ, Movement Assessment Battery for Children, Second Edition (MABC-2) balance, MABC-2 manual dexterity, MABC-2 ball skills, and Beery-Buktenica Developmental Tests of Visual-Motor Integration (Beery-VMI), Motor Coordination (Beery-MC), and Visual Perception (Beery-VP) were used. The NbClust complete procedure was used to best partition the data on 98 children (84 males, 14 females, mean [SD] age: 8 years [2 years 1 month]) into clusters. Deviation contrasts, multivariate analysis of variance, and post hoc comparisons were used to characterize the clusters. RESULTS: Four clusters were revealed: two clusters with a broad motor skill problem, one with relatively preserved visual-motor integration and Beery-MC skills, and a second with abnormal ball skills, balance, and Beery-MC skills. A third cluster with more specific gross-motor problems, and a fourth with relatively preserved ball skills but low Beery-MC and performance IQ, were identified. Balance scores were 'at risk' or 'abnormal' in all four clusters. INTERPRETATION: DCD is a heterogeneous condition. However, subtypes can be discriminated on the basis of more severe difficulties in fine-motor performance, gross-motor performance, or both. There was evidence for generalized motor impairments in around half of all children. Importantly, at least borderline level reduced balance was evident in each subtype. WHAT THIS PAPER ADDS: Four subtypes were identified in a large clinical group of children with developmental coordination disorder (DCD). Subtypes were based on motor, cognitive, and visual-motor abilities. There was evidence of generalized motor impairments in around 50% of children with DCD. A generalized balance problem is present across all subtypes of DCD.

Living with transversal upper limb reduction deficiency: limitations experienced by young adults during their transition to adulthood.

INTRODUCTION: During transition to adulthood young adults with disabilities are at risk of experiencing limitations due to changing physical and social requirements. PURPOSE: To determine whether young adults with transversal upper limb reduction deficiency (tULRD) have experienced limitations in various domains of participation during transition to adulthood and how they dealt with these limitations. PARTICIPANTS: Fifteen participants (mean age 21.4 years) with tULRD. METHODS: A qualitative study was performed using a semi-structured interview based on the Rotterdam Transition Profile to identify the limitations experienced in participation domains. RESULTS: Almost all the participants reported difficulties in finding a suitable study or job. Most young adults were convinced they were suitable for almost any study or job, but their teachers and potential employers were more reserved. Few difficulties were reported on the domains leisure activities, intimate relationships/sexuality, housing/housekeeping and transportation. Participants preferred to develop their own strategies for dealing with limitations. Various aids, adaptations and prostheses were used to overcome limitations. Rehabilitation teams were infrequently consulted for advice in solving transitional problems. CONCLUSION: Young adults with tULRD experience limitations mainly in choosing and finding a suitable study or job. Rehabilitation teams may play a more extensive role in supporting individuals with transitional problems. Implications for rehabilitation Most young adults with transversal upper limb reduction deficiency (tULRD) experience limitations in study and job selection during transition to adulthood, but they do not consult the rehabilitation team. Assessment of abilities in relation to job interests and practicing job specific bimanual activities may be helpful for young adults with a tULRD. How the rehabilitation teams can meet the needs of young adults with tULRD during transitional phases, when autonomy is of growing importance, should be investigated further.

Opinions of youngsters with congenital below-elbow deficiency, and those of their parents and professionals concerning prosthetic use and rehabilitation treatment.

BACKGROUND: Youngsters with unilateral congenital below-elbow deficiency (UCBED) seem to function well with or without a prosthesis. Reasons for rejecting prostheses have been reported earlier, but unfortunately not those of the children themselves. Furthermore, reasons for acceptance are underexplored in the literature. OBJECTIVES: To investigate opinions of children and early and late adolescents with UCBED, and those of their parents and healthcare professionals, concerning (1) reasons to wear or not to wear prostheses and (2) about rehabilitation care. METHODS: During one week of online focus group interviews, 42 children of 8-12 y/o, early and late adolescents of 13-16 and 17-20 y/o, 17 parents, and 19 healthcare professionals provided their opinions on various topics. This study addresses prosthetic use or non-use of prosthetics and rehabilitation care. Data were analyzed using the framework approach. RESULTS: Cosmesis was considered to be the prime factor for choosing and wearing a prosthesis, since this was deemed especially useful in avoiding stares from others. Although participants functioned well without prostheses, they agreed that it was an adjuvant in daily-life activities and sports. Weight and limited functionality constituted rejection reasons for a prosthesis. Children and adolescents who had accepted that they were different no longer needed the prosthesis to avoid being stared at. The majority of participants highly valued the peer-to-peer contact provided by the healthcare professionals. CONCLUSIONS: For children and adolescents with UCBED, prostheses appeared particularly important for social integration, but much less so for functionality. Peer-to-peer contact seemed to provide support during the process of achieving social integration and should be embedded in the healthcare process.

Activity and participation of children and adolescents with unilateral congenital below elbow deficiency: an online focus group study.

OBJECTIVE: To assess whether children/adolescents with unilateral congenital below elbow deficiency experience activity or participation limitations and how they deal with those limitations. METHODS: A qualitative study using online focus group interviews was held with 42 children/adolescents (in 3 age groups: 8-12, 13-16, and 17-20 years), 17 parents and 19 health professionals. Questions were posted concerning activities, participation, prosthetic use, psychosocial functioning, and rehabilitation care. This study concerns the first two topics; activities and participation. RESULTS: Children/adolescents experienced only a few limitations, and there were no activities or participation situations that were impossible. The limitations experienced could be attributed mainly to environmental factors, e.g. people who lack knowledge of the child's capacities. Those factors were particularly decisive in transition phases. Children/adolescents and parents described numerous strategies applied to deal with the deficiency. Professionals described fewer strategies and emphasized the use of adaptive devices and prostheses more than other participants did. CONCLUSION: Having unilateral congenital below elbow deficiency did not interfere with any activity, but not all children/adolescents had the ability to perform all activities. The strategies described by children/adolescents in managing their deficiency should be integrated into healthcare by providing realistic education about the various creative solutions and possibilities of adaptive devices and prostheses, and should be combined with specific training.

Mixed feelings of children and adolescents with unilateral congenital below elbow deficiency: an online focus group study.

The existing literature is inconsistent about the psychosocial functioning of children and adolescents with Unilateral Congenital Below Elbow Deficiency (UCBED). The objective of this qualitative study was to explore the psychosocial functioning of children and adolescents with UCBED in terms of their feelings about the deficiency and what helps them to cope with those feelings. Additionally, the perspectives of prosthesis wearers and non-wearers were compared, as were the perspectives of children, adolescents, parents and health professionals. Online focus group interviews were carried out with 42 children and adolescents (aged 8-12, 13-16 and 17-20), 16 parents and 19 health professionals. Questions were asked about psychosocial functioning, activities, participation, prosthetic use or non-use, and rehabilitation care. This study concerned remarks about psychosocial functioning. Children and adolescents with UCBED had mixed feelings about their deficiency. Both negative and positive feelings were often felt simultaneously and mainly depended on the way people in the children's environment reacted to the deficiency. People staring affected the children negatively, while support from others helped them to cope with the deficiency. Wearing a prosthesis and peer-to-peer contact were also helpful. Non-wearers tended to be more resilient than prosthesis wearers. Wearers wore their prosthesis for cosmetic reasons and to prevent them from negative reactions from the environment. We recommend that rehabilitation teams make parents aware of their great influence on the psychosocial functioning of their child with UCBED, to adjust or extend the currently available psychosocial help, and to encourage peer-to-peer contact.