Title A Novel Balance Training Program for Children with Developmental Coordination Disorder : A Randomized Controlled Trial

This study aimed to compare the effectiveness of a specific functional movement–power training (FMPT) program, a functional movement training (FMT) program and no training in the improvement of balance strategies, and neuromuscular performance in children with developmental coordination disorder (DCD). It was a randomized, single-blinded, parallel group controlled trial. Methods: 161 children with DCD (age: 6–10 years) were randomly assigned to the FMPT, FMT, or control groups. The 2 intervention groups received FMPT or FMT twice a week for 3 months. Measurements were taken before, after, and 3 months after the end of the intervention period. The primary outcomes were the composite score and strategy scores on the sensory organization test as measured by a computerized dynamic posturography machine. Secondary outcomes included the knee muscle peak force and the time taken to reach the peak force. The balance strategies adopted in sensory challenging environments of the FMPT participants showed greater improvement from baseline to posttest than those of the FMT participants (7.10 points; 95% confidence interval, 1.51–12.69; P1⁄4 0.008) and the control participants (7.59 points; 95% confidence interval, 1.81–13.38; P1⁄4 0.005). The FMPT participants also exhibited greater improvement from baseline to the posttest in the knee extensor peak force and time to peak force in the knee flexors. The FMPT program was more effective than the conventional FMT sang, PgD Epi & A PhD, ng, PhD, and Duncan J. Macfarlane, PhD Abbreviations: AP = anterior–posterior, CI = confidence interval, CNS = central nervous system, DCD = developmental coordination disorder, EMG = electromyographic, ES = equilibrium score, FMPT = functional movement–power training, FMT = functional movement training, SOT = sensory organization test, SS = strategy score, TKD = taekwondo. INTRODUCTION D evelopmental coordination disorder (DCD) is a common motor disorder with a prevalence of approximately 6% in typical children of primary school age. Children in whom DCD is diagnosed are characterized by marked impairment in various motor functions, among which poor balance ability is a major concern because it predisposes children to falls, affects their motor skill development and participation in activities. Evidence-based treatment strategies to improve balance performance must, therefore, be developed. It is known that balance responses can be incorporated into hip and ankle strategies that maintain the body’s anterior– posterior (AP) stability in a fixed stance. The hip strategy involves hip flexion and extension movements with opposing ankle joint dorsiflexion and plantar flexion. It is a relatively poor balance strategy because the center of gravity displacement is large and thus induces postural instability. A better balance strategy, the ankle strategy, involves maintaining standing balance while rotating the body as a rigid mass about the ankle joints. Recently, our research team discovered that children with DCD tend to use the hip strategy excessively when they are forced to rely on vestibular input to maintain standing balance, and slowed hamstring muscle force production, a neuromuscular deficit, could be one of the causes. However, the present treatment regimens for children with DCD primarily focus on the induction of neuroplastic changes in the central nervous system (CNS) to enhance functional balance performance by means of functional movement training (FMT) or a task-oriented approach. Less emphasis has been placed on the treatment of neuromuscular impairments, such as slowed hamstring muscle force production, that could also affect balance outcomes. We postulated that interventions for children with DCD should address both the CNS and peripheral neuromuscular deficits to maximize their effectiveness in the improvement of postural control and thus the minimization of health care costs. Power or strength training has been found to be effective in increasing the speed of muscle force production and balance in us neuromuscular mechanisms. One suggested that strength training may unction in a child with DCD. Muscle www.md-journal.com | 1 power training might therefore be an ideal adjunct therapy to FMT for the improvement of the overall balance performance in children with DCD. However, no experimental study has yet investigated this potentially beneficial treatment regimen. This study was performed to compare the effectiveness of power training with FMT, FMT alone, and no intervention in the improvement of balance strategies and performance in children with DCD. We hypothesized that power training with FMT would be more effective in improving neuromuscular and balance performance and balance strategies than FMT alone or no training.