DCD Imaging-Intervention Study
Condition: Motor Skills Disorders
MeSH terms: Motor Skills Disorders
Study type: Interventional

Summary: 
      Developmental coordination disorder (DCD) affects 5-6% of the school-age population, equating
      to ~400,000 children, or 1-2 students in every Canadian classroom. Children with DCD find it
      hard to learn motor skills and perform everyday activities, such as getting dressed, tying
      shoelaces, using utensils, printing, riding a bicycle, or playing sports. Researchers and
      clinicians do not know what causes DCD or why children with DCD struggle to learn motor
      skills. Using MRI, this study will increase understanding of how the brain differs in
      children with/without DCD and determine if rehabilitation can change the brain and improve
      outcomes of children with the disorder.
    

Detailed description: 
      SPECIFIC OBJECTIVES AND HYPOTHESES

      The proposed study proposed is designed to test the overall hypothesis that, compared to
      typically-developing children, children with DCD (+/- ADHD) will show differences in brain
      structure and function, and that rehabilitation will be associated with brain differences
      that reflect improvement of motor function. The investigators will address three specific
      objectives:

      Objective 1: To characterize structural and functional brain differences in children with DCD
      and typically-developing children.

      Hypothesis: Compared to typically-developing children, the investigators expect that children
      with DCD will show smaller cerebellar volume, differences in microstructural development in
      motor, sensory and cerebellar pathways, decreased strength of connectivity in resting,
      default mode, and motor networks. Children with DCD+ADHD will show poorer function in frontal
      and parietal areas compared to children with DCD (Langevin et al., 2014).

      Approach: The investigators will use magnetic resonance (MR) imaging and advanced MR
      techniques to characterize brain structure and function; the investigators will use
      morphometry to measure cerebral and cerebellar volumes, diffusion tensor imaging (DTI) to
      assess microstructural development, functional connectivity MRI to measure connectivity in
      different brain networks, and fMRI to explore patterns of brain activation during a mental
      rotation task.

      Objective 2: To determine if current best-practice rehabilitation intervention induces
      neuroplastic changes in brain structure/function and positive outcomes in children with DCD.

      Hypotheses: Compared to children in the waitlist control group, the investigators expect that
      children in two treatment groups (DCD and DCD+ADHD) will show: (1) strengthened functional
      connectivity in resting, default mode, and motor networks; (2) increased integrity of the
      frontal-cerebellar pathway; (3) increased gray matter volume in the dorsolateral prefrontal,
      motor and cerebellar cortices; and (4) improved performance and satisfaction ratings of
      child-chosen functional motor goals. The investigators also expect that there will be a
      positive association between functional improvements and changes in brain structure/function.

      Approach: The investigators will measure brain changes pre- and post-intervention between
      children with DCD and DCD+ADHD (treatment versus waitlist control). As part of treatment,
      children will identify three functional motor goals as a target for intervention. The
      investigators will use the Canadian Occupational Performance Measure (COPM; Law et al., 2005)
      to measure the child's rating of their performance and satisfaction pre- and
      post-intervention. To supplement the COPM, the occupational therapist will videotape the
      child performing each of their motor goals before and after intervention, and an independent
      occupational therapist will use the Performance Quality Rating Scale (PQRS) to objectively
      measure performance and change in performance (Miller et al., 2001). As a secondary measure,
      the investigators will evaluate fine and gross motor skills using the Bruininks-Oseretsky
      Test of Motor Proficiency-2 (BOT-2: Bruininks & Bruininks, 2005).

      Objective 3: To determine if neuroplastic and functional changes are retained at 3-month
      follow-up.

      Hypothesis: The investigators expect children who maintained functional gains will show
      increased functional connectivity in brain networks, increased integrity of the
      frontal-cerebellar pathway, and increased gray matter volume (as in Objective #2) compared to
      children who did not maintain their functional gains. If most of the children maintain their
      functional gains, the investigators expect improvements in brain structure and function to
      have remained or improved from the post-intervention scan.

      Approach: MR sequences and child ratings of performance and satisfaction of their functional
      motor goals will be repeated in both treatment and waitlist groups.

      The investigators intend to recruit 30 typically-developing children, 30 children with DCD
      and 30 children with DCD+ADHD.

      Neuroimaging analyses will include region of interest analyses (sensory, motor, and
      cerebellar pathways) as well as whole brain analyses using tract-based spatial statistics.
    

Intervention name(s): Cognitive Orientation to Occupational Performance (CO-OP)
Intervention type(s): Behavioral
Intervention description(s): CO-OP is a cognitive approach to solving functional motor problems (Polatajko et al., 2001b). Therapists teach children a global problem solving strategy (Goal-Plan-Do-Check) as a framework for developing specific strategies for overcoming motor problems; these strategies are determined after a dynamic performance analysis by the therapist to determine where the "breakdown" is in performing the task. Occupational therapists will see children once weekly for one hour over 10 weeks as per published protocol (Polatajko et al., 2001b), plus two assessment sessions. Children will select three functional motor goals to be addressed over the course of treatment, rating their performance and satisfaction of these goals pre- and post-intervention.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: DCD; Neuroimaging; Rehabilitation