EFFECTIVENESS OF NEUROMOTOR TASK TRAINING COMBINED

WITH KINAESTHETIC TRAINING IN CHILDREN WITH

DEVELOPMENTAL CO-ORDINATION DISORDER - A RANDOMISED
TRIAL

Sundaresan Chockalingam* Agnel Kevin Gomes**

ABSTRACT
The aim and objectives of this study was to find out the prevalence of Developmental coordination disorder
(DCD, a chronic motor impairment affecting child’s ADL) in school children from 5 to 10 years of age and to
analyse the effectiveness of Neuromotor Task Training when combined with Kinaesthetic training in
managing them. Using Pretest-Posttest Quasi Experimental study design, 56 samples of children with
indication or suspect for DCD in DCDQ’07 who also obtained total scores below the 15th percentile on the
TGMD-2 were randomly assigned for two interventions, Neuromotor Task Training (NTT) combined with
Kinaesthetic training (Intervention Group 1) and NTT alone (Intervention Group 2) for a period of 7 weeks in
small groups. The outcome was assessed with Gross Motor Quotient of TGMD-2. The data were analysed
with Student’t’ tests comparing values within the groups and between the groups. Results showed that the
prevalence of DCD in the local population is 6.82% and there is no significance difference between the
improvements made in the two intervention groups but the differences in the mean value support the combined
therapy group to have some better effects.

KEYWORDS: Developmental Coordination Disorder (DCD), Developmental Coordination Disorder

Questionaire’07(DCDQ’07), Test of Gross Motor Development-2 (TGMD-2), Neuromotor Task Training,
Kinaesthetic Training.

24
 Scientific Research Journal of India ● Volume: 2, Issue: 2, Year: 2013
INTRODUCTION
Developmental coordination disorder
affects about 6% of children between 5 and 11
1
years of age . Prevalence of movement
difficulties in children has been reported as high
as 19%. However, two studies undertaken in the
UK reported a prevalence of 5% and 8.5%
2
respectively . DCD is defined, using the
Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV), as a
condition marked by a significant impairment in
the development of motor coordination, which
interferes with academic achievement and/or
activities of daily living (ADL). These difficulties
are not due to a general medical condition (e.g.,
cerebral palsy) and are in excess of any learning
1
difficulties if present . The symptoms of
developmental coordination disorder may include
marked delays in achieving milestones of motor
development, dropping things, clumsiness, and
poor performance in sports or poor handwriting. If
any of these symptoms interferes with a child’s
performance of daily activities, a diagnosis is
warranted 1. Observations of school-age children
with Developmental coordination disorder during
organized and free play show that these children
spend less time in formal and informal team play
than children without the disorder3.
DCD is defined on the basis of a failure
of the acquisition of both fine and gross motor
skills, which is not explicable on the basis of
impaired general learning and similar exposure to
opportunity to gain motor skills as their peers.
DCD is often seen as the ‘Cinderella’ of
developmental disorders and not always
considered routinely by clinicians 4. However,
25
there is extensive evidence that motor difficulties
have a pervasive effect on children’s lives. The
difficulties affect the child both in school and at
home, and in contrast with similar aged children
who acquire skills with little effort such as
dressing, playing ball games and handwriting,
these children take longer to learn and automate
motor skills. Increasing interest in these children,
in academic research and in clinical and
educational practice, has focused on the need not
only for early identification but also to consider
the presentation in adolescence and adulthood, as
around 70% of children continue to have
difficulties when grown up5.
Over the past forty years, various
treatment programs have been developed for
children with Developmental Coordination
Disorder (DCD). These treatment programs can
roughly be divided into two categories: the
process-oriented approaches and the task-oriented
approaches 6. The process-oriented approaches
concentrate on the treatment of deficits in
processes assumed to underlie poor motor
coordination. Task-oriented approaches, on the
other hand, focus directly at the functional skills
with which a child experiences problems.
Examples of process-oriented approaches are
kinesthetic training developed by Laszlo et al.
(1988) and Sensory Integration Therapy developed
by Ayres (1972). Neuromotor Task Training
(NTT) was recently developed for treating children
with DCD by pediatric physical therapists 7. The
training concerns a task-oriented program based
upon recent insights about motor control and
motor learning. The developmental coordination
disorder questionnaire 2007 (DCDQ’07) was
 ISSN: 2277-1700 ● Website: http://www.srji.info.ms ● URL Forwarded to: http://sites.google.com/site/scientificrji
developed to screen for the presence of motor
8
problems and as an adjunct to standardized tests .
Over the past 10 years, it has also proven to be a
valid measure of everyday functioning, as
academic achievements or activities of daily
living. It is recommended that The Movement
Assessment Battery for Children (M-ABC) and
The Test of Gross Motor Development (TGMD-2)
should be considered for assessing the gross motor
performance of children with DCD in the first
instance. Both these tests give standardized scores
that are easily explained to the patient/parent, and
both have items that children would find
9
acceptable and relevant .
BACKGROUND
Developmental coordination disorders
may first become apparent in early childhood, but
they are difficult to assess reliably before the age
of 5 years. Children with DCD are usually first
noted in primary school when the condition clearly
interferes with school performance or activities of
daily living. Most of these children are therefore
diagnosed between 6 and 12 years of age. Some
17
may even go unnoticed . The teachers may
initially notice children on the basis of difficulties
and poor handwriting is now one of the major
reasons for the clinical referral of children with
18
DCD . The DCD population is considered to be
at risk for a range of associated psychosocial
difficulties, such as poorer than expected
educational achievement and low self-esteem.
Children with DCD may show functional deficits
over a range of motor tasks. Some are impaired in
whole body tasks such as running and jumping,
ball skills, and tasks involving balance, such as
riding a bicycle. Some children may have fine
26
motor difficulties, while others have difficulties
with both fine and gross motor tasks 18.
Use of the DCDQ’07 by occupational
and physical therapists, as well as researchers, to
both screen for DCD and to confirm the functional
consequences of a motor deficit, will support the
identification of children in need of services. The
DCDQ’07 will also allow international
collaboration and application of research results
across cultures 15.
Neuromotor Task Training (NTT) was
developed for treating children with DCD by
pediatric physical therapists. Within this approach,
physical therapists start with the assessment of the
strengths and weaknesses of a child’s functional
performance. Next, therapists will analyze which
cognitive or motor control processes might be
involved in deficient motor skill performance. A
child can fail to learn a specific motor skill
because of attention problems, fear of failure, lack
of motivation, or lack of understanding how to
execute a particular skill. In addition, motor-
control processes might hamper successful
performance, such as timing of the components of
a motor skill pattern, motor planning, or parameter
setting (the execution of a motor act with the
required speed and force).
In NTT, the functional exercises are
designed in such a way that the therapist can
analyze which motor control processes are
deficient. Another important characteristic of NTT
is that teaching principles derived from motor
learning research are applied. The ultimate goal of
treatment is not only to improve functional task
performance during treatment but also to transfer
learned skills to daily life performance.
Kinesthesia is integral to the acquisition
of motor skills in process-oriented treatment
 Scientific Research Journal of India ● Volume: 2, Issue: 2, Year: 2013
approaches. Therapeutic intervention with process-
oriented treatment is based on specifically
designed kinesthetic training activities.
described by Laszlo and Bairstow, this approach
has an inherent reward system built into it through
its use of positive reinforcement, presentation of
desirable activities within the capabilities of the
child, and judicious progression of the level of
difficulty. The usefulness of the process-oriented
treatment approach has been the subject of
considerable study. Sims and colleagues suggested
that much of the success of this approach can be
attributed to a strong motivation effect, fostered by
positive feedback and a sense of self-competence
19
. Children with DCD benefit from using vision in
combination with touch information for standing
control possibly due to their less well developed
internal models of body orientation and self-
motion. Internal model deficits, combined with
other known deficits such as postural muscles
activation timing deficits, may exacerbate the
12
balance impairment in children with DCD .
Group-based motor skill training may
have its own advantages. First, the group setting
provides opportunities for social interaction.
Secondly, children are competitive, and this
motivates them to perform better. Furthermore, a
stronger sense of competence may be developed if
a child can successfully demonstrate the acquired
motor skills in front of his or her peers in the
group. This perceived competence may further
encourage the children’s participation in the
training and in other physical activities affecting
14
their motor competence .
Children with DCD do not form a
homogeneous group. It is possible that, just as
characteristics are showing differences across
clusters of children, differences are evident in the
manner to which children respond to intervention.
They also have stated that some children may
As require varying amounts of exposure to activities
with the amount being the influential factor,
whereas with others, most notably the ones who
did not improve following intervention and
concluded that a qualitatively different type of
approach may be required in dealing with children
with DCD 10.
To date, combined approaches are
largely untested, research has provided limited
evidence to support combined approaches as they
made smaller effects than pure approaches. It will
be important for us to develop a systematic,
evidence-based approach to the treatment of these
children 13. To date there is no studies that have
clearly focused on finding out the incidence of
DCD in South Indian population. Considering
these statement, it is very clear that there is a need
for a good experimental trail on finding the
effectiveness of combined approaches (top down
and bottom up approaches) in children with DCD.
METHODOLOGY
Participants for this study included
children, both boys and girls, aged 5 to10 years
from Bharathidasan Matric Higher Secondary
School, Kanchipuram, Tamil Nadu, India. In two
stage selection process, sequential sampling was
used to screen 1407 students (boys and girls).
Among the subjects screened by staged procedure,
54 were selected and assigned randomly into two
groups and considered for intervention. All
children with indication or suspect for DCD aged
from 5 to 10 years in DCDQ’07, Obtained total
scores on the TGMD-2 below the 15th percentile
and their motor problems could not be attributed to
evident pathological neurological signs were
27
 ISSN: 2277-1700 ● Website: http://www.srji.info.ms ● URL Forwarded to: http://sites.google.com/site/scientificrji
included. Only children attending schools for
general education were considered which implies
an IQ-score in the normal range.
The children those who had received or
were undergoing physical therapy or occupational
therapy and those who have any profound visual or
hearing deficiencies that could not be corrected by
external devices were excluded.
In the first stage selection process, 2
Physical Education Teachers 1 special skill
training staff and 63 Class Teachers from the
School, handling children from 5 to 10 years of
age forming standard I to standard V in State
Board of Education were called for a meeting for
about 2 hrs in school conference hall for two
consecutive days. On the first day of meeting, A
talk about the Developmental coordination
disorder, including the prevalence, nature of the
disorder, diagnostic criteria, complications, role of
health care professional, teachers and parents in
dealing with these children, and management of
the condition were given. On the second day, the
selection of children based on the DCDQ’07 was
demonstrated and the teachers were trained
individually to fill the questionnaire. The teachers
were instructed to observe their class students for 3
days on play ground activities like ball handling,
running, jumping and on class room activities like
writing and learning. With the knowledge and
practice obtained from the meeting, observation on
child’s activities, teachers were asked to fill
questionnaire for the average of 30 students they
handle in the class room. Under supervision the
process of filling up the questionnaire was made
and doubts in marking the questionnaire were
clarified then and there during the process. With
the total scores obtained from the questionnaire,
screening was done to find out the children who
28
are under indication, or suspect for DCD.
In the second stage of selection process,
the children under indication or suspect for DCD
underwent TGMD-2. The TGMD-2 was conducted
in the outdoor play area. 2 Physical Education
Teachers and 1 special skill training staff were
involved in this selection process, assisting the
procedure. On the first testing day, the procedure
was explained to the participants in details. Then,
their names were asked and a name tag was
provided for each of them for identification. The
TGMD-2 was operated with the following
sequences: run, gallop, hop, leap, horizontal jump,
slide, striking a stationary ball, stationary dribble,
catch, kick, overhand throw and underhand roll.
The participants were queued behind the first line
and performed the skill within 50 feet of clear
space, which was marked with tape and cones
were placed.
The assessment was preceded with an
accurate demonstration and verbal description of
the skill, i.e., run. Then, a practice trial was
provided for the child who queued at the front, to
assure the child understands what to do. After that,
two test trials were given to the subjects and the
raw skill score was given for each item ranged
from 0-2. When the first subject was done, the
second one at the queue was instructed to start the
test with the practice trial; an additional
demonstration was also been when he or she did
not appear to understand the two test trials. The
procedures were repeated until the last participant
was completed. The test was then followed by
second skill task, i.e., gallop and the process was
as same as before. However, the sequence of the
queue was alternate so that one child did not
always go first or last. Scoring was made with
observation of all participants’ performance. The
 Scientific Research Journal of India ● Volume: 2, Issue: 2, Year: 2013
assessment protocols were also standardized for all
participants according to the test manual of
TGMD-2 (Ulrich, 2000) (38).
Locomotor Subtest-Run
50 feet of running space and 8 feet of
safe stopping distance were made for this test
(Ulrich, 2000). The child ran as fast as he or she
can from the green cone to the red cone when the
examiner said “Go”. For the second trial, the child
ran from the red cone back to the green cone and
then waited at the end of the queue. According to
Ulrich (2000), the performance criteria for run
were as follows: arms move in opposition to legs,
elbows bent; brief period where both feet are off
the ground; narrow foot placement landing on heel
or toe (i.e., not flat footed); and nonsupport leg
bent approximately 90 degrees (i.e., close to
buttocks).
Locomotor Subtest-Gallop
25 feet distance was made for this test
(Ulrich, 2000). From the green cone, the child
galloped to the line in middle between the green
and red cones and repeated a second trial by
galloping back to the green cone. According to
Ulrich (2000), the performance criteria for gallop
were as follows: arms bent and lifted to waist level
at takeoff; a step forward with the lead foot
followed by a step with the trailing foot to a
position adjacent to or behind the lead foot; brief
period when both feet are off the floor; maintains a
rhythmic pattern for four consecutive gallops.
Locomotor Subtest-Hop
15 feet of clear space was made (Ulrich,
2000). The child was told to hop three times on his
or her preferred foot and then three times on the
other foot towards the line next to the green cone.
The trial was repeated by hopping back to the
green cone. According to Ulrich (2000), the
29
performance criteria for hop were as follows:
nonsupport leg swings forward in pendular fashion
to produce force; foot of nonsupport leg remains
behind body; arms flexed and swing forward to
produce force; takes off and lands three
consecutive times on preferred foot; takes off and
lands three consecutive times on non-preferred
foot.
Locomotor Subtest-Leap
A minimum of 20 feet of clear space was
made and a 10 inch plastic ball was used (Ulrich,
2000). First, the ball was placed 10 feet away from
the green cone. The child stood behind the line of
the green cone and ran and leaped over the ball. A
second trial was made by leaping back to the line
of green cone. According to Ulrich (2000), the
performance criteria for leap were as follows: take
off on one foot and land on the opposite foot; a
period where both feet are off the ground longer
than running; forward reach with the arm opposite
the lead foot.
Locomotor Subtest-Horizontal Jump
10 feet of clear space was made (Ulrich,
2000). The child started behind the starting line of
green cone and jumped as far as he or she can. A
second trial was from the starting line again.
According to Ulrich (2000), the performance
criteria for horizontal jump were as follows:
preparatory movement includes flexion of both
knees with arms extended behind body; arms
extend forcefully forward and upward reaching
full extension above the head; take off and land on
both feet simultaneously; arms are thrust
downward during landing.
Locomotor Subtest-Slide
25 feet of clear space was made during
the test (Ulrich, 2000). The child was told to stand
sideway to the performing space, i.e., left foot
 ISSN: 2277-1700 ● Website: http://www.srji.info.ms ● URL Forwarded to: http://sites.google.com/site/scientificrji
parallel to the starting (green cone) line. The first
trial began by sliding from the starting line to the
middle line between the green and red cone, i.e.,
slide to the left. Then, repeated a second trial by
sliding back to the starting (green cone) line, i.e.,
slide to the right. According to Ulrich (2000), the
performance criteria for slide were as follows:
body turned sideways so shoulders are aligned
with the line on the floor; a step sideways with
lead foot followed by a slide of the trailing foot to
a point next to the lead foot; a minimum of four
continuous step-slide cycles to the right; a
minimum of four continuous step-slide cycles to
the left.
Object Control Subtest-Striking a Stationary Ball
A plastic bat, a batting tee and two 4-
inch lightweight balls were used in this test
(Ulrich, 2000). The batting tee was adjusted to the
child’s waist level. In the performing area, the
child was told to hold the bat with both hand and
hit the ball hard. For time saving, a second trial
was done by using another ball. According to
Ulrich (2000), the performance criteria for striking
a stationary ball were as follows: dominant hand
grips bat above non-dominant hand; non-preferred
side of body faces the imaginary tosser with feet
parallel; hip and shoulder rotation during swing;
transfers body weight to front foot; bat contacts
ball.
Object Control Subtest-Stationary Dribble
An 8- to 10-inch playground ball was
used in this test (Ulrich, 2000). The test was held
in the performing area. The child was told to
dribble the ball four times without moving his or
her feet, using one hand, and then stop by catching
the ball. A second trial was done. According to
Ulrich (2000), the performance criteria for
stationary dribble were as follows: contacts ball
30
with one hand at about belt level; pushes ball with
fingertips (not a slap); ball contacts surface in front
of or to the outside of foot on the preferred side;
maintains control of ball for four consecutive
bounces without having to move the feet to
retrieve it.
Object Control Subtest-Catch
The 8- to 10-inch playground ball was
used as mentioned by Ulrich (2000) in the manual.
15 feet of clear space was also made (Ulrich,
2000). The child and the tosser stood 15 feet away
of each other and the latter tossed the ball
underhand directly to the child with a slight arc
aiming for his or her chest. The child was told to
catch the ball with both hands for two times.
According to Ulrich (2000), the performance
criteria for catch were as follows: preparation
phase where hands are in front of the body and
elbows are flexed; arms extend while reaching for
the ball as it arrives; ball is caught by hands only.
Object Control Subtest-Kick
Two 8- to 10-inch playground balls, a
plastic ring instead of a bean bag to place the ball
were used and 30 feet of clear space was made for
this test (Ulrich, 2000). The ball was placed on the
top of the ring between the green and red cones,
i.e., 10 feet away from the starting line. The child
waited behind the starting line and then ran up and
kicked the ball hard. A second trial was repeated
by using another ball. According to Ulrich (2000),
the performance criteria for kick were as follows:
rapid continuous approach to the ball; an elongated
stride or leap immediately prior to ball contact;
non-kicking foot placed even with or slightly in
back of the ball; kicks ball with instep of preferred
foot (shoelaces) or toe.
Object Control Subtest-Overhand Throw
Two tennis balls were used and 20 feet
 Scientific Research Journal of India ● Volume: 2, Issue: 2, Year: 2013
of clear space was made this test (Ulrich, 2000).
The child was told to stand behind the starting line
and threw the ball hard. A second trial was done
by using another ball. According to Ulrich (2000),
the performance criteria for overhand throw were
as follows: windup is initiated with downward
movement of hand/arm; rotates hip and shoulders
to a point where the non-throwing side faces the
wall; weight is transferred by stepping with the
foot opposite the throwing hand; follow-through
beyond ball release diagonally across the body
toward the non-preferred side.
Object Control Subtest-Underhand Roll
Two tennis balls, a cone were used and
25 feet of clear space was made for this test
(Ulrich, 2000). The cone was placed between the
starting and ending line, i.e., 20 feet away from the
starting line. The child was told to stand behind the
starting line and rolled the ball hard towards the
bean bag. A second trial was repeated by using
another tennis ball. According to Ulrich (2000),
the performance criteria for underhand roll were as
follows: preferred hand swings down and back,
reaching behind the trunk while chest faces cones;
strides forward with foot opposite the preferred
hand toward the cones; bends knees to lower body;
releases ball close to the floor so ball does not
bounce more than 4 inches high.
In the TGMD-2, individual performance
was scored with 1 or 0 to show the presence or
absence of that particular skill while each skill
ranged from 6 to 10 points. Raw scores were
added up across skills to form a sub-set of
locomotor or object control, with ranged from 0 to
48 points. The two sub-set total raw score were
converted into standard scores so to achieve a
Gross Motor Development Quotient (GMDQ) by
summing them. Ninety-six children showing
31
descriptive rating of below average, poor and very
poor were considered for intervention.
Parental consent forms were sent out to
parents of those ninety-six children, and a total of
fifty-four signed forms were returned on time.
After obtaining informed consent from parents,
clinical observations were made to assess the
child’s musculoskeletal flexibility and movement
patterns. This ensured that the child met DSM IV
criteria. TGMD-2 scores of the selected subjects
were recorded as Pre test values. These children
were randomly assigned to one of the two
intervention groups. All underwent 20 minutes of
intervention for 5 days a week for 7 consecutive
weeks. The intervention includes NTT, based on
the assessment of child’s motor performance on
the range of tasks then the kinaesthetic training
based on Laszlo’s kinaesthetic approach. At the
end of 7 weeks of intervention TGMD-2 post test
values were taken for statistical analysis.
INTERVENTION
There were two intervention groups,
NTT combined with kinaesthetic training
(intervention group 1) and NTT alone
(intervention group 2). Fifty- four children from
different class sections of standard I to standard V,
by simple randomization using computer
generated random numbers from statistical website
were assigned to either intervention group 1 or
intervention group 2. Intervention groups had 27
participants each and both the groups were
subdivided into 5 instructional subgroups for the
purposes of instruction.
Intervention group 1
The group was the NTT combined with
KT group consisted of 27 children including 7
females and 20 males. NTT was given in group
 ISSN: 2277-1700 ● Website: http://www.srji.info.ms ● URL Forwarded to: http://sites.google.com/site/scientificrji
intervention, in the school play ground, for 20
(11)
minutes of 3 sessions per week for 7 weeks
was also given as group training for 20 minutes
sessions 2 times per week for 5 weeks (39). These
two interventions were administered on basis of
one intervention a day in alternate days.
Intervention group 2
This was the NTT only group. It consisted of
27 participants with 9 females and 18 males. NTT
was given as group intervention, in school, for 20
minutes of 5 sessions per week for 7 weeks.
Neuromotor task training.
During the training, the therapist noted
the extent to which motor tasks are performed
below the expected level, such as handwriting or
ball skill tasks. Second, they were analyzed for the
cognitive or motor control processes that were
involved in the deficient motor performance. The
reason for the failure to learn a specific motor skill
were found out , for e.g., attention problems, fear
of failure, lack of motivation, or lack of
understanding of how to execute a skill. In
addition, motor control processes might hamper
successful performance such as timing of
. KT components of a motor skill pattern, motor
planning, or parameter setting (the execution of a
motor act with the required speed and force) were
also taken consideration (40).
Each session started with general warm
up program for 10 minutes which was followed by
intervention of task training (considering all the
principles of ntt) over the range of tasks which the
child failed to perform in tgmd2 (locomotor and
object control subsets) during the pre test. The
progression was made by combining two or more
tasks into a game in groups (e.g., tasks like hitting,
over head throw, under arm roll and catch
combined into a game activity of cricket). Each
children were given time to comment on their as
well as others performance. As the children were
trained in group of five, everyone was made to
perform their role as a leader once during the
week.
Kinaesthetic Training
Developed by Laszlo (1985). Training
was based on kinesthetic awareness – class room
and individual practice Performa from Therapy
(41)
skill builders . The activities included in the
training were, 1. Recognizing and Reproducing
line direction and length. 2. Awareness activities
for fingers and hands. 3. Controlling direction of
movements- Dot to dot designs. 4. Recognizing
and controlling grip position 5.Recognizing and
reproducing Size, Shapes- Glue drawing, Template
activities.
RESULTS
The results of prevalence of DCD in
children in age group between 5 and 10 years in
the school population considered shows that the
rate of prevalence is 6.82. The pre test and post
32
 Scientific Research Journal of India ● Volume: 2, Issue: 2, Year: 2013

test values of Group 1 (Neuromotor Task Training Kinaesthetic training against Neuromotor task
Combined with Kinaesthetic Training) was training alone in children with DCD. The results of
analysed using paired‘t’ test. For 24 degrees of the post test values comparing two groups shows
freedom and at 5% level of significance, the COHEN’S d = 0.362229. The results suggest that
table‘t’ value is 2.064 and the calculated ‘t’ value there was a Medium Effect size.
was 11.586 . As the calculated‘t’ value was greater
than the table ‘t’ value and P value < 0.05, there
was a significant effectiveness of Neuromotor
Task Training combined with Kinaesthetic
Training in children with Developmental
Coordination Disorder. The pre test and post test
values of Group 2 (Neuromotor Task Training
Only) was analysed using paired‘t’ test. For 25
degrees of freedom and at 5% level of
significance, the table‘t’ value is 2.060 and the
calculated ‘t’ value was 11.588. As the
calculated‘t’ value was greater than the table ‘t’
value and P value < 0.05, there was a significant
effectiveness of Neuromotor Task Training alone
in children with Developmental Coordination
Disorder.
The pre test values of both the groups were
analysed using independent‘t’ test. For 49 degrees
of freedom and 5% level of significance, the
DISCUSSION
table‘t’ value 1.960 and the calculated ‘t’ value is
Out of 121 children suspected for DCD
0.207. As the calculated‘t’ value was lesser than
with initial screening by DCDQ’07, One child was
the table‘t’ value and P value > 0.05, there was no
diagnosed of having congenital hemiplegia, One
significant difference between the pre test values
with ADHD and 5 dropped out as they were absent
of both groups. Hence there was homogenicity
during the sessions of screening. Thus 114
between both the groups before the experiment.
children underwent secondary screening with
The post test values of both the groups were
TGMD-2. Out of 96 children identified with DCD,
analysed using independent‘t’ test. For 49 degrees
only 54 who consented on time (before the start of
of freedom and 5% level of significance, the
intervention) were included, as the study duration
table‘t’ value 1.960 and the calculated ‘t’ value is
is limited. Two randomized groups for
1.292. As the calculated‘t’ value was lesser than
intervention had 27 subjects each on the initiation
the table‘t’ value and P value > 0.05, there was no
of the study, 2 subjects from the intervention
significant difference between the effectiveness of
group 1 and 1 subject from the intervention group
Neuromotor task training combined with
2 were excluded from the results reported as they

33
 ISSN: 2277-1700 ● Website: http://www.srji.info.ms ● URL Forwarded to: http://sites.google.com/site/scientificrji
missed out many of the sessions during the
intervention period due to illness.
The result from our study on local school
population of Kanchipuram, South India on age
group between 5 and 10 years shows that DCD is
prevailing in 6.82 % of children. The result is
correlating with the previous statement of
‘Approximately 6% of children in mainstream
primary schools demonstrate motor competence
below normal range, although they appear both
1
physically and intellectually normal’ (American
Psychiatric Association, 1994). But in contrast to
the study done on the local population group in
kattankulathur of South India by Ganapathy
Sankar U and Saritha S (2011) have shown that
there is prevailing (Prevalence rate=1.37%) of
Developmental Coordination Disorder among the
(13)
age group of 5–10 years . As this study was done
only with DCDQ’07 screening, the prevalence rate
is only the suspect and the methodology of survey
was also not clearly explained, so this is
incomparable with our results.
The UK population based study by Raghu Lingam
34
et al., (2009), found that 18 of 1000 7-year-olds
have DCD according to strict DSM-IV criteria and
that 49 of 1000 7-yearolds have DCD or probable
(16)
DCD . In our study the approximate of 68 of
1000 (5 to 10 years old children) have DCD and
approximately 86 of 1000 have probable or
suspect for DCD. The problem predominantly
(24)
affects boys in a ratio of 3–4: 1 (Gordon &
McKinley, 1980). In our study the boys to girls’
ratio is 3.36: 1. Thus our results add support to the
previous studies.
Angela D. Mandich et al., (2001), have
stated that, 1. To date, combined approaches are
largely untested and research has provided limited
evidence to support combined approaches. 2.
Combined approaches have demonstrated smaller
effects than pure approaches. 3. The evidence for
bottom up approaches would suggest that no one
approach, or combination of approaches, is
superior to another in improving motor skill. 4. No
bottom up approach has been shown to be reliably
(11)
better than no treatment at all . Considering
these statements, Top down approach of
Neuromotor Task Training was combined with
Bottom up approach of Kinaesthetic Training.
With the hypothesis to prove the effectiveness of
Neuromotor Task Training combined with
Kinaesthetic Training in children with DCD, our
study compared the groups with interventions
combined (NTT with KT) on one group and NTT
alone on another group. The results are statistically
insignificant to prove the effectiveness of
combined group over group with NTT alone, but
there is a considerable difference in the mean
values and the medium effect size shown by
Cohen’s d effect size measure shows its beneficial
effect. The effectiveness of Neuromotor Task
Training in DCD is promising in this study,
 Scientific Research Journal of India ● Volume: 2, Issue: 2, Year: 2013
because there is a significant improvement seen in
both the subsets of TGMD-2 in the two
intervention groups. Kinaesthetic training in
combined therapy group has added some benefits
by producing difference in mean value between
the groups.
The reason for the effectiveness of
intervention may be due to the physical activity as
running, jumping and aerobic game playing which
has a definite impact on children’s frontal lobe, the
primary brain area for mental concentration,
planning and decision making(25). It is also
commonly believed that children automatically
acquire motor skills as their bodies develop but
scientists now believe that the opportunities for
practice, encouragement and instruction are crucial
to the development of mature patterns of
(26)
fundamental motor skills . The benefits made
would have been due to the group training in both
the groups as this has provided opportunity for
social interaction and stronger
(14)
competence . children with DCD. 2. There is a significant
The added benefits of Kinaesthetic training
may be due to the processing of visual information
about the body and external
proprioceptive information about limb and body
position, and then the initiation of an appropriate
corrective response. The integration or mapping of
these two sources of sensory information is also a
critical ingredient in balance control
CONCLUSION
The study was to
effectiveness of Neuromotor
combined with kinaesthetic training in children
with Developmental coordination disorder. With
the DCDQ’07 questionnaire filled by the school
teachers the initial screening was done followed by
secondary screening with TGMD-2 administered
by the principle investigator. The diagnosis was
made with the children falling below 15th
percentile in the test. The intervention were given
in two groups , one with combined therapy and the
other with Neuromotor Task Training alone for a
period of 7 weeks in small groups. The outcome
was assessed with Gross Motor Quotient of
TGMD-2. The data were analysed with Student’t’
tests comparing values within the groups and
between the groups. Results showed that the
prevalence of DCD in the local population is
6.82% and there is no significance difference
between the improvements made in the two
intervention groups.
Thus it is concluded that the
prevalence of DCD in the locality, Kanchipuram
of South India is 6.82%. The conclusions drawn
from our results are, 1. There is a significant
effectiveness of Combined therapy of Neuromotor
sense of Task Training with Kinaesthetic Training in
effectiveness of Neuromotor Task Training in
children with DCD. 3. There are no statistical
environment, significant differences between the effectiveness of
combined therapy Group against Neuromotor Task
Training alone in children with DCD. The
differences in the mean value support the
combined therapy group to have some better
(27)
. effects.
LIMITATIONS AND SUGGESTIONS
find out the This study was done with limited number of
Task Training samples from a single school of a locality in South
India. Intervention duration is not enough to
produce long term effects and the stability of the
effects produced cannot be determined. This
simple measure of gross motor development alone
35
 ISSN: 2277-1700 ● Website: http://www.srji.info.ms ● URL Forwarded to: http://sites.google.com/site/scientificrji

is not enough to measure all the characteristics of participation in assessing and managing these
children with DCD. Movement Assessment children to be considered. Stability of the effects
Battery for Children 2 (MABC-2) which was produced with the intervention to be studied. Other
proven to be a valid measurement tool for children combinations of approaches can be tried.
with DCD should be considered. Parental

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CORRESPONDING AUTHOR:

*M.P.T. (Neurology)., F.N.R., P.G.C.D.E. Health Care Consultant, Bharathidasan Matric Hr Sec School,
Kanchipuram, Tamilnadu, India. & Consultant Physical Therapist, Star Health Care Center, Kanchipuram,
Tamilnadu, India.
**Bachelors in Physiotherapy (India), PG Dip Sci - Exercise Rehabilitation (Clinical Exercise Physiology),
University of Auckland, New Zealand.

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