Seminar 4 –
University of Nijmegen, Netherlands
DCD: Can you treat “it” if you don’t know what “it” is?
Neuromotor Task Training: An intervention based on a combination of
motor control and motor learning theory
Bouwien Smits-Engelsman1,2,3,4 PhD, Eugene Rameckers Mres 3, 4, Roeland Smits 2, 4, Msc
1 Motor Control Lab, Department of Kinesiology, K.U. Leuven, Belgium
2Sint Maartens Kliniek-Research and Education, Nijmegen, The Netherlands
3 Department of Rehabilitation, Radboud University of Nijmegen, The Netherlands
4 Avans+, University for Professionals, Breda, The Netherlands
Corresponding author: firstname.lastname@example.org
First the core problems in motor performance in children with DCD were discussed based on our experimental studies of goal directed movements (see references). It can be concluded that children with DCD as a group are poorer in almost every motor task but also in many non-motor domains. These interrelations between motor and cognitive processing provide example that the systems are more intertwined than previously thought. It is important to notice that there is a large variability between children but there is also an increased variability in performance within the child. As a main result children with DCD showed higher SD on almost every variable (especially in force generation) and this leads to less optimal Signal to Noise Ratios. This makes accuracy in movements more difficult (more endpoint dispersion) but could also impact on learning. The adaptations strategies (freezing and co-contraction, and reliance on feedback) seen in children with DCD could be seen as filtering or compensation mechanism for this phenomenon.
In the search for underlying constraints an overview of the experimental studies were presented, showing that children with DCD have specific problems feedforward control, fine tuning of execution, calibrating their motor system and the re-weighting of information.
Next a model for intervention (Action Model) was presented that was developed on the basis of our experimental work (predominately in goal directed movements) and tested on many different patient groups (Cerebral Palsy, Parkinson Disease, Turner syndrome, Repetitive Strain Injury, see references). This model was recently used to develop the intervention program Neuromotor Task Training (NTT) (Schoemaker et al, 2005). Furthermore motor learning principles have been embedded in the approach. The approach is both child-centred and task-oriented. NTT is taught to paediatric physiotherapists (PPT) in the Netherlands, who learn to make an intervention plan adapted for each child based on the Action Model applied on the functional tasks that will be taught. The choice of tasks depends on which skills the child and/or its caretakers, want to master in daily life and on capabilities of the child.
The tasks trained are designed is such a way that a child is engaged in
functional exercises as close as possible to the skill to be learned but
the task situation is “loaded” according to the task analysis
based on the Action Model (Smits-Engelsman, 1995).
When performance gets better the therapist gradually increases the constraints within the same functional task. Because of this, NTT is expected to have a high degree of transfer to activities in daily life.
In the last part of the talk recent evidence for the efficacy of the treatment approach was reviewed. Moreover, results the relation between a detailed video analysis of the behaviour of the therapist and the changes in performance of the child were presented (Schoemaker et al., 2003; Niemeijer et al., 2003; submitted).
Future cognitive neuroscience research is to focus on specifying the complex interactions among various processes (including interactions among different neurotransmitters, and among genetic, physiological and structural changes in the brain), and how they affect, and are affected by, behaviour and psychological development in children with DCD. This way developmental cognitive neuroscience research hopefully will be able to aid in the early detection and treatment of developmental disorders.
1: Smits-Engelsman BC, Swinnen SP, Duysens J.
The advantage of cyclic over discrete movements remains evident following
changes in load and amplitude.
Neurosci Lett. 2005 Dec 1; [Epub ahead of print]
PMID: 16326008 [PubMed - as supplied by publisher]
2: Waelvelde HV, Weerdt WD, Cock PD, Janssens L, Feys H, Smits Engelsman
Parameterization of movement execution in children with developmental
Brain Cogn. 2005 Nov 25; [Epub ahead of print]
PMID: 16314018 [PubMed - as supplied by publisher]
3: Rameckers EA, Smits-Engelsman BC, Duysens J.
Children with spastic hemiplegia are equally able as controls in maintaining a
precise percentage of maximum force without visually monitoring their
Neuropsychologia. 2005; 43 (13):1938-45. Epub 2005 Mar 29.
PMID: 16168734 [PubMed - in process]
4: Smits-Engelsman BC, Rameckers EA, Duysens J.
Muscle force generation and force control of finger movements in children with spastic hemiplegia during isometric tasks.
Dev Med Child Neurol. 2005 May; 47 (5):337-42.
PMID: 15892376 [PubMed - indexed for MEDLINE]
5: Smits-Engelsman BC, Swinnen SP, Duysens J.
Are graphomotor tasks affected by working in the contra lateral hemi space in 6-to 10-year-old children?
Motor Control. 2004 Oct; 8 (4):521-33.
PMID: 15585905 [PubMed - indexed for MEDLINE]
6: Smits-Engelsman BC, Van Galen GP, Duysens J.
Force levels in uni- and bimanual isometric tasks affect variability measures differently throughout lifespan.
Motor Control. 2004 Oct; 8 (4):437-49.
PMID: 15585899 [PubMed - indexed for MEDLINE]
7: Westenberg Y, Smits-Engelsman BC, Duysens J.
Development of unimanual versus bimanual task performance in an isometric task.
Hum Mov Sci. 2004 Oct; 23 (3-4):461-74.
PMID: 15541529 [PubMed - indexed for MEDLINE]
8: Duysens J, Bastiaanse CM, Smits-Engelsman BC, Dietz V.
Gait acts as a gate for reflexes from the foot.
Can J Physiol Pharmacol. 2004 Aug-Sep; 82 (8-9):715-22.
PMID: 15523528 [PubMed - indexed for MEDLINE]
9: Jongmans MJ, Smits-Engelsman BC, Schoemaker MM.
Consequences of comorbidity of developmental coordination disorders and
learning disabilities for severity and pattern of perceptual-motor dysfunction.
J Learn Disabil. 2003 Nov-Dec; 36 (6):528-37.
PMID: 15493435 [PubMed - indexed for MEDLINE]
10: Van Waelvelde H, De Weerdt W, De Cock P, Smits-Engelsman BC.
Association between visual perceptual deficits and motor deficits in children
with developmental coordination disorder.
Dev Med Child Neurol. 2004 Oct; 46 (10):661-6.
PMID: 15473169 [PubMed - indexed for MEDLINE]
11: Smits-Engelsman BC, Rameckers EA, Duysens J.
Late developmental deficits in force control in children with hemiplegia.
Neuroreport. 2004 Aug 26; 15 (12):1931-5.
PMID: 15305140 [PubMed - indexed for MEDLINE]
12: Schoemaker MM, Niemeijer AS, Reynders K, Smits-Engelsman BC.
Effectiveness of neuromotor task training for children with developmental coordination disorder: a pilot study.
Neural Plast. 2003; 10 (1-2):155-63.
PMID: 14640316 [PubMed - indexed for MEDLINE]
13: Niemeijer AS, Smits-Engelsman BC, Reynders K, Schoemaker MM.
Verbal actions of physiotherapists to enhance motor learning in children with DCD.
Hum Mov Sci. 2003 Nov; 22 (4-5):567-81.
PMID: 14624834 [PubMed - indexed for MEDLINE]
14: Jongmans MJ, Linthorst-Bakker E, Westenberg Y, Smits-Engelsman BC.
Use of a task-oriented self-instruction method to support children in primary school with poor handwriting quality and speed.
Hum Mov Sci. 2003 Nov; 22 (4-5):549-66.
PMID: 14624833 [PubMed - indexed for MEDLINE]
15: Smits-Engelsman BC, Wilson PH, Westenberg Y, Duysens J.
Fine motor deficiencies in children with developmental coordination disorder and learning disabilities: an underlying open-loop control deficit.
Hum Mov Sci. 2003 Nov; 22 (4-5):495-513.
PMID: 14624830 [PubMed - indexed for MEDLINE]
16: Smits-Engelsman BC, Westenberg Y, Duysens J.
Development of isometric force and force control in children.
Brain Res Cogn Brain Res. 2003 Jun; 17 (1):68-74.
PMID: 12763193 [PubMed - indexed for MEDLINE]
17: Nijhuis-van der Sanden MW, Smits-Engelsman BC, Eling PA, Nijhuis BJ,
Van Galen GP.
Low elementary movement speed is associated with poor motor skill in Turner's
Dev Neuropsychol. 2002; 22 (3):643-70.
PMID: 12661974 [PubMed - indexed for MEDLINE
Action Model of Goal-directed Movement
Smits-Engelsman, Steenbergen, Van Galen (2001)