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CONDITION/DISORDER SYNONYMS

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  • DCD

  • Clumsy child syndrome

  • Motor dyspraxia

  • Developmental dyspraxia

  • Sensory integrative dysfunction

  • Disorder of attention, motor, and perception

  • Minor coordination dysfunction

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ICD-9-CM CODE

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  • 315.4 Developmental coordination disorder

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ICD-10-CM CODE

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  • F82 Specific developmental disorder of motor function

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PREFERRED PRACTICE PATTERN

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  • 5C: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—Congenital Origin or Acquired in Infancy or Childhood 1

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PATIENT PRESENTATION

A 5-year-old male is referred for outpatient physical therapy for frequent falling. The parents report he takes Strattera for attention deficit hyperactivity disorder (ADHD) and gets frustrated when trying to play with his 4-year-old sister. Upon examination, the therapist notes the child has mild hypotonia especially in his trunk, has difficulty balancing on one leg, and has poor coordination with kicking or catching a ball. He has fair abdominal strength and descends stairs in a step-to-step pattern.

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KEY FEATURES

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Description
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  • Difficulty performing complex gross or fine motor-coordination tasks

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Essentials of Diagnosis
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  • No cognitive or neurological dysfunction

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General Considerations
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  • Four criteria

    • Difficulty performing age-appropriate motor skills

    • Child has had sufficient opportunity to attain motor skills

    • No medical reason for motor difficulty

    • Difficulties impact academics or ADLs

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Demographics
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  • Fifty percent of children with developmental coordination disorder (DCD) also have ADHD2, 3

  • Affects 5% to 6% of all children4

  • Affects twice as many males as females4

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CLINICAL FINDINGS

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SIGNS AND SYMPTOMS

  • Decreased strength

  • Difficulty with coordination

    • Ball skills

      • Catching

      • Throwing

      • Kicking

    • Single-limb stance

    • Jumping

    • Hopping on one foot

    • Skipping

  • Ligamentous laxity

  • Hypotonia5

  • Soft neurological signs6

  • Atypical gait pattern

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Functional Implications
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  • Falls or trips often

  • Bumps into objects, other people

  • Difficulty using motor skills in new settings

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Possible Contributing Causes
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  • Premature birth4

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Differential Diagnosis
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  • Head injury

  • Progressive neurological disorder

  • Brain tumor

  • Autism

  • Pervasive developmental disorder7

  • Cerebral palsy8,9

  • Visual disturbances

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MEANS OF CONFIRMATION OR DIAGNOSIS

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Diagnostic Procedures
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  • Parent–teacher questionnaires: Connors, Burks

  • Psychological testing

  • IQ testing

  • Developmental and Psychosocial evaluation

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TREATMENT

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Medication
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  • None for DCD

  • Medications available for ADHD

    • Methylphenidate drugs

    • Amphetamines

    • Dexmethylphenidate

    • Dextroamphetamine

    • Lisdexamfetamine

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FIGURE 236-1

Upper motor neuron pathways. Tracts at bottom left are shown outside the cord for clarity only. (From McPhee SJ, Hammer GD. Pathophysiology of Disease: An Introduction to Clinical Medicine. 6th ed. New York, NY:2009, McGraw Hill.)

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