Assessment of gait characteristics and orthotic management in children with Developmental Coordination Disorder: Preliminary findings to inform multidisciplinary care

https://doi.org/10.1016/j.ridd.2013.06.012Get rights and content

Highlights

  • Children with DCD presented with pes planus and hypermobility of lower limb joints.

  • Double support duration and cadence improved following orthotic intervention.

  • Assessment of the foot and lower limb is required in children with DCD.

Abstract

Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder characterised by impaired motor co-ordination and awkward gait. Despite self-reported findings of pes planus and joint hypermobility in children with DCD, there is little objective evidence regarding the clinical management of the foot in children with DCD. The aims of this research were to report clinical findings of foot posture and lower limb hypermobility in children with DCD and to evaluate the impact of foot orthoses on spatio-temporal gait parameters. Children with DCD were recruited into the study. Participants were randomly assigned to an intervention group who received foot orthoses at the start of their rehabilitation programme or to a second group who received foot orthoses at the end of their intervention programme. Foot posture was assessed with the Foot Posture Index and lower limb hypermobility assessed with the Lower Limb Assessment Score. The effect of foot orthoses was evaluated through assessment of spatio-temporal gait characteristics at baseline and post-rehabilitation programme. Fourteen children were recruited (mdn age 7.5 years) with nine children assigned to the group receiving orthoses early (mdn age 8 years) and five children assigned to the post-rehabilitation orthoses group (mdn age 6.5 years). A pes planus foot posture (FPI score = 8) and lower limb hypermobility (LLAS score = 11) were observed. Changes in spatio-temporal gait parameters failed to reach significance (p > .012) following orthotic invention but demonstrated a trend towards a decreased cadence and increased double support duration. Despite non-significant findings this work offers preliminary support for podiatric intervention in the rehabilitation of children with DCD. Further work is required to understand the biomechanics of gait in children with DCD and appreciate the role of podiatry as a component of multidisciplinary care.

Introduction

Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder characterised by impaired motor coordination and reduced ability to perform activities of childhood (Mandich et al., 2001, Polatajko and Cantin, 2006). Awkward and variable execution of movement (Raynor, 2001, Rosengren et al., 2009), reduced muscle strength and power (Raynor, 2001), pes planus (flat feet) and joint hypermobility (Kirby & Davies, 2006) have been reported in DCD. Rehabilitation for children with DCD requires a multidisciplinary approach underpinned by contemporary theories of human movement science (Polatajko & Cantin, 2006). Yet despite previous findings of flat feet and joint hypermobility (Kirby & Davies, 2006), there is little objective evidence regarding the clinical management of the foot in children with DCD.

It has been suggested that foot orthoses, as an addition to current management regimes for children with DCD, are warranted to address aberrant mechanics of the foot and lower limb that are associated with pes planus and joint hypermobility (Kirby & Davies, 2006). Foot orthoses are devices worn in the shoe which alter loading patterns during walking. Foot orthoses have been reported to prevent lower limb injury and reduce symptoms associated with soft tissue stress (Collins et al., 2007, Landorf and Keenan, 2000, Williams and Nester, 2010). In the paediatric context orthoses have also been reported to improve pain and disability in children with Juvenile Idiopathic Arthritis (Powell, Seid, & Szer, 2005). Nevertheless, recent conclusions from a Cochrane review (Rome, Ashford, & Evans, 2010) confirmed that further evidence was required to determine the efficacy of orthoses in the management of childhood conditions. Little is currently known about the clinical management of pes planus and joint hypermobility in children with DCD. The aims of this research were twofold: (1) to report clinical findings of foot posture and lower limb hypermobility in children with DCD and (2) to evaluate the impact of foot orthoses on spatio-temporal gait parameters.

Section snippets

Participants

Children with a diagnosis of DCD aged between 6 and 11 years of age referred to a Physical and Developmental Assessment rehabilitation programme within the Children's Therapy Service at Medway Community Healthcare were considered for participation in the study. Children referred into this programme were entering a seven week programme designed to give children with DCD the opportunity to practice and experience success with skills they found difficult. This consisted of clinical input from

Results

Median FPI-6 score for both feet was 8 and median scores for both limbs were 11. Both groups were similar for age, foot posture and hypermobility score.

There were no significant differences between gait characteristics for the two groups (see Table 1) at baseline (cadence: U = 30, p = .36; stride length: U = 13, p = .24; or double support duration: U = 9, p = .08). At seven week follow-up no significant differences between the groups were observed for cadence (U = 5, p = .019, r = −0.60), double support duration

Discussion

The aim of this study was to report clinical findings of foot posture and lower limb hypermobility in children with DCD. We also sought to evaluate the impact of foot orthoses on spatio-temporal gait parameters in children with DCD. Through utilising reliable and objective clinical measures this study has reported characteristics of the foot and lower limb in children with DCD. Values for foot posture confirmed that children had a pronated foot position during standing, but not a severely flat

Conclusion

Through application of objective clinical measures this study has confirmed a pes planus foot posture and hypermobility of the lower limb in children with DCD. Findings from this research offer preliminary evidence of changes in spatio-temporal gait parameters following orthotic invention despite failing to reach significance. The trend in the data offers preliminary support for podiatric intervention in children with DCD. Further work is required to understand the characteristics of gait and

Acknowledgements

This research was supported by a financial contribution from Canonbury Healthcare. The funder had no role in the design of the study, collection and analysis of data, or writing the manuscript.

References (20)

  • K.J. Murray

    Hypermobility disorders in children and adolescents

    Best Practice and Research Clinical Rheumatology

    (2006)
  • A.C. Redmond et al.

    Development and validation of a novel rating system for scoring standing foot posture: The foot posture index

    Clinical Biomechanics

    (2006)
  • K.S. Rosengren et al.

    Differences in gait complexity and variability with and without Developmental Coordination Disorder

    Gait Posture

    (2009)
  • American Thoracic Society

    Guidelines for the six-minute walk test

    American Journal of Respiratory and Critical Care Medicine

    (2002)
  • M.G. Benedetti et al.

    Diagnosis of flexible flatfoot in children: A systematic clinical approach

    Orthopaedics

    (2011)
  • N. Collins et al.

    Foot orthoses in lower limb overuse conditions: A systematic review and meta-analysis

    Foot and Ankle International

    (2007)
  • F.J.A. Deconinck et al.

    Differences in gait between children with and without Developmental Coordination Disorder

    Motor Control

    (2006)
  • J. Ferrari et al.

    Joint hypermobility: The use of a new assessment tool to measure lower limb hypermobility

    Pediatric Rheumatology

    (2005)
  • A. Kirby et al.

    Developmental Coordination Disorder and joint hypermobility syndrome-overlapping disorders? Implications for research and clinical practice

    Child Care, Health and Development

    (2006)
  • K.B. Landorf et al.

    Efficacy of foot orthoses. What does the literature tell us?

    Journal of the American Podiatric Medical Association

    (2000)
There are more references available in the full text version of this article.

Cited by (0)

View full text