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Fong SSM1, Cheng YTY1, Fong DYT2, Kwong KSC3, Hung YS4, Cheung ACY5, Tsang WWN6
1University of Hong Kong, School of Public Health, Hong Kong, Hong Kong, 2University of Hong Kong, School of Nursing, Hong Kong, Hong Kong, 3Open University of Hong Kong, School of Nursing and Health Studies, Hong Kong, Hong Kong, 4University of Hong Kong, Department of Electrical and Electronic Engineering, Hong Kong, Hong Kong, 5University of Hong Kong, Department of Social Work and Social Administration, Hong Kong, Hong Kong, 6Hong Kong Polytechnic University, Department of Rehabilitation Sciences, Hong Kong, Hong Kong
Background: Developmental coordination disorder (DCD) is a neurodevelopmental motor disorder. However, about 50% of children with DCD also have attention deficit that may harm their motor performances including body balance reactions. A holistic treatment approach that addresses both the motor and attention deficits is thus needed to improve these children's reactive balance performance and overall development.
Purpose: This study aimed to compare the effectiveness of attention-neuromuscular training (AT-NMT), neuromuscular training (NMT) alone, attention training (AT) alone, and control (usual medical care) for improving reactive balance performance among children with DCD.
Methods: A single-blinded, randomized controlled trial involving 175 children with DCD was conducted. The DCD participants were randomly allocated to an AT-NMT group, a NMT group, an AT group, or a control group using computer-generated random codes. The three intervention groups received two training sessions per week for 12 weeks. Outcomes were evaluated at baseline, post-intervention, and 3-month follow-up. Primary outcome - a motor control test (MCT) gave a composite latency score. Secondary outcomes - electroencephalographic recordings during MCT measured the attention level, and surface electromyographic recordings during MCT indicated the lower limb muscle onset latency. Data analysis was based on intention to treat. The trial was registered with ClinicalTrials.gov (NCT02397161).
Results: Children with DCD were randomly assigned to the AT-NMT group (n=43; mean age=7.8 years; 34 boys and 9 girls), NMT group (n=44; mean age=7.6 years; 33 boys and 11 girls), AT group (n=44; mean age=7.2 years; 37 boys and 7 girls), or control group (n=44; mean age=7.2 years; 41 boys and 3 girls). The demographics were well balanced among the four groups. Two-way repeated measures analysis of (co)variance results revealed that MCT composite latency scores of the three intervention groups were lower than that of the control group at both 3 and 6 months (all p 0.0083, Bonferroni adjusted). The attention index (before a MCT backward platform translation) was particularly high in the AT group at 3 months compared to the NMT and control groups (p 0.0083, Bonferroni adjusted). The attention index actually increased by 9.15 points from baseline to 3 months in this group (p=0.005). Regarding the attention index throughout a MCT backward platform translation, it increased by 7.15 at 3 months (p=0.008) and 8.71 at 6 months (p 0.001) compared to the baseline value in exclusively the AT-NMT group. Similar pattern of improvement was observed in the attention index before a MCT forward platform translation in the same group (all p 0.017, Bonferroni adjusted). No significant time, group and group-by-time interaction effects were noted in all other outcomes (p>0.05). In addition, no major adverse events were reported.
Conclusion(s): AT-NMT, NMT and AT were equally effective in improving reactive balance performance in children with DCD but they cannot improve leg muscle responses in these children. In addition, both AT-NMT and AT can improve attention level before or during a direction-specific postural perturbation.
Implications: AT-NMT or AT can be incorporated into rehabilitation treatments for children with DCD to improve their reactive balance performance and the associated mental attention.
Keywords: dyspraxia, attention training, neuromuscular training
Funding acknowledgements: The study was funded by the Research Grants Council of Hong Kong (GRF 17658516).
Purpose: This study aimed to compare the effectiveness of attention-neuromuscular training (AT-NMT), neuromuscular training (NMT) alone, attention training (AT) alone, and control (usual medical care) for improving reactive balance performance among children with DCD.
Methods: A single-blinded, randomized controlled trial involving 175 children with DCD was conducted. The DCD participants were randomly allocated to an AT-NMT group, a NMT group, an AT group, or a control group using computer-generated random codes. The three intervention groups received two training sessions per week for 12 weeks. Outcomes were evaluated at baseline, post-intervention, and 3-month follow-up. Primary outcome - a motor control test (MCT) gave a composite latency score. Secondary outcomes - electroencephalographic recordings during MCT measured the attention level, and surface electromyographic recordings during MCT indicated the lower limb muscle onset latency. Data analysis was based on intention to treat. The trial was registered with ClinicalTrials.gov (NCT02397161).
Results: Children with DCD were randomly assigned to the AT-NMT group (n=43; mean age=7.8 years; 34 boys and 9 girls), NMT group (n=44; mean age=7.6 years; 33 boys and 11 girls), AT group (n=44; mean age=7.2 years; 37 boys and 7 girls), or control group (n=44; mean age=7.2 years; 41 boys and 3 girls). The demographics were well balanced among the four groups. Two-way repeated measures analysis of (co)variance results revealed that MCT composite latency scores of the three intervention groups were lower than that of the control group at both 3 and 6 months (all p 0.0083, Bonferroni adjusted). The attention index (before a MCT backward platform translation) was particularly high in the AT group at 3 months compared to the NMT and control groups (p 0.0083, Bonferroni adjusted). The attention index actually increased by 9.15 points from baseline to 3 months in this group (p=0.005). Regarding the attention index throughout a MCT backward platform translation, it increased by 7.15 at 3 months (p=0.008) and 8.71 at 6 months (p 0.001) compared to the baseline value in exclusively the AT-NMT group. Similar pattern of improvement was observed in the attention index before a MCT forward platform translation in the same group (all p 0.017, Bonferroni adjusted). No significant time, group and group-by-time interaction effects were noted in all other outcomes (p>0.05). In addition, no major adverse events were reported.
Conclusion(s): AT-NMT, NMT and AT were equally effective in improving reactive balance performance in children with DCD but they cannot improve leg muscle responses in these children. In addition, both AT-NMT and AT can improve attention level before or during a direction-specific postural perturbation.
Implications: AT-NMT or AT can be incorporated into rehabilitation treatments for children with DCD to improve their reactive balance performance and the associated mental attention.
Keywords: dyspraxia, attention training, neuromuscular training
Funding acknowledgements: The study was funded by the Research Grants Council of Hong Kong (GRF 17658516).
Topic: Paediatrics
Ethics approval required: Yes
Institution: University of Hong Kong
Ethics committee: Human Research Ethics Committee
Ethics number: EA380914
All authors, affiliations and abstracts have been published as submitted.
