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Cavalcante Neto J.L.1,2, Zámuner A.R.3, Silva R.A.S.4, Menegat D.4, Ignácio A.P.1, Silva E.1, Tudella E.1
1Federal University of São Carlos - UFSCar, Physical Therapy, Sao Carlos, Brazil, 2State University of Bahia, Human Sciences, Jacobina, Brazil, 3Universidade do Sagrado Coração (USC), Physical Therapy, Bauru, Brazil, 4Federal University of São Carlos - UFSCar, Occupational Therapy, Sao Carlos, Brazil
Background: Children with Developmental Coordination Disorder (DCD) have significant motor skills impairment associated with higher prevalence of sedentary lifestyle, which might affect their health and predispose to cardiac risk factors in the future. Indeed, some studies have shown that DCD children present abnormalities in the cardiovascular autonomic control, which is a noninvasive marker for risk of a cardiovascular event. A few studies have proposed motor skills training programs as treatment for this population. However, to our knowledge, no studies have assessed the effects of a motor skills training program on the cardiac autonomic control in these children.
Purpose: To evaluate the effects of a 16-session motor skills training program on the cardiac autonomic control and motor performance in children with DCD.
Methods: Six children (mean, 7.7 years; SD, 0.5 years) were recruited from positive screening for DCD by applying the Developmental Coordination Disorder Questionnaire (DCDQ) and the Movement Assessment Battery for Children - Second Edition (MABC-2) with cutoff point for the total score ≤16. A 16-session motor skills training program was applied twice a week. Each training session was individualized and lasted approximately 60 min. All children underwent the MABC-2 and RR intervals recording (at resting supine position for 10 min) one week before (Baseline) and one week after (Post) the 16-session motor skills training program. Cardiac autonomic control was assessed by means of heart rate variability (HRV), using time domain (Variance, SDNN and RMSSD indices) and spectral (High Frequency, HF; Low Frequency, LFnu and LF/HF ratio indices) analyses. Paired Student T test was applied to compare baseline versus post values. Significance level was set at 5%. Cohens d coefficient was also calculated.
Results: Children with DCD showed a significant increase (p=0.03, d=1.54) in the MABC-2 total score (Baseline: mean=53.8; SD=6.9; Post: mean=68.0; SD=12.0) after the training program. Regarding the cardiac autonomic control, children with DCD presented a significant decrease in Variance (d=2.05, p=0.02) and SDNN indices (d=2.17, p=0.02) after the training program, reflecting a decrease in overall HRV. A significant decrease in the RMSSD (d=0.94, p=0.02) and in the HF (p=0.02, d=1.89) indices was also observed, reflecting a decrease in the cardiac parasympathetic modulation.
Conclusion(s): The results revealed that the 16-session motor skills training program, proposed in the present study, was effective in increasing motor skills performance and in altering cardiac autonomic modulation, by decreasing overall HRV and cardiac parasympathetic modulation, in children with DCD.
Implications: This study highlights the effectiveness of motor skills training in improving motor skills performance in children with DCD. Furthermore, the intervention decreased overall HRV and cardiac parasympathetic modulation, which was unexpected, since decreased HRV has been associated with increased risk for cardiovascular events. On the other hand, decreasing parasympathetic modulation it is of interest in some clinical conditions, such as children with vasovagal syncope. Therefore, this study represents a start point for future studies to address whether children with DCD share a similar autonomic profile with children with vasovagal syncope, which could also contribute to low activity levels commonly seen in DCD children.
Funding acknowledgements: FAPESP - Research Support Foundation of the State of São Paulo (Process number 2015/24291-0).
Topic: Disability & rehabilitation
Ethics approval: Approved by Ethics Committee on Human Research of the Federal University of São Carlos (CAEE/47091115.0.0000.5504), BR
All authors, affiliations and abstracts have been published as submitted.
