Non-randomised clinical trial of intensive versus weekly physiotherapy for children with minor motor difficulties

Abstract

Developmental Co-ordination Disorder (DCD) is a heterogeneous disorder that is said to present in five to eight percent of the school-aged population. Children with DCD have motor inco-ordination and poor fine function, and will often have associated comorbidities such as speech and language and attention deficits. For many years parents of children with DCD were told that their children would grow out of it as they developed. However since then many studies have found that young children described as having poor co-ordination for their age or those diagnosed with DCD, continue to have significant motor problems, together with a variety of emotional, social, educational, psychological and behavioural difficulties. Many interventions have been shown to be effective in improving the motor skills of these children, however very little research could be found on the use of physiotherapy in the treatment of these children. The aim of this study was therefore to determine the effectiveness of two intensities of physiotherapy in improving the motor abilities of children with minor motor difficulties in South Africa. The study was carried out with 34 children (22 males, 12 females) with minor motor difficulties in a private practice setting. An investigation into the effectiveness of weekly 45 minute physiotherapy sessions with no home exercise programme, (which is standard management currently) as compared with a five day intensive intervention (one hour per day) together with a home exercise programme, was conducted. The intervention for each group lasted 12 weeks. The results showed that the for children who received weekly therapy, the mean point scores, scale scores and standard scores for each of the four motor composites as well as for the total motor composite increased from baseline . A protocol of five days of physiotherapy intervention using an NDT approach together with a home exercise programme may be useful in the treatment of children with minor motor difficulties; as the individuals who participated in this programme showed an improvement in overall motor performance after a five day intervention and at six weeks and 12 weeks with the use of a home exercise programme. Results showed that all scores apart from fine motor function improved from baseline (p < 0.05). It was concluded that the 45 minutes once a week physiotherapy intervention using an NDT approach which is currently being used is effective in improving the fine and gross motor skills of children with minor motor difficulties. However if parents are unable to afford weekly intervention but are willing to comply regularly with a prescribed, individualised home exercise programme, a possible protocol of an intensive block of therapy with a home programme may be advised. This protocol however cannot be advised for use with all children with minor motor difficulties and the therapists’ clinical judgment is imperative in this regard.