Self-analysis materials (e.g., photos, charts, study reports to interpret, questions to think about etc.)

Case description for self-analysis: the participant will find out the movement development of the examined child, what were the results of the tests, and will independently consider the decision on further treatment and movement development. 

1. Read the history of the child. 

2. Analyze the test results, pay attention to the quality of movements. 

3. Think about what you would do with this child and then read recommendations given by the physiotherapist. 

Patient: boy, 5 years old, body height 105 cm, body weight 18 kg (normal body sizes) 

Diagnosis: no diagnosed disabilities in medical history 

Reason for visiting a physiotherapist: attended a status check at 5 years of age, health professional (district nurse) and preschool nurse/preschool teacher noted a delay in motor skills, clumsy in fine and gross movements and have some attention issues. Lateral dominance is not stable yet, the signs of crossed laterality or cross-dominance turn up in everyday situations.  

Examination: 

History: no prematurity, normal birth weight, large movements (crawling, climbing) started later, spent a lot of time settled, no sensory problems 

Activity and participation: likes to play outdoors but spends more time indoors, dislikes high climbing frames and unstable surfaces, prefers to play alone rather than with peers 

Test results – Videos included: 

1^ST “CHAPTER” 

1. Copying a square, a triangle and a diamond: The shapes are not recognisable, corners and edges are missing. After repeated attempts, he draws the square close to the frame, almost guiding the pencil on the frame; the corners are rounded here too. He holds the pencil with three fingers.  

2. Folding paper strips: Alternating the coloured stripes, he folds skilfully, without distorting the order. The folds are not evenly spaced, but the child gets to the end of the paper strips. Time: 112 seconds.  

3. Cutting paper with scissors: His grip on scissors is unsteady, fingers fit in the tool upside down. He can only cut with assistance; he does not follow the lines and curves smoothly. He moves forward with small cuts. It takes about 50 seconds to reach the balloon, but he cuts into it.  

2^nd “CHAPTER” 

1. Catching ball with two hands: He is able to catch 3/5 with both hands, both limbs working nicely at the same time, no bending of hips or knees.  

Throwing the ball at a target: He is able to hit 1/5 with both hands, 3 hits meet the edge of the stool.  

2. Finger-foot same side synchronized: Nice rhythmic movement up to 16 seconds then accelerates, the harmony of the movement is slightly out of sync, but the opposite side does not move. 

 

3. Finger-foot opposite side synchronized: Nice rhythmic movement for 8 seconds, then accelerates, movement harmony slightly out of synch, side to be held steady is initially engaged in the exercise, but not at the start of the test.  

3^rd “CHAPTER” 

Pediatric Balance Scale: 

Test 1 – Sitting to standing: He is able to stand up smoothly without using hands and stabilize the position independently.  

Test 2 – Standing to sitting: He sits down safely with his arms held high. He does not need to use his hands.  

Test 3 – Transfers: He is able to transfer safely, but uses his hands on both chairs. He grips the chair armrest and the seat surface of the adult-sized chair.  

Test 4 – Standing unsupported: With feet on the footprints he is able to stand safely for 30 seconds. Holding the position imitating statues and the conversation about it helps to maintain attention span.  

Test 5 – Sitting with back unsupported and feet supported on the floor: He is able to sit safely and securely for 30 seconds.  

Test 6 – Standing unsupported with eyes closed: He can stand safely for 10 seconds with his eyes closed and without moving his feet away from the footprints. Feet are shoulder width apart.  

Test 7 – Standing unsupported with feet together: He is able to place his feet together independently.  We can see some equilibrium reactions in the feet, but the feet do not leave the support surface. He can hold the position for 30 seconds.  

Test 8 – Standing unsupported one foot in front: He needs help to place feet in tandem position, we can see some equilibrium reactions in the front foot, it moves a bit, but does not leave the support surface. He can hold the position for 30 seconds.  

Test 9 – Standing on one leg: He can lift his leg independently and stand on the right leg for 4,5 seconds and on the left leg for 3 seconds.  

Test 10 – Turn 360 degrees: He can turn 360 degrees to the right in 2 seconds, stay in the middle for 1 second, and then also turn 360 degrees to the left in 2 seconds. He is able to turn safely.   

Test 11 – Turning to look behind left and right shoulders while standing still: He turns his head, looks over each shoulder, we can see the trunk rotation also. He does not need any assistance to keep from losing balance.  

Test 12 – Pick up object from the floor from a standing position: He can pick up the eraser from the floor without moving his feet from the support surface, the heels are stable on the floor.  

Test 13 – Placing alternate foot on step stool while standing unsupported: He can stand safely without support and can place both of his feet four times on the step stool. He can complete the task in 13,5 seconds.  

Test 14 – Reaching forward with outstretched arm while standing: In the first position (90 degrees of shoulder flexion) the marker is at 27 centimetres. After reaching forward without stepping the second marker goes to 40 centimetres on the measuring tool. The measured distance is 13 centimetres. 12,7 centimetres or more and safely completed trial worth 3 points.        

Dynamic balance: 

1. One-leg hop test: He is able to hop 5 times on the right leg and 4 times on the left leg.  

2. Tandem Gait (Heel-to-Toe): He steps off the line 5 times and we can see the distance between the heel and the toe.  

3. Tandem Walk: He can complete the test in 35 seconds. At turn, he stops but does not step off the beam. 

DCDQ`07 Questionnaire:  

52 points 

25/30 + 10/20 + 17/25 = 52/75 

Control during movement/Fine Motor, Handwriting/General 

Coordination/TOTAL 

Result of the parent report measure developed to assist in the identification of Developmental Coordination Disorder (DCD) in children) is „probably not DCD” (47-75 points – age 5). 

Results, summary and recommendations: 

The results of the tests and the answers to the questionnaire were consistent, with weaknesses in fine motor skills in daily activities, but somehow better results in eye-hand coordination. The skills of copying and cutting shapes are not like what is expected at his age; however the way of pencil holding is fine. Folding is acceptable for his age. The tests showed that in addition to fine motor skills, spatial perception (based on the ball throwing test) should be developed and it is also necessary to increase the time for maintaining synchronized, rhythmic movements. According to the Pediatric Balance Scale (PBS) and the dynamic balance tests static and dynamic balance should also be developed, as the reduction of the supporting surface showed that balance was affected (PBS: Test 3 – 3 points; Test 8 – 2 points; Test 9 – 2 points; Test 14 – 3 points; all the other tests – 4 points – TOTAL SCORE: 50/56). Hopping on one leg and tandem tests also show the issues. Based on the Pediatric Balance Scale test results, the total score is slightly below the score of children at the same age (5y 0m to 5y 5m - 54.0 ± 2.52 points, Franjoine et al, 2010), so skill developing program would be recommended.  

For the development of fine motor skills we can use fine motor precision and strength activities, because in everyday situations besides the fine and coordinated movements we also need strength in our hands to maintain grasping. Simple tools such as buttons, coins, needles, threads, paper, plasticine, clothespin and tweezers can be used to develop skills in a playful way. Practising gross motor movements or hand-eye coordination exercises can also promote the development of fine motor skills learning about corners and, edges and shapes. Following the shapes depicted on a table or on the floor with hand or foot movements, walking on the lines or rolling a ball on it helps to get to know the shapes. Practising rhythmic movements promotes the strengthening of synchronized movements. The exercises supplemented with clapping also support bilateral movements and the practice of rhythm. In case of Cross Lateral Motion or Bilateral Coordination Exercises a body part crosses the midline of the body (stretching to the air crossing the midline, touching the opposite ear, shoulder, leg, etc.). These can be helpful with unstable dominance and strengthen the connection between the brain hemispheres. The development of balance can be achieved with various tools, unstable surfaces, along with the reduction of the support surface, in a colorful playful form. Practising the motor skills expected at given age, running, jumping, walking in a line, balancing on dynamic devices and providing the opportunity to exercise in a free but safe environment is essential. 

Providing and introducing a variety of new but non-intimidating equipments from swings, slides to sandboxes and playground equipment, which stimulate cognitive and social development can also be used to support the development process. It is also useful to work with the child in pairs initially, then in groups, and to help him or her build relationships with peers. 

Questions to think about (some examples):  

• How can we make training exciting and playful for a child?  
• What tools can be used to develop balance? 
• What tasks/exercises can be practised in the home environment to develop fine motor skills? 
• How can we develop spatial orientation? 

In addition, a problem related to communication with the child and the parents will be described for self-solving.