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Case Report

Effects of Lycra Body Suit Orthosis on a Child With Developmental Coordination Disorder

A Case Study

Rathinam, Chandrasekar MPT, MCSP; Bridges, Selin MSc, MCSP; Spokes, Gillian DPT, MCSP; Green, David PhD

Author Information
JPO Journal of Prosthetics and Orthotics: January 2013 - Volume 25 - Issue 1 - p 58-61
doi: 10.1097/JPO.0b013e31827b5946
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Abstract

Developmental coordination disorder (DCD), also known as developmental dyspraxia, is a common disorder among school-age children. DCD has been described as performance in daily activities that require motor coordination that is substantially below that expected given the person’s chronological age and measured intelligence.1, 2 DCD has an incident rate of 5% to 6%, with male children predominantly affected.3 Children with DCD display substantial and varied motor difficulties as well as persistent educational, social, and emotional problems, which may continue into adulthood.4,5 It is well documented that children with DCD have problems with proprioception, poor physical fitness, balance, coordination, abnormal reflexes, associated movements, visual perception, and motor planning.6–8 Proprioceptors monitor the body’s position and movement in space, encoding kinetic and kinematic information to the central nervous system.9 Deficiency of proprioception has an adverse effect upon planning, organizing, and performing motor tasks, thereby negatively affecting coordination. Current interventions to manage DCD include sensory integration therapy and kinesthetic or neuromotor task training, which are reported to be clinically useful.10

Archibald and Alloway8,11 reported that the Movement Assessment Battery for Children (MABC) is an appropriate tool for assessing Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for children with DCD. The MABC-Second Edition (MABC-2) is an updated, useful assessment tool used to identify motor coordination difficulties in children from 3 to 16 years old. Children who score in the range of 5% to 15% are reported as having problems with coordination.7 Clinical observation (CO) is a widely adopted nonstandardized but clinically useful checklist of items used in the clinical setting to detect areas of difficulty and help identify underlying problems contributing to coordination and/or perception deficits.

In recent years, dynamic Lycra orthoses have been increasingly used as a treatment modality in the management of children with motor impairment including cerebral palsy (CP). Improved postural stability and trunk control and reduced or smoothed involuntary movements in children with hypotonic, ataxic, and athetoid CP have been reported.12–14 The use of Lycra orthoses in brachial plexus palsy was reported to optimize the strength in wrist and elbow joints and support the shoulder joint when performing functional tasks.15 To our knowledge, no study has investigated the effects of a Lycra body suit orthosis (LBSO) in children with DCD. The purpose of this case study was to investigate the effect of an LBSO on a child with DCD and determine whether there is a carryover effect based upon the hypothesis that the use of an LBSO would improve motor coordination, movement skills, and proprioception as indicated by the MABC-2 and CO. This article is a report of a routine clinical intervention, which, although somewhat innovative, is akin to that which typically occurs in this kind of scenario during everyday practice. Written and oral informed consent was obtained from the child’s parents and class teacher respectively for publication of this case report.

DESCRIPTION OF INTERVENTION

The subject, CB, a 5-year-old boy attending a mainstream school, was identified as having problems with coordination, proprioception, and balance by both his parents and class teacher. CB was clinically diagnosed with DCD, and he and his parents agreed to take part in this case study. CB received no other therapy intervention during the study period and he continued to use insoles to manage his ankle pronation.

Previous work has suggested functional improvements with the use of Lycra orthoses for a minimum of 6 hrs a day for 6 weeks.14,16 To avoid the learning effect of MABC-2 tasks and to detect potential changes in motor coordination, the study duration was phased with 12 weeks between intervention and postintervention. Thus, the study extended over 30 weeks, consisting of baseline, intervention, and postintervention phases of 6, 12, and 12 weeks, respectively. CB was assessed by one of the authors, who was blinded to the phase of the study using MABC-2 and CO at the beginning of weeks 1, 7, and 19 and at the end of week 30.

OUTCOME MEASURES

The MABC-2 is a widely used tool designed to assess movement skills in manual dexterity, ball skills, and balance7,8,11; CO consists of the following items: muscle tone, proprioception, asymmetrical (ATNR) and symmetrical (STNR) tonic neck reflex, co-contraction, shoulder and pelvic stability, visual perception, and visual convergence and divergence. These items were assessed using a 3-point nonstandardized subjective scale ranging from 1 to 3, in which 1 denotes significant deficiency; 2, mild/moderate deficiency; and 3, normal.

PROCEDURE

Assessment using MABC-2 and CO was carried out by the authors, and consistency (sequence, time, venue, and examiner) of the assessments was maintained throughout the study period. First and second assessment with MABC-2 and CO was done on the first day of the baseline and intervention phase (first and seventh week). The LBSO, a single-unit dynamic custom-made orthosis (DMOrthotics, UK), which provides a snug fit extending up to mid-arm and lower thigh and torso, was measured at the end of the fifth week and was fitted immediately after the second assessment, at which point the intervention phase began. Information about the properties, procedures, and other details of Lycra garment orthoses is available elsewhere.15 CB’s time wearing the garment was gradually increased from 2 to 8 hrs/day within the first week. He continued to wear the LBSO during the day time for 8 hrs/day per week for the remaining 12 weeks. CB was reassessed at the end of intervention period with the LBSO on. In the postintervention phase, the LBSO was removed and the carryover effect was assessed at the end of the 30th week.

DESCRIPTION OF OUTCOMES

CB showed poor manual dexterity (first percentile), which placed him on the fifth percentile in the preintervention (Table 1). This score increased at the end of intervention phase (50th percentile) but fell sharply after removal (ninth percentile). Improvement in balance was noted at the start of the intervention (37th percentile), although this was further increased through the intervention period (75th percentile), which remained unchanged postintervention. Intriguingly, CB showed decreased aiming and catching performance at the start of the intervention phase (25th percentile) but showed a large improvement at the end of the intervention phase (84th percentile), which improved slightly postintervention (91st percentile).

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Table 1:
MABC-2 centile scores before, during, and after the LBSO intervention

DISCUSSION

In our study subject, the assessment tools used suggest that at baseline, CB demonstrated significant difficulties (fifth percentile) with movement and coordination skills, reduced proximal stability, and poor proprioception and visual tracking. Marked improvements in movement, coordination skills (75th percentile), and functional activities in the classroom were identified at the end of the intervention phase. CB continued to maintain or further improve, albeit at a slower rate, at the end of postintervention, with the exception of manual dexterity, which fell substantially.

The improved MABC-2 score was mainly a result of improvements in his static balance and manual dexterity subsection tasks. Hence, overall improvements in outcome measures are a result of the improved core stability, which enabled the study subject to perform these tasks with greater accuracy. CB also showed improvement in two CO items, visual convergence and ATNR (Figure 1), rather than proprioception.

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Figure 1:
Clinical observation (CO) scores before, during, and post-LBSO intervention. LBSO, Lycra body suit orthosis; MT, muscle tone, ATNR, asymmetrical tonic neck reflex; STNR, symmetrical tonic neck reflex; CC, co-contraction; PS, pelvic stability; SS, shoulder stability; Pr, proprioception; VC, visual convergence; VD, visual divergence).

Previous work in children with CP claimed that improved motor performance using Lycra interventions was a result of its influence on proprioception.12,14 On the contrary, we found that the LBSO had no measurable effect on proprioception, and the progress in motor performance observed in MABC-2 seems to be a result of improved core stability. However, both MABC-2 and CO are not sensitive in detecting subtle changes in proprioception, and thus, objective quantification of kinetic and kinematic changes through accurate laboratory measurement is required to detect the magnitude of an LBSO’s effect in children with DCD.

It is worth noting that the study subject showed improvement at the end of the intervention phase, which also may be accounted for by natural maturation occurring through the normal developmental process. It is hard to differentiate between the developmental aspect and the LBSO effect in the improved motor function. However, the authors favor the view that the LBSO had a positive impact on this child with DCD because such a substantial improvement in MABC-2 score at 24 weeks (intervention and postintervention) is unlikely a result of natural maturation alone. Furthermore, the gains derived from the intervention were maintained for balance and aiming and catching, even after the intervention was removed. That said, the feasibility and cost effectiveness of using an LBSO for DCD children need to be weighed against other interventions that specifically target proprioceptors.

This study is limited by the fact that the MABC-2 is typically a screening tool and not considered particularly sensitive to change over time, thus requiring further evidence of reliability and validity.17 However, the fact that improvements have been noted suggests that changes in motor performance are functionally relevant.

CONCLUSION

The magnitude of improvements in movement and coordination skills in a child with DCD with the LBSO over a short 12-week time frame and the sustained improvement after removal suggest that an LBSO may be beneficial as an adjunct to other targeted therapeutic approaches. In contrast to the literature, the LBSO did not seem to have a measurable effect on proprioception; however, core stability improved. Although the role of natural development and altered sensory processing cannot be excluded from this study, these findings suggest that the LBSO may have a clinical role in the improvement of motor function in children with DCD.

ACKNOWLEDGMENT

We thank DMOrthotics, UK, for providing the Lycra Body Suit for this study and Mrs Jane Rogers for helping us with the MABC-2 checklist information.

REFERENCES

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Keywords:

developmental coordination disorder; Lycra body suit orthosis; dynamic orthosis; proprioception; motor control

© 2013 American Academy of Orthotists & Prosthetists