In their pilot study Schoemaker et al «Schoemaker MM, Niemeijer AS, Reynders K, ym. Effec...»1 evaluated the effectiveness of a Neuromotor Task Training (NTT) for the treatment of children with Developmental Coordination Disorder (DCD). The intervention group was tested before and after 9 and 18 treatment sessions on the Movement ABC (M-ABC) and a dysgrafia scale in order to measure the effectiveness of treatment on gross and fine motor skills. 15 Dutch children (age 7.1-9.2 years, 9 boys and 6 girls) participated in the study. Inclusion criteria were: 1) all children obtained total scores on the M-ABC below the 15th percentile, 2) the motor problems of the children could not be attributed to evident pathological neurological signs, 3) only children attending schools for general education were included, which implies an IQ-score in the normal range. 10 children were included in the intervention group (7 boys, 3 girls) and five (2 boys, 3 girls) in the non-intervention group. All children in the intervention group were referred to a pediatric physical therapist by their general practitioner because of motor co-ordination problems. The children in the no-treatment control group were either referred to physical therapy or were recruited from schools because either their parents or teachers were concerned about their motor skills. Pediatric physical therapists treated the children in the intervention group individually for 30 minutes 18 times once a week. All therapists were qualified pediatric physical therapists who had received instruction in the principles of the NTT. The non-intervention group did not receive any treatment. The content of the intervention was based upon the therapist's assessment of the child's motor performance on a range of tasks. Treatment goals were set for each child individually, which meant that the therapist treated those particular skills a child had found difficult during the assessment. The intervention group was compared to the non-intervention group. Children in the intervention group were tested three times on the M-ABC and the BHK (The Concise Assessment Method for Children's Handwriting): before the start of intervention (T1), after 9 intervention sessions (T2), and after another 9 intervention sessions (T3). Intervention was provided for 30 minutes once a week. Children in the no-treatment control group were tested twice (T1 and T2) with a period of 9 weeks without any intervention in between to measure spontaneous improvement. M-ABC score was the primary outcome. At T1, no significant difference was found between the two groups (p=0.07). In addition, no significant change was found between T1 and T2 for the non-intervention control group (p=0.49). For the intervention group, no significant improvement was found between T1 and T2 (p=0.33). The intervention group, significantly improved from T1 to T3 (p=0.018). When examining the subtests of the M-ABC, a significant improvement between T1 and T3 was found for manual dexterity and ball skills (p= 0.028 and p=0.018 respectively), but not for balance (p =0.108).
In their controlled study Niemeijer et al. «Niemeijer AS, Smits-Engelsman BC, Schoemaker MM. N...»2 evaluated the effect of NTT in the motor performance of children with DCD. 39 Dutch children with diagnosed DCD participated in the study. All children in this study attended Dutch mainstream schools, which implies a normal-range IQ score. Inclusion criteria were: (1) aged between 6 and 10 years; (2) no medical condition thought to have caused the motor problems; (3) no prior physiotherapy; (4) scoring at or below the 15th percentile of the Movement Assessment Battery for Children (MABC); and (5) parental informed consent. 26 children (20 boys, 6 girls, age 6y2mo-10y2mo) were selected to the intervention group and 13 children (6y-10y7mo) in the non-intervention group. The treated group consisted of children who were referred to physiotherapy by their general practitioner (GP) because of motor coordination problems in school and/or at home. They were checked by their general practitioner and pediatric physiotherapist for obvious neurological disorders and other medical conditions that could explain the motor difficulties. The control group was selected using posters in mainstream schools. There was no randomization and the patients were not blinded to the treatment. Treatment was performed by nine weekly 30-minute sessions of NTT or at least 9 weeks of no intervention. Forty pediatric physiotherapists who were instructed in NTT during a 3-year training, performed the training. Children with DCD who did not perform NTT served as a comparison group. The MABC and the Test of Gross Motor Development – 2 (TGMD-2) were administered in the beginning and after nine weeks. In the non-intervention group the evaluation was performed after three months as well. As a result, the nine-week NTT training improved the motor performance of children with DCD [OR 3.89 (95%CI: 0.94-16.1)] measured with MABC-2 and with TGMD-2 as well [OR 26.7 (95%CI: 2.88-248)].
In their quasi-experimental study Ferguson et al. «Ferguson GD, Jelsma D, Jelsma J, ym. The efficacy ...»3 evaluate the efficacy of two task-oriented interventions for children with Developmental Coordination Disorder (DCD): Neuromotor Task Training (NTT) and Nintendo Wii Fit training (Wii training). They compare the efficacy of these two interventions on the motor performance, isometric strength, and cardiorespiratory fitness (aerobic and anaerobic capacity) of children with DCD attending mainstream schools in a low-income setting in South-Africa. Children between the ages 6-10, who scored at or below the 16th percentile on the Movement Assessment Battery for Children -2 (M-ABC2) and whose teachers and/or parents reported functional motor problems in active daily life functions (ADL) where included to the study. Exclusion criteria was 1) repeated grade level more than once 2) if there was diagnosis of a CP or other significant medical disorder as reported by a parent. 27 Children participate in two NTT group and 19 Children in one Wii Training group in three different schools located at low-income areas. Performance was assessed at the baseline and after the interventions by M-ABC2, a hand-held dynamometer, the Functional Strength Measure, the Muscle Power Print and the 20 m Shuttle Run Test. All pre and post measures were conducted by two separate teams of assessors who were blinded as to whether children received intervention or not. The NTT program was implemented for nine weeks, with two sessions per week each lasting between 45-60 minutes conducted by two therapists. The NTT training was individualized to each child's own goals at playing outdoor games. In the Wii Training group, children engaged in 30 min of gaming on the Nintendo Wii Fit balance board, three times a week for a period of six weeks under the supervision and guidance of two qualified therapists. The main findings show that the mean motor performance scores of both groups improved over the study period. The NTT group showed greater improvement in motor performance (total standard scores p<0.01), functional strength (total FSM p<0.01) and cardiorespiratory fitness (p<0.01). Wii Training group showed significant improvement in anaerobic performance (p<0.01). No improvement was seen in isometric strength in either group. This study provides evidence to support the use of both NTT and the Wii training for the children with DCD.
General comments: All the study populations were small, there were no randomization or blinding of the study population. Diagnostic criteria were not met.