Obstacle Course Versus Neuromotor Task Training in Children With DCD

Riphah International University28 enrolled

Overview

Developmental Coordination Disorder (DCD) affects motor planning and functional mobility in children, leading to long-term functional and psychosocial difficulties. This randomized clinical trial will compare the effectiveness of Obstacle Course Training (OCT) and Neuromotor Task Training (NTT) in improving motor planning and functional mobility in children aged 7-10 years diagnosed with DCD. Participants will be randomly allocated to either OCT or NTT for 9 weeks (two sessions per week). Outcomes will be assessed using standardized motor performance measures to determine the more effective intervention.

Developmental Coordination Disorder (DCD) is a prevalent neurodevelopmental disorder affecting approximately 5-6% of school-aged children worldwide. Marked by impairments in motor coordination, skill development, and functional performance. The complex etiology of Developmental Coordination Disorder (DCD) is linked to atypical neurodevelopment, genetic predispositions, and associated co-morbidities such as ADHD and ASD, further influenced by perinatal factors like prematurity and low birth weight. DCD is associated with long-term consequences, including difficulties in activities of daily living (ADLs), reduced participation in physical activities, and impaired psychosocial functioning, which collectively increase the risk of obesity and lower self-efficacy. Early, targeted, and task-specific interventions are crucial. Among these, Neuromotor Task Training (NTT) focuses on improving motor planning through structured, cognitive strategies, while Obstacle Course Training (OCT) provides a dynamic setting that promotes functional movement and real-time problem-solving. This randomized clinical trial will compare the effects of both interventions. The study will be conducted over 10 months at the University of Lahore Teaching Hospital (ULTH) pediatric rehabilitation center and Sehat Medical Complex (SMC) Hanjarwal. The duration of the intervention will be 9 weeks, with 2 sessions per week. There will be two study groups, and convenient sampling techniques will be used. Eligible participants will be children aged 7 to 10 years, both males and females, diagnosed with DCD based on DSM-5 criteria, with a Mini-Mental State Examination (MMSE) score \>24 and an IQ above 75 on the Raven Intelligence Scale. Screening for DCD will be done using the Developmental Coordination Disorder Questionnaire (DCDQ) and motor proficiency will be assessed using the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). Children with a DCDQ score of ≤48 and a BOT-2 score of ≤40 will be included. Children with other neurological, psychiatric, or orthopedic conditions will be excluded. Participants will be randomly assigned to receive either Obstacle Course Training (OCT) or Neuromotor Task Training (NTT) to assess which intervention more effectively improves motor planning and functional mobility. SPSS version 27 will be used for data analysis.

Interventions

Obstacle Course TrainingBEHAVIORAL

Participants will perform Obstacle Course Training on a 12-meter walkway with a midpoint obstacle at low (30% leg length) and high (50% leg length) heights. Training includes single-task walking (8 trials) and dual-task walking (16 trials) with concurrent visual discrimination tasks using flashcards. Walking time, toe clearance, and response accuracy will be recorded. Sessions will be conducted twice weekly for 9 weeks.

Neuromotor Task TrainingBEHAVIORAL

Each session will involve task-oriented activities arranged in multiple stations. Activities will be broken down into planning, execution, and evaluation phases and will include soccer, netball, basketball, tagging games, rope skipping, and other age-appropriate functional games. Children will perform tasks with therapist guidance and feedback to enhance motor planning and performance. Each session will last approximately 45-60 minutes, including warm-up, main activities, and cool-down. The intervention will be delivered over 9 weeks, with 2 sessions per week.

Eligibility

Sex: ALLMin age: 7 YearsMax age: 10 Years

Medical Language ↔ Plain English

Inclusion Criteria: * • Diagnosis of DCD based on DSM4/5 criteria. * Children aged 7-10. * Gender male and female. * Mini-Mental State Examination (MMSE) score \>24 . * Cognitive development appropriate for chronological age. * Raven Intelligence Test Scale (IQ \> 75) . * Developmental Coordination Questionnaire ≤48 points: likely DCD (≤ 10th percentile). * BOT-2 score ≤ 40. Exclusion Criteria: * History of surgery and lower limb injuries over the past 12 months. * Use of assistive devices to balance and walk. * Severe ADHD, Autism Spectrum Disorder (if it significantly interferes with participation), or major psychiatric disorders. * Taking neuroleptics or any other medications that significantly alter muscle tone, coordination, or attention.

Outcomes

Primary Outcomes

Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) for fine and gross Motor Skills

The BOT-2 (Bruininks-Oseretsky Test of Motor Proficiency, Second Edition) scoring converts raw scores into precise motor proficiency metrics for ages 4-21, using sex-specific norms

Time frame: 9 weeks

Timed Up and Go Test (TUG)

The Timed Up and Go (TUG) test measures functional mobility and fall risk in seconds. The test requires a participant to stand up, walk 3 meters, turn, walk back, and sit down. Results \< 10 seconds indicate normal mobility, while times \>13.5-14 seconds indicate a higher risk of falls and frailty, requiring further evaluation