The goal of this clinical trial is to evaluate whether intensive sensory stimulation therapy can improve upper limb motor skills and sensory function in children aged 12-16 years with severe symptoms of Developmental Coordination Disorder (DCD). The main questions it aims to answer are:
1. Will children with DCD who undergo intensive sensory stimulation therapy show greater improvement in upper limb motor function compared to those receiving standard therapy? 2. Will intensive sensory stimulation therapy lead to better sensory function outcomes, including joint position sense, resistance sense, pressure sense, temperature perception, and two-point discrimination? Researchers will compare children receiving intensive sensory stimulation therapy to those receiving standard therapy without intensive sensory stimulation to see if the targeted intervention results in superior improvements in motor and sensory function.
between 12-16 years of age
diagnosed severe symptoms of the developmental coordination disorder based on The Movement Assessment Battery for Children 2nd Edition (M-ABC 2), with scores ranging from 40 to 50
typical intellectual development (i.e., children attending mainstream education)
voluntary participation and informed consent signed by parents or legal guardians
current or previous diagnosis of serious orthopaedic or neurological conditions (e.g. fractures, congenital deformities, cerebral palsy, etc.)
history of any surgical procedures
history of significant musculoskeletal pain or dysfunction lasting more than two weeks and requiring medical or physiotherapeutic intervention, or any such symptoms occurring within one month prior to the study
any current musculoskeletal dysfunction and/or pain
Parallel
Active and passive physical therapy without intensified sensory stimulation
Other interventionIntervention: Passive and active therapy without high sensory stimulation Duration: 4 weeks Frequency: 3 sessions per week Session duration: 60 minutes Intervention structure: Passive therapy (30 minutes): • Stroking and rubbing techniques from classic massage applied in the area of arm forearm and hand with low force and frequency upper limb massage - 15 minutes per limb Active therapy (30 minutes): upper limb muscle strengthening exercises (without globalized vibration); difficulty level individually adjusted to meet participants' current potential, so that in the last sets/reps little manual assistance from the therapist is needed: * Supine pull-ups - 3 sets of 8 reps, \~45 seconds rest between sets * Standing pull-ups - 3 sets of 8 reps, \~45 seconds rest between sets * Standing push-ups - 3 sets of 8 reps, \~45 seconds rest between sets * Standing elbow extensions - 3 sets of 8 reps, \~45 seconds rest between sets
Active and passive physical therapy with intensified sensory stimulation
Other interventionIntervention: Passive and active therapy incorporating high sensory stimulation Duration: 4 weeks Frequency: 3 sessions per week Session duration: 60 minutes Intervention structure: Passive therapy (30 minutes): stimulation of joint receptors, muscle spindles, and tactile pathways: * High-frequency soft tissue mobilisations * Localised high-amplitude vibration (30-50 Hz; Galileo Mano 30, Novotec Medical GmbH) * Deep pressure techniques - Wilbarger brushing protocol followed by joint compressions Active therapy (30 minutes): upper limb and shoulder girdle muscle strengthening exercises with globalized vibration using Redcord Stimula (30-50 Hz; Redcord AS, Norway); difficulty level individually adjusted to meet participants' current potential. Excercises the same as in the control group.
The Jebsen-Taylor Hand Function Test (JTHFT)
The JTHFT (Jebsen et al. 1969, Fabbri et al. 2021) is a standardized assessment tool used to evaluate the hand function of individuals, particularly in clinical settings. This test is particularly relevant for assessing fine motor skills and the ability to perform tasks that require both coordination and dexterity. The tasks include: Writing a Sentence: Assesses the ability to hold a pen and write legibly. Turning Over Cards: Tests finger dexterity by flipping a set of cards one at a time. Picking Up Small Objects: Evaluates the ability to manipulate small items, often using a pre-defined set of objects. Simulated Feeding: Involves using utensils to demonstrate the ability to eat. Stacking Checkers: Measures the manipulation of objects by stacking them. Lifting a Paper Clip: Assesses fine motor skills by picking up a small, light object.
Joint Position Sense
Joint position sense is assessed using active reproduction and position differentiation tests. In reproduction, the participant memorises a target position (90º shoulder abduction) and then attempts to replicate it without visual input. In differentiation, they aim to reach half the target angle (45º). An electronic inclinometer (±1º accuracy) fixed to the upper arm measures angles. Markers are placed on anatomical landmarks, and a goniometer is secured parallel to the humeral axis. Tests are performed seated. The target position is passively assumed under supervision and memorised (×3). The participant then reproduces or differentiates the angle (×2 each), confirming with "stop." Readings are taken after each attempt. Both sides are tested. The absolute positioning error (absolute difference between target and assumed angles) is used for analysis, based on the mean of two measurements.
Sense of Resistance
Resistance sense is assessed using force reproduction and differentiation tests. In the first, the participant replicates a memorised reference force; in the second, they generate half that force. An electronic dynamometer (±0.1 kG accuracy) is attached to a 12 cm sleeve on the upper arm and connected to the floor via an elastic cord. Tests are conducted in 90º shoulder flexion or abduction. The reference force is defined as the effort needed to stretch the elastic cord slightly for 5 seconds. After adjustments, this is repeated three times, and the participant memorises the force. Then, with eyes closed, they reproduce or halve the force, confirming with "stop." The examiner records the values. Each test is repeated three times. Two extremities are tested. The absolute force generation error (normalised difference in %) is used for analysis, based on the mean of three measurements.
Sense of Pressure
Pressure sense is assessed at 5 fixed points on the chest, upper limb, and scapular region, corresponding to different peripheral nerve branches. The test is performed in supine or prone position, depending on the site, with the upper limb abducted to 90º. An algometer is used to apply focused pressure and record force. It has a blunt tip with a 20 mm² contact area and measures with ±0.1 kG accuracy. During testing (eyes closed), the participant says "stop" when pressure at a point becomes uncomfortable but not painful. The examiner records the force at that moment. Each point is tested twice. Pressure is applied perpendicularly to the skin, and both sides are assessed. The maximum applied force does not exceed 6 kG to avoid subcutaneous bruising. The final result is the average of the two measurements.
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The Jerzy Kukuczka Academy of Physical Education in Katowice
Lead sponsor
Daugavpils University, Department of Healthcare
Collaborator
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