He walked in and towered over me. I peeked behind him wondering where his mom was. When I asked him, he gave me a puzzled look and told me he’d driven himself to the clinic. Oh, of course he did. The “kid” was now 20 years old.
I had been seeing this young person since he was 13 and it had been two years since he had last been in. I guess he wasn’t yet driving then. Wow, time flies.
The first time he came to see me he had been fairly recently diagnosed with developmental coordination disorder (DCD), and he was actually shorter than me, just for the record. Also known as dyspraxia, this condition causes significant difficulties with planning and coordinating functional movements such as writing, throwing and catching a ball, riding a bike, running, and jumping.
He was still struggling with some of these tasks, so his mom was seeking some help for him. He had been to see another therapist but had found all the exercises he had been given to be overwhelming with minimal results.
My first observation was that he had significant issues with alignment and asymmetry. His trunk was very twisty and crooked with one shoulder very tight and elevated while the other one was pulling down. He also had very limited mobility through the rib cage with little movement when breathing.
While the underlying neurological components of DCD can’t be changed with treatment, alignment, mobility, and stability sure can. It seems to me that if you have motor planning difficulties, being crooked and unstable surely can’t help.
My experience has been that kids with DCD have low postural tone. This refers to the level of underlying muscle activity that does important things in the background like hold us up against gravity and form a basis of stability from which we can do things like move our limbs. Think of this like a crane needing a stable base in order for the lifting arm to function accurately.
Due to this low level of postural tone, sometimes these kids are quite frankly losing the gravity battle. When this happens, the tower always ends up leaning to one side. It never collapses perfectly symmetrically. Add to this growth, at times extremely rapid, and you have the perfect recipe for further losing your functional mobility and balance. A crooked twisty body is an unstable one that is even more difficult to command.
Treatment of DCD is aimed at restoring alignment, symmetry, and thus postural stability as much as possible. This then translates into improvements in overall balance and coordination. Don’t get me wrong. Someone with DCD is unlikely to make the NBA, but everyday activities can be made easier with less risk of injury. Even though these kids generally avoid sports, everyone still has to do gym class.
I had started by seeing this young person frequently in order to maximize his alignment and stability. Then he would come in more occasionally, almost always during a rapid growth spurt when things would be tighter and he would have more difficulty with full body movements. This last time I saw him he had finally stopped growing, but had been feeling things had gotten tighter and he was just starting to do some strength training at the gym for the first time in his life. Being the intelligent person that he is, he figured it would be a good idea to be reassessed and have some treatment in order to avoid injury in this new activity.
Few things make me happier than being able to intervene BEFORE someone injures themselves trying something new. It has been an absolute pleasure to watch this young person grow up. I can say with absolute certainty that physiotherapy treatment for DCD is helpful. I figure someone who comes to see you for eight years probably agrees as well.
Sometimes when a diagnosis of a neurological condition is given, the thinking is just to accept it and try to cope, but physiotherapy can often be helpful. Even though the underlying neurological challenges will still be there, we can help improve functional mobility as well as prevent problems down the road.
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