Rhythmic Motor Learning in Children With Developmental Coordination Disorders (EPIC2)

Brain Plasticity and Motor Skill Competence Development in Young People With Development Coordination Disorder

The importance of play and physical activity include many benefits on positively improving health and well-being, enhancing children's and young people's thinking and performance in school, improving their sleep and enabling confidence and skill building. However, some children find it hard to learn and perform motor skills, and are at risk of decreased participation in sports and physical activity and subsequently decreased physical fitness and overall health and well-being.

Previous studies from the research group have explored the impact and recovery following acute exercise at different intensities in children and adolescents with and without movement difficulties. Following this, a pathway promoting physical activity and engagement has been successfully established within schools for those with and without movement difficulties. Taking the previous studies further, we want to specifically focus on the children's performance and learning of a sporting skill, such as stepping, and the associated brain activity changes, using available high resolution imaging techniques. This will help us understand how these children perform and learn motor and sporting skills. Evidence obtained from imaging alongside measures of movement has helped the development of optimal therapeutic approaches for other conditions such as stroke and Parkinson's and will help us to develop approaches to help children best learn motor skills and hence gain confidence in performing sporting activities.

Study Overview

• Status: Unknown
• Conditions: Developmental Coordination Disorder
• Intervention / Treatment: Other: EPIC Club

Detailed Description

Children with poor motor skill acquisition and execution despite having opportunity for learning, are now described as having developmental coordination disorder (DCD). There is a prevalence of 5-6% of young people who have normal intelligence who meet this category who have problems affecting their activities of daily living (ADL's). Young people with lower motor skills are one of a number of conditions affecting children identified by the Chief Medical Officer as requiring an improved evidence base for management. Poor motor skill acquisition and execution, whereby skills remain substantially lower than expected despite opportunities for learning; interferes with participation in academic, sporting and leisure activities. Motor performance is slower and of poor quality; and children may have difficulties learning all kinds of motor skills including sporting activities. Importantly people with poor motor skill acquisition and execution can fail to establish the fundamental movement skills and literacy required to integrate in physical pursuits, such as sport, and become exposed to long-term conditions associated with inactivity. Motor sporting skills can be learnt if trained, but difficulties in performing and learning skills persist into adulthood.

Brain imaging during rhythmic motor tasks which are essential in day-to-day (non-)sporting activities, have established that children with poor motor skill acquisition and execution show differences to healthy controls in grey and white matter functional connectivity and in cortical activation patterns during performance of simple movement tasks . Provisional evidence suggests that individuals with poor motor skill acquisition and execution utilise activation processes when learning motor tasks that are more controlled and require extra processing demands, but a systematic review of neural correlates of those with poor motor skill acquisition and execution concludes that data is scarce and more studies are needed. Performance of motor tasks requires a balance between automatic and controlled processes that is dependent upon the demands of the task and the capabilities of the individual. Young people need to be able to consider their environment when performing a sport rather than just thinking about the skill, so that they can work out where the best place to kick a ball on a football pitch is, not just kick the ball. Typically developing (TDC) children acquire motor skills either implicitly or explicitly by observing and imitating other children and adults or by trial and error. Acquisition of motor tasks requires plasticity in the nervous system with improvements in motor performance underpinned by a move from cortically controlled mechanism, towards more automatic performance, freeing up cortical resources. The ability to automate certain parts of motor skills allows the execution of tasks in more complex environments. Provisional evidence suggests that people with poor motor skill acquisition and execution may learn motor skills in a more controlled manner and have a reduced ability to move automatically. To date no studies have explored the brain changes underpinning fundamental motor skills attainment over a training period in people with poor motor skill acquisition and execution.

The main aim contribute evidence towards describing motor performance in relation to brain structure and functioning in children with lower motor skills and DCD,. This study proposes to test both the feasibility and determine the extent of the impact of learning a novel coordination task on motor performance and brain structure and functioning in children with DCD to inform a full-scale trial of skill acquisition.

• Study Type: Interventional
• Enrollment (Anticipated): 87
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • Oxon
    • Oxford, Oxon, United Kingdom, OX2 7EE
      • Cherwell School
    • Oxford, Oxon, United Kingdom, OX3 0BP
      • Clinical Exercise Rehabilitation Unit
    • Oxford, Oxon, United Kingdom, OX3 0BP
      • Oxford Brookes University
    • Oxford, Oxon, United Kingdom, OX3 7QH
      • Cheney School
    • Oxford, Oxon, United Kingdom, OX33 1QH
      • Wheatley Park School

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 12 years to 15 years (CHILD)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• 12-15 years old children (year 9 students only) with normal intelligence in the lowest quartile of fitness (30 with poor motor skill acquisition and performance affecting daily functioning, 30 who score in the lower 25% of fitness measures without poor motor skill acquisition and execution).

Exclusion Criteria:

• Behavioural/intellectual issues that prevent safe participation or may put the participant, investigators and others at risk.
• Any contraindications to perform maximal exercise or physical training, as determined by the Physical Activity Health Questionnaire PARQ sent out to parents before screening.
• Children suffering from muscular/neurological degenerative conditions or with uncontrolled epilepsy/seizures (must be stable epilepsy/on medication for greater than 12 weeks).
• Surgical procedures in the previous 6 months.
• If there are any concerns regarding a child being able to participate safely, we will ask parents/guardians to contact the GP/paediatrician/physiotherapist.
• MRI Scanner: children with metal objects due to surgery or dental care cannot partake in the scanning part of the research.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: BASIC_SCIENCE
• Allocation: NON_RANDOMIZED
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Motor coordination difficulties; Type: Experimental main EPIC club: 60min session / 2 times weekly / 7 weeks	Other: EPIC Club; Weekly exercise gym sessions. Participants will start with a warm-up of 20-25 mins cardiovascular training either doing cycling, treadmill running or cross-training. The remainder of the session consists of strength/resistance and weight-training involving leg press, leg extensor, pull downs, kettle bells, dumbbells. In addition to the above, a novel rhythmical stepping task will be performed over 10 mins.
OTHER: Non motor coordination difficulties; Type: Experimental comparator EPIC club: 60min session / 2 times weekly / 7 weeks	Other: EPIC Club; Weekly exercise gym sessions. Participants will start with a warm-up of 20-25 mins cardiovascular training either doing cycling, treadmill running or cross-training. The remainder of the session consists of strength/resistance and weight-training involving leg press, leg extensor, pull downs, kettle bells, dumbbells. In addition to the above, a novel rhythmical stepping task will be performed over 10 mins.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Novel Stepping Task (assessing change over time)	Rhythmic stepping task measuring coordination	Baseline - change from baseline 6-7 weeks - change from baseline 12 weeks
Functional Near-Infra red Spectroscopy (FNIRs) (assessing change over time)	Monitoring haemodynamic change of the cortex	Baseline - change from baseline 6-7 weeks - change from baseline 12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Physical Activity Audit (PAQ-A) (assessing change over time)	Questionnaire	Baseline - change from baseline 6-7 weeks - change from baseline 12 weeks
Functional Magnetic Resonance Imaging (FMRI) (assessing change over time)	Monitoring change in brain activity	Baseline - change from baseline 6-7 weeks
Movement Assessment Battery for Children 2	Measuring Motor Coordination	Baseline
Inertial Measurement Unit (IMU)	Accelerometry Gait Analysis	Baseline - change from baseline 6-7 weeks - change from baseline 12 weeks
Child Health Utility Questionnaire 9D (assessing change over time)	Questionnaire	Baseline - change from baseline 6-7 weeks - change from baseline 12 weeks
Harter's Self-Perception Profile for children (assessing change over time)	Questionnaire	Baseline - change from baseline 6-7 weeks - change from baseline 12 weeks
Axivity AX3 Accelerometer	7 Day physical activity measurement	Baseline - change from baseline 6-7 weeks - change from baseline 12 weeks

Collaborators and Investigators

• Sponsor: Oxford Brookes University
• Collaborators: University of Oxford; National University of Ireland, Maynooth

Study record dates

Study Major Dates

• Study Start: October 1, 2016
• Primary Completion (ANTICIPATED): August 1, 2018
• Study Completion (ANTICIPATED): August 1, 2018

Study Registration Dates

• First Submitted: April 4, 2017
• First Submitted That Met QC Criteria: May 11, 2017
• First Posted (ACTUAL): May 12, 2017

Study Record Updates

• Last Update Posted (ACTUAL): May 30, 2018
• Last Update Submitted That Met QC Criteria: May 25, 2018
• Last Verified: May 1, 2018

More Information

Terms related to this study

• Keywords: Children; Coordination; Movement; Motor Learning; Motor Skills Disorders
• Additional Relevant MeSH Terms: Mental Disorders; Pathologic Processes; Neurodevelopmental Disorders; Disease; Motor Skills Disorders
• Other Study ID Numbers: 161033

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: As per ethical outline, data will not be stored in a shared repository. All data will be stored in an anonymised format on site. Data access requests should be made to the principle investigator in writing which will be discussed in the data monitoring committee meetings.