Caractérisation clinique et par la tomographie d’émission par positrons quantitative du trouble de l’acquisition de la coordination

Résumé : Le trouble de l’acquisition de la coordination (TAC), d’étiologie encore indéterminée, est une anomalie neurologique affectant environ 6% des enfants de l'âge scolaire. Le TAC se manifeste essentiellement par un déficit au niveau des exécutions motrices. Le présent travail de recherche comporte deux volets portant sur le TAC. Premièrement, une étude clinique sur 129 sujets âgés de 4 à 18 ans a permis de classifier les caractéristiques du TAC en sous-groupes cliniques. Trente-trois caractéristiques du TAC, les plus fréquemment rapportées dans la littérature, ont été recensées chez nos sujets. L'application d'évaluations statistiques a permis de faire ressortir trois classes essentielles. Le deuxième volet consistait à identifier les régions cérébrales impliquées dans une tâche motrice à l'aide de l'imagerie par la tomographie d'émission par positrons (TEP). Deux sujets avec TAC et deux sujets normaux ont été étudiés en deux séances d'imagerie TEP dont l'une au repos et l'autre en tapotant du pouce sur les doigts de la main gauche non-dominante. Les analyses du premier volet ont montré, entre autres, que le TAC touchait 3.17 garçons pour une fille, que tous les sujets étaient lents, que 47% des sujets étaient gauchers ou ambidextres alors que seulement 10% sont gauchers dans la population générale, que 26% avaient une dyspraxie verbale, et que 83% avaient été diagnostiqués anxieux. Les sujets ont été classés en trois sous-groupes: 1- maladroits et autres caractéristiques, sans problème de langage; 2- trouble de l’estime de soi et relation avec les pairs; 3- difficulté de langage. En imagerie, les structures cérébrales ont été classées selon leur captation du 18F-fluorodesoxyglucose (FDG) dans les hémisphères droit et gauche, avant et après l'activation, et en comparaison avec les sujets normaux. Trois types de structures cérébrales sont ressortis avec les statistiques: des structures activées, celles relativement non sollicitées et des structures désactivées. Il y avait plus de variations dans la captation du FDG chez les sujets avec TAC que chez les normaux. En conclusion, la caractérisation des sujets avec TAC par le diagnostic clinique et par l'imagerie peut procurer un plan de thérapie adéquat et ciblé étant donné que le TAC a un large spectre et pourrait coexister avec d'autres déficits cérébraux.

Best practice principles for management of children with developmental coordination disorder (DCD) : results of a scoping review

Background. Developmental coordination disorder (DCD) is a prevalent health condition that is frequently unrecognized despite the substantial evidence that has accumulated regarding how it affects children’s health, education and skills.Most literature focuses on measurement of impairment and description of intervention approaches for individual children; little is known about the principles that should guide best practice and service delivery for children with DCD as a population. The purpose of this study was to identify these principles. Methods. A scoping review was used to ‘map’ the information available to inform intervention and service delivery. Scholarly and grey literature written in English was identified in six databases, using a combination of keywords (e.g. guidelines, management, models and DCD); a ‘snow-balling’ technique was also used in Canada and the UK to access clinical protocols used in publicly funded health care systems. Over 500 documents were screened: 31 met inclusion criteria as they outlined practice principles for children with DCD as a population. Data regarding best practices were independently extracted by two reviewers and then compared with achieve consistency and consensus. Results. Two over-arching themes emerged, with five principles: (1) Organizing services to efficiently meet the comprehensive needs of children (e.g. Increasing awareness of DCD and coordination; Implementing clearly defined pathways; Using a graduated/staged approach); (2) Working collaboratively to offer evidence-based services (e.g. Integration of child and family views; Evidence-based interventions fostering function, participation and prevention). Conclusion Numerous documents support each of the principles, reflecting agreement across studies about recommended organization of services.While these principles may apply to many populations of children with disabilities, this review highlights how essential these principles are in DCD. Researchers, managers, clinicians, community partners and families are encouraged to work together in designing, implementing and evaluating interventions that reflect these principles.

Social participation and interventions supporting teenagers and young adults living with developmental coordination disorder (DCD): results from a Scoping Review

Background: The impact of Developmental Coordination Disorder (DCD) on teenagers’ and young adults’ participation is not well documented. This article aims to synthesize the current knowledge on social participation, which is the performance of an individual in realizing his daily activities and social roles within its life environment. Strategies and interventions to support youths (15-25 years old) with DCD were also synthesized. Methods: A scoping review interrogating three databases and using ‘snowballing techniques’ was performed to identify both scientific and grey literature published between 2004 and 2014. Over 1000 documents were screened and 57 were read in full; 28 met inclusion criteria. A charting form based on 12 life habits described in the Disability Creation Process (DCP) and developed by two reviewers was used to extract data and report the results. Results: All life habits were reported to be affected for teenagers and young adults with DCD, with education and interpersonal relationships being the most frequently discussed. During adolescence and adulthood, new tasks and subsequent difficulties emerge, such as driving. Mental health difficulties emerged as a key theme. Few strategies and interventions were described to support social participation of youths with DCD. Conclusion: Many life habits are challenging for youths with DCD, but few evidence-based strategies and interventions have been designed to help them to increase their social participation.