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.

Exploring Australian intensive care physicians clinical judgement during donation after cardiac death : an exploratory qualitative study

BACKGROUND: Donation after Cardiac Death (DCD) is one possible solution to the world wide organ shortage. Intensive care physicians are central to DCD becoming successful since they are responsible for making the clinical judgements and decisions associated with DCD. Yet international evidence shows health care professionals have not embraced DCD and are often reluctant to consider it as an option for patients. PURPOSE: To explore intensive care physicians' clinical judgements when selecting a suitable DCD candidate. METHODS: Using interpretative exploratory methods six intensive care physicians were interviewed from three hospital sites in Australia. Following verbatim transcription, data was subjected to thematic analysis. FINDINGS: Three distinct themes emerged. Reducing harm and increasing benefit was a major focus of intensive care physicians during determination of DCD. There was an acceptance of DCD if there was clear evidence that donation was what the patient and family wanted. Characteristics of a defensible decision reflected the characteristics of sequencing, separation and isolation, timing, consensus and collaboration, trust and communication to ensure that judgements were robust and defensible. The final theme revealed the importance of minimising uncertainty and discomfort when predicting length of survival following withdrawal of life-sustaining treatment. CONCLUSION: DCD decisions are made within an environment of uncertainty due to the imprecision associated with predicting time of death. Lack of certainty contributed to the cautious and collaborative strategies used by intensive care physicians when dealing with patients, family members and colleagues around end-of-life decisions, initiation of withdrawal of life-sustaining treatment and the discussion about DCD. This study recommends that nationally consistent policies are urgently needed to increase the degree of certainty for intensive care staff concerning the DCD processes.

A systematic review of instruments for assessment of capacity in activities of daily living in children with developmental co-ordination disorder

Children with developmental co-ordination disorder (DCD) face evident motor difficulties in activities of daily living (ADL). Assessment of their capacity in ADL is essential for diagnosis and intervention, in order to limit the daily consequences of the disorder. The aim of this study is to systematically review potential instruments for standardized and objective assessment of children's capacity in ADL, suited for children with DCD. As a first step, databases of MEDLINE, EMBASE, CINAHL and PsycINFO were searched to identify studies that described instruments with potential for assessment of capacity in ADL. Second, instruments were included for review when two independent reviewers agreed that the instruments: (1) are standardized and objective; (2) assess at activity level and comprise items that reflect ADL, and; (3) are applicable to school-aged children that can move independently. Out of 1507 publications, 66 publications were selected, describing 39 instruments. Seven of these instruments were found to fulfil the criteria and were included for review: the Bruininks-Oseretsky Test of Motor Performance-2 (BOT2); the Do-Eat (Do-Eat); the Movement Assessment Battery for Children-2 (MABC2); the school-Assessment of Motor and Process Skills (schoolAMPS); the Tuffts Assessment of Motor Performance (TAMP); the Test of Gross Motor Development (TGMD); and the Functional Independence Measure for Children (WeeFIM). As a third step, for the included instruments, suitability for children with DCD was discussed based on the ADL comprised, ecological validity and other psychometric properties. We concluded that current instruments do not provide comprehensive and ecologically valid assessment of capacity in ADL as required for children with DCD.

Psychometric properties of the DCDDaily-Q: A new parental questionnaire on children's performance in activities of daily living

Difficulties in the performance of activities of daily living (ADL) are a key feature of developmental coordination disorder (DCD). The DCDDaily-Q was developed to address children's motor performance in a comprehensive range ADL. The aim of this study was to investigate the psychometric properties of this parental questionnaire. Parents of 218 five to eight year-old children (DCD group: N=25; reference group: N=193) completed the research version of the new DCDDaily-Q and the Movement Assessment Battery for Children-2 (MABC2) Checklist and Developmental Coordination Disorder Questionnaire (DCDQ). Children were assessed with the MABC2 and DCDDaily. Item reduction analyses were performed and reliability (internal consistency and factor structure) and concurrent, discriminant, and incremental validity of the DCDDaily-Q were investigated. The final version of the DCDDaily-Q comprises 23 items that cover three underlying factors and shows good internal consistency (Cronbach's α>.80). Moderate correlations were found between the DCDDaily-Q and the other instruments used (p<.001 for the reference group; p>.05 for the DCD group). Discriminant validity of the DCDDaily-Q was good for DCDDaily-Q total scores (p<.001) and all 23 item scores (p<.01), indicating poorer performance in the DCD group. Sensitivity (88%) and specificity (92%) were good. The DCDDaily-Q better predicted DCD than currently used questionnaires (R2=.88). In conclusion, the DCDDaily-Q is a valid and reliable questionnaire to address children's ADL performance.

Activities of daily living in children with developmental coordination disorder: Performance, learning, and participation

Background Children with developmental coordination disorder (DCD) face evident motor difficulties in daily functioning. Little is known, however, about their difficulties in specific activities of daily living (ADL). Objective The purposes of this study were: (1) to investigate differences between children with DCD and their peers with typical development for ADL performance, learning, and participation, and (2) to explore the predictive values of these aspects. Design. This was a cross-sectional study. Methods In both a clinical sample of children diagnosed with DCD (n=25 [21 male, 4 female], age range=5-8 years) and a group of peers with typical development (25 matched controls), the children’s parents completed the DCDDaily-Q. Differences in scores between the groups were investigated using t tests for performance and participation and Pearson chi-square analysis for learning. Multiple regression analyses were performed to explore the predictive values of performance, learning, and participation. Results Compared with their peers, children with DCD showed poor performance of ADL and less frequent participation in some ADL. Children with DCD demonstrated heterogeneous patterns of performance (poor in 10%-80% of the items) and learning (delayed in 0%-100% of the items). In the DCD group, delays in learning of ADL were a predictor for poor performance of ADL, and poor performance of ADL was a predictor for less frequent participation in ADL compared with the control group. Limitations A limited number of children with DCD were addressed in this study. Conclusions This study highlights the impact of DCD on children’s daily lives and the need for tailored intervention.

Development and psychometric properties of the DCDDaily: a new test for clinical assessment of capacity in activities of daily living in children with developmental coordination disorder

Objective To develop the DCDDaily, an instrument for objective and standardized clinical assessment of capacity in activities of daily living (ADL) in children with developmental coordination disorder (DCD), and to investigate its usability, reliability, and validity. Subjects Five to eight-year-old children with and without DCD. Main measures The DCDDaily was developed based on thorough review of the literature and extensive expert involvement. To investigate the usability (assessment time and feasibility), reliability (internal consistency and repeatability), and validity (concurrent and discriminant validity) of the DCDDaily, children were assessed with the DCDDaily and the Movement Assessment Battery for Children-2 Test, and their parents filled in the Movement Assessment Battery for Children-2 Checklist and Developmental Coordination Disorder Questionnaire. Results 459 children were assessed (DCD group, n = 55; normative reference group, n = 404). Assessment was possible within 30 minutes and in any clinical setting. For internal consistency, Cronbach’s α = 0.83. Intraclass correlation = 0.87 for test–retest reliability and 0.89 for inter-rater reliability. Concurrent correlations with Movement Assessment Battery for Children-2 Test and questionnaires were ρ = −0.494, 0.239, and −0.284, p < 0.001. Discriminant validity measures showed significantly worse performance in the DCD group than in the control group (mean (SD) score 33 (5.6) versus 26 (4.3), p < 0.001). The area under curve characteristic = 0.872, sensitivity and specificity were 80%. Conclusions The DCDDaily is a valid and reliable instrument for clinical assessment of capacity in ADL, that is feasible for use in clinical practice.

Large-Scale Elastic Net Regularized Linear Classification SVMs and Logistic Regression

Elastic Net Regularizers have shown much promise in designing sparse classifiers for linear classification. In this work, we propose an alternating optimization approach to solve the dual problems of elastic net regularized linear classification Support Vector Machines (SVMs) and logistic regression (LR). One of the sub-problems turns out to be a simple projection. The other sub-problem can be solved using dual coordinate descent methods developed for non-sparse L2-regularized linear SVMs and LR, without altering their iteration complexity and convergence properties. Experiments on very large datasets indicate that the proposed dual coordinate descent - projection (DCD-P) methods are fast and achieve comparable generalization performance after the first pass through the data, with extremely sparse models.

爆轰波在楔面上反射数值分析

应用基元反应模型和频散可控耗散格式(DCD)对氢氧爆轰波在楔面反射进行了数值模拟.计算中氢氧混合物的化学反应采用了8种组分20个反应方程式.在处理化学反应引起的刚性问题时采用了时间算子分裂的方法.模拟了爆轰波在楔面反射由马赫反射向规则反射转变的过程,得到了反射转变临界角,同时考虑了初始压力和组分的影响,并和实验及理论分析结果进行了比较,结果是令人满意的.

正向爆轰驱动高焓激波风洞的数值模拟

对充满氢氧可燃气体、带扩容腔的正向爆轰驱动的激波风洞进行了数值模拟.计算采用了欧拉方程,频散可控耗散差分格式(DCD)和改进的二阶段化学反应模型.在扩容腔附近采用二维轴对称计算模型,而在驱动段和被驱动段的直管道部分则采用一维计算模型.本文分析了爆轰波在管道中的传播、反射和绕射过程.计算结果表明扩容腔的尺寸对爆轰波的传播、反射、汇聚等起着决定性的作用;带扩容腔的正向爆轰驱动的激波风洞能够得到平稳的持续时间较长的气流,提高了实验的精确度和可重复性.

爆轰波在弯管内传播过程数值分析

应用基元反应模型和频散可控耗散格式(DCD)对氢氧爆轰波在弯管内的传播过程进行了数值模拟.计算中氢氧混合物化学反应采用了8种组分20个反应方程式.在处理化学反应引起的刚性问题时采用了时间算子分裂的方法.计算结果表明,在弯管小曲率半径壁面附近,由于膨胀稀疏作用,爆轰波强度减弱,在局部出现前导激波与放热反应区的解藕以及二次起爆现象;在弯管大曲率半径壁面上爆轰波在马赫反射和正规反射之间相互转变,使爆轰波加强.弯管内的爆轰现象与弯管曲率半径有关.

Numerical Investigation of Toroidal Shock Wave Focusing in a Cylindrical Chamber

In this paper, focusing of a toroidal shock wave propagating from an annular shock tube into a cylindrical chamber was investigated numerically with the dispersion controlled dissipation (DCD) scheme. The first case for an incident Mach number of 1.5 was conducted and compared with experiments for validation. Then, several cases were calculated for higher incident Mach numbers varying from 2.0 to 5.0, and complicated flow structures were observed. The numerical study was mainly focused on two aspects: focusing process and flow structures. The process, including diffraction, focusing, and reflection, is displayed to reveal the focusing mechanism, and the flow structures at different incident. Mach numbers are used to demonstrate shock reflection styles and focusing characteristics.

频散可控格式的一种推广形式及其在爆轰波马赫反射中应用

频散可控格式是高精度捕捉激波的新格式.对原有频散可控格式(DCD)进行了推广,给出了适用于网格点排列不规则情况下的DCD格式,使其具有更广泛的适应性,在此基础上构造了在非结构三角形网格下的DCD格式.用一些典型算例对推广后的DCD格式进行检验,结果表明该格式是合理和可靠的,并能够较好地保留原有DCD格式的二阶精度.把推广后的DCD格式和具有8种组分和20个化学反应的基元反应模型相结合,对氢氧爆轰波在直管道中的传播问题及楔面上马赫反射问题进行计算,计算结果和实验结果比较表明,在非结构三角形网格下的DCD格式能够有效地捕捉爆轰波,在爆轰波阵面上不会产生振荡或是抹平间断现象.

准定常强激波马赫反射波形的数值研究

应用DCD频散控制激波捕捉格式,求解二维、多组分、带有化学反应的Euler方程组,数值模拟了准定常强激波的马赫反射问题。研究结果表明:与经典马赫反射理论相比,在强激波条件下,激波诱导的气体分子振动激发和化学反应使马赫反射的三波点轨迹角变小、马赫杆高度变低、楔顶附体激波倾角变小;马赫杆的相对突出量随入射激波马赫数和楔角的增大而增大,而气体分子的振动、离解等真实气体效应能进一步加剧马赫杆的向前突出。

On dispersion-controlled principles for non-oscillatory shock-capturing schemes

The role of dispersions in the numerical solutions of hydrodynamic equation systems has been realized for long time. It is only during the last two decades that extensive studies on the dispersion-controlled dissipative (DCD) schemes were reported. The studies have demonstrated that this kind of the schemes is distinct from conventional dissipation-based schemes in which the dispersion term of the modified equation is not considered in scheme construction to avoid nonphysical oscillation occurring in shock wave simulations. The principle of the dispersion controlled aims at removing nonphysical oscillations by making use of dispersion characteristics instead of adding artificial viscosity to dissipate the oscillation as the conventional schemes do. Research progresses on the dispersion controlled principles are reviewed in this paper, including the exploration of the role of dispersions in numerical simulations, the development of the dispersion-controlled principles, efforts devoted to high-order dispersion-controlled dissipative schemes, the extension to both the finite volume and the finite element methods, scheme verification and solution validation, and comments on several aspects of the schemes from author's viewpoint.