Children With Developmental Coordination Disorder Show Altered Visuomotor Control During Stair Negotiation Associated With Heightened State Anxiety

Abstract

Safe stair negotiation is an everyday task that children with developmental coordination disorder (DCD) are commonly thought to struggle with. Yet, there is currently a paucity of research supporting these claims. We investigated the visuomotor control strategies underpinning stair negotiation in children with (N = 18, age = 10.50 ± 2.04 years) and without (N = 16, age = 10.94 ± 2.08 years) DCD by measuring kinematics, gaze behavior and state anxiety as they ascended and descended a staircase. A questionnaire was administered to determine parents' confidence in their child's ability to safely navigate stairs and their child's fall history (within the last year). Kinematics were measured using three-dimensional motion capture (Vicon), whilst gaze was measured using mobile eye-tracking equipment (Pupil labs). The parents of DCD children reported significantly lower confidence in their child's ability to maintain balance on the stairs and significantly more stair-related falls in the previous year compared to the parents of typically developing (TD) children. During both stair ascent and stair descent, the children with DCD took longer to ascend/descend the staircase and displayed greater handrail use, reflecting a more cautious stair negotiation strategy. No differences were observed between groups in their margin of stability, but the DCD children exhibited significantly greater variability in their foot-clearances over the step edge, which may increase the risk of a fall. For stair descent only, the DCD children reported significantly higher levels of state anxiety than the TD children and looked significantly further along the staircase during the initial entry phase, suggesting an anxiety-related response that may bias gaze toward the planning of future stepping actions over the accurate execution of an ongoing step. Taken together, our findings provide the first quantifiable evidence that (a) safe stair negotiation is a significant challenge for children with DCD, and that (b) this challenge is reflected by marked differences in their visuomotor control strategies and state anxiety levels. Whilst it is currently unclear whether these differences are contributing to the frequency of stair-related falls in children with DCD, our findings pave the way for future research to answer these important questions.

Behavioral and Neuroimaging Research on Developmental Coordination Disorder (DCD): A Combined Systematic Review and Meta-Analysis of Recent Findings

“…One intriguing hypothesis is that children with DCD may actually learn to walk (and reach) slower and more cautiously than is typical, using this as a strategy to compensate for more fundamental deficits in motor control (including cognitive-motor integration). In effect, this strategy would help preserve safety margins when tackling new environments and skills, and reduce injury risk, consistent with data that we reviewed on walking through apertures (Wilmut and Barnett, 2017a ; Wilmut et al, 2017a ) and stair climbing (Parr et al, 2020b ). Similarly, in the literature on aging, compensatory behavior is seen to occur as a response to functional deterioration.…”

“…Group differences on gait parameters were examined under different terrain and task conditions in 11 papers (all high quality): (i) overground walking on regular and irregular terrain (Gentle et al, 2016 ; Wilmut et al, 2017b ; Nieto et al, 2018 ); (ii) treadmill walking (Speedtsberg et al, 2018 ; Yam and Fong, 2018 ); (iii) overground walking with intermittent and occluded vision (Nieto et al, 2018 ); (iv) stair negotiation (Parr et al, 2020b ); and (v) locomotor pointing and obstacle avoidance tasks (Schott et al, 2016 ; Wilmut and Barnett, 2017a , b ; Parr et al, 2020a ; Warlop et al, 2020b ). The overall effect for all gait outcomes was moderate-to-large ( d = 0.70, 95% CI [0.46, 0.94]).…”

“…Over multiple studies of gait and reaching, the motor performance of children with DCD was much more variable, expressed in its topography, kinematics, and kinetics. This was shown by slower and more cautious gait patterns, evidenced by smaller step length, reduced velocity, and increased sway (see Section Gait) on irregular surfaces (Gentle et al, 2016 ; Nieto et al, 2018 ; Speedtsberg et al, 2018 ; Parr et al, 2020b ). These characteristics of movement may be seen as adaptations to minimize the destabilizing momentum of locomotion and to allow additional time to pick up the environmental information necessary to reduce uncertainty (and risks) about the path ahead (Tong et al, 2017 ).…”

“…Group differences on gait parameters were examined under different terrain and task conditions in 11 papers (all high quality): (i) overground walking on regular and irregular terrain (Gentle et al, 2016;Nieto et al, 2018); (ii) treadmill walking (Speedtsberg et al, 2018;Yam and Fong, 2018); (iii) overground walking with intermittent and occluded vision (Nieto et al, 2018); (iv) stair negotiation (Parr et al, 2020b); and (v) locomotor pointing and obstacle avoidance tasks (Schott et al, 2016;Wilmut and Barnett, 2017a,b;Parr et al, 2020a;Warlop et al, 2020b). The overall effect for all gait outcomes was moderate On clinical scales that assess the coordination of gait under different sensory conditions, studies showed that those with DCD have significantly poorer gait coordination than TDC peers (d = 1.57, 95% CI = [0.78, 2.37] on a functional index, and d = 1.06, 95% CI = [0.08, 2.04] on an ataxia index) (Mannini et al, 2017;Hsu et al, 2018).…”

The use of selected parameters of the mini-golf game for screening the motor assessment of children for Developmental Coordination Disorder — preliminary report

“…The visual-spatial function can be assessed using the BVRT test. It is a test that can be used in the diagnosis of DCD, because children with such disorders show some impairment of visual-motor control and visual information processing, which may manifest itself, for example, as difficulty in walking upstairs [36]there is currently a paucity of research supporting these claims. We investigated the visuomotor control strategies underpinning stair negotiation in children with (N = 18, age = 10.50 ± 2.04 years.…”