Differences in White Matter Microstructure Among Children With Developmental Coordination Disorder

Abstract

IMPORTANCE Developmental coordination disorder (DCD) is a motor impairment that significantly interferes with activities of daily living. Little is known about the cause of DCD and how it develops, making it difficult to understand why children with DCD struggle in learning motor skills and to determine the best intervention to optimize function.OBJECTIVE To characterize white matter differences using diffusion tensor imaging in children with and without DCD. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study collected diffusion tensorimaging data at BC Children' MAIN OUTCOMES AND MEASURESThe main outcome measures were diffusion parameters, including fractional anisotropy and mean, axial, and radial diffusivity, which are thought to provide an indirect measure of white matter microstructure. Tract-based spatial statistics, a voxelwise statistical analysis of diffusion parameters, were conducted using a 2-group comparison design matrix with age and attention as covariates. RESULTSThirty children without DCD (mean [SD] age, 9.9 [1.4] years; 21 [70%] boys) and 31 children with DCD (mean [SD] age, 10.1 [1.2] years; 26 [84%] boys) were included in the study. Compared with children without DCD, children with DCD were characterized by significantly lower fractional anisotropy and axial diffusivity in regions of white matter pathways associated with motor and sensorimotor processing, including the corticospinal tract (fractional anisotropy: mean [SD], 0.54 [0.03] vs 0.51 [0.03]; P < .001; axial diffusivity: mean [SD], 0.13 [0.98] vs 0.12 [0.46]; P = .01), posterior thalamic radiation at the retrolenticular part of the internal capsule (axial diffusivity: mean [SD], 0.14 [0.57] vs 0.14 [0.44]; P = .01), and cerebellar pathways (eg, superior cerebellar peduncle, fractional anisotropy: mean [SD], 0.49 [0.05] vs 0.46 [0.03]; P = .03; axial diffusivity: mean [SD], 0.14 [0.66] vs 0.14 [0.63]; P = .009). There were no significant differences in mean diffusivity and radial diffusivity between children with and without DCD. CONCLUSIONS AND RELEVANCE These findings suggest that children with DCD show significant brain differences in motor and sensorimotor white matter pathways compared with children without DCD. The pattern of diffusion parameters in children with DCD suggests that axonal development may be disrupted in this neurodevelopmental disorder. Question What white matter microstructural differences are associated with children with developmental coordination disorder (DCD) compared with children without DCD? Findings In this cross-sectional study of 31 children with DCD and 30 children without DCD, widespread differences in indices of white matter microstructure, including fractional anisotropy and axial diffusivity, were observed in children with DCD compared with children without DCD. Meaning These findings suggest that DCD does not simply represent the low end of typical motor skill ability; these children display altered brain development in sensorimotor pathways.Vancouver, British Columbia, Canada; caseload...

White Matter Changes With Rehabilitation in Children With Developmental Coordination Disorder: A Randomized Controlled Trial

“…Thus far, diffusion MRI studies have used various analysis methods, including tract-based spatial statistics (TBSS; Williams et al, 2017 ; Brown-Lum et al, 2020 ), constrained spherical deconvolution (Hyde et al, 2019 ), tractography (Zwicker et al, 2012 ; Debrabant et al, 2016 ) and graph theory (Debrabant et al, 2016 ) to understand white matter microstructure in children with DCD. Results have shown that children with DCD have altered white matter microstructure in the corpus callosum (Langevin et al, 2014 ; Brown-Lum et al, 2020 ) and sensorimotor, corticospinal, cortico-cerebellar (Zwicker et al, 2012 ; Debrabant et al, 2016 ; Williams et al, 2017 ; Brown-Lum et al, 2020 ), and frontoparietal pathways (Langevin et al, 2014 ; Williams et al, 2017 ; Hyde et al, 2019 ; Brown-Lum et al, 2020 ). Structural connectivity between brain regions (e.g., cerebellar lobule VI and right superior parietal gyrus; Debrabant et al, 2016 ) is also implicated in children with DCD.…”

Neural Basis and Motor Imagery Intervention Methodology Based on Neuroimaging Studies in Children With Developmental Coordination Disorders: A Review

“…They used a predictive statistical model to show that the cerebellum lobule VI and the right parietal superior gyrus are the most effective for distinguishing children with DCD from children with TD. Also, a study by Brown-Lum et al (2020) which investigated the entire brain, showed a decrease in FA of the cerebral peduncle, superior cerebellar peduncle, external capsule, and splenium of the corpus callosum. In the corticospinal tract, cerebral peduncle, posterior thalamic radiation at the retrolenticular part of the internal capsule and external capsule, axial diffusivity was also reduced.…”

“…Previous studies have also shown that children with DCD have low FA in these areas (Zwicker et al, 2012a). Brown-Lum et al (2020) found that children with DCD also had low FA in the cerebellum pathway by examining the entire brain. These pathways enter and exit the spinal cord, pons, and cerebral cortex, and cerebellum, helping to improve motor movements, learn new motor skills, and balance proprioceptive information into a posture (Keser et al, 2015).…”

Successful Application of an Insole with a Metatarsal Inhibition Bar and Deep Heel Cup for Improving Gait Dysfunction in a Patient with Poor Coordination with Disrupted Corticoreticular Tracts: A Case Report

“…In 2012, Zwicker et al showed that the mean diffusivity of the CST and posterior thalamic radiation was lower in children aged 8–12 years than in typically developing children without DCD [ 16 ]. In 2020, Brown-Lum et al reported that 8- to 12-year-old children with DCD had lower FA and mean diffusivity in the brain areas associated with motor and sensorimotor processing than typically developing children using tract-based spatial statistics [ 8 ]. The results of DTI studies have revealed that the microstructural abnormalities in motor function-related neural tracts could be attributed to the development of DCD.…”

“…Although some studies have reported neural impairments in the immature brain of pediatric patients with coordination problems, the pathogenesis related to them or DCD has not been clearly demonstrated [ 5 , 6 , 7 , 8 ]. Many patients with DCD usually have no definite abnormal lesions on conventional brain magnetic resonance imaging (MRI) [ 2 , 3 ].…”