Wilson Peter H, Smits-Engelsman Bouwien, Caeyenberghs Karen, Steenbergen Bert, Sugden David, Clark Jane, Mumford Nick, Blank Rainer
School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia.
Centre for Disability and Development Research, Australian Catholic University, Melbourne, Victoria, Australia.
Dev Med Child Neurol. 2017 Nov;59(11):1117-1129. doi: 10.1111/dmcn.13530. Epub 2017 Sep 5.
To better understand the neural and performance factors that may underlie developmental coordination disorder (DCD), and implications for a multi-component account.
A systematic review of the experimental literature published between June 2011 and September 2016 was conducted using a modified PICOS (population, intervention, comparison, outcomes, and study type) framework. A total of 106 studies were included.
Behavioural data from 91 studies showed a broad cluster of deficits in the anticipatory control of movement, basic processes of motor learning, and cognitive control. Importantly, however, performance issues in DCD were often shown to be moderated by task type and difficulty. As well, we saw new evidence of compensatory processes and strategies in several studies. Neuroimaging data (15 studies, including electroencephalography) showed reduced cortical thickness in the right medial orbitofrontal cortex and altered brain activation patterns across functional networks involving prefrontal, parietal, and cerebellar regions in children with DCD than those in comparison groups. Data from diffusion-weighted magnetic resonance imaging suggested reduced white matter organization involving sensorimotor structures and altered structural connectivity across the whole brain network.
Taken together, results support the hypothesis that children with DCD show differences in brain structure and function compared with typically developing children. Behaviourally, these differences may affect anticipatory planning and reduce automatization of movement skill, prompting greater reliance on slower feedback-based control and compensatory strategies. Implications for future research, theory development, and clinical practice are discussed.
为了更好地理解可能构成发育性协调障碍(DCD)基础的神经和行为因素,以及对多成分理论的启示。
使用改良的PICOS(人群、干预、对照、结局和研究类型)框架,对2011年6月至2016年9月发表的实验文献进行系统综述。共纳入106项研究。
91项研究的行为数据显示,在运动的预期控制、运动学习的基本过程和认知控制方面存在广泛的缺陷集群。然而,重要的是,DCD中的行为问题通常显示受任务类型和难度的调节。此外,我们在几项研究中看到了代偿过程和策略的新证据。神经影像学数据(15项研究,包括脑电图)显示,与对照组相比,DCD儿童右侧内侧眶额皮质的皮质厚度减小,涉及前额叶、顶叶和小脑区域的功能网络的脑激活模式改变。扩散加权磁共振成像数据表明,涉及感觉运动结构的白质组织减少,全脑网络的结构连接改变。
综合来看,结果支持这样的假设,即与正常发育儿童相比,DCD儿童在脑结构和功能上存在差异。在行为上,这些差异可能会影响预期计划并降低运动技能的自动化程度,促使更多地依赖较慢的基于反馈的控制和代偿策略。讨论了对未来研究、理论发展和临床实践的启示。