Premature Birth Clinical Trial
Official title:
Developmental Coordination Disorder in Preterm Children: Examining Brain Changes With CO-OP Intervention
This study will leverage a current longitudinal study of brain development in preterm
children. In the Miller/Grunau Trajectories study, preterm children are returning for
follow-up at 8-9 years. At this appointment, children undergo MRI and neurodevelopmental
testing. Children who are identified with DCD at this appointment will be invited to
participate in this intervention study. Participants will have a 2nd MRI 12 weeks after the
first scan. They will then receive 12 weekly sessions with an occupational therapist,
followed by a third MRI.
Children with DCD who were born very preterm (<32 weeks gestational age) who are not part of
the Miller/Grunau study are also eligible to participate.
RATIONALE Developmental coordination disorder (DCD) is one of the most common disorders in
children (Wann, 2007), affecting 5-6% of the school-age population; this is > 400,000
children in Canada, or 1-2 children in every classroom (American Psychiatric Association,
2013; Statistics Canada, 2013). Compared with children born at term, preterm children (born
2-4 months early) are 6-8 times more likely to develop DCD (Edwards…Zwicker, 2011). DCD
significantly interferes with a child's ability to learn motor skills and to perform everyday
activities, such as getting dressed, tying shoelaces, using a knife and fork, printing,
playing sports, or riding a bicycle. While it was once believed that children would outgrow
this condition, longitudinal research has shown that functional difficulties can persist into
adolescence and adulthood (Cantell, Smyth, & Ahonen, 2003; Cousins & Smyth, 2003).
Furthermore, secondary psychosocial difficulties often develop, including poor self-esteem,
depression, anxiety, problems with peers, loneliness, and decreased participation in physical
and social activities (Zwicker, Harris, & Klassen, 2013). Up to half of children with DCD
will have co-occurring attention deficit hyperactivity disorder (ADHD) (Kadesjo & Gillberg,
1998). As a chronic health condition, DCD often interferes with an individual's function and
quality of life across their lifespan (Cousins & Smyth, 2003; Zwicker et al., 2013)
The cause of DCD is not known, and it is under-recognized, under-diagnosed, and under-treated
(Blank et al., 2012). In particular, the investigators do not understand the neural basis of
DCD, making it difficult to understand why children with DCD struggle to learn motor skills
and to determine how to best intervene to optimize function.
To change the negative trajectory of children with DCD, the investigators need a better
understanding of the neural basis of DCD, along with further rehabilitation efforts to
improve outcomes. Recently, the investigators and others have conducted small neuroimaging
studies to begin to understand brain differences in DCD (Querne et al., 2008; Kashiwagi et
al., 2009, Zwicker et al., 2010, 2011, 2012b). These studies, while novel and significant in
advancing the field of DCD, are limited by small sample sizes. To further define the neural
correlates of DCD, the investigators need to perform larger studies and take advantage of new
neuroimaging techniques. To date, no studies have examined neural correlates of DCD in the
preterm population, a group that is at particularly high risk for the disorder. In addition,
brain imaging studies may determine whether improvements in motor function with current "best
practice" rehabilitation intervention are associated with changes in brain
structure/function. A greater understanding of the neural basis of DCD may result in earlier
diagnosis and early rehabilitation to mediate better brain development.
Currently, the investigators have a study underway that assesses whether rehabilitation
intervention and improved outcomes in children with DCD are associated with concurrent brain
changes (H14-00397). This proposed research extends this study to determine whether preterm
children with DCD show similar brain changes.
SPECIFIC OBJECTIVES AND HYPOTHESES
The proposed study (in conjunction with my current DCD-imaging-intervention study: H14-00397)
will allow us to compare brain structure and function in full-term children with DCD and in
preterm children with the disorder. While the investigators expect similar neural correlates
between the two groups, the investigators hypothesize that the preterm DCD may also show
unique brain differences, which may affect their response to rehabilitation. The
investigators will address two specific objectives as outlined below:
Objective 1: To characterize structural and functional brain differences in full-term and
preterm children with DCD.
Hypothesis: In our current study, the investigators hypothesized that, compared to
typically-developing children, children with full-term DCD will show smaller cerebellar
volume, differences in microstructural development in motor, sensory and cerebellar pathways,
and decreased strength of connectivity in resting, default mode, and motor networks. The
investigators expect that preterm children will show similar structural and functional brain
differences as full-term children with DCD, but that they may also show mild white matter
injury.
Approach: The investigators will use magnetic resonance (MR) imaging and advanced MR
techniques to characterize brain structure and function; the investigators will use
morphometry to measure cerebral and cerebellar volumes, diffusion tensor imaging (DTI) to
assess microstructural development, and functional connectivity MRI to measure connectivity
in different brain networks. The investigators will also explore fMRI during a mental
rotation task and spectroscopy of the basal ganglia.
Objective 2: To determine if current best-practice rehabilitation intervention induces
neuroplastic changes in brain structure/function and positive outcomes in preterm children
with DCD.
Hypotheses: Compared to their waitlist scan, the investigators expect that post-treatment
scans of preterm children will show: (1) strengthened functional connectivity in resting,
default mode, and motor networks; (2) increased integrity of the frontal-cerebellar pathway;
(3) increased gray matter volume in the dorsolateral prefrontal, motor and cerebellar
cortices; and (4) improved performance and satisfaction ratings of child-chosen functional
motor goals. The investigators also expect that there will be a positive association between
functional improvements and changes in brain structure/function.
Approach: The investigators will measure brain changes at three time points: once before a
waiting period as a baseline scan (conducted as part of the Miller-Grunau Trajectories study
at age 8-9 years: C05-0579), once immediately before beginning treatment (12 weeks after the
first scan), and once after 12 weeks of intervention. As part of treatment, children will
identify three functional motor goals as a target for intervention. The investigators will
use the Canadian Occupational Performance Measure (COPM; Law et al., 2005) to measure the
child's rating of their performance and satisfaction pre- and post-intervention. To
supplement the COPM, the investigators will videotape the child performing each of their
motor goals before and after intervention, and an independent occupational therapist will use
the Performance Quality Rating Scale (PQRS) to objectively measure performance and change in
performance (Miller et al., 2001). As a secondary measure, the investigators will evaluate
fine and gross motor skills using the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2:
Bruininks & Bruininks, 2005).
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