Helping Children with Coordination Difficulties (DCD/Dyspraxia): How Physiotherapy Supports Motor Planning and Participation
Every classroom in Coquitlam, Port Moody, Port Coquitlam, and Surrey has children who struggle with physical activities that peers seem to master effortlessly. These children may appear clumsy, avoid sports and playground activities, have messy handwriting, or struggle with everyday tasks like tying shoes or riding a bicycle. Many have Developmental Coordination Disorder (DCD), also called dyspraxia—a condition affecting approximately 5-6% of school-age children.
Despite its prevalence, DCD often goes unrecognized or is dismissed as the child being "just clumsy" or "not athletic." However, DCD is a legitimate neurodevelopmental condition that significantly impacts academic performance, social participation, physical health, and emotional wellbeing. Physiotherapy offers evidence-based interventions that can dramatically improve outcomes for these children, helping them develop motor skills, build confidence, and participate fully in school, sports, and social activities.
Understanding Developmental Coordination Disorder
Developmental Coordination Disorder is characterized by motor skills that are substantially below what would be expected for a child's age and opportunities for learning. The difficulties are not due to intellectual disability, vision problems, neurological conditions like cerebral palsy, or lack of opportunity to learn skills.
Children with DCD struggle with motor coordination in ways that interfere with daily activities and academic achievement. The condition typically becomes apparent in early childhood and, without intervention, persists into adolescence and adulthood.
Key Characteristics of DCD
Motor Planning Challenges: Children with DCD have difficulty planning and executing coordinated movements. Motor planning (also called praxis) involves conceptualizing an action, organizing the sequence of movements required, and executing them smoothly. A child with DCD might know they want to catch a ball but struggle to coordinate the timing, hand positioning, and movement needed to succeed.
Slow Motor Learning: While all children learn new motor skills through practice, children with DCD require significantly more repetitions to learn movements and may lose skills more quickly without continued practice. A typically developing child might learn to ride a bicycle with a few days of practice, while a child with DCD may require weeks or months of consistent effort.
Variability in Performance: Children with DCD often show inconsistent performance—successfully completing a task one day but struggling the next. This inconsistency can be frustrating for both the child and adults supporting them.
Secondary Consequences: Beyond the primary motor difficulties, children with DCD frequently experience lower physical fitness, reduced participation in physical activity, social challenges, anxiety, and lower self-esteem. Research indicates that children with DCD have significantly higher rates of mental health concerns compared to peers.
How Physiotherapy Helps Children with DCD
Physiotherapy plays a crucial role in supporting children with coordination difficulties. Evidence-based physiotherapy interventions can improve motor skills, increase physical activity levels, support school participation, and enhance quality of life.
Task-Oriented and Functional Approaches
Current best practice for DCD emphasizes task-oriented intervention, where therapy focuses on practicing the specific functional activities the child needs or wants to perform. Rather than working on isolated components like balance or strength in abstract contexts, physiotherapists help children practice real-life tasks in relevant environments.
Research strongly supports this approach. When a child in Surrey wants to learn to ride a scooter to keep up with friends, therapy involves actually practicing scooter riding with systematic skill breakdown and progression. If a child in Coquitlam struggles with physical education activities, therapy might occur in a gym setting practicing the specific movements required.
This functional focus makes therapy meaningful to children and families, increasing motivation and engagement. It also ensures skills generalize to real-world situations rather than remaining confined to the therapy clinic.
Cognitive Orientation to Daily Occupational Performance (CO-OP)
CO-OP is a evidence-based intervention approach specifically developed for children with DCD. This cognitive strategy-based approach teaches children to solve their own motor problems using global strategies like Goal-Plan-Do-Check.
The process involves:
Identifying goals that are important to the child
Teaching the child to make a plan for how to achieve the goal
Supporting the child as they try their plan (Do)
Helping the child evaluate whether their plan worked (Check)
Modifying the plan based on results
Rather than the therapist telling the child exactly what to do, CO-OP empowers children to discover solutions. A physiotherapist in Port Moody working with a child who struggles catching a ball might ask: "What could you try differently?" or "Where should you look?" This approach builds problem-solving skills that children can apply to new motor challenges independently.
Studies demonstrate that CO-OP produces significant improvements in motor performance and skill generalization, with benefits maintained over time.
Neuromotor Task Training (NTT)
Neuromotor Task Training is another evidence-based approach for DCD that emphasizes intensive practice of functional tasks with progressive difficulty. NTT involves:
Practicing whole functional tasks rather than isolated components
High numbers of repetitions to support motor learning
Progressive challenge as skills improve
Practice in varied contexts to support generalization
Limited verbal instruction, allowing the child to develop their own movement solutions through practice
A physiotherapist using NTT to help a child in Port Coquitlam learn to kick a ball might begin with a stationary large ball, progress to a rolling ball, then a smaller ball, and eventually practice kicking while running—each step providing numerous repetitions before advancing.
Building Fundamental Movement Skills
Many children with DCD lack proficiency in fundamental movement skills—the basic building blocks for more complex activities and sports. These include:
Locomotor skills: running, jumping, hopping, galloping, skipping
Object control skills: throwing, catching, kicking, striking
Stability skills: balancing, twisting, bending
Physiotherapists assess which fundamental skills need development and design engaging activities to build competence. For school-age children in Surrey and Coquitlam, developing these foundations opens doors to sports participation, active play with peers, and physical education success.
Improving Physical Fitness
Children with DCD typically have lower cardiovascular fitness, strength, and endurance compared to peers. This reduced fitness stems from avoiding physical activities due to poor skills and negative experiences, creating a cycle where limited activity leads to poor fitness, which makes activity even more challenging.
Physiotherapists address this by:
Designing exercise programs that are achievable and enjoyable
Building cardiovascular endurance through activities the child finds fun
Developing strength through functional activities rather than traditional gym exercises
Increasing activity tolerance gradually to prevent discouragement
Improving fitness has benefits beyond physical health. Research shows that better fitness supports motor skill development and increases the child's capacity to participate in physical activities with peers.
Supporting Sports Participation
Many children with DCD want to participate in sports but struggle with the motor demands. Physiotherapists can:
Break down sport-specific skills into learnable components
Provide intensive practice of skills the child finds most challenging
Teach compensatory strategies for managing difficult aspects
Help children find sports that match their abilities and interests
Educate coaches about DCD and appropriate modifications
Not every child with DCD will excel in competitive sports, and that's okay. The goal is finding physical activities the child enjoys and can participate in at a level that feels rewarding. Some children thrive in individual sports like swimming, martial arts, or cycling where they're not compared directly to teammates. Others prefer non-competitive recreational activities.
Addressing School-Related Challenges
Physical demands extend beyond physical education. Children with DCD may struggle with:
Handwriting and other fine motor tasks (though occupational therapy typically addresses these)
Changing for PE class within time constraints
Navigating crowded hallways and stairs
Playground activities and social games
Manipulating school materials and equipment
Physiotherapists can assess school environments, recommend modifications, educate school staff about DCD, and teach children strategies for managing physical demands. For example, a child in Coquitlam might learn to use one of the school's first-floor bathrooms to avoid challenging stairs during busy transitions.
Motor Planning: The Core Challenge
Motor planning difficulty is central to DCD. Understanding this helps explain why children with DCD struggle even when they have adequate strength, flexibility, and basic coordination.
Motor planning involves:
Ideation: Conceptualizing what action to perform
Planning: Determining the sequence and timing of movements needed
Execution: Carrying out the planned movements
Feedback Integration: Using sensory information to adjust movements
Children with DCD may have difficulties at any stage. Some struggle to visualize how to approach a task. Others can conceptualize the action but can't organize an effective movement sequence. Many have difficulty using sensory feedback to adjust movements in real-time.
Physiotherapy interventions address motor planning by:
Providing opportunities to practice planning movements explicitly
Teaching strategies for approaching novel motor tasks
Offering varied practice contexts so children learn to adapt plans
Building a repertoire of successful movement patterns that can be applied to new situations
School and Social Participation
The impacts of DCD extend far beyond physical skills. Children with poor motor coordination often face:
Academic Challenges: Slow handwriting, difficulty with visual-motor tasks, reduced stamina, and problems organizing materials can affect academic performance. Physical struggles may also reduce time available for academic tasks—if a child takes twice as long to change for PE, they have less time for actual physical activity or learning.
Social Difficulties: Playground games and sports are primary contexts for childhood social interaction. Children who can't keep up physically may be excluded, teased, or simply avoid situations where their difficulties are obvious. Research demonstrates that children with DCD have fewer friendships and higher rates of social isolation than peers.
Emotional Impacts: Repeated failure experiences, social exclusion, and awareness of being different from peers contribute to anxiety, depression, and low self-esteem. Children with DCD are at significantly elevated risk for mental health problems.
Activity Avoidance: As negative experiences accumulate, many children with DCD develop avoidance patterns—declining invitations to physical activities, dropping out of sports, choosing sedentary pursuits. This avoidance provides short-term relief from frustration but has long-term consequences for health and social development.
Physiotherapy addresses these broader impacts by:
Building competence that enables participation
Creating successful experiences that boost confidence
Teaching strategies for managing challenging situations
Supporting gradual re-engagement with avoided activities
Collaborating with schools to reduce barriers to participation
Pregnancy and Postpartum Considerations
While DCD is a childhood condition, it often persists into adulthood. Women with DCD who become pregnant may experience unique challenges:
Increased clumsiness due to pregnancy-related changes in balance and coordination
Difficulty with physical demands of pregnancy and labor
Postpartum challenges with physically caring for an infant
Anxiety about managing physical aspects of parenting
Physiotherapy can support pregnant women with DCD through:
Balance and coordination exercises adapted for pregnancy
Body mechanics training for lifting and carrying
Strategies for managing infant care tasks
Addressing pregnancy-related pain and discomfort
Building confidence for the physical demands of parenting
Women with DCD often worry about passing the condition to their children, as DCD has genetic components. If their children do have coordination difficulties, their own experiences can provide valuable insight and empathy, while physiotherapy helps both mother and child develop needed skills.
Identifying Children Who Need Support
DCD is often underdiagnosed. Teachers, parents, and healthcare providers in Port Moody, Coquitlam, Port Coquitlam, and Surrey should consider assessment when a child:
Is noticeably behind peers in motor skill development
Avoids physical activities or appears anxious about physical tasks
Struggles with activities requiring coordination (dressing, using utensils, writing)
Has difficulty learning new motor skills despite practice
Shows extreme variability in performance
Experiences social exclusion related to physical abilities
Demonstrates low self-esteem about physical capabilities
Early identification and intervention are crucial. The longer children go without support, the more they fall behind peers, and the greater the secondary impacts on fitness, social development, and mental health.
What to Expect from Physiotherapy for DCD
When families seek physiotherapy for coordination difficulties, the process typically involves:
Comprehensive Assessment: The physiotherapist evaluates gross motor skills, balance, coordination, motor planning abilities, fundamental movement skills, and how motor difficulties impact daily life. Standardized assessments like the Movement Assessment Battery for Children (MABC-2) may be used. The therapist also discusses the child's perspective on challenges and goals.
Collaborative Goal Setting: Goals should be meaningful to the child and family. Rather than generic objectives like "improve balance," goals might be "ride a bicycle independently to friends' houses" or "participate in lunchtime soccer without feeling left out."
Individualized Intervention: Treatment is tailored to the child's specific needs, using evidence-based approaches like CO-OP or NTT. Sessions typically occur weekly, with home practice between sessions being critical for progress.
School Collaboration: Many physiotherapists communicate with schools to support carryover of strategies, recommend accommodations, and ensure the child receives appropriate support in physical education.
Progress Monitoring: Regular reassessment tracks improvement and guides treatment adjustments. Progress with DCD can be gradual, so celebrating small victories maintains motivation.
Creating Success at Home and School
Families and educators play essential roles in supporting children with DCD:
At Home:
Provide opportunities to practice challenging skills in low-pressure environments
Celebrate effort and improvement, not just outcomes
Encourage physical activity without forcing participation
Break complex tasks into manageable steps
Allow extra time for tasks requiring motor skills
Focus on activities the child enjoys and shows interest in
At School:
Educate teachers about DCD and how it affects the child
Provide extra time for tasks with motor components
Offer alternatives to activities the child finds extremely challenging
Include the child in adapted ways rather than excluding them
Reduce performance pressure in physical education
Watch for and address bullying or social exclusion
Celebrate the child's non-motor strengths
The Long-Term Outlook
DCD doesn't disappear, but children can make substantial progress with appropriate intervention. Long-term studies show that while adults with DCD may continue experiencing some coordination challenges, many develop effective compensatory strategies and find activities they enjoy and excel in.
The most important factors for positive outcomes are:
Early identification and intervention
Evidence-based physiotherapy using task-oriented approaches
Consistent practice of functional skills
Supportive environments at home and school
Focus on building confidence alongside skill development
Finding physical activities the child genuinely enjoys
Many successful adults with DCD found their niche—perhaps individual sports rather than team sports, creative pursuits that involve physicality like dance or martial arts, or simply active lifestyles focused on enjoyment rather than competition.
Finding Support in Your Community
Families in Coquitlam, Port Moody, Port Coquitlam, and Surrey seeking physiotherapy for DCD should look for therapists with:
Pediatric expertise and specific experience with DCD
Training in evidence-based approaches (CO-OP, NTT, task-oriented intervention)
Collaborative approach that includes families and schools
Positive, encouraging interaction style that builds child confidence
Focus on functional goals meaningful to the child
DCD can be frustrating for children and families, but with skilled physiotherapy support, children can develop the motor skills and confidence needed to participate actively in life. Every child deserves the opportunity to play, learn, and connect with peers without being limited by coordination difficulties.
Moving Forward with Confidence
Developmental Coordination Disorder presents real challenges, but it doesn't have to limit a child's potential for an active, engaged life. With early identification, evidence-based physiotherapy intervention, supportive environments, and a focus on individual strengths, children with DCD can develop the skills and confidence needed to participate successfully in school, social activities, and physical pursuits.
For families in the Tri-Cities and Surrey noticing that their child struggles with coordination, seeking assessment from a qualified pediatric physiotherapist is an important first step. The earlier intervention begins, the better the outcomes—not just for motor skills, but for the child's overall wellbeing, social development, and self-esteem.
Children with DCD have unique strengths and abilities. The goal of physiotherapy isn't to make them "normal" or force them into activities they find frustrating. Rather, it's about providing tools and strategies that open doors to participation, building confidence through success experiences, and helping each child find their own path to an active, fulfilling life.
References
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Smits-Engelsman, B. C., Vinçon, S., Blank, R., Quadrado, V. H., Polatajko, H., & Wilson, P. H. (2018). Evaluating the evidence for motor-based interventions in developmental coordination disorder: A systematic review and meta-analysis. Research in Developmental Disabilities, 74, 72-102. https://pubmed.ncbi.nlm.nih.gov/29407287/
Cairney, J., Rigoli, D., & Piek, J. (2013). Developmental coordination disorder and internalizing problems in children: The environmental stress hypothesis elaborated. Developmental Review, 33(3), 224-238. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214155/
Polatajko, H. J., & Cantin, N. (2010). Exploring the effectiveness of occupational therapy interventions, other than the sensory integration approach, with children and adolescents experiencing difficulty processing and integrating sensory information. American Journal of Occupational Therapy, 64(3), 415-429. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972478/
Schoemaker, M. M., Niemeijer, A. S., Reynders, K., & Smits-Engelsman, B. C. (2003). Effectiveness of neuromotor task training for children with developmental coordination disorder: a pilot study. Neural Plasticity, 10(1-2), 155-163. https://pubmed.ncbi.nlm.nih.gov/14640316/
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