University of Groningen
The nature of coordination and control problems in children with developmental coordination
disorder during ball catching
Derikx, Dagmar F A A; Schoemaker, Marina M
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Human Movement Science
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10.1016/j.humov.2020.102688
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Derikx, D. F. A. A., & Schoemaker, M. M. (2020). The nature of coordination and control problems in
children with developmental coordination disorder during ball catching: A systematic review. Human
Movement Science, 74, 1-13. [102688]. https://doi.org/10.1016/j.humov.2020.102688
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Human Movement Science
journal homepage:www.elsevier.com/locate/humovFull Length Article
The nature of coordination and control problems in children with
developmental coordination disorder during ball catching: A
systematic review
Dagmar F.A.A. Derikx
⁎, Marina M. Schoemaker
Centre for Human Movement Sciences, University of Groningen, University Medical Centre Groningen, PO Box 196, 9700 AD Groningen, the Netherlands
A R T I C L E I N F O
Keywords:
DCD Ball catching
Degrees of freedom problem Coordination pattern Childhood development
A B S T R A C T
The aim of this review was to examine what is presently known about the nature of motor coordination and control problems in children with developmental coordination disorder (DCD) during ball catching and to provide directions for future research. A systematic literature search was conducted using four electronic databases (PubMed, Embase, PsycINFO and Web of Science), which identified 15 eligible studies. The results of the included studies were discussed, structured around the target population characteristics, the task used to measure motor coordination and control aspects, and the type of outcome. Children with DCD experience difficulties with both motor coordination and control during ball catching. They have been suggested to apply four compensation strategies to overcome these difficulties: a later initiation of the reaching phase, an earlier initiation of the grasping phase, a higher degree of coupling of the joints both intra- and inter-limb, and fixating the joints. However, despite these compensation strategies, children with DCD still caught fewer balls than typically developing children in all studies. This was especially due to a higher amount of grasping errors, which indicates a problem with the timing of the grasping phase. Directions for future research and practical implications were discussed.
1. Introduction
Developmental coordination disorder (DCD) is a common neurodevelopmental disorder that is characterized by impairments in the development of both fine and gross motor skills (Wilson et al., 2017). The diagnostic criteria as stated in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition specify DCD as having a lower level of motor coordination than expected con-sidering the chronological age, which interferes with activities of daily living or academic achievement. The symptoms first occur in the early developmental period and are not due to any known physical or mental medical condition (American Psychiatric Association, 2013). Following these criteria, 5%–6% of school-aged children are affected by DCD; with boys more likely to be affected than girls (Harris, Mickelson, & Zwicker, 2015).
The coordination problems in children with DCD often limit them to perform functional tasks that are required to participate successfully in sports and leisure activities, such as ball catching (Schoemaker & Smits-Engelsman, 2015). As ball skills take up an important part of sports and games during childhood, children with DCD with poor ball skills are often ridiculed by peers (Patel, Soares, & Wells, 2017), which in turn may contribute to poor self-esteem (Lodal & Bond, 2016). However, although coordination
https://doi.org/10.1016/j.humov.2020.102688
Received 30 September 2019; Received in revised form 23 September 2020; Accepted 23 September 2020
⁎Corresponding author.
E-mail address:d.f.a.a.derikx@umcg.nl(D.F.A.A. Derikx).
Human Movement Science 74 (2020) 102688
Available online 10 October 2020
0167-9457/ © 2020 The Authors. Published by Elsevier B.V.
impairments in everyday motor tasks are the core feature of DCD, surprisingly little research has been performed with a specific focus on coordination (Wade & Kazeck, 2018).
Coordination in general is defined as the patterning of head, body, and/or limb movements relative to the patterning of en-vironmental objects and events (Turvey, 1990). In this review, coordination during ball catching is defined as the ability to organize the movements of the different joints within a limb (intra) and between limbs (inter) in order to smoothly and efficiently catch the ball (Tresilian, 2012;Weiss & Jeannerod, 1998). To catch a ball, a joint can move in multiple different ways within the possible planes of motion. This creates many degrees of freedom (DOFs), which have to be coordinated (Bernstein, 1967). One solution to reduce the number of DOFs to be controlled in a novel or difficult task, is ‘rigidly and spastically fixing’ or freezing the joints by co-contracting the antagonist muscles (Guimarães, Ugrinowitsch, Dascal, Porto, & Okazaki, 2020). Another solution to reduce the number of DOFs to be controlled is by coupling the joints, which can occur both at the intra- and/or inter-limb level of organization (Weiss & Jeannerod, 1998). Coupling can occur to organize the temporal aspects of the movement by linking the angular velocity of the joints or to organize the spatial aspects of the movement by linking the angular displacement of the joints (Heuer, 1996). However, generating a functional and coordinated movement pattern is not sufficient to successfully catch a ball. This movement pattern also has to be adapted to the specific task constraints as the hands have to catch the ball at the right place and at the right time. This requires motor control, which is defined as the process of varying the parameters assigned to the motor pattern, such as force, speed, and timing (Davids, Lees, & Burwitz, 2000;Newell, 1985).
Ball catching is a task known to be difficult for children with DCD. However, studies investigating the nature of the motor coordination and control problems of children with DCD during ball catching have used different samples, methodologies, and conceptual frameworks. Therefore, the aim of this review was to examine what is presently known about the nature of the motor coordination and control problems in children with DCD during ball catching, which factors enable or constrain successful perfor-mance, and to provide directions for future research. The knowledge about which specific problems children with DCD experience during ball catching and whether they apply compensation strategies can be used in clinical practice and in interventions focusing on ball catching skills.
2. Method
This systematic review was written in accordance with the PRISMA 2009 checklist for systematic reviews (Moher, Liberati, Tetzlaff, Altman, & The PRISMA Group, 2009). The protocol for this systematic review was registered with the PROSPERO Inter-national prospective register of systematic review (registration number CRD42019120887) (Derikx & Schoemaker, 2019). 2.1. Search strategy
A systematic literature search was conducted in January 2019 using four electronic databases: PubMed, Embase, PsycINFO, and Web of Science. Search terms were composed for three categories of the research question: 1) DCD, 2) Coordination, and 3) Children and included the following terms: [(developmental coordination disorder) OR (DCD)] AND [(coordinat) OR (reach) OR (grasp) OR (catch) OR (intercept) OR (ball) OR (target)] AND [(child) OR (pediatr) OR (paediatr) OR (youth) OR (teen) OR (school) OR (kids) OR (boy) OR (girl)]. Filters used included journal articles only, English language only, and publication dates between January 1994 and January 2019. This range of publication years was chosen because the term ‘DCD’ has been internationally approved since in 1994 a consensus meeting was held in London, Ontario, Canada (Polatajko, Fox, & Missiuna, 1995).
2.2. Selection criteria
Studies were included if 1) the nature of the motor coordination or control problems of the upper extremity during ball catching in children with DCD was studied, 2) a DCD group was compared with a control group both with a mean age between 5 and 12 years, and 3) DCD was diagnosed using at least a standardized assessment of motor skill. In addition, only English written, peer-reviewed studies published between 1994 and 2019 were included. Exclusion criteria were 1) full text unavailable, 2) reviews, 3) case studies, and 4) studies focusing on an intervention.
2.3. Data extraction
After the articles were retrieved, two reviewers independently determined inclusion eligibility of each article first based on title and abstract and secondly based on full text. Any disagreements between reviewers about the inclusion of studies were resolved through discussion. The following information was extracted from the included articles by one review author: age and sex from study population and control population, details of the task used to measure motor coordination and control patterns during ball catching, movement functionality, and observed results about motor coordination and control patterns during ball catching. The results about observed motor coordination and control patterns were not limited to specific movement outcomes prior to the data extraction, but were included in this review if they fitted within our definition of these constructs. Therefore, results regarding coordination were included if they regarded the ability to organize the movements between the different joints within a limb, and between the different limbs. Results regarding motor control were included if they regarded the process of varying the parameters assigned to the motor pattern, such as force, speed, and timing. A narrative synthesis of the findings from the included studies was structured around the target population characteristics, the task used to measure motor coordination and control aspects, and the type of outcome.
2.4. Quality assessment
Study quality was independently assessed by two reviewers using the criteria proposed by Caçola, Miller, & Williamson (Caçola, Miller, & Williamson, 2017). These criteria included seven questions regarding the appropriate inclusion and description of parti-cipants, appropriate outcome measures, appropriate statistical analyses, consideration of confounding factors, and a discussion of implications and limitations of the findings. These seven criteria were answered with a ‘yes’ or ‘no’ and any disagreements between reviewers about the assessment of study quality were resolved through discussion. The quality of an article was perceived as poor when four or more questions were answered with a ‘no’, as average when three questions were answered with a ‘no’ and as high when two or less articles were answered with a ‘no’ (Caçola et al., 2017). The quality of the included studies was taken into account in the narrative synthesis of the findings.
3. Results
After searching the databases, 4246 articles were identified, of which 1976 remained after removal of duplicates. After screening on title and abstract, 16 articles remained for screening on full text, after which one article was excluded. In this study children with DCD were asked to predict the ball trajectory, but they did not have to act on this prediction (Lefebvre & Reid, 1998). Therefore, the outcome measures of this article did not fall within our definition of coordination. Finally, 15 articles were included in this review (Fig. 1). The reference lists of all included studies were searched, but no additional studies were included in this review. The authors, year of publication, sample size, subject characteristics, task and results are presented inTable 1.
3.1. Included studies
The mean age of the included children with DCD ranged from 7.3 years to 11.0 years. More boys than girls were included, with eight out of 15 studies only including boys with DCD (Asmussen, Przysucha, & Dounskaia, 2014;Asmussen, Przysucha, & Zerpa, 2014;Deconinck et al., 2006;Przysucha & Maraj, 2010;Przysucha & Maraj, 2013;Przysucha & Maraj, 2014;Sekaran, Reid, Chin, Ndiaye, & Licari, 2012). Only two studies included children with a confirmed diagnosis from a child pediatrician (Licari et al., 2018;
Table 1 Overview of the included studies. Study DCD group (n, age [y.m] (mean ± SD, range), sex (♂/♀)) Control group (n, age [y.m] (mean ± SD, range), sex (♂/♀)) Task Movement functionality (DCD vs. TD) Results (DCD showed …) Estil et al. (2002) n = 8, 11.0 ± 0.3, 10.0–11.11 a, ♂4/♀4 n = 8, 10.9 ± 0.4, 10.0–11.11 a, ♂4/♀4 One-handed catch, ball attached to pendulum system. Ball speed: 2.39 m/s, flight time: 1035 ms. – Earlier grasping phases (GI, MHA and HC), more jerky motions of the fingers before HC Van Waelvelde et al. (2004) DCD matched with younger TD: n = 29, 8.9, 8.0–9.8, ♂16/♀13 DCD matched with same age TD: n = 27, 8.9, 8.0–9-8 ♂14/♀13 DCD matched with younger TD: n = 29, 6.6, 5.10–7.8, ♂16/♀13 DCD matched with same age TD: n = 27, 8.5, 7.11–9.7 ♂14/♀13 Modified ball catching items of the TGMD and Long Ball Catching test. DCD matched with younger TD: 31.7% vs. 31.5% DCD matched with same age TD: 31.4% vs. 58.2% Less elbow flexion in preparation of catch, less arm extension in preparation of ball contact and more grasping errors than younger and same age TD Deconinck et al. (2006) n = 9, 7.3 ± 0.9, 6.0–8.11 a,♂9/ ♀0 n = 9, 7.5 ± 0.9, 6.0–8.11 a,♂9/ ♀0 One-handed catch, ball attached to pendulum system, arm fixed to armrest. Ball speed: 2.0 m/s (normal), 2.9 m/s and 3.7 m/s (faster), flight time: 625 ms, 655 ms, and 675 ms. – In all speed conditions: No difference in moment of grasping phases (GI, MHA and HC), lower HC velocity, no difference in total movement time Astill and Utley (2006) n = 8, 7.4 ± 0.3, 7.0–8.0, ♂1/♀7 n = 8, 7.3 ± 0.3, 7.0–8.0, ♂1/♀7 Two-handed catch with ball machine. Ball speed: 6.5 m/s, flight time: 800 ms. 40.0% vs. 76.7% Higher degree of inter-limb coupling in elbows, wrists and, hands, higher degree of intra-limb coupling, more jerky motions of the wrist Utley et al. (2007) n = 8, 7.4 ± 0.3, 7.0–8.11 a,♂4/ ♀4 n = 8, 7.3 ± 0.3, 7.0–8.11 a,♂4/ ♀4 Two-handed catch with ball machine. Ball speed: 6.5 m/s, flight time: 800 ms. 40.0% vs. 76.7% Less ROM of elbows, higher degree of inter-limb coupling of the elbows Astill (2007) 7-8y group: n = 5, 7.6 ± 0.1, 7.5–7.8, ♂3/♀2 9-10y group: n = 5, 9.5 ± 0.2, 9.1–9.7, ♂4/♀1 7-8y group: n = 5, 7.7 ± 0.2, 7.5–8.0, ♂3/♀2 9-10y group: n = 5, 9.6 ± 0.3, 9.2–9.9, ♂4/♀1 Two-handed catch with ball machine at central and lateral positions. Ball speed: 6.5 m/s, flight time: 800 ms. DCD caught significantly fewer balls than TD in both age groups Similar degree of intra-limb coupling in both groups and conditions, more grasping errors, high within-subject variability in hand-wrist coupling Central: Higher degree of inter-limb coupling at elbows, wrists, and hands Lateral: Lower degree of inter-limb coupling at elbows, wrists, and hands Utley and Astill (2007) n = 10, 7.6 ± 0.4, 7.0–8.0, ♂3/ ♀7 n = 10, 7.6 ± 0.3, 7.0–8.0, ♂4/♀6 Two-handed catch with ball machine. Ball speed: 6.5 m/s, flight time: 800 ms. – Joints in fingers frozen, less developmentally advanced movement patterns, trapping the ball against the chest instead of clean catching like TD children Astill and Utley (2008) n = 10, 8.7 ± 0.8, 7.4–9.7 n = 10, 8.7 ± 0.8, 7.3–9.7 Two-handed catch, ball attached to pendulum system. Ball speed: 2.5 m/s, flight time: 598 ms 78.3% vs. 93.3% Later MI, earlier GI, earlier and larger MHA, later moment of HC, higher peak movement velocity Przysucha and Maraj (2010) n = 12, 9.9 ± 0.8, ♂12/♀0 n = 12, 10.5 ± 0.8, ♂12/♀0 Two-handed catch, ball thrown by experimenter at central and lateral positions. Central: 74% vs. 96% Lateral: 47.5% vs. 94.5% DCD showed 3 patterns in both conditions: 1) controlling the ball in front of the body, 2) trapping the ball against the chest, 3) reaching towards the ball with extended elbows. TD showed these patterns during central catching but shifted towards the 1st during lateral catching. Central: More grasping errors Lateral: More spatial errors (continued on next page )
Table 1 (continued ) Study DCD group (n, age [y.m] (mean ± SD, range), sex (♂/♀)) Control group (n, age [y.m] (mean ± SD, range), sex (♂/♀)) Task Movement functionality (DCD vs. TD) Results (DCD showed …) Sekaran et al. (2012) n = 13, 9.4 ± 0.7, 8.0–10.11 a, ♂13/♀0 n = 13, 9.2 ± 0.7, 8.0–10.11 a, ♂13/♀0 Two-handed catch with ball machine. Ball speed: 5.7 m/s, flight time: 890 ms. 88% vs. 98% No difference in moment of MI, earlier shoulder and wrist movement initiation with bigger ROM, less ROM of elbows, longer movement time, lower degree of inter-limb coupling of the elbows Przysucha and Maraj (2013) n = 10, 10.5 ± 1.0, ♂10/♀0 n = 10, 10.8 ± 0.9, ♂10/♀0 Two-handed catch with ball machine at central and lateral positions. Ball speed: 7.0 m/s, flight time: 700 ms. Central: 68% vs. 98% Lateral: 48.5% vs. 91.37% Lower degree of intra-limb coupling between shoulder-elbow and elbow-wrist, more segmented movements, similar degree of inter-limb coupling at both ball positions Przysucha and Maraj (2014) n = 10, 10.5 ± 1.0, ♂10/♀0 n = 10, 10.8 ± 0.9, ♂10/♀0 Two-handed catch with ball machine. Ball speed: 7.0 m/s (baseline) and 9.0 m/ s(fast), flight time: 700 ms (baseline) and 550 ms (fast). Baseline: 65% vs. 98% Fast: 48% vs. 97% Baseline: No difference in moment of MI and peak movement velocity, similar degree of inter-limb coupling of the wrists Fast: No difference in moment of MI, slower peak movement velocity, lower degree of inter-limb coupling of the wrists, caught the ball closer to the body Asmussen, Przysucha, and Dounskaia (2014) n = 10, 11.0 ± 1.2, 9.0–12.11 a, ♂10/♀0 n = 9, 10.6 ± 1.1, 9.0–12.11 a,♂9/ ♀0 One-handed catch with ball machine. Ball speed: 7.0 m/s. 32.0% vs. 85.0% Lower movement velocity, more jerky motions of the wrist, higher within-subject variability in hand-wrist coupling. Inefficient control of the shoulder and elbow, often suppressing passive rotation of the joint instead of exploiting it Asmussen, Przysucha, and Zerpa (2014) n = 10, 11.0 ± 1.2, ♂10/♀0 n = 9, 10.6 ± 1.1, ♂9/♀0 One-handed catch with ball machine. Ball speed: 7.0 m/s. 32.0% vs. 85.0% Higher degree of intra-limb coupling between shoulder-elbow, lower degree of intra-limb coupling between elbow-wrist Licari et al. (2018) n = 11, 9.4y ± 0.7, 8.0–10.11 a, ♂11/♀0 n = 13, 9.2y ± 0.7, 8.0–10.11 a, ♂13/♀0 Two-handed catch with ball machine. Ball speed: 5.7 m/s, flight time: 890 ms. 88.2% vs. 96.2% No difference in moment of MI, longer movement time Note. Abbreviations: DCD = developmental coordination disorder; TD = typically developing; TGMD: Test of Gross Motor Development; GI: grasp initiation; MHA: maximal hand aperture; HC: hand closure; ROM: range of motion; MI: movement initiation. aRange of the age was not specified exactly, but was given in the inclusion criteria for the study.
Sekaran et al., 2012), while the other 13 studies used the criteria of the DSM-IV to determine whether the children had DCD (Asmussen, Przysucha, & Dounskaia, 2014;Asmussen, Przysucha, & Zerpa, 2014;Astill, 2007;Astill & Utley, 2006;Astill & Utley, 2008;Deconinck et al., 2006;Estil, Ingvaldsen, & Whiting, 2002;Przysucha & Maraj, 2010;Przysucha & Maraj, 2013;Przysucha & Maraj, 2014; Utley & Astill, 2007;Utley, Steenbergen, & Astill, 2007;Van Waelvelde, De Weerdt, De Cock, Smits-Engelsman, & Peersman, 2004). Out of those 13 studies, only 11 studies checked whether all criteria were met, while the other two studies only checked whether the children had motor coordination problems (Estil et al., 2002), or whether the children had motor coordination problems that were not due to any known physical or mental medical condition (Van Waelvelde et al., 2004). The ball skill per-formance of the included children with DCD was reported in seven studies. One study used a short ball catching task (Van Waelvelde et al., 2004), while the other six studies used the scores of the Ball Catching task of the Movement-ABC to report on ball skills of the sample (Asmussen, Przysucha, & Dounskaia, 2014;Asmussen, Przysucha, & Zerpa, 2014;Przysucha & Maraj, 2010;Przysucha & Maraj, 2013;Przysucha & Maraj, 2014;Sekaran et al., 2012). One out of these seven studies did not use a cut-off point for inclusion (Asmussen, Przysucha, & Dounskaia, 2014), in three studies children had to score below the 15th percentile (Asmussen, Przysucha, & Zerpa, 2014;Przysucha & Maraj, 2010;Sekaran et al., 2012) and in three other studies children had to score below the 5th percentile (Przysucha & Maraj, 2013;Przysucha & Maraj, 2014;Van Waelvelde et al., 2004). In the remaining eight studies, ball skills per-formance of the included children was unknown (Astill, 2007;Astill & Utley, 2006;Astill & Utley, 2008;Deconinck et al., 2006;Estil et al., 2002;Licari et al., 2018;Utley et al., 2007;Utley & Astill, 2007). Only one study (Przysucha & Maraj, 2010) reported that children with DCD and comorbid conditions such as ADHD and learning disabilities were included, whereas none of the other studies reported on inclusion or exclusion of comorbid conditions. The tasks used varied over the studies with four studies measuring one-handed catching (Asmussen, Przysucha, & Dounskaia, 2014;Asmussen, Przysucha, & Zerpa, 2014;Deconinck et al., 2006;Estil et al., 2002), ten studies measuring two-handed catching (Astill, 2007;Astill & Utley, 2006;Astill & Utley, 2008;Licari et al., 2018; Przysucha & Maraj, 2010;Przysucha & Maraj, 2013;Przysucha & Maraj, 2014;Sekaran et al., 2012;Utley et al., 2007;Utley & Astill, 2007), and one study measuring a combination of one- and two-handed catching (Van Waelvelde et al., 2004). The latter used a Modified Ball Catching Item of the Test of Gross Motor Development (TGMD), a two-handed catching task, to measure motor control and the Long Ball Catching test, a one-handed catching task, to measure grasping errors. The type of catching tasks can be divided into pendulum tasks (Deconinck et al., 2006; Estil et al., 2002), ball machine tasks (Asmussen, Przysucha, & Dounskaia, 2014; Asmussen, Przysucha, & Zerpa, 2014;Astill, 2007;Astill & Utley, 2006;Astill & Utley, 2008;Licari et al., 2018;Przysucha & Maraj, 2013;Przysucha & Maraj, 2014;Sekaran et al., 2012;Utley et al., 2007;Utley & Astill, 2007;Van Waelvelde et al., 2004), and tasks in which the ball was thrown by the experimenter (Przysucha & Maraj, 2010). In 12 out of 15 studies both successful and unsuccessful catches were included in the analyses, whereas the other three studies included only successful catches (Deconinck et al., 2006;Licari et al., 2018;Sekaran et al., 2012).
The quality assessment revealed all included studies to be of high quality (Table 2). Most of the criteria were met in the majority of the included studies, except for the criterion regarding an adequate discussion of the limitations and implications, which was not met in 13 of the included studies (Asmussen, Przysucha, & Dounskaia, 2014;Asmussen, Przysucha, & Zerpa, 2014;Astill, 2007;Astill & Utley, 2008;Deconinck et al., 2006;Estil et al., 2002;Przysucha & Maraj, 2010;Przysucha & Maraj, 2013;Przysucha & Maraj, 2014;Sekaran et al., 2012;Utley et al., 2007;Utley & Astill, 2007;Van Waelvelde et al., 2004).
3.2. Outcome measures
Children with DCD experience problems with ball catching. This is evident from the findings regarding movement functionality, which showed that children with DCD caught fewer balls than their same age TD peers in all studies. Two studies found an increased amount of grasping errors in children with DCD when compared to TD children (Astill, 2007;Van Waelvelde et al., 2004). In another study, most of the errors made in central catching were due to grasping errors, while in lateral catching the amount of grasping errors decreased and the amount of spatial errors increased (Przysucha & Maraj, 2010). Grasping errors are thought to be temporal in nature, since the ball hits the hand but due to an incorrect timing of the hand closure, the ball is not caught. Spatial errors, on the other hand are spatial in nature, since the hands are not positioned correctly and the hands miss the ball completely (Van Waelvelde et al., 2004). Furthermore, in one study children with DCD made more jerky motions with the fingers and wrist before hand closure (Astill & Utley, 2006), and showed a higher within-subject variability in the hand-wrist coupling (Astill, 2007) than TD children, indicating a problem with the timing of the grasp. The studies that reported an increased amount of grasping errors in children with DCD when compared to TD children, included both boys and girls within a broad mean age range (range mean age: 7.6y–9.9y) (Astill, 2007;Przysucha & Maraj, 2010;Van Waelvelde et al., 2004).
3.3. Coordination
One strategy used by children with DCD to reduce the number of DOFs during a novel or difficult task such as two-handed catching, encompassed temporarily freezing the joints (Guimarães et al., 2020). Fixation of the joints was investigated in three studies using kinematics (Przysucha & Maraj, 2013;Sekaran et al., 2012;Utley et al., 2007) and in two studies using qualitative video observation (Utley & Astill, 2007;Van Waelvelde et al., 2004). Children with DCD showed less angular displacement of the shoulder (Przysucha & Maraj, 2013), and less Range of Motion (ROM) and activity in the elbows (Sekaran et al., 2012;Utley et al., 2007;Van Waelvelde et al., 2004) than TD children. Furthermore, children with DCD held the fingers in a locked position (Utley & Astill, 2007) to reduce the number of DOFs to be coordinated.
Table 2 Quality assessment of the included studies. Study Adequate description participants a Diagnosis according to criteria b Controls involved c Adequate description of outcomes d Adequate description of statistics e Consideration of confounding factors f Adequate discussion of limitations and implications g Quality h Estil et al. (2002) Yes No Yes Yes Yes Yes No High Van Waelvelde et al. (2004) Yes No Yes Yes Yes Yes No High Deconinck et al. (2006) Yes Yes Yes Yes Yes Yes No High Astill and Utley (2006) Yes Yes Yes Yes Yes Yes Yes High Utley et al. (2007) Yes Yes Yes Yes Yes Yes No High Astill (2007) Yes Yes Yes Yes Yes Yes No High Utley and Astill (2007) Yes Yes Yes Yes Yes Yes No High Astill and Utley (2008) No Yes Yes Yes Yes Yes No High Przysucha and Maraj (2010) Yes Yes Yes Yes Yes Yes No High Sekaran et al. (2012) Yes Yes Yes Yes Yes Yes No High Przysucha and Maraj (2013) Yes Yes Yes Yes Yes Yes No High Przysucha and Maraj (2014) Yes Yes Yes Yes Yes Yes No High Asmussen, Przysucha, and Dounskaia (2014) Yes Yes Yes Yes Yes Yes No High Asmussen, Przysucha, and Zerpa (2014) Yes Yes Yes Yes Yes Yes No High Licari et al. (2018) Yes Yes Yes Yes Yes Yes Yes High Note. The following criteria were proposed by Caçola, Miller, & Williamson ( Caçola et al., 2017 ). aWas there a clear description of participants regarding age and sex? bWas the diagnosis made by a pediatrician or according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV)? cWere controls involved in the study? dWas there a clear description of the outcomes measured in the study? eWere all the statistical measures described clearly? fWere age and sex comparable at baseline or were these variables controlled for in the analyses? gWas a clear discussion considering implications and limitations of the study presented in the article? hQuality of an article was perceived as poor when four or more questions were answered with a ‘no’, as average when three questions were answered with a ‘no’ and as high when two or less articles were answered with a ‘no’.
organization (Weiss & Jeannerod, 1998). Temporal intra- and inter-limb coupling was examined during two-handed catching by calculating the correlations between the velocities of the different joints within an arm and between the arms, respectively. At the temporal intra-limb level of organization, both an overall higher degree (Astill & Utley, 2006) and a similar degree of coupling (Astill, 2007) were observed for children with DCD when compared to TD children. The study reporting a higher degree of intra-limb coupling for children with DCD, included 7 girls and only 1 boy, while the study reporting a similar degree of intra-limb coupling between both groups included more boys than girls. Regarding temporal inter-limb coupling, two studies reported a higher degree of coupling at the elbows, wrists, and hands in children with DCD during catching at a central position at a normal speed (Astill & Utley, 2006;Utley et al., 2007), while a similar degree of inter-limb coupling at the wrists was found for both groups in another study (Przysucha & Maraj, 2014). The studies that observed a higher degree of coupling for children with DCD included both boys and girls with a relatively low mean age ranging from 7.4 to 9.5 years (Astill & Utley, 2006;Utley et al., 2007), while the study that observed a similar degree of coupling only included boys with a mean age of 10.5 years (Przysucha & Maraj, 2014). A change in task constraints resulted in different findings. A lower degree of inter-limb coupling was found in children with DCD in lateral catching when the hands had to move a different distance (Astill, 2007), and in a condition in which they had to catch the ball fast (Przysucha & Maraj, 2014).
Spatial intra-limb coupling during two-handed catching was investigated in one study by calculating correlations between the displacements of the joints within the arm (Przysucha & Maraj, 2013). This study observed a lower degree of intra-limb coupling between the shoulder and the elbow, and between the elbow and the wrist in boys with DCD with a mean age of 10.5 years compared to TD children (Przysucha & Maraj, 2013). Spatial inter-limb coupling was examined by calculating correlations between the angular displacement of the joints between the two arms (Sekaran et al., 2012;Utley et al., 2007), or was statistically inferred by looking at the interaction effects of the body side variable in the analyses to see whether spatial coupling between the joints across both body sides was comparable (Przysucha & Maraj, 2013). The three studies investigating spatial inter-limb coupling found mixed results. One study observed a similar degree of overall inter-limb coupling in both groups during catching at a central and a lateral position (Przysucha & Maraj, 2013). Regarding spatial inter-limb coupling between the elbows, one study reported a higher degree (Utley et al., 2007), while another study reported a lower degree of coupling for children with DCD when compared to TD children (Sekaran et al., 2012). In the study in which a lower degree of spatial inter-limb coupling was found for children with DCD, a different movement pattern was used; one elbow was flexed and pronated more than the other, because the ball was trapped with one hand above and the other hand below the ball (Sekaran et al., 2012). Age and sex of the included children differed over the studies as well as the ball flight times. However, these variables did not influence the results in a systematic way.
Only one study investigated coupling during one-handed catching. This study examined spatial intra-limb coupling in boys with a mean age of 11.0 years (Asmussen, Przysucha, & Zerpa, 2014). In this study, children with DCD showed a higher degree of intra-limb coupling between the shoulder and elbow, and a lower degree of intra-limb coupling between the elbow and wrist than TD children (Asmussen, Przysucha, & Zerpa, 2014).
Some studies investigated the overall movement patterns of children with DCD during ball catching by using qualitative video observation (Przysucha & Maraj, 2010;Utley & Astill, 2007). According to these studies children with DCD exhibited less devel-opmentally advanced movement patterns than TD children (Utley & Astill, 2007; Van Waelvelde et al., 2004). These less devel-opmentally advanced movement patterns were expressed as different strategies to catch the ball and less adaptation to the ball's flight path. TD children tried to catch the ball in front of the body. Children with DCD tried this as well, but also showed patterns where they reached towards the ball with extended arms or trapped the ball against the chest (Przysucha & Maraj, 2010;Utley & Astill, 2007). Furthermore, children with DCD responded later to the moving ball and made less adaptations to the ball's flight path (Utley & Astill, 2007).
Only one study used inverse dynamics to investigate the strategies exhibited by children with DCD to control the shoulder and elbow joints during one-handed catching. The actively and passively produced rotations were investigated. According to the results children with DCD exhibited an inefficient control of the shoulder and elbow joints, because they often suppressed the passive rotation of the joints instead of exploiting it.
3.4. Control
Four studies investigated temporal control during two-handed catching of which three studies used kinematics (Astill & Utley, 2008;Przysucha & Maraj, 2014;Sekaran et al., 2012) and one study used qualitative video observation (Licari et al., 2018). While children with DCD initiated the reaching movement later than typically developing (TD) children in one study (Astill & Utley, 2008), three studies found no differences in moment of movement initiation between the groups (Licari et al., 2018;Przysucha & Maraj, 2014;Sekaran et al., 2012). Contrary to the later initiation of the reaching movements, one study reported an earlier initiation of the movements to grasp the ball in children with DCD (Astill & Utley, 2008). Another study reported an earlier movement initiation of the shoulder and wrist to ensure an optimal hand position to grasp the ball (Sekaran et al., 2012). Regarding movement velocity of children with DCD, mixed results were observed. Movement velocity was measured in two different ways: two studies measured peak velocity (Astill & Utley, 2008;Przysucha & Maraj, 2014), and two studies measured overall movement time (Licari et al., 2018; Sekaran et al., 2012). Regarding peak velocity, one study found a higher velocity for children with DCD than for TD children (Astill & Utley, 2008), while the other study found no difference between the groups during the baseline condition and a lower peak velocity for children with DCD during the fast condition (Przysucha & Maraj, 2014). The two studies that measured movement time reported longer movement times for children with DCD (Licari et al., 2018;Sekaran et al., 2012).
one study reported an earlier initiation of these movements (Estil et al., 2002), while another study found no difference in grasping onset (Deconinck et al., 2006). For movement velocity, measured as the overall movement time during one-handed catching, mixed results were observed for the DCD group (Asmussen, Przysucha, & Dounskaia, 2014;Deconinck et al., 2006). One study reported longer movement times for children with DCD (Asmussen, Przysucha, & Dounskaia, 2014), whereas movement time was similar to TD children in the other study (Deconinck et al., 2006). The study reporting a longer overall movement time for children with DCD involved a task with longer ball flight times (Asmussen, Przysucha, & Dounskaia, 2014).
4. Discussion
Children with DCD experience difficulties coordinating the many different possible DOFs during two-handed catching. One so-lution to this problem is a higher degree of intra- and/or inter-limb coupling of the joints both in the temporal domain and the spatial domain. Regarding temporal intra-limb coupling a similar or higher degree of coupling was found for children with DCD when compared to TD children (Astill, 2007;Astill & Utley, 2006). This may suggest that some children with DCD increase the degree of temporal intra-limb coupling as a compensation strategy to reduce the amount of DOFs to be controlled. Interestingly, the study reporting a higher degree of intra-limb coupling for children with DCD, included 7 girls and only 1 boy (Astill & Utley, 2006), while more boys than girls were included in the study that found a similar degree of intra-limb coupling between both groups (Astill, 2007). The different findings between these studies might be explained by developmental differences between sexes in ball catching, since boys develop ball skills earlier than girls (Deconinck et al., 2006;Junaid & Fellowes, 2006). Therefore, these boys may not have needed to increase intra-limb coupling due to their more advanced ball catching skills, although they still caught fewer balls than TD children.
4.1. Coordination
The three studies examining temporal inter-limb coupling, reported a similar (Przysucha & Maraj, 2014) or higher degree of coupling (Astill, 2007;Astill & Utley, 2006) during central catching for children with DCD when compared to TD children. These findings suggest that children with DCD may also increase inter-limb coupling as a strategy to reduce the number of DOFs during two-handed ball catching (Astill & Utley, 2006). It was striking that the studies that found a higher degree of inter-limb coupling for children with DCD during central catching at a normal speed (Astill, 2007;Astill & Utley, 2006) included younger children (range mean age: 7.4y-9.5y) than the study with a similar degree of inter-limb coupling (range mean age: 10.5y) (Przysucha & Maraj, 2014). Since younger children most likely have less developed catching skills than older children (Asmussen, Przysucha, & Dounskaia, 2014; Przysucha & Maraj, 2013;Przysucha & Maraj, 2014), they might need this higher degree of coupling as a compensatory strategy to catch the ball (Astill & Utley, 2006). The suggested change in the amount of inter-limb coupling across age led to an improvement in functional performance, although children with DCD still performed worse than TD children. When the degree of task difficulty increased such as in lateral catching (Astill, 2007) or with an increased ball speed (Przysucha & Maraj, 2014), a lower degree of inter-limb coupling was found for children with DCD. During such tasks TD children appeared to treat both inter-limbs as a coupling unit, while the children with DCD appeared to be unable to reduce the amount of DOFs by moving the limbs in synchrony. When each hand had to move a different distance in lateral catching, the limbs moved at different times. One arm appeared to start to move towards the ball, while the other arm appeared to catch up, which resulted in an asymmetrical movement of both arms (Astill, 2007).
Only one study investigated spatial intra-limb coupling during two-handed catching and found a lower degree of coupling be-tween the shoulder and the elbow, and bebe-tween the elbow and the wrist in boys with DCD with a mean age of 10.5 years (Przysucha & Maraj, 2013). This might suggest that children with DCD do not increase spatial intra-limb coupling as a compensation strategy to reduce the amount of DOFs to be controlled. However, this result may also be due to the included population of this study, since 10-year-old boys already may have developed more advanced coordination patterns than girls (Deconinck et al., 2006; Junaid & Fellowes, 2006).
Mixed results were observed for spatial inter-limb coupling, as a higher, similar, and lower degree of coupling was reported for children with DCD when compared to TD children (Przysucha & Maraj, 2013;Sekaran et al., 2012;Utley et al., 2007). Age and sex of the included children differed across studies and the tasks used employed different flight times. Therefore, it is unclear under which conditions children with DCD increase spatial inter-limb coupling as a compensation strategy to reduce the amount of DOFs. The study that found a lower degree of inter-limb coupling between the elbows for children with DCD when compared to TD children, also reported a different movement pattern. One elbow flexed and pronated more than the other, because the ball was trapped with one hand above and the other hand below the ball (Sekaran et al., 2012). A similar kind of trapping movement was found in other studies (Przysucha & Maraj, 2010;Utley & Astill, 2007), which might serve as a compensation strategy to increase the chance of catching the ball and prevent the ball from hitting them.
An explanation for the mixed results that were observed in the spatial domain of coordination might be found in another compensation strategy that was observed in these studies, namely fixation of the joints (Przysucha & Maraj, 2013). Rigidly and spastically fixating the joints by co-contracting the antagonist muscles temporarily reduces the number of active DOFs to be con-trolled (Guimarães et al., 2020). This strategy of fixating a joint was observed in multiple studies at the shoulder (Przysucha & Maraj, 2013), the elbow (Przysucha & Maraj, 2013;Sekaran et al., 2012;Utley et al., 2007;Van Waelvelde et al., 2004), and in the fingers (Utley & Astill, 2007) of children with DCD. By completely freezing out some of the joints, the multiple segments are no longer linked and move independently. This results in more segmented movements (Przysucha & Maraj, 2013). The fixation of joints was also observed in the movement patterns of children with DCD, as they reached towards the ball with the elbows completely extended
(Przysucha & Maraj, 2010). However, this strategy is ineffective, as children with DCD were less able to absorb the force of the ball due to these rigidly fixated elbows (Utley et al., 2007;Van Waelvelde et al., 2004).
Only one study investigated coordination during one-handed catching. This study found a higher degree of spatial intra-limb coupling between the shoulder and elbow, and a lower degree of intra-limb coupling between the elbow and wrist for children with DCD when compared to TD children (Asmussen, Przysucha, & Zerpa, 2014). These results differed from the study examining two-handed catching in a similar population, in which a lower degree of intra-limb coupling between the shoulder and the elbow, and between the elbow and the wrist was observed for children with DCD when compared to TD children (Przysucha & Maraj, 2013). This difference in results shows that different task constraints caused by one-handed and two-handed catching result in different co-ordination patterns (Asmussen, Przysucha, & Zerpa, 2014).
One study investigated the strategies exhibited by children with DCD to control the shoulder and elbow joints during one-handed catching and found that children with DCD exhibited an inefficient control of the shoulder and elbow joints, because these children often suppressed the passive rotation of the joints instead of exploiting it. The results of this study could not be compared due to a lack of other studies investigating these variables (Asmussen, Przysucha, & Dounskaia, 2014).
4.2. Control
Previously, some compensation strategies were suggested to be used by children with DCD to overcome the many DOFs to be controlled during ball catching. However, besides generating a functional and coordinated movement pattern, this movement pattern also needs to be adapted to the specific task constraints in order to catch the ball successfully. Some studies found children with DCD to initiate the reaching movements later (Astill & Utley, 2008) and the grasping movements earlier than TD children during two-handed catching (Astill & Utley, 2008;Sekaran et al., 2012). This could be interpreted as a strategy to compensate for poor motor coordination and control skills that children with DCD have become aware of. To overcome the spatial difficulties, children with DCD may have waited to see where the ball was going before initiating the reaching movement in that direction. In addition, they may have initiated grasping movements earlier in order to have more time to adapt their grasp, if needed, to catch the ball (Estil et al., 2002). However, three studies found no difference in initiation of reaching movements between children with DCD and TD children. These studies all involved tasks with a shorter ball flight time (Licari et al., 2018;Przysucha & Maraj, 2014;Sekaran et al., 2012). This might explain the lack of difference, because the more demanding temporal constraints might have made it impossible to wait and see where the ball was going to land. Therefore, these tasks may have measured the reaction time of the children with DCD rather than their temporal control, resulting in similar moments of reaching initiation (Deconinck et al., 2006). Another explanation for the lack of difference might be that only boys were included in all three studies that found no difference in reaching initiation (Licari et al., 2018;Przysucha & Maraj, 2014;Sekaran et al., 2012), whereas the study that did find a difference did not specify sex (Astill & Utley, 2008). Boys develop ball skills earlier than girls (Deconinck et al., 2006;Junaid & Fellowes, 2006), and thus it might be that these boys did not need to apply this compensation strategy in order to catch the ball. Regardless of whether the children with DCD used this compensation strategy or not, they still experienced difficulties with the timing of the grasp, which was revealed by the increased amount of grasping errors found in both boys and girls with DCD regardless of age (Astill, 2007;Przysucha & Maraj, 2010;Van Waelvelde et al., 2004). The difficulty to time the grasp was thus experienced by children with DCD independent of their age or sex. The mixed results found for movement velocity during two-handed catching could be explained by the method of measurement used. Two studies measured peak movement velocity during the reaching phase of a ball catching task at normal speed, but found contradictory results (Astill & Utley, 2008;Przysucha & Maraj, 2014). However, these studies also found contradictory results for the initiation of the reaching phase. This might explain the difference in peak velocity, because the moment of initiation of the reaching movement determines how much time remains to reach the ball. A later initiation of the reaching phase would decrease the re-maining time to reach the ball and would thus result in a higher peak velocity. One the other hand, earlier initiation of the reaching phase would give more time to reach the ball and thus a lower peak velocity would be sufficient. One of these studies (Przysucha & Maraj, 2014) compared the peak velocity between the baseline and the fast condition. A similar velocity was found for both groups during the baseline condition, while a lower velocity was observed for children with DCD when compared to TD children during the fast condition. These results might imply that children with DCD do not adapt as well to changes in temporal constraints as their TD peers (Przysucha & Maraj, 2014). Another method of measuring movement velocity is to measure overall movement time. Two studies reported overall movement time to be longer in children with DCD when compared to TD children (Licari et al., 2018;Sekaran et al., 2012). This would fit with the slow and inaccurate motor skills often exhibited by children with DCD (Przysucha & Maraj, 2014).
Temporal control was also investigated during one-handed catching. One study reported an earlier initiation of the movements to grasp the ball in children with DCD (Estil et al., 2002), while one study found no difference in grasping onset (Deconinck et al., 2006). In two-handed catching an earlier grasping phase was suggested as a compensation strategy because initiating the grasping move-ments earlier would give more time to adapt the grasp, if needed, to catch the ball (Estil et al., 2002). This might also apply to one-handed catching. Group differences might explain the different findings between these two studies. The study that reported an earlier initiation of the grasp for children with DCD included relatively older (mean age: 10.9y) boys and girls (Estil et al., 2002), whereas the study that reported no difference in initiation of the grasp included relatively younger (mean age: 7.5y) boys (Deconinck et al., 2006). Another explanation for the different findings might lie in the tasks used. The study in which an earlier grasping initiation was observed for children with DCD used a task with a longer ball flight time than the study in which no differences in grasping initiation between the groups were found. The task with a shorter ball flight time may have measured the reaction time of the children with DCD rather than their temporal control, resulting in similar moments of grasping initiation. Another temporal control variable that
was measured in two studies was overall movement time. One study reported a longer movement time for children with DCD (Asmussen, Przysucha, & Dounskaia, 2014), whereas the other study found no difference between the groups (Deconinck et al., 2006). Interestingly the study reporting a longer overall movement time for children with DCD involved a task with longer ball flight times. In this task children with DCD might have had more time to explore and adapt their movements resulting in a longer movement time (Asmussen, Przysucha, & Dounskaia, 2014).
4.3. Limitations and future directions
This is, to the best of our knowledge, the first review with a specific focus on the motor coordination and control problems children with DCD experience during ball catching. Although all studies included in this review were of high quality, some limitations need to be considered. Regarding the included samples, the samples sizes were relatively small, and results were difficult to compare due to differences in age and sex of the included children. Furthermore, except for one study (Przysucha & Maraj, 2010), none of the studies reported on the inclusion or exclusion of comorbid conditions such as ADHD. However, it is well-known that children with ADHD also have motor coordination problems and timing deficits (Fliers et al., 2008;Puyjarinet, Bégel, Lopez, Dellacherie, & Dalla Bella, 2017). Therefore, the potential presence of ADHD in these studies may have influenced the results. Another factor that made the studies hard to compare was that the level of ball skills of the included children was hardly ever reported, and if they were, different inclusion criteria were employed for the level of ball skills. Only seven studies reported the level of ball skills of the included children, and only six studies used poor ball skills as an inclusion criterion. This made it hard to assess the level of ball skills and its effect on the coordination problems experienced. The authors of this review do recognize that some of these issues, such as a sufficient sample size and the homogeneity of the sample are practical in nature and difficult to overcome. However, these issues need to be addressed in order to give more conclusive evidence about coordination and control strategies during ball catching. Therefore, for future studies we recommend to apply power analyses to include sufficient samples sizes and thereby increase the quality of hypothesis testing. Furthermore, answering this empirical question requires further investigation in boys and girls separately and demands the use of a narrow age range, in order the unravel the influence of sex and age. These studies should include children with DCD according to the criteria of the DSM-IV and preferably without comorbid conditions, but if comorbid conditions are present, they should at least be reported. Finally, preferably only children with poor ball skills should be included so that coordination and control patterns can be investigated in children who experience difficulties with this task and clinical practice can be properly informed.
Regarding the description of the outcomes, three studies included only successful catches, while in the remaining studies, both successful and unsuccessful catches were included. This made it hard to determine which coordination and control patterns lead to successful catches in children with DCD and which do not. To determine which of the applied strategies lead to successful catches, in future studies a clear distinction should be made between the coordination and/or control patterns that lead to successful and unsuccessful catches. Furthermore, it has been shown in previous research that as task complexity increases, the difficulties children with DCD experience during a task increase as well (Adams, Lust, Wilson, & Steenbergen, 2014). Therefore, future studies should continue investigating varying task difficulty by including both central and lateral catching and by using different ball speeds. Another issue in studies investigating ball catching in children with DCD is that studies either focus on the temporal or the spatial aspects of motor coordination and control. However, the spatial and temporal aspects of these domains are interlinked, as they both play a role in successful catching. Therefore, future studies should focus on these interlinked domains instead of studying them separately. Another separate but related issue within research into coordination and control patterns during ball catching lies within the distinction between the terms coupling and fixating. Some studies included in this review distinguished coupling and fixating as two separate strategies (Astill & Utley, 2006; Utley et al., 2007), but other studies used the terms fixating and coupling inter-changeably (Przysucha & Maraj, 2013;Sekaran et al., 2012), thereby creating confusion about the strategies used by children with DCD to coordinate their movement. Future research should thus make a clear distinction between these terms.
By applying all these recommendations, a clearer overview could be given about the different coordination and control strategies exhibited by all subpopulations under various conditions. This could inform clinical practice more clearly, because children with DCD make up a heterogeneous group. Children with DCD do not demonstrate a standard pattern of motor behavior, but they have to find their own functional pattern of behavior when dealing with their unique individual constraints in relation to task and environmental constraints (Wilmut, 2017). Therefore, more attention to individual differences in research with children with DCD is warranted. Furthermore, the present review mainly focussed on the motor coordination and control problems of children with DCD during ball catching. However, the ability to use visual information also plays a role in ball catching. It is known that children with DCD fixate their gaze less on the ball prior to catching (Wilson, Miles, Vine, & Vickers, 2013). Therefore, not only coordination and control, but also perceptual-motor integration should be key elements of future research.
4.4. Practical implications
DCD is a condition without a cure and thus the purpose of interventions should be to provide strategies to make motor tasks in daily life easier instead of treating the condition. The four compensation strategies suggested in this review may be helpful to clinical practice, because it is important to identify and understand the different compensation strategies that children with DCD may apply to find adequate motor solutions. These deviations from the normal movement patterns should not be considered as incorrect, because they might be the optimal movement patterns for children with DCD (Latash & Anson, 1996;Wilmut, 2017). Therefore, interventions focusing on improvement of ball catching skills in children with DCD should not aim to correct these deviations, but should encourage children with DCD to explore different movement patterns in order to find the most efficient and accurate ones
(Astill, 2007). An intervention that has showed promising results, is the Quiet Eye Training (QET;Miles, Wood, Vine, Vickers, & Wilson, 2015;Słowiński et al., 2019;Wilson et al., 2013;Wood et al., 2017). This intervention does not solely focus on improving the movements related to ball catching, but focusses on controlling eye movements so that the ball is tracked for a longer period of time. Results show that children with DCD do not only improve their gaze control, but this is also followed by better anticipation and pursuit tracking on the ball, which leads to improved coordination during ball catching (Miles et al., 2015;Słowiński et al., 2019; Wilson et al., 2013;Wood et al., 2017). However, further investigation of the long-term effects of this intervention is required.
5. Conclusion
From the results of this review, it can be concluded that children with DCD experience difficulties with both motor coordination and control during ball catching, which has been shown by the large amount of catching errors observed in children with DCD. Evidence was found for four compensation strategies to deal with coordination and control issues during ball catching: a higher degree of coupling of the joints both intra- and inter-limb, fixating the joints, a later initiation of the reaching phase and an earlier initiation of the grasping phase. However, it is hard to draw firm conclusions about the nature of the coordination and control problems experienced by children with DCD during ball catching, due to the differences between the included studies in subject characteristics and tasks. Therefore, further research is warranted to investigate under which conditions these compensation stra-tegies are applied. Future research should thus focus on further unraveling the different coordination and control patterns exhibited by all subpopulations under different task constraints.
Declaration of Competing Interest
None.
Acknowledgements
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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