This phenomenological study explored the lived experience of six adults with developmental coordination disorder DCD and its potential impact on functional mobility. Utilising the International Classification of Functioning World Health Organisation,the data derived from interviews were analysed to consider how persistent motor impairments impact on activity engagement and participation.
Much of the research evidence pertaining to DCD focuses on children. However, there is increasing acknowledgment that for some, the motor impairments synonymous with DCD continue into adulthood. The findings from this study suggest that for this group of participants, functional mobility can be compromised, restricting activity and participation. However, personal factors were seen to mitigate some difficulties encountered to allow participants to remain actively engaged in a range of adult roles.
Much of the research concerning the impact of living with this motor disability has focused on children; however, there is now a general recognition that DCD is a lifelong condition, with three quarters of children going on to experience difficulties in adulthood [ 23 ].
Individuals who are diagnosed with DCD have difficulties Coordination issues in adults the learning of and the execution of effective and efficient motor skills, which can significantly impact upon a range of activities of daily living [ 4 ].
These difficulties exist in the absence of an underlying physical or neurological condition, intellectual delay or visual impairment [ 1 ]. Clinical feedback from adults living with DCD suggests that they continue to have difficulties with balance and safe functional mobility. In a pilot study conducted by the authors, Coordination issues in adults compared age and gender matched adults with and without DCD, those with DCD were reported to trip and fall more frequently than their typical peers, which is in line with early research in the field [ 6 ].
Difficulties with balance and as a consequence functional mobility 1 have been identified as a key characteristic of this neurodevelopmental disorder [ 7 ]. Furthermore, poor postural control has been postulated as an explanation for the differences between the walking patterns of children Coordination issues in adults and without DCD [ 9 ]. This has, in part, been explained by deficits in neuromuscular activity such as problems with muscle strength, power and the force and timing of muscle contractions [ 10 ].
Whilst there is less research, there is an indication that adults who meet the diagnostic criteria for DCD continue to have difficulties with proficiency of movement compared to age-matched controls well into adulthood [ 5 ]. To help explore the impact of living with such a motor disability, the International Classification of Functioning ICF [ 13 ] offers a framework that can be used to capture and classify information provided about an individual and their functioning.
The framework has "Coordination issues in adults" designed to serve a variety of purposes, including providing a common language and conceptual understanding of the definition of health and disability.
It also offers a systematic coding scheme to gather information about a population [ 13 ]. In the current study, it was used to frame our understanding of the experiences of adults with DCD.
This is the overarching term that encompasses impairments, activity limitations and participation restrictions. As the purpose of this study was to explore the negative or disabling outcomes of living with significant motor difficulties that effect functional mobility, the primary aim was to explore how adult participants with a diagnosis of DCD view their impairments, activity limitations and participation restrictions.
As there is little known about the impact of enduring motor impairments on functional mobility, and as a consequence, activity and participation levels of adults with DCD, a phenomenological approach was adopted. During their clinical visit, all volunteer participants had provided signed agreement to indicate that they were happy to be approached for research studies being undertaken by the Dyscovery research team.
This clinical recruitment strategy ensured that adult participants who took part had received a full multi-disciplinary assessment that explored all the criterion of the diagnostic criteria for DCD [ 1 ] and a diagnosis of DCD had been confirmed.
The diagnostic assessment procedures had excluded participants who were found to have a degenerative or neuromuscular medical condition. Eligible participants were invited to take part in an in-depth interview and where applicable a second follow-up telephone conversation. A sample group of between 8 and 10 participants is often quoted as typical in phenomenological research [ Coordination issues in adults ].
In total, six participants took part in this study. This number was lower than initially intended but following the six interviews, the research team believed that theoretical saturation had been reached and no new themes were emerging from the interviews.
The sample comprised of five females and one male, all of whom met the inclusion criteria. Following the provision of detailed information about the study, all provided written informed consent to take part. The first author conducted one initial in-depth semi-structured interview with each of the participants, to explore their experiences of living DCD and managing safe mobility.
A pilot interview was conducted with one of the participants to ensure the questions elicited the depth of information required. The initial semi-structured interview encouraged participants to reflect on a typical day and specifically reflect on their experiences of navigating the various activities, roles and routines they regularly undertake, identifying any mobility challenges they may experience.
Following transcription of each interview, each participant was invited to review and make changes to the transcript; five of the
Coordination issues in adults participants confirmed that the transcript was an accurate reflection of the interview and one made minor changes to the transcript. This member-checking process increased the trustworthiness of the data and also allowed the participants to expand on their reflections if they wished to do so. Where applicable, participants were also invited to take part in a follow-up individual telephone interview that focused on specific points, which had emerged from the first interview and required further explanation or exploration.
The semi-structured interview was audio recorded and transcribed verbatim and detailed field notes were taken during the telephone follow-up interview including the written recording of verbatim quotes. Participants, prior to becoming involved in the study, had understood and had given consent to anonymised verbatim quotes being
Coordination issues in adults to authenticate their experiences in any future publication of findings.
The ICF [ 13 ], a framework for health and disability, was used to help analyse the information gathered during the semi-structured interviews. Utilising this framework to theme, the data can be considered a form of directed content analysis. Both researchers were involved in the initial analysis stage with both separately coding the scripts.
Both brought different perspectives because of their professional backgrounds to the coding process, which did mean that some recoding was necessary so that both parties confirmed they were happy with the final analysis of the scripts.
Utilising the ICF framework allowed the researcher to identify from the participant own reports how their DCD and environmental factors interact and impact on daily life. The umbrella term Disability refers to the negative outcome of a health condition such as DCD and its interplay with the environment ICF [ 13 ].
Through this framework, Disability can be viewed at three levels: To explore the impact of DCD, interview transcripts were reviewed and coded in light of the negative impact that motor difficulties synonymous with the disorder have at each of these three levels. As such, the findings will be presented in line with the ICF with pertinent verbatim quotes used to authenticate the summary of results. All of the participants discussed how they are regularly very aware of their difficulties with mobility and balance as they pursued daily activities.
They often made the link between Coordination issues in adults impairments and their perceived increased chance of tripping and falling.
I am cautious now when out and about as I have so frequently tripped or missed the curb and twisted my ankle that I now have a weakness there. All six participants spoke of becoming anxious about losing their balance and could explain how they often needed to exert conscious effort to stay on their feet. I know if I loose concentration then I am likely to trip and fall when managing unfamiliar terrain. Each participant had tried to make sense of their situation and had begun to analyse and identify their motor impairments, proposing that they had impairments in such things as body awareness and spatial perception.
I am not good at making judgements about where my body is in space and I think that increases Coordination issues in adults chances of bumping into others
Coordination issues in adults things.
Many discussed how they had tried to address these impairments, for example: I have poor core stability but have been trying to work on this in the gym to try and help my balance.
Interestingly, some on further analysis had been able to identify that increased anxiety pertaining to mobility was having a negative impact on their safety when walking. My gait pattern shortens when I am anxious walking on uneven ground — but this I think probably puts me more of risk of falling.
In addition to the impact on mobility of the more obvious motor impairments associated with DCD, the participants spoke at length about how their energy levels were depleted by the effort having to be afforded to safely navigate their way around the environment.
My energy levels are sapped — sometimes think I must be lazy because others seem to fit more into their day. Fatigue or tiredness was recognised by all participants as a secondary consequence of their motor difficulties and many were aware that being tired also made them more susceptible Coordination issues in adults tripping or falling, for example:.
I get so tired and as a consequence this increases my chances of stumbling - so it is a vicious circle. As suggested by the DSM-5 [ 1 ] diagnostic criteria for DCD, all participants faced challenges with daily functioning. Undertaking personal care activities was seen to potentially increase their chances of becoming unbalanced. These activities were either avoided, as in the case of bathing, or adapted to ensure their safety.
With reference to bathing:. The combination of having to stand on one leg to get in and out and a wet surface is something I avoid. Dressing also highlighted an ongoing reliance on vision to guide movements, which was also noted when discussing moving around at night and carrying large objects that obscured the view of their feet:.
I throw the washing down the stairs for example, rather than carry it as it blocks my view of my feet. Hanging the washing on the line, as reaching up puts me off balance. Concerns were expressed about tasks undertaken away from home with one participant describing her concerns about the walk to work:.
I am aware that I become tense as I begin the descent down from the car park towards the Coordination issues in adults, it is particularly bad in the autumn and winter when it becomes slippery. Things can just take so long to complete because I know I need to slow down to do things to remain upright.
I look at people walking and texting in wonder as I know I would definitely fall or walk into something. Limitations at an activity level did appear to alter their ability to participate, although these were not
Coordination issues in adults overtly discussed. Many discussed participation in terms of how they had made conscious decisions to ensure they could complete roles such as being an employee.
For example, the way they coped in the work place because of their mobility difficulties and consequential fatigue. I aim always to arrive earlier than my colleagues so I can park nearer the building to avoid the steps and slope down from the top car park.
As soon as I could afford to, I dropped a day just to help manage the fatigue. Before that I was spending all weekend trying to recharge my batteries and missed out on family time. Interestingly, whilst DCD is often referred to as a hidden disability, they discussed their concerns about how other colleagues may view them, with one expressing: I am sure people think I am a hypochondriac when I tell them I have sprained my ankle again or when I complain about being tired.
Adding to this, they suggested that others might see them as antisocial as they are often unable to participate in the social aspects of work, which they felt helped to consolidate work relationships. Some did explain that their fear of falling stopped them completing certain past times:.
And another explained that although they try to carry on with leisure activities, their mobility difficulties did impact on their enjoyment:. I really like hill walking, however I have to concentrate so hard on where I am placing my feet and not falling over Coordination issues in adults end up not enjoying the walk at all. Participation in more active leisure pursuits with others outside of the family was also carefully selected: I look at friends skiing and ice skating and think that looks fun but could never think of joining in.
I had to have an additional hand rail put up on the stairs as I became so anxious about falling when carrying the little one down stairs. Two other participants discussed how they and their partners divided the household chores to avoid trip and falls hazards, which at times caused real frustration:. Whilst we make it work…. I do get a little upset at times when I think, surely, I should be able to do basic things like hanging the washing on the line without thinking I am Coordination issues in adults to fall.
Whilst reviewing and coding the scripts, it became obvious that a fourth theme needed to be considered—personal These were the personal attributes that these participants drew upon to mediate the disabling impact of DCD on daily life. Examples of these were the planned adaptations that were referred to throughout the interviews and help to illustrate how they positively utilised other skills to manage the effects of their motor difficulties.
For example, a number of participants discussed how they had problem-solved an issue and had rearranged their home to alleviate the risk of trips and falls:. Re-arrangements extended to their wardrobe and the modification of footwear was commonly discussed:.
I tend to pick flatties for work if I know I may have to move quickly and have bought wedges, that have a Coordination issues in adults base to stand on when going out posh. Carl is a highly intelligent, persistent, 36 year-old-adult. His Developmental Coordination Disorder affects his ability to fluidly complete tasks of daily living.
This phenomenological study explored the lived experience of six adults with developmental coordination disorder (DCD) and its potential. Developmental coordination disorder is part of a cluster of diagnoses called the motor disorders.