Current approaches for training postural control in children with developmental coordination disorder: A systematic review and meta-analysis

Abstract

Aim This study primarily evaluated the effectiveness of postural control training in children with Developmental Coordination Disorder (DCD) and secondarily mapped targeted postural systems and adherence to DCD guidelines. Methods A systematic search (PubMed, Web of Science, Scopus) was conducted. Data on participants, training, postural systems (Anticipatory Postural Adjustments (APA), Reactive Postural Adjustments, Orientation in Space, Control of Dynamics, Sensory Orientation, Biomechanical Factors, Cognitive Functioning), outcome measures, and adherence to DCD guidelines (task-/goal-/context-oriented) were extracted. Effect sizes (ES; Hedges' g) and 95 % confidence intervals (CI) were calculated using a random-effects model. Results Sixteen studies (818 children with DCD; 527 in training) were included, covering twenty training programs: exergaming (n = 7), task-specific (n = 5), sport-specific (n = 4), strength (n = 2), reactive (n = 1), and generic balance (n = 1) training. Compared to no training, postural control training showed large benefits (ES= -1.79, 95 % CI=[-2.37;- 1.14], p < 0.001), however, effects were non-significant when compared between training types (ES: 0.17; CI=[-0.34;0.67]). Most programs targeted up to three postural systems, focusing on APA, Orientation in Space, and Control of Dynamics. Few were goal- or context-specific, limiting adherence to DCD guidelines. Conclusion Large effect sizes indicate beneficial effects for children with DCD after postural control training compared to no training but does not indicate a preference for any type of training. Current training programs lack a multi-systemic approach, potentially limiting effectiveness, and often fail to incorporate goal-oriented and contextspecific elements. These gaps in literature emphasize the need for therapists to consider all postural control systems and DCD guidelines when designing training programs