The Effect of Motor Skill Training Program on Activity of Daily Living in Children with Developmental Coordination Disorder

The incidence of children with developmental coordination disorder (DCD) is about 5% to 6% in school-age with 1.7 to 2.8 times more likely to occur in boys than girls. Difficulties in all motor activities, including activities daily living (ADL) are experienced by children with DCD. Motor skill training (MST) which a task-oriented based on basic motor abilities is highly recommended to improve motor achievement and execution of specific motor functions in children with DCD. The purpose of this study was to determine the effect of MST in increasing ADL ability in children with DCD. This research used pre-experimental study with 'the one group pretest-posttest design'. Ten children were selected as respondents to observe their ADL ability using DCDDaily before and after being given MST. The result of statistical analysis showed significant change in the total ADL score before and after being given MST (mean difference 13.95, p-value 0.001), with mean difference of total score before and after 15.9 (p-value 0.001) and mean difference of total score quality before and after 8.4 (p-value 0.005). The conclusion of this research is motor skill training can help improve ADL abilities in children with DCD.

show lower abilities on ADL compared to their typical peers (Linde et al., 2015).The term DCD is used to replace previous terms such as clumsy child syndrome and motorlearning difficulties, which are often referred to as dyspraxia (Ball, 2006).

The American Psychiartric Association
(APA) in 2013 reported an incidence of DCD was about 5% to 6% in school-age.
DCD is 1.7 to 2.8 times more likely to occur in boys than girls (Harris et al., 2015). The American Physical Therapy Association (2006) reported that 5% of children aged 5- Various ADLs may be affected by DCD, depending on the individual's age. Children entering kindergarten display a strange gait, have problems getting dressed (buttons, shoelaces) and using cutlery and crockery (spoon, cup), poor drawing or painting skills, clumsy use of scissors, and difficulty riding a tricycle or bicycle. At primary school, they have difficulty writing, drawing, and using scissors, and demonstrate clumsiness in ballgames (Geuze et al., 2001). At secondary school, they continue to have problems with handwriting or typing (Kirby et al., 2010(Kirby et al., , 2013. Because of these difficulties at school, they often choose courses designed for lower-ability pupils. They gradually lose motivation and experience repeated 3 Jurnal Ilmu dan Teknologi Kesehatan, Vol.10, No.1, September 2022 (Magalhães et al., 2011).
Consequently, they have a heightened risk of health problems such as being overweight, obesity, and cardiovascular disease (Cairney et al., 2012).
According to APTA Pediatrics (2020), physiotherapy has a major role in developing the right diagnosis and treatment for children with DCD so that they can actively participate in activities of daily living and achieve maximum quality of life according to their potential. They have recommended task-oriented interventions as the first choice in treating children with DCD. Task-oriented interventions are motor activities or programs to improve the achievement and execution of specific functional motor tasks.
Motor Skill Training (MST) is a physiotherapy intervention with a taskoriented approach. Task-oriented is the theoretical basis of motor control and motor learning, focuses on achieving goals through active participation, and progressively increasing task demands (Dannemiller et al., 2020). A variety of functional tasks and exercises are designed to address common motor difficulties faced by children with DCD, such as agility, balance, core stability, and poor movement coordination. When training takes place, task-oriented is adapted to ensure successful task execution while providing adequate challenges for children's motor skills (Farhat et al., 2016).
The study conducted by (Farhat et al., 2015) showed that the physical capacity of DCD

RESULTS AND DISCUSSION
Univariate analysis showed the characteristics of respondents in this study.
Age, gender, education level, and ADL ability were the variables analyzed to determine the characteristics of the respondents involved in this study.   (Wilson et al., 2013). Ninety percent of the respondents are male, it is as previously known that boys have 1.7 to 2.8 times higher risk of experiencing DCD than girls (Harris et al., 2015).

Time
The time score was determined based on the length of time in seconds that respondents needed to complete the examination task.
The average total time score before MST was given was 43.4 and standard deviation was 3.4. Table 3 (Farhat et al., 2015). The poor quality of the tasks performed by the respondents was caused by dysfunction in basic visuo-sensory processing, visualspatial, tactile perception, kinesthetic, greatly affecting the basic processing speed.
These   After being given the MST intervention, the average total quality score was 26.3 and the standard deviation was 3.4 (Table 7). The decrease in the average value of this quality score indicates an increase in the quality of the tasks produced by respondents after being given the MST intervention. For example, the total score quality of writing decreased from 30 to 19, it showed that writing task is hard to accomplised by respondents before the intervention is given.
Poor control over the kinematic and dynamic variables may disturb handwriting movements (Biotteau et al., 2019). The Wilcoxon rank test was then performed to determine whether the MST intervention was statistically significant to the total quality score. This test was chosen because the quality score data before being given treatment was normally distributed while the quality score data after being given treatment was not normally distributed ( MST on the quality of tasks produced by DCD children as research conducted by Farhat et al., (2016) that the quality of ADL tasks in the intervention group experienced a significant increase after being given MST.

Activity of Daily Living
In this study, it was found that all respondents were in the category of having problems with ADL. These results are the interpretation of the measurement of ADL ability using DCDDaily before being given the MST intervention. The total ADL score was the result of the sum of the total time scores and the total quality scores then divided by two. The average total ADL score before being given the MST (pre-test) was 40.85 and the standard deviation was 2.47 (Table 9).  Paired sample t-test was then performed to determine whether the MST intervention was statistically significant. Table 9 shows the difference in the mean total ADL score before and after being given the intervention of 13.95 with a p-value of 0.001 < α (0.05) which means that there is a statistically significant difference in the mean total ADL score before and after the intervention, so that it can be concluded that MST can help children with DCD to improve their speed and quality in performing daily activities.
As in the research of Yu et al., (2018), that motor skills intervention is effective for improving the motor, cognitive, emotional, and abilities of DCD children in performing activity of daily living (ADL).

CONCLUSION
Based on the results and discussions that have been described in this study, it can be concluded that Motor Skill Training has an effect on increasing the ability of activity of daily living in children with DCD. The speed (time) and quality of ADL in DCD children increased after being given MST.

ACKNOWLEDGEMENT
The researchs would like to thank the Head