Effective postural control is essential for motor skill development, yet the specific nature of anticipatory control in children with Developmental Coordination Disorder (DCD) remains poorly understood for complex or dynamic stability tasks. This study investigated anticipatory postural adjustments (APA) during a self-initiated dynamic stability task. The Can Placement Task (CPT)-a self-initiated dynamic stability task-was performed by 23 children with DCD and 30 typically developing (TD) children aged 9-12 years. The task involved standing on one leg while also repositioning a can on the floor. Center of pressure (COP) movement was recorded by two force platforms during the five phases of the movement. The ground reaction force measured external support during both descent to pick up the can and ascent after replacing the can. The study used a mixed-design approach with group (DCD, TD) as a between-subject factor and condition (can position close or far) and phase of movement as within-subject. Distinct movement control characteristics were shown for children with DCD including a greater range of COP movement and higher COP velocity in the anterior-posterior direction prior to movement initiation compared with TD. The DCD group also relied more on external support during both the downward and upward phases of the CPT and needed more trials to complete the task. Only two significant interaction effects involving Group and the within-subject factors emerged. Children with DCD swayed significantly more at specific phases of the task, especially when coming up and restoring balance, and did not adapt COP velocity as a function of reaching distance. Dynamic control of posture in children with DCD is impaired as they struggle to generate the effective APAs necessary to maintain dynamic stability which leads to greater reliance on external support and more corrective movements. The CPT provides a valuable assessment of posture and dynamic balance control during a complex prehension movement performed on one leg; the task highlights distinct movement patterns between children with and without DCD.

Clinical and Developmental Neuropsychology University of Groningen Groningen The Netherlands

Department of Natural Sciences in Kinanthropology Faculty of Physical Culture Palacký University Olomouc Olomouc Czech Republic

Division of Physiotherapy Department of Health and Rehabilitation Sciences Faculty of Health Sciences University of Cape Town Cape Town South Africa

Healthy Brain and Mind Research Centre Australian Catholic University Melbourne VIC Australia

Physical Activity Sport and Recreation Faculty Health Sciences North West University Potchefstroom South Africa

See more in PubMed

American Psychiatriac Association. Diagnostic and statistical manual of mental disorders, fifth edition, text revision (DSM-5-TR) (American Psychiatriac Association, 2022). 10.1176/appi.books.9780890425787

Subara-Zukic, E. et al. Behavioral and neuroimaging research on developmental coordination disorder (DCD): A combined systematic review and meta-analysis of recent findings. Front. Psychol. 13, 809455. 10.3389/fpsyg.2022.809455 (2022). PubMed PMC

Adams, I. L. J., Lust, J. M., Wilson, P. H. & Steenbergen, B. Compromised motor control in children with DCD: A deficit in the internal model? A systematic review. Neurosci. Biobehav Rev. 47, 225–244. 10.1016/j.neubiorev.2014.08.011 (2014). PubMed

Katschmarsky, S., Cairney, S., Maruff, P., Wilson, P. H. & Currie, J. The ability to execute saccades on the basis of efference copy: Impairments in double-step saccade performance in children with developmental co-ordination disorder. Exp. Brain Res. 136 (1), 73–78. 10.1007/s002210000535 (2001). PubMed

Wilson, P. H. et al. Cognitive and neuroimaging findings in developmental coordination disorder: New insights from a systematic review of recent research. Dev. Med. Child. Neurol. 59 (11), 1117–1129. 10.1111/dmcn.13530 (2017). PubMed

Tanaka, H., Ishikawa, T., Lee, J. & Kakei, S. The cerebro-cerebellum as a locus of forward model: A review. Front. Syst. Neurosci. 14, 19. 10.3389/fnsys.2020.00019 (2020). PubMed PMC

Welniarz, Q., Worbe, Y. & Gallea, C. The forward model: A unifying theory for the role of the cerebellum in motor control and sense of agency. Front. Syst. Neurosci. 15, 644059. 10.3389/fnsys.2021.644059 (2021). PubMed PMC

Miall, R. C., Weir, D. J., Wolpert, D. M. & Stein, J. F. Is the cerebellum a Smith predictor? J. Motor Behav. 25 (3), 203–216. 10.1080/00222895.1993.9942050 (1993). PubMed

Wolpert, D. M., Ghahramani, Z. & Jordan, M. I. An internal model for sensorimotor integration. Science. 269 (5232), 1880–1882. 10.1126/science.7569931 (1995). PubMed

Belenkii, V. E., Gurfinkel, V. S. & Paltsev, E. I. On the control elements of voluntary movements. Biofizika. 12 (1), 135–141 (1967). PubMed

Latash, M. Neurophysiological basis of movement 2nd edn (Human Kinetics, 2008).

Klous, M., Mikulic, P. & Latash, M. L. Two aspects of feedforward postural control: Anticipatory postural adjustments and anticipatory synergy adjustments. J. Neurophysiol. 105 (5), 2275–2288. 10.1152/jn.00665.2010 (2011). PubMed PMC

Aruin, A. S. & Latash, M. L. The role of motor action in anticipatory postural adjustments studied with self-induced and externally triggered perturbations. Exp. Brain Res. 106 (2), 291–300. 10.1007/BF00241125 (1995). PubMed

McCombe Waller, S. et al. Impaired motor preparation and execution during standing reach in people with chronic stroke. Neurosci. Lett. 630, 38–44. 10.1016/j.neulet.2016.07.010 (2016). PubMed

Geuze, R. H. Static balance and developmental coordination disorder. Hum. Mov. Sci. 22 (4–5), 527–548. 10.1016/j.humov.2003.09.008 (2003). PubMed

Tsai, C. L., Wu, S. K. & Huang, C. H. Static balance in children with developmental coordination disorder. Hum. Mov. Sci. 27 (1), 142–153. 10.1016/j.humov.2007.08.002 (2008). PubMed

Verbecque, E. et al. Balance control in individuals with developmental coordination disorder: A systematic review and meta-analysis. Gait Posture. 83, 268–279. 10.1016/j.gaitpost.2020.10.009 (2021). PubMed

Wolpert, D. M. & Flanagan, J. R. Computations underlying sensorimotor learning. Curr. Opin. Neurobiol. 37, 7–11. 10.1016/j.conb.2015.12.003 (2016). PubMed PMC

Fong, S. S. M. et al. Deficits in lower limb muscle reflex contraction latency and peak force are associated with impairments in postural control and gross motor skills of children with developmental coordination disorder: A cross-sectional study. Medicine. 94 (41), e1785. 10.1097/MD.0000000000001785 (2015). PubMed PMC

Cignetti, F. et al. Feedforward motor control in developmental dyslexia and developmental coordination disorder: Does comorbidity matter? Res. Dev. Disabil. 76, 25–34. 10.1016/j.ridd.2018.03.001 (2018). PubMed

Kane, K. & Barden, J. Contributions of trunk muscles to anticipatory postural control in children with and without developmental coordination disorder. Hum. Mov. Sci. 31 (3), 707–720. 10.1016/j.humov.2011.08.004 (2012). PubMed

Wilson, P. et al. Cognitive and motor function in developmental coordination disorder. Dev. Med. Child. Neurol. 62 (11), 1317–1323. 10.1111/dmcn.14646 (2020). PubMed

Johnston, L. M., Burns, Y. R., Brauer, S. G. & Richardson, C. A. Differences in postural control and movement performance during goal directed reaching in children with developmental coordination disorder. Hum. Mov. Sci. 21 (5–6), 583–601. 10.1016/S0167-9457(02)00153-7 (2002). PubMed

Wilson, P. H., Ruddock, S., Smits-Engelsman, B., Polatajko, H. & Blank, R. Understanding performance deficits in developmental coordination disorder: A meta-analysis of recent research. Dev. Med. Child. Neurol. 55 (3), 217–228. 10.1111/j.1469-8749.2012.04436.x (2013). PubMed

Smits-Engelsman, B. et al. Which outcomes are key to the pre-intervention assessment profile of a child with developmental coordination disorder? A systematic review and meta-analysis. Biomedical J. 100768. 10.1016/j.bj.2024.100768 (2024). PubMed

Subara-Zukic, E., McGuckian, T. B., Cole, M. H., Steenbergen, B. & Wilson, P. H. Locomotor-cognitive dual-tasking in children with developmental coordination disorder. Front. Psychol. 15. 10.3389/fpsyg.2024.1279427 (2024). PubMed PMC

Rajachandrakumar, R. et al. Atypical anticipatory postural adjustments during gait initiation among individuals with sub-acute stroke. Gait Posture. 52, 325–331. 10.1016/j.gaitpost.2016.12.020 (2017). PubMed PMC

Farinelli, V., Bolzoni, F., Marchese, S. M., Esposti, R. & Cavallari, P. A novel viewpoint on the anticipatory postural adjustments during gait initiation. Front. Hum. Neurosci. 15. 10.3389/fnhum.2021.709780 (2021). PubMed PMC

Inder, J. M. & Sullivan, S. J. Motor and postural response profiles of four children with developmental coordination disorder. Pediatr. Phys. Ther. 17 (1), 18–29. 10.1097/01.PEP.0000154184.06378.F0 (2005). PubMed

French, B., Sycamore, N. J., McGlashan, H. L., Blanchard, C. C. V. & Holmes, N. P. Ceiling effects in the Movement Assessment Battery for Children-2 (MABC-2) suggest that non-parametric scoring methods are required. PLOS ONE. 13 (6), e0198426. 10.1371/journal.pone.0198426 (2018). PubMed PMC

Valtr, L., Psotta, R. & Abdollahipour, R. Gender differences in performance of the Movement Assessment Battery for Children—2nd edition test in adolescents. Acta Gymnica. 46 (4), 155–161. 10.5507/ag.2016.017 (2016).

Bouisset, S. & Zattara, M. Anticipatory postural adjustments and dynamic asymmetry of voluntary movement. In: (eds Gurfinkel, V. S., Ioffe, M. E., Massion, J. & Roll, J. P.) Stance and Motion: Facts and Concepts. Boston, MA: Springer US; 177–183. (1988).

Zattara, M. & Bouisset, S. Posturo-kinetic organisation during the early phase of voluntary upper limb movement. 1 Normal subjects. J. Neurol. Neurosurg. Psychiatry. 51 (7), 956–965. 10.1136/jnnp.51.7.956 (1988). PubMed PMC

Bouisset, S. & Zattara, M. Biomechanical study of the programming of anticipatory postural adjustments associated with voluntary movement. J. Biomech. 20 (8), 735–742. 10.1016/0021-9290(87)90052-2 (1987). PubMed

Henderson, S. E., Sugden, D. A. & Barnett, A. L. Movement Assessment Battery for Children-2 (Harcourt Assessment, 2007).

Smits-Engelsman, B. C. M., Bonney, E., Neto, J. L. C. & Jelsma, D. L. Feasibility and content validity of the PERF-FIT test battery to assess movement skills, agility and power among children in low-resource settings. BMC Public. Health. 20, 1139. 10.1186/s12889-020-09236-w (2020). PubMed PMC

Smits-Engelsman, B. C. M. et al. Inter-rater reliability and test-retest reliability of the Performance and Fitness (PERF-FIT) test battery for children: A test for motor skill related fitness. BMC Pediatr. 21(1). 10.1186/s12887-021-02589-0 (2021). PubMed PMC

Cornilleau-Pérès, V. et al. Measurement of the visual contribution to postural steadiness from the COP movement: Methodology and reliability. Gait Posture. 22 (2), 96–106. 10.1016/j.gaitpost.2004.07.009 (2005). PubMed

Raymakers, J. A., Samson, M. M. & Verhaar, H. J. J. The assessment of body sway and the choice of the stability parameter(s). Gait Posture. 21 (1), 48–58. 10.1016/j.gaitpost.2003.11.006 (2005). PubMed

Cohen, J. Statistical power analysis for the behavioral sciences 2nd edn 567 (Academic, 1988). 10.4324/9780203771587

Kiss, R., Schedler, S. & Muehlbauer, T. Associations between types of balance performance in healthy individuals across the lifespan: A systematic review and meta-analysis. Front. Physiol. 9, 1366. 10.3389/fphys.2018.01366 (2018). PubMed PMC

Chagdes, J. R., Rietdyk, S., Jeffrey, M. H., Howard, N. Z. & Raman, A. Dynamic stability of a human standing on a balance board. J. Biomech. 46 (15), 2593–2602. 10.1016/j.jbiomech.2013.08.012 (2013). PubMed

Winter, D. A. Human balance and posture control during standing and walking. Gait Posture. 3(4), 193–214. 10.1016/0966-6362(96)82849-9 (1995).

Aaberg, E. Muscle mechanics 2nd edn (Human Kinetics, 2006).

Gill, K. K., Lang, D. & Zwicker, J. G. Cerebellar and brainstem differences in children with developmental coordination disorder: A voxel-based morphometry study. Front. Hum. Neurosci. 16, 921505. 10.3389/fnhum.2022.921505 (2022). PubMed PMC

Fong, S. S. M. et al. Neuromuscular processes in the control of posture in children with developmental coordination disorder: Current evidence and future research directions. Curr. Dev. Disord Rep. 5 (1), 43–48. 10.1007/s40474-018-0130-9 (2018).

Fong, S. S. M., Ng, S. S. M. & Yiu, B. P. H. L. Slowed muscle force production and sensory organization deficits contribute to altered postural control strategies in children with developmental coordination disorder. Res. Dev. Disabil. 34 (9), 3040–3048. 10.1016/j.ridd.2013.05.035 (2013). PubMed

Demers, I., Moffet, H., Hébert, L. & Maltais, D. B. Growth and muscle strength development in children with developmental coordination disorder. Dev. Med. Child. Neurol. 62 (9), 1082–1088. 10.1111/dmcn.14507 (2020). PubMed

Gazya, A. A. G., Serief, A. A. A., Abd el Ghaffar, M. A. & Aneis, Y. M. Effect of isokinetic training on knee muscle strength and balance control in children with developmental coordination disorder: A randomized controlled trial. Med. J. Cairo Univ. 82 (2), 69–78 (2014).

Bubic, A., von Yves, D. & Schubotz, R. I. Prediction, cognition and the brain. Front. Hum. Neurosci. 4. 10.3389/fnhum.2010.00025 (2010). PubMed PMC

Harkness-Armstrong, C., Hodson-Tole, E. F., Wood, G. & Mills, R. Children with developmental coordination disorder are less able to fine-tune muscle activity in anticipation of postural perturbations than typically developing counterparts. Front. Hum. Neurosci. 17, 1267424. 10.3389/fnhum.2023.1267424 (2023). PubMed PMC

Smits-Engelsman, B. C. M., Westenberg, Y. & Duysens, J. Children with developmental coordination disorder are equally able to generate force but show more variability than typically developing children. Hum. Mov. Sci. 27 (2), 296–309. 10.1016/j.humov.2008.02.005 (2008). PubMed

Fong, S. S. M., Chung, J. W. Y., Chow, L. P. Y., Ma, A. W. W. & Tsang, W. W. N. Differential effect of Taekwondo training on knee muscle strength and reactive and static balance control in children with developmental coordination disorder: A randomized controlled trial. Res. Dev. Disabil. 34 (5), 1446–1455. 10.1016/j.ridd.2013.01.025 (2013). PubMed

Raynor, A. J. Strength, power, and coactivation in children with developmental coordination disorder. Dev. Med. Child. Neurol. 43 (10), 676–684. 10.1111/j.1469-8749.2001.tb00141.x (2001). PubMed

Kane, K. & Barden, J. Frequency of anticipatory trunk muscle onsets in children with and without developmental coordination disorder. Phys. Occup. Ther. Pediatr. 34 (1), 75–89. 10.3109/01942638.2012.757574 (2014). PubMed

Yam, T. T. T. & Fong, S. S. M. Y-Balance Test performance and leg muscle activations of children with developmental coordination disorder. J. Motor Behav. 51 (4), 385–393. 10.1080/00222895.2018.1485011 (2019). PubMed

Smits-Engelsman, B. C. M., Wilson, P. H., Westenberg, Y. & Duysens, J. Fine motor deficiencies in children with developmental coordination disorder and learning disabilities: An underlying open-loop control deficit. Hum. Mov. Sci. 22 (4–5), 495–513. 10.1016/j.humov.2003.09.006 (2003). PubMed