17-Year-Old Female with Bilateral Motor Coordination Difficulties and Spatial Awareness Challenges

Case at a Glance

A 17-year-old female presents with lifelong bilateral motor coordination difficulties, poor handwriting, hand tremor, spatial awareness deficits, and challenges with fine motor tasks, despite being functionally right-handed.

Patient's Story

The patient reports feeling as though she has 'two left hands' despite identifying as right-handed. She experiences significant difficulty distinguishing between left and right sides of her body, requiring conscious effort to remember which hand she writes with. Her handwriting is severely impaired to the point where she cannot decipher her own notes, leading to academic challenges. She describes bilateral hand tremor that interferes with precision tasks, though she can perform detailed oil painting when able to stabilize her hand. The patient struggles with spatial perception, unable to detect crooked or uneven lines, which particularly affects tasks requiring cutting or precise measurements. She has difficulty with bilateral coordination when using utensils and relies primarily on a single fork for eating. Additionally, she reports general clumsiness, frequent collisions with objects, and difficulty with body positioning and movement coordination.

Initial Assessment

Physical examination reveals bilateral hand tremor at rest and with intention. Fine motor coordination appears impaired bilaterally. The patient demonstrates difficulty with crossing midline movements and shows signs of spatial processing challenges. Handwriting sample confirms severe dysgraphia with poor letter formation and spacing.

The Diagnostic Journey

Initial considerations included developmental coordination disorder (dyspraxia), given the constellation of motor planning difficulties, spatial awareness deficits, and bilateral coordination challenges. The patient's self-reported consideration of autism spectrum disorder prompted evaluation for neurodevelopmental conditions that commonly present with motor coordination difficulties. Occupational therapy assessment was recommended to evaluate crossing midline abilities, spatial awareness, sensory processing, and overall motor planning skills.

Final Diagnosis

Developmental Coordination Disorder (Dyspraxia) with associated dysgraphia and possible comorbid neurodevelopmental condition pending further evaluation

Treatment Plan

Referral to occupational therapist specializing in neurodivergent youth for comprehensive motor skills assessment and intervention. Occupational therapy focusing on crossing midline exercises, spatial awareness training, fine motor skill development, and sensory integration techniques. Consideration for assistive technology for academic writing tasks. Follow-up evaluation for potential autism spectrum disorder assessment if indicated by comprehensive developmental history.

Outcome and Follow-up

Patient to begin occupational therapy services with goals of improving bilateral coordination, spatial processing, and fine motor control. Academic accommodations recommended including use of assistive technology for note-taking. Regular monitoring of progress with motor skills development and reassessment in 6 months to evaluate intervention effectiveness.