Watching and Imagining Movement Boosts Motor Skills and Thinking in Children with Coordination Disorder

Children with developmental coordination disorder, or DCD, struggle with the everyday mechanics of childhood: catching a ball, tying shoelaces, keeping pace on the playground. The condition affects roughly five to six percent of school-aged children, and its consequences reach far beyond clumsy movements. A growing body of research links DCD to difficulties with executive function, the suite of mental skills that governs attention, working memory, and self-control. Now a pilot randomized controlled trial from researchers at Shanghai University of Sport, published in Pediatric Research, offers an intriguing hint that training the body and the mind together may pay dividends on both fronts.

The study, led by Ji-Wei Chen and Guan-Li Ma, who contributed equally to the work, tested a school-based programme that combined fundamental movement skills training with a technique known as action observation and motor imagery, or AOMI. Twenty children with DCD were randomly assigned to one of two groups. The experimental group received movement skills training plus AOMI, while the active control group received the same movement training paired with video-based physical activity education. Both groups completed sessions three times per week for ten weeks, ensuring that any difference between the groups could be attributed to the added mental training rather than to extra attention or practice time.

The logic behind AOMI rests on one of neuroscience’s most celebrated discoveries: the brain’s motor system does not merely execute movements, it also rehearses them. Watching someone perform an action activates many of the same neural circuits that fire when we perform it ourselves, and vividly imagining a movement engages overlapping machinery, including the primary motor cortex and the corticospinal pathways that carry commands to the muscles. Previous meta-analyses have shown that combining action observation with motor imagery can heighten corticospinal excitability and improve movement outcomes in healthy adults. What remained untested was whether this approach, layered onto conventional movement training, could help children whose motor systems develop atypically.

To measure progress, the researchers used the Test of Gross Motor Development, third edition, a widely validated instrument that scores children on locomotor skills such as running and hopping and on ball skills such as catching and throwing. Executive function was probed with three computerized tasks: the More-Odd Shifting task, which taps cognitive flexibility; the Stroop task, a classic test of inhibitory control in which children must suppress the urge to read a word and instead name its ink colour; and a Spatial Working Memory task. The team also computed inverse efficiency scores, which combine reaction time and accuracy into a single measure, a technique designed to guard against the well-known speed-accuracy trade-off that can make raw reaction times misleading.

The results were encouraging, though the authors are careful to frame them as preliminary. Both groups improved their gross motor skills over the ten weeks, which is itself reassuring, since it suggests that structured movement training benefits children with DCD regardless of the cognitive component. But the gains were larger in the experimental group, the children who had watched and mentally rehearsed movements in addition to practising them physically. In other words, the mental layer appeared to amplify the physical one.

The executive function findings followed a similar but more nuanced pattern. The experimental group showed greater improvements mainly in reaction time and inverse efficiency scores, meaning that after training, these children responded faster on cognitive tasks and performed better once speed and accuracy were considered together. Accuracy improvements, by contrast, were limited and reached statistical significance only in selected task conditions. This dissociation is scientifically interesting. It suggests that the intervention may have sharpened the efficiency of cognitive processing rather than fundamentally changing how often children got answers right, a pattern consistent with faster and more automatic recruitment of attentional and inhibitory resources.

Why might watching and imagining movements improve executive function at all? One possibility lies in the deep entanglement of motor and cognitive development. Learning a new movement requires holding instructions in mind, monitoring errors, inhibiting habitual but incorrect responses, and adapting plans on the fly, all of which are executive processes. Neuroimaging work has shown that cognitive control influences motor learning through local variations in inhibitory signalling within the primary motor cortex, and that skilled motor performance engages prediction-error mechanisms shared with cognitive learning systems. By repeatedly asking children to observe, imagine, and then execute movements, the training may have exercised these shared circuits from multiple angles simultaneously, strengthening a network that supports both domains.

The school-based setting is another important feature of the trial. Most existing interventions for DCD focus narrowly on motor skills and are delivered in clinics, which limits their reach. International clinical practice recommendations have emphasized the need for accessible, evidence-based services for these children, and recent systematic reviews of motor-based interventions have called for better-designed randomized trials. A programme that can run in a school gymnasium, three times a week, with no equipment beyond videos and standard sports gear, could be scaled far more easily than specialist therapy. The active control design, in which comparison children received an equally plausible educational video programme, strengthens the case that the AOMI component itself drove the additional benefit.

Still, the caveats deserve emphasis, and the authors state them plainly. Twenty children is a small sample, and pilot trials are designed to test feasibility and generate hypotheses, not to establish definitive efficacy. The registered trial, listed on ClinicalTrials.gov under identifier NCT07486856, will need larger and more diverse cohorts to confirm whether the observed advantages hold up, whether they persist after training ends, and whether they transfer to real-world activities such as classroom participation and playground play. The study was funded by the National Social Science Fund of China, and the authors declare no competing interests, with ethical approval from Shanghai University of Sport and written informed consent from all participants’ guardians.

Even as a pilot, the trial points toward a genuinely integrated future for paediatric rehabilitation. If mentally rehearsing movement can amplify the benefits of physical practice while also nudging executive function in the right direction, then the artificial boundary between motor therapy and cognitive training begins to look like an artefact of history rather than a feature of the brain. For the millions of children who dread the ball games and handwriting drills that classmates find effortless, a ten-week programme of watching, imagining, and moving may offer something more valuable than better test scores: a faster, more confident pathway into the physical world of childhood.

Subject of Research: Motor-cognitive integrated training for executive function and gross motor skills in children with developmental coordination disorder

Article Title: Motor-cognitive integrated training improves executive function and gross motor skills in children with developmental coordination disorder: a pilot RCT

Article References: Motor-cognitive integrated training improves executive function and gross motor skills in children with developmental coordination disorder: a pilot RCT. (n.d.). https://doi.org/10.1038/s41390-026-05549-5

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05549-5

Keywords: developmental coordination disorder, executive function, gross motor skills, motor imagery, action observation, fundamental movement skills, randomized controlled trial, pediatric research, school-based intervention, cognitive training, motor learning, child development