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Wentz E, Conklin A, Martin K, Looper J, Shields N, Fiss A. Informing Clinical Practice Guidelines for Children and Youth With Down Syndrome: A Survey of Key Partners. Pediatr Phys Ther 2024; 36:2-7. [PMID: 38033285 DOI: 10.1097/pep.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
PURPOSE The purpose of this work was to describe input from key partners to inform the scope and priorities for a clinical practice guideline (CPG) pertaining to physical therapy services provided to children and youth with Down syndrome (DS). METHODS A 68-item survey was completed by interventionists and parents (n = 296) of children and youth with DS. RESULTS The most prevalent physical therapy interventions currently being performed included tummy time, postural control activities, activity-based interventions, and play-based interventions. Key partners agreed on the importance of specific clinical outcomes, needing guidance on frequency and dosage of interventions, common barriers to physical therapy intervention, and needing information for discharge criteria in a future CPG. CONCLUSIONS The results of this survey have given the CPG committee the necessary information to inform the CPG process for children and youth with DS.
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Affiliation(s)
- Erin Wentz
- Department of Physical Therapy Education (Dr Wentz), SUNY Upstate Medical University, Syracuse, New York; Department of Rehabilitation and Movement Sciences (Dr Conklin), Rutgers University, Newark, New Jersey; Krannert School of Physical Therapy (Dr Martin), University of Indianapolis, Indianapolis, Indiana; School of Physical Therapy (Dr Looper), University of Puget Sound, Tacoma, Washington; School of Psychology and Public Health (Dr Shields), La Trobe University, Bundoora, Melbourne, Victoria, Australia; School of Physical Therapy (Dr Fiss), Texas Women's University, Dallas, Texas
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Ito Y, Ito T, Ohno A, Kubota T, Tanemura K, Narahara S, Kataoka E, Hyodo R, Sugiyama Y, Hattori T, Kidokoro H, Sugiura H, Noritake K, Natsume J, Ochi N. Gait performance and dual-task costs in school-aged children with Down syndrome. Brain Dev 2023; 45:171-178. [PMID: 36424235 DOI: 10.1016/j.braindev.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/31/2022] [Accepted: 11/06/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This cross-sectional observational study aimed to assess gait performance, its correlation with physical functions, and its dual-task costs in children with Down syndrome (DS), to investigate their gait adaptations. METHODS Gait performance with or without movie-watching tasks was evaluated in 17 children with DS (age, 6-12 years) and 51 age- and sex-matched controls, using three-dimensional gait analysis. We compared participants' demographics, physical functions, and gait performance without tasks between the two groups. In the DS group, correlations between physical functions, the intelligence quotient, and gait variables were assessed. Dual-task costs for gait variables were also compared between the two groups. RESULTS Children with DS showed poorer balance function and muscle strength and lower gait quality than the control group. In the DS group, there was a significant positive correlation between gait speed, step length, and intelligence quotient. There were no correlations between the balance function, muscle strength, intelligence quotient, and gait quality. Dual-task costs for gait speed, step length, and cadence were greater in the DS group; however, there was no significant difference in dual-task costs for gait quality between the two groups. CONCLUSION These findings highlight the importance of providing appropriate interventions for motor functions in school-aged children with DS based on their gait performance in single- and dual-task conditions, as well as on their intelligence quotient.
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Affiliation(s)
- Yuji Ito
- Department of Pediatrics, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Aichi, Japan; Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
| | - Tadashi Ito
- Three-dimensional Motion Analysis Room, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Aichi, Japan
| | - Atsuko Ohno
- Department of Pediatric Neurology, Toyota Municipal Child Development Center, Aichi, Japan
| | - Tetsuo Kubota
- Department of Pediatrics, Anjo Kosei Hospital, Aichi, Japan
| | - Kaori Tanemura
- Department of Orthopedic Surgery, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Aichi, Japan
| | - Sho Narahara
- Department of Pediatrics, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Aichi, Japan
| | - Erina Kataoka
- Department of Pediatrics, Anjo Kosei Hospital, Aichi, Japan
| | - Reina Hyodo
- Department of Pediatrics, Anjo Kosei Hospital, Aichi, Japan
| | | | - Tetsuo Hattori
- Department of Pediatrics, Anjo Kosei Hospital, Aichi, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hideshi Sugiura
- Department of Physical Therapy, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Koji Noritake
- Department of Orthopedic Surgery, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Aichi, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan; Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Nobuhiko Ochi
- Department of Pediatrics, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Aichi, Japan
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Rodríguez-Grande EI, Vargas-Pinilla OC, Torres-Narvaez MR, Rodríguez-Malagón N. Neuromuscular exercise in children with Down Syndrome: a systematic review. Sci Rep 2022; 12:14988. [PMID: 36056081 PMCID: PMC9440024 DOI: 10.1038/s41598-022-19086-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
Abstract
The effects and the prescription parameters of therapeutic exercise are not clear. For this reason, is needed to determine the effect of neuromuscular exercise on balance, muscle strength and flexibility specifying the parameters and characteristics of effective interventions in children between 6 and 12 years and adolescent between 13 and 18 years with Down Syndrome. The present study is a systematic review of effectiveness outcomes balance, muscle strength and flexibility in this population. The databases of PubMed, PEDro, EMBASE, SCIELO, Lilacs, Cochrane library were searched from May to December 2021. We recruited randomized controlled trials (RCTs) which met the inclusion criteria in our study. Ten studies were included. The interventions included mechanotherapy, vibration, and use of different unstable surfaces. The exercise frequency ranged from 3 to 5 days a week, and the duration of each session was between six and 15 min. The frequency was between two and three times a week for 6 and 12 weeks and the intensity were between 60 and 80% of maximal voluntary contraction. Neuromuscular exercise in different modes of application was associated with increases in chest and lower limb muscle strength mean 8.51, CI [2.35-14.67] kg and (21.54 [1.64, 41.43]) kg. Balance also improved when the mode of application was isokinetic training and core stability exercises (- 0.20 [- 0.29, - 0.12]) evaluated with stability index. Neuromuscular exercise appears to be effective for the improvement of both lower limb and chest muscle strength and balance in children over 8 years. No evidence was found in children under 8 years.
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Affiliation(s)
- Eliana-Isabel Rodríguez-Grande
- Doctoral Program in Clinical Epidemiology, Pontificia Universidad Javeriana, Bogotá, Colombia.
- School of Medicine and Health Sciences, GI Rehabilitation Sciences, Universidad del Rosario, Bogotá, Cundinamarca, Colombia.
| | - Olga-Cecilia Vargas-Pinilla
- School of Medicine and Health Sciences, GI Rehabilitation Sciences, Universidad del Rosario, Bogotá, Cundinamarca, Colombia
| | - Martha-Rocio Torres-Narvaez
- School of Medicine and Health Sciences, GI Rehabilitation Sciences, Universidad del Rosario, Bogotá, Cundinamarca, Colombia
| | - Nelcy Rodríguez-Malagón
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
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Motor Coordination and Global Development in Subjects with Down Syndrome: The Influence of Physical Activity. J Clin Med 2022; 11:jcm11175031. [PMID: 36078962 PMCID: PMC9457525 DOI: 10.3390/jcm11175031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Many research studies have investigated motor impairments and delayed development in children with Down Syndrome (DS). However, very few studies detected these features in adults with DS. Hence, this study aimed to investigate the relationship between motor coordination and global development in subjects with DS, including adults. Furthermore, the second aim was to detect any differences in motor coordination and global development as a function of the practice of physical activity (PA) in this population. Methods: Twenty-five participants with DS (10 f, 15 m), with a chronological mean age of 27.24 years and development mean age of cognitive area of 4.93 years, were enrolled and divided into a physically active group (PA-G; n = 15) and a physically inactive group (PI-G; n = 10). All participants performed the Movement Assessment Battery for Children (M-ABC) to assess fine and gross motor skills, while the Developmental Profile 3 (DP-3) checklist was administered to the parents in order to screen strengths and weaknesses of five developmental areas of their relatives with DS. Results: Our results showed positive correlations between the following variables: global motor coordination and global development, global motor coordination and adaptive behavior development area, aiming and catching skills and global development, aiming and catching skills and adaptive behavior development area. As for the practice of PA, PA-G showed higher scores than PI-G in all the tasks of both the M-ABC and the DP-3, though significant differences were found only for the global motor coordination, for the aiming and catching skills, as well as for the physical development area. Conclusions: The findings of this study reinforce the need to implement and encourage the practice of PA in order to promote well-being and social inclusion in subjects with DS.
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Leyssens L, Van Hecke R, Moons K, Luypaert S, Danneels M, Patru J, Willems M, Maes L. Postural balance problems in people with intellectual disabilities: Do not forget the sensory input systems. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:280-294. [PMID: 34693604 DOI: 10.1111/jar.12948] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 07/06/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This pilot study aimed to explore the impact of visual, auditory and vestibular dysfunctions on the postural balance performance in adults with intellectual disabilities. Additionally, a comparison was made between the subjects with intellectual disabilities and a control group concerning static and dynamic balance tasks. METHOD Thirty adults with intellectual disabilities and 25 control subjects received a postural balance assessment. Additionally, the experimental group was subjected to a visual, auditory and vestibular screening. RESULTS The experimental group performed significantly worse and/or showed more sway compared to the control group for all balance tasks (p < .01) except the timed up and go test. Within the experimental group, a significant positive correlation (rs (24) = 0.513, p = .007) was observed between the number of failed sensory screening items and the number of failed balance tasks. CONCLUSIONS These findings suggest significant involvement of peripheral sensorial deficits in the balance problems that people with intellectual disabilities often experience.
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Affiliation(s)
- Laura Leyssens
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Ruth Van Hecke
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Karlien Moons
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Sofie Luypaert
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Maya Danneels
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Julie Patru
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Melina Willems
- Department of Audiology, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Department of Otorhinolaryngology, University Hospital Ghent, Ghent, Belgium
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Zago M, Condoluci C, Manzia CM, Pili M, Manunza ME, Galli M. Multi-segmental postural control patterns in down syndrome. Clin Biomech (Bristol, Avon) 2021; 82:105271. [PMID: 33477082 DOI: 10.1016/j.clinbiomech.2021.105271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/18/2020] [Accepted: 12/31/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with Down Syndrome (DS) exhibit less efficient and unstable standing postural control. The specificities of somatosensorial deficits might result in a different utilization of resources and in distinct whole-body kinematic patterns, to date still unexplored. In this paper we aim at addressing multi-segmental coordination patterns in people with DS while maintaining standing balance under different visual conditions (open and closed eyes). METHODS This cross-sectional observational cohort study involved two groups of 23 patients with DS and 12 healthy controls. A 30-s standing balance test allowed to extract (i) the length of the trajectory of the center-of-pressure sway and 95% confidence ellipse area from Ground Reaction forces, and (ii) Principal Movement (PM) components from full-body motion kinematics; the latter were obtained exploiting a Principal Component Analysis-based approach, also embracing a motor-control perspective through the evaluation of the number of modifications applied by the neuromuscular controller on segments' acceleration. FINDINGS Trajectory length was significantly higher in patients; 95% ellipse confidence area did not differ between groups/condition. Postural movement components differed in people with DS from healthy controls not only in the "observable", behavioural phenotype (PM3 and PM8), but also in the amount of activation of the associated control (PM1 to PM8, over-activated in DS) in all spatial directions. INTERPRETATION Results reinforced the prevalence of a medio-lateral hip strategy (instead of an ankle strategy) in maintaining postural stability. Most important, they revealed a less frequent activation of postural patterns in all spatial directions.
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Affiliation(s)
- Matteo Zago
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Italy.
| | | | | | - Marta Pili
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Italy
| | - Marta Elisa Manunza
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Italy
| | - Manuela Galli
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Italy
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Brugnaro BH, Oliveira MFP, de Campos AC, Pavão SL, Rocha NACF. Postural control in Down syndrome and relationships with the dimensions of the International Classification of Functioning, Disability and Health - a systematic review. Disabil Rehabil 2020; 44:2207-2222. [PMID: 33049152 DOI: 10.1080/09638288.2020.1830439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Postural control assessment in children with Down syndrome (DS) may contribute to understanding the impact of impairments in Body Structures and Functions on Activities and Participation, providing a biopsychosocial approach to support clinical practice. The present study aimed to systematically review the literature addressing postural control in children and adolescents with Down syndrome, with a focus in the interactions among the components of the International Classification of Functioning (ICF). METHODS We conducted a tailored search in PubMed; Web of Science, SCOPUS and Science Direct databases. RESULTS We identified 20 full-texts that fulfilled the inclusion and exclusion criteria. Children and adolescents with DS showed lower postural stability across studies. The ICF components most commonly addressed were Body Structure and Function and Activity. Although the studies measured these components, they did not analyze the interrelationships of components when describing the determinants of postural control in this population. CONCLUSIONS Overall, the studies indicate that children and adolescents with DS show decreased postural stability and greater vulnerability to sensory changes than their typical peers. There is a lack of studies using the biopsychosocial approach. Only few studies have related the activity level of the participants with the variables of postural control. None of them addressed components of Participation and Environmental Factors. The poor methodological quality of the included studies limits the translation of results to clinical practice. Further studies addressing children with disabilities, such as DS, should utilize the ICF framework, thus providing a biopsychosocial approach of health in these individuals.IMPLICATIONS FOR REHABILITATIONChildren with Down syndrome show decreased postural stability and greater vulnerability to sensory changes than their typical peers.In clinical practice, when assessing postural control of individuals with DS, rehabilitation professionals should not only address components of Body Structures and Functions, but also investigate their impact on Activity and Participation.Training of postural control should address strategies that include natural environments and participation situations.The biopsychosocial approach provided by the ICF framework should be implemented in clinical practice.
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Affiliation(s)
- Beatriz Helena Brugnaro
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Maria Fernanda Pauletti Oliveira
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Ana Carolina de Campos
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Silvia Letícia Pavão
- Departament of Prevention and Rehabilitation in Physical Therapy, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | - Nelci Adriana Cicuto Ferreira Rocha
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
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Shieh V, Sansare A, Jain M, Bulea T, Mancini M, Zampieri C. Body-Worn Sensors Are a Valid Alternative to Forceplates for Measuring Balance in Children. JOURNAL FOR THE MEASUREMENT OF PHYSICAL BEHAVIOUR 2020; 3:228-233. [PMID: 37476708 PMCID: PMC10358862 DOI: 10.1123/jmpb.2019-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Aims Clinical evaluation of balance has relied on forceplate systems as the gold standard for postural sway measures. Recently, systems based on wireless inertial sensors have been explored, mostly in the adult population, as an alternative given their practicality and lower cost. Our goal was to validate body-worn sensors against forceplate balance measures in typically developing children during tests of quiet stance. Methods 18 participants (8 males) 7 to 17 years old performed a quiet stance test standing on a forceplate while wearing 3 inertial sensors. Three 30-second trials were performed under 4 conditions: firm surface with eyes open and closed, and foam surface with eyes open and closed. Sway area, path length, and sway velocity were calculated. Results We found 20 significant and 8 non-significant correlations. Variables found to be significant were represented across all conditions, except for the foam eyes closed condition. Conclusions These results support the validity of wearable sensors in measuring postural sway in children. Inertial sensors may represent a viable alternative to the gold standard forceplate to test static balance in children.
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Affiliation(s)
- Vincent Shieh
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Ashwini Sansare
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Minal Jain
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Thomas Bulea
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Cris Zampieri
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
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Hocking DR, Farhat H, Gavrila R, Caeyenberghs K, Shields N. Do Active Video Games Improve Motor Function in People With Developmental Disabilities? A Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2018; 100:769-781. [PMID: 30508504 DOI: 10.1016/j.apmr.2018.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/30/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To conduct a meta-analysis to examine the effectiveness of active video games (AVGs) interventions on motor function in people with developmental disabilities. DATA SOURCES An electronic search of 7 databases (PubMed, EbscoHost, Informit, Scopus, ScienceDirect, Proquest, PsychInfo) was conducted for randomized controlled trials (RCTs) evaluating AVGs to improve motor function in people with developmental disability, published through to May 2018. STUDY SELECTION Only articles in a peer-reviewed journal in English were selected and screened by 2 independent reviewers for RCTs that compared AVGs to conventional therapy. Twelve RCTs involving 370 people with developmental disabilities met the inclusion criteria for quantitative analysis. DATA EXTRACTION Two independent reviewers assessed risk of bias and study quality using the Egger's R, grading of recommendation, assessment, development and evaluation, and Template for Intervention Description and Replication checklists. DATA SYNTHESIS Three meta-analyses revealed a large effect size for AVGs to improve gross motor skills (Hedges' g=0.833, 95% confidence interval [95% CI]=0.247-1.420), small to medium effects for balance (g=0.458, 95% CI=0.023-0.948), and a small, nonsignificant effect for functional mobility (g=0.425, 95% CI= -0.03 to 0.881). Training frequency (ie, number of sessions per week) moderated the effect of AVGs on motor function in people with developmental disabilities. CONCLUSION We conclude that AVGs show task-specific effectiveness for gross motor skills but the effects are moderated by training intensity. However, because of the low number of trials, diverse diagnoses, variable dosage, and multiple outcome measures of the included trials, these results need to be interpreted with caution.
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Affiliation(s)
- Darren R Hocking
- Developmental Neuromotor and Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.
| | - Hassan Farhat
- Developmental Neuromotor and Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Rebeca Gavrila
- Developmental Neuromotor and Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Karen Caeyenberghs
- Microstructural Imaging and Rehabilitative Plasticity Program, School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - Nora Shields
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
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