Transitioning from the level surface to stairs in children with and without Down syndrome: Motor strategy and anticipatory locomotor adjustments

Motion-based technology to support motor skills screening in developing children: A scoping review

BACKGROUND

Acquiring motor skills is fundamental for children's development since it is linked to cognitive development. However, access to early detection of motor development delays is limited.

AIM

This review explores the use and potential of motion-based technology (MBT) as a complement to support and increase access to motor screening in developing children.

METHODS

Six databases were searched following the PRISMA guidelines to search, select, and assess relevant works where MBT recognised the execution of children's motor skills.

RESULTS

164 studies were analysed to understand the type of MBT used, the motor skills detected, the purpose of using MBT and the age group targeted.

CONCLUSIONS

There is a gap in the literature aiming to integrate MBT in motor skills development screening and assessment processes. Depth sensors are the prevailing technology offering the largest detection range for children from age 2. Nonetheless, the motor skills detected by MBT represent about half of the motor skills usually observed to screen and assess motor development. Overall, research in this field is underexplored. The use of multimodal approaches, combining various motion-based sensors, may support professionals in the health domain and increase access to early detection programmes.

Altered Spatiotemporal Gaze Dynamics During Unexpected Obstacle Negotiation in a Fatigued State

Humans use their peripheral vision during locomotion to perceive an approaching obstacle in their path, while also focusing central gaze on steps ahead of them. However, certain physiological and psychological factors may change this strategy, such as when a walker is physically fatigued. In this study, 21 healthy participants walked through a dark room while wearing eye tracking glasses before and following intense exercise. Obstacles were placed in random locations along their path and became illuminated when participants approached them. Results indicate that, when fatigued, participants had altered spatial gaze strategies, including more frequent use of central gaze to perceive obstacles and an increased gaze angular displacement. However, there were no changes in temporal gaze strategies following exercise. These findings reveal how physical fatigue alters one's visual perception of their environment during locomotion, and may partially explain why people are at greater risk of trips and falls while fatigued.

Muscle activation pattern during two-legged hopping in children with and without Down syndrome

This study aimed to characterize muscle activation and its variability during two-legged hopping in children with and without Down syndrome (DS). Seventeen typically developing (TD) children and 15 children with DS were recruited. As only 6 children with DS (4F/2M, 9.95 (1.71) years) completed the test, we used a 2(TD):1(DS) ratio to age- and sex-match 12 TD children. Subjects first hopped at a self-selected free frequency and then three metronome-cued conditions: slow, preferred, and moderate (80%, 100%, and 120% of free frequency, respectively). Across conditions, children with DS exhibited greater pre-activation before landing and greater shape and timing variability in gastrocnemius, vastus lateralis, and biceps femoris than TD children. However, this compensatory strategy limited their ability to change movement speed.

Development of stratified normative data and reference equations for the timed up and down stairs test for healthy children 6-14 years of age

OBJECTIVES

To generate normative data on healthy children aged 6-14 years for the timed up and down stairs (TUDS) test, and to provide reference equations.

DESIGN AND SETTING

Cross-sectional study at two primary schools.

PARTICIPANTS

Healthy children 6-14 years of age.

MAIN OUTCOMES MEASURES

Anthropometric data and Minnesota Leisure-Time Physical Activity Questionnaire from children were collected before the start of the TUDS test. Heart rate, blood pressure and perceived exertion were measured at the beginning and at the end of the test. Two trials of the TUDS test were performed with 15-minute of rest on the same day and the better of the two trials was used in the analyses. The reference equations were established using the anthropometric variables as possible predictors of the TUDS test.

RESULTS

Two hundred fifty eight children (125 boys and 133 girls) were assessed. The mean TUDS test score decreased significantly from 6 to 14 years of age in boys and girls alike, with statistically significant differences between the three age range groups. A significant difference was found between girls and boys in TUDS test score. The 56% of the variation in TUDS test score could be explained by age, height, and weight in boys [TUDS_sec score=(9.967-(0.182×Age_years)+(0.025×Weight_kg)-(2.546×Height_m)], while 50% could be explained in girls [TUDS_sec score=10.553-(0.194×Age_years)+(0.019×Weight_kg)-(2.406×Height_m)]. The inclusion of physical level activity increased the variability explained (boys: 59%; girls: 51%).

CONCLUSIONS

TUDS score improved as the age of the children increased, with boys achieving better values than girls within each age group. TUDS test score can be easily predicted from age, height, and weight. The inclusion of the child's physical activity level increased the variance explained by the equation.

Exploring motor-cognitive interference in children with Down syndrome using the Trail-Walking-Test

BACKGROUND AND AIMS

The dual-task (DT) paradigm is an ecologically valid approach to assess cognitive function in relation with motor demands, particularly for children with Down syndrome (DS). This study aimed to determine DT performance for a complex Change-of-Direction (CoD_W) walking task in children with DS.

METHODS

The sample included 12 children with DS (10.2 ± 1.19 years), 12 typically developing (TD) children matched for chronological (TD-CA: 10.2 ± 1.19 years) and 12 TD children matched for mental age (TD-MA: 5.50 ± 1.24 years). We examined DT performance with the Trail-Walking-Test (TWT): participants (1) walked along a fixed pathway, following a prescribed path, delineated by target markers of (2) increasing sequential numbers, and (3) increasing sequential numbers and letters. Motor and cognitive dual-task costs (DTC) were calculated.

RESULTS

For the TWT, an ANOVA with repeated measures revealed significant differences between DS and the CA, but not the MA group. Overall, there were significant decreases in speed with increasing cognitive demands. In addition, all children produced higher cognitive compared to motor DTC, which were more pronounced in the cognitively more challenging condition.

CONCLUSION

The assessment of motor and cognitive performance in a DT paradigm provided insight in how motor and/or cognitive impairment constrains the ability of children to successfully perform activities in a complex and dynamical environment.

Knee joint kinematics of the pendulum test in children with and without Down syndrome

BACKGROUND

The Wartenberg pendulum test is a common clinical test that is used to measure stiffness about the knee in persons with and without disabilities such as cerebral palsy and Down syndrome (DS). Adults and adolescents with DS show fewer number of swing cycles and a lower relaxation index than healthy controls. However, it is not clear if children with DS show a similar trend compared to typically developing (TD) children.

RESEARCH QUESTION

Was the knee joint kinematics different between children with and without DS during the pendulum test?

METHODS

Thirteen children with DS and 13 TD children participated in this study. There were two load conditions: no load (NL) and with ankle load (AL) equal to 2 % of the subject's body weight. Five trials of a pendulum test were collected for each condition.

RESULTS

The DS group showed a smaller first flexion excursion, a lower relaxation index, lower mean and peak velocities and accelerations during the first and second flexion and extension, and greater variability of acceleration during the first flexion than the TD group across both load conditions. This suggests that the DS group may have greater stiffness of the knee than the TD group to compensate for joint instability.

SIGNIFICANCE

The pendulum test appears to be a valid test to evaluate the passive stiffness of the knee in children with DS. The lower relaxation index in children with DS suggests that larger bursts of quadriceps may be activated during a pendulum test, particularly in the first flexion excursion, to assure the knee joint stability.

Improvement in Overground Walking After Treadmill-Based Gait Training in a Child With Agenesis of the Corpus Callosum

BACKGROUND

Agenesis of the corpus callosum (ACC) is a rare congenital brain defect that produces a wide variety of cognitive and motor impairments. Literature regarding the response of pediatric populations with ACC to physical rehabilitation is scarce. Treadmill-based gait training (TT) has been shown to improve walking ability in some pediatric populations but has not been investigated in children with ACC.

OBJECTIVE

The purpose of this study was to investigate the effect of a novel treadmill intervention paradigm on the gait parameters of a child with ACC.

DESIGN

A single-participant design with 2 phases was used.

METHODS

The settings were the participant's home and the laboratory. The participant was a 13-year-old girl who had ACC and cortical visual impairment and who ambulated independently using a reverse walker for household and short community distances. A home-based TT intervention (2 phases of 3 months of training over 6 months) was implemented, and a laboratory-based gait analysis was conducted at 4 time points: baseline, after each of the 2 training phases, and 3 months after the cessation of training. The intervention consisted of weekly bouts of TT. Phase I incorporated forward, backward, and incline walking for 15 minutes each; in phase II, this protocol was continued, but short-burst interval training for 10 minutes was added. Data collected at each laboratory visit included spatiotemporal parameters and kinematics (joint angles) during overground and treadmill walking.

RESULTS

After both phases of training, increased step length, decreased step width, and foot progression angle and decreased variability of most spatiotemporal parameters were observed for the participant. Further, after phase II, increased peak extension at the hip, knee, and ankle, decreased crouched gait, and improved minimum foot clearance during overground walking were observed. Most gait improvements were retained for 3 months after the cessation of the intervention.

LIMITATIONS

The small sample size of this study and wide variety of presentations within individuals with ACC limit the generalizability of our findings.

CONCLUSIONS

TT may be a safe and effective treatment paradigm for children with ACC. Future research should investigate the effect of intervention dosage on gait improvements and generalization in individuals with ACC.

Variability of spatiotemporal gait parameters in children with and without Down syndrome during treadmill walking

BACKGROUND

Increasing walking speed and including bilateral external ankle load have been shown to improve aspects of the gait pattern of children with Down syndrome (DS). However, it is unknown if speed and ankle load improves the cycle-to-cycle variability in a similar way.

RESEARCH QUESTION

How do changes of walking speed and external ankle load impact spatiotemporal variability during treadmill walking in children with and without DS?

METHODS

Thirteen children with DS (aged 7-10 years) and thirteen age- and sex-matched typically developing (TD) children participated in this study. Subjects completed two bouts of 60-second treadmill walking at two different speeds (slow and fast) and two load conditions (no load and ankle load equaling to 2% bodyweight at each side). Kinematic data was captured using a Vicon motion capture system. Mean and coefficient of variance of spatiotemporal gait variables were calculated and compared between children with and without DS.

RESULTS AND SIGNIFICANCE

Across all conditions, the DS group took shorter and wider steps than the TD group, but walked with a similar swing percentage, double support percentage, and foot rotation angle. Further, the DS group demonstrated greater variability of all spatiotemporal parameters, except for step width and foot rotation angle. Our results indicated that children with DS can modulate their spatiotemporal gait pattern accordingly like their TD peers when walking faster on a treadmill and/or with an external ankle load. Smaller step width variability in the DS group suggests that mediolateral stability may be prioritized during treadmill walking to safely navigate the treadmill and complete walking tasks. Similar temporal parameters but distinct spatial parameters in the DS group suggest that they may have developed similar rhythmic control but are confined by their spatial movement limitations.