Movement skills of younger versus older adults with and without Down syndrome

Health Outcomes of Physical Activity Interventions in Adults With Down Syndrome: A Systematic Review

This systematic review examined whether physical activity interventions improve health outcomes in adults with Down syndrome (DS). We searched PubMed, APA PsycInfo, SPORTDiscus, APA PsycARTICLES, and Psychology and Behavioral Sciences Collection using keywords related to DS and physical activity. We included 35 studies published in English since January 1, 1990. Modes of exercise training programs included aerobic exercise, strength training, combined aerobic and strength training, aquatic, sport and gaming, and aerobic and strength exercise interventions combined with health education. The evidence base indicates that aerobic and strength exercise training improve physical fitness variables including maximal oxygen uptake, maximal heart rate, upper and lower body strength, body weight, and body fat percentage. Sport and gaming interventions improve functional mobility, work task performance, and sport skill performance. We concluded that adults with DS can accrue health benefits from properly designed physical activity and exercise interventions.

Relationship between trunk muscle strength, reaching ability and balance in children with Down syndrome - A cross-sectional study

BACKGROUND

Children with Down Syndrome (DS) present with neuromuscular disturbances leading to delayed developmental milestones, poor quality of movement and poor balance. The aim of this study is to discuss the role of trunk muscle strength in the functional performance of children with DS.

METHODOLOGY

28 children were recruited in the study, 14 with DS and 14 age and gender-matched controls. Trunk muscle strength, reaching ability and balance were assessed using a Handheld Dynamometer, Modified Functional Reach test and Pediatric Balance Scale, respectively.

RESULTS

Children with DS present with poorer trunk muscle strength, reaching ability and balance as compared to typically developing (TD) children. There was a positive correlation between trunk muscle strength and lateral reaching in children with DS. A strong to moderate correlation was observed between the trunk muscle strength and balance in children with DS.

DISCUSSION

Children with DS demonstrated a significantly weak trunk muscle groups. Lateral reaching distance is reduced due to the poor proximal control and they present with near-normal forward reach distance attributed to compensation using the lower trunk muscles. They exhibit poor balance in the components that require a small base of support.

CONCLUSION

Children with DS exhibit weak trunk muscles along with lesser reaching distance and poor balance. Also, trunk muscle strength influences lateral reaching ability. Trunk muscle strength, mainly trunk extensors impacted functional balance in sitting, standing and while performing transfers.

Effects of resistance training interventions on muscular strength in adults with intellectual disability: a systematic review and meta-analysis

PURPOSE

Muscular strength is critical for adults with an intellectual disability (ID) to promote their mobility, cardiovascular capacity, and performance of daily living/recreational/vocational activities. This article reports the results of the first systematic review and meta-analysis of peer-reviewed clinical trials that evaluated the effects of resistance training (RT) interventions on muscular strength in adults with ID.

METHODS

The protocol was registered with PROSPERO (CRD42020184905). The review focuses on clinical trials that recorded quantitative measures of maximum muscular strength. Eleven electronic databases were searched from their earliest available record up to May 2020. After screening 1996 search records, 11 clinical trials were reviewed.

RESULTS

The RT interventions, while heterogeneous, had an overall significant (p ≤ 0.05) effect on muscular strength in adults with ID, ages 25-58 years. The findings were more significant and less heterogeneous for non-combined RT interventions than for interventions that combined RT exercises with aerobic or balance exercises. The TESTEX overall score was 8.3 ± 3.6.

CONCLUSIONS

RT interventions (particularly when not combined with other exercises) are effective in promoting muscular strength in adults with ID. The limited number of studies and the low study quality scores indicate a potential risk of bias, which limits the interpretation of the findings and warrants further investigation.IMPLICATIONS FOR REHABILITATIONMuscular strength is critical for adults with an intellectual disability (ID) to promote their mobility, cardiovascular capacity, and performance of daily living/recreational/vocational activities.RT interventions are an effective means of improving muscular strength in adults with ID, especially when not combined with other forms of exercise.Testing and assessment protocols used in RT programs should be individualized for adults with ID to accommodate their characteristics and should be implemented under conditions similar to those experienced during the training regimen.It is important to implement familiarization sessions before carrying out muscular strength testing or initiating an RT program to ensure safety, accuracy, and effectiveness of the program for adults with ID.

Systematic Review of the Main Motor Scales for Clinical Assessment of Individuals with down Syndrome

Objective: The aim of the present review was to identify the motor scales currently used to assess individuals with Down Syndrome (DS).Method: PubMed, WOS and BVS databases were systematically searched to identify the most relevant published studies that used motor scales in the evaluation of individuals with DS.Results: Of the 99 studies that met the eligibility criteria in this process, 20 experimental and observational studies were found to fully meet the eligibility criteria.Conclusion: We identified several motor scales including the Alberta Infant Motor Scale (AIMS), Test of Infant Motor Performance (TIMP), BAYLEY, Peabody Gross Motor Scale (PGMS-PDMS-GM), Gross Motor Function Measure (GMFM), Movement Assessment Battery for Children (MABC) and Pediatric Evaluation of Disability Inventory (PEDI).

Walking performance in adolescents and young adults with Down syndrome: the role of obesity and sleep problems

BACKGROUND

High prevalence of obesity and features of obstructive sleep apnea (OSA) are major health issues in individuals with Down syndrome (DS), and both may also affect adversely on their daily activities. Further, lower levels of physical work capacity (PWC) have been reported in this population compared to their peers with intellectual disabilities. However, no study examines the relationships between obesity and sleep problems with PWC in individuals with DS. Thus, this study investigated the influence of body mass index (BMI) and different types of sleep problems on PWC in adolescents and young adults with DS (14-31 years).

METHODS

The incremental treadmill walking trial was used to assess PWC.

RESULTS

The negative associations were indicated between BMI and walking steps (p = .03) as well as features with OSA and walking steps (p = .04). Thus, BMI and OSA were included in the regression analysis to estimate the walking steps achieved during walking trials. In addition, Bland-Altman plots demonstrated no overestimation and underestimation of variability in the difference between actual and estimated walking steps developed by using BMI and OSA.

CONCLUSIONS

Obesity and sleep problem are potentially detrimental to walking performance (i.e., fewer walking steps) in individuals with DS. Thus, individuals with DS may adopt a slow walk speed due to the increased balance deficits and physical fatigue that result from obesity and sleep fragmentation, respectively. Exercise interventions, which have the potential to reduce obesity and OSA, are recommended to improve the accomplishment of PWC in individuals with DS.

Using computational support in motor ability analysis of individuals with Down syndrome: Literature review

BACKGROUND

The lack of motor ability is one of the main Down syndrome (DS) effects. However, there are several types of motor disorders that can be attenuated or corrected if they are early identified and properly analyzed.

OBJECTIVES

The aim of our study is to support the local Physical Activity research group, which works with about 25 DS children, by means of computational resources for motor analysis. To that end, we first needed to identify the main computational approaches that support the motor analysis of DS individuals, if they are already connected to intervention programs, and potential opportunities to extend the current state of the art.

METHOD

We carried out a systematic review that identified 28 papers from the current literature. These papers were then analyzed to answer the research questions defined in our study.

RESULTS

Our main findings were: (1) the temporal distribution of papers shows this area is new and it is starting to create a body of knowledge that in fact supports motor treatments of DS individuals; (2) there is a diversity of studies that consider different research directions such as comparisons of motor features of DS with non-DS individuals, characterization of DS motor features, and approaches for intervention programs to improve DS motor abilities; (3) there are several types of sensing hardware that enables the development of studies from different perspectives; (4) spatial monitoring is performed but only in laboratory conditions; (5); mathematical tools are largely used while strategies based on artificial intelligence for automated analysis are ignored; and (6) proposals for DS post-intervention monitoring are not found in the literature.

CONCLUSION

DS motor analysis is still a new research area and it is not mature yet. Thus, the use of computational resources is very pragmatic and focused only on mathematical tools that support the numerical analysis of the acquired data. The main proposals for motor analysis are performed in laboratory, so that there are several opportunities to create computational resources to obtain real-time data on the move. The integration of this data with intervention strategies is also a potential area for future researches.

Wii-based exercise program to improve physical fitness, motor proficiency and functional mobility in adults with Down syndrome

BACKGROUND

People with Down syndrome (DS) usually display reduced physical fitness (aerobic capacity, muscle strength and abnormal body composition), motor proficiency impairments (balance and postural control) and physical functional limitations. Exergames can be an appealing alternative to enhance exercise engagement and compliance, whilst improving physical fitness and motor function. This study aims to analyse the effects of a Wii-based exercise program on physical fitness, functional mobility and motor proficiency of adults with DS.

METHODS

Twenty-seven adults with DS were randomly allocated to an experimental group (Wii; n = 14) or control group (n = 13). Participants in the experimental group completed a 2-month Wii-based exercise program, with three 1-h sessions per week that included training games for aerobic endurance, balance and isometric strength. Participants completed assessments regarding anthropometric measures, physical fitness, functional mobility and motor proficiency.

RESULTS

Mixed ANOVA analysis showed a significant group by time interaction for aerobic endurance, explosive leg power and flexibility. Independent samples t-test for change scores indicated significant between-group differences favouring the experimental group regarding speed of limb movement, trunk strength and functional mobility, as well as a trend towards significance on body weight. Mann-Whitney's U test for change scores demonstrated between-group differences favouring the experimental group for visceral fat as well as running speed and agility. Large within-group effect sizes were observed for explosive leg power (d = 1.691), body weight (d = 1.281), functional mobility (d = 1.218), aerobic endurance (d = 1.020), speed of limb movement (d = 0.867) and flexibility (d = 0.818) in the experimental group.

CONCLUSIONS

Our findings suggest that Wii-based exercise can be an effective tool to improve physical fitness, functional mobility and motor proficiency of adults with DS, including crucial measures such as aerobic capacity and lower limb strength. Exergames using Wii Fit or other equipment can be appealing alternatives for adults with DS to engage in regular physical activity, preventing sedentary behaviour and decreasing the risk to develop cardiovascular diseases.

Ageing of people with Down's syndrome: a systematic literature review from 2000 to 2014

Life expectancy of people with Down's syndrome (DS) has increased considerably, now exceeding 60 years. People with DS start to get old around the age of 45. By referring to the WHO's International Classification of Functioning, Disability and Health (ICF) biopsychosocial perspective, this study aimed to present an up-to-date review of the past 14 years of literature concerning the ageing of people with DS. PUBMED, PsycInfo and the Social Sciences Citation Index were searched for studies published between 2000 and 2014. Studies were selected if they were written in English, focused on people more than 45 years of age with DS, and if terms related to DS and ageing appeared in either the title or the abstract. A total of 30 studies were retrieved and their meaningful concepts were linked to the ICF. In total, 38 ICF categories were identified that were mainly related to intellectual functions (b117) (19%), general metabolic functions (b540) (7.4%), mobility of joint functions (b710), muscle power functions (b730) (4.2%), gait pattern functions (b770) (4.2%) and structure of the brain (s110) (4.3%). Only two studies considered environmental factors, and only one considered the joint analysis of health condition and environmental factors. Data about the ageing of people with DS are predominantly based on medical evaluations and descriptions of their physical impairments. Few attempts have been made towards a comprehensive assessment of elderly people with DS with a joint analysis of their health condition and its interaction with environmental factors.

Are early onset aging conditions correlated to daily activity functions in youth and adults with Down syndrome?

This study aims to answer the research question of "Are early onset aging conditions correlated to daily activity functions in youth and adults with Down syndrome (DS)?" A cross-sectional survey was employed to recruit 216 individuals with DS over 15 years of age in the analyses. A structured questionnaire included demographic data, brief self-reported aging conditions, Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) and activity of daily living (ADL) scales were completed by the primary caregivers who were well-suited for providing information on the functioning conditions of the DS individuals. Results showed that the most five frequent aging conditions (sometimes, usually and always) included frailty (20.2%), vision problem (15.8%), loss of language ability (15.3%), sleep problem (14.9%) and memory impairment (14.5%). Other onset aging conditions included more chronic diseases (13.9%), hearing loss (13%), chewing ability and tooth loss (12.5%), incontinence (11.1%), depressive syndrome (7.7%), falls and gait disorder (7.2%), loss of taste and smell (7.2%). The data also showed scores of DSQIID, onset aging conditions and ADL has significant relationships each other in Pearson's correlation tests. Finally, multiple linear regression analyses indicated onset aging conditions (β=-0.735, p<0.001) can significantly predicted the variation in ADL scores after adjusting other factors (R²=0.381). This study suggests that the authority should initiate early intervention programs aim to improve healthy aging and ADL functions for people with DS.

Gait characteristics in individuals with intellectual disabilities: a literature review

Gait is a functionally highly relevant aspect of motor performance. In the general population poorer gait increases the risk of falls and is a predictor for future disability, cognitive impairment, institutionalization and/or mortality. People with intellectual disabilities (ID) show a delayed motor development, which brings to attention the abnormalities that might accompany gait in this population throughout childhood and adulthood. Therefore, this paper aims (a) to provide a focused review of the available literature on gait characteristics in individuals with ID and (b) to gain insight into available instrumentations measuring gait in this population. We searched the database of PubMed for relevant articles and the reference lists of included articles, resulting in 44 included articles. Forty one studies reported gait characteristics during over-ground walking and six studies during perturbed walking conditions. Most studies investigated syndrome-specific ID populations, only five studies investigated the general ID population. The studies show that gait abnormalities are evident during over-ground walking in the ID population, both in people with genetic syndromes and with ID without genetic syndromes. During perturbed conditions people with ID altered their gait with stability-enhancing adaptations. Abnormalities in gait may be partly explained by physical features, but the interrelatedness between gait and cognition may also be an explanation for the gait abnormalities seen in the ID population. Further research regarding gait characteristics of the ID population, and its relation to cognitive functioning, and adverse health outcomes is needed.

Subgroups associated with lower physical fitness in older adults with ID: results of the HA-ID study

Although physical fitness is generally very low in older adults with intellectual disabilities (ID), levels may differ across subgroups. It is important to identify which subgroups need to be targeted specifically in physical activity and fitness interventions and reference values. Physical fitness was measured with box-and-block-test, response-time-test, Berg-balance-scale, walking speed, grip strength, 30s-chair-stand, 10 m incremental-shuttle-walking test and the extended modified-back-saver-sit-and-reach-test in a large sample of older adults with ID (n=1050), and subgroups associated with lower physical fitness levels were identified applying multivariate linear regression analyses. Both fixed personal characteristics such as being older, being female, having more severe ID and having Down syndrome and modifiable or preventable factors such as physical activity levels, mobility impairments and a need of more intensive care, are independently associated with lower levels of multiple physical fitness components. This first study identifies subgroups of older adults with ID which require adapted reference values, and subgroups that need to be specifically targeted in fitness promotion programs.

Timing of muscle response to a sudden leg perturbation: comparison between adolescents and adults with Down syndrome

Movement disturbances associated with Down syndrome reduce mechanical stability, worsening the execution of important tasks such as walking and upright standing. To compensate these deficits, persons with Down syndrome increase joint stability modulating the level of activation of single muscles or producing an agonist-antagonist co-activation. Such activations are also observed when a relaxed, extended leg is suddenly released and left to oscillate passively under the influence of gravity (Wartenberg test). In this case, the Rectus femoris of adults with Down syndrome displayed peaks of activation after the onset of the first leg flexion. With the aim to verify if these muscular reactions were acquired during the development time and to find evidences useful to give them a functional explanation, we used the Wartenberg test to compare the knee joint kinematics and the surface electromyography of the Rectus femoris and Biceps femoris caput longus between adolescents and adults with Down syndrome. During the first leg flexion, adolescents and adults showed single Rectus femoris activations while, a restricted number of participants exhibited agonist-antagonist co-activations. However, regardless the pattern of activation, adults initiated the muscle activity significantly later than adolescents. Although most of the mechanical parameters and the total movement variability were similar in the two groups, the onset of the Rectus femoris activation was well correlated with the time of the minimum acceleration variability. Thus, in adolescents the maximum mechanical stability occurred short after the onset of the leg fall, while adults reached their best joint stability late during the first flexion. These results suggest that between the adolescence and adulthood, persons with Down syndrome explore a temporal window to select an appropriate timing of muscle activation to overcome their inherent mechanical instability.

Relationships between task-oriented postural control and motor ability in children and adolescents with Down syndrome

Individuals with Down syndrome (DS) have been characterized by greater postural sway in quiet stance and insufficient motor ability. However, there is a lack of studies to explore the properties of dynamic postural sway, especially under conditions of task-oriented movement. The purpose of this study was to investigate the relationships between task-oriented postural control and motor ability in children and adolescents with DS. The participants were 23 children and adolescents with DS (DS group, M±SD age, 14.4±2.8 years) and 18 age- and gender-matched peers (M±SD age, 13.8±3.6 years). A force plate was used to collect postural data represented by center of pressure (COP) parameters. Postural measurements were conducted for both groups in quiet standing with eyes open and with eyes closed, and also while throwing a ball at erect standing. Assessments of motor ability were only applied to the DS group by using two dimensions of the original version of Gross Motor Function Measure and 4 subtests of the Bruininks Oseretsky Test of Motor Proficiency, second edition. The results showed that while the participants with DS showed greater displacement and higher velocity of COP sways at quiet standing, they exhibited smaller COP displacement in anterior/posterior direction during throwing the ball. Three areas of motor ability, including standing motor skills, walk/run/jump motor skills and muscle strength, were found to make a significant contribution to the displacement and velocity of postural sway during the voluntary movement. It is suggested that future research should focus on investigating the definite underlying mechanism of postural sway during movement and the influence of increasing motor ability on the reactive postural sway in this population.