The effect of physical training on static balance in young people with intellectual disability

The effect of individual and paired Brailletonik exercises on balance and reaction time in children with intellectual disability

BACKGROUND

children with Intellectual Disabilities (ID) are less proficient in motor skills compared to normally developing children, which means they need more time for learning skills. In this context, the purpose of this research is to investigate the effect of the Brailletonik physical activity program (BPAM) on the balance and reaction time of children with ID.

METHODS

The statistical sample is consisted of 30 children aged 8 to 12 (21 boys, 9 girls) with ID with an average age of 9.8 ± 1.39, who were selected through convenience sampling. Participants were divided into two groups of individual BPAM, and pair BPAM. Training sessions were held for 21 sessions (seven weeks) and each session included 30 min of training. To measure static balance and reaction time, Stork Stand test and Simple Reaction Time Software were used respectively. The analysis of covariance (ANCOVA) and Bonferroni's post hoc test were used to analyze the data. Data analysis was performed using SPSS software version 26 at a significance level of p ≤ 0.05.

RESULTS

The results showed that individual and paired exercise groups had significant progress from pre-test to post-test in both variables of balance and reaction time (p = 0.001). Also, the comparison of the performance of the groups in the post-test showed that the average performance of the paired exercise group was significantly better than the individual exercise group in the balance variable (p = 0.03) and in the reaction time variable (p = 0.01).

CONCLUSION

Accordingly, it can be concluded that BPAM in paired groups has a greater effect on the balance and reaction time of children with ID.

Postural Balance in Boys With Intellectual Disabilities Who Participate in Soccer Training

PURPOSE

The aim of this study is to investigate the postural balance in children with intellectual disabilities who participate in soccer training compared with their sedentary peers.

METHOD

Two groups of boys with intellectual disabilities aged 8-10 years participated in this study: a soccer group (n = 12) and a sedentary group (n = 12). Postural balance was assessed using a force platform under 4 different conditions: open eyes, and closed eyes, on firm and foam surfaces. The Timed Up and Go Test, 10-m Walking Test, and Four-Square Step Test were also conducted.

RESULTS

The soccer group had significantly lower (P < .05) center of pressure values compared with the sedentary group, on both firm and foam surfaces, but only under the open eyes condition. They were significantly faster (P < .05) in the Timed Up and Go Test, 10-m Walking Test, and Four-Square Step Test compared with their sedentary peers. However, there were no significant differences between the 2 groups on the sit-to-stand and turn-to-sit phases of the Timed Up and Go Test.

CONCLUSION

Soccer participation may have a positive effect on postural balance in boys with intellectual disabilities. These findings may have implications for the development of exercise programs to improve postural balance and reduce the risk of falls in this population.

Structured Program for Developing the Psychomotor Skills of Institutionalized Children with Special Educational Needs

Tailoring motor activities to the unique needs of children with special educational requirements has shown considerable efficacy. Our study aimed to develop a structured program specifically designed to enhance psychomotor abilities, focusing on balance and motor-cognitive skills among 28 students (aged 12-14) from two institutional centers in Romania. The program spanned 36 weeks, with biweekly 30 min sessions. Psychomotor skills were assessed through tests measuring balance, speed of movements, and upper limb motor laterality. Initial and final data were collected for evaluation. A statistical analysis, employing the Kolmogorov-Smirnov and Wilcoxon Z tests, compared the assessments. The results indicated significant improvements in movement speed, with a notable increase in stimulus identification (averaging from approximately 13 to 14) (p < 0.05) and reduced processing time (decreasing from about 28.7 to 28 s) (p < 0.05). However, while the structured program demonstrated substantial enhancements in specific motor and cognitive-motor skills, it did not yield significant changes in dynamic balance, maintaining values close to 0.9 (p > 0.05) for open-eyed balance and 0.88 (p > 0.05) for closed-eyed balance. Additionally, an analysis of the processing speed in pulses per second showcased a marginal decline, from approximately 0.46 to 0.45, revealing notable disparities between the initial and final measurements (p < 0.05).

Effect of dance movement therapy on balance in adults with Down Syndrome. A pilot study

Systematic participation in dance therapy may improve balance and reduce risk of falls. The aim of this study was to assess the effect of dance therapy on balance and risk of falls in adults with Down syndrome. Study participants comprised 23 persons with Down syndrome aged 26- 49 years who underwent dance therapy. Before and after the therapy, all participants were measured on a BioSway balance platform using three tests: postural stability, limits of stability, and M-CTSIB fall risk. Mean result was lower following intervention (2.40 ± 1.81 vs. 1.65 ± 1.32; p = .006) in the postural stability test. The limits of stability test found a statistically significant difference (26.30 ± 8.99 vs. 37.90 ± 12.54; p < .001). The results of this study only partially supported the hypothesis that dance therapy improves balancing skills in adults with Down Syndrome.

Association between the Upper Quarter Dynamic Balance, Anthropometrics, Kinematics, and Swimming Speed

Besides recurrently assessed water-based parameters, there are also some individual characteristics that affect swimming performance that are not water related. In the past few years, dynamic balance has been associated with land sports performance. Conversely, evidence on this topic in swimming is scarce. The purpose of this study was to assess the association between on-land dynamic balance and swimming performance. Sixteen young adults and recreational swimmers were recruited for the present study (8 males 20.8 ± 2.0 years, and 8 females 20.1 ± 1.9 years). A set of anthropometric features were measured. The upper quarter Y-balance test was selected as a dynamic balance outcome, and swimming speed as the swimming performance indicator. The results showed a moderate and positive correlation between dynamic balance and swimming performance (p < 0.05). Speed fluctuation was highly and negatively related to swimming speed (p < 0.001), i.e., swimmers who had higher scores in the dynamic balance were more likely to deliver better performances. This suggests that in recreational swimmers, the stability and mobility of the upper extremity had a greater influence on swimming performance. Therefore, swimming instructors are advised to include dynamic balance exercises in their land-based training sessions to improve their swimmers' performance.

The effectiveness of dance movement therapy for individuals with Down syndrome: a pilot randomised controlled trial

BACKGROUND

Individuals with Down syndrome (DS) exhibit deficits in static and dynamic balance abilities and maladaptive functions. This study aimed to determine the effectiveness of dance movement therapy (DMT) group intervention in individuals with DS.

METHODS

The 31 participating individuals with DS, aged 5-29 years, were randomly divided into intervention (n = 16) and control (n = 15) groups. Posturography was used for static balance measurement, timed up and go test for dynamic balance measurement and the Achenbach System of Empirically Based Assessment (ASEBA) questionnaire for adaptive function and behavioural problem measurement in participants before and after the DMT interventions. The intervention group underwent 60-min DMT intervention once a week for 10 times, while the control group had usual daily activities.

RESULTS

The results revealed a statistically significant difference and large effect sizes in dynamic balance [(f(1, 29) = 4.52, P = 0.04, η_p   ² = 0.14)] in the intervention group compared with the control group. There were no statistically significant differences in static balance and ASEBA scores between the groups.

CONCLUSIONS

This study found that the DMT interventions helped to improve the dynamic balance in individuals with DS.

Dual-Task Training Effects on the Cognitive-Motor Interference in Individuals with Intellectual Disability

This study explored the effect of dual task (DT) training compared to single task (ST) training on postural and cognitive performances in DT conditions in individuals with intellectual disability (ID). Postural sways and cognitive performances were measured separately and simultaneously before and after 8 weeks in the ST training group (STTG), the DT training group (DTTG) and the control group (CG) that did not received any training. Before training, postural sways and cognitive performances were higher in the DT condition compared to ST one in all groups. After training, postural sways were higher in the DT condition compared to the ST only in the STTG and the CG. The cognitive performance increased after training only in the DTTG.

Sleep apnea in people with Down syndrome: Causes and effects of physical activity?

Poor sleep quality is recognized as a major risk factor for poor health, increasing the incidence of serious chronic diseases. In people with Down syndrome, sleep apnea prevalence is significantly greater, it is caused by genetic, anatomical, endocrine, and metabolic abnormalities. The consequences of sleep disruption due to sleep apnea are very serious, especially in terms of neurocognitive and cardiovascular effects, leading to reduced life expectancy and quality of life in this population. However, the management, care, and treatment of related disorders in people with Down syndrome are still inadequate and limited. Therefore, this article wants to increase understanding and awareness about sleep apnea and the benefits of physical activity in improving sleep quality in the Down syndrome community, families, and their care specialists.

Video-Based Behaviorally Coded Movement Assessment for Adolescents with Intellectual Disabilities: Application in Leg Dribbling Performance

Measuring motor performance in individuals with intellectual disabilities (ID) is quite challenging. The objective of this study was to compare the motor performances of individuals with ID and those with typical development (TD) during soccer dribbling through video-based behavior-coded movement assessment along with a wearable sensor. A cross-sectional research design was adopted. Adolescents with TD (N = 25) and ID (N = 29) participated in the straight-line and zigzag soccer dribbling tests. The dribbling performance was videotaped, and the footage was then analyzed with customized behavior-coding software. The coded parameters were the time for movement completion, the number of kicks, blocks, steps, the number of times the ball went out of bounds, the number of missed cones, and the trunk tilt angle. Participants with ID exhibited significantly poorer performance and demonstrated greater variances in many time and frequency domain parameters. It also revealed that participants with ID kicked with both feet while dribbling, whereas those with TD mainly used the dominant foot. The present findings demonstrated how the ID population differed from their peers in lower-extremity strategic control. The customized video-based behavior-coded approach provides an efficient and effective way to gather behavioral data and calculate performance parameter statistics in populations with intellectual disabilities.

Eight-week virtual reality training improves lower extremity muscle strength but not balance in adolescents with intellectual disability: A randomized controlled trial

Purpose: This study aims to assess the effects of 8-week virtual reality (VR) training on balance and lower extremity muscle strength in adolescents with intellectual disability (ID).

Methods: Thirty adolescents with intellectual disability were randomly divided into the virtual reality group and control group. The participants in the virtual reality group and the control group received the virtual reality training and the physical education (PE) course, respectively, for 8 weeks. The Berg Balance Scale (BBS), Timed Up and Go (TUG) test and lower extremity muscle strength were measured before and after the training.

Results: The between-group results showed that the participants in the virtual reality group increased the muscle strength of hip flexors (p &lt; 0.001), hip extensors (p = 0.002), hip abductors (p &lt; 0.001), knee flexors (p &lt; 0.001), knee extensors (p = 0.002) and ankle plantar flexors (p = 0.042) significantly after training, compared to the control group. However, no significant improvement was found in the berg balance scale and timed up and go scores between the virtual reality group and control group after training (p &gt; 0.05). The within-group results showed that the strength of all the muscle groups significantly increased after training in the virtual reality group (p &lt; 0.05) compared to the baseline. However, no significant difference was found in the muscle strength in the control group before and after training. The within-group berg balance scale and timed up and go scores showed no significant improvements in both groups.

Conclusion: Virtual reality training intervention might be effective in improving the lower extremity muscle strength, but no significant improvement was found on balance ability in adolescents with intellectual disability.

The effect and durability of functional exercises on Balance Evaluation Systems Test (BESTest) scores in people with intellectual disabilities: a preliminary report

BACKGROUND

Problems and limitations of movement in individuals with ID are highly common, which particularly may cause the loss of basic performance and limit the person's independence in doing their daily activities. The purpose of this study was to examine the effect and durability of functional exercises on balance evaluation systems test (BESTest) scores of individuals with ID.

METHODS

In the present study, 34 participants with ID were selected randomly and divided into three groups: training groups [unstable group (UG); n = 12; age = 21.46 ± 5.37 years and stable group (SG); n = 12; age = 18.50 ± 2.11 years] or the control group (CG; n = 10; age = 19.50 ± 1.27 years). The postural stability measure was collected with the BESTest. The training groups did the functional exercises for 8 weeks, 3 days/week and 1 h/day. The control group did not experience any training. Statistical analysis was performed in SPSS 22 software on a significance level (P < 0.05).

RESULTS

Both UG and SG training improved the outcome measures [biomechanical constraints (F = 14.04; P = 0.001), limits of stability/verticality (F = 54.39; P = 0.001), postural responses (F = 26.28; P = 0.001), anticipatory postural adjustment (F = 22.72; P = 0.001), stability in gait (F = 51.95; P = 0.001), sensory orientation (F = 83.87; P = 0.001) and total score (F = 114.1; P = 0.001)]. These improvements were maintained at a 1-month follow-up, although the effect was slightly reduced. The results showed that the training group at an unstable level has more balanced improvement compared to the training group at a stable level.

CONCLUSION

This study presents evidence that functional exercises can be recognised as a comprehensive and effective mediator in the improvement of balance in individuals with ID and also affect performance and movement activities.

Neuromuscular exercise in children with Down Syndrome: a systematic review

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.

Motor Coordination and Global Development in Subjects with Down Syndrome: The Influence of Physical Activity

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.

Investigation of the effects of physical education activities on motor skills and quality of life in children with intellectual disability

Aim: This study was carried out in order to examine whether there is a difference between the quality of life and motor skills of children with intellectual disability who participate in physical education activities and those who do not participate. Method: This study was conducted with a total of 34 children with 16 children in the control group (8 girls, 8 boys) and 18 children in the experimental group (11 boys, 7 girls) using a pre-test, post-test and control group experimental design. A 14-week "Physical Education Activities Program" was applied to the children in the experimental group. Children in the control group did not participate in physical education activities. The Bruininks Oseretsky test of motor proficiency second edition brief form 2010 to measure the motor performance and "Pediatric Quality of Life Inventory (PedsQL)" developed by Varni et al. in 1999 were used for children with intellectual disability. Findings: When the motor skill tests of the children with intellectual disability in the experimental group were evaluated, significant improvements were found in fine motor precision, fine motor integration, manual dexterity, bilateral coordination, balance, speed and agility, upper limb coordination, strength tests and all dimension scores for quality of life compared to the pre-test (p < 0.05). In the control group, a statistically significant improvement was observed in the quality of life Physical Functioning score and fine motor integration, bilateral coordination, and upper limb coordination tests (p < 0.05). More significant improvement was observed in motor skills and quality of life in children with intellectual disability who participated in the 14-week physical education program compared to the control group. Conclusion: Physical education activities contributed positively to improving the motor skills and quality of life of children with intellectual disability.

Promoting Participation in Physical Activity in Children and Adolescents With Down Syndrome

Children with Down syndrome (DS) often have lower physical activity (PA) levels compared with their peers with typical development, and face challenges to being physically active such as medical comorbidities, access issues, and societal stigma. Physical therapists are experts in exercise prescription and PA and are thus uniquely qualified to successfully promote participation in children with DS, in spite of inherent challenges. Our perspective is that a shift in physical therapy service delivery is needed. We suggest that physical therapists change the focus of their interventions for children with DS from underlying impairments such as low tone or joint laxity or from developing motor skills in isolation and "correct" movement patterns. Instead, physical therapists should allow the PA preferences and the environmental contexts of the children and adolescents they are working with to direct the treatment plan. In this way, physical therapist intervention becomes more child centered by concentrating on developing the specific skills and strategies required for success in the child's preferred PA. In this article, we consider the role of pediatric physical therapists in the United States, as well as in low- and middle-income countries, in promoting and monitoring PA in children with DS from infancy through adolescence. Examples of physical therapist interventions such as tummy time, movement exploration, treadmill training, bicycle riding, and strength training are discussed, across infancy, childhood, and adolescence, with a focus on how to successfully promote lifelong participation in PA.

LAY SUMMARY

Physical therapists are experts in exercise and physical activity and are thus uniquely qualified to promote participation in children with Down syndrome. Instead of focusing on impairments or "correct" movement patterns, physical therapists are encouraged to allow the child and the child's environment to direct the treatment plan.

Current Trends in Pediatric Physical Therapy Practice for Children With Down Syndrome

BACKGROUND

Physical therapists (PTs) have a broad range of approaches to the management of Down syndrome (DS).

PURPOSE

To examine the breadth of physical therapy practice for children with DS.

METHODS

A survey was distributed to 1000 randomly selected members of the Academy of Pediatric Physical Therapy.

DATA ANALYSIS

Responses were categorized into 13 thematic subcategories and 3 International Classification of Functioning, Disability and Health (ICF) subcategories.

RESULTS AND DISCUSSION

One hundred eight PTs participated. Joint stability and alignment were the most common physical therapy-related problem. Functional movement was the most common physical therapy intervention. Most clinicians identified and treated at the ICF level of body functions and structure. Multiple assessment tools were used and tended to include norm-referenced tests. There was diversity of interventions with varying amounts of supporting evidence.

CONCLUSIONS

PTs manage children with DS for a wide variety of needs with a variety of interventions.

EFFECTS OF KAYAKING ON MOTOR SKILLS IN CHILDREN AND ADOLESCENTS WITH DOWN SYNDROME

ABSTRACT Introdução A síndrome de Down (SD) é uma afecção genética que se caracteriza por distribuição numérica inadequada no pareamento cromossômico, com material genético extra relacionado com o par 21 que leva a alterações que afetam o desenvolvimento de diversos componentes motores. Objetivos Analisar os efeitos do treinamento de canoagem durante oito semanas sobre as habilidades motoras grossas em crianças e adolescentes com SD. Métodos Sete indivíduos com SD (10,8 ± 2 anos), quatro do sexo masculino e três do sexo feminino participaram do estudo. Para avaliar as habilidades motoras grossas, empregou-se a bateria de Teste de Coordenação Corporal para Crianças (Körperkoordination Test für Kinder, KTK). O teste de Wilcoxon foi usado para comparar os valores de habilidades motoras grossas antes e depois do KTK e o teste de Mann-Whitney foi usado para comparar os indivíduos por sexo. O tamanho do efeito foi calculado pela escala de Cohen (1977) e nível de significância de p < 0,05 foi adotado. Resultados Os indivíduos apresentaram resultados estatisticamente significativos em todas as tarefas do teste de coordenação motora grossa e o efeito produzido pela intervenção foi moderado. Conclusão Conclui-se que oito semanas de treinamento de canoagem são suficientes para produzir desenvolvimento das habilidades motoras grossas de crianças e adolescentes com Síndrome de Down. Nível de Evidência IV; Série de casos.

The impact of multicomponent programmes on balance and fall reduction in adults with intellectual disabilities: a randomised trial

BACKGROUND

One challenge a modern society faces is this: providing those vulnerable and ageing groups of adults who have intellectual disabilities with appropriate support for improving static and dynamic balance. Balance is a crucial component of physical fitness and, consequently, of fall reduction and prevention. The aim of the present randomised controlled trial was to evaluate the efficacy, after 16 weeks, that three different Special Olympics physical activity programmes had on balance and on fall reduction in adults with intellectual disabilities.

METHOD

A convenience sample of 150 persons with mild and moderate intellectual disabilities was recruited from the accessible Special Olympics Slovenia population of physically inactive adults with intellectual disabilities. The sample was randomised to the experimental group 1 (multicomponent balance-specific exercise programme group with additional workshops on such social gerontology topics as active and healthy ageing; N = 50), the experimental group 2 (multicomponent wellness programme group; N = 50) and a control group (regular Special Olympics athletic training; N = 50).

RESULTS

Significant differences were found between groups in the balance scores throughout the study period and in the ability to decrease fall frequency.

CONCLUSIONS

Balance assessment is a high predictor of frequency of falls, and among adults with intellectual disabilities, it significantly correlates with exercise. The results indicate that a multicomponent balance-specific exercise programme with a significant sociogerontological component on active ageing could be a useful intervention for intellectually disabled adults who have poor balance and who experience frequent falls.

Gait and postural control patterns and rehabilitation in Down syndrome: a systematic review

[Purpose] To describe (1) the current knowledge on gait and postural control in individuals with Down syndrome in terms of spatiotemporal, kinematics and kinetics, and (2) relevant rehabilitation strategies. [Methods] Randomized and non-randomized clinical trials published between January 1997 and October 2019 were selected by searching four scientific databases. We included studies on patients with Down syndrome involving gait analysis or postural control. A custom data-extraction and appraisal form was developed to collect the key features of each article. The PEDro Scale was used to evaluate the methodological quality of the studies. [Results] A total of 37 out of 146 cross-sectional and longitudinal studies were included in the review. The main abnormalities included: reduction of gait velocity and step length, poor static balance with increased anteroposterior and mediolateral oscillations and a larger step width. [Conclusion] A number of compensatory patterns during movement was observed, with a direct influence on improvements in stability and postural control throughout daily life. Intensive gait training at an early age appears to produce long-term improvements in this population. Future research should focus on the interaction between the motor and cognitive function, and on the functional effects due to the exposure to an enriched environment.

Recruitment settings, delivery contexts, intervention techniques and outcomes of health promotion programmes for young adults with intellectual and developmental disabilities: A systematic review

BACKGROUND

People with intellectual and developmental disabilities (IDD) are at risk of developing long term health conditions, and a preventative health agenda research is emerging. However, little is known about the recruitment settings, delivery contexts, intervention techniques and outcomes of health promotion programmes for this population. Therefore, the aim of this review was to synthesize and evaluate these characteristics.

METHOD

A systematic review of studies identified from multiple databases on healthy lifestyle interventions for adolescents and young people with IDD was conducted. Data were synthesized and evaluated using a logic model. Quality of rigour was also assessed.

RESULTS

Sixteen geographically diverse studies were selected and evaluated. Participants were most commonly recruited from schools, with interventions typically taking place in a gym setting and involving physical activity training.

CONCLUSIONS

This review indicates that physical activity and dietary interventions in people with IDD may lead to lifestyle changes, however more robust evidence is required. Educational settings are conducive, with settings beyond schools requiring further consideration.

Body balance analysis of children and youth with intellectual disabilities

BACKGROUND

Children and adolescents with intellectual disabilities (IDs) are an identified group with postural disturbances resulting from a lack of integration among the visual, vestibular and proprioceptive systems. The insufficient level of maturity of the sensory systems is at least partly responsible for disturbances in maintaining body balance. More sway can increase the risk of falls and body injuries. The aims of the study were (1) to compare the ability to maintain the body balance of children and youth with a varying degree of ID, both with the eyes open and closed, and (2) to determine to what extent factors such as sex, level of ID, visual stimulus and body height independently affect the ability to maintain body balance in children and adolescents with ID.

METHOD

The study involved 131 people aged 13-21 years (65 girls and 66 boys). The participants were classified as (1) with mild disability (42 girls and 47 boys) and (2) with moderate disability (23 girls and 19 boys), based on IQ test results. Sway measures were collected with the Zebris platform, with the eyes open and closed. Sway path, sway path in anterio-posterior and medio-lateral directions and sway area were analysed.

RESULTS

Boys with moderate ID were characterised by a significantly more sway indicating their worse postural balance ability than boys with mild ID, both in the trials with open eyes and closed ones. The type of test (eyes open/eyes closed) to a small extent had influenced the body balance of the examined children with ID. Results of analyses of covariance had showed that all analysed factors (sex, level of ID, type of the test performance and body height), irrespectively from direction of sway (sway path in anterio-posterior and medio-lateral directions), worked independently influencing body balance.

CONCLUSIONS

It could be assumed that lower height, moderate disability and male sex are factors significantly reducing ability of maintenance of balance of children and youth with ID.

Physical therapy in Down syndrome: systematic review and meta-analysis

BACKGROUND

Down syndrome is the most common chromosomal abnormality, with a worldwide incidence of around 0.1% in live births. It is related to several conditions in which the physical therapy could take action-preventing co-morbidities. This study aims to evaluate the effectiveness of physical therapy in Down syndrome, to know and compare the effectiveness of different physical therapy interventions in this population.

METHODS

A systematic review and a meta-analysis of randomised controlled trials were conducted. The search was performed during June 2018 in the following databases: PubMed, Web of Science, Physiotherapy Evidence Database and Scopus. The studies were selected using predefined inclusion and exclusion criteria. The Physiotherapy Evidence Database scale evaluated the quality of the methods used in the studies. Subsequently, the data were extracted, and statistical analysis was performed when possible.

RESULTS

A total of 27 articles were included, of which nine contributed information to the meta-analysis. Statistical analysis showed favourable results for the strength of upper and lower limbs [standardised mean difference (SMD) = 1.46; 95% confidence interval (CI): (0.77-2.15); and SMD = 2.04; 95% CI: (1.07-3.01)] and mediolateral oscillations of balance [SMD = -3.30; 95% CI: (-5.34 to -1.26)].

CONCLUSIONS

The results show the potential benefit of certain types of physical therapy interventions, specifically in strength and balance, in people with Down syndrome. There are still many aspects to clarify and new lines of research.

The effects of hemsball on the motor proficiency of students with intellectual disabilities

Objective: The effects of hemsball game skills development program on the motor proficiency level of children in the 12-16 age group with mild and moderate intellectual disabilities (ID) have been examined in this study. Method: A total of 50 (25 experimental group +25 control group) students, 23 of which had mild intellectual disabilities (ID) and 27 with moderate ID studying in special education classes in the schools in Afyonkarahisar province in Turkey participated in the study. While no training was given to the control group, the students in the experimental group were subjected to 60 min of applications involving a basic hemsball training program per day for 3 days per week throughout 12 weeks. Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) sub-tests (balance, bilateral coordination, upper-limb coordination) were applied twice, once before starting the program (pre-test) and once after the program was completed (post-test). The obtained data were tested with paired-samples t-test and independent-samples t-test. Result and Conclusion: As a result of the study, it was noted that the application of the hemsball game skill development program had incurred significant differences between the experimental and control group according to the post-test as well as the pre-test and post-test for the experimental group which were positive. However, it was determined that the application was more effective in students with moderate level ID than students with mild ID.

Physical Activity Research in Intellectual Disability: A Scoping Review Using the Behavioral Epidemiological Framework

Through a scoping review, the current state of physical activity research in people with intellectual disability was examined. A search of publications between 2000 and 2014 retrieved 362 articles that met inclusion criteria. Eligible studies were coded according to the Behavioral Epidemiological Framework. Of the articles identified, 48% examined associations between physical activity and health outcomes, 9% developed or tested methodology to measure physical activity, 34% examined factors that influence physical activity, 8% evaluated interventions to change physical activity, and 1% examined the dissemination of physical activity/health promotion programming. The categories with lower proportions of studies represent the need for greater population-specific research in physical activity measurement, interventional designs, and translational programs.

Fundamental movement skills and balance of children with Down syndrome

BACKGROUND

Conclusive evidence supports the importance of fundamental movement skills (FMS) proficiency in promoting physical activity and countering obesity. In children with Down Syndrome (DS), FMS development is delayed, which has been suggested to be associated with balance deficits. This study therefore examined the relationship between FMS proficiency and balance ability in children with DS, with the aim of contributing evidence to programmes that address FMS delay.

METHODS

Participants consisted of 20 children with DS (7.1 ± 2.9 years old) and an age-matched control group of children with typical development (7.25 ± 2.5 years). In the first part of the study, FMS (i.e. locomotor and object control) proficiency of the children was tested using the Test of Gross Motor Development-2. Balance ability was assessed using a force platform to measure centre of pressure average velocity (AV; mm/sec), path length (mm), medio-lateral standard deviation (mm) and antero-posterior standard deviation (mm). In the second part of the study, children with DS participated in 5 weeks of FMS training. FMS proficiency and balance ability were tested post-training and compared to pre-training scores. Verbal and visuo-spatial short-term memory capacities were measured at pre-training to verify the role of working memory in skill learning.

RESULTS

FMS proficiency was associated with centre of pressure parameters in children with DS but not in children with typical development. After controlling for age, AV was found to predict significant variance in locomotor (R²  = 0.61, P < 0.001) and object control (R²  = 0.69, P < 0.001) scores. FMS proficiency and mastery improved after FMS training, as did AV, path length and antero-posterior standard deviation (all P < 0.05). Verbal and visuo-spatial short-term memory did not interact with the effects of training.

CONCLUSIONS

Children with DS who have better balance ability tend to have more proficient FMS. Skill-specific training improved not only FMS sub-skills but static balance stability as well. Working memory did not play a role in the changes caused by skills training. Future research should examine the causal relationship between balance and FMS.

The Effect of a Psychomotor Education Program on the Static Balance of Children With Intellectual Disability

Children with intellectual disability (ID) demonstrate lower balance ability which results in substantial delays in motor growth and limits their function level. Psychomotor education comprises a holistic movement approach, with the aim to improve all aspects of each child personality. The aim of this study was to assess the effect of a psychomotor education program on static balance of school-aged children with ID. Twenty children with ID who were 8-12 years old participated in the study. They were assigned to 2 groups, 1 experiment and 1 control. The experiment group attended a 16-week psychomotor education program at a frequency of 2 lessons per week, for 45 minutes. All the children who participated in the above measurements had (a) recording of anthropometric characteristics, (b) assessment of motor developmental index, and (c) measurement of static balance. The static balance ability was measured by means of an electronic pressure platform. Each child was requested to keep a quiet stance posture under 4 different conditions: double-leg stance with eyes opened or closed while they observed a visual or visual-auditory target. Participants of the intervention group reduced the values of static balance variables for all the positions. In conclusion, findings of this study clearly indicate that psychomotor education program has an important contribution to make for the most benefit of children with ID in terms of static balance.

Impact of Frisbee game course on the upper limb motor function of students with intellectual disabilities

Objectives: Upper limb motor dysfunction often occurs in individuals with intellectual disabilities, affecting their daily self-care abilities and employability. Therefore, enhancing their upper limb motor function could improve the quality of life. This study investigated the impact of Frisbee game course on the upper limb motor function of students with intellectual disabilities. Methods: A self-designed Frisbee game course was made available to 10 senior vocational students with moderate to severe intellectual disabilities in a special school in New Taipei City, Taiwan. The students participated 40 min each time, 4 times a week, for 6 weeks. Pre and post-test functional capacity and Frisbee throwing distance were measured. Descriptive statistics and paired-sample t-test were performed for the data analysis. Results: Frisbee game course improved the lifting capacity, significantly improved the grip strength (dominant hand), upper limb power, hand-eye coordination, and gross and fine hand motor skills of students with intellectual disabilities. Conclusion: Frisbee game course can improve upper limb muscle strength, power, coordination ability, and dexterity. Schools should implement Frisbee game courses and ensure their availability in the health and physical education of students with intellectual disabilities to enhance their upper limb motor function, employability, and vocational adaptability, thus improving their quality of life.

Effectiveness of a cross-circuit exercise training program in improving the fitness of overweight or obese adolescents with intellectual disability enrolled in special education schools

This study assessed the effects of a cross-circuit training intervention program on the body composition, cardiorespiratory fitness, balance, and muscular strength endurance of overweight or obese students with intellectual disability. A total of 43 students with intellectual disability (aged 13-19 years) were enrolled in this program; 28 overweight/obese students were assigned to either an obesity-control group (n=14) or obesity-exercise group (n=14), and those with normal weight were assigned to a normal weight group (n=15). The experiment was divided into three periods: pretest (involving the three groups), exercise intervention (involving only the obesity-exercise group), and post-test (involving the obesity-exercise and obesity-control groups). The test involved measuring the body composition, 1-min sit-ups, dynamic and static balance, vertical jumps, and modified Bruce treadmill protocols for measuring cardiorespiratory fitness. The exercise program involving the cross-circuit training concept was conducted nonstop with different types of exercise activities. The training program lasted 12 weeks, and it was executed 5days a week, with each daily session lasting 50min. The results revealed that the obesity-exercise group demonstrated reduced weight, BMI, and fat mass after the intervention program. Moreover, the exercise tolerance test (including total exercise time and maximal heart rate), dynamic balance, sit-up, and vertical jump performance of the participants improved significantly. In conclusion, the cross-circuit training program effectively improved cardiorespiratory fitness, dynamic balance, muscular strength and endurance, and weight control in overweight or obese students with intellectual disability enrolled in a special education school.

Effects of Neuromuscular Training on Children and Young Adults with Down Syndrome: Systematic Review and Meta-Analysis

PURPOSE

To synthesize existing research evidence and examine effects of neuromuscular training on general strength, maximal strength, and functional mobility tasks in children and young adults with Down syndrome.

METHODS

PubMed and EBSCO were used as a data source. To attain the aim of this study, literature search was performed under following inclusion criteria: (1) included participants with Down syndrome, (2) implemented a neuromuscular training intervention and measured outcome variables of general strength, maximal strength, and functional mobility tasks, (3) had a group of participants whose mean ages were under 30 years old, (4) employed a prospective controlled design, and (5) used mean and standard deviations to express the outcome variables. Effect size was calculated from each study based on pre- and post-testing value differences in general strength, maximal strength, and functional mobility tasks between control and intervention groups. The effect size was further classified in to one of the following categories: small, moderate, and large effects.

RESULTS

Seven studies met inclusion criteria. Analysis indicated large to moderate effects on general strength, moderate to small effects on maximal strength, and small effect on functional mobility tasks by neuromuscular training.

CONCLUSIONS

Although there were limited studies, the results showed that neuromuscular training could be used as an effective intervention in children and young adults with Down syndrome.

WHAT THIS PAPER ADDS

Synthesis of seven reviewed studies indicated that neuromuscular training could be beneficial to optimize general and maximal muscular strength development in children and young adults with Down syndrome.

The effect of a combined strength and proprioceptive training on muscle strength and postural balance in boys with intellectual disability: An exploratory study

The aim of our study was to investigate the effect of a combined strength and proprioception training (CSPT) program on muscle strength and postural balance in children with intellectual disability (ID). The maximum voluntary contraction (MVC) and postural parameters (CoPVm, CoPLX, CoPLY) of 20 children with ID were recorded before and after 8 weeks of a CSPT program. The participants were divided into two groups: an experimental group who attended a CSPT program and a control group who continued with daily activities. In the trained group, the MVC increased significantly (p<0.001) after the training period and the postural parameters decreased significantly in Double-Leg Stance (DLS) and One-Leg Stance (OLS) during the firm surface condition as well as in the DLS during the foam surface condition; in both eyes open (EO) and eyes closed (EC) conditions. A CSPT program improves postural balance in children with ID could be due to the enhancement in muscle strength and proprioceptive input integration.

Does extending the dual-task functional exercises workout improve postural balance in individuals with ID?

Maintaining postural balance, overcoming visual and motor coordination disorders and experiencing problems with low general fitness - typical of intellectually disabled individuals - adversely affect the performance quality of their activities of daily living (ADLs). Physical fitness and postural balance can be improved by taking part in special intervention programs. Our study was designed to test whether extending the dual-task intervention program (combining ADLs with balance exercises on unstable surfaces) from 12 to 24 weeks additionally improved postural balance in individuals with intellectual disability (ID). We also attempted to assess whether the effects of the above intervention program were still noticeable after 8 weeks of holidays, in which participants did not take any rehabilitation exercises. A total of 34 adolescents, aged 14-16 years (15.06±0.9), with moderate ID took part in our study. The experimental group (E) consisted of 17 individuals, who continued the intervention program originated 3 months earlier, and the control group (C) comprised the same number of participants. Postural balance was assessed on a stabilometric platform Alfa. Having extended the workout period by another 12 weeks, we noticed that the path length of the center of pressure (COP) covered by participants on tests with their eyes open and closed significantly shortened. After a lapse of 8 weeks from the completion of the program, the experimental group revealed a statistically significant decrease in the velocity along the medio-lateral (M/L) and anterior-posterior (A/P) axes. The remaining variables stayed at the same level and the control group did not demonstrate any statistically significant changes. Dual-task exercises, in which enhancing functional tasks of daily living is combined with a parallel stimulation of balance reactions, may improve static balance in persons with ID.

The effect of dual-task functional exercises on postural balance in adolescents with intellectual disability - a preliminary report

PURPOSE

The study aimed to assess the effectiveness of an original intervention programme of unstable surface dual-task functional exercises on postural stability in adolescents with intellectual disability (ID).

METHODS

A total of 34 adolescents with ID, aged 14-16 years, were engaged in our study. A 17-person experimental group (E) took part in a 12-week intervention programme which consisted of unstable surface functional exercises, designed after activities of daily living (ADLs). Another group of 17 youngsters constituted a control group (C). Within a span of 12 weeks, the postural stability assessment was conducted twice in both groups, employing a stabilometric platform ALFA AC International East.

RESULTS

After taking part in the intervention programme, the experimental group (E) improved all their scores (p < 0.05). The path length of the COG and the time in which the dynamic test was performed were shorter in the experimental group (E), while the control group (C) scored worse in comparison with their initial results.

CONCLUSIONS

A distinctly positive effect of unstable-surface dual-task functional exercises on postural stability in individuals with ID was also revealed in our tests. Implications for Rehabilitation Rehabilitation of intellectually disabled persons should be carried out individually and contain ADL-based exercises. The use of unstable surfaces, making the above training more difficult, naturally stimulates the trainee to focus more closely on the task being performed. Implementation of dual-task exercises, consisting in compiling functional tasks with balance training, in the intervention programme for adolescents with ID is likely to improve efficiency of their everyday living and the quality of their lives.

The effect of the degree of disability on nutritional status and flat feet in adolescents with Down syndrome

Excessive weight and obesity are ranked among lifestyle diseases. In the case of weight gain, the effectiveness of therapy based on diet and physical activity depends considerably on patients themselves, but despite this the number of those who successfully manage to lose weight is still not satisfactory. Preventing or treating excessive weight gain in the intellectually disabled is extremely difficult since they have a higher risk for developing obesity. The below presented study assessed the effect of the degree of intellectual disability on nutritional status in adolescents with Down syndrome. It also focused on some correlations between the degree of disability and a selected constituent of the body posture, i.e. flat feet. A total of 54 males and 26 females with mild and moderate Down syndrome, aged 18.68 ± 1.73, residents of Special Needs Education Centre in Tarnów, Poland, participated in the study, in which body weight and height, BMI, fat tissue percentage and the longitudinal arch of the foot were measured. A total of 17.5% of individuals with mild and 50% of individuals with moderate ID were found overweight or obese. Weight gain more often occurred in females. It seemed that flat feet were affected to a greater extent by the participants' nutritional status than their degree of disability. The study found no unambiguous effect of the degree of disability on the nutritional status and flat feet in individuals with Down syndrome.

Two men with multiple disabilities carry out an assembly work activity with the support of a technology system

OBJECTIVE

To assess whether two persons with multiple disabilities could learn a work activity (i.e., assembling trolley wheels) with the support of a technology system.

METHOD

After an initial baseline, the study compared the effects of intervention sessions relying on the technology system (which called the participants to the different workstations and provided feedback and final stimulation) with the effects of intervention sessions carried out without technology. The two types of intervention sessions were conducted according to an alternating treatments design. Eventually, only intervention sessions relying on the technology system were used.

RESULTS

Both participants managed to assemble wheels independently during intervention sessions relying on the technology system while they failed during sessions without the system. Their performance was strengthened during the final part of the study, in which only sessions with the system occurred.

CONCLUSION

Technology may be critical in helping persons with multiple disabilities manage multi-step work activities.

Effects of whole body vibration training on balance in adolescents with and without Down syndrome

The present study aimed to determine whether a whole body vibration training program (WBV) is able to improve static standing balance in adolescents with and without Down syndrome (DS). Thirty adolescents with DS aged 11-20 years (DSG) and 27 adolescent, age/sex matched, without DS (CG) joined the study. Participants of each group were divided into two comparable groups, those who performed WVB (in DSG: VDSG; in CG: VCG) and those who did not perform WVB (in DSG: nVDSG; in CG: nVCG). Static-standing-balance under four conditions (C1: open-eyes/fixed-foot-support; C2: closed-eyes/fixed-foot-support; C3: open-eyes/compliant-foot-support; C4: closed-eyes/compliant-foot-support) was examine, before and after a 20-week WBV training program. For balance study, Postural-Parameters (PPs), based on center of pressure (COP) oscillations (anterior/posterior and medial/lateral COP excursion and COP mean velocity), and PPs ratios among the four conditions were calculated. After WBV training, no significant differences were found in any parameter in the VCG and nVCG and neither in the nVDSG, but there was a decrease of mean values in the analyzed PPs under C4, with significant differences in medial/lateral COP excursion and COP mean velocity, and a significant decrease in the ratio C4/C1 of the mean velocity in VDSG. Therefore, WBV training had positive effects in the balance of DS adolescents although only under specific conditions, with vision and somatosensory input altered. The positive results of this study are encouraging and open a wide field of research, looking for the most efficient program for this population.

Effects of a trampoline exercise intervention on motor performance and balance ability of children with intellectual disabilities

Balance and motor impairments are most evident among inactive individuals with ID that might be particularly susceptible to a loss of basic functioning and further limit the person's autonomy in activities of daily living. The aim of the study was to assess the effect of a 12-week trampoline exercise intervention program on motor and balance ability of school aged children with intellectual disability (ID). Eighteen healthy schools aged children (mean age=10.3 ± 1.6 years) with moderate ID were assigned either to an experimental group (n=9) or a control group (n=9). The experiment group attended a 12 weeks trampoline training intervention program consisting of daily individualized 20-min sessions, while the control group followed the regular school schedule. Balance was assessed using three tasks of increased difficulty (double-leg stance with eyes opened or closed, and one-leg stance with eyes opened) performed while standing on an electronic pressure platform (EPS). Motor performance of all participants was tested using sit and reach test and long and vertical jump tests all derived from the Eurofit Test Battery of physical fitness. Trampoline intervention resulted in significant improvements of participants' performance in all motor and balance tests. In conclusion, trampoline training can be an effective intervention for improving functional outcomes and can be recommended as an alternative mode of physical activity programming for improving balance and motor performance. Furthermore, it also supports the idea that individuals with ID require enjoyable and interesting intervention programs such as the trampoline program used in this study so as to remain active and consequently to facilitate their overall development and promote a more active and healthier way of life.

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.