Commentary

Cross-sectional study of motor development among children after the Fontan procedure

OBJECTIVES

To determine the gross motor skills of school-aged children after the Fontan procedure and compare the locomotor and object control skills with normative data. Study design This study followed a cross-sectional design.

SETTING

This study was based on hospital outpatient visit, with accelerometry conducted at home. Patients This study included 55 patients, including 22 girls in the age group of 6-10 years, 5.1 years after Fontan. Main outcome measures Test of Gross Motor Development - Version 2, daily activity by accelerometer, medical history review, child and parent perceptions of activity.

RESULTS

Being involved in active team sports increased locomotor percentile score by 10.3 points (CI: 4.4, 16.1). Preference for weekend outdoor activities (6.9, CI: 2.0, 11.8), performing at least 30 minutes of moderate-to-vigorous physical activity daily (24.5, CI: 7.3, 41.8), and reporting that parents seldom criticise the child's physical activity (21.8, CI: 8.9, 34.8) were also associated with higher locomotor percentile scores (p < 0.01). Object control percentile scores were higher (p < 0.03) with involvement in formal instruction (5.9, CI: 1.1, 10.6) and being restricted to "activities within comfortable limits" (27.6, CI: 7.7, 47.5). Older chronological age (r = 0.28), a more complicated medical history (r = 0.36), and older age at Fontan (r = 0.28) were associated with greater skill delay (p < 0.04).

CONCLUSIONS

Children after Fontan attain basic motor skills at a later age than their peers, and deficits continue for more complex skills as age increases, suggesting a need for longitudinal monitoring of gross motor skill development through the elementary school years. Future research might investigate whether a gross motor skill rehabilitation programme can provide these children with the motor skills needed to successfully participate in a physically active lifestyle with peers.

Activities in daily living and schoolwork task performance in children with complex congenital heart disease

AIM

To examine if children with complex congenital heart disease (CHD) differ significantly from healthy children in performance of activities in daily living (ADL) and schoolwork tasks.

METHODS

Fourteen children with complex CHD (3-14 years) were matched in pairs by age and gender to healthy children (n = 14). The ADL Taxonomy was used to evaluate ability to perform ADL and the School Version of the Assessment of Motor and Process Skills (AMPS) to evaluate quality of schoolwork task performance.

RESULTS

The children with complex CHD had significantly lower mean ADL, school motor and school process performance. Eight of the pairs differed significantly in school motor ability, ten in school process performance and nine in ability to perform ADL.

CONCLUSION

This study indicates that there is a difference in overall performance both in ADL and schoolwork task performance between children with complex CHD and healthy children. These findings may suggest that early interventions should be provided for children with complex CHD, who often do not receive such services, in order to enhance participation in childhood ADL and schoolwork.