Down syndrome and sport participation

More Than a Flesh Wound: Trisomy 21 Patients Undergoing Posterior Spinal Fusion for Scoliosis Have High Odds of Wound Complications

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

Patients with trisomy 21 (T21) often have soft tissue differences that lead to greater risk of postoperative wound complications. Our aim was to use a matched cohort of adolescent idiopathic scoliosis (AIS) patients with >2 year outcomes to determine odds of specific wound complications when comparing T21 and AIS patients.

METHODS

14 T21 and 544 AIS patients were available for matching. Propensity score matching was conducted using logistic regression models and yielded a 1:5 match of 14 T21 patients and 70 AIS patients. Bivariate analyses were conducted across both patient groups. The proportion of wound complications was estimated along with a 95% confidence interval. Multivariable logistic regression analysis was utilized to determine if there was a significant association between T21 patients and wound outcomes.

RESULTS

64% of T21 patients experienced a wound complication (9/14; 95% CI = 35.63-86.02) while only 3% of the AIS patients experienced a wound complication (2/70; 95% CI = .50-10.86). Patients with T21 had 56.6 times the odds of having a wound complication compared to matched AIS patients (OR = 56.57; 95% CI = 8.12-394.35; P < .001), controlling for age at surgery, BMI percentile, and propensity score. T21 patients had 10.4 times the odds of reoperation compared to AIS patients (OR = 10.36; 95% CI = 1.62-66.02; P = .01).

CONCLUSION

T21 patients have 10.4× the odds of reoperation and 56.6× the odds of overall wound complication when compared to AIS patients in a 1:5 matched cohort with appropriate controls. This is important for surgical planning, surgeon awareness, and communication with families preoperatively.

Psychosocial aspects of sports medicine in pediatric athletes: Current concepts in the 21st century

Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e., effects of stress, anxiety, depression, suicide in athletes, ADHD and stimulants, coping with injuries, drug use, and eating disorders), violence in sports (i.e., concepts of the abused athlete including sexual abuse), dealing with supervisors (i.e., coaches, parents), peers, the talented athlete, early sports specialization and sports clubs. In the second part of this discussion, we cover ergolytic agents consumed by young athletes in attempts to win at all costs. Sports doping agents covered include anabolic steroids (anabolic-androgenic steroids or AAS), androstenedione, dehydroepiandrostenedione (DHEA), human growth hormone (hGH; also its human recombinant homologue: rhGH), clenbuterol, creatine, gamma hydroxybutyrate (GHB), amphetamines, caffeine and ephedrine. Also considered are blood doping that includes erythropoietin (EPO) and concepts of gene doping. In the last section of this discussion, we look at disabled pediatric athletes that include such concepts as athletes with spinal cord injuries (SCIs), myelomeningocele, cerebral palsy, wheelchair athletes, and amputee athletes; also covered are pediatric athletes with visual impairment, deafness, and those with intellectual disability including Down syndrome. In addition, concepts of autonomic dysreflexia, boosting and atlantoaxial instability are emphasized. We conclude that clinicians and society should protect our precious pediatric athletes who face many challenges in their involvement with organized sports in a world obsessed with winning. There is much we can do to help our young athletes find benefit from sports play while avoiding or blunting negative consequences of organized sport activities.

Assessing motor competence in kicking in individuals with Down syndrome through wearable motion sensors

BACKGROUND

Kicking a ball is a very frequent action in sport and leisure time activities and a low proficiency in this skill could limit the participation in recreational sport activities. This issue is emphasised in individuals with Down syndrome (IDS) for which data about motor competence in kicking are limited to children. Here, we aim at evaluating the kicking competence of IDS combining a qualitative and a quantitative method.

METHODS

Twenty-three adult IDS and 21 typically developed individuals (ITD) volunteered to participate in the study. Peak-to-peak 3D linear acceleration and angular velocity were recorded at 200 samples/s using two inertial measurement units placed on the lower back and lateral malleolus of the dominant limb during kicking. Motor competence in kicking was assessed according to the criteria proposed in the test of gross motor development version 3 (TGMD-3).

RESULTS

Individuals with Down syndrome showed lower motor competence (ITD: 5.9 ± 1.2; IDS: 3.2 ± 2.0) and lower angular velocities about the cranio-caudal (ITD: 3.0 ± 1.8; IDS: 2.1 ± 1.1 rad/s) and medio-lateral axes (ITD: 4.5 ± 1.5; IDS: 3.0 ± 1.1 rad/s) of the trunk compared with ITD. Shank angular velocity about the medio-lateral axis was lower in IDS (ITD: 14.3.6 ± 4.0; IDS: 9.9 ± 2.8 rad/s).

CONCLUSIONS

The lower trunk angular velocity in IDS may limit the possibility to rely on the proximal-to-distal sequencing commonly observed in kicking and generate high shank angular velocity upon ball impact. The lower trunk angular velocity may result from orthopaedic features of the pelvic girdle and possibly from a poorer neuromuscular control of core muscles.

Active Parents-Active Children-A Study among Families with Children and Adolescents with Down Syndrome

From a public health perspective, it is important that children with Down syndrome (DS) lay the foundations of physical activity (PA) early in life to keep active in school, as teenagers and as adults. The aims were to investigate PA patterns in children and adolescents with DS, as well as their parents’ and siblings’ PA patterns. Methods: A survey was performed among 310 families with children with DS (54% boys and 46% girls) aged 8–18 years (mean 14.04, SD 3.18) in Sweden. Chi-squared tests and multiple logistic regression were carried out. Results: Nineteen percent of children and adolescents with DS and 34% of the parents were active three or more times per week. The child’s PA level was significantly associated with parents’ PA (OR = 5.5), siblings’ PA (OR = 5.1) and the child’s locomotion ability (OR = 3.5). Physically active parents had active children to a greater extent than inactive parents (59% vs. 29%; p < 0.001). Conclusions: Physically active parents have active children. To promote PA among children and adolescents with DS, it is important to promote and pay attention to the parents’ and siblings’ PA behavior, as children with DS are dependent on support from the family.

Feasibility and Potential Benefits of an Exercise Intervention in a Male With Down Syndrome Undergoing High-Dose Chemotherapy for Acute Lymphoblastic Leukemia: A Case Report

In patients with hematological malignancies, exercise is studied as a supportive measure with potential benefits on therapy and disease-related side effects. However, clinical trials have not yet integrated people with Down syndrome (DS), although this disability is associated with an increased risk for hematological malignancies. Therefore, we examined safety and feasibility of a mixed-modality exercise intervention in a male with DS undergoing high-dose chemotherapy for acute lymphoblastic leukemia. Furthermore, physical capacity and fatigue were assessed. Exercise sessions took place 3 times/wk over a 5-week period. Adherence to the exercise program was 100%, and no serious adverse events occurred. In contrast to the training sessions, applied endurance testing was not feasible. Furthermore, maintenance of fatigue level was observed. In conclusion, cancer patients with DS suffering from leukemia should not be excluded from physical activity or exercise programs.

Injury among adolescents with intellectual disability: A prospective cohort study

INTRODUCTION

Injury is the leading cause of mortality and morbidity in adolescents worldwide, and injury rates have been shown to be higher among youth with intellectual disability. Despite this, injury among adolescents with intellectual disability remains poorly investigated. This study aimed to identify characteristics associated with injury among adolescents with intellectual disability living in the community.

METHODS

A cohort of adolescents with intellectual disability living in southern Queensland, Australia was investigated prospectively between January 2006 and June 2010. Personal characteristics were collected via postal questionnaire. Injury information, including mechanism and location of injury, was extracted from general practitioner records. The association between demographic, social and clinical characteristics of participants and episodes of injury was investigated using negative binomial regression.

RESULTS

A total of 289 injuries were recorded from 432 participants over 1627.3 years of study-time. The overall annual injury incidence was 17.5 (95%CI 14.7, 20.9) per 100 person years. Presence of ADHD and less severe disability was associated with increased risk of injury. Down syndrome and reduced verbal communication capacity were associated with decreased risk of injury. Falls accounted for the highest single mechanism of injury (19.0%) with the majority (73.2%) of injuries involving either upper or lower limbs.

CONCLUSIONS

ADHD is a co-morbidity that increases risk of injury among adolescents with intellectual disability. A critical component of injury prevention is avoidance of the great variety of environmental risk factors for injury relevant to this population.

Motor skill assessment in children with Down Syndrome: relationship between performance-based and teacher-report measures

of previous studies show a large interindividual variability with regard to motor skills and motor abilities in children with Down Syndrome (DS). In order to provide detailed information for intervention, adequate assessment methods seem to be necessary to address the child's unique motor profile. Typically, children are either examined using a bottom-up (performance-based assessment of motor skills) or a top-down approach (e.g. client-report measure), but rarely both approaches. The aim of this study was to examine the relationship between standardized performance-based, and teacher-report measures of children's motor performance. The performance- and process-based assessment Test of Gross Motor Development (TGMD-2), and the teacher-based Movement Assessment Battery - Checklist (MABC-C) for young children were used to assess the motor performance of 18 children with DS (11 boys, 7 girls) aged 7-11 years (M = 9.06, SD = 0.96) and an age- and sex-matched sample of typically developing (TD) 18 children (11 boys, 7 girls; M = 8.99, SD = 0.93). TD children achieve consistently better results compared to children with DS, both in the TGMD-2 and MABC-C, which differ significantly in most cases. When gender differences were examined for the TGMD-2 scores, boys with DS were better performers of the run, gallop, leap, and catch, as well as the locomotor and object-control skill sum scores, whereas girls of the TD group were more proficient in these areas. TD children achieve significantly better results in 21 out of 28 items of Section A+B of the MABC-C, compared to the children with DS; whereas there are no significant differences for Section C (non-motor factors). Our results show more significant relationships between TGMD-2 and MABC-C sub- and overall scores for the TD sample compared to the children with DS. The correlations range between r = -.21 and -.65 for TD children and between r = -.15 and -.65 for the children with DS. The correlations between both approaches show that the combination of both methods could be useful in getting a more detailed picture of the child's individual motor profile in order to create tailor-made therapies and interventions, both for children with DS and TD children.

Evidence-based risk assessment and recommendations for physical activity clearance: cognitive and psychological conditions

Physical activity has established mental and physical health benefits, but related adverse events have not received attention. The purpose of this paper was to review the documented adverse events occurring from physical activity participation among individuals with psychological or cognitive conditions. Literature was identified through electronic database (e.g., MEDLINE, psychINFO) searching. Studies were eligible if they described a published paper examining the effect of changes on physical activity behaviour, included a diagnosed population with a cognitive or psychological disorder, and reported on the presence or absence of adverse events. Quality of included studies was assessed, and the analyses examined the overall evidence by available subcategories. Forty trials passed the eligibility criteria; these were grouped (not mutually exclusively) by dementia (n = 5), depression (n = 10), anxiety disorders (n = 12), eating disorders (n = 4), psychotic disorders (n = 4), and intellectual disability (n = 15). All studies displayed a possible risk of bias, ranging from moderate to high. The results showed a relatively low prevalence of adverse events. Populations with dementia, psychological disorders, or intellectual disability do not report considerable or consequential adverse events from physical activity independent of associated comorbidities. The one exception to these findings may be Down syndrome populations with atlantoaxial instability; in these cases, additional caution may be required during screening for physical activity. This review, however, highlights the relative paucity of the reported presence or absence of adverse events, and finds that many studies are at high risk of bias toward reporting naturally occurring adverse events.

Sport participation by physically and cognitively challenged young athletes

Many physically and cognitively challenged athletes participate in organized and recreational sports. Health benefits of sport participation by athletes with disabilities have been well recognized. A careful preparticipation evaluation and proper classification of athletes ensures safe sports participation by athletes with disabilities. Some conditions in these athletes, such as problems with thermoregulation, autonomic control, neurogenic bladder and bowel, latex allergy, and many associated and secondary complications deserve special consideration. This article reviews common medical issues that relate to sport participation by athletes with physical and cognitive disabilities.