Gillian D. Ferguson

The effect of the Nintendo Wii Fit on balance control and gross motor function of children with spastic hemiplegic cerebral palsy

Objective: To study the impact of training using the Nintendo Wii Fit in 14 children with spastic hemiplegic cerebral palsy. Methods: A single-subject single blinded design with multiple subjects and baselines was utilised. Interactive video gaming (IVG) in lieu of regular physiotherapy was given for 3 weeks. Outcome measures included modified balance and running speed and agility (RSA) scales of the Bruininks–Oserestky test of Motor Performance 2 and the timed up and down stairs (TUDS). Results: Balances score improved significantly (F(2, 26) = 9.8286, p = 0.001). Changes over time in the RSA (F(2, 26) = 0.86198, p = 0.434) and the TUDS (F(2, 26) = 1.3862, p = 0.268) were not significant. Ten children preferred the intervention to conventional physiotherapy. Conclusion: Most children preferred the IVG but as the effect did not carry over into function, IVG should not be used in place of conventional therapy and further research is needed into its use as an adjunct to therapy.

The determinants of self-reported health-related quality of life in a culturally and socially diverse South African community.

OBJECTIVE To determine factors predictive of the score on the visual analogue scale (VAS) of the EQ-5D questionnaire. METHODS The responses of 1159 residents of a socially and ethnically diverse suburb of Cape Town, South Africa, to the EQ-5D questionnaire were analysed using forward stepwise multiple regression. The variables entered included ethnic group, religious affiliation (Christian or Muslim), income level, unemployment, recent illness or disability and each level of the five EQ-5D domains. FINDINGS The model developed accounted for an adjusted r(2) of 0.234 and included 11 variables. In addition to the EQ-5D domains, the presence of a disability, an income of less than 420 US dollars per month, unemployment and age in years were significant predictors of VAS score. CONCLUSION The substantial contribution of health state to the VAS indicates that it is a valid measure of health-related quality of life (HRQoL) across population groups. However, the subjects with lower social status reported a worse HRQoL than their health state alone warranted and this variable might need to be taken into account if the VAS is to be used to compare health states across populations. This paper provides empirical evidence of how HRQoL is perceived by different socioeconomic, cultural, ethnic and religious communities within a developing country.

The prevalence of motor delay among HIV infected children living in Cape Town, South Africa.

Children living with HIV often display delayed motor performance owing to HIV infection of the central nervous system, the effects of opportunistic infections and, indirectly, owing to their social environments. Although these problems have been well documented, the impact of the virus on the development of South African children is less well known. The aim of this study was to document the motor performance of a group of HIV infected children in Cape Town, South Africa. The Bayley Scales of Infant Development Second Edition were administered to 51 HIV infected children [mean age 15.8 months (SD=7.5, range 6.2-31.7 months)] of whom 34 were receiving antiretroviral therapy. Their performance was compared with an age-matched reference sample (n=35), whose HIV status was unknown. The HIV infected sample and the age-matched sample were comparable with regard to caregivers level of education (P=0.42), employment status (P=0.35) and income (P=0.28). However, the HIV infected sample had significantly more hospital admissions (P<0.01), their caregivers were mostly single (P=0.04) and most lived in formal houses (P<0.01). The prevalence of significant motor delay was 66.7% in the HIV infected sample compared with 5.7% in the age-matched sample. As expected, the performance of the HIV infected sample was significantly poorer than the age-matched sample. However, the extent of the delay is a cause of concern as so many children presented with significant motor delay. Unexpectedly, a significant number of healthy children also displayed delayed performance. It is recommended that the developmental performance of HIV infected children be monitored over an extended period to determine whether the developmental delay can be reduced with treatment. In the interim, there is a need to provide stimulation and treatment to the large number of children who are developmentally delayed as a result of HIV infection, including those uninfected children in the community who are at risk owing to their socio-economic status.

The motor development of orphaned children with and without HIV: Pilot exploration of foster care and residential placement

BackgroundThe AIDS epidemic has lead to an increase in orphaned children who need residential care. It is known that HIV leads to delayed motor development. However, the impact of place of residence on motor function has not been investigated in the South African context. The aim of the study was therefore to establish if children in institutionalised settings performed better or worse in terms of gross motor function than their counterparts in foster care. A secondary objective was to compare the performance of children with HIV in these two settings with those of children who were HIV negative.MethodsForty-four children both with and without HIV, were recruited from institutions and foster care families in Cape Town. The Peabody Development Motor Scale (PDMS II) was used to calculate the total motor quotient (TMQ) at baseline and six months later. Comparisons of TMQ were made between residential settings and between children with and without HIV.ResultsTwenty-one children were infected with HIV and were significantly delayed compared to their healthy counterparts. Antiretroviral therapy was well managed among the group but did not appear to result in restoration of TMQ to normal over the study period. HIV status and place of residence emerged as a predictor of TMQ with children in residential care performing better than their counterparts in foster care. All children showed improvement over the six months of study.ConclusionsFoster parents were well supported administratively in the community by social welfare services but their children might have lacked stimulation in comparison to those in institutional settings. This could have been due to a lack of resources and knowledge regarding child development. The assumption that foster homes provide a better alternative to institutions may not be correct in a resource poor community and needs to be examined further.

Physical fitness in children with Developmental Coordination Disorder: Measurement matters

Children with Developmental Coordination Disorder (DCD) experience considerable difficulties coordinating and controlling their body movements during functional motor tasks. Thus, it is not surprising that children with DCD do not perform well on tests of physical fitness. The aim of this study was to determine whether deficits in motor coordination influence the ability of children with DCD to perform adequately on physical fitness tests. A case-control study design was used to compare the performance of children with DCD (n=70, 36 boys, mean age=8 y 1 mo) and Typically Developing (TD) children (n=70, 35 boys, mean age=7 y 9 mo) on measures of isometric strength (hand-held dynamometry), functional strength, i.e. explosive power and muscular endurance (Functional Strength Measurement), aerobic capacity (20 m Shuttle Run Test) and anaerobic muscle capacity, i.e. muscle power (Muscle Power Sprint Test). Results show that children with DCD were able to generate similar isometric forces compared to TD children in isometric break tests, but were significantly weaker in three-point grip strength. Performance on functional strength items requiring more isolated explosive movement of the upper extremities, showed no significant difference between groups while items requiring muscle endurance (repetitions in 30s) and items requiring whole body explosive movement were all significantly different. Aerobic capacity was lower for children with DCD whereas anaerobic performance during the sprint test was not. Our findings suggest that poor physical fitness performance in children with DCD may be partly due to poor timing and coordination of repetitive movements.

Short-term motor learning of dynamic balance control in children with probable Developmental Coordination Disorder

PURPOSE To explore the differences in learning a dynamic balance task between children with and without probable Developmental Coordination Disorder (p-DCD) from different cultural backgrounds. PARTICIPANTS Twenty-eight Dutch children with DCD (p-DCD-NL), a similar group of 17 South African children (p-DCD-SA) and 21 Dutch typically developing children (TD-NL) participated in the study. METHODS All children performed the Wii Fit protocol. The slope of the learning curve was used to estimate motor learning for each group. The protocol was repeated after six weeks. Level of motor skill was assessed with the Movement ABC-2. RESULTS No significant difference in motor learning rate was found between p-DCD-NL and p-DCD-SA, but the learning rate of children with p-DCD was slower than the learning rate of TD children. Speed-accuracy trade off, as a way to improve performance by slowing down in the beginning was only seen in the TD children, indicating that TD children and p-DCD children used different strategies. Retention of the level of learned control of the game after six weeks was found in all three groups after six weeks. The learning slope was associated with the level of balance skill for all children. This study provides evidence that children with p-DCD have limitations in motor learning on a complex balance task. In addition, the data do not support the contention that learning in DCD differs depending on cultural background.

Action planning and position sense in children with Developmental Coordination Disorder

The present study examined action planning and position sense in children with Developmental Coordination Disorder (DCD). Participants performed two action planning tasks, the sword task and the bar grasping task, and an active elbow matching task to examine position sense. Thirty children were included in the DCD group (aged 6-10years) and age-matched to 90 controls. The DCD group had a MABC-2 total score ⩽5th percentile, the control group a total score ⩾25th percentile. Results from the sword-task showed that children with DCD planned less for end-state comfort. On the bar grasping task no significant differences in planning for end-state comfort between the DCD and control group were found. There was also no significant difference in the position sense error between the groups. The present study shows that children with DCD plan less for end-state comfort, but that this result is task-dependent and becomes apparent when more precision is needed at the end of the task. In that respect, the sword-task appeared to be a more sensitive task to assess action planning abilities, than the bar grasping task. The action planning deficit in children with DCD cannot be explained by an impaired position sense during active movements.

Using the ICF Framework to Explore the Multiple Interacting Factors Associated with Developmental Coordination Disorder

Developmental Coordination Disorder (DCD) is classified as a heterogeneous disorder of motor learning and functioning. The purpose of this paper is to critically analyse the current knowledge of DCD using the International Classification of Functioning and Disability Framework (ICF) model of disability. Since DCD is diagnosed on the basis of functional problems, we discuss the relationships between known activity limitations and participation restrictions, impairments of body structure and function, and contextual factors associated with these functional limitations. We conclude that the manifestation of both the primary and secondary problems seen in DCD are dependent on the integrity, capacity and adaptability of cognitive and neuromotor structures. We assert that personal and environmental factors either facilitate or restrict skill acquisition and learning. Understanding the interaction between individual and contextual factors is, thus, fundamental to designing interventions that address primary functional problems and ameliorate the development of health and psychosocial impairments in DCD.

Motor Learning: An Analysis of 100 Trials of a Ski Slalom Game in Children with and without Developmental Coordination Disorder

Objective Although Developmental Coordination Disorder (DCD) is often characterized as a skill acquisition deficit disorder, few studies have addressed the process of motor learning. This study examined learning of a novel motor task; the Wii Fit ski slalom game. The main objectives were to determine: 1) whether learning occurs over 100 trial runs of the game, 2) if the learning curve is different between children with and without DCD, 3) if learning is different in an easier or harder version of the task, 4) if learning transfers to other balance tasks. Method 17 children with DCD (6–10 years) and a matched control group of 17 typically developing (TD) children engaged in 20 minutes of gaming, twice a week for five weeks. Each training session comprised of alternating trial runs, with five runs at an easy level and five runs at a difficult level. Wii scores, which combine speed and accuracy per run, were recorded. Standardized balance tasks were used to measure transfer. Results Significant differences in initial performance were found between groups on the Wii score and balance tasks. Both groups improved their Wii score over the five weeks. Improvement in the easy and in the hard task did not differ between groups. Retention in the time between training sessions was not different between TD and DCD groups either. The DCD group improved significantly on all balance tasks. Conclusions The findings in this study give a fairly coherent picture of the learning process over a medium time scale (5 weeks) in children novice to active computer games; they learn, retain and there is evidence of transfer to other balance tasks. The rate of motor learning is similar for those with and without DCD. Our results raise a number of questions about motor learning that need to be addressed in future research.

Reliability and Structural and Construct Validity of the Functional Strength Measurement in Children Aged 4 to 10 Years

Background Adequate muscle strength, power, and endurance are important in childrens daily activities and sports. Various instruments have been developed for the assessment of muscle function; each measures different aspects. The Functional Strength Measurement (FSM) was developed to measure performance in activities in which strength is required. Objective The study objective was to establish the test-retest reliability and structural and construct validity of the FSM. Design A cross-sectional descriptive study was conducted. Methods The performance of 474 children with typical development on the FSM was examined. Test-retest reliability (n=47) was calculated with the intraclass correlation coefficient (2.1A) for agreement. Structural validity was examined with exploratory factor analysis, and internal consistency was established with the Cronbach alpha. Construct validity was determined by calculating correlations between FSM scores and scores obtained with a handheld dynamometer (HHD) (n=252) (convergent validity) and between FSM scores and scores on the Movement Assessment Battery for Children–2 (MABC-2) (n=77) (discriminant validity). Results The test-retest reliability of the FSM total score ranged from .91 to .94. The structural validity revealed one dimension, containing all 8 FSM items. The Cronbach alpha was .74. The convergent validity with the HHD ranged from .42 to .74. The discriminant validity with MABC-2 items revealed correlations that were generally lower than .39, and most of the correlations were not significant. Exploratory factor analysis of a combined data set (FSM, HHD, and MABC-2; n=77) revealed 2 factors: muscle strength/power and muscle endurance with an agility component. Limitations Discriminant validity was measured only in children aged 4 to 6 years. Conclusions The FSM, a norm-referenced test for measuring functional strength in children aged 4 to 10 years, has good test-retest reliability and good construct validity.