Single leg hopping in children with and without Fetal Alcohol Spectrum Disorder: a descriptive study of dynamic postural stability and kinematics

Moore, Keryn (2017-03)

Thesis (MScPhysio)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY : Introduction: Fetal Alcohol Spectrum Disorder (FASD) is a leading preventable cause of acquired developmental disabilities. Impairments of motor function and dynamic postural stability (DPS) are found in children with FASD. These impairments may negatively impact on these children’s ability to perform their required activities of daily living and engage with their peers in play and sporting activities. To date no research has been conducted on DPS in children with FASD in South Africa. Aim: DPS and kinematics during single leg hopping were described in two groups of typically developed nine-year-old children from an urban and rural setting (controls) and a group of nine-year-old children with FASD from a rural setting (cases). Any differences in DPS and kinematics between the three groups were also determined. Purpose of the study Identifying and describing potential motor and DPS impairments in South African children with FASD will add to the body of available research and could provide the basis for the development of interventions aimed at improving overall motor function of these children, and therefore their ability to participate better in their activities of daily living. Methodology: Participants performed a consecutive single leg hopping task and landed on a pressure mat to stabilise on one leg. Motion analysis systems and a pressure mat were used to describe 1) spatiotemporal and centre of pressure (COP) parameters and 2) joint kinematics i.e. hip, knee and ankle angles in the sagittal plane. Spatiotemporal parameters included stance and swing times and speed. COP parameters included anteroposterior (AP) and mediolateral (ML) velocity and range of motion (ROM). Descriptive results are presented in median and ranges and differences between groups were determined by Kruskal-Wallis and Mann-Whitney U statistical tests. The level of significance was set at p<0.05. Results: Fifty-six children participated; 14 children with FASD (cases), 14 rural controls and 28 urban controls. The urban controls had statistically significant longer stance and swing times (p<0.001) than the case and rural control groups. COP parameters were not statistically significantly different; however the case group displayed greater AP velocity and AP ROM values compared to both control groups (APvel: p=0.78; APROM: p=0.66). In terms of kinematics, the urban controls hopped with statistically significant greater hip flexion compared to the case group (p=0.017). Rural and urban controls hopped with more knee flexion compared to the case group, although this was not significant (p=0.16). The cases and rural controls showed statistically significant greater knee flexion at initial foot contact (IFC) onto the pressure mat than the urban controls (cases and urban controls: p=0.04; rural and urban controls: p<0.001). The urban control group landed in statistically significant more plantarflexion at IFC onto the mat than the case group (p<0.001) and the rural control group (p=0.03) and during landing, the urban control group moved into statistically significant more hip flexion compared to the case group (p=0.015) and the rural control group (p= 0.026). Conclusion: The differences in spatiotemporal, COP and kinematic parameters highlight different movement strategies and DPS capabilities between the groups. The case group hopped in a more extended position of the lower limbs and displayed increased COP AP velocity and ROM compared to the control groups, which may be an indication of impaired DPS. Identifying and exploring the aspects that underlie these impairments through objective measurement methods may assist in the development of evidence-based physiotherapy treatments for these children. This is the first study of its kind in South Africa and further research is warranted.

AFRIKAANSE OPSOMMING : Inleiding: Fetale Alkohol Spektrum Afwykings (FASA) is ‘n voorste voorkombare oorsaak van ontwikkelingsgestremdhede. Gebreke in motoriese funksie en dinamiese posturale stabiliteit (DPS) word in kinders met FASA gevind. Hierdie gebreke mag ‘n negatiewe invloed he op hierdie kinders se vermoee om hul vereiste daaglikse aktiwiteite uit te voer en om saam met hul portuurgroep deel te neem aan speel- en sportaktiwiteite. Tot op hede is nog geen navorsing oor DPS in kinders met FASA in Suid-Afrika gedoen nie. Doelwit: DPS en kinematika gedurende een-been hop is in twee groepe van tipies ontwikkelde negejarige kinders van ‘n stedelike en landelike omgewing (kontroles) en ‘n groep negejarige kinders met FASA van ‘n landelike omgewing (gevalle) beskryf. Enige verskille in DPS en kinematika tussen die drie groepe is ook bepaal. Doel van die studie: Identifisering en beskrywing van potensiele motoriese en DPS gebreke in Suid-Afrikaanse kinders met FASA sal ‘n bydra maak tot die liggaam van beskikbare navorsing en kan die basis wees vir die ontwikkeling van intervensies met die doel om algehele motorise funksie van hierdie kinders te verbeter, en daarom hul vermoee om deel te neem aan hul daaglikse aktiwiteite te verbeter. Metodologie: Deelnemers het ‘n agtereenvolgende een-been hop taak uitgevoer en geland op ‘n drukmat om te stabiliseer op een been. Bewegingsanaliserende sisteme en ‘n drukmat is gebruik om 1) tydruimtelike en middelpuntdruk (MPD) veranderlikes en 2) gewrigskinematika, maw. hoeke van die heup-, knie- en enkel in die sagittale vlak te beskryf. Tydruimtelike veranderlikes het staan- en swaaitye en spoed ingesluit. MPD veranderlikes het anteroposterior (AP) en mediolaterale (ML) snelheid en omvang van beweging (OVB) ingesluit. Beskrywende resultate word in mediaan en omvange voorgestel en verskille tussen die groepe is met Kruskal-Wallis en Mann-Whitney U toetse bepaal. Die vlak van beduidendheid was by p<0.05 vasgestel. Resultate: Ses-en-vyftig kinders het deelgeneem; 14 kinders met FASA (gevalle), 14 landelike kontroles en 28 stedelike kontroles. Die stedelike kontrole groep het statisties beduidend langer staan- en swaaitye (p<0.001) gehad teenoor die gevalle en landelike kontrole groepe. MPD-veranderlikes was nie statisties beduidend verskillend nie; alhoewel die gevalle-groep groter AP snelhede en AP OVB waardes in vergelyking met albei die kontrolegroepe getoon het (AP snelhede: p=0.78; AP OVB: p=0.66). In terme van kinematika het die stedelike kontrole groep met statisties beduidend meer heupfleksie gehop in vergelyking met die gevalle-groep (p=0.017). Landelike en stedelike kontrole groepe het met meer kniefleksie gehop in vergelyking met die gevalle-groep, alhoewel dit nie beduidend was nie (p=0.16). Die gevalle-groep en die landelike kontrole groep het statisties beduidend meer kniefleksie by inisiele voetkontak (IVK) op die drukmat getoon as die stedelike kontrole groep. (gevalle- en stedelike kontrole groep: p=0.04; landelike en stedelike kontrole groepe: p<0.001). Die stedelike kontrole groep het met statisties beduidend meer plantaarfleksie by IVK op die mat geland as die gevalle-groep (p<0.001) en die landelike kontrole groep (p=0.03). Gedurende die landing het die stedelike kontrole groep in statisties beduidend meer heupfleksie inbeweeg in vergelyking met die gevalle-groep (p=0.015) en die landelike kontrole groep (p=0.026). Gevolgtrekking: Die verskille in tydruimtelike, MPD en kinematiese veranderlikes beklemtoon verskillende bewegingstrategiee en DPS vermoens tussen die groepe. Die gevalle-groep het in ‘n meer geekstendeerde posisie van die onderste ledemaat gehop en het verhoogde MPD AP snelhede en OVB getoon teenoor die kontrole groepe wat moontlik ‘n aanduiding kan wees van gebrekkige DPS. Identifisering van en ondersoek instel na die onderliggende aspekte van hierdie gestremdhede, deur gebruik te maak van objektiewe metodes van meting, mag bydrae tot die ontwikkeling van bewys-gebaseerde fisioterapeutiese behandeling vir hierdie kinders. Hierdie is die eerste studie van sy soort in Suid-Afrika en verdere navorsing is geregverdig.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/100874
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