The effects of an eight week grouped exercise programme on gross motor proficiency in children with minimal motor dysfunction.

Kolesky, Jacqueline Mary (2017-03)

Thesis (MScPhysio)--Stellenbosch University, 2017.


ENGLISH SUMMARY : Background: During typical development of a child, experience and maturation both influence the development of neuromuscular and musculoskeletal systems, which enable children to explore their environment and develop and refine their motor skills. These skills develop in such a way, that when a child is ready to begin formal schooling, they have built up a repertoire of movement skills that, it is hoped, will be sufficient to function effectively in the classroom, on the playground, and at home. The reality is however, that some children do not arrive at school with the movement skills necessary for coping with the demands of a school environment. Most recently this group of children, given specific criteria, are now classified as having Developmental Coordination Disorder (DCD) according to the Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV). Scarce-skilled staff shortages has limited individual therapy and these children are often treated in groups, despite limited proven efficacy. This study aims to validate the current practice of group therapy in special schools by investigating whether group exercise physiotherapy does improve the gross motor function of children with minimal motor dysfunction/DCD aged four to fourteen years old. Methods: The study took place in a special school in the Eastern Cape that caters for learners with average intellectual ability but present with barriers to learning. Thirty-seven children were assessed at pre and post intervention on the Bruininks-Oseretsky Test of Motor Proficiency (BOTM-P) as well as the Beery Test for visualmotor integration by a blinded research assistant and occupational therapist respectively. They were randomly allocated to either a control (N=19) or an intervention group (N=18). The intervention group was then further subdivided into groups of three to four per group to attend group exercise sessions of 30 minutes three times per week. Group exercises were aimed at improving hand-eye coordination, ball skills and balance by incorporating aerobic exercises and strengthening exercises. Results: There was a significant increase (p=.004) in the total scores tested by the experimental group on the BOTM-P after the eight week intervention. Global motor proficiency skills (gross motor, response speed, upper limb co-ordination, visualmotor control and upper limb speed and dexterity) improved clinically, but not significantly (p=0.14). Beery scores showed clinical improvement, but were not statistically significant. Conclusions: The results of this study support the hypothesis that an eight week group exercise program can improve the gross motor skills of children with DCD. It would seem that implementing such an intervention is a viable option, especially where resources limit the availability of one to one therapy.

AFRIKAANSE OPSOMMING : Agtergrond: Kinders wat ‘n gebrek aan motoriese koördinasie het om ouderdoms verwante take te verrig, gegewe dat hulle normale intellektuele vermoens het en die afwesigheid van ander neorologiese abnormaliteite, word geklassifiseer as “Developmental Coordination Disorder” (DCD) volgens die DSM IV. Beperkte professionele menslike hulpbronne voorkom individele terapie en hierdie kinders word gewoonlik behandel in grofmotoriese groepe, ongeag dat daar min bewyse is dat dit ‘n effektiewe behandelings metode is. Die doel van hierdie studie is om vas te stel of ‘n fisioterapie groepsoefenprogram ‘n effektiewe behandelingsvorm is om die grofmotoriese vaardighede in vier tot viertienjarige skool kinders, met ‘n diagnose van DCD, verbeter. Metodes: Sewe-en-dertig kinders was geassesseer met die “Bruininks-Oseretsky Test of Motor Proficiency (BOTM-P)” en die “Beery Test for visual-motor integration” deur ‘n geblinde navorsingsassistent. Hulle is in twee groepe gedeel, ‘n kontrole groep wat nie intervensie gekry het nie (N=18) en ‘n eksperimentele groep (N=19) deur eenvoudige ewekansige toewysing. Die eksperimentele groep was verder onderverdeel in groepe van drie tot vier om groepsoefeningsessies by te woon drie keer ‘n week vir 30 minute. Die doel van die groepsoefeninge was om die volgende areas te verbeter: handvaardigheid, balvaardigheid en balans deur die inkorporasie van balansaktiwiteite, spierversterkingsoefeninge en koördinasie oefeninge. Die deelnemers was weer geassesseer met die BOT-MP en ‘Beery Test’ na die agt weke lange intervensie program. Resultate: Daar was 'n beduidende toename (p=.004) in die algehele telling deur die eksperimentele groep op die BOT-MP na die agt weke deelname. Globale motor vaardigheide (grof motories, reaksie spoed, boonste ledemaat koordinasie, visuelemotoriese beheer en boonste ledemaat spoed en behendigheid) het klienies verbeter, maar was nie statisties beduidende (p=0.14). Beery tellings het klinies verbeter, maar was nie statisties beduidende. Gevolgtrekking: Die resultate van hierdie studie ondersteun die hipotese dat 'n doelgerigte groepsoefeningsprogram wel die grofmotoriese vaardighede van kinders met ‘n diagnose van DCD verbeter. Fisioterapeute kan 'n groepsofeningsprogram met vertroue implementeer waar 'n tekort aan menslike hulpbronne een tot een terapie beperk.

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