The validity and reliability of the Functional Strength Measurement (FSM) in children with intellectual disabilities

The impact of leisure physical activity on the physical fitness of young adults with intellectual disabilities

BACKGROUND

Individuals with intellectual disability are less physically active than individuals without intellectual disabilities, and rarely reach the recommended daily level of physical activity. There is sufficient scientific evidence for the beneficial effects of exercise on the cardiovascular and muscular fitness of young adults with mild-to-moderate intellectual disabilities.

THE AIM

To assess the impact of leisure physical activity on the physical fitness of adults with intellectual disabilities.

METHOD

21 people (35,4 ± 11,61 years) with intellectual disabilities were allocated to two groups: I group (mean age 32,14 ± 9 years, 2 months, 1 t/week) and group II (mean age 38,25 ± 13,39 years, 2 months, 2 t/week). At the baseline and at the end of the intervention, the cardiorespiratory fitness, lower-body muscular strength and endurance, mobility and balance were assessed with 6-min walking (6MWT), lateral step-up (LSUT), sit-to-stand (30CST), Timed Up and Go (TUG) and Tinetti balance tests.

RESULTS

Both groups showed improvements in cardiorespiratory endurance, muscular strength, and balance. Significant improvements were observed in Group I in the TUG (p = 0.002), LSUT (p = 0.001), and 6MWT (p = 0.004) results. Group II also demonstrated progress in TUG (p = 0.010), LSUT (p = 0.008), and 6MWT (p = 0.012), though they did not reach recommended physical activity benchmarks. Significant differences between the groups were observed in leg strength and mobility (p < 0.05). These findings suggest that short-term, low-frequency interventions may be insufficient for individuals with low baseline fitness.

CONCLUSION

This study fills a gap in the literature by focusing on young adults with ID and shows that leisure PA can yield meaningful functional improvements. However, higher frequency and longer-duration interventions are likely needed to achieve recommended physical activity levels. The findings offer practical insights for developing inclusive, evidence-based PA programs for this underserved population.

LAY SUMMARY

For individuals with intellectual disabilities, physical capability is often assessed through abilities essential to daily living-such as coordination, balance, muscular strength, endurance, and flexibility. As people age, functional strength and exercise tolerance tend to decline. This study showed that in young adults with mild to moderate intellectual disabilities, leisure physical activity improves fitness and mobility and can reduce some cardiovascular risk factors. Programs should prioritize exercises that improve gait, balance, and physical function to lower fall risk and support greater independence. These findings highlight that leisure physical activity is a simple, cost-effective way to promote health in this population.

Physical fitness assessment tools for children with developmental coordination disorder and their feasibility for low-income settings: A systematic review

Background

This study systematically reviewed the literature on physical fitness assessment tools for children with developmental coordination disorder compared with typically developing children aged 7 to 10 and analyzed the feasibility of these tools for use in low-income settings.

Methods

Searches were conducted in the PubMed, Scopus, Web of Science, and EBSCO/RIC databases. The Newcastle - Ottawa Quality Assessment Scale assessed the methodological quality of the studies, and a checklist adapted from COSMIN assessed the feasibility of the instruments.

Results

From 8470 studies initially retrieved, 21 were included in this systematic review. The most assessed physical fitness components in children with developmental coordination disorder compared with typically developing children were cardiorespiratory fitness and muscle strength. Most studies had high methodological quality. The shuttle run (cardiorespiratory fitness) and handgrip dynamometer (muscle strength) were the most used tools. The PERF-FIT, long jump, and 6-min walk test were considered the most feasible tools for low-income settings, while the incremental treadmill test was deemed the least feasible.

Conclusion

The findings evidenced several viable tools for testing physical fitness in children with DCD compared to typically developing peers from low-income countries. The most viable, as PERF-FIT, long jump and 6-min walk test should be used on large scale in low-income settings.

The strength of balance: Strength and dynamic balance in children with and without hypermobility

BACKGROUND

Generalized Joint hypermobility (GJH) is predominantly non-symptomatic. In fact, individuals with joint flexibility usually perform better than their non-hypermobile counterparts during physical activities. Notwithstanding, strength and balance are essential to maintain the control of the extra range of motion during activities and to prevent musculoskeletal complications. There are limited and conflicting pieces of evidence in literature regarding the association between strength and balance in children with GJH.

OBJECTIVES

The purpose of this study was to examine differences in functional strength, dynamic balance, proprioception, and isometric strength in children with and without joint hypermobility and determine the association between strength outcomes and dynamic balance.

METHOD

A cross-sectional study was conducted among children aged 6 to 11. Hypermobility was determined using the Beighton Score, with scores ≥6 representing hypermobility. Functional strength was assessed with the Functional Strength Measure (FSM), isometric strength was determined with a handheld dynamometer (HHD), the Y-Balance Test (YBT) was used to assess dynamic balance and the Wedges test to measure proprioception.

RESULTS

This study included 588 participants (age: 7.97 ± 1.3 years; height: 128±10.1 cm; mass: 27.18 ± 7.98 kg). 402 children were classified as having normal mobility and 186 as being hypermobile. Hypermobile children had better functional strength in the lower extremities than children with normal range mobility but lower reach distance in the YBT. No differences in proprioception, functional strength of the upper extremity or isometric strength in the hands were found. However, isometric lower extremity force was less in hypermobile children than children with normal range mobility. Irrespective of their joint mobility, a fair significant correlation existed between total Y-balance distance and FSM items r = 0.16-0.37, p = 0.01. Correlations between total Y-balance distance and isometric strength of knee and ankle muscles ranged between r = 0.26-0.42, p = 0.001.

CONCLUSION

Hypermobile joints seem to co-occur with lower extremity isometric strength, more functional strength in the lower extremities and less reaching distance in dynamic balance. The opposing direction of the results on functional and isometric strength tests highlights the importance of the type of outcome measures used to describe the association of strength and the range of motion.

Effects of a 24-week exercise program on anthropometric, body composition, metabolic status, cardiovascular response, and neuromuscular capacity, in individuals with intellectual and developmental disabilities

Introduction: The prevalence of overweight and obesity has increased in the last decades, including in people with Intellectual and Developmental Disabilities (IDD). This is even more concerning when it is globally accepted that a low physical condition contributes to the deterioration of functionality and increases the risk of developing chronic diseases during life, with effective implications for health and well-being. The aim of the present study is to investigate the effects of two physical exercise intervention programs on institutionalized individuals with IDD. Methods: Twenty-one adults with IDD (43.04 ± 11.18 years) were split by convenience into three groups: i) an indoor training group (IG; N = 7; 24-week machine-based gym intervention), ii) an outdoor training group (OG; N = 7; 24-week outdoor intervention with low-content materials), and iii) a control group (CG; N = 7). Assessed outcomes included indicators of health and neuromuscular capacity. The ShapiroWilk (n < 50) and Levene tests were used to verify data normality and homoscedasticity. A Kruskal-Walli test was performed to understand if there were differences between the groups. For comparison purposes and to assess hypothetical differences between groups, the Wilcoxon signed-rank test and the Friedman test were used. The respective effect size was calculated, and the significance level was defined at 0.05. Results/Discussion: There was a difference in fat mass in OG (initial ≠ intermediate; Bonferroni corrected: t = 2.405; p = 0.048; W = 0.08 and initial ≠ final moments; Bonferroni corrected: t = 2.405; p = 0.048; W = 0.08). Indoor intervention programs seem to be more effective than outdoor intervention programs for reducing heart rate rest (t = -2.912; p = 0.011; W = -0.104) when compared with CG. Conclusion: A low-cost outdoor intervention in contact with nature appears to be more effective for fat mass reduction. The results for heart rate variability are not clear and robust. Finally, an indoor intervention using weight-training machines appears to be a good method to promote neuromuscular capacity.

The effect of a motor intervention programme for learners identified with moderate to severe intellectual disabilities

Background

Intellectual disabilities (ID) cause problems in intellectual and adaptive functioning which negatively affect motor proficiency levels.

Aim

This study investigates the impact of a motor intervention programme on the motor proficiency levels of learners identified with moderate to severe ID.

Method

A quasi-experimental design was used to recruit participants which included 46 learners aged 15–17 years, identified with moderate to severe ID, selected from a South African special school. Participants were randomly divided into two groups. The 15 experimental learners received a 30-minute motor intervention programme, 3 times a week for a period of 6 weeks, whereas the 23 control learners continued with their normal physical education classes. Groups were assessed using the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2) Brief Form.

Results

The motor intervention programme significantly improved the total scores (p = 0.0380) and the overall motor proficiency levels (p = 0.0447) of the experimental group.

Conclusions

This study reveals evidence that a motor intervention programme can be used as an effective means to improve the motor proficiency levels of learners with moderate to severe ID.

Implications

A motor intervention should be implemented as soon as possible to enhance the motor proficiency levels of these learners.

Strength measurements in patients with Dravet Syndrome

BACKGROUND

Dravet Syndrome (DS) is a developmental and epileptic encephalopathy, characterized by drug resistant infantile onset seizures and cognitive and motor impairment. Walking problems progressively occur and crouch gait is frequently observed. Muscle weakness is hypothesized as contributing impairment. Yet, so far, no studies have performed strength measurements in patients with DS, most likely due to cognitive impairment.

AIMS

To determine the feasibility and validity of strength measurements in the framework of gait analysis and to outline strength problems in patients with DS.

METHODS

Manual muscle testing, dynamometry (hand grip strength and handheld dynamometry) and functional tests (underarm throwing, standing long jump, sit-to-stand, stair climbing) were performed in 46 patients with DS. Results were compared to age-related reference values from literature.

RESULTS

Forty one percent (19/46) of the patients (aged 5.2-24.8 years, median: 15.8 years) accomplished all measurements and scored generally below the fifth percentile of norm values. The remaining 59% (27/46) was not able to complete all strength assessment due to cognitive, behavioural and motor difficulties. Handheld dynamometry seemed most sensitive and specific to detect isolated muscle strength. Validity of the functional tests was controversial, as motor proficiency, balance and coordination may interfere.

CONCLUSION

Although measuring strength in patients with DS was challenging in the context of gait analysis, decreased muscle strength was observed in patients that could perform strength measurements. Handheld dynamometry is preferred over functional tests for future investigations of muscle strength and its interference with gait are required for better understanding of walking problems.

Ecological, convergent, and discriminative validities of the cognitive abilities screening instrument in people with dementia

BACKGROUND

The Cognitive Abilities Screening Instrument (CASI) assesses global cognitive function in people with dementia with 9 domains (i.e., long-term memory, short-term memory, concentration, orientation, attention, abstraction and judgment, language abilities, visual construction, and category fluency). However, the ecological, convergent, and discriminant validities of the CASI have not yet been examined.

PURPOSE

This study designed to investigate these 3 validities of the CASI in people with dementia.

METHODS

Fifty-eight participants underwent assessments with the CASI, 3 functional measures, and 3 cognitive measures. Pearson's r was used to estimate correlations among the CASI and 3 functional measures for examining ecological validity. We computed correlations (r) among the CASI and 3 functional measures for examining convergent validity. An independent t-test was applied to compare the levels of disability, and ceiling/floor effects were analyzed for examining discriminative validity.

RESULTS

The CASI total score and domains had moderate to high correlations with 3 functional measures (r = 0.42-0.80), except in 2 CASI domains (i.e., attention and language). The CASI total score and domains showed moderate to high correlations with 3 cognitive measures (r = 0.45-0.93). The t-test results revealed significant differences (P < .05) in the CASI total score and other domains except for the short-term memory domains. Four domains of the CASI showed noticeable ceiling effects (22.4-39.7%).

CONCLUSIONS

The CASI has adequate ecological validity, good convergent validity, and acceptable discriminative validity in people with dementia. The 5 domains with nonsignificant differences or ceiling effects should only be used with caution to distinguish people with dementia.

Physical fitness of children and adolescents with moderate to severe intellectual disabilities

Background: Low levels of physical fitness are associated with low physical and mental health. The aims of this study were to assess the health-related physical fitness of children with intellectual disability (ID), and study the association of physical activity and motor development with physical fitness.Methods: One hundred and twenty-eight children with moderate to severe ID (83 boys; age 2-18 years) visiting specialised day programme centres engaged in field-based physical fitness tests (body composition, muscular strength, muscular endurance, and cardiorespiratory fitness). Scores were compared to reference values, and with linear regression analysis the association between the fitness outcomes and physical activity and motor development was studied.Results: High rates of overweight (23-25%) and obesity (10-15%) were found. A majority of the participants (71-91%) scored below reference values for muscular strength, endurance, and cardiorespiratory fitness tests. Physical activity and motor development were positively associated with scores on several fitness test (β = 0.27-0.44; p < 0.05).Conclusions: Children with moderate to severe ID visiting specialised day programme centres have strikingly low physical fitness levels. Policies and interventions to increase the physical fitness for this specific group of children are urgently needed, in which increasing physical activity and motor skills are expected to be effective components.Implications for rehabilitationStrikingly low levels of physical fitness were seen in children and adolescents with moderate to severe intellectual disabilities.This vulnerable group is in need of appropriate interventions to increase their physical fitness levels.Increasing the physical activity is a potential component in these interventions.Improving motor development will most likely lead to improved physical fitness as well.