Dual-task effects on postural sway during sit-to-stand movement in children with Down syndrome

Investigation of the relationship between dual-task performance and functionality and psychosocial features in children with Duchenne Muscular Dystrophy: A controlled study

AIMS

The aim of this study is to investigate the variations in dual-task performance between children with Duchenne Muscular Dystrophy (DMD) and their typically developed peers. Simultaneously, we explored the impact of psychosocial features and functional parameters on dual-task performance in children with DMD.

METHODS AND PROCEDURES

A total of 45 children with DMD and 49 typically developed peers were included in the study. After recording the demographic information of the children, the motor-motor and cognitive-motor dual-task performances of all children were assessed by adding motor (carrying a half-filled bottle of water in both hands) and cognitive tasks (mental practice and memory) to the 10 Meter Walk Test (10MWT). Then Brooke Lower Extremity Functional Classification (BLEFC), 6-Minute Walk Test (6MWT), North Star Ambulatory Assessment (NSAA), Gait Assessment Scale for Duchenne Muscular Dystrophy (DMD-GAS), Four Square Step Test (FSST), Modified Mini-Mental State Examination (MMSE), Pediatric Quality of Life Inventory (PedsQL)-Neuromuscular Module, and Pediatric Fear of Falling Questionnaire (Ped-FOF) were assessed for motor performance, ambulation levels, walking abilities, balance, cognitive levels, quality of life, and fear of falling, respectively.

RESULTS

In our study, a significant difference was found between the dual-task performances of children with DMD and their typically developed peers, with typically developed children performing better in motor-motor, cognitive motor/mental, and cognitive motor/memory tasks (p < 0.001). Relationships were identified between the dual-task performances of DMD children and the 6MWT (r: -0.715; -0.651; -0.641; respectively), NSAA (r: -0.669; -0.434; -0.451; respectively) DMD-GAS (r: -0.626; -0.409; -0.424; respectively), FSST (r: 0.747; 0.534; 0.503; respectively), PedsQL-Neuromuscular Module (parent report) (r: -0.432; -0.340; -0.357; respectively), and Ped-FOF (r: 0.512; 0.449; 0.436; respectively), (p < 0.05).

CONCLUSIONS AND IMPLICATIONS

Our study indicated that dual-task performance in children with DMD is lower than that of their peers, and it is related to the children's motor skills, ambulation levels, and psychosocial features. These findings suggest that incorporating assessments and approaches for dual-task performance into rehabilitation programs aimed at preserving or improving motor functions, ambulation levels, and quality of life may be important for a holistic approach to managing the disease.

The effect of motor dual-task training on gait and mobility performances in children with intellectual disabilities

The study investigated the impact of motor dual-task training on gait and mobility in children with intellectual disabilities. Performance was assessed using the Timed Up and Go Test (TUGT) and the 10-Meter Walking Test (TMWT) before and after an 8-week training period, with participants divided into a Trained Group (n=12) and a Control Group (n=14). Results indicated that, across both groups and regardless of session, TUGT and TMWT scores were significantly higher (p < 0.001) in the motor dual-task condition compared to the single-task condition. Post-training, TUGT scores significantly decreased (p < 0.05) in the single-task condition. The Trained Group showed significant improvements in second motor-task performance on both TUGT (p < 0.05) and TMWT (p < 0.001) under dual-task conditions, while the Control Group showed no change. The study demonstrated the effectiveness of motor dual-task training in enhancing mobility in children with intellectual disabilities.

Underlying neurophysiological and biomechanical mechanisms related to postural control of children with Developmental Coordination Disorder differ from those in typically developing children

BACKGROUND

Although many studies have provided important insights into postural control in children with Developmental Coordination Disorder (DCD), relevant aspects remain unresolved.

AIMS

To investigate the underlying mechanisms related to postural control in children with and without DCD during standing tasks, using global, structural, and spectral descriptors of the Center of Pressure (CoP) trajectory.

METHODS

Sixty-eight children (9.88 ± 0.96 years) participated in this study, divided into two groups: DCD and typically developing (TD) peers. Participants stood upright on a force platform for 30 seconds, under different conditions of vision (open or closed eyes), and surface (compliant or firm). To compute features from the CoP displacements, global, structural, and spectral analyses were employed.

OUTCOMES AND RESULTS

The main results showed that children with DCD (a) displayed higher variability and velocity of the CoP displacement than TD children (global descriptors), (b) needed more postural commands to control balance when compared to TD children (structural descriptors), and (c) used sensory inputs differently when compared to TD children (spectral descriptors). Moreover, the differences between groups of children and the effects of vision and somatosensory inputs were task- and outcome-dependent.

CONCLUSIONS AND IMPLICATIONS

Postural deficits in children with DCD can be traced to an action problem based on poorer prediction (structural results) and a perception problem of environmental changes (spectral results). Structural descriptors can assess functional stability and changes in anticipatory commands, while spectral descriptors may indicate (in)adequate use of sensory information, which can help to choose the content of tasks in interventions.

Association between participation at home and functional skills in children and adolescents with Down syndrome: A cross-sectional study

BACKGROUND

According to a biopsychosocial approach to health and disability, participation at home and functional skills are important components of the functioning. Therefore, knowledge about interactions between these components allows for targeting specific interventions.

OBJECTIVE

This study investigated whether participation opportunities (frequency and involvement) for children/adolescents with Down syndrome (DS) in a realistic environment at their own home are associated with the functional skills related to the domains of Daily Activities, Mobility, Social/Cognitive and Responsibility.

METHODS

This was an observational study. Forty-eight children/adolescents with DS participated (mean age: 10.73 ± 3.43; n = 27 females). Participants were evaluated using the Participation and Environment Measure for Children and Youth (PEM-CY) home environment setting (raw frequency and engagement scores) and Pediatric Evaluation of Disability Inventory speedy version (PEDI-CAT-SV) (continuous score).

RESULTS

Significant and positive correlations were found between the frequency of participation at home with Daily Activities (ro = 0.320), Social/Cognitive (ro = 0.423) and Responsibility (ro = 0.455). For involvement, significant and positive correlations were found with Daily Activities (ro = 0.297), Social/Cognitive (ro = 0.380) and Responsibility (ro = 0.380). For the PEDI-CAT-SV Mobility, no significant correlation was found.

CONCLUSIONS

Higher frequency and involvement of participation at home are associated with greater functional skills assessed, except for Mobility. This study provided pioneering insights about the relationships between the level of home participation and functional skills in DS, generating evidence that could guide approaches to participation-focused intervention.

Effects of Smartphone Activities on Postural Balance in Adolescents with Intellectual Disabilities

Considering the rising prevalence of smartphone usage among adolescents with intellectual disabilities and their frequent motor challenges, understanding its impact on their physical well-being is important. This study aims to investigate the impact of smartphone activities on postural balance in adolescents with intellectual disabilities. Two groups of adolescents participated in the study: an intellectual disability group (IDG) (n = 16) and atypical development group (TDG) (n = 12). Static postural balance, using a stabilometric platform on firm and foam surfaces, and dynamic balance, using the Timed Up-and-Go Test (TUGT), were performed under various conditions, such as playing a game, watching videos, video calls, and listening to music. The center of pressure (CoP) values significantly increased (p < 0.05) during all smartphone activities (except listening to music) compared to the control condition in both groups, with the IDG demonstrated a more pronounced increase (p < 0.05) during playing video games and video calls on the firm surface. TUGT scores significantly increased (p < 0.05) during smartphone activities, with greater changes observed in the IDG (p < 0.05), and significantly decreased (p < 0.01) during listening to music in both groups. Our study suggests that adolescents with intellectual disabilities need special tools and guidance to ensure their safety and well-being when using smartphones.

Motor Skills and Executive Functions in Pediatric Patients with Down Syndrome: A Challenge for Tailoring Physical Activity Interventions

Down syndrome (DS) is one of the most common chromosomal disorders. In addition to this variety of dysmorphic features. DS is also associated with a wide range of diseases and related comorbidities affecting different organs and systems. These comorbidities, together with societal and environmental influences, have a negative impact on physical activity in people with DS. Low levels of physical activity and energy expenditure have been identified as crucial players in worsening the acquisition of motor skills and executive functions. Executive functions are critical for the many skills (creativity, flexibility, self-control, and discipline) impacting our quality of life and make it possible to control impulses, mentally play with ideas, and stay focused. We proposed a broad overview of the available literature regarding motor skills and executive functions in pediatric patients with DS to understand the specific challenges for tailoring physical activity interventions. Motor skill interventions are effective in improving motor competence and performance on cognitive, emotional, and physical aspects in children with DS. Interventions based on executive functions in DS subjects are effective to contrast the cognitive decline and improve the everyday use of executive functions in youth and adults. Targeted interventions are mandatory for maximizing the benefits of physical activity, minimizing potential risks, and ultimately improving the overall health outcomes and quality of life for individuals with DS.

Scoping review of dual-task interference in individuals with intellectual disability

Dual-task paradigms can provide insights on the structures and mechanisms underlying information processing and hold diagnostic, prognostic, and rehabilitative value for populations with cognitive deficits such as in individuals with intellectual disability (ID). In this paradigm, two tasks are performed separately (single-task context) and concurrently (dual-task context). The change in performance from single- to dual-task context represents dual-task interference. Findings from dual-task studies have been largely inconsistent on whether individuals with ID present with dual-task-specific deficits. The current review aimed to map the published literature on dual-task methods and pattern of dual-task interference in individuals with ID. A scoping review based on Arksey and O'Malley's five-stage methodological framework was performed. Seventeen electronic databases and registries were searched to identify relevant studies, including gray literature. Charted data from included studies were analyzed quantitatively and qualitatively. PRISMA guidelines informed the reporting of this review. Twenty-two studies involving 1,102 participants (656 with ID and 446 without ID) met the review's inclusion criteria. Participants in the included studies were heterogeneous in sex, age (range 3-59 years), etiology and ID severity. Included studies characterized their ID-sample in different ways, most commonly using intelligence quotient (IQ) scores. Other measures of intellectual function (e.g., mental age, ID severity, verbal and/or visuospatial ability scores) were also used, either solely or in combination with IQ. Methods of dual-task testing varied across studies, particularly in relation to dual-task combinations, equation of single-task performance between groups, measurement and reporting of dual-task performance for each single-task, and task priority instructions. Thematic content of the included studies were: (1) structural interference to dual-tasking; (2) etiology-based differences in dual-tasking; (3) gait and balance dual-task performance; (4) testing executive function using dual-task paradigms; and (5) training effect on dual-task performance. Although the evidence consistently supported the intact dual-tasking ability of individuals with ID, the pattern of dual-task interference was inconsistent. Likewise, the evidence was inconclusive regarding dual-task deficit specific to individuals with ID because of heterogeneity in dual-task study designs among included studies.

Cognitive-motor interference during standing stance across different postural and cognitive tasks in individuals with Down syndrome

BACKGROUND

Individuals with Down syndrome (DS) presented both cognitive and motor impairments that could influence each other. Therefore, exploring cognitive-motor interference during standing stance is relevant in this population.

AIMS

This study explored the dual task (DT) effects on postural balance during diverse cognitive tasks and sensory manipulations in individuals with DS, compared to those with typical development (TD).

METHODS AND PROCEDURES

Fifteen adolescents with DS (age = 14.26 ± 1.27 years; height = 1.50 ± 0.02; weight = 46.46 ± 4.03 kg; BMI =20.54 ± 1.51 kg/m²) and thirteen with TD (age = 14.07 ± 1.11 years; height = 1.50 ± 0.05; weight = 44.92 ± 4.15 kg; BMI =19.77 ± 0.94 kg/m²) participated in this study. Postural and cognitive performances for the selective span task (SST) and the verbal fluency (VF) were recorded during single task (ST) and DT conditions. Postural conditions were: firm eyes open (firm-EO), firm eyes closed (firm-EC) and foam-EO. Motor and cognitive DT costs (DTC) were calculated and analyzed across these different cognitive and postural conditions.

OUTCOMES AND RESULTS

In the DS group, postural performance was significantly (p < 0.001) altered during all DT conditions, compared to the ST situation. Moreover, the motor DTC was significantly (p < 0.001) higher while performing the VF task than the SST. However, in the control group, postural performance was significantly (p < 0.001) impaired only while performing the VF test in the DT-Firm EO condition. For both groups, cognitive performances were significantly (p < 0.05) altered in all DT conditions compared to the ST one.

CONCLUSION

Adolescents with DS are more prone to DT effects on postural balance than those with TD.

Dual-task affects postural balance performance in children with intellectual disability

BACKGROUND

Dual-task designs have been used to study the degree of automatic and controlled processing involved in postural balance. The aim of the present study was to explore postural balance performance during dual-task condition in children with intellectual disability compared to those with typical development.

METHODS

Fifteen children with intellectual disability aged from 7 to 12 years old and fifteen age-matched children with typical development participated in this study. Participants were asked to maintain static balance on a force platform during a baseline condition (single task) and while performing the Picture Recognition Memory Test (dual-task condition).

RESULTS

The results showed that dual-task similarly affects postural performance of both typically developing children and those with intellectual disability (p < .001).

CONCLUSIONS

Children with intellectual disability and children with typical development have difficulties in maintaining their balance when carrying out a concurrent cognitive task. Intellectual disability did not lead to a more strongly compromised balance performance in dual-task situation.

Biopsychosocial Factors Related to Postural Sway During Sit-to-Stand Movement in Children and Adolescents With Down Syndrome: A Cross-Sectional Study

We investigated factors related to postural sway during sit-to-stand movement in children and adolescents with Down syndrome (DS). Our assessment of participants followed the biopsychosocial model. Body function and structure were represented by muscle strength and postural sway during sit-to-stand movement, which were assessed by manual muscle testing and kinetics analysis, respectively. The Gross Motor Function Measure and Pediatric Balance Scale depicted the activity component. In addition, we included these relevant contextual factors: age, Home Observation for Measurement of the Environment, family income, and maternal schooling. A correlation analysis verified a suspected association between biopsychosocial and postural sway variables. There were significant separated correlations between postural sway in the three phases of the sit-to-stand movement, and age, GMFM-88 dimension D, and muscle strength. Thus, postural control in sit-to-stand movement was related to biopsychosocial factors involving different life aspects of children and adolescents with DS, and these factors should be addressed in rehabilitation therapy intended to improve postural control among these individuals.

Neuromuscular exercise in children with Down Syndrome: a systematic review

The effects and the prescription parameters of therapeutic exercise are not clear. For this reason, is needed to determine the effect of neuromuscular exercise on balance, muscle strength and flexibility specifying the parameters and characteristics of effective interventions in children between 6 and 12 years and adolescent between 13 and 18 years with Down Syndrome. The present study is a systematic review of effectiveness outcomes balance, muscle strength and flexibility in this population. The databases of PubMed, PEDro, EMBASE, SCIELO, Lilacs, Cochrane library were searched from May to December 2021. We recruited randomized controlled trials (RCTs) which met the inclusion criteria in our study. Ten studies were included. The interventions included mechanotherapy, vibration, and use of different unstable surfaces. The exercise frequency ranged from 3 to 5 days a week, and the duration of each session was between six and 15 min. The frequency was between two and three times a week for 6 and 12 weeks and the intensity were between 60 and 80% of maximal voluntary contraction. Neuromuscular exercise in different modes of application was associated with increases in chest and lower limb muscle strength mean 8.51, CI [2.35-14.67] kg and (21.54 [1.64, 41.43]) kg. Balance also improved when the mode of application was isokinetic training and core stability exercises (- 0.20 [- 0.29, - 0.12]) evaluated with stability index. Neuromuscular exercise appears to be effective for the improvement of both lower limb and chest muscle strength and balance in children over 8 years. No evidence was found in children under 8 years.

Comparison of Lower and Upper Quarter Y Balance Test Performance in Adolescent Students with Borderline Intellectual Functioning Compared to Age- and Sex-Matched Controls

The Lower (YBT-LQ) and Upper (YBT-UQ) Quarter Y Balance Test are well established assessment tools for the examination of dynamic balance and shoulder mobility/stability, respectively. However, investigations on YBT-LQ/UQ performance in students with borderline intellectual functioning (BIF) (i.e., intelligence quotient of 70–84 etc.) are lacking. Thus, the aim of the study was to compare YBT-LQ/UQ performance in students with and without BIF. Thirty students with BIF (age: 13.7 ± 1.2 years) and 30 age-/sex-matched students without BIF (age: 13.7 ± 1.3 years) performed the YBT-LQ and/or YBT-UQ. Normalized maximal reach distances (% leg/arm length) per reach direction and the composite score were used as outcome measures. A univariate analysis of variance was conducted to test for significant group differences. Irrespective of limb and reach direction, students with BIF compared to those without BIF showed significantly worse YBT-LQ (p ≤ 0.001–0.031; Cohen’s d = 0.57–1.26) and YBT-UQ (p ≤ 0.001–0.015; Cohen’s d = 0.68–1.52) performance with moderate to large effect sizes. Due to the poorer performance levels of students with BIF, specifically tailored interventions should be developed that have the potential to improve their dynamic balance and shoulder mobility/stability.

Association between the level of attention and dual-task costs on postural sway and cognitive yield in children, adolescents, and young adults

BACKGROUND

Postural stability requires attentional resources. Dual-task paradigms are used to investigate the attentional demand of the studied tasks. However, no studies have been conducted on the subjects' level of attention, analyzing its association with dual-task costs (DTC).

RESEARCH QUESTION

To evaluate the attentional level and DTC on postural sway and cognitive yield in children, adolescents, and young adults, investigating age-related differences, and to analyze if the participants' attention level is associated with DTC.

METHODS

Postural sway and cognitive-yield of 30 children, 24 adolescents, and 32 young adults were assessed in a dual-task paradigm. We calculated DTC on postural sway and cognitive yield. Attention level was tested using Psychological Battery for Attention Assessment. We tested the association between DTC and attention level.

RESULTS

Young adults showed higher DTC on area and velocity of postural sway than children and adolescents. No differences in DTC on cognitive yield were found between the groups. Children showed lower attention levels than adolescents and young adults. Attention level was negatively associated with DTC on cognitive yield in young adults. Focused Attention is responsible for 24.4% of the variance in DTC on cognitive yield.

CONCLUSION

Age impacts DTC on postural stability, but not on cognitive performance. The smaller changes in sway found in children/adolescents when dual-tasking, potentially reflect less developed attentional levels and postural control, which make them performing postural tasks closed to their stability boundaries, and, therefore, make them prioritize stability protection more than adults. Similar DTC on cognition between groups may reflect an equalization of the chosen cognitive task at everyone's difficulty level. The lower attention levels of children may reflect an attentional system in development, with prioritization o postural tasks when dual-tasking to maintain stability. Although attention level increases throughout age, attention only predicted DTC on cognition. Better Focused Attention's levels predicted lower DTC on cognitive yield for young adults.

Postural control in Down syndrome and relationships with the dimensions of the International Classification of Functioning, Disability and Health - a systematic review

PURPOSE

Postural control assessment in children with Down syndrome (DS) may contribute to understanding the impact of impairments in Body Structures and Functions on Activities and Participation, providing a biopsychosocial approach to support clinical practice. The present study aimed to systematically review the literature addressing postural control in children and adolescents with Down syndrome, with a focus in the interactions among the components of the International Classification of Functioning (ICF).

METHODS

We conducted a tailored search in PubMed; Web of Science, SCOPUS and Science Direct databases.

RESULTS

We identified 20 full-texts that fulfilled the inclusion and exclusion criteria. Children and adolescents with DS showed lower postural stability across studies. The ICF components most commonly addressed were Body Structure and Function and Activity. Although the studies measured these components, they did not analyze the interrelationships of components when describing the determinants of postural control in this population.

CONCLUSIONS

Overall, the studies indicate that children and adolescents with DS show decreased postural stability and greater vulnerability to sensory changes than their typical peers. There is a lack of studies using the biopsychosocial approach. Only few studies have related the activity level of the participants with the variables of postural control. None of them addressed components of Participation and Environmental Factors. The poor methodological quality of the included studies limits the translation of results to clinical practice. Further studies addressing children with disabilities, such as DS, should utilize the ICF framework, thus providing a biopsychosocial approach of health in these individuals.IMPLICATIONS FOR REHABILITATIONChildren with Down syndrome show decreased postural stability and greater vulnerability to sensory changes than their typical peers.In clinical practice, when assessing postural control of individuals with DS, rehabilitation professionals should not only address components of Body Structures and Functions, but also investigate their impact on Activity and Participation.Training of postural control should address strategies that include natural environments and participation situations.The biopsychosocial approach provided by the ICF framework should be implemented in clinical practice.

Impact of dual task on postural sway during sit-to-stand movement in children with unilateral cerebral palsy

BACKGROUND

To verify the effect of dual-task on postural oscillation during sit-to-stand movement in children with Cerebral Palsy.

METHODS

17 children with spastic unilateral cerebral palsy and 20 typically-developing children, aged 5 to 12 years, performed the following tasks: Simple task: sit-to-stand with arms crossed against the chest; bimanual dual-task: sit-to-stand while carrying a tray; unimanual dual-task: sit-to-stand while holding a plastic cup with one hand. For data analysis, sit-to-stand was divided in three phases: preparation (phase 1), rising (phase 2), and stabilization (phase 3). Postural control was measured using a force plate, and the variables analyzed were: area, anterior-posterior and medial-lateral velocity, and STS duration. Analysis of variance was applied to test the effects of group; task conditions and interactions.

FINDINGS

Children with cerebral palsy presented higher values of postural oscillation when compared to their typical pairs. Bimanual and Unimanual dual tasks presented greater postural oscillation values in sit-to-stand phase 1 compared to simple task. In bimanual dual-task, children with cerebral palsy presented lower values of velocity in phases 3, and greater postural oscillation and duration of the task when compared to single-task and unimanual dual-tasks. I.

INTERPRETATION

The insertion of a secondary task seems to interfere differently children with cerebral palsy, depending on the specific demands of each task. Thus, the importance of inserting dual tasks in the interventions is emphasized, considering that they are executed extensively in the day to day, and can act as facilitators or challenge in the execution of functional tasks.