Effects of a physical activity program in motor coordination of children with cerebral palsy, ataxic diagnosis

Effects of a physical activity program in motor coordination of children with cerebral palsy, ataxic diagnosis

ABSTRACT

Seen as a disturbance of posture and movement control as a consequence of a non progressive injury that affects the brain in a period of development, Cerebral Palsy leads to changes in the reception, storage and programming of the movements (e.g. Bartlett et al., 2000; Andrada, 2001). The present study intends to investigate the effects of an intervention program that includes motor activities orientated to express the motor coordination in children with Cerebral Palsy. The sample was constituted by 4 children with ataxia (three girls and one boy), aged between 9 and 14 years old. The tests applied to evaluate the levels of motor coordination were the following: Balance of Berg, the Mira Stambak, the Tapping Pedal, the Pursuit Rotor and the Minnesota Manual Dexterity. All the subjects of the sample were submitted to a first evaluation (with the tests mentioned above) and a final evaluation (with the same tests) after the end of the program. The statistic procedures included the descriptive statistic (mean and standard deviation) and the inferential statistic (Wilcoxon test). The level of significance was fixed on p? 0,05. The results achieved through the comparison of the two moments of evaluation (first and final) showed the existence of improvements, mainly in the rhythm, hand-eye coordination and balance. With this work we can conclude that the applied program improved the motor coordination’s performance of our sample, though not in a significant way. Therefore, the present study seems to suggest that the practice of physical activity by children with Cerebral Palsy can contribute to an improvement in their motor coordination levels.

1. Introduction

According to the localization of the injury, Cerebral Palsy can occur in several forms that, in terms of the body topography, can be called hemiplegy, diplegy and tetraplegy with variations in terms of the qality of tonus (hypotonic, hypertonic our spasticity) (Bartlett et al., 2000). The dysfunctions in movement and the impact of these on the body’s development have been studied. Investigations carried out suggest that the limitation of motor experience resulting from Cerebral Palsy, the factor that better explains the low level of organization of the body form and of the spatial organization of these children. In the case of ataxia, it is considered to represent 4% of all Cerebral Palsy cases. Here there is a change in balance with difficulties, at the proximal level, in the control of the head, body and limbs. Ataxia is usually associated to a low tonus and to a decrease in global motor coordination, as well as in the fine motor coordination. This fact is reflected in very slow and careful movements, associated with the fear of falling (Bobath, 1989). We see that the disturbance in motor function can imply a factor of disorganization in various aspects of the child’s behaviour – perceptive, cognitive, social, etc. So the child seems to need motor and sensorial experiences that are welltimed, suitable and balanced for his/her harmonious development. Harmonious motor experiences that stimulate and develop his/ her adaptability and that are economical, that is to say, that are effective in proportion to the amount of energy used (Rodrigues, 1998). We intend to carry out a study about motor coordination in four children with Cerebral Palsy, to evaluate the manual dexterity, the eye-hand coordination, the pedal dexterity, the rhythm and the balance. To do such we are going to use the Minnesota Manual Dexterity Test, the Pursuit-Rotor, the Tapping Pedal, the Mira Stamback Rhythm Structures Test, and the Balance Scale of Berg, respectively. SEM ITÁLICO

2. Aim of the study

This study intends to investigate, in a population of children with Cerebral Palsy (ataxia), the changes in manual dexterity, eye-hand coordination, pedal dexterity, rhythm and balance, through the application of a program of motor activities.

3. Methods

For the present work we used a sample of four subjects, aged between nine and fourteen years old, selected from the database of the Rehabilitation Centre of Cerebral Palsy of Porto and whose motor diagnosis is ataxia. First, there was an evaluation in the initial moment and then there was another evaluation after the program of motor activities. This program lasted for fourteen weeks and we intended to verify if there were any significant developments in the following coordinative abilities: manual dexterity, eye-hand coordination, pedal dexterity, rhythm and balance. The manual dexterity was evaluated through the Minnesota Manual Dexterity Test (Lafayette Instruments): Collocation Test and Turning Test; for the eye-hand coordination, we applied the Pursuit-Rotor (Lafayette Instruments); to what concerns the pedal dexterity, we used the Tapping Pedal; for the rhythm we applied the Mira Stamback Rhythm Structures Test and finally, to what concerns the balance, we used the Balance Scale of Berg. The statistic procedures included the descriptive statistic (mean and standard deviation) and the inferential statistic (Wilcoxon test). The level of significance was fixed on p? 0,05. TIREI TODAS AS ABREVIATURAS POIS ELAS SÓ FORAM USADAS AQUI, NA METODOLOGIA.

4. Presentation of the Results

In the presentation of the results we are going to analyze the effects achieved with the proposed program, in order to understand which were the improvements achieved and in which areas, for each of the subjects and for the group in general. The order of the presentation will be as follows: i) individual; and ii) for each motor area.

4.1. Individual analysis of the elements of the sample

In Table 1 we describe the results achieved in the different domains concerning the comparison between the first and the second moment of observation for subject “X”.

Table 1 – Comparative analysis of the results in the 1st moment and in the 2nd moment of evaluation of the subject “child X” (motor diagnosis – ataxia).

Table 1. Effects of a physical activity program in motor coordination of children with cerebral palsy, ataxic diagnosis

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To what concerns the manual dexterity and according to Table 1, the subject “X” performed the collocation test in 319 seconds in the 1st moment and, in the 2nd moment, in 272 seconds; in the turning test there was an increase in the time of performance. In the rhythm, there were improvements and, in the second moment, the subject achieved the highest score that is possible to achieve in this test. However, in the first moment, a good score (86%) had already been achieved. In the eye-hand coordination domain, there was in increase in the contact between the stiletto and the disc (from 4,74 to 6,27 seconds). Concerning the pedal dexterity, the subject improved his/ her performance in both tasks (preferred foot – from 11 to 12 beats; non preferred foot – from 9 to 11 beats). In the balance, there was also an improvement: from 25 to 32 points. Thus, we can conclude that the subject “X” improved in all the abilities, except for the Manual Dexterity in the turning test. In Table 2 we present the results obtained in the different domains, concerning the comparison between the two moments of observation for the subject “Y”.

Table 2 – Comparative analysis of the results in the 1st moment and in the 2nd moment of evaluation of the subject “child Y” (motor diagnosis – ataxia).

Table 2. Effects of a physical activity program in motor coordination of children with cerebral palsy, ataxic diagnosis

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As we can see in Table 2, to what concerns the manual dexterity, the subject “Y” performed the collocation test in 155 seconds in the 1st moment and, in the 2nd moment, in 132 seconds, improving in this way the performance. In the turning test, there was an increase in the time of performance of 15 seconds (1st moment: 158; 2nd moment: 173). To what concerns the rhythm, there were also improvements: 81% of success in the 1st moment and 95% of success in the 2nd moment. In the eye-hand coordination, there was an increase in the time of performance in the chasing test: 12, 43 seconds in the 1st moment and 15, 34 seconds in the 2nd moment. In the domain of the pedal dexterity and for the preferred foot, the number of beats stayed the same (16) from the 1st to the 2nd moment; to what concerns the beats with the non preferred foot, the subject performed the task with more beats in the 2nd moment (15) than in the 1st moment (12). In the balance, the subject achieved the score of 48 points in the 1st moment and a score of 50 points in the 2nd moment, so there was a slight improvement. According to these results, we can conclude that this element of the sample improved in all the abilities, except for the pedal dexterity/ preferred foot (in which the same result was achieved in the 2nd moment) and in the manual dexterity / turning test (in which the subject took more time to perform the task in the 2nd moment). In Table 3 we describe the results achieved in the different domains concerning the comparison between the first and the second moment of observation for the subject “Z”. Table 3 – Comparative analysis of the results in the 1st moment and in the 2nd moment of evaluation of the subject “child Z” (motor diagnosis – ataxia).

Table 3. Effects of a physical activity program in motor coordination of children with cerebral palsy, ataxic diagnosis

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According to Table 3 and to what concerns the manual dexterity, the subject performed the collocation test in 226 seconds in the 1st moment and, in the 2nd moment, in 197 seconds, so there was a decrease in the time of performance. In the turning test, there was almost the same time of performance (188 seconds in the 1st moment and 189 seconds in the 2nd moment). As for the rhythm, there was an increase in the percentage of success, because in the 1st moment the subject achieved 48% of correct answers and in the 2nd moment 76%. In the eye-hand coordination, there was an increase in the contact between the stiletto and the disc: 0, 63 seconds in the 1st moment and 1, 82 seconds in the 2nd moment. To what concerns the manual dexterity, the subject improved the performance of the task with the preferred foot (from 7 to 9 beats), whereas with the non preferred foot, there was a decrease in the number of beats (from 10 to 9) in the time allowed. In the balance, there was a score of 33 points in the 1st moment and of 37 points in the 2nd moment, so there was a slight improvement. Therefore we can conclude that the subject “Z” improved in all the evaluated tasks, except for the pedal dexterity/ non preferred foot (in which there was one more beat in the 2nd moment) and in the manual dexterity/ turning test (in which the subject took one more second to perform the task). In Table 4 we show the results achieved in the different domains, concerning the comparison between the first and the second moment of observation for the subject “W”. Table 4 – Comparative analysis of the results in the 1st moment and in the 2nd moment of evaluation of the subject “child W” (motor diagnosis – ataxia).

Table 4. Effects of a physical activity program in motor coordination of children with cerebral palsy, ataxic diagnosis

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As for the manual dexterity and according to Table 4, the subject carried out the collocation test in 128 seconds in the 1st moment and, in the 2nd moment, in 124 seconds. In the turning test, there was also a decrease in the time of performance (177 seconds in the 1st moment and 148 seconds in the 2nd moment). In the rhythm, there were improvements: 52% of success in the 1st moment and 62% in the 2nd moment. In the eye-hand coordination domain, there was an increase in the contact between the stiletto and the disc (from 9, 10 to 14, 01 seconds from the 1st to the 2nd moment, respectively). To what concerns the pedal dexterity, the subject improved the performance in both tasks (preferred foot: from 13 to 15 beats; non preferred foot: from 12 to 13 beats). There was also an improvement in the balance, because in the 1st moment the score achieved was 44 points and in the 2nd moment 49. Bearing in mind Table 4, we can conclude that the subject “W” improved in all the evaluated items. 4.2. Analysis of each motor area

Table 5 presents, in brief, the results achieved in the different domains for the subjects of the total sample: ataxic.

Table 5 – Subjects of the total sample: ataxic. Comparative analysis of the results from the 1st moment to the 2nd moment of evaluation. Mean, standard deviation, values of z and p.

Table 5. Effects of a physical activity program in motor coordination of children with cerebral palsy, ataxic diagnosis

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We notice that the group with motor ataxic diagnosis achieved an average of 207,00±68,77 seconds in the manual dexterity/ collocation test (1st moment), whereas in the 2nd moment it achieved an average of 181,25 ± 68,77 seconds; though we didn’t find any significant differences (p=0,068), we consider that this value shows a tendency which allows us to suggest the existence of improvements at this level. In the turning test, the average of the 1st moment is of 200,00±52,81 and in the 2nd moment 205±72,01. No statistically significant differences were found (p=0,465) at this level, inclusively the results got worse from the 1st to the 2nd moment. No statistically significant differences were found (p=0,066) in the rhythm domain, though the value of p is slightly close to the value considered significant. The percentage of success increased from the 1st to the 2nd moment, from 65,75 ± 19,52 to 83,25 ± 17,54, respectively. To what concerns the hand-eye coordination, we can notice that the time of contact in seconds didn’t increase significantly (p = 0,068), although we consider the existence of a tendency towards significant improvements from the 1st moment (6,73± 5,14) to the 2nd moment of final evaluation (9,36± 6,42). Based upon the results described in Table 5, we also notice that the averages achieved by the group at the level of pedal dexterity, didn’t show significant differences, with the preferred foot (from 11,75± 3,78 to 13,00± 3,16; p=0,102), as well as with the non preferred foot (from 10,75± 1,50 to 12,00± 2,58; p=0,197). In both situations we can notice that the averages increased, which means that, as a whole, the elements of the group performed more beats with their feet.

Finally, and to what concerns the balance, in the 1st moment, the average of the score is of 37,50±10,47 and in the 2nd moment it is of 42,00±8,91. Although no statistically significant differences were observed (p=0,068), there is, however, a tendency towards an improvement from the 1st to the 2nd moment, because the value of p is close to the level considered significant. According to Table 5, the most evident improvements were at the levels of the rhythm and the balance, but also in the non bi-manual tasks performed by the upper limbs, namely, in the manual dexterity (in the collocation test) and in the eye-hand coordination.

5. Discussion of the results

The motor development of children is a long process that progresses from a rudimentary to a specialized motor skill, from simple to complex and from gross to fine, due to a process of development of the muscular tonus and the creation of new neurological connections (Neto, 1997). Calrberg et al. (2005) mention that the children with Cerebral Palsy show a muscular activity that disturbs the balance between the agonist and the antagonist muscles. Inevitably, this difficulty reflects itself in the performance of coordinate movements and also in the acquisition of certain skills, necessary to the performance of tasks inherent to the motor development. In general, some studies have described an improvement in the evaluated motor abilities (e.g. Siebes et al., 2001; Strapasson et al., 2002; Mulligan et al., 2004; Morton et al., 2005). Our results are supported by the study (e.g. Teles, 2004). This researcher studied the influence of a program of motor activities, orientated for 12 weeks (2 times a week) in 30 subjects aged between 17 and 39 years old. For the evaluation of the levels of coordination she used the following tests: Minnesota Manual Dexterity Test, Bassin Antecipation Timing, Mira Stamback Test of Rythmic Structures, Pursuit-Rotor, Tapping Pedal, and the Back Balance Test. She concluded that the implemented program improved the performance at the level of motor coordination, suggesting that the practice of physical exercise by subjects with mental deficiency can contribute to the improvement of the levels of motor coordination.

6. Conclusions

The results achieved comparing the two moments of evaluation (initial and final) showed the existence of improvements, mainly at the level of the Rhythm, the Hand-eye Coordination and the Balance. With this work we can conclude that the implemented program improved the performance of motor coordination in our sample, though not in a significant way. Therefore, the present study seems to suggest that the practice of physical activity by children with Cerebral Palsy can contribute to the improvement in the levels of their motor coordination.