ASSESSMENT OF PHYSICAL WORK CAPACITY AMONG CHILDREN WITH DOWN SYNDROME

1
ASSESSMENT OF PHYSICAL WORK CAPACITY
AMONG CHILDREN WITH
DOWN SYNDROME
Eman K. Mohammed1 ; Gehan M. Abd-El Maksoud2 ;
Basant H. Elrefaey3 ; Ahmad M. Elemam4
and Hany M. Fares5
1 Physical therapist at Fedmin public hospital, Al Fayoum
2 Professor of Physical Therapy for Growth and Development Disorders for Children
and Its Surgery, Faculty of Physical Therapy, Cairo University.
3 Professor of Physical Therapy for Cardiovascular/ Respiratory Disorders and
Geriatrics, Faculty of Physical Therapy, Cairo University
4 Consultant of cardiology, National heart Institute
5 Lecturer of Physical Therapy for internal medicine and surgery, Faculty of physical
therapy, Canadian Ahram University
1E-mail - missblack200926@gmail.com
Key Words: Down syndrome, physical work capacity, 6 minute walk
test.
ABSTRACT
Background: People with DS seem to have a lower physical fitness than
their peers without disabilities. Purpose: The aim of this study was to
compare between children with down syndrome and typically developing
children regarding the physical work capacity through 6-minute walking
test. Subjects and Methods: Thirty children, aged from 8 to 12 years of
both sexes were participated in this study. They were selected from the
public schools and special needs schools of Al-Fayoum government.
They were assigned into two groups; group A which included typically
developing children; n=15 and group B which included down syndrome
children n=15. Assessments of physical work capacity via Six Minute
Walk Test were performed. Results: There was a significant increase in
distance in the normal children compared with that of children with down
syndrome (p > 0.05). Conclusion: Physical work capacity of children
with down syndrome is lower than typically developing children.
INTRODUCTION
Down syndrome (DS) is caused by the presence of the whole or part
of an extra copy of chromosome 21. The disorder can be diagnosed in utero
by screening or karyotyping, or early after birth by muscle hypotonia (poor
muscle tone) and other symptoms and confirmed by karyotype analysis of a
blood sample. Global estimation of the incidence of Down syndrome is 1 in
1,000 to 1 in 1,200 live births (Irving et al., 2008).
Egypt. J. of Appl. Sci., 36 (7-8) 2021 102-109
2
Recent biomedical and molecular studies have suggested that the
chromosomal anomaly in Down syndrome determines several alterations in
protein expression patterns which result in particular biochemical,
physiological, anatomical, and behavioral characteristics such as imbalance
of the oxidative metabolism (Roat et al., 2007), impaired nervous system,
musculoskeletal disorders, congenital problems of the heart, narrowed
airways, reduced dynamic lung function, obesity, poor sinus drainage,
immunological abnormalities, premature ageing, poor sleep quality and high
risk of psychopathologies, dementia and behavioral problems (Coppus et
al., , 2006).
Many people with Down syndrome have poor strength, poor muscle
mass, and high body fat percentage and so are disposed to cardiovascular
health problems (Andriolo et al., 2010).
The evidence supports the importance of the assessing and monitoring
physical fitness component during childhood and adolescence. It is thus key
to have valid alternative approaches available to measure Cardiorespiratory
fitness (CRF) (Bergmann et al., 2014).
The assessment of physical work capacity through submaximal
exercise tests including the 6-minute walking test (6MWT) which is a
simple and inexpensive test that is well-tolerated by the patient. 6MWT is
considered as an alternative to cardiopulmonary exercise testing
(Ponikowski et al., 2016).
So the current study aimed to assess the physical work capacity of
children with down syndrome through 6-minute walking test.
MATERIALS AND METHODS
Study Design
This study is Cross sectional one shot design study. It was
conducted from April 2019 up to July 2020.
Subjects
A convenience sample of 30 students. Children were selected from
public primary and middle schools and special needs schools from Al-
Fayoum government. Students age ranged from 8 to 12 years and both
genders were selected. The children were assigned into two groups:
group A which included typically developing children; n=15 and group B
which included down syndrome children n=15. Inclusive criteria
included children with good cognition that enables them to understand
the study, children with normal or corrected vision and hearing and non
athletic students. Exclusive criteria included history of congenital
cardiovascular or cardiopulmonary disease, participants who had
participated in fitness training in the last 6 months and children with
musculoskeletal problems as connective tissue disorders.
Ethical considerations:
Written consents were obtained from all students parents before
the study, the steps of assessment polices were explained to students'
103 Egypt. J. of Appl. Sci., 36 (7-8) 2021
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parents by the investigators. Approval by the Ethical Committee of the
Faculty of Physical Therapy, Cairo University were obtained
Procedures
A) Evaluative procedure
1- Anthropometric assessment
Participant Height was measured without shoes near a wall to the
nearest 0.1cm, body weight measured using standard weight and height
scale when not available portable weight scale were used in light indoor
clothing without shoes.
2-Six Minute Walk Test
Six Minute Walk Test is a sub-maximal exercise test used to assess
aerobic capacity and endurance. The distance covered over a time of 6
minutes is used as the outcome by which to compare changes in
performance capacity.
Application
- The child was instructed to walk as far as possible for 6 minutes
back and forth in the hallway. Six minutes is a long time to walk, so
the child would be exerting himself and he would probably get out of
breath or become exhausted. The child was permitted to slow down,
to stop, and to rest as necessary. He could lean against the wall while
resting, but resume walking as soon as he was able. He walked back
and forth around the cones. He should pivot briskly around the cones
and continue back the other way without hesitation.
- The physical therapist demonstrated the test before starting
- The physical therapist Read this standardized encouragement during
the test.
- After the 1st minute: ―You are doing well. You have 5 minutes to
go.‖
- When the timer shows 4 minutes remaining: ―Keep up the good
work. You have 4 minutes to go.‖
- When the timer shows 3 minutes remaining: ―You are doing well.
You are halfway done.
- When the timer shows 2 minutes remaining: ―Keep up the good
work. You have only 2 minutes left.
- When the timer shows 1 minute remaining: ―You are doing well.
You only have 1 minute to go.
- With 15 seconds to go: ―In a moment I’m going to tell you to stop.
When I do, just stop right where you are and I will come to you.‖ At
6 minutes: ―Stop‖
- If the child stops at any time prior, the therapist can say: ―You can
lean against the wall if you would like; then continue walking
whenever you feel able.‖
Egypt. J. of Appl. Sci., 36 (7-8) 2021 104
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- The therapist did not use other words of encouragement (or body
language) to influence the patient’s walking speed. The therapist
accompanied the participant along the walking course, but kept just
behind them. And did not lead them.
- The walking distance was measured and recorded.
- Reasons for immediately stopping a 6MWT included the following:
(1) chest pain, (2) intolerable dyspnea, (3) leg cramps, (4)
staggering, (5) diaphoresis, and (6) pale or ashen appearance (ATS
statement: guidelines for the six-minute walk test, 2002).
Data Analysis:
Subject characteristics were compared between groups using the
independent t-test. Chi squared test was conducted for comparison of sex
distribution between groups. Normal distribution of data was checked
using the Shapiro-Wilk test. Levene’s test for homogeneity of variances
was conducted to test the homogeneity between groups. Independent ttest
was conducted for comparison of distance between groups. The level
of significance for all statistical tests was set at p < 0.05. All statistical
analyses was conducted through the statistical package for social studies
(SPSS) version 25 for Windows (IBM SPSS, Chicago, IL, USA).
RESULTS
Subject characteristics:
Table (1) showed the subject characteristics of the study groups.
There was no significant difference between children with down
syndrome and normal children in age and sex distribution (p > 0.05).
Table 1. Basic characteristics of participants.
Children with
down syndrome
Normal
children p-value
Mean ± SD Mean ± SD
Age (years) 9.93 ± 1.14 10.22 ± 1.07 0.27
Sex, n (%)
Girls 13 (43.3%) 18 (45%)
0.89
Boys 17 (56.7%) 22 (55%)
SD, standard deviation; p-value, level of significance
Comparison of distance between children with down syndrome and
normal children:
There was a significant increase in distance in the normal children
compared with that of children with down syndrome (p > 0.010), with
mean difference of -254.7 meter and 95% CI of (-270.47: -238.92).
Table (2). Comparison of distance between children with down
syndrome and normal children:
Children with
down syndrome
Normal
children
Mean ±SD Mean±SD MD (95% CI) t- value p-value
Distance
(meters)
257.8 ± 7.41 512.5±36.19
-254.7
(-270.47: -238.92)
-32.21 0.001
SD, standard deviation; MD, Mean difference; CI, confidence interval; p-value,
level of significance.
105 Egypt. J. of Appl. Sci., 36 (7-8) 2021
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Figure (1). Mean distance between children with down syndrome and
normal children.
DISCUSSION
Down Syndrome (DS) is a genetic disorder caused by a trisomy of
chromosome 21 and is the most common genetic cause of intellectual
disability (ID) (Franceschi et al., 2019). DS is associated with
significant health problems as diseases such as congenital heart disease,
obstructive sleep apnea, celiac disease and endocrinopathologies.
Endocrine disorders are usually characterized by thyroid disorders, low
bone mass, diabetes, short stature and propensity to be overweight/obese
(Franceschi et al., 2019 and Whooten et al., 2018).
Because ambulation is one predictor of survival among adults with
DS, the aim of this study was to investigate the physical work capacity in
children with down syndrome via 6 minute walk test.
The results of the current study revealed that physical work
capacity of down children is significantly lower than normal children of
comparable age and gender. This is may be due to that young people with
DS have higher rates of overweight and obesity than young people
without DS. Prevalence in overweight and obesity varied between 23–
70% in DS patients (13.3–52.9 and 0–62.5%). (Bertapelli et al.,2016).
The causes of the development of overweight and obesity in DS are:
hypotonia (decreased muscle tone), susceptibility to systemic
inflammation, metabolic diseases and/or slow metabolism (Brantmüller,
et al., 2015). Usually, people affected by DS consume less healthy food,
and show physical limitations, depression, and lack of social and
financial support. Besides, medications contribute to weight gain
Egypt. J. of Appl. Sci., 36 (7-8) 2021 106
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(Cushing et al.,. 2012). It was also reported that people with DS have
poor strength, poor muscle mass (Andriolo et al., 2010).So all these
factors contributed to the results of physical work capacity of DS
children.
Significant difference of physical work capacity in this study is
supported by the findings of Mendonca et al., 2010 who concluded that
Persons with (DS) have reduced peak and submaximal exercise capacity.
Available data suggest that reduced exercise capacity in persons with DS
results from an interaction between low peak oxygen uptake (VO(2peak))
and poor exercise economy. Of several possible explanations,
chronotropic incompetence has been shown to be the primary cause of
low VO (2peak) in DS. In contrast, poor exercise economy is apparently
dependent on disturbed gait kinetics and kinematics resulting from joint
laxity and muscle hypotonia. Importantly, there is enough evidence to
suggest that such low levels of physical fitness (reduced exercise
capacity and muscle strength) limit the ability of adults with DS to
perform functional tasks of daily living.
Moreover, the results of this study agree with findings of (Casey et
al., 2012) who evaluated the reliability of the 6-minute walk test
(6MWT) in individuals with Down syndrome and explored factors
affecting walking distance. 6MWT showed good test-retest reliability and
the reported 6MWD appeared lower than that previously reported for
individuals without Down syndrome.
The current study has some limitations such as the small sample
size that it may not be possible to generalize these results to the whole
population of down syndrom. Further studies on a larger population of
children with DS have to be carried out. Additionally, the children who
participated in this study were restricted to definite age group to one type
of CP with the age group from eight to twelve years. So, more studies are
needed on other age groups of DS.
Based on current study results, clinical management of reduced
physical work capacity in DS seems important to ensure that these
individuals remain productive and healthy throughout their lives.
CONCLUSION
Based on the results of this study, physical work capacity of down
children significantly differs from typical development children .
ACKNOWLEDGMENTS
The authors thank all the children and parents who participated in
this study.
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سعة العمل البدني لدي الأطفال المصابين بمتلازمه داون
، ايمان خميفة محمد 1 ، جيهان مسعد عبد المقصود 2 ، بسنت حمدي الرفاعي 3
احمد معوض الامام 4 ، هاني محمود فارس 5
1 اخصائى علاج طبيعى بمستشفي فيدمن بمحافظة الفيوم
2 أستاذ بقسم العلاج الطبيعي للأطفال - کمية العلاج الطبيعي - جامعة القاهرة.
3 استاذ بقسم العلاج الطبيعي لاضط ا ربات الجهاز الدورى التنفسى و المسنين
4 استشا ري ام ا رض القمب بمعهد القمب القومي
5 مدرس العلاج الطبيعي لام ا رض الباطنة و الج ا رحة – کمية العلاج الطبيعي –جامعة الاه ا رم الکندية
الممخص
الخمفية: يمتمک الاشخاص المصابين بمتلازمة داون مستوي منخفض من المياقة البدنية مقارنة
باق ا رنهم الاصحاء
الغرض : الهدف من هذه الد ا رسة هو مقارنة الاطفال المصابين بمتلازمة داون و الاطفال
طبيعي التطور من ناحية سعة العمل البدني بواسطة اختبار المشي لمدة 6 دقائق .
الطرق : شارک في هذه الدارسة 03 طفلا، ت ا روحت اعمارهم ما بين 8 الي 21 عاما من کلا
الجنسين . تم اختيارهم من مدارس عامة و مدارس لذوي الاحتياجات الخاصة بمحافظة الفيوم
. تم توزيعهم الي مجموعتين المجموعة ا و التي اشتممت عمي 21 طفل طبيعي التطور. و
المجموعة ب و التي اشتممت عمي 21 طفل من المصابين بمتلازمة داون.تم إج ا رء تقييم سعة
العمل البدني بواسطة اختبار المشي لمدة 6 دقائق
النتائج: أظهرت النتائج زيادة ذات دلالة احصائية في مسافة المشي في الاطفال طبيعي
التطور مقارنة بالاطفال المصابين بمتلازمة داون
الاستنتاجات : سعة العمل البدني لدي الاطفال المصابين بمتلازمة داون اقل من الاطفال
طبيعي التطور
الکممات المفتاحية : متلازمة داون ، سعة العمل البدني ، اختبار المشي لمدة 6 دقائق
109 Egypt. J. of Appl. Sci., 36 (7-8) 2021