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Postural balance, physical activity and capacity among young people with intellectual disability
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to investigate postural balance, physical activity, physical capacity and their associations in young people (16-20 years) with intellectual disability (ID), mild to moderate. The aim was also to study the reliability and concurrent validity of postural balance tests.

To evaluate postural balance, one assessor used five common postural balance tests and one new test. The tests were performed twice for 89 young people with ID (one to twelve days apart). Intraclass correlation coefficients greater than 0.80 were achieved for four of the common balance tests: Extended Timed Up and Go Test (ETUGT), Modified Forward Reach Test (MFRT), One-Leg Stance Test (OLS), and a Force Platform Test (FPT). The smallest real difference ranged from 12% to 40%; less than 20% is considered to be low. For the six balance tests, the concurrent validity varied between none to low.

Falls are more common for young people with ID compared to young people without ID. One reason could be impaired postural balance. The postural balance for young people with ID has not been thoroughly investigated. Therefore, five balance tests and three muscle strength tests were used to compare young people with ID with an age-matched control group without ID (n=255). The young people with ID had significantly lower scores on most of the postural balance tests and muscle strength tests of the trunk and lower limbs. Muscle strength, height, and body mass index had no strong association with postural balance. The results also illustrated that young people with ID did not rely more on vision for their balance ability compared to peers without ID.

It seems that postural balance is impaired for young people with ID when evaluated with common tests. An everyday situation is to react to unexpected balance disturbances to avoid falls by using different postural responses. Since young people with ID seem to fall more often than peers without ID, it is valuable to investigate if those postural responses are different between the groups. Therefore, young people with and without ID (n=99) were exposed to six backward surface translations and several postural muscle responses were evaluated: muscle synergies and strategies, muscle onset latency, time-to-peak amplitude, and adaptation. The responses of the investigated muscles – the gastrocnemius, the biceps femoris, and the erector spinae L4 level – were measured using electromyography. The results showed that there were no differences between the two groups with respect to synergies or strategies, muscle onset latency, and time-to-peak amplitude. An overall pattern was seen, that young people with ID adapted their muscle response slower in all three muscles than peers without ID, but this pattern was not statistically significant.

Studies have shown that people with ID have impaired postural balance, a lower level of physical activity, and lower aerobic capacity compared to people without ID. The association is however not investigated. Therefore, postural balance (postural sway indirectly measured with the subjects standing on a force platform), physical activity (measured with a pedometer), and aerobic capacity (measured with a sub-maximal ergometer cycle test) were used to assess young people with and without ID (n=106). To investigate the subjects’ view of their own health, the subjects completed an adapted questionnaire that addressed their perceived health. The analysis showed no significant associations between postural balance, level of physical activity, and aerobic capacity. The subjects in the ID group, both men and women, had significantly lower aerobic capacity compared to subjects without ID. The answers from the health questionnaire did not correspond to the measured outcomes from the physical tests for young people with ID.

In conclusion, ETUGT and MFRT can be used to evaluate change in postural balance over time in young people with mild to moderate ID. The low concurrent validity suggests that the postural balance tests probably challenge various subsystems. Young people with ID have impaired postural balance and perform lower on muscle strength tests than age-matched controls. Postural muscle responses after external perturbations seem to be similar for young people with and without ID, but the ability to adapt muscle responses after repeated perturbations appears to be slower for young people with ID. The studies in the thesis also indicate that young people with ID have reduced level of physical activity and lower aerobic capacity. The lack of association between the different physical functions indicates that they should be evaluated and exercised separately. Young persons with ID might have more difficulty realising the health advantage of being physically active, as they do not seem to make this connection. Because of this, it is important that parents/guardians, school staff, physiotherapists, and others encourage them to participate in physical activity.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2013. , 82 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1579
Keyword [en]
mental retardation, postural stability, muscle strength, balance perturbation, aerobic capacity, young adults
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-71227ISBN: 978-91-7459-677-9 (print)OAI: oai:DiVA.org:umu-71227DiVA: diva2:622818
Public defence
2013-06-13, Aulan, Vårdvetarhuset, Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-05-23 Created: 2013-05-23 Last updated: 2014-12-18Bibliographically approved
List of papers
1. Test-retest reliability, smallest real difference and concurrent validity of six different balance tests on young people with mild to moderate intellectual disability
Open this publication in new window or tab >>Test-retest reliability, smallest real difference and concurrent validity of six different balance tests on young people with mild to moderate intellectual disability
2012 (English)In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 98, no 4, 313-319 p.Article in journal (Refereed) Published
Abstract [en]

Objectives Some studies have reported that people with intellectual disability may have reduced balance ability compared with the population in general. However, none of these studies involved adolescents, and the reliability and validity of balance tests in this population are not known. The purpose of this study was to examine the reliability of six different balance tests and to investigate their concurrent validity.

Design Test-retest reliability assessment.

Settings All subjects were recruited from a special school for people with intellectual disability in Bollnas, Sweden.

Participants Eighty-nine adolescents (35 females and 54 males) with mild to moderate intellectual disability with a mean age of 18 years (range 16 to 20 years).

Interventions All subjects followed the same test protocol on two occasions within an 11-day period.

Main outcomes Balance test performances.

Results Intraclass correlation coefficients greater than 0.80 were achieved for four of the balance tests: Extended Timed Up and Go Test, Modified Functional Reach Test, One-leg Stance Test and Force Platform Test. The smallest real differences ranged from 12% to 40%; less than 20% is considered to be low. Concurrent validity among these balance tests varied between no and low correlation.

Conclusion The results indicate that these tests could be used to evaluate changes in balance ability over time in people with mild to moderate intellectual disability. The low concurrent validity illustrates the importance of knowing more about the influence of various sensory subsystems that are significant for balance among adolescents with intellectual disability.

(C) 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Keyword
Postural balance, Functional reach, Timed up and go, ICC, Intellectual disability
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-62147 (URN)10.1016/j.physio.2011.05.006 (DOI)000310580900007 ()
Available from: 2012-12-14 Created: 2012-12-10 Last updated: 2017-12-06Bibliographically approved
2. Adolescents with intellectual disability have reduced postural balance and muscle performance in trunk and lower limbs compared to peers without intellectual disability
Open this publication in new window or tab >>Adolescents with intellectual disability have reduced postural balance and muscle performance in trunk and lower limbs compared to peers without intellectual disability
Show others...
2013 (English)In: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 34, no 1, 198-206 p.Article in journal (Refereed) Published
Abstract [en]

For adolescent people with ID, falls are more common compared to peers without ID. However, postural balance among this group is not thoroughly investigated. The aim of this study was to compare balance and muscle performance among adolescents aged between 16 and 20 years with a mild to moderate intellectual disability (ID) to age-matched adolescents without ID. A secondary purpose was to investigate the influence of vision, strength, height and Body Mass Index (BMI) on balance. A group of 100 adolescents with ID and a control group of 155 adolescents without ID were investigated with five balance tests and three strength tests: timed up and go test, one leg stance, dynamic one leg stance, modified functional reach test, force platform test, counter movement jump, sit-ups, and Biering-Sorensen trunk extensor endurance test. The results showed that adolescents with an ID in general had significantly lower scores in the balance and muscle performance tests. The group with ID did not have a more visually dominated postural control compared to the group without ID. Height, BMI or muscle performance had no strong correlations with balance performance. It appears as if measures to improve balance and strength are required already at a young age for people with an ID. 

Keyword
Young adults, Postural control, Mental retardation
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-64952 (URN)10.1016/j.ridd.2012.07.008 (DOI)000312520100022 ()
Available from: 2013-03-07 Created: 2013-02-04 Last updated: 2017-12-06Bibliographically approved
3. Postural muscle responses and adaptations to backward platform perturbations in young people with and without intellectual disability
Open this publication in new window or tab >>Postural muscle responses and adaptations to backward platform perturbations in young people with and without intellectual disability
2014 (English)In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 39, no 3, 904-908 p.Article in journal (Refereed) Published
Abstract [en]

This study examines postural muscle responses to backward perturbations in young people with and without intellectual disability (ID). The study included 56 young people with ID and 43 age-matched without ID volunteers. The subjects stood on a platform that was moved backwards in a surface translation. Lower and upper leg muscles and lower back spine muscles were recorded with surface electromyography (EMG). Muscle onset latency, time to peak amplitude (EMG), adaption of muscle responses to repeated perturbations (using IEMG for epochs), and synergies and strategies were assessed. The result showed no differences between the two groups in muscle onset latency, time to peak amplitude, synergies, and strategies. However, young people with ID tended to adapt their IEMG less compared to the controls. These findings suggest that young people with ID have limited ability to adapt their postural muscle responses to repeated perturbations.

Place, publisher, year, edition, pages
Elsevier, 2014
Keyword
Mental retardation; Balance perturbations; EMG; Postural control; Young adults
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-71230 (URN)10.1016/j.gaitpost.2013.11.018 (DOI)000332960600013 ()
Available from: 2013-05-23 Created: 2013-05-23 Last updated: 2017-12-06Bibliographically approved
4. Postural stability, physical activity, aerobic capacity and their associations for young people with and without intellectual disabilities
Open this publication in new window or tab >>Postural stability, physical activity, aerobic capacity and their associations for young people with and without intellectual disabilities
Show others...
2014 (English)In: European Journal of Adapted Physical Activity, ISSN 1803-3857, E-ISSN 1803-3857, Vol. 7, no 1, 22-30 p.Article in journal (Other academic) Published
Abstract [en]

Previous studies show that people with intellectual disability (ID) appear to have impaired postural stability, a lower level of physical activity, and lower aerobic capacity compared to persons without ID, limitations that could affect their health. This study investigates these physical functions and their associations in a group of young people with ID compared to an age-matched group without ID. In total, this cross-sectional study included 106 high school students (16-20 years): 57 students with mild to moderate ID and 49 agematched students without ID (control group). Tests were performed for postural stability, level of physical activity, and aerobic capacity. Both females and males with ID had significantly lower estimated maximum oxygen uptake (l O2/min) (p< 0.001 for females and p=0.004 for males) and a lower aerobic capacity expressed relative to body weight (ml O2/ kg*min) (p< 0.001 for females and p=0.012 for males) compared to age-matched peers. Analyses of associations were made using the Pearson’s correlation coefficient and multivariate linear regression analysis. No significant associations could be found. Physical status appears impaired for young people with ID and functions, such as postural stability, should be evaluated separately

Keyword
Mental retardation, physical capacity, motor activity, postural equilibrium, youth, teenage
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-71233 (URN)
Available from: 2013-05-23 Created: 2013-05-23 Last updated: 2017-12-06Bibliographically approved

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