Prevention of obesity and balance problems through adapted physical exercises in persons with Down syndrome

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Prevention of obesity and balance problems through adapted physical exercises in persons with Down syndrome

Raluca Mihaela Hodorca, Tonuf Onose,

Beatrice Abalaei, Adriana Albu

Синдром Дауна є захворюванням, викликаним наявністю додаткової хромосоми в генетичній конструкції, людини.Це захворювання супроводжується серцево-судинними недугами, легеневими розладами, порушення функції щитоподібної залози, дисфункцією кишечника, судоми, ожирінням, схильністю до інфекцій, імуннодефіцитними станами, лейкемією та розладами центральної нервової системи.Мета. Виявити вплив кінетзітерапевтичних засобів і методів на покращення стану здоров 'я пацієнтів з синдромом Дауна. У дослідженні взяли участь вісім пацієнтів одного віку та статі у яких було діагностовано синдром Дауна та пов'язані з ним стани.Місцем проведення дослідження був зал гімнастики факультету фізичного виховання і спорту Iasi.Процедури проводилися з 15.01.по 15.06.2018 р. з частотою 3 рази протягом тижня. Під час дослідження використовували таке обладнання: подограф, сантиметровастрічка, медична вага, мати, дзеркала, гімнастичний кулі та кола. При виконанні вправ застосовували ігровий метод, що підвищувало ефективність реалізації завдань і полегшувало перебіг адаптаційних процесів до фізичних навантажень.Результати. Одним із проявів ефективності застосованих засобів і методів кінезітерапії було зменшення індексу вагии тіла.Водночас вірогідно, порівняно з вихідним станом, покращилися функціональні показники серцево-судинної системим, а також зросла величина екскурсії грдної клітки. down syndrome chromosome genetic

Ключові слова: синдром Дауна, ожиріння, серцево-судинна система, кінезітерапія.

Down syndrome is a medical condition caused by the presence of an additional chromosome in the genetic (genome) construction of the affected. Down syndromes are cardiovascular diseases, pulmonary disorders, thyroid disorders, intestinal dysfunction, seizures, obesity, susceptibility to infections, immune system diseases, leukemia, and central nervous system disorders. The underlying hypothesis was to verify whether the proposed recovery programs are tolerated by the subjects, improving the symptomatology and to what extent kinetotherapeutic methods and techniques have made progress in their health condition. In the research, eight subjects of age and gender, all diagnosed with Down's syndrome and associated conditions, took part in the research. The place of the action is represented by the gymnastics hall of the Faculty of Physical Education and Sport Iasi, between 15.01.2018 - 15.06.2018 with a frequency 3 times x week. Materials used in the research were: podograph, metric band, scales, mattresses, mirrors, gymnastics bank, balls and circles. We involved the use of application trails and exercises in the form of games, which included the performance of various tasks and the adaptation to new conditions. The calculation of the final body mass index reveals an improvement in obesity symptoms by decreasing the number of kilograms. We can also see the contribution ofphysiotherapy to this progression by weight loss gradually, avoiding over-training, a harmful phenomenon for people with Down's syndrome and heart disease. As a result of the interpretation of the data obtained about the chest perimeter in the inspiration, there was a slight increase in the values, indicating an improvement of the respiratory act and a slight adaptation to the effort.

Key words: Down Syndrome, obesity, cardiovascular system, kinesitherapy.

Introduction

Down syndrome is a medical condition caused by the presence of an additional chromosome in the genetic (genome) construction of the affected. On average, it was estimated that one in every 800-900 children was born with this condition, making it the most common known genetic anomaly (Muresan M. D., 2011).

Pathologies associated with Down's syndrome are cardiac disorders, pulmonary disorders, thyroid disorders, intestinal dysfunction, seizures, susceptibility to infections, immune system diseases, leukemia, and central nervous system disorders.

Children and adolescent with DS have a higher risk for obesity. He recognition of physiological and behavioral factors that can increase this risk are crucial for developing personalized plans to approach each individual in order to avoid the gain of excess weight (Murray, J., Ryan-Krause, P., 2010).

Balance reaction is additionally problematic due to inadequate co-contraction caused by muscle weakness, mental retardation, dysfunction in sensory integration processes, cartilage hypoplasia, and improper bone density (Russell DJ, Rosenbaum P, Avery L., 2002).

Physical inactivity is a major public health problem, and there is irrefutable scientific evidence showing that lack of regular physical activity is a major risk factor in many chronic conditions (Marcu V., Dan, M., 2007).

Psychomotricity is the result integrating education and maturation of motor and mental functions, and, regarding the movements, it refers to their determination: will, affection, needs, and impulses (Abala§ei, 2012). (Abalasei, B., 2012).

Psychomotor disorders are a real problem for these children that make it impossible adapting to normal social situations, establishing a fear of movement. At the same time, there is the opposite of these problems, where motor and psychomotor skills are well developed, leaving them a voluminous motorcycle baggage, with which they can perfectly cope with daily challenges (Robanescu N., 2001).

Many children with Down Syndrome are late to reach the early motor milestones such as grasping, rolling, sitting, standing and walking. That is why it may be important to start adapted physical activities early (Sacks & Buckley, 2003).

Lack of physical activity is another major contributor to overweight and obesity. In only 1 study did most (60%) adults with DS who were surveyed report that they ''exercised'' daily, but other studies reported that those with DS were more sedentary than those without DS (Jobling A, Cuskelly M., 2006).

Despite all the limitations, it is advisable to practice physical exercise adapted to the individual capacities of each SD patient. Here are recommendations that demonstrate the need for these individuals to develop strength, muscular endurance and cardiorespiratory endurance, in order to provide: strengthening of the joints, reduction of the risk of respiratory infections and reduction of muscle hypotonia (Cooper-Brown L, Copeland S, Dailey S, Downey D, Petersen MC, et al., 2008).

The underlying hypothesis was to verify whether the proposed recovery programs are tolerated by the subjects, improving the symptomatology and to what extent kinetotherapeutic methods and techniques have made progress in their health condition.

Material and method

In the research were included eight subjects of all age and gender, all diagnosed with Down's syndrome and associated conditions. The place of the action was at the Faculty of Physical Education and Sport Iasi, between 15.01.2018 - 15.06.2018 with a frequency 3 times x week. Materials used in the research were: podograph, metric band, scales, mattresses, mirrors, gymnastics bank, balls and circles.

The program used involved the application and exercise exercises in the form of games, which involved performing different tasks and adapting to new conditions such as using the right leg to jump into circles (helping to develop laterality), walked through obstacles in orthostatism and quadrupedy (to develop oculo-motor coordination and spatio-temporal orientation), to perform movements in front of the mirror (to shape body shape). The exercises complex exemplified above is designed to help and support the day-to-day activities of people with psycho-motor impairment.

Results and discussions

Subjects (tabl. 1) were tested for height, weight, resting thoracic perimeter, inspiration thoracic perimeter, thorax expiratory perimeter, resting abdominal perimeter (in orthostatism), abdominal perimeter in inspiration, abdominal perimeter in expiration, abdominal resting perimeter in the decubitus), the abdominal perimeter in the decubitus, the abdominal perimeter exits in the decubitus, the distance between the internal ma- leoles, the Romberg test and the “fingers-to-ground” test (orthostatism with open eyes and closed eyes) (tabl. 2)

Table 1

The calculation of the final body mass index reveals an improvement in obesity symptoms by decreasing the number of kilograms. We can also see the contribution of physiotherapy to this progression by weight loss gradually, avoiding over-training, a harmful phenomenon for people with Down's syndrome and heart disease.

The comparative results of the two tests show a weight loss during physical therapy programs, going towards the direction of normal weight (tabl. 3).

To make the Romberg test, the patient is asked to stand straight with his hands in the extension of the body and with the peaks and sticks glued. The test follows two steps: 1. The patient is in the straight-open position. If the balance is maintained in this position, it goes to the second stage. 2. The patient is asked to close his eyes so that maintaining orthostatism will require the integrity of both superficial and profound sensitivity.

Subjects managed to maintain the equilibrium position for the time specified in the previous table, then exhibited steady-state disturbances manifested by instability with the tendency of grasping a support point and immediate opening of the eyes (figure 1).

Table 2 The results obtained by the research subjects at the initial and final measurements

As a result of the final measurements of the Romberg balance test, improvements in time were seen in some subjects, unlike other subjects who have stagnated. All these data can be seen in the table and figure below.

Table 3

Comparison between initial weight and final weight

“The fingers-ground test evaluates both the degree of mobility of the spine through the torsion flexion movement as well as the mobility of the coxofemoral joints and the suppleness of the sciatic and gastrocnemius muscles. The distance between the soil and the peak of the medius (dactilion) is measured; the normal value is zero. The excess or excess mobility is marked with either minus or plus” (Cordun, 2009) (tabl. 4).

Figure 1. Initial and final measurements of the Romberg test.

As a result of the interpretation of the data obtained about the chest perimeter in the inspiration, there was a slight increase in the values, indicating an improvement of the respiratory act and a slight adaptation to the effort.

Tabel 4

The results of the initial “finger-ground” test

As a result of the final measurements, there was an improvement of the measured parameters due to the physiotherapy programs used during the working period, this being highlighted in the tables and graphs above.

Conclusions

The efficient combination of physiotherapeutic means is achieved by the obvious improvement of the symptomatology during the rehabilitation program. This can be noticed primarily by lowering the weight of the subconscious.

Secondly, spatial-temporal orientation and coordination have been improved, proven by the implementation of application paths without difficulty and without orientation errors.

There has also been an increase in the quality of the respiratory act, materialized by increasing the chest perimeter in the inspiration, accompanied by increased effort adaptation during the sessions, as observed by reducing pauses between the effort.

From the point of view of the psychomotric behavior, a progress of the balance, by the success at the end of the sessions, of all the subjects, is highlighted by the application of numerous trails of equilibrium exercises. For example, the patient L.O. at the beginning of the sessions he was afraid and opposed to climbing and walking without support on the gym, and at the end he managed to go without support and in perfect balance.

Inability to jump on both legs through circles of patient T.D. has been resolved during physiotherapy sessions by adapting exercise that stimulates the jump, starting by jumping with a ball held at the knee, then succeeding without any help or ancillary material. переводческий островский шекспир жанр

The conclusions that we have made following the research and the confirmation of the hypothesis from which we started are an example that once again demonstrates the place of kinetotherapy in the complex recovery process of children with Down syndrome.

References

1. Abalasei, B. (2012). Psychomotricity and psychomotor re-education, Ankara: Spor Yaynevi ve Kitabevi.

2. Cooper-Brown L, Copeland S, Dailey S, Downey D, Petersen MC, et al. (2008) Feeding and swallowing dysfunction in genetic syndromes. Dev Disabil Res Rev 14: 147-157.

3. Cordun M. (2009). Kinantropometrie, Bucuresti. Editura: CD PRESS, pag.201.

4. Jobling A, Cuskelly M. Young people with Down syndrome: a preliminary investigation of health knowledge and associated behaviours. J Intellect Disabil Res. 2006;31(4):210Y218.

5. MarcuV, Dan, M. KINETOTERAPIE, EDITURA UNIVERSITATII DIN ORADEA, 2007, 287.

6. Muresan MD. (2011). O sansa data copilului cu Sindrom Down. Sebes: Editura Emma Books.

7. Murray J, Ryan-Krause P (2010) Obesity in children with Down syndrome: Background and recommendations for management. Pediatr Nurs 36: 314-319

8. Robanescu N. (2001). Reeducarea neuromotorie. Bucuresti, Editura Medicala, pag. 89.

9. Russell DJ, Rosenbaum P, Avery L. Gross Motor Function Measure. User's Manual. Mac Keith Press. Ontario 2002.

10. SacksB,& Buckley S. (2003). What do you know about the movement abilities of children with Down Syndrome? Down Syndrome News and Update 2(4), 131-141.

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